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PubMed2001

Teaching the adult ostomy patient.

Ostomy education is based on principles of adult learning, including assessment of the learners' readiness, ability, and need to learn. Such teaching incorporates specific strategies designed to promote cognitive, affective, and psychomotor learning and strategies to overcome potential cultural barriers. In addition, modifications may be included to meet the needs of aged or disabled patients who have cognitive deficits or low literacy skills. Finally, ostomy education must include an evaluation of its effectiveness. This article reviews general guidelines for planning, implementing, and evaluating patient education for adult patients with ostomies.

Adult↗
PubMed2001

Living with an ostomy and short bowel syndrome: practical aspects and impact on daily life.

PURPOSE: Practical aspects and impact on daily life of short bowel syndrome (SBS) and an ostomy were explored in people with SBS. Interest was focused on nutrition and excretion, ostomy problems, associated medical and surgical problems, socioeconomic situation, and social and leisure activities. SUBJECTS AND SETTING: Six subjects (range, 38-68 years) with Crohn's disease were included from the University Short Bowel Clinic at Sahlgrenska University Hospital, Gothenburg, Sweden. Average disease duration was 25 years, and mean small intestinal length was 107 cm; 4 subjects were receiving parenteral nutrition at home. METHODS: Subjects were interviewed in their homes using a semistructured interview divided into the areas of focus. Data were transcribed by shorthand and were rewritten into the computer the same day. A questionnaire on nutrition and excretion was answered by the subjects in writing and mailed to the interviewer. RESULTS: The most significant observation was the limited ability to act spontaneously, because all daily activities involved considerable planning. Three subjects said they had never accepted the ostomy; the others would not return to their pre-stoma lifestyle. The 2 subjects with a colostomy described special emptying patterns that caused limitations in social life that had not been reported previously. Fistulas were reported as having been the most trying part of the disease. Three subjects worked part time, which was of utmost importance for quality of life. Fatigue influenced social and leisure activities. CONCLUSION: People with SBS are bothered by a number of demanding problems in various aspects of life. Therefore, a team approach toward care is critical to allow for coordination of action toward the various needs. It also seems unlikely that standard instruments of quality of life can capture the complicated situations with which these subjects live. It appears that coping mechanisms also need to be considered.

Activities of Daily Living↗
PubMedDate not supplied

[Ostomy: limitless rehabilitation? The nurse's point of view].

Knowing about the concept of rehabilitation and the semantic and philosophic meaning of the word limit (frontier), the author gives five basic propositions to justify the process of caring for rehabilitation of the ostomy patient. Concluding, the author states that this process has as limit its starting point. Therefore, it has to begin at preoperative stage. On the other hand, the limit as a point of arrival will established by the ostomy patient's motivation and his/her capacity of being involved in the self care activities and social participation. The author also declares that when rehabilitation is reached as a result of rehabilitation assistance process, it will be part of the dynamics of interpersonal relationships focusing on a new life style or a new social reality and, finally, as part of the process of living the ostomy person.

Attitude of Health Personnel↗
PubMedDate not supplied

The impact of an ostomy on sexuality.

Creation of an ostomy results in physiological and psychological changes that affect sexuality. Major physiological complications for men include erectile dysfunction and ejaculatory difficulties. For women, dyspareunia is the most common physiological complication. The presence of an ostomy can alter a person's body image, which, in turn, influences the desire for sexual activity. Sexuality concerns should be addressed with all patients undergoing ostomy placement. The PLISSIT model, which outlines four stages of interventions used in sexual counseling, can be used to guide nursing care.

Adaptation, Psychological↗
PubMed1992

[Living with an ostomy: a preliminary study].

This study reveals some aspects of ostomy patients life experience. The data were obtained by using the participant observation technique during the monthly meeting session of the Ostomy Patients Association from July 1989 to August 1991. The findings showed that the ostomized patients were concerned with: 1) the ostomy pouch (how to get it); 2) other persons opinion about ostomized patients; 3) their sexuality, and stoma care. The patients perceived themselves as physically disable and inferior persons. Some of them perceived themselves as having a normal life. Other patients also had to cope with the stigma of cancer.

Adaptation, Psychological↗
PubMed2004

Challenges of ostomy care and obesity.

In the United States, 13 to 16 million people are morbidly obese to the extent that medical intervention, simply based on obesity-related comorbidities, is needed. The challenge of ostomy care and the very obese patient lies in the skill and planning required for successful physical, emotional, and spiritual recovery. It is commonly believed that from the onset, the obese patient having surgery is at a significant disadvantage. Care of the obese patient requiring ostomy surgery includes considerable challenges - from preoperative preparation, including finding an optimal location for stoma placement, to the challenge of preventing complications during the intraoperative and postoperative phases of care. Concerns regarding pain management, immobility, skin injury, respiratory issues, embolic threats, and caregiver injury increase when treating the obese patient and must be addressed specifically. A case study approach is used as a framework to discuss the ostomy experience.

Comorbidity↗
PubMed1997

Development of an ostomy competency.

Staff educators and staff nurses developed an ostomy competency, with the guidance and expertise of the advanced practitioner and enterostomal nurse at a large teaching hospital. The competency improved the quality of care for surgical ostomy patients. Care was standardized and staff nurses' clinical knowledge was enhanced. Following the sessions, staff nurses verbalized increased confidence in working with patients with ostomies and demonstrated increased autonomy and problem-solving abilities. No variances in educational aspects of care were noted on clinical pathways.

Clinical Competence↗
PubMed1982

Providing sexual information to ostomy patients.

Forty patients with a permanent colostomy, ileostomy, or ileal conduit were interviewed. Besides changes in sexual performance postoperatively, the authors specifically attempted to determine answers to other sexual variables such as attractiveness, appliance problems, and partner reactions. The extent of information provided to patients on sexuality prior to the permanent ostomy was also examined. There was a significant but predictable incidence of male impotence and female dyspareunia after surgery. Despite innumerable sexual variables, other than performance, which these patients faced postoperatively, 42 per cent received no information regarding sexuality at the time of ostomy surgery. most patients (97.5 per cent) stated that sexuality, including variables other than performance, should be discussed primarily by the surgeon prior to permanent ostomy surgery. The enterostomal therapist has an important role in the total patient adjustment in the long-term postoperative period.

Adaptation, Psychological↗
PubMed1983

Partner reaction following ostomy surgery.

This study was conducted to obtain information regarding sexual adjustment following ostomy surgery and to explore the spouse/partner's reaction upon resuming sexual activities following surgery. Home interviews were conducted with 40 subjects who had a permanent stoma, where the mean length of time since surgery averaged 4.6 years. Retrospective perceptions of the spouse/partner's reactions were varied. A majority reported that their spouses reacted positively to the first sexual experience following ostomy surgery. However a substantial number of subjects stated that their sexual partner reacted with caution ("fear of hurting me") or in a negative manner. This and previous studies indicate that the sexual partner plays a key role in helping the person adjust following ostomy surgery.

Adaptation, Psychological↗
PubMed1995

Trends in pediatric ostomy surgery: intestinal diversion for necrotizing enterocolitis and biliary diversion for biliary hypoplasia syndromes.

Ostomies are placed in children for different indications than in the older population. Many ostomies of childhood are placed because of congenital or neonatal problems that require temporary or long-term diversion to stabilize the neonatal patient. Necrotizing enterocolitis, the most common reason for placement of neonatal colostomies and ileostomies, is increasing in frequency as more prematurely born infants survive. Recently, there has been an increase in treatment of various biliary hypoplasia syndromes with biliary cutaneous diversion. Children with biliary hypoplasia syndromes are a challenging group of patients who frequently can be helped by ostomies. This article reviews current information on biliary cutaneous diversion for the biliary hypoplasia syndromes and intestinal diversion for necrotizing enterocolitis.

Bile Ducts↗
PubMedDate not supplied

The experience of flatus incontinence from a bowel ostomy: a hermeneutic phenomenology.

OBJECTIVE: To interpret and present possible meanings in the stories of people with bowel ostomies about their experience of impact of flatus incontinence on their life and being. DESIGN: Hermeneutic phenomenology guided by a Gadamerian perspective. SETTING AND SUBJECTS: Six people with a bowel ostomy were recruited from a city in Australia. METHODS: In-depth, nonstructured interviews generated rich text. Interviews were videotaped. A variety of interpretive, hermeneutic techniques were applied for text interpretation RESULTS: Nine existential themes of meaning emerged: I am undignified, I am a secret, I am always with gas, I am not myself alone, I am without choice, I am a seeker of control, I am the smell, I am not normal, and I am living a life-sort of. Through symbiotic interpretation, writing, and re-writing, themes were encompassed in a short story: a creative synthesis of actual events and interpreted understandings for ostomates about possible meanings of experiencing flatus incontinence. CONCLUSION: Flatus incontinence for people with bowel ostomies can be quite discommoding and impact on their interactions, self-image, sexuality, social activity, and psychological well-being. Nurses need to understand this for empathetic interaction, patient assessment, intervention selection, research planning, and pertinent education.

Adaptation, Psychological↗
PubMed1994

Evaluation of a Swedish version of the Ostomy Adjustment Scale.

The main aim of the present study was to adapt an instrument measuring patients' adjustment to life with an ostomy to Swedish conditions and to test reliability and validity of the adapted instrument. The Ostomy Adjustment Scale (OAS), which is focused on three domains: physical function, psychologic state, and social interaction, was selected as suitable. After translation into Swedish, equivalence and internal consistency of the scale were calculated. Subjects with various types of urine or faeces diversions were recruited for self-rating with the OAS and a visual analogue scale estimating total quality of life (QOL). The instruments were tested in 48 patients with five different diagnoses, 36 with and 12 without ostomy, and re-tests were carried out in 25 of the patients. Reliability (Cronbach's alpha) was 0.95. A positive correlation was found between the OAS and QOL (r = 0.67), indicating that the instrument has some validity.

Adaptation, Psychological↗
PubMed1976

An ostomy information clinic. A community resource.

This article has included some facets of discussions that take place at the Ostomy Information Clinic in Milwaukee. All types of ostomates attend one or more clinics to obtain information and help with management of their ostomies. Topics explored are management of drainage, odor control, use of the cone irrigation, digestion, nutrition and diet, and travel tips. In addition to ostomates, nurses often attend the clinics with or without their patients. Consultation is also provided to the Visiting Nurses' Association and local hospital nursing staffs. I would like to encourage other nurses to consider conducting ostomy information clinics in conjunction with the American Cancer Society. Not only is there a great need, but it is a personally rewarding and satisfactory experience.

Colostomy↗
PubMed1991

Ostomy appliances and equipment.

A well-fitted ostomy appliance that provides skin protection as well as comfort at a reasonable cost can enhance an individual's rehabilitation and return to a normal lifestyle. Conversely, a poorly selected appliance which fails to adhere and protect the skin and contributes to frequent leakage may undermine the client's self-confidence and feelings of well-being. Nurses who are knowledgeable in ostomy care and appliances are in a unique position to facilitate and expedite the patient's full recovery and adjustment following ostomy surgery.

Disposable Equipment↗
PubMed1989

Psychological response to illness: exploring two reactions to ostomy surgery.

This paper has discussed two psychological responses to ostomy surgery, denial and personal control, both of which can be maladaptive in situations faced by ostomy patients. Nursing interventions for each response were suggested and discussed in relation to two case studies. It is hoped the the information presented will be useful to nurses dealing with persons undergoing ostomy surgery and experiencing maladaptive behavior.

Adaptation, Psychological↗
PubMed1987

Psychosocial issues: the person with an ostomy.

Rehabilitation of a person with an ostomy is a complex process that requires the comprehensive, concerted efforts of not only the health care team but family, friends, and the community as well. Competence in the physical aspects of ostomy care enhances psychologic adjustment. Advance planning ensures that nurses will address those issues that foster rehabilitation. Physical, emotional, and interpersonal problems must be closely scrutinized so that appropriate therapeutic interventions can be initiated at the earliest possible moment. Informed, assertive nurses who appreciate the complexity of adaptation to an ostomy, and who are committed to providing comprehensive care in a therapeutic manner, increase the rehabilitation potential of all of their patients.

Body Image↗
PubMed1987

Ostomies: the art of pouching.

Excellent ostomy management is the goal for each new ostomate. Nurses are in pivotal positions to assist in selection and use of a variety of ostomy appliances and products. Individuals with ileostomies, transverse colostomies, sigmoid colostomies, or urostomies have unique management needs. Equipment recommendations and pouching procedures are detailed for each ostomy type. Access to proper instruction will enable the new ostomate to remain socially and physically active.

Colon, Sigmoid↗
PubMed1997

Analysis of late stomal complications following ostomy surgery.

BACKGROUND AND AIMS: This study was aimed to evaluate the late complications of ostomy surgery in a strictly followed patient population of a university hospital. MATERIAL AND METHODS: An actuarial analysis of the complications of 156 patients with permanent ostomies using the life-table method was performed. RESULTS: The crude and actuarial risks of late stomal complications in 156 patients after a mean follow-up of 8 years were 39 per cent and 59 per cent. The cumulative risk of complications did not differ between the stoma types. Paracolostomy hernia was the most common complication of the colostomy, 27 per cent, retraction of ileostomy, 24 per cent, and intestinal obstruction of urostomy, 28 per cent. Mesenteric fixation was here associated with a lower chance of prolapse (P < 0.025), but the closure of lateral space did not reduce the risk of intestinal obstruction. Skin irritation was more common after a creation of ileostomy than after other stoma creations (P < 0.001). The revisional surgery rate was lower following colostomy than following other stoma formations (P < 0.034). Adaptation to the stoma had occurred in 74% of the patients, but 8 per cent of the patients had intractable symptoms at the time of the analysis. CONCLUSION: Ostomy surgery involves a high rate of late complications and there is a small but important subgroup of patients whose quality of life is seriously affected.

Colostomy↗