Adaptation of a stoma care pathway and use of telephone clinics during the pandemic: patient experience survey

With the arrival of the COVID-19 pandemic, outpatient clinics had to adjust and reduce the number of face-to-face appointments. The Cambridge stoma service has a recognised pathway of stoma care but needed to adjust this in line with government guidelines. The team took the opportunity to audit the current pathway and complete a patient experience survey to determine the future of the service and potential adaptations to the pathway in the future. Aim: To determine the need for adaptation and improvement of the standard stoma clinics pathway. Method: A survey was conducted using a postal questionnaire to all patients who attended stoma clinics between April and June 2020. Findings: 160 questionnaires were sent and 72 responses returned (45%). All elements of the virtual clinic were rated positive by more than 80% of respondents, with nearly 90% of them feeling that all their stoma care needs were met. When asked to indicate their preferred consultation methods (patients were allowed to choose more than one), face to face received 50 votes, telephone 32 votes and video clinic 5 votes. Conclusion: There is a need to adapt the standard clinic pathway to be able to offer standardised care but with flexibility to adjust to circumstances and patients' preferences.

Stoma product selection: a guide for community nurses

With 205 000 people in the UK with a stoma, it is likely that community nurses will need to consider which stoma products are most appropriate to use with this group of patients. This article explores the three output stomas, what stoma appliances are most commonly used for each type of stoma and why. Understanding how often stoma appliances should be changed empowers the community nurse in their decision-making process to ascertain whether changes to current care are needed. There is also information available about some of the more commonly used stoma accessories and when these may be necessary. With so many stoma-related products available, it can be difficult to know what to use and when; therefore, this article seeks to offer data to aid stoma care in the community.

Home care for children with gastrostomy

ABSTRACT Objectives: to describe home care practices performed by family members for maintaining the life of children with gastrostomy. Methods: qualitative research using the Sensitive Creative method, with the Criatividade e Sensibilidade Corpo Saber [Corpo Saber Creativity and Sensitivity] dynamics. The participation included ten family caregivers of children with gastrostomy. The outpatient clinic of a federal hospital in Rio de Janeiro was the setting. Lexical analysis was used through the IRaMuTeQ® software. Results: Theme 1, entitled “The care for maintaining life performed by family members of children with gastrostomy at home”, was analyzed, comprising three classes: “The gastrostomy tube home care routine”; “The care with the gastrostomy/stoma”; and “Food and medication home care routine of children with gastrostomy”. Final Considerations: family caregivers used strategies to maintain the device and acquired new knowledge in this field, and in nursing competence, regarding stoma care, food administration, medication, and syringes.

PENGARUH EDUKASI TERHADAP KEMAMPUAN KELUARGA DALAM PERAWATAN STOMA PADA PASIEN YANG MENGALAMI KOLOSTOMI DI RSUP. H. ADAM MALIK MEDAN TAHUN 2021

The family can be involved in the patient's stoma care, so the family is expected to be able to monitor and help the patient to achieve self-care. Stoma is a bowel hole that appears on the surface of the abdomen in the reddish mucosa form. One way to increase family knowledge is by providing education. Education is an intervention that can help patients and families to maintain stoma health with appropriate care. The purpose of this study was to determine the effect of education on the ability of families on the treatment of stomas in patients undergoing colostomy at the General Hospital H. Adam Malik Medan. This research is a quantitative analytic study with a quasi-experimental research design by the pre and post test treatment groups. The population in this study were 71 people. A sample of 42 respondents representing the families of patients who had a colostomy at the General Hospital H. Adam Malik Medan. In this study, the analysis used is the Willcoxon Signed Rank Test, with p value <0.05. The average value of ability of the family before being educated was 2.00 and a range of 2 to 3. This shows that the ability of familieswas less in caring for stoma while the ability after being educated was of 3.00 and a range of 3 to 3. Its means that the family was able to perform stoma care for his family who had a colostomy. From the differences in the median value and probability was p <0.05. It can be concluded that education has an effect on increasing the ability of families in stoma care in patients undergoing colostomy.

Effect of a Mobile Patient Education Application on Adjustment to Stoma and Development of Peristomal Skin Lesions: A Quasi-Experimental Study

BACKGROUND: Patients with a stoma face difficulties in everyday life. A mobile application (app) may assist them in managing their stoma and adjusting to change. PURPOSE: This study developed a mobile app for patients with a stoma and evaluated its effectiveness in improving psychosocial adjustment, self-care, and prevention of peristomal skin lesions. METHODS: The research utilized a quasi-experimental design and was conducted using a posttest control group. The study consisted of 60 patients who had undergone surgery in 3 university hospitals in Istanbul, Turkey, from November 2018 through December 2019. The experimental group (n = 30) used the STOMA-M mobile app, and the control group (n = 30) used an educational booklet that contained images and text that correlated to the content found in the app. Data collection was carried out using an individual characteristics assessment form, Ostomy Adjustment Inventory (OAI-23), Peristomal Skin Lesions Assessment and Classification Instrument, and a stoma care training evaluation form in the first and third months after discharge. Data were analyzed using IBM SPSS Statistics 22.0 software. RESULTS: Sociodemographic characteristics of individuals in the experimental and control groups were similar; 70% (n = 42) required stoma placement because of cancer treatment. More than half of the participants (53.3%; n = 32) had an ileostomy, and 78.3% (n = 47) had a temporary, open stoma. The experimental group’s OAI-23 score, social engagement subscale score, stoma care status, and satisfaction with education e high. The OAI-23 scores in the control group were not significant, and their anger subscale score and the score of item 16, Caring for my stoma is difficult, decreased in the third month compared with baseline. Peristomal skin lesions did not develop in the control group at the third month of follow-up. CONCLUSION: The levels of adjustment to stoma, ability to care for the stoma themselves, and satisfaction with education received were higher in individuals using the mobile app compared with those using the printed booklet. However, the app was not effective in preventing peristomal skin lesions. Additional studies are needed to determine what features of a mobile app may be useful for preventing such lesions.

Implementation of a patient progress diary for stoma patients living with dementia

With an ageing population and an increase in the prevalence of dementia, stoma care nurses (SCNs) are experiencing greater challenges in their role supporting this group of patients with their stoma care. Following concerns raised in our department by relatives about the care and teaching provided in this area, with patients occasionally denying having even seen an SCN, the need for a visual tool to enable timely interventions and increase knowledge for family, carers and ward staff became apparent. There is a comprehensive list of local and national guidelines underlining the need to provide more support and an increased comprehensive teaching plan specially tailored to dementia patients’ needs. The development of a patient progress diary, with a traffic light system showing each stage that the patient has reached, has provided a visual, up-to-date guide to the patient’s stoma management and highlights the need for further input to enable the patient to be discharged home safely and in a timely manner. The diary was formulated by the SCNs and printed by Coloplast, culminating in an easy-to-read booklet with a pictorial step-by-step guide to be inserted into patients’ washbags. The diary was reviewed by Great Western Hospitals Patient Advice and Liaison Service (PALS) and the Carers Committee, who provided positive feedback and subsequently supported the development of this patient-focused tool. Since introducing the diary, our team has decided to implement it with all patients, with positive feedback from patients, relatives, carers and ward staff. This has assisted in safe, timely and effective discharge planning.

Implementing digital technology during the pandemic: impact on stoma nursing services at a tertiary referral centre

The COVID-19 pandemic has been one of the greatest challenges to the NHS, creating turmoil in the public health workforce and for all of those who use its services. Its immediate impact was a rapid change in how care in the NHS is planned, delivered and accessed, with no concession for stoma care services. Investment in global resources detailing COVID-19 recovery plans and the steady increase in national data related to the transmission and treatment of the virus has allowed stoma care nurses to better understand the long-term effects of the pandemic and mitigate future risk to specialist nursing services. This article describes how this crisis has provided an opportunity to radically change systems and processes in stoma care through the use of digital technology to continue interaction with patients, communicate with the multidisciplinary team and collaborate with relatives or carers, and as a platform to enhance personal development, training and education.

Perception of leakage: data from the Ostomy Life Study 2019

Background: Leakage is a common problem for people with a stoma. Aim: To investigate how people with a stoma and stoma care nurses perceive different patterns of effluent under the baseplate. Methods: The Ostomy Life Study 2019 included a user survey and a nurse survey covering experiences of leakage and the perception of leakage. Findings: Most people with a stoma perceived effluent reaching outside the baseplate as leakage (88–90%), whereas effluent close to the stoma only was not perceived as leakage by the majority (81–91%). Effluent covering major parts of the baseplate was perceived as leakage by most respondents with a colostomy or ileostomy (83%), whereas fewer respondents with a urostomy perceived this as leakage (57%). Most of the nurses (70%) did not perceive effluent close to the stoma as leakage. Conclusion: This study revealed that effluent confined to the area next to the stoma is generally not perceived as leakage.

Investigating the demands for mobile internet-based home nursing services for the elderly

The great value of home nursing services in the treatment of ailments in elderly patients has attracted increasing attention. This study describes a new mobile internet-based home nursing service system and investigates the reasons for its use among elderly patients. 520 cases of mobile internet-based home nursing services were investigated. The proportion of major reasons to use mobile internet-based home nursing services among the elderly was analyzed and the satisfaction rate was investigated. The constituent ratios of nursing care for pressure ulcers, peripherally inserted central catheter (PICC), subcutaneous injection, general stoma care, psychological care, and intramuscular injection were 61.35%, 28.85%, 6.15%, 1.92%, 1.35%, and 0.38%, respectively. The satisfaction rate with mobile internet-based home nursing services among elderly patients was 100%. Considering the demand for home nursing services for elderly patients, this is the first time that a new mobile internet-based home nursing service has been applied to provide home nursing services to elderly patients and meet their home nursing service needs. Treatment for pressure ulcers, PICC, subcutaneous injection, general stoma care, psychological care, and intramuscular injection were found to be the main reasons to use mobile internet-based home nursing services among the elderly. The new mobile internet-based home nursing service system provides convenient home nursing services to elderly patients and ensures that they get equal rights in home nursing. The results provide basis for healthcare policy makers to formulate new home nursing policies for elderly patients.

Journal scan

A brief overview of recently published articles on gastroenterology, hepatology and stoma care