Improving Self-Care Outcomes in Ostomy Patients via Education and Standardized Discharge Criteria

The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers: A qualitative study

BACKGROUND

Ostomy care nurses are responsible for the management of patients with colostomy from the time of diagnosis. Currently, most ostomy care services are provided in outpatient ostomy care centers in order to reduce patients' hospital stay and reduce hospitalization-related costs. Many different factors can affect colostomy nursing care provision in these centers. Identification of these factors can facilitate quality care provision.

MATERIALS AND METHODS

This descriptive qualitative study was conducted in 2020-2021 to explore the barriers and facilitators to nursing care for patients with permanent colostomy in Tehran and Qom ostomy centers. Participants were twelve nurses with ostomy care licenses, two adult patients with permanent colostomy for at least two years, and one family caregiver of a patient with permanent colostomy purposefully selected from outpatient ostomy care centers in Iran.

RESULT

Data were collected via fifteen in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's conventional content analysis. The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers came into three main categories, namely specialized capabilities of colostomy care, care continuity, and caring status in the family.

CONCLUSION

These findings imply that not only nurses, but also patients, family caregivers, and referral systems can influence nursing care provision to permanent colostomy. Effective management of these factors can improve the quality of ostomy nursing care.

eHealth Promoting Stoma Self-care for People With an Elimination Ostomy: Focus Group Study

BACKGROUND

The construction of an elimination stoma has a physical, psychological, and social impact on the person. The development of stoma self-care competence contributes to the adaptation to a new health condition and improvement of quality of life. eHealth refers to everything associated with information and communication technology and health care, including telemedicine, mobile health, and health informatics. The use of eHealth platforms by the person with an ostomy, as a digital application that includes websites and mobile phone apps, can bring scientific knowledge and well-informed practices to individuals, families, and communities. It also allows functionalities that enable the person to describe and identify early signs and symptoms and precursors of complications and to be guided to an adequate health response for their problems.

OBJECTIVE

This study aimed to define the most relevant content and features to promote ostomy self-care integrated into an eHealth platform as a digital app or website to be used by patients for self-management of stoma care.

METHODS

We developed a descriptive, exploratory study with a qualitative approach using the focus group methodology, which was oriented to reach a consensus of at least 80%. A convenience sample of 7 participants consisting of stomatherapy nurses was used. The focus group discussion was recorded, and field notes were taken. The focus group meeting was fully transcribed, and a qualitative analysis was performed. The research question was: Which content and features for ostomy self-care promotion should be integrated into an eHealth platform as a digital app or website?

RESULTS

An eHealth platform, which can be a smartphone app or website, for people with ostomy should provide content aimed at promoting self-care, namely in the field of knowledge and self-monitoring, as well as the possibility of interacting with a stomatherapy care nurse.

CONCLUSIONS

The stomatherapy nurse has a decisive role in promoting adaptation to life with a stoma, namely through the promotion of stoma self-care. Technological evolution has emerged as a useful tool to enhance nursing interventions and promote self-care competence. The development of an eHealth platform aimed at promoting ostomy self-care should include the capabilities for telehealth and help with decision-making regarding self-monitoring and seeking differentiated care.

Effects of Socio-educational Interventions on the Quality of Life of People with a Digestive Ostomy

Introduction

The creation of digestive stomata is associated with a change in people's lives. Causing a strong impact that influences all dimensions of life. This paper reports on the effects of socio-educational interventions on the quality of life (QOL) of people with a digestive ostomy.

Objective

To describe the effect of a nursing intervention on the QOL of people with a digestive ostomy.

Methods

A quasiexperimental study was conducted whose sample consisted of 12 people who were ostomized in a public hospital in Colombia. Participants were selected through convenience sampling and randomly assigned to the intervention group and the control group. For the control group, an educational process was carried out through a theoretical session with virtual mediation (educational video). The QOL was evaluated before and after the interventions through the Montreux questionnaire.

Results

The average age was 57(+7) years. No statistical differences were found between the groups in the QOL index or for any of the dimensions that make up QOL. Pretest and post-test analysis for each intervention separately showed improvement in two dimensions of QOL for each group; in the intervention group body image dimension (p  =  .017) and the positive coping dimension (p  =  .027). In the control group, the physical well-being dimension (p  =  .037) and social concerns dimension (p  =  .034).

Conclusions

The personalized educational intervention or carried out through virtual pedagogical mediation, generated a clinically significant increase in the dimensions of QOL, without statistical differences. The study adds knowledge about the impact that digestive stomata have on the QOL, which is why it is necessary to establish specialized interdisciplinary teams to care for the person's new condition at home during the following months.

A close adherence to a stoma-therapeutic pathway improves immediate stoma-related outcomes and reduces the length of hospital stay

PURPOSE

New stoma creation is related to a wide range of implications and stoma-related complications could occur frequently. The aim was to assess the impact of a close stoma-therapeutic-care pathway (STCP) in terms of length of stay, autonomy in the management of the pouch, readmission rate, and stoma-related complications.

METHODS

Patients undergoing surgery for colorectal disease and first stoma creation from January 2017 to December 2020 were analyzed. All patients enrolled had joined the Enhanced Recovery after Surgery (ERAS) protocol.

RESULTS

Among 143 enrolled, 56 (40%) did not completely follow the STCP (group A), whereas 87 (60%) demonstrated strict compliance (group B). The hospital stay lasted 8 days in group B and 11.5 in group A (p = 0.001). The first look at the stoma needed 1 day in group B and 3 days in group A (p < 0.001), emptying the pouch 2 days in group B and 5 days in group A (p < 0.001). Finally, the ability to change the pouch was 3 days in group B and 6 days in group A (p < 0.001). Nine (16.1%) stoma-related complications were counted in group A and 16 (18.4%) in group B, and 30-day readmission was 10.1% in group B and 11.5% in group A (p = 0.82 and p = 1, respectively, not significant).

CONCLUSIONS

The STCP has been shown to reduce the hospital stay and to have a protective role making the patient autonomous in the management of the stoma.

Nursing Interventions to Promote Self-Care in a Candidate for a Bowel Elimination Ostomy: Scoping Review

Objectives: To identify nursing interventions, their characteristics, and outcomes for promoting self-care in candidates for a bowel elimination ostomy. Materials and methods: A scoping review was carried out based on the Joanna Briggs Institute’s recommendations. For this, studies published in Portuguese, English, and Spanish on the Web of Science, CINAHL, and Scopus databases and without a time limit were selected on November 9, 2020. Results: Of 2248 articles identified, 41 were included in this review. We identified 20 nursing interventions associated with the self-care of patients with an ostomy; most of them have gaps in their content, method, and frequency or dosing. More than 30 indicators were identified to assess the impact of nursing interventions; however, most of them were indirect assessments. Conclusion: There is scarce evidence regarding the different aspects that must be involved in nursing interventions for patients with a stoma. Moreover, there is no standardization in methods, frequency, or dosing of intervention. It is urgent to define the content, method, and frequency of nursing interventions necessary to promote self-care in patients with a bowel elimination ostomy and to use assessment tools that directly measure stoma self-care competence.

DIGITAL HEALTH AND SELF-CARE IN PEOPLE WITH INTESTINAL OSTOMIES: AN INTEGRATIVE REVIEW

Objective: synthesize the scientific production related to digital health in ostomies to promote self-care. Method: integrative review with research in online databases, seeking to answer the following guiding question: What are the digital approaches used to teach self-care to patients with ostomy identified in the publications? Results: six different ways of using digital health to promote self-care in people living with intestinal ostomies were identified. Five were published in the National Library of Medicine (MEDLINE) database and one published in the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Base de Dados de Enfermagem da Biblioteca Virtual em Saúde (BDENF),in the period from 2017 to 2020. Conclusion: the six approaches studied can be used simultaneously in individuals with ostomies and can be considered complementary, as they act in different aspects of the individual’s routine, with the ultimate goal being to improve the quality of life of the person with an intestinal ostomy.

SAÚDE DIGITAL E AUTOCUIDADO EM PESSOAS COM ESTOMIAS INTESTINAIS: REVISÃO INTEGRATIVA

Objetivo:sintetizar a produção científica relacionada à saúde digital em estomias para a promoção do autocuidado. Método: revisão integrativa com pesquisa em bases de dados on-line, buscando responder a seguinte questão norteadora: Quais são as abordagens digitais utilizadas para o ensino do autocuidado de pacientes com estomia identificadas nas publicações? Resultados: foram identificadas seis diferentes maneiras de empregar a saúde digital para promover o autocuidado em pessoas vivendo com estomias intestinais. Cinco foram publicadas na base de dados da National Library of Medicine (MEDLINE) e uma publicada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Base de Dados de Enfermagem da Biblioteca Virtual em Saúde (BDENF), no período de 2017 a 2020. Conclusão: as seis abordagens estudadas podem ser utilizadas simultaneamente em indivíduos com estomias e podem ser consideradas complementares, pois têm ação em diferentes aspectos da rotina do indivíduo, sendo o objetivo final a melhoria da qualidade de vida da pessoa com estomia intestinal.

Nursing interventions for the promotion of tracheostomy self-care: A scoping review

AIMS AND OBJECTIVES

To map nursing interventions, their characteristics, and outcomes, in promoting self-care of the person with a tracheostomy.

BACKGROUND

The development of competencies in self-care of a person with a tracheostomy is recognised as one of the most significant nursing intervention areas for the promotion of autonomy, prevention of complications and adaptation. Identifying nursing interventions for the promotion of self-care of the person with a tracheostomy enables enhanced clinical practice knowledge within different care contexts and the identification of gaps in the available evidence.

DESIGN

The Joanna Briggs Institute (JBI) methodology was used to perform this scoping review.

METHOD

A search was conducted on the CINAHL, Scopus, Web of Science, PubMed, JBI Database of Systematic Reviews and Implementation Reports, and Cochrane Database of Systematic Reviews. The search for grey literature included Portugal´s Open Access Scientific Repository, OpenGrey, and ProQuest Dissertations and Theses. Studies published in Portuguese, English, Spanish and French were included. The PRISMA-ScR checklist was used.

RESULTS

From a total of 4,224 identified articles, 31 were included in this review. Multiple nursing interventions were identified and grouped into four types of action: informing, managing, determining and attending. Although most interventions are implemented with the face-to-face method, there is a growing interest in using technologies for this purpose. The dose is the characteristic most poorly described in interventions. Various results were obtained; however, valid assessment tools were not always used.

CONCLUSIONS

Designing and testing intervention programmes for the promotion of self-care of the person with a tracheostomy is necessary, based on available and robust evidence to guide clinical practice.

RELEVANCE TO CLINICAL PRACTICE

This review allowed to systematise nursing interventions to promote self-care of the person with a tracheostomy. The use of combined interventions and methodologies is likely to be more effective in care delivery.