Peristomal skin irritation and the use of a silicone-based barrier film

Maintaining skin integrity is vital to ensure good adhesion of the stoma pouch, and to avoid discomfort for the person with a stoma, ensuring a good quality of life. However, there are many risk factors associated with potential peristomal skin soreness, and a large number of research studies have highlighted the vast number of patients who actually experience these problems (Mahjoubi, 2005; Ratliff et al, 2005; Herlufsen et al, 2006; Lynch et al, 2008; Meisner and Balleby, 2008). Clinical nurse specialists in stoma care are responsible for ensuring that all patients are fully assessed, and also that patients are given appropriate evidence-based care to avoid peristomal skin irritation, where possible. This article will discuss the common causes of peristomal skin breakdown, the tools available to assist with assessment, and how to best treat peristomal skin irritation.     

Peristomal skin care: an overview of available products

Intact skin provides a protective barrier between the body and its environment. The frequent application and removal of stoma appliances can damage skin by stripping away the epidermal layer. Hydrocolloid flanges in either a one- or two-piece appliance hold moisture in the mass and are therefore more skin friendly than older appliances with acrylic adhesives, making hydrocolloid the choice for ostomy appliance manufacturers. Peristomal skin problems are a significant problem for the stoma patient. As many as one third of colostomy patients and more than two thirds of ileostomy and urostomy patients will be affected (Lyons and Smith, 2003). The correct and judicial use of barrier creams, gels, lotions, sprays and wipes in peristomal skin care can play an important role in giving the stoma patient a good quality of life.     

Using complexity to promote group learning in health care

Rationale Multidisciplinary groups are common in the health care arena, from operating teams to mental health treatment groups to guideline development groups. Differences among group members in information, background, training and skills can potentially help groups reach good decisions and complete complex tasks in variable circumstances. Too often, however, differences in values, status and preferences prevent these groups from achieving the potential benefits of diversity, marooning them instead in an unproductive fixed state. Aim Drawing on the literature on diversity and complex adaptive systems, we discuss how to improve the functioning of multidisciplinary groups by increasing the spontaneous flow of information and energy to shift groups into the complex state. Conclusion Differentiation needs to be balanced by integration. Differences that pose obstacles need to be transformed into gradients to achieve complex self‐organization and effective group coordination.     

Methodology of reprocessing one-time use accessories

The current climate of falling reimbursements has prompted evaluation of reusing single use (disposable) endoscopic accessories. A number of different accessories have undergone study of both function and sterility after reuse. These studies, albeit limited in number, do show that selected equipment can be sterilized without impairment of function. Nonetheless, despite the data, widespread adoption of accessory reuse remains hampered by lingering concerns over cross-contamination and medical and legal risks.     

The art of motivating behavior change: the use of motivational interviewing to promote health

Health promotion and disease prevention have always been essential to public health nursing. With the changing health care system and an increased emphasis on cost-containment, the role of the nurse is expanding even more into this arena. A challenge for public health nurses, then, is to motivate and facilitate health behavior change in working with individuals, families, and communities and designing programs based on theory. Leading causes of death continue to relate to health behaviors that require change. The purpose of this article is to integrate theory with practice by describing the Transtheoretical Model of Change as well as the principles of motivational interviewing that can be used in motivating behavioral change. A case scenario is presented to illustrate the use of the models with effective interviewing skills that can be used to enhance health. Implications for practice with an emphasis on providing an individually tailored matched intervention is stressed.     

Comparison of home health care outcomes and service use for patients with wound/skin diagnoses

The purpose of this comparative study was to evaluate patient outcomes for wound healing and home health care service use for patients whose care was paid for by the traditional Medicare program versus a Medicare managed care organization (MCO). Results showed that there were no differences between the groups in wound healing at discharge, functional ability at discharge, or the numbers of home visits. Changes in the Medicare reimbursement system for home health care may have provided an equalizing effect between Medicare MCO and traditional Medicare patients with wound/skin diagnoses in home health care agencies in the Midwest.     

Strategies to promote sexual health

This article examines trends in sexually transmitted infections in the UK. Screening, treatment and education of adults and adolescents are discussed. Suggestions are made for improvements to sexual health, as outlined in The National Strategy for Sexual Health and HIV (Department of Health 2001).