Peristomal skin care and the use of accessories to promote skin health

Stomas are frequently encountered by nurses. Common complications include problems with the peristomal skin-the skin around the stoma. It has been reported that up to 80% of people with a stoma, who are termed ostomates, are affected. The three main types of stomas are colostomy, ileostomy and urostomy; all these come with a risk of sore peristomal skin. These stomas pass faeces or urine, which are collected in a stoma appliance that adheres to the peristomal skin. It is essential to ensure that this skin is free from breaks or soreness as this might lead to appliance leakage. This article is aimed at ward nurses and will focus on some of the stoma accessories that are used to treat, protect or 'level' peristomal skin. Accessories, such as barrier creams or films, can be used to protect skin. Filler paste, seals and convex appliances, for example, can be used to resolve creases in the skin or to treat a retracted stoma. The situations in which stoma accessories might be useful in resolving peristomal skin problems or retaining its integrity are numerous.     

行动研究法对提高普外科护士肠造口护理能力的效果研究

目的评价行动研究法在普外科结直肠病房护士肠造口护理能力培训中的应用效果。方法2019年1—8月采用行动研究法,识别问题后,按照“计划-行动-观察-反思”的螺旋循环方式,制定系统的、理论联系实际的培训方式对结直肠病房护士进行肠造口护理能力培训。评价培训前后的护士肠造口护理能力(理论知识、常规肠造口袋更换、常见肠造口并发症处理)及患者对护士满意度。结果经过2轮培训护士理论知识、正常造口更换及常见肠造口并发症处理、患者对护士满意度方面均明显提高,干预前后比较差异有统计学意义(P<0.05)。结论采用行动研究法的循环螺旋模式,对普外科护士进行系统的、规范化的培训,可提高护士肠造口护理能力,提高患者对护士肠造口护理水平的满意度。     

Caring for a patient with a urostomy in a community setting

Around 7500 people in the UK have a urostomy. A urostomy is normally performed if a person has bladder cancer, congenital bladder abnormalities. Many people who have a urostomy have long term conditions and may require the help and support of community nurses. This article examines common complications of urostomy including stomal complications, urinary tract infections and dermal complications. Although stoma complications are common and can affect quality of life, many people with a stoma tend not to seek help. Community nurses can provide care and support to optimize stoma management and enable the person with a urostomy to enjoy the best possible quality of life.     

Resuming a normal life: holistic care of the person with an ostomy

A community nurse may often encounter an ostomate (person with a stoma) but may not be regularly involved in their stoma care. This article explains the main types of stoma, stoma appliances and indications for some operations. Explanations are provided on some of the stoma appliances and accessories and when these might be useful to the community nurse and the ostomate. Stoma care is explained, including how to undertake a basic stoma appliance change. Issues that community nurses might be questioned about, such as diet and driving, are explored to assist the community nurse in providing holistic care for ostomates.     

Managing a colostomy or ileostomy in community nursing practice

After stoma formation the patient should be independent with their own stoma care. However, with emphasis being placed on community nurses for ongoing aftercare of ostomates: Skingley (2004) has asserted that many community nurses did not feel confident undertaking stoma care. This article is ideally placed for the community nurses to obtain a broad overview of some of the key points pertaining to stoma care. The article looks at care of ostomates and ileostomates in relation to available appliances and also discusses dietary recommendations.     

Care of patients with complications following formation of a stoma

Adjusting to living with a stoma is a difficult process that can be made even harder if complications arise. Community nurses should be aware of the most common problems that can occur and of the solutions or treatments required. Working with specialist stoma-care nurses, community nurses can offer psychological support and practical solutions.     

Parastomal hernia: an exploration of the risk factors and the implications

Risk may be defined as 'the chance that something may happen to cause loss or an adverse effect' (Concise Oxford Medical Dictionary, 2003). Patients undergoing stoma formation are at risk of developing a wide range of complications following surgery. A parastomal hernia is an adverse effect that can contribute to postoperative morbidity. The risk of developing a parastomal hernia is dependent upon a number of variables, and stoma care nurses need to be aware of these to plan the appropriate care for patients undergoing stoma formation. This article discusses the issues surrounding the development of parastomal hernias and also looks at ways in which the risk factors associated with the development of a parastomal hernia may be minimized.     

Stoma management: enhancing patient knowledge

Community nurses are likely to encounter people with a stoma, most commonly a colostomy. An appliance is used to collect and contain the stomal output. There are various appliances available, each designed to specifically care for a particular type of stoma. Ostomates (people with a stoma) are trained to care for their stoma while they are in hospital by the stoma specialist nurse. However, it is possible that complications can occur, such as sore peristomal skin, and in this instance a stoma accessory can be used to good effect. There are many accessories available, which can make choice difficult. However, an understanding of why accessories are used can assist in the assessment and treatment choice. It may be necessary to request the assistance of the stoma specialist nurse.     

“造口护理工作坊”在肠造口护理中的作用

[目的]采用“造口护理工作坊”业务培训的方式加强临床护理人员对造口相关知识及护理操作的认识,提高对造口相关并发症的预防和处理能力。[方法]成立造口专业小组,组织造口相关科室护士长及护理骨干进行业务培训。[结果]提高了临床护理人员的专业知识,掌握了规范的造口相关操作,并对如何预防和护理造口相关并发症有了一定的了解。[结论]“造口护理工作坊”业务培训的方式为临床护理人员提供了学习、交流平台,提高了对造口病人全方面护理的重视,促进了造口专业的发展。     

Common peristomal skin problems and potential treatment options

Stomas are encountered by nurses in many different fields and may be newly formed or many years old. Caring for ostomists can be problematic, particularly if complications occur. One of the more common problems for ostomists is excoriated peristomal skin. Sore skin can occur for a number of reasons and the cause can be an indicator for the therapy required. At times the treatment can be simple but often the skills of a stoma specialist nurse are required. This article focuses on some of the more commonly encountered ostomy problems that nurses may be faced with. The potential problems are described and potential treatment options are offered.     

Stoma care in the school setting.

An ostomy is an artificial opening in the body for the purpose of eliminating excretions from a working organ or for providing nourishment. Artificial openings may be from the stomach, intestine, urinary bladder, kidney, or trachea. The stoma is the terminal end of the ostomy, or the opening that is visible on the surface of the skin. This article will discuss stoma creation and the care of a stoma, as well as the complications and effects of living with one. Although the focus of this article is urinary stomas, the care is similar for all types. It is imperative that all care providers understand stoma care and potential problems that may arise. There are ongoing issues of quality of life for children with stomas, including body image and peer reaction. School nurses are in a unique position to educate children and families on the proper care of a stoma, to recognize potential complication, and to educate staff and student peers.     

襻式造口支撑棒装置的设计及应用

目的 设计襻式造口支撑棒装置并探讨其在造口护理中的应用效果。 方法 自行设计和制作襻式造口支撑棒装置,该装置由2片固定翼硬片、2片固定翼软片、1根支撑棒棒体组成。选取2019年8月—2020年10月浙江省某三级甲等综合医院收治的拟行直肠肿瘤切除+回肠襻式造口手术的患者及其照顾者作为研究对象,将患者随机分为试验组、对照组1和对照组2,试验组采用自制的襻式造口支撑棒装置,对照组1和对照组2分别使用传统缝合法和环套法固定支撑管,比较3组的一般资料、护士和照护者更换造口袋操作时间、操作时患者的疼痛程度、造口相关并发症发生率等指标。 结果 3组的一般资料、护士和照护者更换造口袋操作时间比较,差异无统计学意义（P>0.05）;护士和照护者更换造口袋操作时患者局部疼痛程度评分比较,试验组分别为（1.90±0.64）分、（1.33±0.83）分,对照组1分别为（4.11±0.77）分、（4.21±0.64）分,对照组2分别为（2.52±0.68）分、（2.63±0.60）分,3组比较,差异均有统计学意义（均P<0.001）;患者压力性损伤、造口黏膜皮肤分离、造口周围皮炎并发症发生率比较,试验组分别为0、3.23%、12.90%,对照组1分别为32.26%、32.26%、54.84%,对照组2分别为20.00%、26.67%、40.00%,差异均有统计学意义（均P<0.05）。 结论 自行设计的襻式造口支撑棒装置应用于造口护理,能有效降低患者造口相关并发症的发生率,减轻护理时局部的疼痛程度,提高患者的舒适度。     

Management of intestinal failure and high-output stomas

Intestinal failure and a high faecal output from a stoma or fistula are rare gastrointestinal complications. Intestinal failure occurs when the intestine fails to absorb sufficient fluids and nutrients to maintain life, and can result from bowel resection or malabsorption. The management of these conditions raises many issues which nurses caring for affected patients need to consider. This article will discuss those relating to feeding, appliances and medication. Two methods of feeding that can be useful in patients with intestinal failure, namely parenteral nutrition (intravenous feeding) and fistuloclysis (feeding via an intestinal fistula), will be explored. Finally, a short case study will be presented to highlight the effects of some of these interventions and the problems that they can cause for patients.     

The pre- and postoperative nursing care for patients with a stoma

This article revisits the various issues that surround the nurse caring for a patient with a stoma (colostomy, ileostomy or urostomy). Understanding the basic anatomy, reasons for stoma formation and the surgical operations, including variations such as continent stomas, can assist the nurse in caring for this patient group. The article discusses briefly the various stoma appliances that can be used by the nurse or ostomate (person with a stoma). Practical tips on pre- and postoperative nursing care of the patient with a newly formed stoma are provided for the nurse. In some cases, unfortunately, complications may occur following stoma-forming surgery; these are discussed and nursing advice provided. One of the most important ways in which the nurse can support the patient is to teach the patient his/her stoma care, ensuring independence before discharge and showing empathy and compassion.     

Stoma care: empowering patients through teaching practical skills

Teaching patients practical skills in stoma care is a complex process and although, arguably, at the very heart of stoma care nursing practice, has been largely ignored in the literature. Teaching principles are based upon social learning theory and educationalists provide guidelines on the most effective way to teach a practical skill. These guidelines have been utilized by nurses when teaching patients with newly formed stomas how to change a pouch. The process of adapting to a stoma and its daily management takes time. Psychologically, however, some patients will adapt more easily than others and researchers have attempted to identify factors which may account for this. Studies have demonstrated that patients who are satisfied with the amount of preoperative information they receive are less likely to develop psychological problems. Psychological adjustment may be affected if patients feel that they have developed insufficient pouch changing skills or have problems with leakage from their pouch or sore skin around their stoma. Studies have also demonstrated that cognitive factors, such as patients feeling in control of their illness and stoma, have been found to play a role in psychological adaptation. Clinical nurse specialists in stoma care are in an ideal position to target these cognitive factors using a variety of strategies including effective practical teaching to empower patients, thus facilitating psychological adaptation following stoma surgery.     

Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma

Aims and objectives. This study was carried out to assess the effectiveness of the PLISSIT model in solving sexual problems of individuals with stoma. Background. Creating a stoma due to intestinal cancer may prolong the life expectancy of individuals. However, the problems resulting from stoma may cause significant changes in an individual’s life and adversely affect relations with family members and social and sexual life. Design. Experimental. Methods. The study consisted of individuals with stoma, living in Ankara. The sample consisted of 60 patients. The case group consisted of 30 patients living in Ankara; and the control group consisted of 30 patients living outside Ankara. In data collection, a questionnaire form, the PLISSIT model intervention plan and Golombok–Rust Inventory of Sexual Satisfaction (GRISS) were used. The individuals in the case group were paid eight home visits. During these visits, sexual problems of individuals with stoma were assessed and solutions sought under the guidance of the PLISSIT model intervention plan. Results. Increase of mean scores of Golombok–Rust Inventory of Sexual Satisfaction and subgroups before evaluating the sexual problems by the PLISSIT model and the sixth week scores which the sexual activity is anticipated to start have been observed, but after evaluating the sexual problems by using the model, the mean scores decreased. It was determined that negative effects of concerns related to sexual life; some physical and emotional features and physiological problems have been observed and difference between the groups is significant (p < 0·05). Conclusions. As a result, it can be claimed that decreasing sexual problems can be accomplished by using the PLISSIT model. Relevance to clinical practice. People with stoma can meet sexual problems. However, nurses experience some difficulties while handling sexual problems. It is thought that an intervention plan prepared within the framework of the PLISSIT model will guide nurses in solving sexual problems of individuals with stoma and providing integrated care and help individuals to express their sexual problems.     

Essential care for patients with stomas

As nurses in any clinical setting may see patients with a stoma, it is vital they develop a basic understanding of stoma care. This article outlines the three main types of stoma, the specific appliances used for each type, examples of operations that might lead to stoma formation and the reasons for forming them.     

永久性乙状结肠造口患者生活质量及其影响因素的分析

目的 探讨永久性乙状结肠造口患者的生活质量及其影响因素.方法 对73例直肠癌行永久性乙状结肠造口3个月以上的患者进行生活质量、手术后适应能力、社会支持和自尊的问卷调查.结果 造口患者的生活质量与患者对造口适应能力、社会支持和自尊各变量均呈正相关（r=0.37～0.44,P＜0.01）.感知到的能力,婚姻,社会支持,造口旁疝,造口用品费用,便秘,家庭关系这7个变量进入了造口患者生活质量总分的回归方程等是影响患者生活质量的主要因素.结论 造口治疗师或护士应帮助患者及其家人接受并适应有造口的生活,提高造口自理能力,减少与造口有关的并发症和问题,加快患者的生理和心理康复,从而帮助患者提高生活质量.     

Changing practice: the role of the community stoma nurse

Over the past few decades the nursing profession has recognized the need for major reforms to ensure that it meets future challenges and changes. As a community stoma care nurse, the author was given the challenge of improving stoma care education for all community nurses within the local community trust. This article describes how the community stoma care nurse established what areas of stoma care community staff felt needed updating. However, it also demonstrates that not taking time to plan or use a change tool meant that this was not an organized process and outcomes were not measurable. The article also looks at some recommendations for improving future implementation of stoma care teaching sessions.     

Clinical treatment options for peristomal pyoderma gangrenosum

Pyoderma gangrenosum is a rare debilitating skin disease of unknown aetiology that manifests itself as painful lesions and is often associated with inflammatory bowel disease. Stoma care nurses will encounter it directly around the stoma as peristomal pyoderma gangrenosum (PPG). There are many case reports of varying methods of treatment for PPG, although none have proven to be efficacious in all circumstances. When these lesions develop in the peristomal area, treatment must be balanced with the need to maintain an intact stoma appliance.