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.

Resúmenes seleccionados del 24º Congreso Bienal de WCET^® en Glasgow, Reino Unido

DOI: 10.33235/wcet.45.1.34-40

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Los delegados del Congreso WCET^®, en Glasgow, Reino Unido, celebrado en septiembre disfrutaron de un programa científico de gran éxito, con contenidos diversos, estimulantes y de gran calidad.

Para los numerosos miembros que no pudieron asistir, he aquí una muestra de lo que presentaron los ponentes de todo el mundo.

Papel del personal de enfermería en la atención a las mujeres con incontinencia urinaria en atención primaria de salud

Lívia M Martins, N/A, RN, BSN, MSN, PhD, Enfermera Estomaterapeuta TiSOBEST, Directora Técnica de la Unidad de Salud Familiar de las Clínicas del Hospital de la Fundación Prof. Dra. Célia de Almeida Ferr-FAEPA, Facultad de Medicina de Ribeirão Preto, Universidad de São Paulo, Brasil

Rosaura Soares Paczek MD
Enfermera, Brasil

Objetivos Describir el papel de la enfermera estomaterapeuta en mujeres con problemas de IU en la APS.

Finalidad y antecedentes La incontinencia urinaria (IU) es la pérdida involuntaria de orina, causada por diversas condiciones, impactando en la calidad de vida y limitando las actividades de la vida diaria.¹ En Brasil, 20% a 43% de las mujeres sufren de alguna pérdida urinaria,² datos similares encontrados en la población femenina mundial por la International Continence Society (ICS).³ La Atención Primaria de Salud (APS) es la puerta de entrada al Sistema Único de Salud (SUS) brasileño, donde la enfermera, durante la Consulta de Enfermería, con habilidades de comunicación y técnicas propedéuticas, puede asistir integralmente a la paciente.^4,5

Métodos Informe de experiencia realizada en un servicio público de salud en el interior del Estado de São Paulo/Brasil en 2022-2023.

Resultados Desde junio de 2022 hasta noviembre de 2023, una enfermera estomaterapeuta preocupada con la calidad de vida de las mujeres con IU, inició el entrenamiento de la musculatura del Suelo Pélvico (TMAP), en un servicio público de salud del interior del Estado de São Paulo/Brasil. Durante las consultas de enfermería, cuando se identificaban quejas de IU, se utilizaba la Escala de Oxford para la evaluación y se iniciaba el TMAP, basado en el protocolo de evaluación y el TMAP para la asistencia a mujeres con incontinencia urinaria, el entrenamiento de la debilidad del músculo perineal (cambio de fuerza del MAP) y la resistencia del músculo perineal alterado (cambio de soporte del MAP). Todas las mujeres que iniciaron el tratamiento TMAP para la incontinencia urinaria siguen en tratamiento, hay un alto nivel de adherencia al tratamiento y de satisfacción de las usuarias con la mejora progresiva de los síntomas.

Conclusión/Resultado La Atención Primaria es un escenario favorable para que las enfermeras asistan a las personas con IU evaluando e indicando ejercicios de TMAP a las mujeres con queja o riesgo de IU.

Palabras clave estomaterapia, incontinencia urinaria, incontinencia urinaria de urgencia, incontinencia urinaria de esfuerzo, atención primaria de salud, cuidados de enfermería.

Referencias

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

Intervenciones educativas para mejorar los conocimientos del personal de enfermería en la prevención de desgarros cutáneos en adultos institucionalizados y ancianos: una revisión de alcance

Heidi M. Hevia, PhDc, Profesora, PhDc
Universidad de São Paulo, Brasil

Cinthia Viana Bandeira da Silva. Silva, MD
Máster, Escuela de Enfermería de la Universidad de São Paulo, Brasil

Marilia Mastrocolla PhD
Departamento de Gestión de la Actividad Académica, Universidad de São Paulo, Brasil

Juliana Takahashi, MD
Bibliotecaria, Universidad de São Paulo, Brasil

Lily Rios Mazzachiodi, Md
Profesora, Universidad Andrés Bello, Chile

Vera Lucia Conceição de Gouveia. Santos, CETN, MD, PhD
Profesora titular, Escuela de Enfermería, Universidad de São Paulo, Brasil

Objetivos Mapear y sintetizar el estado actual de la bibliografía sobre intervenciones educativas para prevenir desgarros cutáneos en adultos y ancianos, proporcionadas por enfermeras a profesionales de enfermería en diversos entornos sanitarios.

Finalidad y antecedentes Los desgarros cutáneos son lesiones frecuentes que pasan desapercibidas y no se notifican. La investigación avala que las intervenciones educativas permiten formar a la persona sanitaria y evitar la aparición de estas lesiones, mediante la aplicación de medidas preventivas, impactando en la incidencia y prevalencia de estas heridas.

Métodos Se realizó una revisión de alcance siguiendo la metodología del JBI incluyendo artículos que cumplieran con el marco Concepto de Población y Contexto, publicados en inglés, español y portugués y sin límite de tiempo. Se consultaron diez bases de datos, además de estudios no publicados y literatura gris. Las búsquedas se gestionaron con Endnote y posteriormente se exportaron a la herramienta Rayyan. Dos revisores independientes examinaron los artículos recuperados de las bases de datos por título y resumen siguiendo los criterios de inclusión. A continuación, los mismos revisores leyeron el texto completo de los artículos seleccionados; un tercer revisor resolvió algunas discrepancias y se llegó a un acuerdo final. Los datos de los artículos seleccionados se extrajeron en una hoja de cálculo.

Resultados: se obtuvieron 694 artículos, de los cuales cuatro cumplían los criterios de inclusión. Se identificaron dos modalidades de intervenciones educativas en los estudios prospectivos cuasiexperimentales: clases presenciales con la presentación de PowerPoint y formación en línea disponible 24 horas al día, siete días a la semana, a través del sitio web de la institución. Las medidas de resultado primarias fueron el nivel de conocimiento y la incidencia de desgarros cutáneos.

Conclusiones/Resultados La intervención educativa proporcionada por las enfermeras mejoró el conocimiento de los desgarros cutáneos y redujo su incidencia. Se necesitan más estudios primarios para examinar las intervenciones o tecnologías educativas preferidas y factibles para mejorar el aprendizaje y la adquisición de conocimientos. Los estudios futuros también deberían analizar el impacto directo de los conocimientos sobre el cambio de práctica y la incidencia de desgarros cutáneos.

Palabras clave ancianos, formación continuada de enfermería, lesiones de tejidos blandos, prevención.

Referencias

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).

Optimización de la terapia de compresión para adaptarse a los cambios dinámicos de fluidos, mediante una envoltura de compresión ajustable con velcro: Una mujer joven con linfedema en estadio 3 y una herida crónica que no cicatriza

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

Jan Hajek, MD, FRCPC
Dr. Universidad de British Columbia, Canadá

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

Objetivos Mejorar la comprensión y la capacidad para atender a personas con linfedema grave complicado por cambios dinámicos de fluidos: Destacar la necesidad de una atención individualizada; compartir conocimientos sobre los cambios dinámicos de fluidos; describir las ventajas de los vendajes compresivos ajustables.

Finalidad y antecedentes El linfedema es una afección desatendida, desfigurante e incapacitante. El tratamiento dura toda la vida, puede ser difícil, costoso y requerir muchos recursos. El tratamiento requiere un enfoque multidisciplinar, un fuerte apoyo comunitario, acceso a médicos con experiencia y una comprensión de los cambios dinámicos del líquido linfático con la terapia de compresión.

Métodos Estudio de caso de una mujer de 33 años con linfedema grave en la pierna izquierda relacionado con una trombosis venosa profunda (TVP) previa y un índice de masa corporal (IMC) elevado. Sus cuidados se complicaron por una enfermedad mental y una gran herida crónica en la espinilla izquierda. Había sido tratada sin éxito durante años en la comunidad con un vendaje compresivo de 2 capas y sufría hinchazón progresiva de la pierna, debilidad, aumento del tamaño de la herida y episodios recurrentes de celulitis. En 2022, fue ingresada en el hospital. Fue evaluada por los equipos de Medicina Interna, Enfermedades Infecciosas, Cirugía Plástica, Cirugía Vascular y enfermera de WOC. Se consideró la posibilidad de una intervención quirúrgica (el procedimiento Charles), pero los riesgos superaban a los posibles beneficios. Se siguió un plan de tratamiento individualizado, que incluía NPWT, matriz extracelular, compresión ajustable con velcro hasta el muslo y cuidados de enfermería las 24 horas del día para mantener el nivel de compresión.

Resultados Con una compresión constante y ajustes frecuentes para compensar los cambios dinámicos del líquido linfático, se produjo una notable mejoría. El perímetro de la pantorrilla se redujo de 88 cm a 55 cm, y el del muslo de 118 cm a 76 cm en seis semanas. La herida se curó. Su calidad de vida mejoró. Tras el alta, su linfedema se estabilizó y pudo ponerse la prenda de compresión ajustable de forma independiente.

Conclusión/Resultado Destacamos la reducción del líquido linfático, la cicatrización de la herida y la mejora de la calidad de vida tras la aplicación de un sistema de compresión ajustable de velcro a la altura del muslo.

Palabras clave linfedema, compresión, velcro.

Referencias

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.

Estudio de caso: La experiencia vivida por una joven con necesidades médicas complejas, trasplante del intestino delgado, NPT y un estoma, la historia de Linda

Kathleen L. Capitulo, PhD, RN, FAAN, FNYAM, IIWCC, C-CNS
Profesora, Escuela de Enfermería Rory Myers en NYU, NYC; Escuela de Medicina Icahn en Mount Sinai, NYC; y Universidad Médica de Zhengzhou, China.

Objetivos 1. Identificar tres retos del trasplante de intestino delgado. 2. Identificar las necesidades psicosocioculturales y educativas de un niño con una enfermedad potencialmente mortal. 3. Identificar dos estrategias para mejorar la calidad de vida de una persona dependiente de NPT con un estoma.

Finalidad y antecedentes El trasplante de intestino delgado, uno de los más complejos, presenta retos en cuanto a la herida, el estoma, la enfermería y los cuidados médicos. Esta presentación de caso contará la experiencia vivida por Linda. Nació con la enfermedad de microvellosidades inclusivas, su periplo a lo largo de 19 años de hospitalizaciones, 13 cirugías abdominales mayores, trasplante de intestino delgado, tres ileostomías, de vuelta a casa, complicaciones del trasplante, rechazo crónico, ex trasplante, abandono familiar, cuidados complejos del estoma, hospitalización de larga duración y dependencia de la NPT.

Métodos Se trata de un estudio de caso, explorado como una experiencia cualitativa vivida por un niño/adolescente, registrada e informada por el autor, un investigador cualitativo experimentado.

Resultados Se incluyen los cuidados de un niño pequeño, un niño, un adolescente con un trasplante de intestino delgado, estomas y NPT a largo plazo, incluidos los viajes con NPT y un estoma, se explorarán las cuestiones relacionadas a largo plazo con los problemas psicosociales, de desarrollo, educativos, nutricionales, de trasplante y médicos, así como las lecciones aprendidas y las implicaciones para la práctica, la educación y la investigación. Se tratarán las complicaciones, incluidas las heridas, los problemas periestomales y los errores médicos.

Conclusión/Resultado Este caso es un ejemplo de una niña/adolescente extraordinaria cuya resiliencia, tenacidad y fuerza le ayudaron a sobrevivir, contra todo pronóstico, hasta los 19 años; y su legado disipa mitos de prohibiciones (incluidos los viajes), y la experiencia de profesionales innovadores y atentos que crearon y mejoraron su calidad de vida y la de otros niños y adultos jóvenes que padecen enfermedades potencialmente mortales, ostomías, heridas y complicaciones cutáneas.

Palabras clave trasplante de intestino delgado, estomas, NPT, niño.

Referencias

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

Se ha convertido en parte de mí: vivir con el síndrome de resección anterior baja tras la reversión de la ostomía

Catherine Buergi, MScN
Enfermera de ostomía y continencia, Hospital Universitario de Zurich, Suiza.

Objetivos Conocer en profundidad las necesidades de la vida diaria de los pacientes con síndrome de resección anterior baja (LARS) para proporcionarles un apoyo más adecuado.

Finalidad y antecedentes Aunque se sabe que la calidad de vida de las personas con LARS es limitada y que sufren los síntomas, se dispone de poca información sobre su experiencia de la vida diaria más de un año después de la reversión del estoma y sus necesidades. Este estudio fue llevado a cabo para abordar esta deficiencia y completar el conjunto de conocimientos existentes que describen sus retos y necesidades.

Métodos Se realizaron entrevistas a siete pacientes (2 mujeres, 5 hombres), entre doce y 42 meses después de la reversión del estoma. Todas las entrevistas se grabaron en audio, se transcribieron y se analizaron mediante el enfoque fenomenológico interpretativo.

Resultados El análisis reveló tres categorías centrales que abordan la carga de vivir con LARS: Interiorizar las nuevas condiciones de vida; planificar activamente una nueva vida cotidiana; y conocer el cuerpo y controlar los síntomas. La "imprevisibilidad" surgió como el reto clave. Estar informado de antemano sobre los problemas que se espera que surjan, tener la posibilidad de hablar sobre los problemas, así como recibir apoyo de los compañeros se identificaron como medios para aliviar los retos de los pacientes cuando viven con LARS. Sin embargo, en términos globales faltaron el seguimiento estructurado postratamiento.

Conclusión/Resultado Entre 12 y 42 meses después de la reversión del estoma, los participantes habían interiorizado sus nuevas condiciones de vida. Su nivel de aceptación de la situación era considerable. Hay indicios de que una cultura de información abierta antes de la reversión de la ostomía contribuyó a estar mentalmente preparado para la situación después de la cirugía. Hablar abiertamente de sus problemas ayudó a los participantes a organizar su vida cotidiana. Para mejorar la calidad de vida, una atención postoperatoria estructurada a cargo de enfermeras y otros profesionales sanitarios podría cubrir la necesidad de información sobre los posibles problemas tras la estomareversión y cómo afrontar la imprevisibilidad hasta que se haya establecido una rutina normal. Además, debe facilitarse el acceso a grupos de compañeros.

Palabras clave síndrome de resección anterior baja, cáncer colorrectal, reversión del estoma, calidad de vida, resección rectal.