Effects of Evidence-Based Continuing Care Bundle on Health Outcomes in Rectal Cancer Patients With Temporary Stomas: A Multicenter Randomized Controlled Trial

Nursing interventions for the self-efficacy of ostomy patients: A systematic review

BACKGROUND

Self-efficacy interventions, which include the acquisition of skills that enable patients to manage their health on a daily basis, play a key role in ostomy patients, which leads to significant changes in the quality of life of patients. In this context, nursing interventions to increase self-efficacy of ostomy patients are very important. In this context, nursing interventions are crucial to increase the self-efficacy of ostomy patients.

OBJECTIVES

The aim of this systematic review is to describe nursing interventions for ostomy patients' self-efficacy (primary outcome) and the impact of these interventions on patient outcomes (complications, quality of life, satisfaction, psychological resilience, stoma adaptation) (secondary outcomes).

METHOD

As a systematic review, this study included articles published in PUBMED, Web of Science, Science-Direct, TUBITAK-ULAKBIM, and TRDizin databases between January 2013 and January 2023 that included nursing interventions for self-efficacy ostomy patients. This systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The risk of bias was assessed using the RoB2 tool developed by Cochrane.

RESULTS

A total of 1211 articles were retrieved from the databases using Turkish and English keywords. Fifteen studies met the study criteria. These studies found that various interventions, such as training, telephone follow-up, psychosocial support groups, or mobile applications provided to intervention groups, increased self-efficacy, decreased stoma-related complications, improved stoma adaptation, and improved quality of life by increasing patients' knowledge and awareness of stoma.

CONCLUSION

Nursing interventions to improve the self-efficacy and adaptation of ostomy patients are critical. This improvement leads to a reduction in adverse patient outcomes and ostomy complications, shorter hospital stays, and increased patient and nurse satisfaction.

Effect of continuous nursing on wound infection and quality of life in patients with cancer-related stoma: A meta-analysis

A meta-analysis was conducted to comprehensively assess the effect of continuous nursing on wound infection and quality of life in patients with cancer-related stomas, providing an evidence-based rationale for the care of these patients. A computerised search of PubMed, Web of Science, Ovid, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data for randomised controlled trials (RCTs) on the effect of continuous nursing on wound infection and quality of life in patients with cancer-related stoma was conducted from the time the database was created to March 2023. The retrieved literature was screened, data were extracted, and the quality of the literature was evaluated according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Seventeen RCTs involving 1437 patients were included. Of the 1437 patients, 728 were in the continuous nursing group and 709 were in the control group. The results showed that continuous nursing significantly reduced the rate of wound infection in patients with cancer-related stomas (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.16-0.53, p < 0.001) and improved their quality of life (standardised mean difference: 1.90. 95% CI: 1.32-2.47, p < 0.001). Available evidence suggests that continuous nursing for patients with cancer-related stomas can significantly reduce wound infections and improve their quality of life.

Analysis of the Effectiveness of the Nurse-Led "Outpatient-Ward-Home" Management Model in Chronic Kidney Patients

Objective

To investigate the application and effect of the nurse-led "outpatient-ward-home" management model in the care of patients with chronic kidney disease (CKD).

Methods

120 patients with CKD admitted to our hospital between April 2020 and April 2021 were selected as trial subjects. All patients were divided into experimental and control groups according to the random number table method, with 60 cases in each group. The patients in the experimental group implemented the nurse-led "outpatient-ward-home" management model; the patients in the control group were given routine care and telephone follow-up. The self-rating anxiety scale (SAS), self-rating depression scale (SDS), Pittsburgh Sleep Quality Index (PSQI) score, self-management scores, nutritional status, renal function indicators, and chronic renal failure quality of life scale (QLICD-CRF2.0) were compared between the two groups before and 6 months after the intervention.

Results

Before the intervention, there were no statistically significant differences between the control and experimental groups in SAS, SDS, PSQI scores, self-management scores, QLICD-CRF2.0 scores, body mass index (BMI), prealbumin (PAb), albumin (ALB), serum creatinine (Scr), blood urea nitrogen (BUN), and glomerular filtration rate (GFR) levels (P > 0.05). After 6 months of intervention, SAS, SDS, PSQI scores, Scr, BUN, and GFR levels were lower in the experimental group than in the control group; self-management scores, QLICD-CRF2.0 scores, BMI, PAb, and ALB levels were higher in the experimental group than in the control group (P < 0.05).

Conclusion

The nurse-led "outpatient-ward-family" intervention model can improve the negative emotions and sleep disorders of CKD patients, enhance patients' self-management ability, and to a certain extent, slow down the disease process and improve the quality of life.

The comparison between experimental nursing and routine nursing interventions on the quality of life of stoma patients: A systematic review and meta-analysis

The advance in nursing care for stoma patients is a challenging issue, which will influence the life quality. The quality of life is a major issue in the recovery of stoma patients. The evidence of experimental nursing has not been explored enough. A systematic search and a meta-analysis were performed for the studies of experimental nursing interventions versus routine warming interventions on patients with a stoma. The comparisons between nursing interventions were performed to find which kind of intervention will be superior in improving life quality. After a restricted selection, 10 studies, 460 subjects with experimental nursing intervention, and 478 controls with the routine nursing intervention were enrolled in a variety of causes of the stoma. The focused outcome was the quality of life. The meta-analysis was performed by Review Manager 5.4. Among the stoma patients, the meta-analysis favours the experimental nursing intervention group with higher scores of life quality when compared to the routine nursing intervention group. The meta-analysis results were with positive mean differences, significant tests for overall effect, and significant heterogeneities in the random-effects model. The experimental nursing intervention showed higher positive effects on the quality of life when compared to routine nursing intervention for stoma patients. Experimental nursing intervention might be an option for stoma nursing practitioners to improve stoma care.

Continuing Care Bundle in Elderly Patients with Rectal Cancer after Radical Resection with Permanent Stoma

Objective. A continuing care bundle can achieve a better outcome than a single implementation after discharge. This study aims to investigate the effect of this intervention in elderly patients with rectal cancer after radical resection with a permanent stoma. Methods. Elderly patients diagnosed with rectal cancer underwent radical resection with permanent stoma, they were divided into the control group (n = 42) and bundle group (n = 42). The control group received the conventional care, and the bundle group received the continuing care bundle in addition to the conventional care. At 1- and 3-month after discharge, self-efficacy, self-care knowledge, ability to change stoma appliances, negative emotions, quality of life, and patient satisfaction were observed. Results. The increased levels of self-efficacy, self-care knowledge, and ability to change stoma appliances were displayed in the bundle group after discharge as compared with that in the control group, along with the enhanced score of SF-36 subscales, including physical function (PF), role physical (RP), global health (GH) and vitality (V), social function (SF), and mental health (MH). Furthermore, patients showed alleviated depression and anxiety after the continuing care bundle as compared to those after conventional care. Besides, the bundle groups had higher patient satisfaction than the control group. Conclusions. Continuing care bundle can serve as an effectiveness intervention in elderly rectal cancer patients after radical resection with permanent stoma via increasing self-efficacy and self-care knowledge, enhancing the ability to change stoma appliance, reliving the negative emotion, and improving quality of life and patient satisfaction.

Internet+Continuous Nursing Mode in Home Nursing of Patients with T-Tube after Hepatolithiasis Surgery

This study was to explore the effect of a continuous nursing model based on the mobile Internet in the home nursing of patients with T-tube after hepatolithiasis surgery. A continuous nursing system based on the mobile Internet was constructed, and 94 discharged patients with T-tube after biliary tract surgery were selected as the study subjects. The differences of complication rate, referral rate, nursing satisfaction, self-care ability, and quality of life score through the 36-item short form health survey (SF-36) after routine health education nursing (control group, n = 47) and continuous nursing mode based on the Internet (observation group, n = 47) were explored. The results showed that the success rate of the continuous nursing system based on mobile Internet in processing user requests was 96.2%. After nursing, the total complication rates of the control group and the observation group were 34.0% and 6.4%, the total satisfaction rates were 42.6% and 87.2%, and the referral rates were 23.4% and 6.4%, respectively, and the difference was statistically significant (P < 0.05). After nursing, the scores of self-care ability and SF-36 quality of life in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05). In summary, the continuous nursing platform based on mobile Internet technology can meet the needs of users, and the nursing mode can significantly improve the home self-care ability of discharged patients with T-tube after surgery and improve the nursing effect, which is conducive to the rehabilitation of patients.

Effects of continuous care on health outcomes in patients with stoma: A systematic review and meta-analysis

Objective

Continuing care, which is an extension of post-discharge care, is recognized as a crucial element of high-quality health services and is essential to patients. This systematic review aims to identify the effectiveness of continuing care for patients with stomas.

Methods

PubMed, EMBASE, Cochrane Trial Register and Web of Science databases were searched. Study selection and quality appraisal were performed independently by two reviewers. We calculated the mean differences (MD) or the relative risk (RR) with 95% confidence intervals and assessed heterogeneity.

Results

Nine studies (1134 participants) met the inclusion criteria. This meta-analysis revealed that, in the continuous care group, the stoma self-efficacy (MD ​= ​6.46; 95% CI ​= ​3.81–9.11; P ​< ​0.001; I² ​= ​0%), and the quality of life (MD ​= ​7.48; 95% CI ​= ​5.13–9.82; P ​< ​0.001; I² ​= ​0%) increased significantly 1 month after discharge; stoma adjustment and care satisfaction also showed a trend toward improvement while stoma complications (RR ​= ​0.71; 95% CI ​= ​0.58–0.87; P ​= ​0.001; I² ​= ​25%) decreased significantly. Continuing care did not decrease hospital readmission rates or medical costs.

Conclusions

Continuing care showed beneficial effects in improving health outcomes and care satisfaction for patients with stomas compared with routine care. We proposed an integrated continuing care program with different elements and recommendations for its implementation.

A systematic review and meta-analysis of the effectiveness of self-management interventions in people with a stoma

AIMS

Explore the evidence from randomized controlled trials for the effect of self-management interventions on quality of life, self-management skills and self-efficacy, and to explore which intervention characteristics are associated with effectiveness.

DESIGN

Systematic review.

DATA SOURCES

A search of the literature was conducted in these databases: MEDLINE (OVID), EMBASE (OVID) and PsychINFO (OVID) from January 2000 to February 2020.

REVIEW METHODS

Studies were included if participants had a bowel stoma, were over the age of 18 and the design was a randomized controlled trial of a self-management programme. The outcome measures for this review were quality of life, self-management skills and self-efficacy. The Behaviour Change Technique Taxonomy was used to code interventions for underlying components and alongside other intervention characteristics, associations with improvements in outcomes were explored.

RESULTS

The search identified 3141 articles, 16 of which were eligible. A meta-analysis of self-efficacy scores from five studies (N = 536) found an improvement in those that received the self-management intervention at follow-up with a 12-point mean difference compared with the usual care group. Effects on quality of life and self-management skills were mixed, and meta-analyses of these data were not possible. Across 13 studies an average of 10 behaviour change techniques were used with, credible source (e.g. nurse, doctor, therapist) (n = 13), instruction on how to perform the behaviour (n = 13), demonstration of the behaviour (n = 12) used most often. The behaviour change technique of self-monitoring was associated with an improvement in quality of life. The involvement of a nurse was associated with higher self-efficacy and self-management skills.

CONCLUSION

This review suggests that self-management interventions can increase peoples' self-efficacy for managing their stoma.

IMPACT

A standardized approach to the reporting of interventions and the measures used is needed in future studies to better understand the effect on quality of life and self-management skills.