Enhancing Stoma Care Education for Junior Doctors: A Comprehensive Teaching Series

Introduction Colorectal stomas are prevalent in surgical wards and demand careful medical attention, particularly in stoma management. Junior doctors play a vital role in this care, but their limited exposure and training may hinder their ability, impacting patient care. Given the dearth of literature, we aimed to assess junior doctors' stoma care knowledge and the efficacy of a specialized teaching course in boosting their confidence and skills. Methods The research, conducted at the West Suffolk Hospital NHS Trust in the UK, engaged 60 junior doctors, predominantly from Foundation Year 1 and Year 2, from August 2021 to December 2022. To ensure effective management and assessment, participants were divided into four groups, each comprising 15 doctors. A pivotal aspect of the study was implementing a structured stoma teaching series delivered by a panel of seasoned surgical experts. This series, conducted every Friday for three weeks, comprehensively covered all facets of stoma care. Both before and after the teaching series, assessments were administered to measure the impact of this educational intervention on the participants' understanding of stomas. The study meticulously adhered to ethical guidelines, with all participants providing informed consent, and measures were implemented to guarantee anonymity, thus safeguarding the privacy and confidentiality of all individuals involved. The primary objective of this investigation was to evaluate the efficacy of the stoma teaching series in augmenting the knowledge and comprehension of stomas among junior doctors. The findings of this study hold significant potential in guiding healthcare professionals toward developing more efficacious stoma education programs, ultimately leading to improved patient care outcomes. Results The study involved 60 junior doctors categorized into four groups from August 2021 to December 2022. It aimed to assess their understanding of colorectal stomas, focusing on complications and their knowledge about stoma appliances and care nurses. A questionnaire was used to evaluate their knowledge in these areas at the start of their surgical rotation, which showed significant knowledge gaps among participants. Of the 60 participants, 48 (80%) expressed slight or no confidence in basic stoma care, while 54 (90%) admitted unfamiliar with managing stoma complications. Astonishingly, all 60 (100%) participants lacked awareness of fundamental stoma care concepts. Significant improvements were observed following a comprehensive stoma teaching series covering basic stoma knowledge, its complications and management, and practical stoma care. Feedback from the course revealed positive outcomes, with 54 (87%) doctors feeling confident or very confident in basic stoma knowledge and 48 (80%) reporting increased familiarity with managing stoma complications. Remarkably, all 60 (100%) doctors indicated comfort with stoma care concepts after the sessions. Participants emphasized the course's value in medical education and professional development, citing enhanced practical skills such as communication and teamwork. Conclusion Our study revealed junior doctors' limited stoma knowledge, emphasizing the need for a dedicated teaching program that significantly improves their understanding. Focused stoma education is vital for junior doctors to deliver optimal patient care, necessitating hospitals to promote awareness for improved patient outcomes.

Assessing and documenting dark skin tones in stoma care

The stoma care nurse (SCN) assesses peristomal skin during each patient intervention. Living in a diverse multicultural society, the SCN needs to consider dark skin tones and how these are documented. This article looks at how the literature on peristomal skin assessment and available tools discuss skin colour, and compare this with the tissue viability literature. Stoma care and peristomal skin literature features very little about skin colour. Registered nurses are often unaware of the differences when assessing light skin tones versus dark skin tones. The article discusses how to assess for, identify and document problems around peristomal skin with patients who have dark skin tones. The differences in skin breakdown between light skin tones and dark skin tones are highlighted. There needs to be further research and development of tools to assist clinicians in identification and documentation relating to skin tone, thus providing consistency in assessment.

Nurse specialist and ostomy patient: Competence and skills in the care pathway. A scoping review

AIMS AND OBJECTIVES

To summarise the evidence published to date regarding nursing core competence in stoma care of any type of ostomy throughout the patient's ostomy surgery candidate care pathway from preoperative to follow-up.

BACKGROUND

Nurses should play a key role in all ostomy patient care pathways to help them to adapt to the new physics and psychological conditions from the preoperative phases to the prevention of tardive stomal complications.

DESIGN

Scoping review.

METHODS

This scoping review was conducted following the methodological framework proposed by Arskey and O'Malley, following the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review. PRISMA-ScR Checklist is included in the manuscript. The following databases were queried: PubMed, EMBASE and CINAHL, from August to October 2022.

RESULTS

The search strategy in the consulted databases identified 3144 studies. Different types of ostomies were found and investigated: tracheostomy, gastrostomy, jejunostomy, ileostomy, colostomy and urostomy. The results of the included studies helped address the objective that allowed the ostomatherapy skills to be broken down into the different periods of the care pathway.

CONCLUSION

Caring for an ostomy patient requires advanced skills and a trusting relationship. The skills outlined in this research suggest how essential the stoma care nurse specialist is in these patients' care.

Cultural Adaptation, Content Validation, and Reliability of the SACS 2.0 Instrument for Colombian Spanish

OBJECTIVE

To realize the cultural adaptation and content validation and evaluate the reliability of the SACS 2.0 instrument in Colombian Spanish.

METHODS

The researchers conducted a methodological study with a quantitative approach. The adaptation process was carried out in five stages: translation, synthesis, reverse translation, evaluation by a committee of experts, and testing of the adapted version. In addition, the interobserver reliability was evaluated by four nurses who examined 210 stomas.

RESULTS

All of the proposed stages were carried out successfully, and an adapted version of the instrument in Colombian Spanish was obtained. During the content validation stage, the instrument obtained a content validity index of 1. The adapted version of the test showed substantial agreement for the aspect of clarity, adequacy, and understandability. In the interobserver reliability, there was agreement in 95.7% of the evaluations for the classification of the lesions according to the quadrants (κ = 0.97-0.99).

CONCLUSIONS

Authors achieved a culturally adapted, valid, and reliable instrument for the evaluation and classification of peristomal skin alterations in Colombian Spanish.

Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese

PURPOSE

To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version.

DESIGN

Psychometric (methodologic) evaluation of the instrument.

SUBJECTS AND SETTING

Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order.

METHODS

The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors.

RESULTS

The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study.

CONCLUSION

This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.

Ostomy 101 for dermatologists: Managing peristomal skin diseases

An estimated 1 million North Americans live with ostomies, with up to 80% of ostomy patients developing stoma-related skin morbidities. While ostomy nurses are often the first line of management, dermatologists may be involved in the care of ostomy patients with complex or persistent peristomal skin complications. Therefore, an understanding of the ostomy apparatus and possible peristomal skin conditions that may arise allows dermatologists to identify skin complications early and work effectively with a multidisciplinary team. In this article, we aim to review the ostomy apparatus, discuss the differential diagnoses, and provide practical guidelines for the management of peristomal skin conditions. Pubmed, Ovid Medline, and Google Scholar were searched for relevant articles assessing peristomal skin complications and their management. Peristomal skin complications may be local (e.g., contact dermatitis, infection, fistula, and mechanical trauma) or secondary to systemic disease (e.g., inflammatory bowel disease, pyoderma gangrenosum, and psoriasis). Ensuring appropriate ostomy fit and proper use of ostomy accessory products helps to reduce effluent leakage and prevent damage to the peristomal skin. For persistent peristomal skin conditions, corticosteroid sprays, systemic therapies, and surgical interventions may be warranted.

Peristomal Skin Health: A WOCN Society Consensus Conference

The Wound, Ostomy, and Continence Nurses (WOCN) Society identified the need to define and promote peristomal skin health. A task force was appointed to complete a scoping literature review, to develop evidence-based statements to guide peristomal skin health best practices. Based on the findings of the scoping review, the Society convened a panel of experts to develop evidence- and consensus-based statements to guide care in promoting peristomal skin health. These consensus statements also underwent content validation using a different panel of clinicians having expertise in peristomal skin health. This article reports on the scoping review and subsequent 6 evidenced-based statements, along with the generation and validation of 19 consensus-based statements, to assist clinical decision-making related to promoting peristomal skin health in adults.

Evaluation of short-term loop colostomy in dogs using conventional and supporting subcutaneous silicone drain techniques

Objective:

This study aimed at evaluating the supporting and non-supporting loop colostomy techniques in dogs.

Materials and Methods:

In this study, 12 adult healthy mongrel dogs were used to carry out a short-term (21 days) temporary flank loop colostomy. The dogs were divided into two groups (n = 6). In the first group (Con group), conventional stoma fixation was operated without loop support. In the second group [subcutaneous silicone drain (SSD) group], an SSD was used as a supporting bridge. The stoma was fixed by a modified, interrupted seromuscular vertical mattress suture pattern. Both peristomal and stomal complications were recorded.

Results:

Results showed that a total of seven dogs (58%) suffered complications. There was a significant tendency toward less peristomal (p = 0.012) and stomal complications (p = 0.001) in the SSD group. The intensity of pain was significantly (p < 0.05) different between the two groups in the first week post surgery. Comfort with stoma care was significantly (p = 0.015) better in the SSD group, experiencing the best results.

Conclusion:

It is concluded that an appropriate stoma location, using a soft supporting bridge, stoma fixation using modified interrupted neuromuscular vertical mattress sutures, and proper appliance fixation by adhesive tapes and a tight T-shirt may overcome the complications of short-term loop colostomy in dogs and introduce a satisfaction for stoma care.

Adapted Crusting Technique in Children with Peristomal Lesions: A Case Series

OBJECTIVE

To describe the care of pediatric patients who had a gastrostomy and developed peristomal lesions and received a systematic single adapted crusting technique in a pediatric ICU in a tertiary Brazilian hospital.

METHODS

An analysis of six cases presenting traumatic, noninfectious peristomal lesions with ostium enlargement resulting in gastric residual leaks. All six patients received the same treatment over 7 to 15 days.

RESULTS

Lesion improvement was observed in all patients after 48 hours and considered attributable to the standard treatment recommended by ostomy professionals.

CONCLUSIONS

The adapted crusting technique was effective in the treatment of children with peristomal lesions. This technique may be beneficial to other patient and organizational outcomes such as improving safety of care, decreasing pain and discomfort, reducing nursing workload and hospital costs, and improving quality of life.

Clinical governance for ostomates at risk of peristomal skin complications

This clinical study focuses on peristomal skin complications (PSCs). For many patients, the causative factor behind peristomal moisture-associated skin damage was contact dermatitis caused by effluent leakage, resulting in sore and excoriated skin. PSCs are costly to the patient in relation to pain, time and worry and also impact nursing activity levels and healthcare costs. The study identifies the number of patients presenting with PSC, the causative factors and their resolution using medical grade Manuka honey flanges.

Medical Adhesive-Related Skin Injuries and Associated Risk Factors in a Pediatric Intensive Care Unit

OBJECTIVE

To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU).

METHODS

A cross-sectional design was adopted in the PICU of a university-based children's hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed.

MAIN OUTCOME MEASURES

Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients' clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically.

MAIN RESULTS

The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings.

CONCLUSIONS

Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).

Assessing physical activity levels in people living with a stoma

Physical activity is important for physical and mental health; however, people with a stoma commonly experience a reduction in physical activity following stoma formation. Further research into physical activity levels in people living with a stoma is necessary to determine which factors are associated with engagement in regular physical activity, and with inactivity.

AIM

The primary aim of this study was to assess physical activity levels in adults living with a stoma in the community. The secondary aim was to investigate the relationship between activity levels, self-efficacy for exercise, perceived benefits and barriers to exercise, depression, body image and stoma-related quality of life.

METHOD

A cross-sectional questionnaire survey was sent to healthy individuals living with a urostomy, ileostomy or colostomy, recruited from six stoma support groups in the East Midlands. The primary measure was physical activity levels; secondary measures were self-efficacy for exercise, perceived barriers and benefits to physical activity, depression, body image and stoma-related quality of life. Descriptive analysis of the data was undertaken using a computer analysis package.

RESULTS

The questionnaire was sent to 116 adults and completed by 94 adults, giving a response rate of 81%. Of the participants who answered the questions on levels of physical activity, 83% ( n =71/86) did not achieve government-recommended levels of physical activity. Less active participants perceived greater barriers to physical activity and had lower self-efficacy for exercise than participants who were more active. Reported physical activity was not associated with body image, depression or stoma-related quality of life.

CONCLUSION

Most participants were physically inactive. Interventions that reduce barriers to exercise and support self-efficacy in people with a stoma can assist them to increase their physical activity levels, as well as reducing the risk of chronic disease associated with sedentary lifestyles.

Instrumentos de avaliação das complicações na pele periestoma: revisão integrativa

Objetivo: identificar y analizar las herramientas utilizadas para evaluar las complicaciones de la piel periestoma a través de revisión integradora de la literatura. Materiales y método: la búsqueda se dio en estas bases y portales de datos: Biblioteca Virtual de la Salud (BVS), PubMed/MEDLINE, CINAHL, Scopus y Web of Science, de enero a febrero de 2018. Durante la búsqueda en las bases de datos, se utilizaron los descriptores: ostomía, colostomía, dermatitis y las palabras clave: instrumentos, complicaciones de la piel periestoma y evaluación de la piel periestoma. Se incluyeron estudios que cumplieron los siguientes criterios: que estén disponibles en su totalidad, que estén publicados en español, inglés y portugués, no se tuvo en cuenta el rango de tiempo y tenía que ser acerca de las herramientas de evaluación de las condiciones de la piel periestoma. Resultados: el análisis identificó la existencia de nueve instrumentos con diferentes parámetros para describir la piel periestoma. En general, los instrumentos describen los cambios basados en la clasificación de la complicación, en la causa del daño a la piel o en las características clínicas presentes. Los estudios evidenciaron, además, que la mayoría de los instrumentos no poseen propiedades de medida probadas. Conclusión: de los nueve instrumentos de evaluación identificados, solo cuatro tienen propiedades de medidas probadas. El enfermero debe conocer los instrumentos existentes confiables y válidos para describir y clasificar la gravedad de los problemas de la piel periestoma, lo que aporta a la sistematización de un diagnóstico más preciso y mejora, por lo tanto, la calidad del cuidado.

Avoiding emergency stoma surgery with the use of sugar

George Theofanis, Mahmud Saedon, Soo Hua Kho, Francesk Mulita, Stylianos Germanos and Edmund Leung discuss the use of sugar as an aid to reducing a stomal prolapse.

Comparing ostomates' perceptions of hydrocolloid and silicone seals: a survey

Most stoma flanges are made of hydrocolloid material. Hydrocolloid is a hydrophilic material that attracts water, potentially resulting in moisture becoming trapped between the flange and skin. Also, as hydrocolloids are absorbent, the material breaks down over time, and there is a risk that some of the adhesive can remain on the skin on removal. Unlike hydrocolloids, silicone comprises fully cross-linked silicone polymers whose properties have been engineered to manage moisture without breaking down (i.e. manage the transepidermal water loss (TEWL)). A questionnaire survey was undertaken to determine ostomates' perceptions of silicone versus hydrocolloid stoma care products (both flanges and seals). The survey was sent to 229 ostomates who had used silicone seals, of whom 78 returned it (a response rate of 34%). The results suggest that use of the silicone seals resulted in a improvement in the condition of the peristomal skin condition, reduced leakage and increased wear time. Further research into this area is required.