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A literature review about self‐care on ostomy patients and their caregivers
Abstract
Self‐care is a key concept for ostomy patients as much as for chronically ill patients. Many studies describe how reaching a good self‐care level permits patient to perceive a higher quality of life, to adjust faster to the new condition, to grow empowerment feelings and to reduce readmissions and negative outcomes. There are many studies that state the negative impact of living with an ostomy on patients' quality of life. Quality of life is proven to be strictly related to self‐care ability. Health professionals cannot fail to consider this aspect of ostomized patients' life to identify existing lacking areas of self‐care abilities and to be able to project‐specific educative interventions so to improve the impact that living with an ostomy has on patients. Specific self‐care assessment tools could ensure self‐care measurement, specific educational intervention planning and evaluation of caregivers' role.
... According to the mentioned cases, it is vital to provide the required care to patients with ostomy [17]. Studies have shown that proper family care [18] and educating patients about self-care can improve the QOL notably [19]. erefore, educating family members and the patients can have an impact on their QOL [17][18][19]. ...
... Studies have shown that proper family care [18] and educating patients about self-care can improve the QOL notably [19]. erefore, educating family members and the patients can have an impact on their QOL [17][18][19]. Using the results from different studies in this area, nurses can have a deeper knowledge of the challenges and the factors in the QOL of clients with ostomy. ...
... ese questions are not scored and only give a description of the respondent. Section 3 (the effects of ostomy on the QOL) contains 43 questions on different aspects of physical health (1-11), psychological health (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), social health (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), and spiritual health (37-43) [29]. e questions in this part are scored based on Likert's rating scale of 0-10 and are used to calculate the mean score of the QOL. ...
Background:
Family-centered intervention can be used as a therapeutic intervention to improve the quality of life (QOL) in clients with ostomy. This study aimed to determine the effects of family-centered intervention on the QOL in ostomy clients.
Methods:
A quasi-experimental study was carried out with participation of 70 clients with colostomy and 70 caregivers (family members). The participants were selected through convenient sampling and randomly allocated into the experimental and control groups. The experimental group received family-centered education. The education program included four sessions, 50-60 min each, that were implemented in two weeks at hospital wards or clients' houses for the clients' companions. Afterwards, the caregivers implemented the care at home for one month. The subjects in the control group received routine care before being discharged. The QOL of the clients in both groups was measured using the city of hope-QOL-ostomy questionnaire before and one month after the intervention.
Results:
The mean scores of the QOL after family-centered intervention in the experimental and control groups increased from 197.97 to 207.49 and from 195.2 to 199.03, respectively. The paired t-test showed a significant change in the experimental and control groups after the intervention at a confidence level of 95% (p=0.0001; p=0.002). In addition, after the intervention, however, there was a significant difference between the two groups in all these areas except for social aspects (p=0.007).
Conclusion:
Family-centered intervention can be used as a therapeutic intervention to improve the QOL in clients with ostomy. The intervention was effective in the physical, spiritual, psychological, and social health of these clients.
... 5 Ostomy creation is a dramatic, life-changing event 3 that affects all aspects of a patient's life, especially the emotional, sexual, and social contexts. 6,7 The most common psychological issues experienced by patients with an ostomy are depression, anxiety, changes in body image, low self-esteem, sexual problems, denial, loneliness, hopelessness, and stigmatization. 4,[8][9][10] In addition, ostomy creation is associated with social problems, such as loss of interest and decreased participation in social activities, avoidance of traveling, decreased work activities, and a notable deterioration in patients' quality of life. ...
... 4,[8][9][10] In addition, ostomy creation is associated with social problems, such as loss of interest and decreased participation in social activities, avoidance of traveling, decreased work activities, and a notable deterioration in patients' quality of life. 7,10,11 One of the most important factors defining the followup process after any surgical treatment, and influencing self-care and quality of life of patients with an ostomy, is patients' psychosocial adjustment. 12,13 People with an ostomy may find adjusting to their new health condition difficult 3 because living with an ostomy may be a further burden on quality of life for both patients and their families. ...
... A urostomy is often permanent, and it is rarely used outside of oncology; consequently, patients with a urostomy may have been influenced by these two aspects. 7,16,27 Limitations The data collected were cross-sectional and, thus, the researchers could not describe trends in variables over time. In addition, some behavioral variables, such as self-care behaviors, were not investigated in the current study. ...
Objective:
To describe predictors of adjustment to living with an ostomy among Italian adults with an enterostomy or a colostomy.
Methods:
A multicenter, cross-sectional design was performed, sampling 403 patients with an ostomy in three different outpatient clinics of northern Italy between April 2018 and December 2020. Data were collected by stoma therapists in ambulatory settings using the Italian version of the Ostomy Adjustment Inventory-23 and patient medical records.
Results:
Acceptance was lower among women, patients who underwent emergency surgery, those with a urostomy, and those with a body mass index of less than or equal to 25 kg/m2. Negative feelings were associated with higher body mass index, colostomies, shorter length of time of living with an ostomy, and emergency ostomy creation.
Conclusions:
Being young and having a high level of education are protective against psychosocial problems and help promote acceptance and social engagement. The findings of this study help identify patients who are likely to be more vulnerable and need greater support through specific educational and motivational interventions.
... A necessidade da estomia e do uso de equipamentos coletores resultam em mudanças na rotina de vida, alterando a autoimagem e a autoestima, deflagrando preocupações que vão além da doença, que levou a construção da estomia, reconhecida como deficiência física pelo Decreto no. 5296 de 02 de dezembro de 2004 (Brasil, 2004), que requer cuidados especializados, sendo imprescindível o ensino do autocuidado, tanto para o paciente como familiar cuidador (Seo, 2019;Villa et al., 2019). Além disso, a doença que definiu a necessidade a estomização também interfere no processo de aceitação, pois quando envolve diagnóstico oncológico é vinculado à dor, sofrimento e morte, com não aceitação de ter que viver com a estomia. ...
... No contexto hospitalar, a assistência especializada implica em intervenções de enfermagem com ensino pré-operatório aliada à demarcação de estoma, ensino de autocuidado com estoma e equipamentos coletores/adjuvantes para paciente e familiar cuidador, bem como a alta responsável para os serviços secundários de atendimento aos estomizados (Hardiman et al., 2016;Seo, 2019;Villa et al., 2019;Sasaki et al., 2020). E a assistência a estes pacientes devem incluir a avaliação periódica em relação à condição geral, à evolução clínica e a respostas aos tratamentos, assim como em relação à utilização e indicação destes equipamentos coletores e a possibilidade de RTI, além dos aspectos psicossociais (Hueso-Montoro et al., 2016;Silva et al., 2017;Aguiar et al., 2018;Lira et al, 2019;Sasaki et al., 2020;Sasaki et al., 2021). ...
... A estomia impacta na qualidade de vida, na autoimagem e na autoestima da pessoa, que necessita utilizar equipamentos/adjuvantes, que têm custo elevado e, portanto, o seguimento especializado pelas equipes multiprofissionais deve focalizar o autocuidado (Hardiman et al., 2016;Silva et al, 2017;Seo, 2019;Villa et al., 2019;Sasaki et al., 2020;Sasaki et al., 2021) estar articulado e integrado à Rede de Atenção à Saúde, para a redução de complicações e do tempo para a RTI, bem como preparo destas pessoas para as mudanças pós RTI, considerando-se o preparo e reabilitação pélvica (Hardiman et al., 2016;Qureshi et al., 2018). ...
Objetivo: Analisar as características sociodemográficas, clínicas e terapêuticas de pessoas submetidas à Reconstrução de Trânsito Intestinal. Metodologia: trata-se de um estudo retrospectivo, descritivo-analítico, quantitativo, realizado em um centro de reabilitação especializado em uma cidade paulista, com levantamento de 134 prontuários de pacientes que realizaram Reconstrução de Trânsito Intestinal (RTI), aprovado pelo Comitê de Ética em Pesquisa (Parecer nº 2.831.709). Resultados e discussão: Com a análise de prontuários da população de pacientes que realizaram RTI 134 (100%), obteve-se média de idade de 57,3 anos, predominantemente do sexo masculino 78 (58%), do atendimento pelo sistema público de saúde 122 (91%); do diagnóstico oncológico 63 (47%); de cirurgia de urgência 88 (66%); e de 92 (69%) pessoas com colostomias. Houve correlação estatisticamente significante entre tipo de estomia, caráter da cirurgia, técnica cirúrgica e o diagnóstico de indicação cirúrgica, diferentemente das variáveis cirurgia e o tempo de estomia. Conclusão: Há necessidade de prevenção e diagnóstico precoce de CCR, além do planejamento da assistência à saúde para o seguimento de controle cirúrgico e oncológico, para agilização de reconstrução de trânsito intestinal (RTI) quando possível, além do preparo desta clientela para as mudanças na vida após RTI, bem como no gerenciamento da previsão e provisão de equipamentos coletores e adjuvantes, o que requer integração das ações dos diferentes níveis de atendimento desta clientela.
... Self-care has increasingly been a focus of attention by nurses (Jaarsma et al., 2020), namely in people with a stoma (Villa et al., 2019). Self-care competence has been associated with improved quality of life (Zhang et al., 2019), adaptation to the new condition (Altınbaş et al., 2021), reduced complications, and a consequent reduction of hospital readmissions (Graboyes et al., 2017;Hardiman et al., 2016). ...
... Previous studies indicate that the development of competence in self-care is important for the person undergoing a tracheostomy to adapt to their new living condition and to continue to perform their activities of daily life (Altınbaş et al., 2021). In this population, a high level of quality of life is directly related to a high level of self-care competence (Villa et al., 2019). Thus, an educational plan is essential for the person undergoing stoma creation to ensure that the basic skills for stoma care are learned (Prinz et al., 2015). ...
Aims and objectives: To map nursing interventions, their characteristics, and outcomes, in promoting self-care of the person with a tracheostomy.
Background: The development of competencies in self-care of a person with a tracheostomy is recognised as one of the most significant nursing intervention areas for
the promotion of autonomy, prevention of complications and adaptation. Identifying
nursing interventions for the promotion of self-care of the person with a tracheostomy enables enhanced clinical practice knowledge within different care contexts and
the identification of gaps in the available evidence.
Design: The Joanna Briggs Institute (JBI) methodology was used to perform this scoping review.
Method: A search was conducted on the CINAHL, Scopus, Web of Science, PubMed,
JBI Database of Systematic Reviews and Implementation Reports, and Cochrane
Database of Systematic Reviews. The search for grey literature included Portugal´s
Open Access Scientific Repository, OpenGrey, and ProQuest Dissertations and
Theses. Studies published in Portuguese, English, Spanish and French were included.
The PRISMA-ScR checklist was used.
Results: From a total of 4,224 identified articles, 31 were included in this review.
Multiple nursing interventions were identified and grouped into four types of action: informing, managing, determining and attending. Although most interventions
are implemented with the face-to-face method, there is a growing interest in using
technologies for this purpose. The dose is the characteristic most poorly described in
interventions. Various results were obtained; however, valid assessment tools were
not always used.
Conclusions: Designing and testing intervention programmes for the promotion of
self-care of the person with a tracheostomy is necessary, based on available and robust evidence to guide clinical practice.
Relevance to clinical practice: This review allowed to systematise nursing interventions to promote self-care of the person with a tracheostomy. The use of combined
interventions and methodologies is likely to be more effective in care delivery
... The daily care of the stoma is a challenge that the person has to learn to manage, and the availability of information seems to facilitate the acquisition of autonomy; however, not adapting the information to the person can induce stress and anxiety, as mentioned by the participants (21). ...
... The family of the person undergoing the construction of a stoma assumes a role that ranges from making recommendations to the patient from the performance of self-care to being substituted in terms of care when the patient is unable to take care of him or herself (21), thereby justifying the need to involve and train the family to care for the stoma. ...
Background & Aim: The construction of an ostomy has a physical, psychological, and social impact, requiring the need to adapt. The way this event is experienced is influenced by several factors, namely ostomy self-care competence, the aspect most referred to in the literature. Nurses' specific and systematic intervention positively influences the person's adaptation to the ostomy. This study aimed to describe the perception of nurses and people with ostomies about promoting ostomy self-care.
Methods & Materials: A qualitative descriptive study was conducted. Semi-structured interviews were conducted with ten nurses specializing in stoma therapy and twelve people with bowel elimination ostomy. Content analysis was performed according to Bardin with categorical analysis.
Results: Two themes emerged from the interviews: the promotion of awareness, with three categories and four sub-categories, and the promotion of ostomy self-care, with five categories and twenty-four sub-categories. In promoting awareness, the participants mentioned key contents that could be included in the nurse’s approach: assessing awareness, content for promoting awareness, and awareness indicators. Within the scope of promoting self-care, categories emerged, such as the intervention standardization, the contents, the methodologies, and the resources to promote self-care.
Conclusion: This study adds to evidence about promoting awareness of bowel elimination ostomy and self-care competence after the procedure. These results can be useful for nurses, allowing them to reflect on clinical practice and helping to improve the planning of their intervention in promoting stoma self-care.
... (4) Within this context, the informal caregiver is understood as the person with or without a family bond, in charge of making decisions and supporting in daily life activities; (5) they play a key role in developing the capacity for selfcare in patients with ostomy by providing time and effort to offer tangible and emotional care, which is associated with better self-control behavior, better control of the disease, and lower risk of mortality. (6) People person with permanent discharge ostomy and their informal caregivers develop dyadic affective and care relationships characterized by permanence over time, mutuality, and reciprocity through interpersonal relations. (7) It is important to understand how these dyadic relationships take place around a challenging health phenomenon, like having a permanent discharge ostomy, given that informal caregivers provide emotional support, support in comprehending the information and in the instrumental care of the ostomy, besides economic support, in food preparation, dressing, in daily life activities, and on reincorporation to the new role; likewise, in the case of older adults or people with limitations to perform their self-care, even more demanding support is required from their informal caregivers. ...
... Overall, according with the Federation Association of Incontinence and Ostomy (FAIS), the number of people who currently live with an ostomy in the world is estimated in two-million. (6) In Colombia, a 2018 study conducted in a health center in Bucaramanga reports the epidemiological profile of the population with ostomies, describing that 57% were men, 51% > 63 years of age, colostomy predominated (71%), and 59.8% of the discharge stomas were temporary. (8) In turn, these require in their care frequent hygiene and observation of the normal characteristics of the stoma, besides changing their devices. ...
Objective.
To understand the experiences and perceptions of care dyads (person and caregiver) when having a permanent discharge ostomy.
Methods.
Meta-synthesis that followed the ENTREQ standards and was registered in PROSPERO CRD42020221755; It was developed in three phases: (i). Search for studies in academic search engines, with MeSH terms: [(Patients) AND (Ostomy)) AND (Caregivers)], including qualitative primary studies published between 2000 and 2020; (ii). Assessment of the methodological quality with the CORE-Q instrument and the credibility of qualitative findings under the guidelines of the Johanna Briggs Institute; and (iii). Comparative analysis according to the guidelines by Sandelowski and Barroso.
Results.
The work identified 664 studies; in screening, 35 passed to full-text analysis; 22 to methodological quality evaluation; and 10 to meta-synthesis. The study found 43 qualitative findings that constituted four categories: dyads perform instrumental and emotional care; ambivalent family caregiving feelings and actions; assertive and effective family care; and rejection of bodily changes and sexual dysfunction. These categories constitute the central meta-theme: “The dyads experience a life rupture, which is restored in a sea of ambivalent emotions and learning; at the same time, affective, instrumental and assertive care is constructed”.
Conclusions.
People who experience having a permanent discharge ostomy express their rejection to the change in bodily image, alterations in sexual life and as a couple. Caregivers and families are the main source of support by being facilitators in self-care, through relationships of mutuality and reciprocity.
... Al pari delle altre malattie croniche, la gestione di questi pazienti richiede un processo multidisciplinare coordinato tra operatori sanitari e pazienti [4,5]. La cronicità della malattia renale impone infatti al paziente molte modifiche del proprio stile di vita che diventano spesso difficili da mantenere a lungo termine [6]. ...
... Inoltre, la visione del paziente è a volte in conflitto con l'opinione del professionista sanitario su ciò che è meglio per sé stesso (talvolta il paziente può preferire condizioni mediche meno ottimali dal punto di vista clinico o persino scegliere di interrompere la dialisi) in cambio di una maggiore libertà o controllo sugli aspetti della propria vita quotidiana [8]. Di conseguenza è importante che il paziente in dialisi, come accade per gli altri pazienti con patologie croniche, acquisisca un certo grado di autonomia nella gestione della propria condizione di salute attraverso lo sviluppo di abilità di self-care [5,9,10]. ...
Hemodialysis is the most common treatment in patients with end-stage chronic kidney disease and the wide accessibility of this therapy has prolonged the patients' lifespan. However, it involves alterations in their emotional sphere and, often, a reduction in therapeutic compliance as the chronicity of kidney disease requires lifestyle changes difficult to maintain in the long term. The management of a chronic medical condition is in fact a complex process that necessarily requires multidisciplinary action. The concepts of "Self-efficacy" and "Self-management" fall within the Self-Determination Theory and are relevant in this context because they refer to the beliefs that everyone has about their abilities to control behavior and determine the success in adhering to prescribed therapies. Furthermore, the promotion of self-efficacy and self-management through an educational approach that makes use of so-called "eHealth" tools can help develop greater self-awareness in dialysis patient, a better control over their care choices and an increased adherence to therapeutic-dietary indications. This article aims at highlighting the importance of implementing an approach based on eHealth in the management of hemodialysis patients. It also wants to raise awareness of the related multidisciplinary theories to be applied in this clinical context to promote greater therapeutic adherence, and therefore a better quality of life and care.
... To counteract the multiple difficulties deriving from living with an ostomy, patients are required to perform self-care Villa, Mannarini, et al., 2019), which is defined as "the process of maintaining the physiological stability of the stoma and peristomal skin (self-care maintenance), facilitating the perception of problems and complications (self-care monitoring) and directing the management of these problems and complications (self-care management)" (Villa, Vellone, et al., 2019, p. 26). Literature has shown that self-care can be difficult for ostomy patients (Bulkley et al., 2018). ...
... Wakabayashi et al., (2011) found even lower rates of emergency service use in individuals with substantial caregiver support (Trivedi et al., 2012). Notably, caregivers also play a key role in promoting self-care abilities Villa, Mannarini, et al., 2019). ...
Aims and objectives
To describe caregiver contribution (CC) to ostomy self-care and identify its associated variables among caregivers of ostomy patients.
Background
Self-care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self-care behaviours. So far, the CC to ostomy self-care has not been investigated thoroughly.
Design
This is a cross-sectional and multicentre study conducted at seven outpatient clinics of two Italian regions.
Methods
We recruited 252 caregivers between February 2017–May 2018. The Caregiver Contribution to Ostomy Self-Care Index (CC-OSCI) was used to measure CC to ostomy self-care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study.
Results
The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self-care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self-care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self-care management.
Conclusions
We found a variety of sociodemographic factors associated with CC to ostomy self-care.
Relevance to clinical practice
Sociodemographic variables associated with CC to ostomy self-care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging.
... Examining the relationship between partner dynamics and sleep, OSA creates a collateral burden to spouses and/or bedtime partners who may often sleep apart from their partners suffering from OSA [46,47]. Partners frequently complain about snoring and sleep interruptions but are also worried about their bed partners who experience various breathing abnormalities during the night [48]. In conclusion, the consequences of OSA itself and its treatment expand beyond the individual that suffers from the disease [45]. ...
Obstructive sleep apnea (OSA) is considered a chronic disease that requires long-term multidisciplinary management for effective treatment. Continuous Positive Airway Pressure (CPAP) is still considered the gold standard of therapy. However, CPAP effectiveness is limited due to poor patients’ adherence, as almost 50% of patients discontinue treatment after a year. Several interventions have been used in order to increase CPAP adherence. Mindfulness-based therapies have been applied in other sleep disorders such as insomnia but little evidence exists for their application on OSA patients. This review aims to focus on the current data on whether mindfulness interventions may be used in order to increase CPAP adherence and improve the sleep quality of OSA patients. Even though controlled trials of mindfulness and CPAP compliance remain to be performed, this review supports the hypothesis that mindfulness may be used as an adjunct method in order to increase CPAP adherence in OSA patients.
... The aim of this study was to better understand family caregivers' experiences of caring for family members with urostomy. Consistent with other research ndings [24,25,26], most family caregivers asserted that, despite the di culties, they wish to remain actively involved in the care of their loved ones. ...
Background
In China, bladder tumors rank first for morbidity and mortality among urological and reproductive system tumors. In 2014, there were 78,100 new bladder tumor cases and 32,100 deaths in China, with morbidity and mortality rates of 5.71/100,000 and 2.35/100,000,respectively. Total radical cystectomy plus urinary flow conversion is the gold standard for the treatment of muscle-layer invasive bladder cancer. With an increasing number of radical cystectomies each year, the number of patients living with urostomy is growing. After discharge, primary care of urostomy patients is given at home, and high demands are placed on home caregivers due to issues of privacy and the complexity of replacing the urostomy device. This research explored the challenges faced by the family caregivers of urostomy patients.
Methods
We used descriptive qualitative research methods to conduct interviewswith twelve family caregivers of patients with urostomy. The interviewees were selected using the purposive sampling technique at the First Hospital of Shanxi Medical University. All interviews were recorded, transcribed, and analyzed using thematic analysis.
Results
Three critical challenges were identified – confusion, family crisis, and psychology. Within these three themes, six sub-themes emerged. They were knowledge and skill deficiency, uncertainty, role conflict, economic burden, emotional overwhelmed and calm acceptance.
Conclusion
Family caregivers play a critical role in patient care, and especially in urostomy care. Caregiving is associated with significant challenges that hinder the family caregiver’s ability to effectively care for the patient, further diminishing the caregiver’s quality of life. Therefore, healthcare professionals should consider the challenges faced by family caregivers and take measures to obviate them through education, preparation, and support.
... 18,[26][27][28]34 A possible explanation is that the patients with ostomy experience These problems lead to anxiety and depression in these patients, finally. 29 Given that patients with ostomy can be considered the same as chronically ill patients 35 and it has been observed in different groups that anxiety and depression are higher in people with chronic diseases than people without chronic diseases, 36 and 57%, respectively. 46 The results of systematic review and metaanalysis in patients with inflammatory bowel disease showed that 35% of patients experienced symptoms of anxiety and 21% of patients experienced symptoms of depression. ...
Aim:
The prevalence of anxiety and depression in patients with ostomy is reported differently. The aim of this systematic review and meta-analysis is to estimate the global prevalence of anxiety and depression in patients with ostomy.
Method:
A systematic search of Embase, Proquest, Scopus, PubMed and Web of Science (ISI) databases was conducted from January 1990 up to May 5th, 2021. A total of 3392 records were retrieved and 18 studies were ultimately included. Two reviewers independently assessed full-text of articles according to predefined criteria. A random-effects model was used to estimate the prevalence of anxiety and depression and I2 index was used to assess the heterogeneity of the studies. Subgroup analysis and mea-regression were conducted to explore potential sources of heterogeneity. The review protocol is registered in PROSPERO and is available online. Data analysis was performed using R software version 4.3.1.
Results:
In this study, the pooled prevalence of anxiety was 47.60% (95% CI, 29.94-65.26) and the pooled prevalence of depression was 38.86% (95% CI, 29.29-48.43). The subgroup analysis showed the prevalence of anxiety and depression in different regions was not significantly different (p=0.854, p=0.143 respectively). Nevertheless, the highest and lowest prevalence of anxiety were in Asia and the America 51.79% and 31.69%, respectively and the highest and lowest prevalence depression were in Asia with 49.80% and Europe with 10.10%, respectively.
Conclusion:
The finding of this study showed the global prevalence of anxiety and depression in patients with ostomy is high. Therefore, all health care providers who deal with these patients should use appropriate psychological strategies, techniques and interventions to reduce anxiety and depression in these patients. This article is protected by copyright. All rights reserved.
... We performed this scoping review according to the framework of Arkesey and O'Malley [43]. This framework consists of five steps: (1) identifying the research questions; (2) identifying relevant studies; (3) selecting studies; (4) extracting collected data; and (5) reporting results. ...
Background: Continuous positive airway pressure (CPAP) is the gold standard treatment
for obstructive sleep apnea (OSA). The benefits of this therapy were studied and analyzed over time; patient adherence is often poor, as many factors negatively influence it. A topic that needs clarification is whether adherence to CPAP treatment in a patient with OSA is influenced by the behavior of a partner or spouse. Methods: A scoping review was conducted to evaluate the role of partner involvement in the CPAP treatment management in a patient with OSA. The research project was performed between August and September 2021 by consulting the main biomedical databases: CINHAL, Embase, PsycINFO, and PubMed. Results: Among 21 articles considered valid for our aim, 15 are qualitative studies, 5 are quantitative and 1 presents a mixed method. We identified several thematic areas and “key” elements, which are prevalent in the studies evaluated. Conclusions: The presence of a partner promotes adherence to CPAP therapy in patients with OSA, resulting in ameliorating their overall quality of life. To increase CPAP adherence, a trained nurse could represent a reference figure to technically and emotionally support couples during the adaptation period and in the long term.
... Tali aspetti incidono non solo sul "peristomal health" e sul mantenimento della integrità della cute peristomale ma permettono altresì di promuovere le abilità di self-care e di adattamento indispensabili alla persona con stomia per ottenere un buon livello di qualità di vita percepita. 16 Tale esigenza ha portato negli ultimi 15 anni allo sviluppo di diversi strumenti di classificazione per consentire all'operatore di valutare e classificare in modo oggettivo la lesione e di intervenire appropriatamente: quali ad esempio il SACS (Studio Osservazionale Multicentrico sulle alterazioni Cutanee Post-enterostomie), 9,11 l'LSD Score, 17 l'Ostomy Skin Tool (OST), 18,19 il Peristomal Lesion Scale (PLS). 20 Tali strumenti di classificazione delle alterazioni della cute peristomale rispondono più ad una esigenza di classificazione degli operatori sanitari che ad una esigenza delle persone portatrici di stomia. ...
Background:
The ostomy patient's quality of life also depends on their peristomal health and thus first and foremost on keeping healthy peristomal skin. This is by no means an easy task, given that the incidence of peristomal skin disorders can be a factor in up to 80% of cases. Over the past 15 years, several tools have been developed to classify peristomal skin lesions to facilitate the management of the problem. These tools, however, meet the needs of healthcare professionals and those of patients. Hence the decision to work on an advanced version of the SACS©, currently the most widely used tool, with the setting up of the SACS Evolution Consensus Group.
Methods:
By applying the simplified Delphi method, the SACS Evolution Consensus Group critically re-read what had been garnered from the literature in the light of their personal clinical experience, identified the key issues to be addressed, and processed and refined the relevant statements. This made it possible to achieve the challenging objective of creating a peristomal health tool to help prevent peristomal skin lesions.
Results:
SACS Evolution is, indeed, a promising tool for preventing peristomal lesions. It is structured on two different levels, one for the patient and one for the healthcare professional, each characterized by specific language and based on an innovative concept of healthy peristomal skin, which is essential for those who work on peristomal health.
Conclusions:
The SACS Evolution Consensus Group thus aims to validate this peristomal health tool and has already started a validation process so that the tool can be used in clinical practice.
... [1][2][3][4][5][6][7][8][9] Studies of several pre-and postoperative follow-up programs and education in ostomy care performed by stoma care nurses (SCNs) have shown that such follow-up and education promote the patient's self-care and adjustment process to life with an ostomy. 4,[9][10][11] Questionnaires such as The Ostomy Adjustment Inventory 23, 12 the Stoma Selfefficacy scale [13][14][15] and the Ostomy Adjustment Scale (OAS) [16][17][18][19][20] has been validated in several countries and used to measure psychosocial adjustment to ostomy. ...
Background:
The Ostomy Adjustment Scale (OAS), which consists of an overall sum score along with 34 single-item scores, has been frequently used to measure self-reported adjustment to life with an ostomy. However, it is unknown whether the OAS can be divided into meaningful thematic subscales that may make it easier to administer and to apply in a clinical feedback system.
Purpose:
The purpose of this study was to specify thematic OAS subscales and evaluate their psychometric properties.
Patients and methods:
A cross-sectional study was conducted with 302 patients across Norway having colostomy, ileostomy, or urostomy. The OAS items were divided into different subscales by expert nurses and patients based on clinical and theoretical considerations. The overall structural validity of this analysis of the OAS was examined using robust confirmatory factor analysis. We evaluated the overall goodness of fit using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker-Lewis index (TLI). Factor loadings from the confirmatory factor analysis were used to calculate composite reliability values for the new OAS scales.
Results:
The OAS was divided into seven subscales. The overall structure validity was acceptable with RMSEA = 0.053 (90% CI, 0.045-0.060), CFI = 0.913 and TLI = 0.904. The composite reliability values of all scales were >0.70.
Conclusions:
The OAS can be divided into seven clinically meaningful subscales with acceptable psychometric properties.
Trial register:
ClinicalTrials.gov Registration Number: NCT03841071. Date 18. February 2019 retrospectively registered.
... Most of the patients enrolled in this study (58.9%) had a history of CRC, and their ostomies were mainly permanent (74.1%) ( Table 1). These results are not surprising because CRC is among the most frequent cancers in males (Bray et al, 2018) and in view of the fact that both CRC and BC often lead to permanent ostomies (Sun et al, 2013;Villa et al, 2019a). In line with other studies underscoring the importance of education preoperatively and at follow-up performed by a specialist nurse (Faury et al, 2017;Seo, 2019;Wen et al, 2019), the authors found that most patients received extensive or adequate information during admission (64.4% (Figure 2), usually from a stoma nurse specialist or non-specialist nurse (44.1%). ...
Background
An increasing number of patients worldwide are living with an ostomy. Among them, self-care management skills and stoma self-care abilities are associated with better quality of life.
Aims
To identify the sociodemographic and clinical characteristics of Italian ostomy patients and investigate their knowledge of stoma management.
Methods
A questionnaire was used to gather the sociodemographic and clinical data of 433 adult patients. Participants responded to a nine-item survey assessing their knowledge of stoma management.
Findings
Respondents reported having received extensive or adequate information in 64.4% of cases, and the remaining 35.6% reported receiving little or no information at any time. The health professional who imparted at least adequate information was a stoma nurse specialist in 32.1% of cases, usually during admission (24.0%) or before and during admission (19.6%).
Conclusion
This study demonstrated that most patients received adequate information regarding the ostomy.
... 4 The most common diseases requiring an ostomy are cancer, inflammatory bowel disease, intestinal volvulus, trauma, bowel obstruction or familial adenomatous polyposis. 5 In 2018, the estimate was of over 1.8 million new cases of colorectal cancer and 549,000 new cases of bladder cancer. 6 People facing this type of operation experience a major change in their daily life with physical (intestinal, urinary and sexual function, stomal complications), psychological (body image, depression), social (isolation, loneliness, anxiety, decreased relationships) repercussions and a consequent decline in quality of life. ...
Subjects undergoing ostomy are increasing and share a reduced quality of life. The patient flow (PF) is the pathway of a patient from hospital admission to discharge and should provide care appropriateness to the patient himself. In the recent literature no paper exists regarding the PF of the patient undergoing (intestinal or urinary) ostomy, which is the objective of the present article. This paper stems from the work done during the Educational Camp entitled "The Patient Flow in Stoma Care," which took place on three separate days (27<sup>th</sup> May, 18<sup>th</sup> September, and 21<sup>st</sup> November 2019) at B. Braun Milano S.p.A. and regarded 33 stomatherapy nurses from all over Italy supervised by the authors. The participants, divided into heterogeneous groups, developed the PF by means of three specific work methodologies: mental maps, timeline and appreciative inquiry. The elaborated PF was inspired to the International Charter of the Ostomates' Rights. The efficacious and empathic communication and the role of the patient and/or the caregiver as the main characters are transversal to every step and must be always pursued. The PF is developed in eight macro-areas: diagnosis; pre-admission; admission and preoperative phase; surgical operation; awakening; postoperative phase; discharge; follow-up. In agreement with the recent literature, this systematic approach will give benefits to the patients in terms of outcome and perception of taking charge before, during and after the ostomy. At the same time the performances, the therapeutic appropriateness, the optimization of technology and healthcare resources and the staff satisfaction will equally be guaranteed.
... Patients with a permanent ostomy can live with it even for several years (Krouse et al., 2016) if we consider the ostomies as the result of colorectal (Sun et al., 2013) or bladder cancer (Jensen, Kiesbye, Soendergaard, Jensen, & Kristensen, 2017), which have a 5-year survival rate of between 40% and 65% Siegel et al., 2017). Therefore, an ostomy can lead to complex and lifelong consequences for patients (Villa, Mannarini, et al., 2019;Wen et al., 2019). ...
Aims
To describe self‐care in ostomy patients, to identify socio‐demographic and clinical variables associated with self‐care and to identify the association between self‐care self‐efficacy and self‐care over and above the variables associated with self‐care.
Design
Longitudinal and multicentre study. Data were collected between February 2017‐May 2018.
Methods
In this study, 523 ostomy patients were enrolled at baseline (T0) and 362 were followed‐up after 6 months (T1). The Ostomy Self‐Care Index was used to measure self‐care maintenance, monitoring, management, and self‐efficacy. Correlations between self‐care dimensions and patient socio‐demographic and clinical characteristics were performed with Pearson's or Spearman's correlations. Three separate two‐step hierarchical regression analyses were performed to identify variables associated with self‐care maintenance, monitoring, and management.
Results
Participants’ mean age was 69 years (SD 12.4); 63.9% were male and most had enterostomies (38.8% colostomies, 29.3% ileostomies) and permanent ostomies (72.5%). Patients had adequate self‐care maintenance and monitoring at T0 and T1, while they had lower self‐care management and self‐efficacy at baseline. Significant variables associated with better self‐care maintenance and self‐care monitoring were female gender, more information received during hospitalization and better autonomy in stoma management, while a better level of education was an additional variable associated with self‐care monitoring. Self‐care self‐efficacy produced a significant increase in the explained variance of self‐care maintenance and self‐care monitoring. None of the selected variables were significantly associated with self‐care management.
Conclusion
Middle‐high levels of self‐care maintenance, monitoring, management, and self‐efficacy were found. The variables associated with ostomy self‐care and the role of self‐care self‐efficacy identified in this study can help in developing tailored nursing interventions.
Impact
This study found specific variables associated with ostomy self‐care which could contribute to guiding future interventions aimed at improving self‐care in ostomy patients.
This chapter will inform you of the different types of urinary diversions relevant for neuro-urological patients: ureterostomy, ileal conduit and Mitrofanoff/Monti, and related care and education based on the principles of enhancing self-efficacy in order to secure best possible quality of life. Self-efficacy is a concept defined by Bandura as the belief of one’s capability to organize and execute the courses of action required to manage prospective situations and exercise control. By strengthening the patient’s self-efficacy through stepwise stoma education, this adaptation process may be accelerated, and the psychological and social burden can be lightened and support early adaption of the required skills necessary to independently provide a full change of a stoma appliance. Besides stoma care, this chapter also aims to further inform about possible complications in relation to stoma surgery and related care.
Objective:
The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor.
Methods:
A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS).
Results:
Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR =5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%.
Conclusions:
The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.
Prostate, kidney, and bladder cancer are the three most frequently diagnosed urological cancers. Educational programs could teach patients to become experts in disease management. The aim of this scoping review was to explore the literature to identify the educational requirements and strategies for improving and implementing educational processes for urological patients undergoing surgery. We searched several databases, including PubMed, CINAHL, Embase, Scopus, PsycINFO, and Cochrane Library. All adult patients undergoing urological educational interventions were included in the review. Of 3,197 initially identified articles, 42 were retained. Urological patients undergoing prostatectomy, cystectomy, and nephrectomy require cognitive, psychological, and functional support. For each level of support, several methods exist to provide support, including informational brochures, preoperative counseling, telephone support, online content, educational videos, support groups, individual stress management interventions, peer support, online interventions, partner support, and various educational programs that help the patient manage negative effects associated with the urological intervention.
Purpose of the review:
As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful.
Recent findings:
Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients. Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.
Objective: This descriptive cross-sectional study investigated the quality of life (QoL), self-care knowledge access, and self-care needs of colorectal cancer patients after colostomy.
Methods: A total of 142 colorectal cancer patients in the Tumor Hospital of Yunnan Province were invited to this survey one month post-colostomy. QoL of the participants was assessed using the Chinese version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF). A self-prepared questionnaire was also administered to explore the sources of self-care knowledge and self-care needs of this population.
Results: Response mean scores of the four domains of WHOQOL-BREF, namely, physical health, psychological health, social relations, and environmental health were 53.49, 57.95, 65.78 and 50.75, respectively. No significant differences were found in the gender, age, education level, and occupation type in QoL scale among the groups using the u test and ANOVA (p > 0.05). However, female colostomates scored higher grades in the physical area of QoL than male patients; the participants who willingly attended the self-care courses obtained higher scores in social area than those who were not willing.
Conclusion: The QoL of this population was not favorable. Self-care program can be developed in accordance with the needs and educational background of the colostomates.
This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to self-management included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.
Research has shown that the early promotion of stoma management skills can signifcantly enhance the psychological adjustment of stoma patients post-surgery (O’ Connor, 2005). However, experiential evidence has shown that this does not always occur due to staff shortages and increased workloads. In this article, Antonella Di Gesaro aims to highlight the importance of teaching stoma patients to self-care. The author’s experiences on teaching stoma management skills will be deliberated and the effects this has on the enhanced recovery programme (ERP). Improving nurse documentation in order to enhance continuity of care will be discussed and the potential legal issues this could involve. Finally, the importance of effective communication, teamwork and effective practical teaching to empower patients to self-care will be reinforced.
Introduction:
Chronic illnesses care represents a challenging issue for people well-being and future health systems' sustainability. Promotion of self-care is considered a key point for chronically ill patients' care. The aim of this literature was to explore: how self-care of chronic illness has been theoretically defined; how self-care can be assessed in clinical and research settings; what associations exist between self-care and health outcomes of chronically ill patients.
Results:
A wide range of definitions and terminologies related to self-care of chronic illness has been found in the literature. Although some common elements useful to explain the concept of self-care have been identified, the physical, cognitive, emotional and social processes underlying self-care remain controversial and poorly defined. Valid and reliable disease-specific assessment tools have been developed and used in a growing number of studies; however, the lack of utilization of standardized instruments in clinical practice has been referred by many authors. Significant correlations between self-care of chronic illness and outcome measures e.g. general health status, quality of life and healthcare costs, are reported by a limited number of studies.
Conclusion:
Supporting patient self-care is recognized as a crucial factor in chronic illness care. A deeper analysis of variables and processes influencing self-care could help for a full description of the phenomenon. A systematic evaluation of self-care in health professionals' everyday clinical practice is strongly recommended. The development of general non-disease-specific assessment tools could facilitate the evaluation of complex patients, especially those with multiple co-morbidities. Although self-care has been recognized as a vital intermediate outcome, further large-scale studies clarifying the association between self-care and patients' and health systems' outcomes are needed.
Caregivers play an important role in contributing to heart failure (HF) patients' self-care but no prior studies have examined the caregivers' contributions to HF patients' self-care and no prior studies have examined potential determinants of the caregivers' contribution to HF patients' self-care.
Bladder cancer is the fourth most common cancer among European males. Once diagnosed with muscle invasive bladder cancer, a radical cystectomy is the first line treatment, which results in a urostomy. The placement of a urostomy and the care required impacts the patient's life. Previous research validated the Urostomy Education Scale as the first standardized tool capable of documenting the patients' level of stoma self-care skills and useful to guide patient education interventions. A Danish-Dutch Fellowship was established to support and provide further evidence of applicability of the Urostomy Education Scale.
The frequency of ostomy surgery in Canada is not known, but it is estimated that approximately 13,000 ostomy surgeries are performed annually in Canada. This systematic review incorporates evidence for the assessment and management of colostomies, ileostomies, and urostomies, as well as the peristomal skin. The review was completed as part of a best practice guideline document generated by a task force appointed by the Registered Nurses' Association of Ontario.
to investigate the care undertaken in the health services for people with intestinal stoma, from the perspective of articulating the actions proposed in the Amplified and Shared Clinic, with a view to promoting autonomy.
qualitative study. Participants: 10 people who received a stoma, and their family members. Data was collected between 10th January and 30th June 2011, through two semi-structured interviews. Analysis was through the stages: anxiety, synthesis, theorization and recontextualization.
presented in the categories: (1) the need to carry out stoma care; (2) receiving health support and care after discharge from hospital; (3) returning to daily activities and social reinsertion.
the study identified common factors which influence the process of development of autonomy and the relationship which health professionals have with this achievement.
Stoma patients and their caregivers need to be autonomous in stoma care, but there are few instruments for measuring the level of self‐care. This study aims to develop and test the psychometric properties of the Ostomy Self‐Care Index (OSCI) and the Caregiver Contribution to Self‐Care in Ostomy Patient Index (CC‐OSCI), from a clinical, operative and psychosocial perspective. A multicentre validation study was conducted on a convenience sample of 468 ostomy patients and 227 caregivers. The signed informed consent forms were obtained before data collection. Tool validation was performed by testing content validity, construct validity, criterion and internal consistency. Two indexes were developed, building on the self‐care theory of chronic illness. For the OSCI, 32 items were developed and grouped into four 5‐point Likert scales: maintenance, monitoring, management and confidence. For the CC‐OSCI, 22 items were developed and grouped into three 5‐point Likert scales: maintenance, monitoring and management. The content validity indexes for the OSCI and CC‐OSCI were 95% and 93%, respectively. Exploratory factor analysis showed appropriate factor loadings (OSCI: min 0.395 to max 0.852; CC‐OSCI: min 0.442 to max 0.841). Criterion validity was established through significant correlation between levels of quality of life, complications, readmissions and self‐care in patients and caregivers. Strong internal consistency was found for the overall index, and within the scales (OSCI: α = 0.975; CC‐OSCI: α = 0.972). The OSCI and CC‐OSCI are valid and reliable indexes. Further studies specifically aimed at predicting the level of self‐care are especially recommended.
Aim
To explore the experiences of self-care of patients with urostomy and to identify the influencing factors of self-care.
Background
The creation of a urostomy results in the loss of an important bodily function and an alteration of the body image and causes physical, psychological, and social changes in the lifestyle through the adjustment and management of the new condition. In literature, there are few studies that analyze the lifestyle of people with urostomy.
Methods
In this qualitative design, an interpretative phenomenological analysis was used. Eleven people living with urostomies took part in semi-structured interviews consisting of open-ended questions about their self-care experience. Data were collected between March and September 2016.
Results
Six themes and twelve subthemes emerged from the data analysis. The themes were: Surgery impact, body image, daily and social-life activities, stoma and sexuality, managing stoma education, family and friends' support.
Conclusions
This study highlights the impact a stoma has on people's lives. This impact should be absorbed with personalized education before the surgery with the eventual need of a continuous and planned educational course respecting the patients' needs. This study shows that a continuous and planned educational plan is crucial for patients living with urostomies. Therefore, nurses should provide patients an adequate support and a personalized education program to cope with ostomy.
Background:
Patients who undergo a colorectal operation that includes a new ileostomy incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills and evaluated its effect on readmissions after ileostomy creation.
Methods:
On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from 2 years before (period 1) and 1 year after (period 2) the checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units.
Results:
Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly greater all patient refined diagnosis related group weights (3.6 vs 3.3, P = .006) and longer initial duration of stay (13.3 vs 11.3 days, P = .006), and they were more likely to be emergency admissions (49% vs 38%, P = .04). The readmission rate on the intervention unit decreased from 28% in period 1 to 20% in period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (P = .04).
Conclusion:
Implementation of a patient-centered, self-care-oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation.
Aim:
To identify factors that may serve as facilitators and barriers to self-management described by adults living with chronic illness by conducting a qualitative metasynthesis.
Background:
Self-management is an individuals' active management of a chronic illness in collaboration with their family members and clinicians.
Design:
Qualitative metasynthesis.
Data sources:
We analysed studies (N = 53) published between January 2000-May 2013 that described factors affecting self-management in chronic illness as reported by adults aged over 18 years with chronic illness.
Review methods:
Sandelowsi and Barroso approach to qualitative metasynthesis: literature search; quality appraisal; analysis and synthesis of findings.
Results:
Collectively, article authors reported on sixteen chronic illnesses, most commonly diabetes (N = 28) and cardiovascular disease (N = 20). Participants included men and women (mean age = 57, range 18-94) from 20 countries representing diverse races and ethnicities. We identified five categories of factors affecting self-management: Personal/Lifestyle Characteristics; Health Status; Resources; Environmental Characteristics; and Health Care System. Factors may interact to affect self-management and may exist on a continuum of positive (facilitator) to negative (barrier).
Conclusion:
Understanding factors that influence self-management may improve assessment of self-management among adults with chronic illness and may inform interventions tailored to meet individuals' needs and improve health outcomes.
Background:
Increasingly there is a focus on self-care strategies for both malignant and non-malignant conditions. Models of self-care interventions have focussed on the individual and less on the broader context of family and society. In many societies, decision-making and health seeking behaviours, involve family members.
Objective:
To identify elements of effective family-centred self-care interventions that are likely to improve outcomes of adults living with chronic conditions.
Design:
Review paper.
Data sources:
MEDLINE (Ovid), CINAHL, Academic Search Complete, PsychInfo and Scopus between 2000-2014.
Review methods:
Quantitative studies targeting patient outcomes through family-centred interventions in adults were retrieved using systematic methods in January, 2015. Search terms used were: 'family', 'spouse', 'carer', 'caregiver', 'chronic', 'chronic disease', 'self-care', 'self-management' and 'self-efficacy'. Reference lists were reviewed. Risk of bias assessment was performed using the Cochrane Collaboration's tool. Data were reported using a narrative summary approach.
Results:
Ten studies were identified. Improvements were noted in readmission rates, emergency department presentations, and anxiety levels using family-centred interventions compared with controls. Elements of effective interventions used were a family-centred approach, active learning strategy and transitional care with appropriate follow-up.
Conclusions:
Involving the family in self-care has shown some positive results for patients with chronic conditions. The benefits of family-centred care may be more likely in specific socio-cultural contexts.
Limitations:
The review has year limits and further research needs to identify support for both the patients and family caregivers.
Purpose:
To assess quality of life (QOL) and its influencing factors of bladder cancer patients after ileal conduit.
Methods:
From January 2012 to December 2013, a cross-sectional survey with questionnaires was performed in West China hospital, in which the effect of patient characteristics on their QOL was evaluated, and then the correlation of stomal self-management, social support and QOL of the patients were also explored.
Results:
A total of 188 patients were included. Poor sexual life satisfaction was common among responders. There was a positive correlation between QOL and social support as well as the stomal self-management (all p ≤ 0.002). Additionally, the patients who were female, aged less than 60, participated in work, family income more than 4000¥ per month, a longer postoperative period, and without any stomal complications (all p < 0.05) would have a better QOL.
Conclusions:
The overall QOL of the patients was good except the satisfaction with sexual life. The better the stomal self-management and social support, the better the QOL. Personalized nursing care and health guidance should be provided to the patients, so as to improve their QOL and promote their health.
Activation, the state of possessing the skills, knowledge, and confidence to manage one's own health, is associated with positive self-management behaviors in individuals with chronic illness. Little is known about its role in cancer survivorship. The aims of this study were to describe activation in patients with colorectal cancer and their family caregivers, examine the relationship between patient and caregiver activation, and determine whether activation is related to symptom distress, depression, anxiety, fatigue, physical activity, and work productivity. Using a longitudinal, correlational design, a convenience sample of 62 patients and 42 family caregivers completed surveys during postoperative hospitalization, and at 6 weeks and 4 months postop. Activation scores for both patients and caregivers were stable over time, were not correlated, and were at the third level of activation. Linear mixed effects models revealed that negative emotions were associated with less patient activation and lower caregiver self-efficacy for caring for oneself.
The purpose of this study was to examine the relationship between uncertainty and adaptation among individuals requiring surgery resulting in an incontinent ostomy.
Descriptive correlational study.
The study sample comprised adult persons with incontinent ostomies created during calendar years 2009 and 2010. The research setting was an academic medical in the Northeastern United States. Respondents were 18 to 83 years old, with a mean age of 53.88 ± 19.58 years (mean ± SD); 54.9% were women.
A WOC nurse reviewed electronic medical records of patients who had undergone incontinent ostomy surgery to determine whether they met inclusion criteria. A letter outlining the study was mailed to potential subjects requesting their participation; 2 validated instruments were included: the Ostomy Adjustment Scale and the Mishel Uncertainty in Illness Scale-Adult Form. The form also queried demographic information. After 2 weeks, a postcard was sent to remind study participants to complete and return the documents.
The leading medical diagnosis resulting in ostomy surgery was cancer (45.1%), followed by Crohn's disease or ulcerative colitis (35.3%). The sample was evenly distributed between those having their ostomies less than 1 year and those having them more than 1 year. Most incontinent stomas were ileostomies (60.8%), 33.3% were colostomies, and 5.9% were urostomies. Nearly three-quarters (74.5%) indicated that they were independent regarding ostomy self-care.
The results suggest a strong association between certainty and adaptation among adult patients with an incontinent ostomy. The WOC nurse, as patient advocate, can offer persons with a new ostomy an overall perspective on the ostomy experience.
The Ostomy Adjustment Scale (OAS) has been widely used to measure the adjustment to an ostomy. Although the instrument had been used among subjects from various backgrounds, psychometric properties had never been evaluated.
The primary aim of this study was to test the psychometric properties of the OAS among Chinese colostomy patients, and the secondary aim was to examine the predictors of colostomy adjustment.
The translated OAS was tested using a convenience sample of 207 colostomy patients from a university-affiliated cancer center in China.
The content validity of the OAS was 0.91. Four items were removed during the process of validity and reliability testing. The final Chinese version of the OAS consisted of 30 items (OAS-C-30) with 4 subscales as follows: negative affect, normal functioning, therapy attitude, and life worry. The Cronbach's α, the intraclass correlation, and a split-half Spearman-Brown coefficient for the total scale were 0.915, 0.902 and 0.871, respectively. Multiple linear regression analysis showed that stoma self-efficacy, stoma acceptance, excessive aerofluxus, constipation, family relationship, and body image loss were the predictors of adjustment among Chinese colostomy patients.
The OAS-C-30 has been proven to be a valid and reliable measure to assess the adjustment among colostomy patients.
The OAS-C-30 is a useful instrument to assess and monitor the level of adjustment among patients with permanent colostomies. The identified predictor variables for adjustment also provide insights to clinicians to assist them in planning interventions to facilitate the adjustment of colostomy patients.
Background:
Self-management is widely accepted as an essential component of chronic care. Nevertheless, little is known about patients' perceptions of self-management.
Purpose:
This study aims to explore which self-management tasks and support needs people with chronic illness perceive for themselves, and to establish whether these tasks and support needs are disease specific.
Methods:
A nationwide representative sample of 2,064 people with chronic disease filled in the Patient Assessment of Self-management Tasks questionnaire.
Results:
Many respondents perceive self-management tasks in the daily management of their condition, although few indicate a need for support. Respondents who feel a need for support in one aspect of self-management are likely to feel a need for support in other aspects as well. Type of disease has a small effect on self-management tasks and even smaller on support needs.
Conclusion:
Although the self-management tasks patients perceive may be partly disease specific, self-management support does not necessarily need to be disease specific.
Purpose:
We evaluated persons living with a colostomy in order to characterize and describe relationships among adjustment, self-care ability, and social support.
Subjects and setting:
One hundred twenty-nine colostomy patients from 5 hospitals in Guangzhou, capital city of the Guangdong province, were recruited by convenience sampling.
Instruments:
Cross-sectional data were collected from a survey that included demographic and pertinent clinical data related to their ostomy. The survey also incorporated Chinese language versions of the Ostomy Adjustment Scale, Exercise of Self-Care Agency Scale, and Perceived Social Support Scale. These scales were used to measure the levels and degrees of adjustment, self-care ability, and social support of colostomy patients.
Methods:
Respondents completed the survey during outpatient clinics visit after creation of a colostomy.
Results:
Scores from the Ostomy Adjustment Scale revealed that 96.9% of colostomy patients reported low to moderate adjustment (128.6 ± 19.38) to their stoma. Self-care ability and social support of patients were positively correlated with the adjustment level (R = 0.33, R = 0.21). Several factors, including being a housewife, paying medical expense by oneself, inability to manage the ostomy without assistance, and not participating in an ostomy support group, were associated with a lower level of adjustment (P < .05). Worries about odor and antipathy toward the ostomy significantly contributed to lower levels of adjustment to the stoma (P < .01).
Conclusion:
Overall adjustment to a colostomy was moderate. Self-care ability and social support associated with having a colostomy positively influenced adjustment. Adjustment was also influenced by occupation, health insurance provider, and ability to care for the stoma without requiring assistance.
Background:
With the loss of an important bodily function and the distortion in body image, a stoma patient experiences physical, psychological, and social changes. With limited current studies exploring experiences of patients in the management of their stoma, there is a need to explore their experiences, their needs, and factors that influence their self-management.
Objective:
The aim of this study was to investigate patients' experiences of performing self-care of stomas in the initial postoperative period.
Methods:
This study adopted a descriptive qualitative approach from the interpretive paradigm. Semistructured interviews were conducted with 12 patients 1 month postoperatively in a colorectal ward in a hospital in Singapore. Thematic analysis was applied to the interview data.
Results:
Five themes were identified: process of acceptance and self-management of stoma, physical limitations, psychological reactions, social support, and need for timely and sufficient stoma preparation and education.
Conclusions:
This study highlights the importance of health professionals' role in helping patients adjust preoperatively and postoperatively and accept the presence of a stoma. Health professionals need to be aware of the physical, psychological, and social impact of stoma on patients in the initial 30-day postoperative period.
Implications for practice:
Research findings informed the type and level of assistance and support to be offered to patients by nurses and the importance of encouraging patients to be involved in stoma care at an early stage, which will ultimately contribute to effective and independent self-management. Patients can be prepared preoperatively to reduce the psychological and social impact of stoma after creation of their stoma.
To assess health-related quality of life in patients with urothelial (bladder) cancer 6 months following radical cystectomy with construction of a urostomy.
The target sample was 54 patients with urothelial cancer who underwent radical cystectomy with Bricker-type incontinent urinary diversion between December 2008 and December 2009; 37 out of 54 (68%) of potential respondents agreed to participate. Seven potential subjects died within the 6-month period and we were unable to locate 10 potential respondents.
The Stoma-Quality of Life was developed to be valid for measurement of 20 items that query the impact of the ostomy on the health-related quality of life and its impact on daily life. Scores were categorized as 70% to 100% (indicating good quality of life), 30% to 69% (indicating moderate quality of life), and 0 to 29% (indicating poor quality of life).
Subjects responded to the Stoma-Quality of Life questionnaire by telephone 6 months after urostomy surgery.
Thirty-five were ranked as having a good quality of life. The remaining 2 subjects had scores indicating moderate quality of life; no respondent was ranked as having a poor quality of life.
Health-related quality of life was ranked as good in 95% of a group of patients managed by radical cystectomy and Bricker ileal conduit construction and moderate in 5%. Based on these findings, we conclude that the Bricker-type incontinent urinary diversion remains a viable treatment option for bladder cancer that allows an acceptable health-related quality of life.
Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.
The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and metastatic colorectal disease separately. Moreover, evidence based algorithms for diagnostics and treatment were composed which were also submitted to the Delphi process.
The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members.
Multidisciplinary consensus on key diagnostic and treatment issues for colon and rectal cancer management using the Delphi method was successful. This consensus document embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.
Purpose/Objectives: To summarize empirical evidence relating to stressors that may affect patients' psychosocial health following colostomy or ileostomy surgery during hospitalization and after discharge.
Data Sources: An extensive search was performed on the CINAHL®, Cochrane Library, PubMed, PsycINFO, Scopus, Science Direct, and Web of Science electronic databases.
Data Synthesis: Eight articles were included with three qualitative and five quantitative research designs. Most studies were conducted in Western nations with one other in Taiwan. Following colostomy or ileostomy surgery, common stressors reported by patients during hospitalization included stoma formation, diagnosis of cancer, and preparation for self-care. After discharge, stressors that patients experienced encompassed adapting to body changes, altered sexuality, and impact on social life and activities.
Conclusions: This review suggests that patients with stomas experience various stressors during hospitalization and after discharge. Additional research is needed for better understanding of patient postoperative experiences to facilitate the provision of appropriate nursing interventions to the stressors.
Implications for Nursing: To help patients deal with stressors following stoma surgery, nurses may provide pre- and postoperative education regarding the treatment and recovery process and encourage patient self-care. Following discharge, nurses may provide long-term ongoing counseling and support, build social networks among patients with stomas, and implement home visit programs.
Knowledge Translation: Stoma surgery negatively affects patients' physical, psychological, social, and sexual health. Postoperative education programs in clinical settings mostly focus on physical health and underemphasize psychological issues. More pre- and postoperative education programs are needed to help patients cope with stoma stressors.
Purpose:
The purpose of this study was to measure health-related quality of life (HRQOL) in a group of community-dwelling persons with urostomies.
Subjects and settings:
The study sample comprised 60 people with urostomies who had been discharged for at least 1 month prior to participation and attended an ostomy outpatient clinic at a municipal hospital in Osaka, Japan.
Methods:
Data were collected via interview. Health-related quality of life was assessed using a Japanese language version of the Medical Outcomes Research Short Form 36, version 2. Demographic and clinical data were collected via questionnaire designed for this study that queried age, cancer diagnosis, time since surgery, type of urostomy, job status, presence of visual disorders, peristomal skin problem, information about caregivers in the home, and participation in a support group. Health-related quality of life scores were adjusted by gender and age distribution from standard scores among the general population in Japan.
Results:
The majority of participants (85.0%) were diagnosed with bladder cancer, and the median time since surgery was 3.4 years. Health-related quality of life scores among those who had surgery during the past 4 years were significantly lower than scores of participants living with an ostomy for more than 4 years. Ostomy surgery associated with an underlying cause other than bladder cancer was associated with a significantly lower score on the social function domain of the Medical Outcomes Research Short Form 36, version 2. Presence of a support person at home was associated with significantly lower scores on the mental health domain. Participation in a support group for persons with ostomies significantly lowered the body pain domain score.
Conclusion:
This study shows the factors relevant to the HRQOL of the participants with urostomies. We recommend that WOC nurses should pay particular attention to people who had ostomy surgery and had such factors, because of the higher likelihood for lower HRQOL.
Nearly 50% of adults have one or more chronic illnesses. Self-care is considered essential in the management of chronic illness, but the elements of self-care in this context have not been specified in a middle-range theory. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. The key concepts include self-care maintenance, self-care monitoring, and self-care management. Assumptions and propositions of the theory are specified. Factors influencing self-care including experience, skill, motivation, culture, confidence, habits, function, cognition, support from others, and access to care are described.
In general, social support from family members affects chronic illness outcomes, but evidence on which specific family behaviors are most important to adult patient outcomes has not been summarized. We systematically reviewed studies examining the effect of specific family member behaviors and communication patterns on adult chronic illness self-management and clinical outcomes. Thirty studies meeting inclusion criteria were identified, representing 22 participant cohorts, and including adults with arthritis, chronic cardiovascular disease, diabetes, and/or end stage renal disease. Family emphasis on self-reliance and personal achievement, family cohesion, and attentive responses to symptoms were associated with better patient outcomes. Critical, overprotective, controlling, and distracting family responses to illness management were associated with negative patient outcomes. Study limitations included cross-sectional designs (11 cohorts); however results from longitudinal studies were similar. Findings suggest that future interventions aiming to improve chronic illness outcomes should emphasize increased family use of attentive coping techniques and family support for the patient's autonomous motivation.
Self-efficacy, one's expectations regarding the ability to perform some specific task, was studied prospectively in the adaptation process of stoma patients. One week after surgery, stoma-related self-efficacy was assessed in 59 patients (26 cancer patients and 33 patients with benign diseases) who had undergone intestinal stoma surgery. Twenty-nine items concerning self-efficacy were formulated. Factor analysis with oblique rotation resulted in two factors: a social functioning-related self-efficacy factor and a stoma care-related self-efficacy factor. Psychosocial adjustment was assessed by means of the Psychosocial Adjustment to Illness Scale (PAIS-SR) at 4 and 12 months after surgery. The PAIS-SR renders one global adjustment score and (in this study) five subscores for adjustment to specific life domains: vocational environment, domestic environment, sexual relationship, social environment, and psychological distress. In a multiple regression analysis, the relevance of self-efficacy for later adjustment was determined after partialing out the effects of relevant sociodemographic and medical factors. Strong evidence was found for the important role of self-efficacy in the process of adapting to a stoma; stronger feelings of self-efficacy shortly after the operation predicted fewer psychosocial problems in the course of the first postoperative year. Stoma care-related self-efficacy appears especially important in the first phase after surgery. Social functioning-related self-efficacy explains significant proportions of the variances in PAIS-SR total score and PAIS-SR subscores, in both the short (4 months after surgery) and long runs (12 months after surgery). If patients expect to be able to take care of their stoma, their postoperative adjustment is relatively good. By strengthening patients' self-efficacy, this adaptation process may be accelerated, and the psychological and social burden can be lightened.
This paper is a report of a study to examine adjustment and its relationship with stoma acceptance and social interaction, and the link between stoma care self-efficacy and adjustment in the presence of acceptance and social interactions.
There have been significant advances in stoma appliances and an increase in nurses specialising in stoma care. Despite this, a large proportion of patients continue to experience adjustment problems, which suggests that improvements in the management of the stoma are by themselves not enough to enhance psychosocial functioning. Illness acceptance and interpersonal relationships are widely reported as correlates of adjustment to chronic illness, but these have not been specifically examined in patients with a colostomy. Evidence of their association could offer stoma therapists alternative ways of aiding adjustment.
Between 2000 and 2002, 51 patients with colostomies provided demographic and clinical data and completed validated questionnaires to measure acceptance of the stoma, relationship with others and stoma care self-efficacy 6 months after surgery.
Multiple regression analysis showed that stoma care self-efficacy, stoma acceptance, interpersonal relationship and location of the stoma were strongly associated with adjustment. The model explained 77% of the variance. Stoma-care self-efficacy accounted for 57.5%, the psychosocial variables 13% and location of the stoma 4.6%. The addition of gender, which was not statistically significant (P > 0.05), explained a further 1.9% of the variance.
Addressing psychosocial concerns should become part of the care routinely given to stoma patients. We recommend more emphasis on dispelling negative thoughts and encouraging social interactions.
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