Stoma Patients Research Articles

Mucocutaneous separation in stoma patients: a critical review

There are many stoma complications that can impact an ostomate's quality of life, particularly those affecting the surrounding skin, which is essential for maintaining appliance integrity to prevent leakage of effluent. Peristomal skin conditions affect up to half of new ostomates and can make psychological adaptation more difficult. Among the most common of these conditions is mucocutaneous separation, which affects up to a quarter of new ostomates. Reported incidence is highly inconsistent, likely due to disparate assessment criteria, poor recognition and/or underreporting. Mucocutaneous separation occurs in the first month following surgery and is caused by a breakdown in the wound healing process. The resulting cavity between the stoma and peristomal skin causes pain and discomfort, as well as impeding appliance adherence, increasing the potential of leaks. Although there is no standardised system of categorisation for assessment, nurses can use the Ostomy Skin Tool or the mild–severe system of Herlufsen et al along with management guidelines. Wound care principles should be applied to promote healing by secondary intention. In superficial mucocutaneous separation, pectin-based stoma powder can aid adherence. A moist environment can be cultivated with wound dressings, such as hydrogel, hydrocolloid or alginates. Slough can be treated with irrigation or a desloughing agent. Any wound exudate suggests the cavity should be filled with paste or absorptive dressing. Hydrocolloid wafers, pastes, mouldable rings and seals may have helpful healing properties and can create a smooth surface. Nutrition should also be addressed. Nurses must rely on experiential learning for treatment strategies and product selection. However, empirical evidence on the efficacy of these therapies in mucocutaneous separation would be invaluable in guiding evidence-based clinical decisions. Stoma care nurses have an essential role in assessing and treating this common and challenging condition.

Evaluation of Sexual Satisfaction and Function in Patients Following Stoma Surgery: A Descriptive Study

Many patients who undergo stoma surgery experience erectile dysfunction or dyspareunia after the procedure. The purpose of this study was to evaluate sexual satisfaction and function in stoma patients. Data were collected from 100 stoma patients between March 2015 and 2016 using the International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI), and Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Statistical analysis was performed using descriptive methods, the Mann–Whitney U test, and Kruskal–Wallis test. GRISS female (n = 24) and male (n = 76) mean scores were 6.20 ± 2.02 and 7.43 ± 1.44, respectively. FSFI mean score was 6.17 ± 8.97 and IIEF mean score was 23.5 ± 18.0. Severe erectile dysfunction was present in 60.5% of males (n = 46). Reportedly, 79.0% of patients had not been informed about possible sexual problems after surgery. Patients shared their experience with sexual problems with a partner (n = 28), medical doctor (n = 9), or no one (n = 20). Statistical significance was found between GRISS female mean scores and education level, marital status, chronic disease and stoma status (permanent/temporary) (p < .05), and between FSFI mean scores and chronic disease and drug use (p < .05). This study suggests that stoma patients experience sexual dissatisfaction and sexual dysfunction, and most patients had not been informed about possible sexual problems and treatment options. Based upon our findings, patients undergoing stoma surgery should receive perioperative sexual counseling conducted by a multidisciplinary team including stomatherapy nurses.

Implementing a 7-day stoma care service: an impact assessment

In light of NHS England's recommendation to create a 7-day NHS, the colorectal and stoma care service at the Nottingham University Hospitals NHS Trust piloted a 7-day service. Combined colorectal/stoma care nursing roles were separated into dedicated roles; a holistic enhanced-recovery care pathway was implemented; and partial and full weekend working patterns for nurses was trialled. A comparative study assessed the efficacy of the changes. After implementation, stoma patients had a statistically significant 2-day average reduction in length of stay and an increase in the number of weekend discharges was noted. This reduction in length of stay represents a potential saving of over £150 000 for the Trust and the NHS. Although the impact of other concurrent service changes should be taken into account, this suggests that a 7-day service is a financially viable option.

Enhancing the quality of life for stoma patients with appropriate accessory use

Enhancing the quality of life for stoma patients with appropriate accessory use

Giving a stoma a name: a mixed-methods study of naming habits and attitudes among ostomates

Background: In their clinical practice, the authors noted that some ostomates give their stoma a personalised name. Aim: To establish which patients in the authors' clinical practice have named their stoma and examine their relevant behaviours and attitudes. Method: Two mixed-methods qualitative surveys were sent to randomly selected adult stoma patients in a single centre; these surveys were then collected for both statistical and textual analysis. Results: Two-thirds of patients named their stoma; most of these names were gendered, with more male (52%) than female (27%), especially among male ostomates. Humorous or diminutive names were popular, often reflecting the stoma's appearance or function, or beginning with ‘s’ or ‘st’. Rationales for naming included creating humour, a personal connection and a codename for selective communication in public. Stomas were often named by younger family members. Conclusions: Nurses may wish to encourage their patients to name their stoma as a positive coping strategy towards acceptance during the transition period following ostomy surgery.

Effects of a home care mobile app on the outcomes of discharged patients with a stoma: A randomised controlled trial

To explore the effects of a home care mobile app on the outcomes of stoma patients who discharged from hospital. Patients with a newly formed stoma experience many difficulties after surgery. Mobile application (app) has the potential to help patients self-manage their diseases and adjust to the changes in their lives and is a convenient way to ensure the continuity of care. However, there is a lack of studies about the effects of a mobile app on the transitional care for improving discharged stoma-related health outcomes. A randomised controlled trial. A total of 203 patients with a permanent stoma in tertiary hospitals in China were randomly assigned into two groups. Patients in the control group (n=103) received routine discharge care. Patients in the intervention group (n=100) received home care via a mobile app besides routine care. The psychosocial adjustment level, self-efficacy scale and stoma complications incidence were measured in the follow-up period and compared between the two groups. Data were collected at four time points: before intervention (baseline), at 1, 3 and 6months after discharge. The psychosocial adjustment level and stoma self-efficacy score of the intervention group were significantly higher than those of the control group, respectively, at 1-, 3- and 6-month follow-up (all p<0.05). The incidence of stoma complications in the intervention group was tending to reduce at 1, 3 and 6months after discharge. The findings indicated that follow-up care at home via a mobile app can effectively improve the psychosocial adjustment level, self-efficacy scale and other related outcomes of stoma patients. The home care mobile app is an effective intervention to support the psychosocial adjustment and self-efficacy of stoma patients after discharge. It ensures the continuity of care and provides nursing guidance for the patients timely.

Implementing a 7-day stoma care service: an impact assessment

In light of NHS England's recommendation to create a 7-day NHS, the colorectal and stoma care service at the Nottingham University Hospitals NHS Trust piloted a 7-day service. Combined colorectal/stoma care nursing roles were separated into dedicated roles; a holistic enhanced-recovery care pathway was implemented; and partial and full weekend working patterns for nurses was trialled. A comparative study assessed the efficacy of the changes. After implementation, stoma patients had a statistically significant 2-day average reduction in length of stay and an increase in the number of weekend discharges was noted. This reduction in length of stay represents a potential saving of over £150 000 for the Trust and the NHS. Although the impact of other concurrent service changes should be taken into account, this suggests that a 7-day service is a financially viable option.

Spiritual wellbeing and quality of life in stoma patients

Aim: Although there has been considerable recent research from around the world on the effect of spiritual wellbeing in a variety of chronic conditions, little research has been conducted specifically on the spiritual wellbeing of patients with a stoma. Therefore, this study aimed to quantify spiritual wellbeing in ostomates and determine whether this had any impact on their quality of life (QoL). Method: This study was conducted in Iran in 2016, and 70 ostomates were enrolled through convenience sampling. The data collection instrument was based on Palutzian and Ellison's Spiritual Wellbeing Scale and the City of Hope Quality of Life-Ostomy Questionnaire. Results: Among the 70 participants, 38 were women (54%). The mean of the total QoL scores was 4.4 (SD=0.7). When separated into physical, psychological, social and spiritual dimensions, the mean QoL scores were 5.7 (SD=0.8), 4.2 (SD=0.7), 3.4 (SD=0.7) and 4.7 (SD=1.1), respectively. The mean score for spiritual wellbeing was 75.1 (SD=7.7). Physical, psychological, social and spiritual dimensions of QoL and total QoL had direct and significant correlations. Conclusion: These results demonstrated that there is a relationship between QoL and spiritual wellbeing levels in ostomates, and this can be used by health-care planners and caregivers to improve the QoL of their patients.

A Cross-sectional Study of Nutritional Status, Diet, and Dietary Restrictions Among Persons With an Ileostomy or Colostomy

Little is known about the nutritional status and dietary habits of persons with an intestinal stoma, and no specific dietary guidelines have been established. A cross-sectional study was conducted among patients of a Stoma Patient Health Care Service in Juiz de Fora, Brazil, to compare the nutritional status of persons with an ileostomy or colostomy and to evaluate which foods are avoided most frequently and why. Anthropometric measurements (weight, height, arm circumference, and triceps and subscapular skinfold thickness) and body fat were assessed. Habitual dietary intake (energy, protein, carbohydrate, fiber, fat, calcium, iron, sodium, potassium, thiamin, riboflavin, vitamin B6, vitamin B3 [niacin], and vitamin B12) was assessed using a validated quantitative food frequency questionnaire. Foods avoided and reasons for avoidance (increased odor, increased gas, increased output, constipation, appliance leakage, and feelings regarding leaving home) were assessed. All data were collected without personal identifiers and stored in electronic files. Data were analyzed descriptively, and the Student's t test or Mann-Whitney test was used to compare the groups. Chi-squared analysis with Yates' continuity correction or Fisher's exact test was employed to examine the differences in the frequency of avoided foods by reasons for avoidance between the 2 groups. Of the 103 participants (52 [50.5%] men, 51 [49.5%] women; mean age 60.5 ± 12.9 years); 63 (61.2%) had a colostomy and 40 (38.8%) had an ileostomy. For both groups combined, time since surgery ranged from 1 to 360 months. Anthropometric measurements and body composition did not suggest nutritional deficiencies and did not differ significantly between groups. Persons with an ileostomy had a significantly lower fat and niacin intake than persons with a colostomy (P <.05). No other dietary intake differences were observed. Avoiding foods due to appliance leakage was more common among participants with an ileostomy (8, 20%) than a colostomy (3, 4.8%), and vegetables and fruits were reported as the most problematic foods. None of the other cited reasons was significantly different. The results of this study confirm that many persons with a stoma adjust their dietary intake and avoid certain foods which, especially in persons with an ileostomy, may increase their risk for nutritional deficiencies. Additional research to assess dietary intake and nutritional status variables as well as patient needs is needed to facilitate the development of specific nutritional status monitoring and dietary recommendations for persons with an ileostomy or colostomy.

Please hold the line: setting up a telecare service for stoma patients using Skype

Telehealth is an efficient and cost-effective way to follow up patients discharged after the enhanced recovery after surgery (ERAS) pathway. Colorectal and stoma care clinical nurse specialist (CNS) teams explored giving patients the option to have their follow-up appointment via the online videotelephony application Skype, instead of by telephone. A literature review returned no applicable results. A pilot study of patients going through colorectal preoperative assessment showed that there was interest in the idea, but that not all patients were able to access Skype. Seven participants returned questionnaires reporting unanimous satisfaction with the service. To improve patient access, tablets were procured and given to those stoma patients undergoing planned surgery who did not have their own device. Video calls allow for visual assessment of the patient, as well as personalised face-to-face interaction. The CNS teams aim to roll this service out further by increasing access for patients.

Stigma and its influencing factors among Chinese patients with stoma.

Although stomas are necessary for disease treatment, they unavoidably affect patients' lives from physical, psychological, social, spiritual, and familial perspectives and contribute to feelings of embarrassment and shame. This study explored the current status and factors influencing stigma among Chinese patients with stoma. A total of 209 patients with stoma at the stoma clinic of a tertiary cancer centre in Guangzhou, China, were recruited and investigated by using the Social Impact Scale, the Coping Self-Efficacy Scale, the State Self-Esteem Scale, and a demographic questionnaire. Multivariate linear regression was used to identify the factors influencing stigma. The mean Social Impact Scale score was 69.65±13.18, which represents a moderate effect; specifically, 44% of the patients experienced high levels of stigma. Stoma patients with the following characteristics had high levels of stigma: young, low coping self-efficacy, low stoma acceptance by one's spouse or other family members, poor perceived body image, stool leakage, and no experience of participating in activities with other stoma patients. Medical staff members should pay more attention to stigma in stoma patients. Coping self-efficacy, family members' acceptance of the stoma, and participation in activities with other stoma patients are influencing factors that protect these patients against stigma, whereas body image loss and stool leakage place them at higher risk for stigma. Interventions aimed at improving protective factors and decreasing risk factors should be considered to reduce the level of stigma in patients with stoma.

What's in a name: friend or foe? Coping strategies used by stoma patients.

What's in a name: friend or foe? Coping strategies used by stoma patients.

Quality of Life and Characteristics of Colostomy Patients

Introduction: Colostomy imposed multiple impacts on the patient’s life including physical, psychological, social, and spiritual. This study aims to identify the level of quality of life as well as to examine the differences of quality of life among colostomy patients with regards to certain demographic characteristics.Methods: This study used a cross-sectional and descriptive analytical approach. Seventy-one colostomy patients were recruited purposively to participate in the study. The studied variables included quality of life and demographic characteristics. The data was collected by using the WHO Quality of Life – BREF instrument. One-way ANOVA and an independent t-test were employed to analyse the differences in quality of life with regards to certain demographic characteristics.Results: The study found that the majority of subjects perceived that their level of quality of life ranged between very low to moderate (77.4%). Satisfaction with support from friends was rated as the highest item of quality of life, whereas satisfaction with sexual relationships was rated as the lowest item of quality of life. There was no significant difference in the patients’ quality of life with regards to age group, educational background, occupation, length of being ostomate, sex, and other health problems.Conclusions: The study implied that nurses need to realise and pay attention to multiple aspects of stoma patient’s quality of life. Nursing care should not merely focus on stoma care but also holistically consider on meeting sexual needs, as well as the psychological, social, and spiritual needs of the patients.

Institution of a Preoperative Stoma Education Group Class Decreases Rate of Peristomal Complications in New Stoma Patients.

The purpose of this study was to compare selected postoperative complications (including stomal and peristomal complications), hospital length of stay, and readmission rates in a group of patients who attended a preoperative educational intervention to a retrospective group of patients who did not receive the intervention. Retrospective, comparison cohort study. The intervention group comprised 124 patients who attended an educational session for persons with fecal ostomies at a single tertiary care center in the Northeastern United States. They were compared to findings from a group of 94 individuals who underwent ostomy surgery during a 1-year period before initiation of the class. Patients undergoing emergent procedures or who had previous stomas were excluded. We found no significant differences between the 2 cohorts with respect to age, gender, comorbidities, open versus minimally invasive procedures, or colorectal diagnoses. A preoperative 2-hour stoma education class was led by certified WOC nurses for all patients undergoing colorectal surgeries in which the creation of a stoma was anticipated. This session included a didactic portion outlining postoperative expectations in the management of new ostomies (including dietary changes, prevention of dehydration, and an overview of ostomy supplies), as well as a hands-on portion to practice stoma care skills. We compared postoperative complications within 30 days (particularly stoma-related complications, including pouch leakage due to loss of seal, and peristomal skin irritation) between the group attending the education session and the control group. We also compared length of stay and 30-day readmission rates. Patients who participated in the educational intervention experienced significantly fewer peristomal complications than did patients in the historic control group (44.7% vs 20.2%, P = .002). Logistic regression analysis revealed that participation in the group was associated with a lower likelihood of peristomal skin complications (odds ratio = 0.35; 95% confidence interval, 0.18-0.67). Their length of stay (median 6 days vs 5 days, P = NS), and the proportion who experienced 30-day readmission (20.2% vs 15.3%, P = NS), did not significantly differ. A preoperative stoma education group class significantly reduced the likelihood of frequent leakage from the ostomy pouching system and peristomal skin irritation.

Quality of life assessment in stoma patients in a tertiary care hospital in South India: a cross- sectional study

Background: Quality of life (QOL) of patients is affected due to procedures done to treat the disease. A good QOL is essential to achieve a holistic approach in treating patients.Methods: We did a cross-sectional study in a tertiary care hospital to describe, identify and compare the factors affecting the QOL of these patients.Results: 42.5% had a permanent stoma and a majority 32.5% were due to a malignancy. Major concerns were skin rash and irritation, depression, loneliness and suicidal thoughts. 62.5% of the total had not gone to work after creation of a stoma. Malignancy was found to be a significant predictor of having a low QOL score.Conclusions: Quality of life of stoma patients in present study was not ideal. There is a definite need to have support groups for these patients in all hospitals.

Evaluating nursing standards in a stoma care service: results of an internal audit

An audit was undertaken using the Association of Stoma Care Nurses (ASCN) UK nursing standards to allow the stoma care team to benchmark their current service. Patients were contacted 1 month after discharge from hospital, and a telephone interview was conducted using the ASCN audit questionnaire. The data were analysed and presented to the team, and an action plan was agreed. Results highlighted that, although there were many areas of good practice, there were also areas that needed improvement, including offering patients a preoperative chance to meet another stoma patient and making them aware of their individualised care plan and of potential stoma complications prior to discharge. In addition, patients needed sufficient time to discuss how they felt and to be informed about relevant support groups and prescription changes relating to their appliance and accessory requirements.

Diversion colitis 25\xa0years later: the phenomenon of the disease

BackgroundDiversion colitis (DC) seems to be common in stoma patients, and the restoration of the continuity of the digestive tract is crucial for relief from the inflammatory process. No prospective studies of the late effects of DC on the lower gastrointestinal (GI) tract mucosa and the clinical condition of patients have been reported.MethodsData from 23 patients who underwent stoma creation were analysed during the reversal period (A) and at an average of 3 months (B1) and 5.6 years (B2) after restoration of GI tract continuity. Every monitoring visit included endoscopy, histology and assessment of the clinical condition of patients.ResultsShortly after GI tract restoration (B1), a significant decrease in inflammation was observed. The Ki67 positivity percentage increased, but this was not significant. At an average of 5.6 years after restoration (group B2), the clinical symptoms were mild. More patients presented with endoscopically detected inflammation of the mucosa, but its severity was not significantly higher than that at 3 months after reversal. Histological inflammation was more common, and its severity was significantly higher than that shortly after reversal but similar to that before reversal. The Ki67 positivity percentage decreased at the last examination (B2).ConclusionsThe results of this study show a complex recurrence of histological inflammation several years after GI tract restoration but without clinical and endoscopic inflammation and with good clinical condition. DC can potentially have a late influence on the rectal mucosa, even after stoma closure.

The potential benefits of using aloe vera in stoma patient skin care.

Individuals living with an ostomy may suffer from a variety of peri-stomal skin complications related to the use of their stoma appliance or accessories. These conditions can be serious enough to significantly impact on a patient's quality of life and may result in severe clinical complications (such as infection). This article is a review of the literature with the objective of investigating and presenting evidence for the well-documented use of aloe vera in the prevention of skin conditions similar to those seen in peri-stomal skin complications. An exploration for the potential use of aloe vera directly or indirectly (as an adjunct to medical devices such as wafers) in stoma patients is presented with the view that this use may be beneficial in the prevention of such peri-stomal skin complications.

Physical activity and exercise after stoma surgery: overcoming the barriers.

This article presents the results from a large nationwide survey completed in 2016 that investigated the physical health and wellbeing of people living with stomas in the UK. In particular, the survey looked at physical activity and exercise, general attitudes and opinions about exercise, whether or not advice about physical activity had been received and other general questions about parastomal hernia and quality of life. There were 2631 respondents making it one of the largest known surveys to date. The findings were concerning yet unsurprising, highlighting a trend toward inactivity after stoma surgery and a fear of exercise in general. People also seem to have poor knowledge about appropriate activities, with many suggesting that the fear of developing a parastomal hernia is a major barrier to activity. Unsurprisingly, those who have a stoma owing to cancer seem to fare worse, reporting even lower levels of physical activity and worse quality of life compared to those with other conditions. This indicates that people who have a combination of a cancer diagnosis and also a stoma may need more specific or additional support in the longer term. The most concerning finding, however, was that the majority of patients could not recall being given any advice about exercise or physical activity by their nurse or surgeon. While this survey presents some initial findings, it raises questions for further research and work. It also highlights a significantly neglected area in both research and support for stoma patients and the health professionals caring for them.

Investigation of self-care ability and influencing factors of rectal cancer patients with temporary ileum stoma

Objective To describe self-care agency and its influence factors of the patients with temporary ileum stoma. Methods The descriptive statistics of non-experimental study was performed in the study. The convenience sample consisted of 144 patients from 3 hospitals in Shanghai. The self-care agency was measured by the Colostomy Self-care Agency Scale. Results 144 cases of colorectal cancer temporary ileum stoma patients′ self-care ability scored an average of 57.02±7.00, including self-care willingness (37.19 ± 4.04) points, self-care knowledge 17 points, self-care skills 3 points. The multiple stepwise regression analysis showed that seven factors were statistically significant including age, gender, culture level, living area, postoperative months, presence of complications, whether to accept professional nursing training or education. Conclusions Temporary ileum stoma in patients of rectal cancer with medium self-care ability, but self- care skill level is relatively not high and should be strengthen attention in patients with rectal cancer undergoing ileum stoma. Targeted nursing intervention should be carried out to improve the self-care ability and improve the quality of life of patients with stoma. Key words: Temporary ileum stoma; Self-care agency; Influencing factors