乡村永久性肠造口患者出院后造口情况调查

目的调查乡村永久性肠造口患者出院后的造口情况,为提高肠造口患者生活质量提供依据。方法 采用造口门诊复查、电话回访、家庭访视、造口联谊会的方式,对36例因各种肠道疾病实施永久性肠造口患者进行问卷调查。结果出现造口并发症有25例(69.4%),其中造口周围皮炎12例,造口旁疝10例,造口脱垂、造口水肿、造口局部肿瘤复发各1例。能完全进行造口自我照顾28例(77.8%),每天用于造口护理的时间小于30min占44.4%,平时不用造口袋3例占8.3%,只有6.1%使用质量好的两件式黏贴造口袋。结论对乡村永久性肠造口患者需给予更有针对性的支持和帮助。     

访视护理对提高肿瘤术后患者生活质量的影响

探讨访视护理对提高肿瘤术后患者生活质量的影响。方法：将我科160例肿瘤患者分为干预组和对照组各80例，对照组患者出院时建立医患联系卡，进行电话访视；干预组患者出院时建立回访档案，由责任护士进行家庭访视护理。采用癌症患者生活质量评估量表对患者进行生活质量的评估。结果：干预组患者生活质量明显高于对照组，差异有统计学意义（P〈0．05）。结论：家庭访视护理干预可明显提高肿瘤术后患者的生活质量。     

家庭访视对直肠癌腹壁造瘘口患者自我护理行为的影响

目的 了解直肠癌腹壁造瘘口患者出院后存在的家庭和社会问题及家庭访视对问题解决的效果.方法 对36例直肠癌腹壁造瘘口出院患者进行家庭访视,评估患者健康情况及对相关知识,相关技能知晓情况,给予健康教育及心理治疗.结果 患者出院后第一次家庭访视与经过4个月家庭访视及健康教育效果比较,各项护理指标均有显著改善(P<0.05).结论 对出院后直肠癌造瘘口患者开展家庭访视和健康教育,可促进康复并提高患者自我护理能力,减少并发症的发生率,从而提高患者的生活质量.     

社区老年胃造瘘管饲患者常见护理问题及对策

目的介绍社区老年胃造瘘管饲患者常见护理问题及对策。方法对老年胃造瘘管饲患者及家属进行家庭指导，门诊复诊指导，家庭访视。回顾性分析15例留置3—5年零7个月胃造瘘管饲患者的护理。结果营养失调、电解质紊乱、造瘘口感染、脱管、造瘘口肉芽组织生长是社区老年胃造瘘管饲患者常见护理问题及并发症。结论做好营养匀浆的配制与保存；用10％氯化钠溶液清洗局部预防肉芽组织生长所引起的局部出血和造瘘感染；避免腹胀发生；定期补充白蛋白血，口服补钾、补钠；每隔2—4个月不定期更换胃造瘘管。采取有效的预防和护理措施，保证胃造瘘管饲家庭护理患者有效的营养，提高治疗效果，避免各种并发症发生，促进病人康复。     

结肠灌洗对造口病人生活质量的影响

[目的]探讨结肠灌洗对肠造口病人生活质量的影响。[方法]将52例直肠癌Miles术后病人随机分为两组，观察组（22例）采用结肠造口灌洗法，对照组（30例）采用自然排便法，根据测试评分分为优、良、中、差。[结果]观察组生活质量优占59．1％，对照组占23．3％，两组比较有统计学意义（P〈0．01）。[结论]结肠造口灌洗可明显提高病人的生活质量。     

浅谈对造口患者回访工作的实践和体会

随着人们生活水平的不断提高，造口患者对生活质量的要求与期望也相应提高。患者不仅要求在住院期间能够得到良好的服务及生命保障，而且要求出院后也能有良好的全程服务及生活护理保障。我科坚持一切“以病人为中心”的人文关怀理念，以提高医院服务质量和信誉为出发点，自2007年7月开始开展了由经过培训的造口护士对出院后造口患者定期电话回访并适时上门访视的一系列全过程系统服务，了解造口患者出院后的心理状况、生活现状及造口情况，有针对性地进行进一步的健康指导，使患者得到适时的帮助，及时解决了造口患者家庭护理中遇到的困难，现报道如下。     

家庭访视护理对老年慢性病病人生活质量的影响

[目的]探讨符合本地区实际情况，满足社区老年慢性病病人家庭护理需求的护理服务模式。[方法]对曾收治于本病区的160例老年慢性病病人按出院顺序随机分成观察组和对照组各80例。对照组只建立医患联系卡，不施加任何干预。观察组为其建立医患联系卡和健康档案。固定访视护士对其进行为期一年的家庭访视护理。内容涉及专病护理、基础护理、康复护理、心理护理、预防保健及健康教育等方面。两组干预前后采用健康状况调查问卷（GQOLI-74）进行测评。[结果]家庭访视护理后观察组综合评分显著高于访视前（P〈0．01），亦显著高于对照组（P〈0．01）。[结论]家庭访视护理能有效地提高社区老年慢性病病人生活质量。     

肠造口患者生活质量与社会支持的相关性分析及护理

目的：探讨肠造口患者生活质量与社会支持的相关性，以寻求护理对策。方法：调查86例肠造口患者的社会支持情况，并与正常对照组进行比较，分析肠造口患者生活质量与社会支持的相关性。结果：肠造口患者的社会支持与正常对照组比较有极显著性差异（P〈0．01）；生活质量与其社会支持呈正相关（γ=0．626，P〈0．01）。结论：肠造口患者得到比正常人高的社会支持，其生活质量与社会支持密切相关，护理过程中重视社会支持可改善护理效果，提高肠造口患者的生活质量。     

家庭访视对经皮内镜下胃造瘘术后病人生活质量的影响

[目的]探讨家庭访视对经皮内镜下胃造瘘术后病人生活质量的影响。[方法]将60例接受经皮内镜下胃造瘘术病人随机分为观察组和对照组各30例,对照组采用常规护理,观察组在常规护理基础上接受家庭随访,两组病人在干预前后均填写 SF 36健康调查量表,并比较两组病人生活质量和并发症发生情况。[结果]观察组病人 SF 36量表中躯体疼痛、活力、社会功能、情感职能和精神健康维度得分均高于对照组,也高于自身干预前,差异有统计学意义(P<0.05);观察组病人并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。[结论]家庭访视能降低PEG病人术后并发症发生率,提高其生活质量。     

某院肠造口患者新型造口产品使用情况调查

目的通过调查某院肠造口患者新型造口产品使用情况,分析未使用新型造口产品的患者的经济状况。方法选择2009年1月至2011年12月行永久性肠造口的患者163例,了解手术后半年使用新型造口产品情况。结果163例患者中有134例为非职工基本医疗保险占82．2％,其中新农村合作医疗116例占86．6％,使用新型造口袋35例占30．2％;城镇居民医疗保险14例占10．4％,使用新型造口袋10例占71．4％;未参保险的4例占3％,使用新型造口袋0例占0．0％。163例患者中职工医疗保险29例占17．8％,除1例有定时排便习惯未使用造口袋外,其余均使用了新型造口袋。结论患者的经济状况决定了新型造口产品的使用情况,在国家改善农村医疗保障的同时,医务人员应根据患者的经济状况介绍一些实用低耗的造口用品和造口护理方法,同时取得家属支持。国内应生产适合我国国情的价廉物美的新型造口产品,以取代国外昂贵的造口产品,降低产品费用,使更多的造口患者能够用得起,从而提高患者的生活质量。     

Sexual health and quality of life among male veterans with intestinal ostomies

PURPOSE: This secondary analysis was conducted to expand our understanding of the challenges men with ostomies face regarding intimate relationships and sexual functioning. We examined quantitative and qualitative data to examine sexual functioning, intimate relationships, and health-related quality of life (HR-QOL) among military veterans who are living with an intestinal stoma. SETTING: Three Veterans Health Administration sites. SAMPLE: Four hundred eighty-one male veterans. METHODS: Case-control, mixed-methods design; cases were those who had ostomies for at least 2 months, and controls had a similar major intestinal surgical procedure that did not result in an ostomy. Quantitative and qualitative data on sexual functioning, relationships, and other dimensions of HR-QOL were collected using the modified City of Hope Quality of Life-Ostomy questionnaire. RESULTS: The overall response rate was 49%. Prevalence of erectile dysfunction was significantly higher among ostomates compared with controls (P < .001). Although a greater proportion of veterans with ostomies reported being sexually active before surgery compared with controls (P < .001), the proportion of men who had resumed sexual activity after surgery is significantly lower among the ostomy group (P = .015). Compared with veterans with ostomies who did not resume sexual activity after surgery, those who were sexually active reported a higher total HR-QOL score and higher scores on all 4 modified City of Hope Quality of Life-Ostomy dimensions (psychological, social, physical, and spiritual well-being). Veterans with ostomies who had resumed sexual activity after their ostomy also reported that their ostomy had caused significantly less interference with social activities, less isolation, less interference with their personal relationships, and less interference with their ability to be intimate. These men also reported less difficulty adjusting to the ostomy. Results of qualitative analyses showed that problems with intimacy and sexual function are among the greatest challenges faced by ostomates. CONCLUSION: Presence of an ostomy was associated with lower rates of sexual activity and higher erectile dysfunction. The lower rates of sexual activity and sexual satisfaction were related to the social and psychological dimensions of HR-QOL among men with ostomies. Interventions to address sexual concerns of male ostomates and their partners may prevent decrements to HR-QOL for these patients. IMPLICATIONS FOR PRACTICE: Results of the study have implications for the clinical nurse specialist role in supporting and educating patients with ostomies to minimize the negative impact of an intestinal ostomy on sexual health and HR-QOL. Implications also relate to the need to educate current and future nurses about the importance of assessing sexual health.     

PS1-09: Comparing the Greatest Challenges of Long-Term Rectal Cancer Survivors with Anastomosis Versus Ostomy

Background Patients surgically treated for rectal cancer receive either an intestinal ostomy (externalization of the bowel to the abdominal wall) or, more frequently, an anastomosis (reconnection) of the rectum. While the challenges of intestinal ostomies have been previously described by this research team, much less is known about the long-term challenges of living with an anastomosis. Understanding the challenges of long-term rectal cancer survivors with both types of surgeries is important for informing and improving current practice. Methods We mailed our survey to 1000 long-term (at least 5 years post-diagnosis) rectal cancer survivors in KP Northern California and KP Northwest during 2010-2011. Our overall response rate was 57.7% (577/1000). The survey contained an open-ended question that asked respondents to write about the greatest challenge they experienced after their cancer surgery. Seventy-three percent of respondents provided a response to this "greatest challenge" question. Responses were analyzed qualitatively to compare the challenges reported by patients with anastomosis vs. ostomy. Results Challenges related to managing bowel function and output were found in both groups. Ostomy patients reported challenges to managing ostomy equipment that were unique to their condition-ostomy appliance failures, skin breakdown around the ostomy, and finding suitable places to empty, clean, and reconnect their appliance. Other notable differences in the greatest challenges among ostomy and anastomosis patients included: patients with an ostomy reported a range of psychosocial challenges relating to depression, shame, stigma, and post-operative psychological trauma about having an ostomy and such psychosocial impacts were notably absent among anastomosis patients; patients with ostomies reported regret about having an ostomy, but patients with anastomosis did not report regret about the surgery they received; and, anastomosis patients mentioned more challenges from radiation after effects, including pain, fistulae, and strictures. Discussion Our findings about rectal cancer survivors with ostomies mirror previously published reports. Even in the face of impaired bowel function, rectal cancer survivors with anastomoses express little psychological distress or regret about treatment choice. The lasting effects of radiation therapy, however, are of special concern to this group.     

From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies

Purpose

The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of this paper is to describe the health-care experiences of long-term (>5 years) CRC survivors with ostomies.

Methods

Thirty-three CRC survivors with ostomies who were members of Kaiser Permanente, an integrated care organization, in Oregon, southwestern Washington and northern California participated in eight focus groups. Discussions from the focus groups were recorded, transcribed, and analyzed for potential categories and themes.

Results

Health-care-related themes described CRC survivors’ experiences with diagnosis, treatment decision-making, initial experiences with ostomy, and survivorship. Participants discussed both positive and negative health-care-related experiences, including the need for continued access to trained nurses for ostomy self-care, access to peer support, and resources related to managing persistent, debilitating symptoms.

Conclusions

Long-term CRC survivors with ostomies have both positive and negative health-care experiences, regardless of health-related quality of life (HRQOL) and gender. Long-term support mechanisms and quality survivorship care that CRC survivors with ostomies can access are needed to promote positive adjustments and improved HRQOL.

Structured abstract

The current literature in CRC survivorship suggests that HRQOL concerns can persist years after treatment completion. The coordination of care to manage persistent late- and long-term effects are still lacking for CRC survivors living with an ostomy. Findings from this qualitative analysis will aid in the development of support strategies that foster more positive adjustments for CRC survivors living with an ostomy and support their ongoing ostomy-related needs.     

PS1-10: Spiritual Well-being and the Challenges of Living With an Ostomy: Resilience, Adaptation and Loss Among Colorectal Cancer Survivors

Background Spiritual well-being (SpWB), defined as hopefulness, inner peace, and sensing a reason to be alive, is integral to health related quality of life (HRQOL). It is only partially related to spirituality and religiosity. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We explored expressions of SpWB reported by CRC survivors with ostomies. Methods We recruited all adult CRC survivors (>=5 years) with permanent ostomies who were members of Kaiser Permanente Northwest, Northern California, or Hawai'i during 2000-2006 to complete a mailed survey (n=283). We asked participants to respond to an open-ended question about the greatest challenge they encountered in having an ostomy. Responses from the 62% (176 of 283) of patients who answered this question were analyzed based on the City of Hope HRQOL model for content related to SpWB, and to identify and categorize the SpWB themes found. Results The responses of 51% (90 of 176) of participants contained SpWB content. Seventeen SpWB themes were identified, reflecting positive, negative, and ambivalent dimensions. Some responses contained multiple themes but each theme was coded only once for each person. Fifty-three of 90 people (59%) expressed positive themes which included "positive attitude" "appreciate life more" "helping others helps me" "strength through religious faith" "leading an active life" and "I am fortunate." Negative themes included "struggling to cope" "not feeling 'normal'" and "loss" and were least common, expressed by only 28 of 90 people (31%). Ambivalent themes were most common (67%; 60 of 90 individuals) and included "learning acceptance" "ostomy is the price for survival" "reason to be around despite suffering" and "continuing to cope and function despite challenges." Discussion These CRC survivors with ostomies infrequently cited negative SpWB as a major challenge, though the greatest number of SpWB responses were ambivalent. More commonly, SpWB themes were mentioned as a source of resilience or part of the struggle to adapt to their altered body after cancer surgery. SpWB interventions should be broadly constructed to include the many types of SpWB, as opposed to narrowly defining SpWB only in terms of spirituality or religiosity.     

造口患者电话咨询256例次数据分析

目的通过电话咨询及时解决造口患者出院后的问题;了解出院后的需求,逐步完善现有的专科健康教育内容;探讨开展造口患者电话咨询的意义。方法记录有统计学意义的电话咨询资料256例次,将数据进行分类整理和分析。结果61-80岁造口患者电话咨询所占比例较高(64.5%);造口术后1年内的患者电话咨询比例较高(85.0%)。咨询内容中造口用品信息、造口周围皮肤问题和排泄物渗漏分别为32.8%、30.1%、24.6%。通过电话能直接解决问题的有201例次,占78.5%。结论开展造口患者出院后电话咨询有助于了解造口患者的各项需求,及时解决大部分患者的问题,改善他们的生活质量,对完善健康教育内容和开展延伸服务有指导意义。     

Untreated peristomal skin complications among long-term colorectal cancer survivors with ostomies

This ethnography of family caregiving explored why peristomal skin complications are common and undertreated among colorectal cancer survivors with intestinal ostomies. Data were collected through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review, and analyzed with qualitative theme and matrix analyses. Survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications. Half of the survivors received unpaid help with ostomy care, and all such help came from spouses. Married couples who collaborated in ostomy care reported that having assistance in placing the ostomy appliance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines. In addition, survivors who struggled to manage ostomy care independently reported more obstacles to alleviating and seeking treatment for skin problems. Oncology nurses can improve treatment of peristomal skin problems by asking patients and caregivers about ostomy care and skin problems, examining the peristomal area, and facilitating routine checkups with a wound, ostomy, and continence nurse.     

Ostomy patients' perceptions of quality of care

AIM: This paper reports a study whose aim was to assess the quality of care in ostomy patients seen from a patient perspective. BACKGROUND: A stoma operation causes profound changes in a patient's life because of resulting physical damage, disfigurement, loss of bodily function, and change in personal hygiene. Such changes are a cause of major concern for patients and raise important issue for the quality of care. METHODS: The study group comprised patients who had undergone a colostomy for rectal cancer or an ileostomy for ulcerative colitis, all attending a stoma outpatient clinic. Quality of care was assessed using the identity-oriented dimension of the validated questionnaire 'Quality of Care from the Patient's Perspective'. Forty-two ileostomy and 49 colostomy patients completed the questionnaire. RESULT: While the vast majority of patients in both groups thought that most topics in the questionnaire were important, most rated many aspects of their quality of care as unsatisfactory. One-third of the colostomy patients and one-half of the ileostomy patients were dissatisfied with the information they received about the results of medical examinations and laboratory tests, and an even higher proportion was dissatisfied with their opportunities to participate in the decision-making process or to discuss sexual matters. Stoma-related complications, which occurred in 71% of the ileostomy patients and in 43% of the colostomy patients, had no impact on these results. CONCLUSION: Information and counselling for patients having ostomies, both on the part of specialist nurses and colorectal surgeons, appeared to deficient, suggesting that standards for quality of care require continuous evaluation and revision.     

社区护理干预提高造口病人生活质量的研究

目的 探讨对造口病人实施社区护理干预,提高其生活质量的效果。方法 调查、建立造口病人健康档案、服务、召开造口病人联谊会。结果 开展社区护理干预后造口病人的生活质量明显高于社区护理干预前,11项评价指标分别经秩和检验,10项P<0.01,1项P<0.05,存在显著性差异。结论 实施造口病人近距离、低消费的社区服务有利于提高造口病人生活质量。     

The basics of ostomies.

Basic ostomy care can be intimidating because nurses don't often see colostomies, ileostomies, or urostomies. While there are as many different ostomies as there are people who have them, there are some commonalities in the care of the stoma. These can be generalized to all stomas, regardless of the type of output. Some care, however, is specific to the placement of the stoma and the type of effluent flowing from the opening. This article will provide the gastroenterology nurse an overview of the basic features of ostomies as well as routine ostomy care.     

Dealing With the Unthinkable: Bladder and Colorectal Cancer Patients’ and Informal Caregivers’ Unmet Needs and Challenges in Life After Ostomies

ObjectivesWe examined patient and informal caregiver unmet needs to identify areas for targeted supportive care interventions and programs to enhance both patient and informal caregiver experience.Data SourcesA total of 30 patients who underwent ostomy surgeries for bladder or colorectal cancers and 13 informal caregivers participated in the study. Patients were enrolled at the Icahn School of Medicine at Mount Sinai between 2017 and 2018. Qualitative data were collected by individual interviews, audiotaped, and transcribed verbatim. Transcribed data were iteratively analyzed using Atlas.ti to explore patient and caregiver unmet needs.ResultsPatients and informal caregivers reported having insufficient psychological preparation for ostomy surgeries, and very limited hands-on training on stoma care and utility of stomal appliances. Unmet psychological needs related to depression, anxiety, and distress caused by changes in body image and sexual, urinary, and bowel function were reported. Patients and caregivers also reported significant patient medical needs in the acute postoperative period including pain, fatigue, sleep disturbance, inflammation, and complications resulting in hospital readmissions. Colorectal cancer patients specifically experienced significant challenges with changes in diet and nutrition that contributed to ostomy care burden. Both patients and caregivers recommended seeking psychological and social support to enhance both patient and caregiver emotional adjustment to life after ostomies.ConclusionMeeting patient and informal caregiver unmet informational and supportive care needs is imperative to improve their quality of life and adjustment.Implications for Nursing PracticeAn effective supportive care plan should be designed and utilized in clinical care to improve ostomy patients’ and caregivers’ outcomes.