The nursing care of a patient with enterocutaneous faecal fistulae

Experience of living with an enterocutaneous fistula

AIMS AND OBJECTIVES

The purpose of this study was to describe patients' experiences of living with an enterocutaneous fistula.

BACKGROUND

An enterocutaneous fistula is a complex and serious illness that usually occurs as a complication from surgery or spontaneously as a result of an underlying disease. The illness is demanding both physically and mentally and causes substantial medical and nursing problems for the afflicted individual.

DESIGN

A descriptive design with a qualitative approach.

METHODS

In-depth interviews were performed with nine participants who had experiences of living with an enterocutaneous fistula. The analysis was conducted using descriptive phenomenology according to Giorgi.

RESULTS

The essence of this study was that living with an enterocutaneous fistula is about handling an illness that causes several limitations in daily life and the following five themes emerged from the data: restrictions in daily life, approaches to illness, emotions, dependence and need of support. A constant fear of leakage from the fistula appliance, being dependent on intravenous fluids and being dependent on health care professionals caused isolation and social restriction.

CONCLUSIONS

The participants had many strategies for handling their illness. By being well trained, engaged and having a positive and understanding approach, health care professionals can encourage hope, motivation and self-care. This can lead to decreased dependence and help the patient to better handle their illness.

RELEVANCE TO CLINICAL PRACTICE

The competence of health care professionals is essential in the care of patients with an enterocutaneous fistula.

High-output fistula

Despite improvements in healthcare delivery, mortality rates for high-output fistulae remain unchanged. The pathophysiology and causes of fistulae are reviewed in this article. An overview of the diagnostic procedures to delineate fistulae and underlying bowel disease together with their complications is included. Management of high-output fistulae consists of assessment and stabilization of patients, followed by conservative management by a multidisciplinary team until spontaneous or surgical closure of fistulae.

A cost-effectiveness analysis of fistula treatment in the abdominal region using a new integrated fistula and wound management system

OBJECTIVE

To evaluate wear time and costs of a new fistula and wound management system (FWMS) compared to standard fistula treatments.

METHODS

Data were collected from 22 patients with an abdominal fistula recruited from 5 sites in the United States. This economic evaluation was based on a cost-effectiveness analysis with wear time, material costs, and labor costs taken into account.

RESULTS

A longer wear time for each pouch as well as simpler handling by nurses amounted to an average lower cost of $83 per day of treatment with the FWMS. A large variation was observed in the collected data. However, the sensitivity analysis showed that 77% of patients achieved a cost reduction when changing to the FWMS.

CONCLUSION

The FWMS was less costly than traditional methods for managing abdominal fistula, probably due to longer wear time and less time spent on each pouching session.

Stoma complications encountered in the community, A-Z

There can be a variety of long-term stoma-related complications that may be brought to the attention of the community nurse. Some of these problems are explored in this article. Solutions and advice are offered to assist community nurses in their care of this patient group.

Professional holistic care of the person with a stoma: online learning

Stoma care nurse specialists are valued for their diverse expertise, but it is essential that all practitioners who regularly care for people with stomas have the opportunity to develop professionally and influence this important area of practice. The vision of a clinical and educational team from Suffolk and south Norfolk led to the development of innovative web-based learning material. The aim is to inspire nurses to engage actively with people who have a stoma. 'Professional care of the person with a stoma' is about caring for the whole person, physically and emotionally, from the period before surgery, to their continuing care in the community. An overview of four aspects of stoma care is presented here as a way of sharing with a wider audience the expert practice harnessed during the development of this web-based module.

Priorities in nursing management of fistulas in a community setting

The aim of this article is to discuss care in the community of patients with a fistula. Areas considered include definition and classification of fistulae, potential causal factors and associated diseases. The article concentrates on enterocutaneous fistulation and the care of patients, but also includes a summary about caring for a patient with an anal fistula. The essential elements of nursing in a community setting are described, and information given on skin care, nutrition, fluids and appliances.

The management and care of people with stoma complications

There are a variety of complications that are associated with stomas. These are described and their causes explained. A number of solutions are presented and advice that the nurse can give is offered. Some of the complications are commonly seen by the nurse, such as sore skin, whereas others are rare, such as an allergy to the stoma appliance. There may be sexual dysfunction after surgery, which may be temporary or permanent. These and many other potential problems are elaborated upon to aid the nurse when caring for people with stomas.