Clinical guidelines and care protocols.

Clinical guidelines and care protocols are intended to provide information, based on an appraisal of the current best evidence of clinical and cost-effectiveness, regarding therapeutic interventions for given conditions.With the establishment of the National Collaborating Centre for Nursing as a part of National Institute for Clinical Excellence (NICE), it is anticipated that an increasing number of clinical guidelines that focus on aspects of nursing care will be developed at a national level. The Department of Health also aims to introduce nationally agreed multidisciplinary care protocols which will dictate how certain conditions are to be managed.These developments have the potential to enhance healthcare provision and nursing practice. However, they also introduce potential dilemmas for nurses. This paper discusses some of the issues involved in the development and implementation of clinical guidelines and care protocols in intensive care nursing.     

An independent stoma care service.

This article describes the establishment of an independent stoma care service, and the problems the author encountered. Set up just over four years ago, it is one of the few independent stoma care services in the UK. It currently caters exclusively for patients in private hospitals in London and the South-East of England, and the author also holds a clinic in Harley Street. Over 300 patients benefit from the service.     

Sexuality following stoma formation. 2: Nursing care

This is the second of a two-part unit on issues surrounding sexuality following stoma formation. Part 1 outlined background, and the need to provide holistic patient care that incorporates both the physical and psychosocial issues surrounding stoma formation. This part outlines practical advice and support that nurses can provide for patients.     

Practical stoma care

Patricia Black looks at the reasons behind and management of different types of stoma as well as outlining some of the possible problems associated with stomas. She emphasises the importance of caring for a stoma patient's psychological as well as physical wellbeing.     

Adjustment to colostomy: stoma acceptance, stoma care self-efficacy and interpersonal relationships

AIM: This paper is a report of a study to examine adjustment and its relationship with stoma acceptance and social interaction, and the link between stoma care self-efficacy and adjustment in the presence of acceptance and social interactions. BACKGROUND: There have been significant advances in stoma appliances and an increase in nurses specialising in stoma care. Despite this, a large proportion of patients continue to experience adjustment problems, which suggests that improvements in the management of the stoma are by themselves not enough to enhance psychosocial functioning. Illness acceptance and interpersonal relationships are widely reported as correlates of adjustment to chronic illness, but these have not been specifically examined in patients with a colostomy. Evidence of their association could offer stoma therapists alternative ways of aiding adjustment. METHOD: Between 2000 and 2002, 51 patients with colostomies provided demographic and clinical data and completed validated questionnaires to measure acceptance of the stoma, relationship with others and stoma care self-efficacy 6 months after surgery. FINDINGS: Multiple regression analysis showed that stoma care self-efficacy, stoma acceptance, interpersonal relationship and location of the stoma were strongly associated with adjustment. The model explained 77% of the variance. Stoma-care self-efficacy accounted for 57.5%, the psychosocial variables 13% and location of the stoma 4.6%. The addition of gender, which was not statistically significant (P > 0.05), explained a further 1.9% of the variance. CONCLUSION: Addressing psychosocial concerns should become part of the care routinely given to stoma patients. We recommend more emphasis on dispelling negative thoughts and encouraging social interactions.