The effect of stoma care training delivered using two different methods on nurses' meaningful learning self-awareness, perceived learning and stoma care skills levels: A randomized controlled study.

Worldwide, stomas represent a medical and social problem. Data from the literature on stoma management are extensive but not homogeneous. In Italy, no guidelines exist for this topic. Thus, clear and comprehensive clinical guidelines based on evidence-based data and best practice are need. In 2018, the Multidisciplinary Italian Study group for STOmas, called MISSTO, was founded. The aim was to elaborate guidelines for practice management of enteral and urinary stomas in adults. A systematic review of the literature was performed using PubMed, National Guideline Clearinghouse, and other databases. The research included guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation", "stoma creation", "stoma complications", "stoma care", and "stoma reversal".The systematic review was performed for each topic, and studies were evaluated according to the GRADE system, AGREE II tool. Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care was held. Afterdiscussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines was elaborated and prepared for publication. This manuscript is focused on statements on the surgical management of enteral stomas. These guidelines are the first Italian guidelines on multidisciplinary management of enteral stomas with the aim of assisting surgeons during stoma management and care.

Urinary stomas represent a worldwide medical and social problem. Data from literature about stoma management are extensive, but inhomogeneous. No guidelines exist about this topic. Therefore, clear, and comprehensive clinical guidelines based on evidence-based data and best practice are needed. The aim of this article was to elaborate guidelines for practice management of urinary stomas in adults. Experts guided review of the literature was performed in PubMed, National Guideline Clearing-house and other databases (updated March 31, 2018). The research included guidelines, systematic reviews, meta-analysis, randomized clinical trials, cohort studies and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care" and "stoma reversal." The systematic review was performed for each topic and studies were evaluated according to the GRADE system, AGREE II tool. Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low level of scientific evidence statements a consensus conference composed by expert members of the major Italian scientific societies in the field of stoma management and care was performed. After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines with definitive recommendations was elaborated and prepared for publication. This manuscript is focused on statements about surgical management of urinary stomas. These guidelines include recommendations for adult patients only, articles published in English or Italian and with complete text available. These guidelines represent the first Italian guidelines about urinary stoma multidisciplinary management with the aim to assist urologists and stoma specialized nurses during the urinary stoma management and care.

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.

This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. Scoping review and generation of evidence and consensus-based clinical guidelines. The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

Introduction Transobturator male urethral slings are a surgical option for the management of stress urinary incontinence (SUI). Historically, patient continence and satisfaction rates are influenced by several variables, including: baseline incontinence severity, prior surgical interventions, and exposure to radiation. Ideal or “standard” patients for sling placement have mild or moderate incontinence and no prior incontinence procedures or radiation exposure. Standard patients have been proposed to have better postoperative continence and satisfaction rates than their “nonstandard” counterparts. Objective In this study we sought to compare the efficacy and complication rates of transobturator male sling placement between standard and nonstandard patients. Methods A retrospective, single-institution review was performed of all patients who underwent either an AdVance™ or an AdVanceXP™ sling insertion between October 2016 and May 2023. Patient demographics, preoperative and postoperative continence rates, and complication rates were collected. Patients were then stratified as “standard’ vs “nonstandard”. Standard patients were defined as having a history of radical prostatectomy (robotic or open) and no prior radiation or prior incontinence procedure. Nonstandard patients had prior history of transurethral resection of the prostate, simple prostatectomy, radical cystectomy, prior sling insertion, or prior radiation. The continence and complication rates were compared between groups. Continence was measured in pads per day (PPD). Improvement in continence was defined as a reduction of at least 50% in PPD at 6 weeks postoperatively. Baseline and postoperative PPD were tabulated with median and 25th-75th percentiles, then compared using Wilcoxon signed-rank test. Other variables were summarized with frequency and percentages, and compared using Fisher’s exact test. Results 62 patients were included in this study, of which 48 and 14 were standard and nonstandard, respectively. Mean age was 66 (52-85) years and body mass index (BMI) was 29 (20.3-39.8) kg/m2. No difference in baseline characteristics were noted between the groups (Table 1). 77% of patients had an improvement in SUI following sling placement: 38/48 (79%) patients in the standard group and 10/14 (71%) patients in the non standard group. The most common complication among both groups was urinary retention requiring catheterization (29%), which resolved spontaneously within two weeks in all patients. In the nonstandard group, one patient developed an abscess, one had a scrotal hematoma, and two patients had urinary tract infections (UTI). One patient with history of radiation developed a urethrocutaneous fistula requiring sling removal. There was no significant difference in overall complication rates between standard and nonstandard patients. Comparable rates of improvement in preoperative to postoperative SUI were noted: 2.5 to 0.8 PPD in the standard group and 3.3 to 1.0 PPD in the nonstandard group (Figure 1). Conclusions In this study, nonstandard and standard patients had similar continence and complication rates following urethral sling placement. Future prospective studies are warranted to assess the safety and long-term outcomes of standard and nonstandard patients. Disclosure No.

Simulation technologies are gaining widespread acceptance across a variety of educational domains and applications. The current research examines whether basic nursing procedure training with high-fidelity versus low-fidelity mannequins results in differential skill acquisition and perceptions of simulator utility. Fifty-two first-year students were taught nasogastric tube and indwelling urinary catheter insertion in one of two ways. The first group learned nasogastric tube and urinary catheter insertion using high-fidelity and low-fidelity mannequins, respectively, and the second group learned nasogastric tube and urinary catheter insertion using low-fidelity and high-fidelity mannequins, respectively. The dependent measures included student performance on nasogastric tube and urinary catheter insertion testing, as measured by observer-based instruments, and self-report questionnaires probing student attitudes about the use of simulation in nursing education. Results demonstrated higher performance with high-fidelity than with low-fidelity mannequin training. In response to a self-report posttraining questionnaire, participants expressed a more positive attitude toward the high-fidelity mannequin, especially regarding its responsiveness and realism.

Beginning and advanced students’ perceptions of the use of low- and high-fidelity mannequins in nursing simulation

A pilot study exploring the differences between high- and low-fidelity mannequins in the assessment of clinical performance. Standardized clinical scenarios were used to test 12 intensive care paramedics (ICP). Each ICP was randomly assigned to a scenario using either a high-fidelity (SimMan) or low-fidelity mannequin (Laerdal Heart Start 2000), followed by a crossover assessment using the alternative scenario. We examined both the objective and subjective outcomes. Objective performance was assessed by three independent assessors, all accredited Advanced Paediatric Life Support instructors. Subjective outcomes were measured by assessment questionnaires and a rating scale. The overall proportion that passed the high-fidelity mannequin scenario was 0.47 compared with 0.58 in the low-fidelity mannequin scenario. The difference was -0.11 (95% CI -0.32-0.11). The subjective outcomes were charted and presented within the article. The ICP preferred the use of high-fidelity mannequin for assessment purpose. There was no significant objective difference between the two mannequins.

Low-fidelity simulation vs. standardized patients in prevention and management of pressure injury education

Using standardized patients to improve the hygiene care skills of first-year nursing students: A randomized controlled trial

BackgroundSimulation-based education offers a risk-free platform to prepare future health professionals for interprofessional collaboration during high-stakes emergencies. This study involved the design, implementation, and evaluation of a disaster-focused simulation to enhance interprofessional competencies among health professions students.MethodsAn interprofessional education (IPE) simulation covering the four disaster preparedness and management phases (mitigation, preparedness, response, recovery) was conducted for undergraduate health professions students. Students, assessors, and standardized patients (SPs) participated in the evaluation. Data on interprofessional competencies were collected from students using the Team’s Perception of Collaborative Care Questionnaire, from assessors using the Modified McMaster-Ottawa Scale, and from SPs using the Standardized Patient Team Evaluation Instrument. Descriptive statistics were used to summarize study variables. Paired sample t-tests were conducted to compare score differences between assessors. Learning curve across cases were tested using one-way repeated measures ANOVA, and associations between global scores and demographic variables were analyzed using t-test or ANOVA, as appropriate.ResultsThirty-three students, 13 assessors, and 8 SPs participated in the evaluation. response rates were 33.3% (students), 92.9% (assessors), and 100% (SPs). Students self-reported positive perceptions of teamwork in the activity, with over 90% agreement across all domains. Assessors’ ratings for the response phase corroborated these findings, with over 80% of students scoring at or above expectations in all domains. SPs’ evaluations were also high, with 70% agreeing that students demonstrated positive interprofessional practice behaviors. For the diabetic ketoacidosis case, teams’ global performance scores were calculated as the mean of the two assessors’ ratings. Students with prior IPE experience (M = 2.42, 95% CI: 2.24–2.60) and those who had completed a prior practice placement (M = 2.48, 95% CI: 2.30–2.65) performed significantly better than students without IPE experience (M = 2.06, 95% CI: 1.80–2.33) or a prior practice placement (M = 2.12, 95% CI: 1.86–2.37). While not statistically significant, a trend towards improved performance across cases in the response phase suggested a learning curve effect.ConclusionsSimulation-based IPE can strengthen interprofessional competencies for disaster preparedness and management, with greatest benefit when preceded by other IPE activities and clinical placements.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00391-x.

IntroductionCritical thinking is regarded as imperative to healthcare quality and patientoutcomes; therefore, effective strategies in nursing education are requiredto promote students’ critical thinking abilities, leading to their successin clinical work. Accordingly, simulation-based education has been suggestedas a measure for achieving this goal.ObjectiveThe aim of this study was to explore whether a nursing education course withblended simulation activities (hands-on simulations with high-fidelitymanikins and a web-based interactive simulation program) could increasenursing students’ critical thinking skills.MethodA quasiexperimental, one-group pretest and post-test design was utilized.Data were collected through premeasurement and postmeasurement using acritical thinking questionnaire and were analyzed using paired samplet-tests, independent sample t-tests,and the nonparametric Wilcoxon signed-rank test. The effect size wascalculated using Cohen's d formula.ResultsSixty-one nursing students (57 women and four men, mean age 30 years)participated in the study. Findings of the paired samplet-test showed a significantly higher mean score forposteducation than pre-education, indicating a significant change in nurses’critical thinking capabilities (p < .001). The resultsfor Cohen's d formula ( − 0.87) of the mean scores betweenpre-education and posteducation indicated a large effect size. The Wilcoxonsigned-rank test also showed a statistically significant increase in thestudents’ critical thinking abilities between pre-education andposteducation measures (p < .001). No statisticallysignificant differences were found in the mean score according to age orsex.ConclusionThis study concluded that blended simulation-based education can increasenursing students’ critical thinking capabilities. As a result, this studybuilds on the use of simulation as a measure for developing and promotingcritical thinking abilities during nursing education.

Clinical classes are the milestones that help pharmacy students gain clinical competency and to prepare them for their professional life. Although didactic methods provide theoretical knowledge, the retention rate of information is relatively low when compared with problem based teaching methods. Simulators such as high fidelity mannequins or standardized simulated patients are often preferred by clinical teachers in schools that teach health profession. High and low fidelity mannequins, and computerized simulators require a cost and dedicated space, which can be a disadvantage. On the other hand, standardized patients are advantageous to develop communication skills. Hence, use of simulation based methods in clinical training are useful in general, because they lead students to self-directed learning strategies, critical thinking and rational decision-making. Therefore, dissemination of simulation techniques is important to improve clinical skills.

Inappropriate stoma site, improper management of stoma, and stoma complications lead to diminished quality of life of ostomates. Healthcare professionals involved in stoma creation and/or care should have the fundamental and updated knowledge of the management of stomas and their complications. This review article consists of the following major sections: principles of perioperative patient management, early complications, and late complications. In the “principles of perioperative patient management” section, the current concepts and trends in preoperative education, stoma site marking, postoperative education, and patient educational resources are discussed. In the “early complications” section, we have focused on the etiology and current management of ischemia/necrosis, fluid and electrolyte imbalances, mucocutaneous separation, and retraction. In the “late complications” section, we have focused on the etiology and current management of parastomal hernia, stoma prolapse, parastomal varices, and pyoderma gangrenosum. Pre- and postoperative patient education facilitates the patient's independence in stoma care and resumption of normal activities. Healthcare providers should have basic skills and updated knowledge on the management of stomas and complications of stomas, to act as the first crisis manager for ostomates.

The purpose of this study was to explore the opinions of nurses regarding their knowledge of and perceived responsibility for providing ostomy care. The target population of this descriptive study was staff nurses working in an acute care hospital in Ankara, Turkey. Data were collected by a questionnaire that included 2 sections. The first section queried descriptive information about the nurses, the perceived responsibility for providing ostomy care for patients. The second section included 54 items that focused on knowledge about stoma care. Evaluating the answers of the nurses to all statements in general (54 propositions), the median value of the "I do not know/false" answers (27.50) was observed to be close to the median value of the "true" answers (26.5). These results indicated that the staff nurses' knowledge of ostomy care was not at the desired level. Responses from section 2 indicated that nonspecialty practice staff did not consider stoma care as their responsibility. Factors that influenced knowledge of ostomy care were number of years working as a nurse, level of education, level of reviewing professional literature on ostomy care, and participation in scientific meetings on the subject. Study findings reveal that knowledge level of nonspecialty nurses about intestinal stoma care is inadequate, and most staff nurses did not consider themselves responsible for stoma care.