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OSTOMY

Ostomy Literature Review 2009

Journal of Wound, Ostomy and Continence Nursing: July/August 2010 - Volume 37 - Issue - p S20-S24
doi: 10.1097/WON.0b013e3181e408ce
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O1 TITLE: AUA and WOCN Society Joint Position Statement on the Value of Preoperative Stoma Marking for Patients Undergoing Creation of an Incontinent Urostomy

AUTHORS: WOC Nurses and Urologist Committee Members

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(3):267–268

ARTICLE TYPE: Multidisciplinary Position Statement

DESCRIPTION/RESULTS:

  • This document follows the position statement made by the WOCN and American Society of Colorectal Surgeons about stoma site marking for fecal ostomies.
  • The principles of site marking are similar to those advocated in the 2007 statement. This position statement emphasizes the importance of site marking for urinary stomas.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • This position statement sets the standard for stoma site marking and preoperative education for every patient undergoing urostomy.

O2 TITLE: The Experience of Fecal Leakage Among Ileostomists

AUTHORS: Redmond C, Cowin C, Parker T

SOURCE:British Journal of Nursing 2009 (Stoma Care Supplement);18(17):S12–S17

ARTICLE TYPE: Descriptive, Cross-Sectional Study

DESCRIPTION/RESULTS:

  • Researchers used a questionnaire to identify stomal and peristomal in 1035 persons with ileostomies; 76% of respondents had lived with an ostomy for more than 5 years. More than half (57%) experienced daytime leakage, and 61% reported nighttime leakage. Fewer than half of those reporting leakage had sought professional help. In addition, 65% reported “sore skin,” 41% reported red irritated peristomal skin, 20% reported bothersome folds and scars, and 17% reported parastomal hernias. Stomal retraction was reported by 10% and prolapse by 1%. One- quarter of respondents used convex wafers and 30% used 2-piece pouches. The use of barrier films did not reduce the incidence of leakage; using more accessories was associated with a higher likelihood of leakage.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • These findings reveal a high prevalence of leakage following creation of an ileostomy, and they provide a compelling rationale for ongoing access to WOC professional services.

O3 TITLE: Accessories or Necessities? Exploring Consensus on Usage of Stoma Accessories

AUTHORS: Rudoni C, Dennis H

SOURCE:British Journal of Nursing. 2009;18(18):1106–1112

ARTICLE TYPE: Research Report; Cross-sectional Survey

DESCRIPTION/RESULTS:

  • Surveys were returned by 193 ostomy nurses with an average of 10 years' experience and 120 persons with ostomies 2-10 years in duration. Forty-six percent of respondents had an ileostomy, 30% had a colostomy, and 24% had a urostomy. A majority (72%) of patients reported that accessory products are essential or very important to their stoma care and quality of life. The top-5 accessories recommended by ostomy nurses were adhesive remover spray, deodorizers, barrier wipes, paste, and adhesive remover wipes. The top-5 accessories used by persons with ostomies were adhesive remover wipes, barrier wipes, adhesive remover spray, deodorizers, and gauze swabs. Prevention of odor was rated high by persons with stomas and low by ostomy nurses. Seventy-four percent of ostomy nurses indicated that patients should seek their advice before using an accessory product but 64% of persons with ostomies report that they do not do this.

WHAT DOES THIS MEAN TO ME AND MY PRACTICE?

  • WOC nurses must consider the psychological need for an accessory product as well as its physical/clinical need. Additional research is needed to more fully understand the role of various accessory products among persons living with an ostomy.

O4 TITLE: Managing the Cutaneous Vesicostomy

AUTHORS: Sledge F, Gray M

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(1):94–99

ARTICLE TYPE: Integrative Review Article/Case Studies

DESCRIPTION/RESULTS:

  • Children with neurogenic bladder dysfunction who are not able to be managed with intermittent catheterization or pharmacologic treatment may undergo cutaneous vesicostomy to ensure low pressure bladder drainage. A vesicostomy also relieves upper urinary tract distress, including hydronephrosis, urinary tract infection frequency, vesicoureteral reflux, and deteriorating renal function.
  • Nevertheless, children with vesicostomy experience continuous urinary incontinence, and have a stoma that is not amenable to pouching. This places them at risk for incontinence-associated dermatitis and creates challenges for urinary containment.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • It is important that the caregivers for these children have access to CWOCN who can assist them with the ongoing challenges associated with presence of a vesicostomy.

O5 TITLE: Early Postoperative Complications Following Ostomy Surgery: A Review

AUTHOR: Butler D

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(5):513–519

ARTICLE TYPE: Integrative Review Article

DESCRIPTION/RESULTS:

  • This article reviews the etiology and management of stomal and peristomal complications.
  • The author notes that the risk for stomal complications is affected by multiple preoperative, intraoperative, and postoperative factors that require the skill of an experienced clinician to assess and provide an effective pouching system.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Accurate assessment of and prompt attention to peristomal and stomal complications by the WOC nurse facilitate the patient's adjustment to an ostomy.

O6 TITLE: A Prospective Multicenter Evaluation of A Moldable Stoma Skin Barrier

AUTHORS: Hoeflok J, Guy D, Allen S, St. Cyr D

SOURCE:Ostomy Wound Management 2009;55(5):62–69

ARTICLE TYPE: Multicenter Product Evaluation

DESCRIPTION/RESULTS:

  • A new technology in skin barriers for stomas is evaluated in several Canadian health systems. The study is industry sponsored.
  • The moldable wafer does not require cutting and conforms well to the stoma reducing the potential for peristomal skin breakdown from an opening cut too large.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • The article provides a nice model for conducting product evaluations and suggests a high level of approval particularly from nurses with the new moldable wafer.

O7 TITLE: Terminal Patients with Urinary Diversion: Are There Specific Treatment or Nursing Care Problems in the Primary Healthcare Sector?

AUTHORS: Jensen KB, Kiesbye B, Jensen KM-E

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(4):424–427

ARTICLE TYPE: Cross-Sectional Survey

DESCRIPTION/RESULTS:

  • Primary care providers (physicians and home care nurses) completed a survey comparing their experiences with 71 patients with ileal pouches, continence cutaneous urinary diversions (Indiana pouches), or orthotopic neobladders (Hautmann neobladders).
  • No differences in the frequency or severity of management challenges were noted when incontinent and continence urinary diversion techniques were compared.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Similar to the perceptions of patients, long-term results for specific types of urinary diversions (ileal conduit, cutaneous continent diversions, or orthotopic neobladders) do not differ. This information may be especially useful when counseling patients making decisions about creation of urostomy versus an orthotopic neobladder.

O8 TITLE: Current Trends in the Management of Bladder Cancer

AUTHORS: Patel A, Campbell C

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(4):413–421

ARTICLE TYPE: Integrative Review Article

DESCRIPTION/RESULTS:

  • Comprehensive review of bladder cancer etiology, diagnosis, and management for the WOC nurse.
  • Includes surgical and medical treatments and possible new therapies currently in clinical trials.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Since the incidence of bladder cancer incidence is rising in the United States, WOC nurses are likely to see more patients with urinary diversions. This article provides a valuable review of the underlying disease most likely to result in creation of a urostomy.

Psychosocial/Cultural Adjustment With an Ostomy

O9 TITLE: Young Adults With Permanent Ileostomies: Experiences During the First 4 Years After Surgery

AUTHOR: Sinclair L

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(3):306–316

ARTICLE TYPE: Qualitative Descriptive Study

DESCRIPTION/RESULTS:

  • The authors used a narrative inquiry method to describe experiences of 7 persons aged 24 to 40 years with an ileostomy. The researchers focused on the perioperative period, including the decision to undergo surgery and the first 4 postoperative years.
  • Various themes were identified including postoperative pain, nursing care, ostomy care, and the need for information and education. Respondents also identified struggles related to the decision to undergo surgery (if elective) and challenges integrating the ostomy as “part or me.”
  • Following surgery, respondents recounted their experiences reconnecting with others. They described initiating this process with nursing staff, followed by reconnection with family, friends, and associates within their work setting.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • These study findings emphasize the importance of the care provided by both CWOCN and other nurses. These patients clearly looked to nurses to provide information and education following surgery, and they perceived the nurses as role models, who acted as initial contacts allowing the person to reconnect with others on a social level while struggling to integrate the stoma as part of an altered physical appearance. Of note, patients recalled the responses of all nurses they came into contact with, emphasizing the importance of ongoing education about physical care and psychosocial support for patients undergoing ostomy surgery.

O10 TITLE: The Influence of Husbands' or Male Partners' Support on Women's Psychosocial Adjustment to Having an Ostomy Resulting From Colorectal Cancer

AUTHORS: Altschuler A, Ramirez M, Grant M, et al

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(3):299–305

ARTICLE TYPE: Descriptive Study, Mixed Quantitative/ Qualitative Design

DESCRIPTION/RESULTS:

  • Thirty women with a permanent ostomy who were at least 5 years status post colorectal cancer surgery participated in the study. Quantitative data were extracted from the City of Hope HRQOL questionnaire; qualitative data were derived from semistructured interviews.
  • Husbands and partners exerted clinically relevant effects on psychosocial adjustment of women with colorectal cancer and intestinal ostomies. Women reporting the highest HRQOL expressed the most positive support from husbands.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • These findings suggest that emotional support from a spouse or partner profoundly influences psychosocial adjustment to an intestinal stoma.

O11 TITLE: Sexuality Among Patients With a Colostomy: An Exploration of the Influences of Gender, Sexual Orientation, and Asian Heritage

AUTHOR: Li CC

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(3):288–296

ARTICLE TYPE: Integrative Review Article

DESCRIPTION/RESULTS:

  • The psychological impact of sexual dysfunction on the person with a colostomy is perceived differently by men and women. Perceptions of sexuality after ostomy surgery are profoundly affected by sexual orientation, the attitude and response of the person's sexual partners, and cultural values.
  • While progress has been made in surgical techniques to decrease physical aspects of postoperative sexual dysfunction and treatment for the resulting dysfunction is available, reestablishing sexual function remains a challenge following ostomy surgery.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Sensitivity to the influence of sexual orientation, cultural values and the attitude of sexual partners is essential when providing sexual care and counseling for the patient undergoing surgery resulting in a colostomy.

O12 TITLE: Cultural and Religious Beliefs in Stoma Care Nursing

AUTHOR: Black P

SOURCE:British Journal of Nursing 2009;18(13):790–793

ARTICLE TYPE: Literature Review

DESCRIPTION/RESULTS:

  • In the Islamic faith, output from an ileostomy is considered clean but colostomy or urostomy output is unclean and excretion must be followed by a ritual cleansing (ablution) of the body. Only the left hand can be used for ostomy care and running water must be used. Many Muslims will request the stoma be sited above the umbilical area. Fasting during Ramadan can lead to dehydration. For Muslims, a stoma often negatively affects quality of life and participation in religious activities.
  • Many strictly observant Jews will not perform activities on Saturday that involve work, and this may include pouching.
  • Since persons in the Sikh faith do not consume animal-based gelatin, the elixir form of medications, such as loperamide, must be used rather than the capsule. The symbolic underwear worn by Sikhs must not be removed for any reason.
  • Many Hindus will want to apply a clean ostomy pouch before they pray.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Ostomy nurses need to recognize how cultural and religious beliefs influence stoma surgery and ongoing ostomy management. This article reviews faith based factors likely to influence postoperative management of the person undergoing ostomy surgery.

O13 TITLE: Young Peoples' Experience of Living With Ulcerative Colitis and an Ostomy

AUTHORS: Savard J, Woodgate R

SOURCE:Gastroenterology Nursing 2009;32(1):33–41

ARTICLE TYPE: Qualitative (Phenomenological) Study

DESCRIPTION/RESULTS:

  • Interviews with 5 women and 1 man, aged 19-24 years, identified themes associated with ulcerative colitis and a temporary ostomy. The principal theme identified was “concealing and revealing the self,” described as how respondents presented their true self to others. Additional themes identified included “uneasy feelings” (embarrassment, feeling different, frustration, worry, why me?); “it's hard” (restrictions, unpredictability (loss of control, pain); and renewed sense of self (freedom, new lease on life). Initially, changing body image caused patients to hide their illness and ostomy but eventually most reported a renewed sense of self once they began to feel healthy again. Most reported, once the ostomy was closed, the illness/surgery had changed their lives for the better.

WHAT DOES THIS MEAN TO ME AND MY PRACTICE?

  • These study results reveal the considerable psychosocial distress associated with the experience of creation of a temporary ostomy during the course of surgical management of ulcerative colitis. A review of study findings is valuable because it can produce insights into individualized counseling, education and psychosocial support during this challenging process.

O14 TITLE: Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations By Sex

AUTHORS: Krouse R, Herrinton J, Grant M, Wendel C, Green S

SOURCE:Journal of Clinical Oncology 2009;27(28):4664–4670

ARTICLE TYPE: Comparison Cohort Study

DESCRIPTION/RESULTS:

  • Four hundred ninety-one men and women with a colorectal cancer diagnosis at least 5 years before were compared to a group of subjects with rectal cancer but no ostomy.
  • Two hundred forty-six persons with ostomies were given the ostomy portion of the City of Hope Health Care QOL survey. The comparison group was 245 participants with rectal cancer but no ostomy. This comparison cohort completed a general HR QOL questionnaire.
  • Women were twice as likely to express feelings of depression owing to physical changes and illness as male respondents. Younger women were even more likely to report difficult adjustment.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Women, and younger women in particular, may require particular support in order to cope with the physical changes associated with creation of an ostomy for treatment of colorectal cancer.

O15 TITLE: Happily Hopeless: Adaptation to a Permanent, But Not to a Temporary, Disability

AUTHORS: Smith DM, Loewenstein G, Jankovic A, Ubel PA

SOURCE:Health Psychology 2009;28(6):787–791

ARTICLE TYPE: Descriptive Study (Repeated-Measures Analysis)

DESCRIPTION/RESULTS:

  • Thirty participants with a permanent stoma and 41 with a temporary ostomy were initially interviewed while hospitalized for ostomy surgery. Follow-up surveys that incorporated several validated instruments used to measure psychological well-being (life satisfaction and quality of life) were mailed at one week, one month and 6 months after discharge from the hospital.
  • Overall life satisfaction and quality of life increased over time for patients with permanent, but not temporary, ostomies.
  • Based on these findings, the researchers conclude that knowledge that an ostomy is temporary interferes with adaptation, leading to a paradoxical situation in which people who are better off objectively are worse off subjectively.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Patients with temporary ostomies may need encouragement to move on with their lives and not wait for their reversal surgery before resuming their activities.

Fistulas

O16 TITLE: Management of Complex Abdominal Wounds With Small Bowel Fistulae Isolation Techniques and Exudate Control to Improve Outcomes

AUTHORS: Brindle T, Blankenship J

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(4):396–403

ARTICLE TYPE: Integrative Review Article/Case Studies

DESCRIPTION/RESULTS:

  • An integrative review of management options for persons with enterocutaneous small bowel fistulae within large abdominal wounds is provided.
  • The authors then describe several cases that illustrate their approach to fistula management based on isolation of the fistula from the wound bed and complete diversion of effluent from the adjacent tissues of the wound bed. The authors argue that this technique is particularly useful for high-output enteric effluent (1-6 L daily). They also argue that the technique is cost-effective.
  • The authors advocate additional research in the area of fistula management.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • The careful description and illustrative figures in this article provide options for the CWOCN challenged to manage enterocutaneous fistulae in the hospital setting.

Survivorship

O17 TITLE: The Challenges of Colorectal Cancer Survivorship

AUTHORS: Denlinger CS, Barsevick AM

SOURCE:Journal of the National Comprehensive Cancer Network 2009;7(8):883–893

ARTICLE TYPE: Integrative Review Article

DESCRIPTION/RESULTS:

  • The authors review late and long-term (> 3 years) effects of newer treatment regimens for colorectal cancer (CRC). The most common sequelae of CRC treatments include erectile dysfunction (80%), inability to defer defecation (78%), ejaculatory problems (72%), voiding frequency (70%), female sexual dysfunction (62%), urinary incontinence requiring containment devices (57%), chronic diarrhea (49%), fatigue (23%), and peripheral neuropathy (12%). Women who receive pelvic radiation have a 27% lifetime risk for pelvic fracture. Overall survival is decreased in very obese or underweight individuals and in those who consumed a diet high in meat, fat, refined grains, and desserts.
  • A 47% improvement in disease-free survival was shown for those who walked at an average pace for 6 hours or more a week. Lower CRC-specific mortality is associated with consistent aspirin use and high circulating levels of 25-hydroxy vitamin D. Quality of life (physical and functional) improves after most CRC survivors reach the 3-year postdiagnosis milestone.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Our responsibility to our patients continues into the period of long-term survivorship. Goals of care include management of physical, sexual, and psychological symptoms, promotion of healthy diet and exercise, and encouragement to adhere to recommended preventive care guidelines.

Professional Practice

O18 TITLE: Development and Psychometric Evaluation of the Ostomy Adjustment Inventory-23

AUTHORS: Simmons K, Smith J, Maekawa A

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(1):69–76

ARTICLE TYPE: Validation Study

DESCRIPTION/RESULTS:

  • Condition specific QOL instruments among persons with ostomies are limited. Therefore, the researchers adapted the Ostomy Adjustment Inventory–23 (OAI-23) from the Ostomy Self-Adjustment (OAS) Scale. The OAS Scale was used in a study in 2000 in Japan. The authors adapted this scale to create the OAI-23.
  • It was tested on 570 subjects in the UK with colostomies, ileostomies, or urostomies and found to be a valid and reliable measure of psychosocial adjustment.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • Clinicians with an interest in assessing their patients' adjustment to an ostomy have an ostomy-specific tool to use, and nurses wishing to do research may want to use this tool.

O19 TITLE: Should WOC Nurses Measure Health-Related Quality of Life in Patients Undergoing Intestinal Ostomy Surgery?

AUTHORS: Pittman J, Kozell K, Gray M

SOURCE:Journal of Wound, Ostomy and Continence Nursing 2009;36(3):254–265

ARTICLE TYPE: Systematic Literature Review (Evidence-Based Report Card)

DESCRIPTION/RESULTS:

  • The authors report results of an integrative literature documenting the clinical relevance of changes in health-related quality of life (HRQOL) following ostomy surgery. Health-related quality of life is impaired by ostomy surgery; multiple factors influence the magnitude of impairment including number and severity complications, sexual function, and ability to pay for ostomy supplies. Impairment is usually transient.
  • A systematic review identified 2 randomized clinical trials evaluating improve HRQOL in these patients.
  • A systematic literature identified 4 instruments used to measure HRQOL following ostomy surgery; none has been adapted for clinical use.

WHAT DOES THIS MEAN FOR ME AND MY PRACTICE?

  • HRQOL is impaired following ostomy surgery, but the effect is usually transient (persisting for 1 year or less) and can be ameliorated by nursing interventions. Routine measurement of HRQOL is indicated but existing instruments need to be adapted for clinical use.
Copyright © 2010 by the Wound, Ostomy and Continence Nurses Society