Family dynamics and health locus of control in adults with ostomies.

OBJECTIVE: The purpose of this study was to investigate the relationship between family dynamics and health locus of control in families who had a member with an ostomy. DESIGN: The study used a cross-sectional design. SETTING AND SUBJECTS: Data were collected by means of questionnaires completed by 2 groups of families. Twenty-nine subjects in the ostomy group were registered with a local chapter of the United Ostomy Association. Thirty subjects in the non-ostomy control group were recruited from a local church, a university housing complex, and a hospital volunteer service. INSTRUMENTS: The Family Dynamics Measure of 62 Likert-type items measured 6 bipolar dimensions of family dynamics. The Multidimensional Health Locus of Control Scale of 18 Likert-type items measured internal or external locus of control. METHODS: Questionnaires were mailed to subjects by staff at the local ostomy association and other cooperating groups. Completed questionnaires were returned by mail to the researcher. RESULTS: Subjects in the ostomy group perceived significantly greater control by powerful others and greater rigidity in the family compared with the non-ostomy group. When families were perceived as rigid, both groups reported significantly greater control by powerful others. Subjects in the ostomy group who reported greater role reciprocity in the family perceived greater health locus of control by powerful others. CONCLUSIONS: Health care professionals and family members (powerful others) play an important role in helping a person with an ostomy. Assessing family dynamics can help professionals identify which aspects of family life are associated with locus of control for the person with an ostomy.     

Improving stoma management in the low-vision patient

Teaching the low-vision patient with an ostomy to manage a stoma independently provides a significant challenge for the WOC nurse. Although guide strips, lighted mirrors, and other handheld devices are available to patients with impaired eyesight, these products, when used alone, may be inadequate for the patient with an ostomy. In addition, there is a paucity of literature available to the WOC nurse describing specific interventions for the low-vision patient with an ostomy. Common visual problems encountered when managing people with an ostomy are reviewed. Specific Interventions are discussed, including products designed to assist the low-vision patient with an ostomy with stoma care. A case study is provided that underscores the importance of consulting a low-vision specialist in the care of the patient with a new ostomy who has low vision as a result of albinism.     

Survey of wound, ostomy and continence (WOC) nurse clinicians on stomal and peristomal complications: a content validation study.

PURPOSE: Validated and reliable stomal and peristomal complication definitions and associated interventions are lacking. Available literature is either narrowly medically focused or only of case study level. The objectives of this study were to establish content validation data for the proposed stomal and peristomal complication definitions and their associated interventions, to obtain the data related to contact with stomal and peristomal complication patients, and to gain insight into the ostomy care process. METHODS: A researcher-designed survey was sent to 2900 expert Wound, Ostomy and Continence nurse clinicians via a national mailing to a representative nonrandomized sample of participants who identified that they included ostomy care in their professional practice. In total, 686 nurses returned the survey, a response rate of 24%. The purposive sample was asked to quantify the degree of validity of the survey's stated stomal and peristomal definitions and interventions. Hand-written qualitative comments of the participants were transcribed, analyzed, and themes were derived. RESULTS: On a scale of 1 to 4, the mean score for all definitions and interventions was 3.64 (SD=0.30). The overall survey's content validity index was .91. Ratings demonstrated high consensus validation on the stomal and peristomal definitions and interventions, with definitions scoring higher. The mean scores and the content validity index results on selected items were slightly lower for interventions, especially stomal interventions. Qualitative analysis of participants' comments about the whole instrument generated 10 themes and associated subthemes related to omitted complications and interventions and general observations about the ostomy care process and the validation research process. CONCLUSION: The proposed stomal and peristomal definitions and interventions were rated as generally valid. Further research documenting validation of participants' comments is necessary. Given the findings, additional complications and interventions not identified in the literature were noted and need to be further scrutinized and researched.     

The pouch acting as a mediator between "being a person with an ostomy" and "being a professional": analysis of a pedagogical strategy.

OBJECTIVE: This study analyzes the process of constructing and reconstructing the meanings of the concepts ostomy, ostomy patient, and the nurse's role in managing an ostomy after the experience of wearing a pouch. SUBJECTS AND SETTING: Thirty nurses who were students in the Enterostomal Therapy Nursing Education Program in 1992 and 1993 participated in this study. All of the participants were female, ages 20 to 55 years, had graduated from nursing at least 6 years previously, and had been working at acute care hospital units or at outpatient care centers. The research was completed at the Enterostomal Therapy Nursing Education Program in the Nursing College of the University of S?o Paulo. METHODS: All participants wore a pouch and lived as an ostomy patient for a 24-hour period and then were interviewed about their experience. Two major themes were identified after analysis: "being a person with an ostomy" and "being a professional." RESULTS: The experience of wearing a pouch promoted changes in perceived role, self-esteem, body image, sexuality, and social relations. These changes were sometimes perceived as stigmatization and sometimes as enhancing social support. The perceptions caused a crisis that provoked the use of coping and social defense mechanisms that ultimately altered the participants' perceptions of the meaning of "being a nurse." Prior to this learning experience, the participants' management of patients with ostomies was fragmented and marked by a dissociation among activity, thinking, and feeling. Before the experiences, participants defined their management of patients with ostomies as mostly technical, focusing on the ostomy and the pouch. Following the experience, participants proposed changes in practice designed to care for the whole human being, revealing an incorporation of the affective, symbolic, and relational dimensions critical to managing the care of patients with an ostomy. CONCLUSION: The results showed that having subjects wear a pouch as a pedagogic strategy was successful in directing the participants' thinking about new meanings concerning "being a professional," resulting in some potential profound changes in the future nursing care of their patients.     

肠造口患者社会疏离感现状及影响因素研究

目的 了解肠造口患者社会疏离现状并分析其影响因素,为帮助造口患者回归社会提供依据。方法对277例结直肠癌行肠造口患者采用一般资料调查表、一般疏离感量表、社会影响量表进行调查分析。结果肠造口患者一般疏离感得分（2.98±0.82）分,社会影响得分（2.92±0.60）分,多元线性回归分析结果显示：社会影响、主要照顾者、造口类型、住院次数是肠造口患者社会疏离感的主要影响因素（均P<0.05）。结论肠造口患者社会疏离感处于中等偏上水平,对主要照顾者为父母、临时造口、住院频繁的患者采取个体化干预,以改善其社会疏离感状况。     

Adult survivors of childhood sexual abuse as patients: two case studies.

Adult survivors of childhood sexual abuse comprise a high percentage of the patients seen in gastrointestinal and genitourinary clinics and are commonly found among the patient population treated by WOC nurses. The physical and emotional consequences of sexual abuse may permeate the survivor's life, but rise to the forefront only with the additional stress of an ostomy or urinary diversion. Two case studies are described involving women the authors encountered in their practices.     

Comorbidities play a larger role in predicting health-related quality of life compared to having an ostomy

BACKGROUND: Previous research suggests an ostomy worsens health-related quality of life (HR-QOL), but comorbidities also can affect HR-QOL. METHODS: Eligible patients had abdominal operation with ostomy (cases) or similar procedure without ostomy (controls). Patients were recruited for this case-control study from 3 Veterans Affairs hospital medical and pharmacy records. Comorbidities were assessed with Charlson-Deyo Comorbidity Index. Multinomial logistic regression evaluated the impact of comorbidities and having an ostomy on HR-QOL, measured using the Medical Outcomes Study Short Form 36 for Veterans. RESULTS: A total of 237 ostomates (cases) and 268 controls were studied. Average age was 69 years; 64% of cases had colostomy, 36% ileostomy. Twenty-nine percent of patients had a high level of comorbidities. Cases and controls were similar except for reasons for undergoing surgery. High comorbidity was a significant predictor of low HR-QOL in 6 domains of the Short Form 36 for Veterans; having an ostomy was a significant predictor in 4. CONCLUSIONS: High comorbidity significantly influences low HR-QOL and impacted more domains than having an ostomy.     

The role of the WOC nurse in an ostomy support group

The creation of an ostomy provokes an emotional crisis for its recipient. The ostomy patient typically experiences a wide range of emotions and often feels a profound sense of isolation. Although health care professionals are able to provide substantial education and training, the patient usually requires additional knowledge and experience to manage and cope with the ostomy on a day-to-day basis. An ostomy support group can provide this much-needed information and emotional support. The WOC nurse can serve a vital role as facilitator for the ostomy support group. To fulfill this role, an understanding of key issues in promoting and maintaining a successful support group is necessary. These issues include understanding the role of the support group and how it differs from the self-help group, marketing the group, acting as a group facilitator, recognizing leadership resources within the group, and evaluating its effectiveness.     

Evidence-based nursing care management for the pregnant woman with an ostomy.

Pregnancy presents many problems without working through additional problems in coping with an ostomy. Yet many women with an ostomy do get pregnant and do deliver healthy babies. Evidence-based nursing is of the utmost importance, as there is little published information on this topic. Because of the scarcity of pregnant subjects within the ostomy category, most studies, by necessity, select a purposive subject base. Therefore, other information sources regarding nursing management of the pregnant woman with an ostomy take on considerably more importance. This article explores other forms of evidence that can be used in managing the care of pregnant ostomy patients and specifically how nurses can integrate various sources of information in designing an evidence-based nursing care plan. Nonpharmacologic forms of relaxation therapy, easily used by nurses, such as mindfulness-based stress reduction, guided imagery, and hypnosis, are also identified as some ways nurses can relieve anxiety and experiential stress associated with pregnancy in women who have an ostomy.     

Oral care and its role in WOC nursing

The impact of nutritional status and the ability of the patient to fight infection directly are related to the practice of the WOC nurse, who is well versed in the care of the body's integument with respect to patients with ostomies, wounds, tubes, and incontinence. The status of the patient's oral cavity and its relationship with nutrition and wound healing have not, however, been adequately addressed by WOC nurses. Involvement of the WOC nurse in preventive and therapeutic oral care can ensure a healthier gastrointestinal tract, improved nutritional status, and improved outcomes in caring for the person with a wound, ostomy, or incontinence. This article reviews the literature related to oral care and discusses its relevance to WOC nursing practice.     

Morbidity and mortality of ostomy closure.

Ostomy closure following the Hartmann procedure is perceived to be associated with higher morbidity and mortality rates than is ostomy closure following divided colostomy, loop colostomy, and divided ileostomy-colostomy so that ostomy closure after Hartmann procedure may be denied to certain patients. To test that perception, the charts of 59 patients undergoing a Hartmann procedure and 43 patients having ostomy closure after divided colostomy, loop colostomy, or divided ileostomy-colostomy were reviewed. Ostomy closure after Hartmann procedure was accomplished in 46 patients. These 46 patients (Group I) were compared with the 43 patients having ostomy closure following divided colostomy, loop colostomy and divided ileostomy-colostomy (Group II). No deaths occurred in either group. The morbidity rate was 30% for Group I and was 19% for Group II. This difference is not significant. Major complications involved wound, lung, small bowel, and colonic anastomoses. Anastomotic stricture rate was 9% for Group I and 5% for Group II. Small bowel and anastomotic complications in both groups occurred only when ostomy closure was performed after a delay of less than 6 months after ostomy construction. Stricture occurred only after end-to-end colocolostomy and coloproctostomy and did not occur after ileocolostomy or ileoproctostomy. All strictures were successfully treated by reoperation. Anastomotic leak and pelvic abscess did not occur in either group. We conclude that ostomy closure after Hartmann procedure may be more difficult and time consuming than is ostomy closure after loop colostomy, divided colostomy, or divided ileostomy-colostomy, but ostomy closure after Hartmann procedure does not have a higher morbidity rate. We advise a delay of 6 months between ostomy construction and ostomy closure and submit that all patients whose general condition permits reoperation may safely undergo ostomy closure.     

Overview of psychosocial problems in individuals with stoma: A review of literature

This literature review was conducted to summarise empirical evidence relating to psychosocial health following ostomy surgery during hospitalisation and after discharge. Both qualitative and quantitative studies were searched from 2000 to 2017 using PubMed, CINAHL, Ebrary, Elsevier, Science Direct, and Scopus. Twenty‐seven articles were included that examined the patient's psychosocial health following colostomy or ileostomy surgery. Among the 27 included studies, 11 adopted qualitative research methods and 16 used quantitative designs. Most of the studies were conducted to determine psychosocial problems and emotions of the individuals, their adaptation to the stoma, and their quality of life. Most of the psychosocial problems identified in these studies were poor body image perception and self‐respect, depression, sexual problems, and lower psychosocial adaptation. This literature review has illustrated the patient's psychosocial health following stoma surgery. Further studies exploring the effect of psychosocial interventions could be planned.     

Late vs early ostomy closure for necrotizing enterocolitis: analysis of adhesion formation, resource consumption, and costs

BackgroundSurgeons prefer to close ostomies at least 6 weeks after the primary operation because of the anticipated postoperative abdominal adhesions. Limited data support this habit. Our aim was to evaluate adhesion formation—together with an analysis of resource consumption and costs—in patients with necrotizing enterocolitis who underwent early closure (EC), compared with a group of patients who underwent late closure (LC).MethodsChart reviews and cost analyses were performed on all patients with necrotizing enterocolitis undergoing ostomy closure from 1997 to 2009. Operative reports were independently scored for adhesions by 2 surgeons.ResultsThirteen patients underwent EC (median, 39 days; range, 32-40), whereas 62 patients underwent LC (median, 94 days; range, 54-150). Adhesion formation in the EC group (10/13 patients, or 77%) was not significantly different (P = 1.000) from the LC group (47/59 patients, or 80%). No differences were found in the costs of hospital stay, surgical interventions, and outpatient clinic visits.ConclusionsOstomy closure within 6 weeks of the initial procedure was not associated with more adhesions or with changes in direct medical costs. Therefore, after stabilization of the patient, ostomy closure can be considered within 6 weeks during the same admission as the initial laparotomy.     

Intensive preoperative ostomy education for the radical cystectomy patient

ObjectivesPatients undergoing radical cystectomy with ileal conduit formation usually receive training on the use of their stoma during their initial hospitalization – while actively recovering from surgery – often with little follow-up or reinforcement. Many of these patients are not equipped to deal with these significant body changes, which can lead to additional clinic visits, stoma-related complications, and decreased patient satisfaction/health-related quality of life (HRQOL). In an effort to improve patient education, we sought to evaluate the feasibility of implementing a preoperative comprehensive stoma education session termed the “stoma bootcamp” for patients scheduled for a radical cystectomy and ileal conduit (RCIC). We tracked patient related outcomes to determine its impact.MethodsWe performed a longitudinal, quality-improvement feasibility study at the University of Kansas Health System. All patients who were scheduled to undergo a RCIC for bladder cancer were offered enrollment into the study at their preoperative clinic visit. The “stoma boot camp” consisted of a 3-hour group session within 2 weeks of the surgery date. Patients were given a short presentation by residents and advanced practice providers regarding the operation, recovery, and expectations for their post-operative care. Ostomy nurses then demonstrated basic urostomy care – pouching, sizing, emptying – along with trouble-shooting tips for common ostomy problems. Measurements of HRQOL questionnaires were completed at the initial visit, after “boot camp,” and at defined time points after surgery for 12 weeks. This included using an ostomy adjustment score. Length of stay, unplanned stoma-related interventions, and re-admissions within 30 days were also tracked.ResultsIn this initial pilot program, 51 patients participated in the stoma bootcamp. The patients had an average ostomy adjustment score (OAS) of 150.4 (95% CI 142.0, 158.8) at discharge from the hospital, and these high OAS levels persisted throughout the 12 weeks of follow-up data without any significant decline. Short-form 36 (SF-36) scores demonstrated numerical improvements in each individual category at the 6-week mark above baseline. These improvements persisted at the 12-week mark.ConclusionsIn this study we were able to establish the feasibility of implementing a preoperative comprehensive stoma education session for patients scheduled for a RCIC. Additionally, we were able to document favorable HRQOL data and improved ostomy adjustment scores surrounding the education session.     

Optimising clinical interventions for sexual difficulties within a relationship

Sexual dysfunction is a common experience for both men and women. Its management and treatment is often limited by patient and physician ignorance. In addition, medical and interventional organ-focussed therapies in medicine often fail to treat the individual as a whole person, and systemically clinicians often fail to recognise the importance of assessing whether the relationship (when present) is in need of professional input. This article reviews recent clinical advances in the management of men, women and couples with sexual problems using both medical and psychological interventions.     

Studying the effect of structured ostomy care training on quality of life and anxiety of patients with permanent ostomy

Patients with ostomy are faced with several physical, psychological, and social challenges and need to be prepared to overcome these challenges. Studies have shown that training plays an important role in helping patients to adapt with ostomy, live with it, and improve their psychological well‐being and quality of life (QOL). Therefore, the present study aimed to determine the effect of structured ostomy care training on QOL and anxiety of the patients with permanent ostomy. In this randomised clinical trial study, 60 eligible participants were recruited from the only ostomy clinic in Kerman, Iran. They were selected using a purposive sampling method and randomly assigned to either a control group that received routine ostomy care or an intervention group that attended oral and practical training and a question and answer session by a trained ostomy nurse and received an ostomy information booklet besides their routine care. Outcome variables were anxiety and QOL in general and its physical, mental, social, and spiritual dimensions in detail. By using the anxiety subscale of Hospital Anxiety and Depression Scale (HADS) and City of Hope‐quality of life [COH‐QOL], data were collected before and 2 months after intervention in both groups. Data were analysed by SPSS version 19 using χ², analysis of variance (ANOVA), independent t, and paired t test and multiple regression analysis. The results showed that the intervention group had significantly lower mean scores in anxiety (P = .001) and a higher mean score in overall QOL (P = .009) compared with the control group. The most significant increase was observed for psychological, social, and physical aspects, and the least was in the spiritual aspect, all of which improved after intervention. After controlling the effects of confounding variables such as age, ostomy period, and number of children, the structured training programme still had a positive effect on QOL. Structured ostomy care training, including face‐to‐face education and personal practice of using ostomy equipment, along with written material provided by the ostomy nurse specialist, may lead to an increase in the overall QOL and a decrease in the perceived anxiety level in patients. This type of training is not routinely delivered to ostomy patients in our health care setting, so it is feasible to prepare surgical wards and to educate nurses to work with their patients before and after ostomy creation. Furthermore, to ease patients' religious concerns, we recommend counselling, and the support of religious leaders in the Muslim community may play a key role to adaptation regarding religious matters after ostomy surgeries and alleviate patients' concerns.     

Enterostomy closure site hernias: a clinical and ultrasonographic evaluation

BACKGROUND: Parastomal hernia with a reported incidence of up to 50% is a major problem after ostomy formation. Hernias at the closure site may be a problem after the closure of the enterostomy. In this study, in addition to physical examination, we used ultrasonography (USG) in order to find the true incidence of ostomy closure site and laparotomy incisional hernias. METHODS: We examined patients with closed enterostomy sites by both physical examination and USG for the detection of hernias. Risk factors for hernia formation, such as age, gender, body mass index (BMI), ostomy type, and surgical site infections, were determined. RESULTS: The evaluation of 31 patients with ostomies resulted in a 32% incidence of closed ostomy site hernias when patient medical history, physical examination, and ultrasonographic examination were used together. With physical examination and USG, incisional hernias at the laparotomy incision were found in 58% of cases. USG was able to detect hernias which were not clinically evident at the ostomy closure site and the laparotomy wound. BMI, age, gender, ostomy type, and surgical site infection did not have a significant effect on hernia formation. CONCLUSION: Ostomy closure site and laparotomy incisional hernias are important clinical problems with a high incidence after ostomies are closed. Closure of the enterostomy site should be regarded as a hernia repair rather than a simple fascial closure. USG is a valuable clinical tool in combination with physical examination for the detection of minor defects.     

Co-constructing sexual recovery after prostate cancer: a qualitative study with couples

Background

Men are likely to experience deterioration in sexual functioning as a consequence of treatment for prostate cancer. Indeed, sexual difficulties are common across all treatment modalities.

Objective

To determine the impact of treatment for prostate cancer on intimacy and sexual expression/relationships from the perspective of couples.

Methods

An observational study was conducted including in-depth interviews with 18 people affected by prostate cancer; comprising eight couples and two individual men.

Results

Four categories were identified that illustrated the impact of prostate cancer on intimacy and sexual recovery. These related to social influences and language used to describe the loss or recovery of sexual activities; difficulties in discussing sexual activity with clinicians; the clash of individual impact of prostate cancer recovery versus the impact on the couple, and the re-integration of sexual activities into the relationship.

Conclusions

Though only one person in a partnership experiences cancer, these data indicated the extent to which prostate cancer treatment also impacts on partners. The study indicates that adjustment to erectile dysfunction (ED) takes time, but is a highly significant event in couples’ lives and its importance should not be under-estimated. Consequently, we suggest that relational models of care should be considered, whereby side-effects are recognised as impacting on both members of the partnership (for example ED, or lack or ejaculate). Supportive care in this context, therefore, may best be based on a relational approach using language and interventions that are appropriate to the patient and their situation.     

造口旁疝的诊治

目的：探讨造口旁疝的诊断方法及有效的治疗措施。方法：回顾性地分析1990－1997年行结肠造口术病例429例，随访时间5－12年。结果：11例发生造口旁疝，肠造口手术至出现造口旁疝时间中位数为30个月。7例行造口带治疗，4例行造口旁疝修补术。结论：造口旁疝的主要表现为造口旁肿物，如扪及造口旁缺损即可诊断。B超或CT检查有助于诊断。早期或症状轻微者经造口带治疗多可缓解症状。原位筋膜修补术加体网补片修补术是最佳手术方法，该术式成功的关键在于手术前严格 的肠道准备，术中注意无菌操作，术后合理使用抗生素，避免造口周围伤口感染。