Selected abstracts from the 24th Biennial WCET® Congress in Glasgow, UK

doi:10.33235/wcet.45.1.34-40

Volume 45 Number 1

Selected abstracts from the 24th Biennial WCET^® Congress in Glasgow, UK

DOI 10.33235/wcet.45.1.34-40

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Abstract

Delegates at the WCET^® Congress, in Glasgow, UK in September, were treated to a very successful scientific programme with diverse, stimulating and high-quality content.

For the benefit of the many members who were unable to attend, here is a sample of what was presented by speakers from around the world.

Role of nurses in the care of women with urinary incontinence in primary health care

Lívia M Martins, N/A, RN, BSN, MSN, PhD, TiSOBEST
Stomotherapist Nurse, Technical Manager of the Family Health Unit of the Prof. Dr. Célia de Almeida Ferr-FAEPA Foundation Hospital Clinics, Faculty of Medicine de Ribeirão Preto, University of São Paulo, Brazil

Rosaura Soares Paczek MD
Nurse, Brazil

Aims/Objectives To describe the role of the stoma nurse to women with UI complaints in PHC.

Purpose & Background Urinary incontinence (UI) is the involuntary loss of urine, caused by various conditions, impacting on quality of life and limiting daily life activities.¹ In Brazil, 20% to 43% of women suffer from some urinary loss,² similar data found in the female population worldwide by the International Continence Society (ICS).³ Primary Health Care (PHC) is the gateway to the Brazilian Unified Health System (SUS), where the nurse, during the Nursing Consultation, with communication skills and propaedeutic techniques, can assist the patient integrally.^4,5

Methods Experience report conducted in a public health service in the interior of the State of São Paulo/Brazil in 2022–2023.

Results From June 2022 until November 2023, a stomotherapist nurse concerned with the quality of life of women with UI, began the training of muscles of the Pelvic Floor (TMAP), in a public health service in the interior of the State of São Paulo/Brazil. During nursing consultations, when complaints of UI were identified, the Oxford Scale was used for evaluation and the TMAP was initiated, based on the evaluation protocol and TMAP for assistance to women with urinary incontinence, the training of weakness of the perineal muscle (MAP strength change) and resistance of the impaired perineal muscle (MAP support change). All women who started TMAP treatment for urinary incontinence are still undergoing treatment, there is a high level of adherence to treatment and customer satisfaction with progressive improvement of symptoms.

Conclusion/Outcome Primary Care is a favorable scenario for nurses to assist people with UI by evaluating and indicating TMAP exercises for women with either complaint or risk for UI.

Keywords stomatherapy, urinary incontinence, urgency urinary incontinence, stress urinary incontinence, primary health care, nursing care.

References

Assis GM, Silva CPC da, Martins G. Proposal of a protocol for pelvic floor muscle evaluation and training to provide care to women with urinary incontinence. Rev esc enferm USP [Internet]. 2021;55:e03705. Available from: https://doi.org/10.1590/S1980-220X2019033503705
Oliveira LGP, Tavares ATDVB, Amorim TV, Paiva A do CPC, Salimena AMO. Impacto da incontinência urinária na qualidade de vida de mulheres: revisão integrativa da literatura. Rev enferm UERJ, Rio de Janeiro, 2020. 28:e51896.DOI: https://doi.org/10.12957/reuerj.2020.51896
Abrams P, Cardozo L, Wagg A, Wein A. Incontinence. 6 ed. Tóquio: The International Consultation on Urological Diseases;2017.
Brasil. Ministério da Saúde. Portaria nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Brasília, DF: Ministério da Saúde, 2017. Disponível em: http://www.brasilsus.com.br/index.php/legislacoes/gabinete -do- -ministro/16247-portaria-n-2-436-de-21-de-setembro-de-2017
Santos SM dos R, Jesus MCP de, Amaral AMM do, Costa DMN da, Arcanjo RA. A consulta de enfermagem no contexto da atenção básica de saúde, Juiz de Fora, Minas Gerais. Texto contexto - enferm [Internet]. 2008Jan;17(1):124–30. doi https://doi.org/10.1590/S0104-07072008000100014
Assis GM, Silva CPC, Martins G. Proposta de protocolo de avaliação e treinamento da musculatura do assoalho pélvico para atendimento à mulher com incontinência urinária. Rev. esc. enferm. USP 55. 2021. https://doi.org/10.1590/S1980-220X2019033503705

Educational interventions to improve knowledge among nurses in the prevention of skin tears in institutionalised adults and older adults: a scoping review

Heidi M. Hevia, PhDc, Professor, PhDc
University of São Paulo, Brazil

Cinthia Viana Bandeira da Silva. Silva, MD
Master, School of Nursing at University of São Paulo, Brazil

Marilia Mastrocolla PhD
Department of Academic Activity Management, University of São Paulo, Brazil

Juliana Takahashi, MD
Librarian, University of São Paulo, Brazil

Lily Rios Mazzachiodi, Md
Profesor, Andres Bello University, Chile

Vera Lucia Conceição de Gouveia. Santos, CETN, MD, PhD
Full Professor, School of Nursing, University of São Paulo, Brazil

Aims/Objectives To map and synthesise the current state of the literature on educational interventions to prevent skin tears in adults and older adults, provided by nurses to nursing professionals in various healthcare settings.

Purpose & Background Skin tears are common injuries that go unreported and unnoticed. Research supports that educational interventions allow the health person to be trained and prevent the occurrence of these injuries, by implementing preventive measures, impacting the incidence and prevalence of these wounds.

Methods A scoping review following the JBI methodology was performed including articles that complied with the framework Population Concept and Context, published in English, Spanish and Portuguese and without time limit. Ten databases were consulted in addition to unpublished studies and grey literature. Searches were managed using Endnote and subsequently exported to the Rayyan tool. Two independent reviewers screened the articles retrieved from the databases by title and abstract following the inclusion criteria. Then, the full text of selected articles was read by the same reviewers; a third reviewer solved some discrepancies, and a final agreement was reached. Data from the selected articles were extracted into a spreadsheet.

Results: 694 articles were obtained, among which four met the inclusion criteria. Two modalities of educational interventions in the prospective quasi-experimental studies were identified: face-to-face classes using the PowerPoint presentation and online training available 24 hours a day, seven days a week, through the institution´s website. The primary outcome measures were knowledge level and skin tears incidence.

Conclusion/Outcome The education intervention provided by nurses improved knowledge of skin tears and reduced their incidence. More primary studies are needed to examine the preferred and feasible educational interventions or technologies to enhance learning and knowledge acquisition. Future studies should also review the direct impact of knowledge on practice change and skin tears incidence.

Keywords aged,adults, continuing nursing education, soft tissue injuries, prevention.

References

LeBlanc K. Best practice recommendations for the prevention and management of skin tears in aged skin. Wounds International [Internet]. 2018 [cited 2023 Apr 10];1–21. Available from: https://www.woundsinternational.com

McTigue T, D’Andrea S, Doyle-Munoz J, Forrester DA. Efficacy of a Skin Tear Education Program. Journal of Wound, Ostomy & Continence Nursing [Internet]. 2009 Sep;36(5):486–92. Available from: https://journals.lww.com/00152192-200909000-00004

Pagan M, Harvey P. Implementing a pilot skin and wound care programme in two residential aged care facilities. Wound Practice and Research. 2019 Dec;27(4).

Lopez V, Dunk AM, Cubit K, Parke J, Larkin D, Trudinger M, et al. Skin tear prevention and management among patients in the acute aged care and rehabilitation units in the Australian Capital Territory: A best practice implementation project. Int J Evid Based Healthc. 2011 Dec;9(4):429–34.

Tamai N, Sanada H, Keiyu Hospital O. Effect of an education program on the prevention of skin tears for nurses in a Japanese long-term care hospital: A pre-post study. Vol. 24, Ostomy, and Continence Management. Japanese Society Wound; 2020.

Peters MDJ, Godfrey C, McInerney P, Khalil H, Larsen P, Marnie C, et al. Best practice guidance and reporting items for the development of scoping review protocols. JBI Evid Synth. 2022 Apr 9;20(4):953–68.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med [Internet]. 2018 Oct ;169(7):467–73. Available from: https://www.acpjournals.org/doi/10.7326/M18-0850

Optimizing compression therapy to accommodate for dynamic fluid shifts, using an adjustable Velcro compression wrap: A young woman with stage 3 lymphedema, and a chronic nonhealing wound

Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN
WOC Nurse, Vancouver Coastal Health/ Macdonalds Prescriptions, Canada

Jan Hajek, MD, FRCPC
Dr. University of British Columbia, Canada

Nadereh Rezania, BSc,BSN, WOC/RN
WOC/RN, Vancouver Coastal, Canada

Aims/Objectives To improve the understanding and ability to care for people with severe lymphoedema complicated by dynamic fluid shifts: To highlight the need for individualized care; To share knowledge of dynamic fluid shifts; To describe the benefit of adjustable compression wraps.

Purpose & Background Lymphedema is a neglected, disfiguring, and disabling condition. Treatment is life-long, can be difficult, costly, and resource-intensive. Management requires a multidisciplinary approach, strong community support, access to experienced clinicians, and an understanding of the dynamic lymphatic fluid shifts with compression therapy.

Methods A case study of a 33-year-old woman with severe lymphedema of her left leg related to previous deep vein thrombosis (DVT) and elevated body mass index (BMI). Her care was complicated by mental illness and a large chronic wound over her left shin. She had been unsuccessfully managed for years in the community with a 2-layer compression wrap and suffered progressive leg swelling, debility, increasing wound size, and recurrent episodes of cellulitis. In 2022, she was admitted to hospital. She was assessed by Internal Medicine, Infectious Diseases, Plastic Surgery, Vascular Surgery teams, and WOC nurse. Surgical intervention (the Charles procedure) was considered, but the risks outweighed the potential benefits. An individualiSed management plan was pursued, including NPWT, extracellular matrix, thigh-high adjustable Velcro compression, and 24-hour nursing care to maintain the level of compression.

Results With consistent compression, frequent adjustments to account for dynamic lymphatic fluid shifts, there was marked improvement. The circumference of the calf reduced from 88cm to 55cm, and thigh from 118cm to 76cm in six weeks. The wound healed. Her quality of life improved. Post-discharge, her lymphedema stabiliSed, and she was able to apply the adjustable compression garment independently.

Conclusion/Outcome We highlight the reduction of lymphatic fluid, wound healing, and improved quality of life following the application of an adjustable thigh-high Velcro compression system.

Keywords lymphedema, compression, Velcro.

References

Damstra, R. J., & Partsch, H. (2013). Prospective, randomized, controlled trial comparing the effectiveness of adjustable compression Velcro wraps versus inelastic multicomponent compression bandages in the initial treatment of leg lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 1(1), 13-19. https://doi.org/10.1016/j.jvsv.2012.05.001
Gott, F. H., Ly, K., Piller, N., & Mangion, A. (2018). Negative pressure therapy in the management of lymphoedema. Journal of Lymphoedema, 13(1).
Haesler, E., & BN, F. W. A. (2022). WHAM Evidence summary: Managing lymphoedema: Compression therapy.

Case study: The Lived Experience of a Young Person with a Complex Medical Needs, Small Intestinal Transplant, TPN, and a Stoma, Linda’s Story

Kathleen L. Capitulo, PhD, RN, FAAN, FNYAM, IIWCC, C-CNS
Professor, Rory Myers School of Nursing at NYU, NYC; Icahn School of Medicine at Mount Sinai, NYC; and Zhengzhou Medical University, China.

Aims/Objectives 1. Identify three challenges of small bowel transplant. 2. Identify psycho-social-cultural and educational needs of a child with a life threatening illness. 3. Identify two strategies to improve the quality of life for a person that is TPN dependent with a stoma.

Purpose & Background Small bowel transplant, among the most complex transplants, presents challenges in wound, stoma, nursing, and medical care. This case presentation will tell Linda’s lived experience. She was born with microvillus inclusive disease, her journey through 19 years of hospitalisations, 13 major abdominal surgeries, small bowel transplant, three ileostomies, going home, transplant complications, chronic rejection, ex-plant, family abandonment, complex stoma care, long term hospitalisation, and TPN dependence.

Methods This is a case study, explored as a qualitative, lived experience of a child/teen, recorded and reported by the author, an experienced qualitative researcher.

Results Care of a toddler, child, teen with a small bowel transplant, stomas, and long term TPN are included, including travel with TPN and a stoma, issues related to long term psycho-social, developmental, educational, nutritional, transplant, and medical issues will be explored, as well as lessons learned and implications for practice, education, and research. Complications, including wounds, peristomal issues, and medical errors will be discussed.

Conclusion/Outcome This case is an exemplar of an extraordinary child/teen whose resilience, tenacity, and strength helped her survive, against all odds, to age 19; and her legacy dispelling myths of prohibitions (including travel), and the experience of innovative, and caring professionals that created and improved the quality of her life and the lives of other children and young adults experiencing life threatening illness, ostomy, wound and skin complications.

Keywords small-intestinal transplant, stomas, TPN, child.

References

Capitulo, K. & Shohatee, L. (2015). Complex issues: travelling with total parenteral nutrition and an ostomy. World Council of Enterostomal Therapy Journal. 35(3), p. 36-41.
Zorzetti, N., Marino, I. R., Sorrenti, S., Navarra, G. G., D’Andrea, V., & Lauro, A. (2023). Small bowel transplant - novel indications and recent progress. Expert review of gastroenterology & hepatology, 17(7), 677–690. https://doi.org/10.1080/17474124.2023.2221433

It has become a part of me: living with low anterior resection syndrome after ostomy reversal

Catherine Buergi, MScN
Ostomy and Continence Nurse, Zürich University Hospital, Switzerland.

Aims/Objectives To generate an in-depth understanding of daily living needs of patients experiencing low anterior resection syndrome (LARS) in order to provide a more appropriate support.

Purpose & Background Even though, it is known that the quality of life of people with LARS is limited and that they suffer from the symptoms, there is limited information available on their experience of daily living more than a year after stoma reversal and their needs. This study was undertaken to address this deficiency and to add to the existing body of knowledge describing their challenges and needs.

Methods Interviews were conducted with seven patients (2 women, 5 men), twelve to 42 months after stoma reversal. All interviews were audio-recorded, transcribed, and analysed using the Interpretative Phenomenological Approach.

Results Analysis revealed three central categories addressing the burden of living with LARS: Internalising new living conditions; actively planning a new everyday life; and knowing the body and controlling symptoms. ‘Unpredictability’ emerged as the key challenge. Being informed in advance about the problems expected to arise, having the possibility to talk about problems, as well as receiving peer support were identified as means to ease patients’ challenges when living with LARS. However in total they missed structure aftercare.

Conclusion/Outcome Twelve to 42 months after stoma reversal, participants had internalised their new living conditions. Their level of acceptance of their situation was substantial. There are indications that a culture of open information before ostomy reversal contributed to being mentally prepared for the situation after surgery. Talking openly about their problems helped participants organise their everyday life. In order to enhance quality of life, a structured aftercare by nurses and other health professionals could cover the information need about potential problems after stomareversal and how to deal with the unpredictability until a normal routine has been established. Furthermore, access to peer groups should be provided.

Keywords low anterior resection syndrome, colorectal cancer, stoma reversal, quality of life, rectal resection.

References

Desnoo L, Faithfull S. A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery. Eur J Cancer Care. 2006; 15(3): 244-251. doi: 10.1111/j.1365-2354.2005.00647.x

Lange M. (2009). Long-term outcome of rectal cancer treatment. (Doctoral Thesis). University of Leiden, Netherland. Rotterdam; 2009.

German Cancer Society [Deutsche Krebsgesellschaft]. S3-Leitlinie Kolorektales Karzinom, Langversion 2.0, AWMF; 2012. http://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom/

Juul T, Ahlberg M, Bionde S, Espin E, Jimenez LM, Matzel KE, Jansson Palmer G, Sauermann A, Trenti L, Zhang W, Laurberg S, Christensen P. Low Anterior Resection Syndrome and Quality of Life: an International Multicenter Study. Dis Colon Rectum, 2014; 57:585-591.

Bryant C, Lunniss PJ., Knowles CH, Thaha MA, Chan, CL. Anterior resection syndrome. Lancet Oncol. 2012; 13(9), 403-408. doi: 10.1016/s1470-2045(12)70236-x

Emmertsen KJ, Laurberg S. Bowel dysfunction after treatment for rectal cancer. Acta Oncol. 2008; 47(6), 994-1003. doi: 10.1080/02841860802195251

Ollsson F, Berterö C. Living with faecal incontinence: trying to control the daily life that is out of control. J Clin Nurs, 2014; 24: 141-150. doi: 10.1111/jocn.12617

Owen J, Papageorgiou A. The lived experience of stigmatisation in patients after stoma reversal. Gastrointest Nurs; 2008; 6: 26-33.

Pachler J, Wille-Jorgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Systematic Reviews. 2012; 12, CD004323. doi: 10.1002/14651858.CD004323.pub4

Taylor C, Bradshaw E. Tied to the toilet: lived experiences of altered bowel function (anterior resection syndrome) after temporary stoma reversal. JWOCN. 2013; 40(4): 415-421. doi: 10.1097/WON.0b013e318296b5a4

Reinwalds M, Blixter A, Carlsson E. Living with a resected rectum after cancer surgery. Struggling not to let bowel function control life. J Clin Nurs. 2017; 00, 1-12. doi: 10.1111/jocn.14112

Smith JA, Flowers, P, Larkin M. Interpretative Phenomenological Analysis. London: Sage; 2009.

Kruse J. Qualitative Interviewforschung. Ein integrativer Ansatz [Qualitative research. An integrative approach]. Weinheim: Beltz Juventa; 2015.

Paterson BL. The Shifting Perspectives Model of Chronic Illness. J Nurs Schol. 2001; 33(1), 21-26.

Blixter A., Reinwalds M. Excuse me, where is the toilet? (Masterthesis). University of Götheborg; 2014.

Meyer A, Coroiu A, Korner A. One-to-one peer support in cancer care: a review of scholarship published between 2007 and 2014. Eur J Cancer Care. 2015; 24: 399-312.

Beaver K., Latif S., Williamson S., Procter D., Sheridan J., Heath J., Sursnerwala S., Luker K. An exploratory study of the follow-up care needs of patients treated for colorectal cancer. J Chin Nurs. 2010; 19 (23-24) 3291-3300. doing:10.1111/J.1365-2702.2010.03407.x

Keane, C., Fearnheas, N.S., Bordeianou, L., Christensen, P., Espin Basany, E., Laurberg, S., Mellgren, A., Messick, D., Orangio, G.R., Varje, A., Wing, K., Bissett, I., & Group, L. I. C., (2020). International consensus definition of low anterior resection syndrome. Colorectal Dis, 22 (3) 331-341. https:doi.org/10.1111/codi.1495

An evidence-informed care model to improve the quality of care in newly ostomized patients

Marianne Krogsgaard, PhD, Associate Professor
Clinical Nurse Specialist, Department of Surgery, Center for Surgial Science, Zealand University Hospital, Koege, Denmark; Department of People and Technology, Roskilde University, Denmark.

Marie Pilebo
Stoma care nurse; ET Department of Surgery, Zealand University Hospital, Denmark.

Aims/Objectives To develop an evidence-informed practice to prevent readmissions due to dehydration in newly ostomized patients.

Purpose & Background In adult patients with a newly constructed ileostomy around 40% are readmitted within 30-60 days postoperatively. Readmission is in most cases due to dehydration which increases mortality, risk of renal failure, and impacts negatively on patients’ quality of life. The aim of this intervention was to develop an evidence-informed practice to prevent readmissions due to dehydration in newly ostomized patients.

Methods Based on a literature search an evidence-informed care model and guideline was developed. The model involved pre, - per.- and postoperative interventions from patients, ward nurses, stoma care nurses, surgeons, and nurses from primary health care sector (PHS-nurses). Key elements in intervention were: Teaching patients about correct diet and fluid intake, signs of dehydration, monitoring of output, when and where to seek help; Written information, such as leaflets on prevention of dehydration to patients, PHS-nurses and ward nurses; discharge criteria such as maximum output from stoma 1500 ml/day, no need for supplementary IV fluid, urinary output and weight is stable, sufficient self-management of stoma care; home monitoring involving patients monitoring daily weight and fluid intake/output. Blood tests x2 primary health sector; and follow-up including telephone follow-up x 1 within 3 + 30 days, outpatient stoma clinic follow-up x 2 within 40 days.

Results Implementation at two wards has been ongoing since May 2022. Staff knowledge has increased and cooperation with PHS-nurses has improved. Patients express involvement in care and are more likely to seek help and advice from professionals in time. In case of readmission, patients’ fluid balance seem to be less impacted.

Conclusion/Outcome An evidence-informed care model has the potential to prevent readmission due to dehydration after newly ileostomy formation.

Keywords stoma care, dehydration, readmission, patient involment, patient education.

Prevalence of peristomal skin complications in the first 12-weeks post discharge following urinary/faecal stoma formation surgery

Tania L. Norman, BN, BCN, STN, MNurs(Res) student
Stomal Therapy Nurse, WA Ostomy Association, Australia.

Aims/Objectives The aim of the research was to describe the number and aetiology of PSCs in the first 12 weeks post-discharge from hospital following faecal or urinary stoma formation surgery and to measure their effects on QoL.

Purpose & Background Peristomal skin complications (PSC) following faecal and urinary stoma formation are commonly reported in the early post-operative period and are largely preventable, however there is little Australian data. PSCs often cause readmission to hospital and have an overall negative impact on quality of life (QoL).

Methods Stomal therapy nurses collected baseline data using a Peristomal Risk Assessment Tool (PRAT) from patients who underwent urinary or faecal stoma formation surgery from two hospitals in Perth, Western Australia over a 3-month period. Ostomates were assessed weekly for 4-weeks then fortnightly until 12-weeks post discharge either face-to-face or by telephone and photographic images were taken.

Results All ostomates presented with three or more PSCs during the course of the study, with the majority (63%) attributed to irritant dermatitis and 47% percent classified as ‘bruising’. PSCs were seen in ostomates who had stomas less than 20mm in height and in those who received less pre-operative education. If the ostomate suffered with anxiety and depression they were more likely to have a PSC, which led to a negative effect on their QoL.

Conclusion/Outcome The results from this study align to the PSCs reported in the international literature and highlight the importance of regular postoperative STN follow-up especially in the early post-operative period. The study has identified the main contributing factors for PSCs which can be used to identify ostomates at high risk of developing PSCs and guide prevention strategies.

Keywords stoma, peristomal , complications, aetiology, quality of life.

References

Taneja, C., Netsch, D., Rolstad, B. S., Inglese, G., Eaves, D., & Oster, G. (2019). Risk and economic burden of peristomal skin complications following ostomy surgery. Journal of Wound, Ostomy, and Continence Nursing, 46(2), 143-149. https://doi.org/10.1097/WON.0000000000000509
Cengiz, B., Bahar, Z., & Canda, A. E. (2020). The effects of patient care results of applied nursing intervention to individuals with stoma according to the health belief model. Cancer Nursing, 43(2), E87–E96. https://doi.org/10.1097/NCC.0000000000000678.
Chaudhri, S., Brown, L., Hassan, I., & Horgan, A. F. (2005). Preoperative intensive, community-based vs. traditional stoma education: A randomized, controlled trial. Diseases of the Colon & Rectum, 48(3), 504-509. https://doi.org/10.1007/s10350-004-0897-0
Meisner, S., Lehur, P.-A., Moran, B., Martins, L., & Jemec, G. B. E. (2012). Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modelling study. PLOS I ONE, 7(5). doi: 10.1371/journal.pone.0037813
LeBlanc, K., Whiteley, I., McNichol, L., Salvadalena, G., & Gray, M. (2019, Mar/Apr). Peristomal Medical Adhesive-Related Skin Injury: Results of an International Consensus Meeting. J Wound Ostomy Continence Nurs, 46(2), 125-136. https://doi.org/10.1097/WON.0000000000000513
Pitman,J Rawl SM, Schmidt CM et al. Demographic and clinical factors related to ostomy complication and quality of life in veterans with an ostomy. JWOCN 2008;35(5):493-503.
Colwell, J. Belitz J, Survey of wound, ostomy and continence (WOC) nurse clinicians on stomal and peristomal complications: a content validation study. JWOCN 2019;46(2):143-149.
Down G et al. Clinical preventative-based best practices to reduce the risk of peristomal skin complications-an international consensus report. WCET Journal 2023;43(1):11-19

Autism: Living with a stoma and the challenges of nursing someone following discharge from hospital

Jo Sica, CNS Stoma Care
Your Healthcare, Kingston, UK

Aims/Objectives To give an insight into the challenges the community stoma specialist nurse faced when caring for a high functioning autistic patient with a newly formed stoma To demonstrate the pathway of care for this patient who had very high needs.

Purpose & Background Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviours or interests. People with ASD may also have different ways of learning, moving, or paying attention. Autism is a lifelong developmental disability which affects how people communicate and interact with the world. More than one in 100 people are on the autism spectrum and there are around 700,000 autistic adults and children in the UK.

Methods A literature search was carried out and provided extremely limited material on adults with autism and a stoma. There are a few published articles relating to autistic children with stoma. My immediate peer group had limited experience. The national associations provide very helpful information that allowed the practitioner to incorporate into the patient’s care. This case study will show the patients journey and adjustment to life with a stoma and ongoing medical issues he needed to address.

Results The case study showed the importance in engaging with the multidisciplinary team as being key in ensuring all the healthcare professionals are aware of his limitations.

Conclusion/Outcome Caring for this patient has developed the author’s understanding of autism in particular to using language that is understood and recognising signs of stress in these individuals. Initially the patient insisted on being seen on a weekly basis but the author was able to reduce these appointments as time went on without causing stress to the patient and also ensuring he felt safely supported.

Keywords Autism Multi disciplinary team Behaviours Trust.

References

Irizorry LA, Justianano VO. Sigmoid Volvulus in a child with Autism Spectrum Disorder. Journal of Paediatric Surgery Case Reports. 2022;76:102065

Bladder & Bowel UK. Amanda Morgan talks about her daughter’s life with a stoma. 2018, October 8. https://www.bbuk.org.uk/life-with-a-stoma

National Autistic Society Fact Sheets . https://www.autism.org.uk/advice-and-guidance. Last accessed January 2024.

英国格拉斯哥第24届两年一度WCET^®精选摘要

DOI: 10.33235/wcet.45.1.34-40

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今年9月，在英国格拉斯哥举办的WCET®大会上，参会代表们领略了一场内容丰富、形式多样且质量卓越的科学盛宴。

为了让未能亲临现场的成员也能了解会议的精彩内容，我们精心挑选并整理了以下来自全球各地发言人的精华摘要。

初级卫生保健中护士对尿失禁女性的护理职能

Lívia M Martins, N/A, RN, BSN, MSN, PhD, TiSOBEST
巴西，圣保罗大学，Ribeirão Preto医学院，FAEPA基金会医院临床部家庭健康单元技术经理，造口治疗护士

Rosaura Soares Paczek MD
巴西，护士

目的/目标阐述造口护士在初级卫生保健（PHC）中对尿失禁（UI）女性的护理职能。

目的与背景尿失禁（UI）指由多种病因导致的非自主排尿，会影响生活质量并限制日常活动。¹巴西有约20%-43%女性存在尿失禁症状，²这一比例与国际尿控协会（ICS）对全球女性人群的调查数据基本一致。³初级卫生保健（PHC）是巴西统一卫生系统（SUS）的首诊入口，护士可通过护理会诊与诊断技术为患者提供整体护理服务。^4,5

方法 2022-2023年在巴西圣保罗州某公立卫生服务机构开展经验报告。

结果 2022年6月至2023年11月期间，一位关注女性UI患者生活质量的造口治疗护士在上述卫生服务机构启动盆底肌训练（TMAP）。在护理会诊中，如识别出患者有UI主诉，则采用牛津量表评估，并依据针对女性尿失禁的评估方案和TMAP，实施会阴肌力训练（MAP肌力改变）和会阴肌耐力训练（MAP支撑改变）干预措施。所有接受TMAP治疗的患者目前仍在持续治疗中，表现出良好的依从性及满意度，症状亦呈逐步改善趋势。

结论/结局初级卫生保健为护士评估并指导存在UI主诉或风险女性开展骨盆底肌训练（TMAP）提供了良好的实践场景。

关键词造口治疗、尿失禁、急迫性尿失禁、压力性尿失禁、初级卫生保健、护理干预。

参考文献

Assis GM, Silva CPC da, Martins G. Proposal of a protocol for pelvic floor muscle evaluation and training to provide care to women with urinary incontinence. Rev esc enferm USP [Internet]. 2021;55:e03705. Available from: https://doi.org/10.1590/S1980-220X2019033503705
Oliveira LGP, Tavares ATDVB, Amorim TV, Paiva A do CPC, Salimena AMO. Impacto da incontinência urinária na qualidade de vida de mulheres: revisão integrativa da literatura. Rev enferm UERJ, Rio de Janeiro, 2020. 28:e51896.DOI: https://doi.org/10.12957/reuerj.2020.51896
Abrams P, Cardozo L, Wagg A, Wein A. Incontinence. 6 ed. Tóquio: The International Consultation on Urological Diseases;2017.
Brasil. Ministério da Saúde. Portaria nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Brasília, DF: Ministério da Saúde, 2017. Disponível em: http://www.brasilsus.com.br/index.php/legislacoes/gabinete -do- -ministro/16247-portaria-n-2-436-de-21-de-setembro-de-2017
Santos SM dos R, Jesus MCP de, Amaral AMM do, Costa DMN da, Arcanjo RA. A consulta de enfermagem no contexto da atenção básica de saúde, Juiz de Fora, Minas Gerais. Texto contexto - enferm [Internet]. 2008Jan;17(1):124–30. doi https://doi.org/10.1590/S0104-07072008000100014
Assis GM, Silva CPC, Martins G. Proposta de protocolo de avaliação e treinamento da musculatura do assoalho pélvico para atendimento à mulher com incontinência urinária. Rev. esc. enferm. USP 55. 2021. https://doi.org/10.1590/S1980-220X2019033503705

提升护士预防机构内成人及老年人皮肤撕裂知识的教育干预：一项范围综述

Heidi M. Hevia, PhDc, Professor, PhDc
巴西，圣保罗大学

Cinthia Viana Bandeira da Silva. Silva, MD
巴西，圣保罗大学，护理学院，硕士

Marilia Mastrocolla PhD
巴西，圣保罗大学，学术活动管理系

Juliana Takahashi, MD
巴西，圣保罗大学，图书馆馆长

Lily Rios Mazzachiodi, Md
智利，安徳烈斯贝略大学，教授

Vera Lucia Conceição de Gouveia. Santos, CETN, MD, PhD
巴西，圣保罗大学，护理学院，正教授

目的/目标梳理并综合当前文献中，护士在不同医疗保健机构中对护理专业人员开展的、用于预防成人及老年人皮肤撕裂的教育干预措施

目的与背景皮肤撕裂是一种常见但常被漏报和忽视的软组织损伤。研究表明，教育干预可提升医护人员的认知水平，使其通过落实预防措施降低该类伤口的发生率与患病率。

方法本范围综述采用JBI方法学开展，纳入符合“人群-概念-情境”（PCC）框架的文献，语种包括英语、西班牙语和葡萄牙语，不设时间限制。共检索10个数据库，另纳入未发表研究和灰色文献，文献管理采用Endnote，筛选工作借助Rayyan工具完成。两名评审员独立根据入选标准对数据库中检索出的文章进行标题/摘要筛选，随后由筛选出该篇文章的评审员全文阅读；如有分歧，由第三位评审员介入并达成一致意见。将所选文章的数据提取至电子表格。

结果：经筛选共获得694篇文章，其中4篇符合入选标准。这些研究为前瞻性准实验设计，使用两种教育干预模式：采用PowerPoint演示文稿的面对面授课，以及通过机构网站提供的7天24小时在线培训。主要结局指标为知识水平与皮肤撕裂发生率。

结论/结局由护士主导的教育干预可有效提升护理人员在皮肤撕裂预防方面的知识水平，并降低实际发生率。后续仍需开展更多原始研究，以探索更优且具可行性的教育方式或技术手段以促进知识学习与掌握。同时，亦需进一步探讨教育提升对临床实践改变与皮肤撕裂发生率的直接影响。

关键词老年人、成人、继续护理教育、软组织损伤、预防。

参考文献

McTigue T, DÅfAndrea S, Doyle-Munoz J, Forrester DA. Efficacy of a Skin Tear Education Program. Journal of Wound, Ostomy & Continence Nursing [Internet]. 2009 Sep;36(5):486–92. Available from: https://journals.lww.com/00152192-200909000-00004

Pagan M, Harvey P. Implementing a pilot skin and wound care programme in two residential aged care facilities. Wound Practice and Research. 2019 Dec;27(4).

Tricco AC, Lillie E, Zarin W, OÅfBrien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med [Internet]. 2018 Oct ;169(7):467–73. Available from: https://www.acpjournals.org/doi/10.7326/M18-0850

应用可调节魔术贴加压绷带优化压迫疗法以适应动态体液转移：一例III期淋巴水肿伴慢性不愈合伤口的年轻女性病例

Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN
加拿大，温哥华沿岸卫生局/Macdonalds Prescriptions，WOC护士

Jan Hajek, MD, FRCPC
加拿大，不列颠哥伦比亚大学，博士

Nadereh Rezania, BSc,BSN, WOC/RN
加拿大，温哥华沿岸卫生局，WOC/RN

目的/目标本研究旨在提升对合并动态体液转移的重度淋巴水肿患者的护理认知与能力：强调个体化护理的必要性；分享动态体液转移管理经验；阐述可调节加压绷带的获益。

目的与背景淋巴水肿是一种常被忽视的毁容性致残疾病，治疗周期长、难度大、花费高、资源需求大。其有效管理依赖多学科合作、社区支持、专业临床团队的介入，以及对压迫疗法中淋巴液动态转移机制的深入理解。

方法本研究为一例33岁女性患者的病例分析，其左下肢重度淋巴水肿与既往深静脉血栓形成（DVT）及高体重指数（BMI）相关。合并精神疾病及左胫前慢性大面积创面，増加了护理难度。患者在社区长期接受双层压迫绷带治疗无效，症状包括进行性水肿、衰弱、伤口扩大及反复蜂窝织炎发作。2022年住院后，分别接受了内科、感染科、整形外科、血管外科及WOC护士团队的评估，虽曾考虑行Charles手术，但因风险过高最终未行，转而采用个体化护理方案，包括负压伤口治疗（NPWT）、细胞外基质敷料、大腿高位可调节魔术贴压迫系统以及全天候护理维持压迫强度。

结果通过持续压迫治疗并根据淋巴液动态变化灵活调整压迫程度，效果显著改善。6周内小腿围从88 cm减至55 cm，大腿围从118 cm减至76 cm，伤口愈合，生活质量得到改善。出院后该患者淋巴水肿稳定，能够独立穿戴可调节压力服。

结论/结局本研究强调大腿可调节魔术贴压迫系统可减少淋巴液、加速伤口愈合并提升生活质量。

关键词淋巴水肿、压迫治疗、魔术贴。

参考文献

Damstra, R. J., & Partsch, H. (2013). Prospective, randomized, controlled trial comparing the effectiveness of adjustable compression Velcro wraps versus inelastic multicomponent compression bandages in the initial treatment of leg lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 1(1), 13-19. https://doi.org/10.1016/j.jvsv.2012.05.001
Gott, F. H., Ly, K., Piller, N., & Mangion, A. (2018). Negative pressure therapy in the management of lymphoedema. Journal of Lymphoedema, 13(1).
Haesler, E., & BN, F. W. A. (2022). WHAM Evidence summary: Managing lymphoedema: Compression therapy.

病例研究：Linda的故事：一位接受小肠移植、TPN及造口的复杂病患青年的生存体验

Kathleen L. Capitulo, PhD, RN, FAAN, FNYAM, IIWCC, C-CNS
纽约市，纽约大学罗里·迈尔斯护理学院；纽约市，西奈山伊坎医学院；中国，郑州大学医学院，教授。

目的/目标 1.明确小肠移植的三大挑战。2.确定患危及生命疾病的儿童在心理-社会-文化及教育方面的需求。3.提出两种改善TPN依赖型且带造口患者生活质量的策略。

目的与背景小肠移植作为最复杂的器官移植手术之一，在伤口、造口、护理及医疗管理方面均面临多重挑战。本案例将呈现Linda的真实生存经历，她出生时即被诊断为微绒毛包涵体病，19年间多次住院，接受13次大型腹部手术、1次小肠移植、3次回肠造口术，术后经历移植并发症、慢性排斥反应及移植物取出手术。其间还遭遇家庭遗弃，长期住院，依赖TPN维持生命，并需应对极其复杂的造口护理需求。

方法这是一项采用质性研究方法的病例研究，由一位经验丰富的质性研究者以“亲历视角”方式记录和分析Linda在儿童和青少年阶段的生存体验。

结果本研究详述了从婴幼儿至青少年阶段，接受小肠移植术后伴有造口并长期依赖全胃肠外营养（TPN）患者的照护经历。内容涵盖患者在携带TPN与造口情况下旅行所面临的实际挑战，以及其长期在心理社会适应、发育与教育需求、营养管理、移植风险与整体医疗问题方面的相关议题。此外，文章还探讨了护理实践中的经验启示、对教育与研究的影响，并重点分析了伤口并发症、造口周围问题及医疗差错等相关问题。

结论/结局该病例展示了一位非凡儿童/青少年（现19岁）在重重困难下顽强的毅力与生存意志，并通过自身经历打破了诸如“不可旅行”等关于危重病患的固有禁忌。她的故事不仅提升了医疗专业人员对创新性、人文照护的认知，也切实改善了她及其他患有危及生命疾病、造口、伤口和皮肤并发症的儿童和青少年的生活质量。

关键词小肠移植、造口、TPN、儿童。

参考文献

Capitulo, K. & Shohatee, L. (2015). Complex issues: travelling with total parenteral nutrition and an ostomy. World Council of Enterostomal Therapy Journal. 35(3), p. 36-41.
Zorzetti, N., Marino, I. R., Sorrenti, S., Navarra, G. G., DÅfAndrea, V., & Lauro, A. (2023). Small bowel transplant - novel indications and recent progress. Expert review of gastroenterology & hepatology, 17(7), 677–690. https://doi.org/10.1080/17474124.2023.2221433

已成为我生命的一部分：造口还纳术后低位前切除综合征患者的生活体验

Catherine Buergi, MScN
瑞士，苏黎世大学医院，造口和尿失禁护士。

目的/目标本研究旨在深入了解低位前切除综合征（LARS）患者的日常生活需求，以便提供更恰当的支持与照护。

目的与背景尽管已知LARS患者生活质量受限且饱受症状困扰，但关于造口还纳术后超一年患者的日常生活体验及需求的研究和信息十分有限。本研究旨在填补该空白，并补充现有关于其挑战与需求的认知体系。

方法对7例造口还纳术后12-42个月的患者（2例女性，5例男性）进行访谈，采用解释现象学分析法对所有访谈进行录音、逐字转录及系统分析。

结果分析结果揭示LARS患者三大核心生活负担：适应新生存状态；主动规划日常生活；身体认知与症状控制。“不可预测性”成为关键挑战。参与者认为，术前若能获得关于潜在问题的充分告知、术后可获得开放讨论空间及同伴支持，将有助于缓解生活中的困难。然而，绝大多数患者表示缺乏系统性术后随访与支持。

结论/结局造口还纳术后12-42个月，患者已适应新生存状态，并高度接纳现状。研究表明造口还纳术前开放信息文化有助于患者在心理上为术后情况做好准备，能够坦诚地谈论自身问题，有助于他们更好地调整和适应日常生活。为提升生活质量，护理人员及其他卫生专业人士应提供结构化的术后随访服务，帮助患者了解造口还纳后可能出现的问题，并指导其在生活节律尚未恢复前，妥善应对各种不可预期的情况。此外，应为患者提供同伴支持小组等资源，増强社会联结。

关键词低位前切除综合征、结直肠癌、造口还纳术、生活质量、直肠切除术。