TITLE: Does Preoperative Teaching and Stoma Site Marking Affect Surgical Outcomes in Patients Undergoing Ostomy Surgery?
AUTHORS: Colwell J, Gray M
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2007; 34(5):492-496
ARTICLE TYPE: Systematic Literature Review (Evidence-Based Report Card)
DESCRIPTION/RESULTS:
* The authors provide a systematic review of existing evidence about preoperative education and stoma site marking for patients undergoing intestinal or urinary ostomy surgery. The review reveals scant evidence to support the need for preoperative education or stoma site marking but a strong consensus among clinical experts persists that all patients should have preoperative education with stoma site marking.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* Given the decreasing length of stay in the hospital for ostomy patients in the hospital, preoperative education allows added time to prepare patients for discharge after surgery. A stoma site on a flat surface away from folds and creases will make pouching the stoma less difficult for the patient.
TITLE: ASCRS and WOCN Joint Position Statement on the Value of Preoperative Stoma Marking for Patients Undergoing Fecal Ostomy Surgery
AUTHORS: WOC Nurses and Colorectal Surgeon Committee Members
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2007; 34(6):627-628
ARTICLE TYPE: Multidisciplinary Position Statement
DESCRIPTION/RESULTS:
* Preoperative site marking should be done by an educated and competent clinician. The colon and rectal surgeon and WOC nurse are optimally prepared to mark stoma sites. A procedure for stoma site marking is included.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* WOC nurses must educate physicians and staff on the importance of stoma site marking and make this a priority for preoperative care.
TITLE: Ostomy Pouch Wear Time in the United States
AUTHORS: Richbourg L, Fellows J, Arroyave WD
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2008; 35(5):504-508
ARTICLE TYPE: Research Report; Cross-Sectional Survey
DESCRIPTION/RESULTS:
* This landmark study reports results of a survey distributed by ostomy nurses and through UOAA groups to ostomates who have had a stoma 6 months or longer; 551 surveys were returned. The mean wear time for ostomy pouches in the United States was found to be 4.8 days. Persons with urostomies reported an average wear time of 5.02 days, those with ileostomies reported 5.01 days, and those with colostomies reported an average of 4.55 days.
WHAT DOES THIS MEAN TO ME AND MY PRACTICE?
* "How long can I wear this pouch?" is a frequent question posed by new ostomates. This survey gives the WOC nurse an idea of what an average wear time may be based on what ostomates across the country are reporting.
TITLE: Difficulties Experienced by the Ostomate After Hospital Discharge
AUTHORS: Richbourg L, Thorpe JM, Rapp CG
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2007; 34(1):70-79
ARTICLE TYPE: Research Report; Cross-Sectional Survey
DESCRIPTION/RESULTS:
* Thirty-four persons living with an ostomy responded to a mailed survey querying difficulties experienced after hospital discharge. The top 5 difficulties experienced by the respondents (n = 34) were peristomal skin irritation (76%), pouch leakage (62%), odor (59%), reduction in previously enjoyed activities (54%), and depression/anxiety (53%). Twenty percent of the ostomates who experienced difficulties after surgery did not seek help. Ostomates primarily sought help from nurses when they experienced problems related to the stoma and expressed the most satisfaction with ostomy nurses. For mental health, sleep, and sexual problems, a medical doctor was the practitioner of choice.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* Difficulties with an ostomy after hospital discharge are common. Follow-up with a WOC nurse after hospital discharge improves the adjustment to an ostomy.
TITLE: Stoma Surgery for Colorectal Cancer: A Population-Based Study of Patient Concerns
AUTHORS: Lynch BM, Hawkes AL, Steginga SK, Leggett B, Aitken JF
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2008; 35(4):424-428
ARTICLE TYPE: Research Report, Cross Sectional Study
DESCRIPTION/RESULTS:
* As part of a larger study of the Colorectal Cancer and Quality of Life conducted in Australia, a subset of 232 persons with ostomies were interviewed by phone at 5, 12 and 24 months. Painful or irritated peristomal skin (40%) and odor (41%) and noise from the appliance (88%) were the most commonly reported stoma-related difficulties. The proportion of participants reporting these difficulties decreased over time. Provision of preoperative information was comprehensive, and satisfaction with preoperative information was high. However, 34% of patients said they were not seen by an ostomy nurse prior to surgery. Issues relative to their stoma were discussed in the hospital, but there was little support at office visits after hospital discharge.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* WOC nurses providing follow-up after discharge from the hospital may be instrumental in successful survivorship with colorectal cancer and an ostomy.
TITLE: Peristomal Skin Care: An Overview of Available Products
AUTHOR: Black P
SOURCE:British Journal of Nursing 2007; 16(17): 1048-1056
ARTICLE TYPE: Integrative Literature Review, Recommendations for Practice
DESCRIPTION/RESULTS:
* Peristomal skin problems affect approximately one-third of colostomy patients and more than two-thirds of ileostomy and urostomy patients. The author reviews available literature and provides recommendations for judicious use of wafers, skin protectors, and adhesive removers for peristomal skin care. The failure of some healthcare professionals to recognize the difference between alcohol, oil, and silicone-based peristomal skin protectors and adhesive removers may lead to unnecessary peristomal skin problems for the patient. The use of a protocol aids healthcare professionals and patients to reach a defined standard for prevention and care of their peristomal skin.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* It is important for the WOC nurse to be aware of those products that will provide the best protection for the peristomal skin and help the patient to avoid painful and distressing skin breakdown.
TITLE: Incidence of Complications of the Stoma and Peristomal Skin Among Individuals With Colostomy, Ileostomy, and Urostomy: A Systematic Review
AUTHOR: Salvadalena G
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2008; 35(6):596-607
ARTICLE TYPE: Systematic Literature Review
DESCRIPTION/RESULTS:
* The author identifies and reviews 21 studies published between 1990 and 2007 that purport to measure the incidence of stomal and peristomal complications. However, differences in research design, operational definitions, and timing of measurements do not allow meta-analysis. The author emphasizes that variability in study designs and absence of operational definitions are particular problems.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* WOC nurses are in a position to collect data about stomal and peristomal complications and conduct or contribute to studies that use a prospective design, consistent operational definitions, and valid and reliable measurement methods. The content validation study by Colwell and Beitz (reviewed subsequently in this supplement) is strongly recommended as a resource for ensuring studies measuring the prevalence and incidence of stomal or peristomal complications are based on standardized and content validated definitions.
TITLE: Survey of Wound, Ostomy and Continence (WOC) Nurse Clinicians on Stomal and Peristomal Complications: A Content Validation Study
AUTHORS: Colwell JC, Beitz J
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2007; 34(1):57-69
STUDY/DESIGN: Research Report; Cross-Sectional Survey
DESCRIPTION/RESULTS:
* The authors report results of a survey intended to validate proposed definitions of stomal and peristomal complications. The survey was sent to 2900 WOC and ostomy nurses; 686 were returned. Proposed definitions tended to be rated as valid with only minor revisions required. Consensus for proposed interventions tended to be weaker.
WHAT DOES THIS MEAN TO ME AND MY PRACTICE?
* Additional research is urgently needed to elucidate the epidemiology of stomal and peristomal complications, including prevalence and incidence, as well as risk and protective factors. Promulgation of standardized and validated definitions for these complications is an essential first step. This research will ultimately benefit patients by enhancing the evidence base for providing education about potential stomal and peristomal complications, and by evaluating preventive interventions, and treatment options when complications occur.
TITLE: A Proposal for Classifying Peristomal Skin Disorders: Results of a Multicenter Observational Study
AUTHORS: Bosio G, Pisani F, Lucibello L, Fonti A, Scrocca A, Morandell C, Anselmi L, Antonini M, Militello G, Mastronicola D, Gasperini S
SOURCE:Ostomy Wound Management 2007; 35(9): 38-43
ARTICLE TYPE: Research Report; Prospective Observational Study
DESCRIPTION/RESULTS:
* Patients seen in eight national ostomy centers in Italy were divided into two groups; group 1 comprised those with early complications (<1 year with an ostomy), and group 2 comprised patients with late complications (<1 year with an ostomy). Peristomal skin was examined and photographed at weeks 0, 4, 12, 24 weeks. Six hundred fifty-six ostomy patients were observed.
RESULTS:
* Three hundred eighty were in group 1-early complications and 276 in group 2-late complications. Of those, 339 patients (52%, 272 men and 67 women) had peristomal skin disorders. Data and images were shared in 3 consensus conferences where expert panels of ET nurses and surgeons developed a staging system with a pocket ruler and guideline for clinicians.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* The study provides a standardized classification system based on observations in a cohort of 339 persons with an ostomy. Standardized and validated definitions for peristomal skin are necessary for researchers to measure the prevalence and incidence of these complications, and evaluate the safety and efficacy of preventive and active treatment options.
TITLE: Obstructive Uropathy Secondary to Pneumoperitoneum in a Patient With Ileal Conduit (with Commentary)
AUTHORS: Ahmad J, Andrabi S, Rathore M (with Commentary by Hocevar B)
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2007; 34(6):678-679
ARTICLE TYPE: Case Study
DESCRIPTION/RESULTS:
* A patient with a urostomy underwent laparoscopic cholecystectomy and experienced stomal edema and decreased urine output post-operatively. This case suggests that laparoscopic procedures in patients with abdominal stomas should be performed with caution, and in these patients it may be advisable to maintain a pneumoperitoneum at pressures below 10 mm Hg. It seems logical to place a drainage catheter such as a Foley catheter in the stoma allowing free drainage and preventing an obstructive complication.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* Education of staff and patients with ostomies having laparoscopic abdominal surgery should include the risk of edema and stomal obstruction.
TITLE: Intestinal Diversion (Colostomy or Ileostomy) in Patients With Severe Bowel Dysfunction Following Spinal Cord Injury
AUTHORS: Hocevar B, Gray M
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2008; 35(2):159-166
ARTICLE TYPE: Systematic Literature Review (Evidence-Based Report Card)
DESCRIPTION/RESULTS:
* The authors identified six studies that compared intestinal ostomy with management program for neurogenic bowel in patients with spinal cord injuries. A majority of patients found that the ostomy shortened the time for bowel management and a significant portion wished that they had been offered this option earlier. Health Related Quality of Life (HRQOL) outcomes for patients with intestinal ostomies were equivalent or superior to conservative bowel management.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* The WOC can be instrumental in the success of a bowel management program for a person with a spinal cord injury and can help the person view surgery as an alternate management method rather than as a "failure" of their current treatment. Stoma site marking is crucial for persons with spinal cord injuries so the stoma will be visible and accessible for the patient or caregiver to manage care of the stoma.
TITLE: Low Back Pain in People With a Stoma: Patients' Views
AUTHORS: Wilson IM, Kerr DP, Lennon S
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2007; 34(5):515-520
ARTICLE TYPE: Research Report; Analysis of Narrative From Focus Group
DESCRIPTION/RESULTS:
* Eleven persons living with an ostomy and no previous abdominal surgeries who were living in Northern Ireland participated in the study. The majority reported experiencing low back pain. Most perceived that the pain was related to having a stoma or the disease that precipitated the surgery.
* These results suggest that low back pain is common following ostomy surgery, and patients with an ostomy believe their pain is related to the presence of the ostomy. Further study is needed to determine the incidence of low back pain in persons with an ostomy and to determine whether the presence of an abdominal stoma causes low back pain.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* WOC nurses should query their ostomy patients about low back pain, and determine whether this pain is de novo (occurring following ostomy surgery) or persistent. Ostomy nurses are strongly encouraged to document and publish additional case reports or case series in order to further define this potential sequela of an abdominal stoma.
TITLE: Quality of Life Outcomes in 599 Cancer and Non-Cancer Patients With Colostomies
AUTHORS: Krouse R, Grant M, Ferrell B
SOURCE:Journal of Surgical Research 2007; 138(1):79-87
ARTICLE TYPE: Research Report; Comparative Cohort Study
DESCRIPTION/RESULTS:
* HRQOL was measured in 599 respondents with colostomies associated with colorectal cancer or various benign conditions using an ostomy specific instrument. Common factors leading to impaired HRQOL included sexual problems, flatus, constipation, travel difficulties, and dissatisfaction with physical appearance. Patients with an ostomy because of colorectal cancer (n = 517) had less difficulty adjusting to their colostomies than did those with non-malignant disease (n = 82).
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* Healthcare practitioners should be aware of the long-term effect of an ostomy on overall quality of life and encourage ostomates to follow-up through UOAA groups and a WOC nurse.
TITLE: The Impact of Stabilizing Forces on Postsurgical Recovery in Ostomy Patients
AUTHORS: Nichols T, Riemer M
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2008; 35(3):316-320
ARTICLE TYPE: Analysis of Data From Large Database
DESCRIPTION/RESULTS:
* Survey responses from 1495 persons with an ostomy revealed that maintenance of a stable marriage or intimate relationship and persistence of employment predicted a positive life satisfaction score after ostomy surgery.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* The risk for prolonged impairment of HRQOL in increased when ostomy surgery and the associated disorder results in loss of a job or intimate partner (spouse). These individuals are more likely to need sustained psychosocial support than persons able to maintain a stable intimate relationship and employment.
TITLE: Demographic, Clinical, and Quality of Life Variables Related to Embarrassment in Veterans Living With an Intestinal Stoma
AUTHORS: Mitchell KA, Rawl SM, Schmidt CM, Grant M, Ko CY, Baldwin CM, Wendel C, Krouse RS
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2007; 34(5):524-532
ARTICLE TYPE: Research Report; Cross-Sectional Survey
DESCRIPTION/RESULTS:
* The authors report a secondary analysis of the VA Ostomy Health-Related Quality of Life Study focusing on embarrassment in 239 veterans with ostomies. Nearly half of the participants (48%) rated their embarrassment as low, but 26% reported high embarrassment. A high embarrassment rating was associated with younger and non-partnered veterans, who also reported higher rates of anxiety and depression. The primary sources of embarrassment identified by respondents were leakage, odor, and noise.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* Leakage, odor, and noise from an ostomy can cause embarrassment, and assistance from a WOC nurse to address these issues can positively impact quality of life.
TITLE: Sexual Health and Quality of Life Among Male Veterans With Intestinal Ostomies
AUTHORS: Symms MR, Rawl SM, Grant M, Wendel CS, Coons SJ, Hickey S, Baldwin CM, Krouse RS
SOURCE:Clinical Nurse Specialist 2008; 22(1):30-40
ARTICLE TYPE: Research Report; Case Control Study
DESCRIPTION/RESULTS:
* The authors reported a secondary analysis of data collected for the VA Ostomy Health-Related Quality of Life Study. Two hundred twenty-four veterans who underwent intestinal surgery and creation of an ostomy were compared with 257 controls with similar intestinal procedures but without an ostomy. Almost half (44%) of veterans with ostomies who were sexually active before ostomy surgery became inactive after their procedure, versus 17% of controls. Less than 2.0% of those who were sexually inactive prior to surgery became sexually active after their procedure.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* Discussion of sex and sexuality after ostomy surgery is an important part of the WOC nurse role. Referral for counseling and evaluation of erectile dysfunction may be appropriate.
TITLE: Demographic and Clinical Factors Related to Ostomy Complications and Quality of Life in Veterans With an Ostomy
AUTHORS: Pittman J, Rawl S, Schmidt CM, Grant M, Ko CY, Wendel C, Krouse RS
SOURCE:Journal of Wound, Ostomy and Continence Nursing 2008; 35(5):493-503
ARTICLE TYPE: Research Report; Cross-Sectional Survey
DESCRIPTION/RESULTS:
* The authors report a secondary analysis of the VA Ostomy Health-Related Quality of Life Study. They found that age, income, employment, preoperative care (stoma site marking and education), having a partner, ostomy type, reason for ostomy, time since surgery, total quality-of-life scores and scores on all 4 domains of quality of life were related to the severity of the ostomy complications of skin irritation and pouch leakage. Age was inversely related to severity of ostomy complications and difficulty adjusting. Having had the stoma site marked preoperatively was associated with less difficulty adjusting to an ostomy, and having had preoperative ostomy education was associated with less severe problems with skin irritation and leakage.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* This article highlights the importance of stoma site marking and education in ostomy management as a means of facilitating adjustment to an ostomy and an acceptable quality of life for the ostomate.
TITLE: Does Intestinal Resection Affect the Absorption of Essential Vitamins, Minerals and Bile Salts?
AUTHOR: Lambert GM
SOURCE:Ostomy Wound Management 2007; 54(6): 36-47
ARTICLE TYPE: Integrative Literature Review
DESCRIPTION/RESULTS:
* The question is whether those who have had colectomies with ostomies or continent diversions are at greater risk for osteoporosis due to less intestinal surface for absorption. The literature reviewed does not support this, and as with the general population, genetic predisposition, sedentary lifestyle and dietary factors pose the greatest risk.
WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?
* Extensive information about the anatomy and physiology of digestion in this article can provide the WOC nurse with information for patient and staff education.