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PubMedDate not supplied

Strategies for online teaching and learning: lessons learned.

Distance learning and Web-based learning are accepted components of the American higher educational system. Strategies for teaching and learning in this medium require a different perspective on the teacher-student relationship and the educational process. The authors describe an innovative online learning endeavor focusing on a specialty practice area in contemporary healthcare: wound, ostomy, and continence nursing. Special emphasis is placed on the teaching-learning approaches that were successfully incorporated into the program.

Computer-Assisted Instruction↗
PubMed1979

Asymptomatic cecal stenosis after necrotizing enterocolitis.

Survival of infants with necrotizing enterocolitis may be complicated by intestinal stricture(s) as a result of healing of ischemic segments of bowel. An asymptomatic cecal stenosis not visible on barium enema was identified at operation for reestablishment of intestinal continuity. Infants recovering from acute necrotizing enterocolitis deserve continued surveillance for mechanical and functional abnormalities of the gastrointestinal tract. Patency of the intestinal lumen distal to the ostomy site should be clearly demonstrated by the surgeon when continuity is reestablished.

Cecal Diseases↗
PubMed1994

Loop ileostomy: a reliable method of diversion.

Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.

Adolescent↗
PubMed1998

A grounded theory of reimaging.

Several cross-sectional, qualitative studies suggest that physical alterations in appearance or functioning have the potential to influence self-esteem. There have been no studies describing the process of adapting to body image disruption. A grounded theory of reimaging is proposed, based on the experiences of 28 participants who had experienced significant weight change, loss or paralysis of body parts, ostomies, scarring from burns or trauma, or surgical reconstruction. Participants were interviewed at 3, 6, 12, and 18 months following the physical alteration. Three phases, action processes, influencing factors, and outcomes, of reimaging are described.

Adaptation, Psychological↗
PubMed2003

Laparoscopic parastomal hernia repair.

Parastomal hernia is a common complication of ostomy construction. The morbidity and recurrence rates associated with repair can be quite high. Among the various approaches to repair, the lowest recurrence rates are associated with the use of mesh. We report a case in which a parastomal hernia was repaired laparoscopically. By employing this minimally invasive approach, our patient avoided the morbidity associated with laparotomy for intraperitoneal mesh placement.

Aged↗
PubMedDate not supplied

Combination povidone-iodine and alcohol formulations more effective, more convenient versus formulations containing either iodine or alcohol alone: a review of the literature.

Topical antiseptic formulations containing single active ingredients of alcohol and iodine are recognized by the Food and Drug Administration as "generally safe and effective" for "preparation of the skin prior to surgery" or "prior to an injection" including "catheter care, ostomy hygiene, and intravenous site preparation" (Federal Register, 1994). However, a synergistic effect results from the combination of ethyl or isopropyl alcohol and povidone-iodine. Because each active ingredient has different modes of action and performance characteristics, these combination formulations are faster acting with a broader spectrum of antimicrobial activity than formulations containing povidone-iodine alone, and more persistent than formulations containing ethyl or isopropyl alcohol alone.

Anti-Infective Agents, Local↗
PubMed1994

Biotherapy for colon cancer: promise or progress?

In the United States, more than 149,000 new cases of colorectal cancer are expected in 1994. Surgery remains the most effective method of treatment for this disease. Because these operations often result in formation of an ostomy, ET nurses frequently care for patients with colorectal cancer. Many of these patients will receive additional types of therapy after operation, including such traditional therapies as radiation and chemotherapy. Biotherapy, one of the newest therapeutic modalities in cancer care, is increasingly being used in the treatment of colorectal cancer. Because the ET nurse may be one of the few nurses caring for patients throughout the course of their disease, knowledge of the various biotherapeutic agents and the management of patients receiving them is vital.

Colonic Neoplasms↗
PubMed1995

A descriptive study of the career mobility of ET nurses.

A qualitative study of the career mobility of ET nurses in the United States was conducted. Self-report questionnaires and demographic data sheets were mailed to a sample of 117 ET nurses, and the return response was 54.3%. Members of the study sample ranged in age from 29 to 58 years, and the range of duration of practice as an ET nurse was 1.5 to 18 years. The current positions of the respondents varied from staff nurse in a non-ET nurse role to director of marketing or education for manufacturers of wound, ostomy, and incontinence products. Practice sites were evenly distributed between industry and clinical. Analysis of self-report questionnaires and telephone interviews identified 30 themes, which were reassessed for similarities and condensed to eight themes. These include consequences of the experience of being an ET nurse, precipitating event that resulted in a career change, ET nursing as a demarcation in practice, perception as currently practicing as an ET nurse, career mobility, feelings regarding ET nursing experiences, self-directedness in professional growth, and trajectory from clinical nursing to the business world.

Adult↗
PubMedDate not supplied

Wound-healing outcomes using standardized assessment and care in clinical practice.

INTRODUCTION: Wound-healing outcomes applying standardized protocols have typically been measured within controlled clinical trials, not natural settings. Standardized protocols of wound care have been validated for clinical use, creating an opportunity to measure the resulting outcomes. PURPOSE: Wound-healing outcomes were explored during clinical use of standardized validated protocols of care based on patient and wound assessments. DESIGN: This was a prospective multicenter study of wound-healing outcomes management in real-world clinical practice. METHOD: Healing outcomes from March 26 to October 31, 2001, were recorded on patients in 3 long-term care facilities, 1 long-term acute care hospital, and 12 home care agencies for wounds selected by staff to receive care based on computer-generated validated wound care algorithms. After diagnosis, wound dimensions and status were assessed using a tool adapted from the Pressure Sore Status Toolfor use on all wounds. Wound, ostomy, and continence nursing professionals accessed consistent protocols of care, via telemedicine in home care or paper forms in long-term care. A physician entered assessments into a desktop computer in the wound clinic. Based on evidence that healing proceeds faster with fewer infections in environments without gauze, the protocols generally avoided gauze dressings. RESULTS: Most of the 767 wounds selected to receive the standardized-protocols of care were stage III-IV pressure ulcers (n = 373; mean healing time 62 days) or full-thickness venous ulcers (n = 124; mean healing time 57 days). Partial-thickness wounds healed faster than same-etiology full-thickness wounds. CONCLUSIONS: These results provide benchmarks for natural-setting healing outcomes and help to define and address wound care challenges. Outcomes primarily using nongauze protocols of care matched or surpassed best previously published results on similar wounds using gauze-based protocols of care, including protocols applying gauze impregnated with growth factors or other agents.

Canada↗
PubMedDate not supplied

Diverticulosis and diverticulitis spectrum of a modern malady.

Diverticulosis and diverticulitis are common disorders in modern society and represent different places on the spectrum of diverticular disease. Often called a problem of western civilization, diverticular disease is rare in developing countries. This article provides an overview of the epidemiology of diverticular disease, risk factors, and clinical presentation in varying phases. Differential diagnostic testing and comprehensive management from the medical, surgical, and wound, ostomy, and continence nursing perspectives are also addressed. Nurses play a key role in supporting people with diverticular disease and referring them for appropriate assessment, treatment, and support.

Diverticulitis, Colonic↗
PubMedDate not supplied

A pilot study assessing the effectiveness of a glycerin suppository in controlled colostomy emptying.

UNLABELLED: The focus of this research was to explore another way for the patient to manage their colostomy. It was hoped that by inserting a glycerin suppository into the colostomy one would be able to evacuate the lower large intestine more effectively and efficiently. OBJECTIVE: To determine if persons with a sigmoid colostomy could obtain fecal continence by instituting a daily self-administered bowel-stimulating suppository. DESIGN: Randomized crossover comparative study comparing usual ostomy emptying practice with emptying with a glycerine suppository to stimulate controlled emptying. SETTING AND SUBJECTS: Adult males and females with a sigmoid colostomy were studied in their homes. INSTRUMENTS: The instruments included a profile questionnaire, a take-home diary, crossover and end-of-study questionnaires, and an exit questionnaire. METHODS: Subjects were randomized to their usual pouching method or to the experimental suppository method for 14 days each. RESULTS: There was no difference in fecal output, fecal volume, or flatus between the 2 groups. The action of the suppository was affected by its failure to remain in the bowel for an adequate amount of time. CONCLUSION: Further research is needed to determine if an adjunct device/method to hold the suppository in place would produce successful results.

Adult↗
PubMedDate not supplied

Case studies of an infant, a toddler, and an adolescent treated with a negative pressure wound treatment system.

Three pediatric case studies (infant, toddler, and adolescent) using negative pressure wound treatment system (NPWS) in a children's hospital are described. Each child had complex surgical wounds and different goals for the therapy. The infant had an ulcerating labial hemangioma surgically removed, and the NPWS was used to expedite granulation tissue in preparation for a split-thickness skin graft. The critically ill toddler required abdominal fasciotomies for compartment syndrome, and the NPWS was applied to reduce interstitial abdominal edema and manage the excessive wound drainage. The adolescent initially had surgery to correct a pectus excavatum; when the sternal wound became infected and required debridement, the NPWS was used to expedite wound healing. The results of the NPWS were positive. Although this therapy has been used more commonly in adults, these case studies demonstrate its efficacy in several different types of wounds and age groups of children. The wound, ostomy, continence nurse should include the NPWS in his or her treatment differential as a valuable option for pediatric patients.

Bandages↗
PubMedDate not supplied

Writing a grant proposal--part 2: research methods--part 2.

As part of a Spotlight series on grant writing by members of the Center for Clinical Investigation of the Wound Ostomy and Continence Nursing (WOCN) Society, this article completes an explanation about writing the Methods section of a grant proposal. The aim of this series is to enhance the skills of WOC nurses to increase submissions of high-quality grants related to WOC nursing science and success in garnering funding, particularly from foundation grants, such as that of the WOCN. In this article, writing about the sample and setting, power analysis, sampling and recruitment procedures, implementation and data collection procedures, statistical analysis plan, and ethical considerations are described.

Data Collection↗
PubMedDate not supplied

Preparing a grant proposal--Part 5: Organization and revision.

Translating a research idea into a well-written grant proposal takes planning and commitment. This Spotlight is the fifth in a series by the members of the Center for Clinical Investigation (CCI) of the Wound, Ostomy and Continence Nurses (WOCN) Society. The aim of this series is to facilitate high-quality grant writing and encourage submissions to WOCN's grants program. This article provides guidance on the development of a grant proposal and the revisions necessary to result in a polished final product.

Humans↗
PubMedDate not supplied

Thirty years of experience living with a continent ileostomy: bad restrooms--not my reservoir--decide my life.

OBJECTIVE: This study describes long-term adjustment of people with a continent ileostomy. SUBJECTS AND METHODS: Subjects were 68 people (25 males and 43 females) who underwent an operation for ulcerative colitis with a continent ileostomy (Kock pouch). The median number of years subjects had lived with a continent reservoir was 31 (range 29-36) at follow-up and the median subject age was 60 (40-89). Subjects completed a 36-item questionnaire designed to assess adjustment to ostomy surgery. Subjects ranked the questionnaire using a 6-point Likert scale; a response alternative "not relevant" was available. Content analysis was conducted on subjects' responses to an open-ended question covering aspects of their quality of life. RESULTS: High median adjustment ratings were found for all 36 statements; the maximum median rating of 6 appeared on 28 items. Eight items with the lowest median ratings were in the following domains: embarrassing situations, activity, body image, sexuality, and good care. Five items on medical care and 3 items on sexuality were most frequently considered "not relevant" by respondents. The most frequently mentioned quality-of-life domains were family, health, friends, and employment. Content analysis indicated that respondents were self-reliant, although they indicated that they experienced considerable impediments to bowel evacuation outside of the home. CONCLUSIONS: In the long-term, people with a continent ileostomy have good self-care. The quality and availability of public restrooms, however, reduces their daily activities away from home.

Adaptation, Psychological↗
PubMedDate not supplied

Issues and challenges in staging of pressure ulcers.

Wound assessment is a key element of effective wound care, and assessment of pressure ulcers includes accurate determination of wound stage. Although the original staging system established by Shea was based on his understanding of the pathology involved in pressure ulcer development, subsequent staging systems (and the one currently in use) were intended simply to establish the level of tissue damage. Recently, clinicians have drawn attention to numerous limitations associated with the current staging system, including the inability to differentiate between an inflammatory response involving intact skin and a deep tissue injury (deep bruising) underneath intact skin. This is a clinically significant difference because clinicians have noted that most inflammatory responses resolve with intervention, whereas most areas of deep tissue injury progress to full-thickness ulcers even when appropriate intervention is provided. A second area of controversy involves partial-thickness (Stage 2) lesions; because many of these lesions are caused by maceration and/or friction (as opposed to pressure) clinicians are frequently unclear regarding which of these lesions should be staged. In response to these concerns, the National Pressure Ulcer Advisory Panel convened a consensus forum and published white papers to clearly outline the issues; they solicited clinician feedback on the white papers and the Wound, Ostomy, Continence Nurses Society provided a written response. This article summarizes the key points of the white papers, WOCN Society response, and consensus forum discussion.

Humans↗
PubMedDate not supplied

Pressure ulcer pain.

OBJECTIVE: To describe and interpret the complexities of the pain experienced by persons with painful pressure ulcers. DESIGN: Heideggerian hermeneutic phenomenology. SETTING AND SUBJECTS: Ten participants with pressure ulcers hospitalized in an acute-care community hospital were interviewed. METHODS: Multiple taped interviews, transcripts, and field notes were collected over an 8-month period. Data analysis occurred over a 16-month period and included an initial process of naming the text, identifying themes, and writing the interpretations of each participant's story. Secondary analysis comprised reading across the texts for commonalities and shared meanings. These data were related to other literature sources, shared with a team of researchers familiar with the Heideggerian hermeneutic phenomenology process, and with wound, ostomy, and continence nurses. RESULTS: A total of 22 themes and 1 constitutive pattern were identified. Participants with varying stages of pressure ulcers shared poignant stories about their pain. Many related their accounts and instances of actions by health personnel and the treatment interventions that were painful. Some related their accounts of communication failures that contributed to stress, tension, and anxiety. CONCLUSIONS: The findings of this study clearly indicate the need for increased attention to pain assessment and pain management in nursing education, nursing practice, and nursing research. The findings also suggest that the commonly used definition of pain is insufficient and needs revision.

Adaptation, Psychological↗