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.     

Psychological, sexual and cultural issues for patients with a stoma

Patients undergoing stoma surgery will more readily adapt to their new body image and way of life if they receive professional and voluntary input from the ostomy agencies such as the British Colostomy Association, from the preoperative stage through to rehabilitation and their return to the community. Nursing has moved away from mechanistic, task-oriented care to holistic care and, apart from the physical changes that a stoma will cause, there are other areas to be considered to improve the patient's quality of life after surgery. Patients undergoing stoma surgery experience a profound threat to their sense of physical integrity and self-concept with the change of body image in relation to bodily functions. Sexuality is an integral part of the whole person and is a highly complex phenomenon. Many patients find it difficult to discuss their sexual feelings, especially after a body image change and the nurse should be able to help patients identify and adapt to alterations in sexual self-concept. Cultural background plays an important part in patients' lives, including their beliefs, whether personal or religious, their perceptions of recovery, behaviour and concepts of and attitude towards the disease process. Nurses must combine sound, general information with open, respectful questions to the patient or family and be committed to responding flexibly and constructively. This article describes some of the potential problems that may be faced by patients after stoma surgery and increased knowledge of these areas will allow nurses to improve patient care and satisfaction.     

“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。     

68例经腹会阴联合直肠癌根治术患者切口及造口的护理

总结了68例低位直肠癌患者行经腹会阴联合直肠癌根治术(Miles)后切口及造口的处理方法.通过术前造口定位、预配造口袋体验,以及术后切口、造口的观察护理、造口护理技能指导及并发症的防治,使患者顺利接受手术、接受造口,学习造口相关护理知识,掌握造口护理技能.本组术后切口Ⅰ期愈合57例,Ⅱ期愈合11例,均采用湿性疗法处理后切口顺利愈合.本组发生造口并发症19例,均得到及时有效治疗,效果满意.     

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.     

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.     

Assessing the value of silicone and hydrocolloid products in stoma care

Intact skin among many other functions provides a protective barrier between the body and its environment, which is critical in regulating transepidermal water loss (Wilkinson and Moor, 1982). The frequent application and removal of adhesives can damage skin by stripping away the outer epidermal layers. Older people, very young children and those with an underlying skin disorder may be particularly at risk (Gibelli et al, 1999; Lyons and Smith, 2003). Hydrocolloid adhesives, which hold moisture in the adhesive mass, are more skin friendly than the acrylic adhesives they now replace and have now become the material of choice for ostomy flanges and flange extenders (Smith et al, 2007). To understand stoma care nurses' awareness of the value of technologically advanced silicone and hydrocolloid products, the authors undertook a nationwide postal survey. The survey, commissioned by four companies in the United Kingdom, who make silicone and hydrocolloid products that can be used in stoma care, were keen to evaluate the awareness of these products to confirm their importance to the patient and why they should be appropriately categorized for reimbursement by the Department of Health.     

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.     

膀胱全切除并移植肾输尿管皮肤造口术二例的护理

目的探讨膀胱全切除并移植肾输尿管皮肤造口术的护理。方法回顾性总结2例同种异体肾移植术后患者行膀胱全切除并移植肾输尿管皮肤造口术的临床资料及围术期的护理体会。结果 2例患者的造口均位于右侧下腹,留置输尿管支架管接引流袋,手术成功,未出现并发症。出院后6个月,2例患者移植肾功能良好,输尿管造口功能正常,日常生活均能自理。结论术前重点做好患者的心理护理及选择合适的造口产品,术后做好引流管护理、抗感染护理、排斥反应的治疗及护理、皮肤造口护理以及出院指导,可提高膀胱全切除并移植肾输尿管皮肤造口术的手术效果,改善患者的生活质量。     

36例膀胱肿瘤尿流改道腹壁造口患者的出院后护理干预

报告了36例膀胱肿瘤尿流改道腹壁造口患者出院后的护理干预。1年内36例存在不同程度的焦虑心理,34例无法自己更换造口袋,11例出现造口皮肤问题,7例出现尿路感染,3例出现尿酸盐结晶,1例出现造口局部疼痛。护士进行为期1年的电话咨询、技术指导、上门家访、造口沙龙的措施,上述问题基本得到解决。患者自我护理能力提高,造口并发症发生率下降,对未来的生活充满信心。认为出院后的护理干预有利于提高患者的自我护理能力和生活质量,使其尽快回归患病前的社会生活状态。     

以健康行为HAPA模型为指导提高造口患者自我效能的研究

目的建立一套以健康行为HAPA模型（health action process approach,健康行动过程取向）为指导,有利于增强膀胱癌造口患者自我效能的医院-家庭一体化康复护理模式。方法选取58例膀胱癌行泌尿造口手术的患者,应用医院-家庭一体化康复护理模式进行康复护理。于患者出院后1年应用一般自我效能感量表、造口自我护理调查问卷对患者的自我效能和造口自我护理能力进行评价。结果除5例患者在1年内死亡,不能参与自我效能和造口自我护理能力的评价外,其余53例患者中,自我效能评分：优（31~40分）32例,良（21~30分）15例,一般（10~20分）6例,优良率为88.68%;44例（83.02%）患者能独立完成造口护理,46例（86.79%）患者没有出现造口相关并发症。结论以健康行为HAPA模型为指导增强自我效能的护理干预模式,能显著提高患者的自我效能,提高康复护理效果。     

改良造口护理方法在回肠造口术后早期的应用

目的探讨改良造口护理方法在回肠造口术后早期护理的应用效果。方法选取2015年1月—2016年12月于广西玉林市第一人民医院行直肠低位前切除加预防性回肠造口术的患者62例,以2016年1—12月的33例为观察组,以2015年1—12月的29例为对照组。对照组给予常规护理,3次护理均使用肠造口袋;观察组在此基础上增加内置卫生棉条,第1次护理使用防逆流尿路造口袋,第2～3次护理使用肠造口袋。比较两组患者单次护理所需时间及发生底盘渗漏、粪水性皮炎情况。结果观察组单次造口护理时间比对照组明显缩短,差异有统计学意义(P0.05);观察组发生底盘渗漏、粪水性皮炎例数均较对照组明显降低,差异有统计学意义(P0.05)。结论实施改良造口护理方法,明显缩短了回肠造口护理时间,有效降低了造口周围皮肤并发症的发生率,提高了患者生活质量。     

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.     

Bowel and bladder dysfunction among teens

Adolescence is a stressful time for all children, let alone for those who have additional health needs, especially when that health need centers around something so private as bowel or bladder function. These students tend to feel different, have difficulty making friends and isolate themselves in fear of ridicule or rejection. It is only within the last three decades that continence issues have even been brought to the public's attention, by such people as June Allyson and Florence Henderson. However, these are older women to whom youngsters cannot relate. During the same 30-year time period, an organization called The United Ostomy Association was becoming visible as a leading support organization for adults who have had bowel or bladder dysfunction and related ostomy surgery. Thankfully, 25 years ago, two nurses, one who had a daughter with an ostomy, approached this organization to begin a program to meet the needs of teens. The teen support network has grown into an annual UOA Youth Rally and a national support network with a website, discussion board and mentoring program, all supervised by volunteer adults. The adults are either WOC Nurses (Wound, Ostomy and Continence), or adults who are members of UOA who have had an ostomy or have a child with an ostomy. The information presented in this article is intended to provide school nurses with a resource they may utilize while coordinating care for their students who have bowel and/or bladder dysfunction.     

术后尿路造口改进造口袋粘贴方法的实践

目的 探讨改进的造口袋粘贴方法效果.方法 按就诊顺序将66例尿路造口病人分为观察组和对照组.观察组36例采用改进的造口袋粘贴方法:剪断底盘保护纸,借用胶布撕开保护纸并贴袋.对照组30例采用常规肠造口粘贴方法.结果 两组病人手套粘连、手套破损发生率、护理人员手部细菌合格率及造口袋粘贴时间比较,差异有统计学意义(P＜0.05).结论 采用自行设计的造口袋粘贴方法使标准预防到位,降低护理人员手部细茵污染率,延长造口袋使用寿命.     

Living with a stoma: a review of the literature

Aims and objectives. This systematic review looks at the psychological and social impact of stoma surgery on peoples’ lives. Background. The formation of a stoma can have a negative effect on a person's quality of life and affect lifestyle in a number of ways. Methods. The review examines nursing literature from 1990 to date and focuses on how stoma patients’ lives are affected by the presence of a stoma. It informs nursing practice so nurses are better able to help individuals improve, maintain or recover their health following ostomy surgery. Results. The findings of the review indicate that stoma surgery can impact on individuals’ lives in many different ways. Relevance to clinical practice. Knowledge of the problems stoma patients can experience can help nurses plan care in an individualized way. Recommendations for nursing practice and future research are made.     

Paediatric stoma care nursing in the UK and Ireland

Improving quality of care and developing and maintaining high standards of care are issues that are high on the NHS, nursing, and paediatric care agendas. Stoma formation will have an impact on the wellbeing and lifestyle of the person and their family, whatever the person's age. The specialty of stoma care nursing in the UK and Ireland is well established. However, the sub-specialty of paediatric stoma care nursing is much smaller in its 'membership' and its client group. There are differences in the needs of, and the associated care of, paediatric stoma patients even within this overall patient group. Paediatric stoma care nurses are in an ideal position to increase awareness about the specialty and improve standards of nursing care for neonates, children, adolescents and their families. However, until the establishment of the Paediatric Stoma Nurse Group (PSNG) in 2005, this 'position' had not being utilized. This article discusses the ongoing work of the PSNG to devise standards of paediatric stoma care nursing, best practice guidelines, relevant patient/parental information and establish itself as a valuable, proactive and independent forum for all healthcare professionals involved in the care of children with stomas.     

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。     

Peristomal skin integrity

The primary goal of skin care for the person with a stoma is prevention of skin breakdown. The first step is careful maintenance of the skin from the time of surgery forward. The patient and family should be taught every step of protecting the skin and recognizing early signs and symptoms of potential breakdown. The loss of peristomal skin integrity affects the person's entire well-being. Pouches will not adhere as well and accidental leaks occur. The impact on psychologic well-being is difficult to measure, but can be assumed to be significant. A circular effect can begin in which the skin irritation leads to accidents, which further compromise the skin integrity. Time may be lost from work or school. Damaged skin is also painful. The cost of treating peristomal skin breakdown can be high. The products used in ostomy care are relatively expensive. A single skin barrier may range from $3 to $5. Frequent changes will be necessary to assess and treat the lesions adding to the cost. Prevention is in the realm of effective nursing care and will include assessment of the skin, selection and application of appropriate pouches and skin barriers, patient and family teaching programs, and follow-up evaluations after hospitalization.     

肠造口患儿造口周围皮肤损伤危险因素调查与预防

目的探讨肠造口患儿造口周围皮肤损伤危险因素与预防。方法选择2017年2月至2019年2月我院收治的114例肠造口患儿为研究对象,其中发生造口周围皮肤损伤40例。收集其年龄、疾病原因等病历资料,通过经单因素及多因素logistic回归分析调查肠造口患儿造口周围皮肤损伤的危险因素。结果多因素logistic回归分析显示,造口回缩、合并其他并发症、主要照顾者护理能力差、水样粪便、未按时电话随访是肠造口患儿造口周围皮肤损伤的独立危险因素(P<0.05)。结论肠造口患儿造口周围皮肤损伤发生率较高,与造口回缩、并发症、主要照顾者护理能力、粪便类型、电话随访等有关,应据此采取针对性预防措施降低造口周围皮肤损伤风险。