A review of the outcome of stoma surgery on spinal cord injured patients

A study was conducted to determine the short-term and long-term outcome of stoma formation on spinal cord injured (SCI) patients. Twenty-seven medical records of SCI patients with colostomy, ileostomy or urostomy were reviewed. Eighteen SCI patients were then interviewed or completed a comprehensive questionnaire to determine the physical and psychological effects of the surgery and to assess changes in lifestyle due to the formation of the stoma. It was found that bowel and bladder management was greatly improved in most cases, resulting in improved quality of life for these patients. Other positive psychological effects were noted and the question of a colostomy being offered earlier in the rehabilitation of the SCI patient was raised.     

Do people with an ileostomy have a different back pain experience to those with a colostomy? A postal survey in Northern Ireland

Background.?The abdominal muscles play a vital role in lumbar stability. The stoma surgery creates a permanent flaw in the abdominal wall and this may increase the risk of low back pain for people with a stoma.

Purpose.?To determine whether there was a difference in back pain experience between the two stoma groups: ileostomy and colostomy.

Method.?A postal questionnaire sent to people in Northern Ireland with an ileostomy or colostomy.

Results.?Over half (56.7%, n?=?417) had back pain in the last 6 months and the primary perceived cause was the stoma surgery. There was a statistically significant deterioration in functional activities in those with back pain when ‘today’ was compared with ‘before surgery’. Those with a colostomy had generally poorer outcomes in respect of pain and disability, than those with an ileostomy.

Conclusion.?Low back pain in people with a stoma is a real and complex issue, especially as there are significant differences between those with an ileostomy when compared with people with a colostomy. Many factors are likely to contribute to a person developing low back pain, not least, the underlying reason for the surgery and the surgical procedure itself.     

以信息化为基础的延续护理在临时性回肠造口病人中的应用评价

[目的]探讨基于信息化为基础的延续护理对临时性回肠造口病人的影响,为医护人员实施护理干预措施提供参考。[方法]选取在福建省肿瘤医院行低位直肠癌根治性手术的120例病人,病人均行临时性回肠造口术,术后3~6个月行造口还纳术。运用随机数字表法将120例病人分为对照组和观察组各60例。对照组采用常规护理,观察组在常规护理的基础上给予延续护理。比较两组的生活质量、癌因性疲乏、造口术后并发症、自我效能及满意度。[结果]所有临时性造口病人出院时生活质量及自我效能均较差。二次手术前观察组病人生活质量和自我效能高于对照组(P<0.05),观察组病人癌因性疲乏评分低于对照组,造口并发症例数少于对照组(P<0.05),满意度评分高于对照组(P<0.05)。[结论]信息化为基础的延续护理可促进临时性回肠造口病人康复,提高生活质量、自我效能,减少造口并发症,提高病人的满意度。     

预防性肠造口术后患者自我管理能力及影响因素分析

目的调查预防性肠造口患者自我管理能力的现状,探讨影响因素。方法采用问卷调查方法对100例预防性肠造口患者进行问卷调查,内容包括患者的一般人口学资料、造口相关资料、自我管理水平。结果预防性肠造口患者的自我管理总分为(90.87±12.68)分,处于中等水平。年龄段、文化程度、造口术前定位、接受程度是影响预防性肠造口患者自我管理能力的主要影响因素(P<0.05)。结论预防性肠造口患者自我管理能力有待加强。医务人员应采取个性化的干预措施,提高患者对疾病的自我管理能力。     

Providing dietary advice for the individual with a stoma

Concerns over diet and nutrition are common among ostomists and their carers. It is important for healthcare professionals involved in the care of patients with a colostomy, ileostomy or urostomy to appreciate that stoma surgery changes the body's usual processes of nutritional absorption and excretion, so that informed support and advice on diet can be provided. A considerable proportion of patients admitted to hospital in the United Kingdom are malnourished, or at risk of becoming so. Patients undergoing gastrointestinal surgery resulting in stoma formation are at particular risk as a result of the potential for preoperative malnutrition caused by the effects of their underlying disease and prolonged periods of fasting during the immediate pre- and postoperative period. Screening and monitoring of the nutritional status of individuals with a stoma should be an ongoing process, beginning preoperatively and continuing after discharge from hospital. This article will examine the effects of stoma formation on diet and consider ostomists' potential for altered absorption of nutrients. Current issues relating to patient nutrition in the hospital setting, their relevance for stoma patients and the role of the nurse in the provision of nutritional care will also be discussed.     

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.     

Exploring the conditions leading to stoma-forming surgery

The most common disease leading to the formation of a stoma is cancer. However, there are many other diseases that affect the gastrointestinal or urinary system that may also require either a temporary or permanent stoma to be formed (a colostomy, ileostomy or urostomy). Stoma-forming surgery may be undertaken for a number of reasons, such as to eradicate a disease or improve the patient's quality of life. Cancer, inflammatory bowel disease and diverticular disease are the most common conditions that lead to stoma formation. However, faecal incontinence, familial adenomatous polyposis, Hirschsprung's disease, spina bifida and Ehlers-Danlos syndrome may also require a stoma to be formed. The nurse's role in caring for these patients at a potentially traumatic period of their life is discussed.     

结肠癌造口患者自我管理能力的现状及影响因素分析

目的:了解结肠癌造口患者自我管理能力的临床现状,并分析其影响因素。方法:选择2018年1至12月在广东省中医院治疗的191例结肠癌造口患者,应用一般情况调查表、社会支持量表(Social Support Rating Scale,SSRS)、肠造口患者自我管理问卷进行调查,数据采用SPSS22.0软件进行统计分析。结果:结肠癌造口患者的自我管理得分为(98.34±10.66)分,得分相对较低,症状管理、信息管理和心理护理的得分率均低于60%。回归分析结果显示:年龄、社会支持情况、文化程度、是否独居、造口护理情况、造口时间和住院次数均为自我管理得分的影响因素,共可解释69.5%的方差变异量。结论:结肠癌造口患者的自我管理能力相对不足,临床医护人员应加强评估并制订有针对性的健康教育策略,以提升其疾病自我管理能力,改善临床预后。     

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.     

Best practice in discharging patients with a stoma

Pre-operative preparation and postoperative education are both essential elements for the recovery and successful discharge into the community of patients with a stoma. The ultimate goal of any stoma care nurse is to provide patients with the necessary practical skills and knowledge to return to a lifestyle they enjoyed before surgery (Abrahams, 1984). The basic pre- and postoperative planning that is required for patients who have had bowel surgery under elective conditions with a confirmed colorectal pathology, for example, rectal cancer or inflammatory bowel disease, is described below. Stomas include colostomy, ileostomy, jejunostomy and urostomy. They can either be end stomas (one segment of bowel is exteriorised), or loop stomas (two segments of bowel are exteriorised), and they may be permanent or temporary.     

结肠造口患者造口自我护理能力和希望水平的相关性研究

目的探讨结肠造口患者的造口自我护理能力和希望水平及其相关性。方法采用一般情况调查表、造口自我护理量表-普通版、Herth希望量表对102例结肠造口患者进行调查。结果造口患者的自我护理能力总分为(38.77±5.85)分;希望总分(38.98±4.85)分,均处于高水平。希望总分、身体形象改变、家庭人均月收入和自我接受造口与结肠造口患者的造口自我护理能力密切相关(P0.01或P0.05)。结论护士应注意给造口患者以希望和力量,促使患者接受造口和身体形象的改变,以提高其造口自我护理能力。     

临时性回肠造口患者自我护理水平现况及其影响因素分析

目的：调查临时性回肠造口患者造口自我护理水平现况并分析其影响因素，为临床制订针对性护理措施提供参考。方法：采用方便抽样方法，应用一般资料问卷、造口患者自我护理量表对177例临时性回肠造口患者进行调查，采用多元线性回归分析造口患者自我护理水平的影响因素。结果：临时性回肠造口患者造口自我护理能力得分（36.10 ±10.54）分，回归分析结果显示：生活自理能力、婚姻状况、家庭人均月收入、年龄是临时性回肠造口患者自我护理水平的影响因素。结论：临时性回肠造口患者自我护理水平有待提高，护理人员应关注非在婚、生活自理能力低下、家庭人均收入低及高龄的临时性回肠造口患者，并给予相应的措施，改善造口患者自我护理水平。     

结肠造口患者出院早期造口护理情况的调查

目的调查结肠造口患者出院早期造口护理情况。方法方便性抽样选取2008年12月至2009年10月广州市7所三级甲等医院胃肠外科103例结肠造口术后出院患者,分别在其出院后1个月和3个月采用自行设计的造口护理情况表和造口自我护理量表-早期版(stoma self-care scale,early stage version,SSCS-early stage version)进行测试。结果出院后1个月和3个月造口患者的自我护理总分及各条目、造口自理状态、平均每天护理造口的时间以及独立更换造口袋的人数比较,差异均有统计学意义(均P<0.01);但造口不适情况比较,两个时间段差异无统计学意义(P>0.05)。结论造口护士应根据患者的具体情况给予有针对性的指导,以提高患者造口自我护理能力,减少造口不适的发生,促使患者早日回归社会。     

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.     

直肠癌结肠造口术后院外健康教育对病人生活质量影响的研究

[目的 ]探讨院外健康教育对直肠癌结肠造口术后病人生活质量的影响。 [方法 ]将 60例直肠癌结肠造口术病人随机分为实验组和对照组 ,实验组 3 0例从术后 1个月起针对生活质量问题进行院外健康教育 ,而对照组 3 0例未采取院外护理干预。均于术后 1个月和 6个月进行问卷调查收集资料 ,并进行统计学处理。 [结果 ]实验组术后半年生活质量明显高于对照组 ,造口自理能力差、悲观与抑郁、影响日常生活、社会活动能力下降指标两组比较均具有统计学意义。 [结论 ]术后早期有计划地进行院外健康教育 ,可提高病人生活质量。     

Factors associated with the feeling of stability in the daily life among colostomy patients

Aim: Colostomy patients must lead a stable life after discharge. However, little is known about the feeling of stability in the daily life of these patients. The purpose of the present study was to identify the associated factors. Methods: The subjects were outpatients who met all of the following criteria: (i) a permanent colostomy for the treatment of colonic, rectal, or anal cancer; (ii) under 80 years of age; (iii) a colostomy history of less than 10 years; and (iv) no significant prior physical or psychiatric disorders. Data were collected by conducting interviews using a questionnaire, examining medical records, and asking the nurses responsible for patients’ care. The following measures were evaluated: patients’ feeling of stability in the daily life, patients’ characteristics, physical condition, support resources, self‐evaluation of their current life, and hospital characteristics. Statistical analysis was performed using t‐tests, Spearman's rank correlation coefficients, and structural equation model. Results: Data from 133 patients were available for analysis. The final model fitted the data well. All estimated parameters were significant. The opportunity to attend periodic stoma clinics and support from nurses contributed to the feeling of stability in the daily life and had a positive effect on patients’ self‐evaluation of their current life. Conclusions: The results of this study corroborated the necessity for an outpatient support system to enhance the feeling of stability in the daily life after hospital discharge. This finding supports the need to improve stoma care systems and to make such systems more available.     

结肠癌造口患者心理健康水平的现状及其影响因素

目的了解结肠癌造口患者心理健康水平的现状并分析其影响因素,为制订提升肠造口患者的心理健康水平和生活质量的干预措施提供理论依据。方法采用方便抽样法,选择2015年10月至2016年10月在上海市、浙江省及江苏省5所三级甲等医院造口门诊就诊的409例肠造口患者为研究对象,采用一般资料调查表、中文版造口患者心理健康量表(psychological well-being scale,Chinese version)、肖水源的社会支持评定量表(social support revalued scale,SSRS)及综合医院焦虑抑郁表(hospital anxiety depression scale,HADS)对其进行调查。结果结肠癌造口患者心理健康水平得分为(61.29±20.10)分,多因素分析结果显示,抑郁、焦虑和自理程度、婚姻状态及每月用于造口产品的费用是结肠癌造口患者心理健康水平的影响因素,可解释总变异量的34.6%。结论肠癌造口患者的心理健康处于中等水平,医护人员及社会工作者应采取针对性措施,提高患者的自我照护能力,减轻其焦虑、抑郁水平。     

Study of peristomal skin disorders in patients with permanent stomas

The aim of this article was to investigate the frequency, severity and diversity of peristomal skin disorders among individuals with a permanent stoma in a community population. All individuals with a permanent stoma (n=630) in a Danish community population were invited to participate in a cross-sectional study. A total of 202 individuals (101 men; 101 women) agreed to participate. Data were collected through questionnaires and clinical examinations. It was found that peristomal skin disorders were higher for participants with an ileostomy (57%) and urostomy (48%) than in those with a colostomy (35%). Of the diagnoses of skin disorders, 77% could be related to contact with stoma effluent. Only 38% of diagnosed participants agreed that they had a skin disorder and more than 80% did not seek professional health care. The study revealed a high frequency of peristomal skin disorders. Participants frequently failed to perceive that they had a skin irritation and did not seek help. This suggests that more education and perhaps regular, annual follow-up visits at local stoma care clinics are needed.     

上海市肠造口患者自我效能现状的调查

目的了解上海市肠造口患者自我效能的现状。方法2011年12月至2012年11月,方便性抽样选择上海市某三级甲等医院、上海造口协会、造口阳光之家的153例肠造口患者采用患者一般资料问卷、造口患者自我效能量表对其进行调查。结果本组患者的自我效能得分为（66．07±20．34）分,处于中等水平。不同造口时间、是否存在并发症、每月用于造口的费用、婚姻状况、教育程度、年龄、有无宗教信仰、是否有其他疾病、造口类型、职业状态等的造口患者自我效能得分差异均无统计学意义（均P〉0．05）;不同性别及自理程度造口患者的自我效能得分差异有统计学意义（均P〈0．05）。结论应重点关注女性、自理程度低的肠造口患者的自我效能,并给予针对性干预,以提高患者生活质量。