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.

Resumos selecionados do 24º Congresso da Bienal WCET^® em Glasgow, Reino Unido

DOI: 10.33235/wcet.45.1.34-40

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Os delegados ao Congresso WCET^®, em Glasgow, Reino Unido, em Setembro, foram recebidos com um programa científico bastante bem sucedido, de conteúdo diversificado, estimulante e de alta qualidade.

Para benefício dos muitos membros que não puderam comparecer, aqui podem encontrar uma amostra do que foi apresentado por oradores de todo o mundo.

Papel dos enfermeiros nos cuidados às mulheres com incontinência urinária nos cuidados de saúde primários

Lívia M Martins, N/A, RN, BSN, MSN, PhD, Enfermeira Estomaterapeuta do TiSOBEST, Responsável Técnica da Unidade de Saúde da Família do Hospital das Clínicas da Fundação Profa. Dra. Célia de Almeida Ferr-FAEPA, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil

Rosaura Soares Paczek MD
Enfermeira, Brasil

Metas/Objetivos Descrever o papel do enfermeiro estomaterapeuta junto das mulheres com queixas de IU nos CSP.

Motivo e Antecedentes A incontinência urinária (IU) é a perda involuntária de urina, causada por diversas condições, impactando na qualidade de vida e limitando as atividades de vida diária.¹ No Brasil, 20% a 43% das mulheres sofrem de alguma perda urinária,² dados semelhantes encontrados na população feminina mundial pela Sociedade Internacional de Continência (ICS).³ A Atenção Primária à Saúde (APS) é a porta de entrada para o Sistema Único de Saúde (SUS), onde o enfermeiro, durante a Consulta de Enfermagem, com habilidades de comunicação e técnicas propedêuticas, pode assistir o paciente de forma integral.^4,5

Métodos Relato de experiência realizado em um serviço público de saúde no interior do Estado de São Paulo/Brasil em 2022-2023.

Resultados De junho de 2022 a novembro de 2023, uma enfermeira estomaterapeuta preocupada com a qualidade de vida de mulheres com IU, iniciou o treinamento da musculatura do Assoalho Pélvico (TMAP), em um serviço público de saúde no interior do Estado de São Paulo/Brasil. Durante as consultas de enfermagem, quando identificadas as queixas de IU, foi utilizada a Escala de Oxford para avaliação e iniciado o TMAP, com base no protocolo de avaliação e TMAP para assistência à mulher com incontinência urinária, o treinamento de fraqueza da musculatura perineal (mudança de força da MAP) e resistência da musculatura perineal prejudicada (mudança de apoio da MAP). Todas as mulheres que iniciaram o tratamento TMAP para a incontinência urinária ainda estão a fazer o tratamento, existe um elevado nível de adesão ao tratamento e a satisfação dos clientes com a melhoria progressiva dos sintomas.

Conclusão/Decorrência A Atenção Primária é um cenário favorável para o enfermeiro assistir pessoas com IU, avaliando e indicando exercícios de TMAP para mulheres com queixa ou risco de IU.

Palavras-chave estomaterapia, incontinência urinária, incontinência urinária de urgência, incontinência urinária de estresse, cuidados de saúde primários, cuidados de enfermagem.

Referências

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

Intervenções educativas para melhorar os conhecimentos dos enfermeiros sobre a prevenção de lacerações cutâneas em adultos institucionalizados e idosos: uma análise de escopo

Heidi M. Hevia, PhDc, Professora, PhDc
Universidade de São Paulo, Brasil

Cinthia Viana Bandeira da Silva. Silva, MD
Mestre, Escola de Enfermagem da Universidade de São Paulo, Brasil

Marilia Mastrocolla PhD
Departamento de Gestão da Atividade Académica, Universidade de São Paulo, Brasil

Juliana Takahashi, MD
Bibliotecária, Universidade de São Paulo, Brasil

Lily Rios Mazzachiodi, Professora Md, Universidade Andrés Bello, Chile

Vera Lúcia Conceição de Gouveia. Santos, CETN, MD, PhD
Professor Titular, Escola de Enfermagem, Universidade de São Paulo, Brasil

Metas/Objetivos Mapear e sintetizar o estado atual da literatura sobre intervenções educativas para a prevenção de lacerações cutâneas em adultos e idosos, realizadas por enfermeiros e profissionais de enfermagem em vários contextos de cuidados de saúde.

Motivo e Antecedentes As lacerações cutâneas são lesões comuns que passam despercebidas e não são reportadas. Pesquisas apoiam o fato de que as intervenções educativas permitem formar o profissional de saúde e prevenir a ocorrência destas lesões, através da implementação de medidas preventivas, com impacto na incidência e prevalência destas feridas.

Métodos Foi efectuada uma revisão de âmbito seguindo a metodologia JBI, incluindo artigos que cumpriam o protocolo Conceito e Contexto da População, publicados em inglês, espanhol e português e sem limite de tempo. Foram consultadas dez bases de dados, para além de estudos não publicados e literatura cinzenta. As pesquisas foram geridas utilizando o Endnote e posteriormente exportadas para a ferramenta Rayyan. Dois revisores independentes examinaram os artigos recuperados das bases de dados por título e resumo, seguindo os critérios de inclusão. Em seguida, o texto completo dos artigos selecionados foi lido pelos mesmos revisores; um terceiro revisor resolveu algumas discrepâncias e chegou-se a um acordo final. Os dados dos artigos selecionados foram extraídos para uma planilha.

Resultados: foram obtidos 694 artigos, entre os quais quatro cumpriam os critérios de inclusão. Foram identificadas duas modalidades de intervenções educativas nos estudos prospectivos quasi-experimentais: aulas presenciais utilizando a apresentação em PowerPoint e treinamento online disponível 24 horas por dia, sete dias por semana, através do website da instituição. As medidas de resultado primárias foram o nível de conhecimento e a incidência de lesões cutâneas.

Conclusão/Decorrência A intervenção educativa providenciada pelos enfermeiros melhorou os conhecimentos sobre as lacerações cutâneas e reduziu a sua incidência. São necessários mais estudos primários para examinar as intervenções ou tecnologias educativas preferidas e viáveis para melhorar a aprendizagem e a aquisição de conhecimentos. Estudos futuros devem também analisar o impacto direto dos conhecimentos na mudança de práticas e na incidência de lesões cutâneas.

Palavras-chave idosos, adultos, educação contínua em enfermagem, lesões dos tecidos moles, prevenção.

Referências

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).

Otimização da terapia de compressão para se adaptar às mudanças dinâmicas de fluidos, utilizando um invólucro de compressão ajustável com velcro: Uma mulher jovem com linfedema de estágio 3 e uma ferida crônica que não cicatriza

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

Jan Hajek, MD, FRCPC
Dr. Universidade da Colúmbia Britânica, Canadá

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

Metas/Objetivos Melhorar a compreensão e a capacidade de cuidar de pessoas com linfedema grave complicado por mudanças dinâmicas de fluidos: Destacar a necessidade de cuidados individualizados; Compartilhar conhecimentos sobre as mudanças dinâmicas de fluidos; Descrever os benefícios dos invólucros de compressão ajustáveis.

Motivo e Antecedentes O linfedema é uma doença negligenciada, desfigurante e incapacitante. O tratamento dura toda a vida e pode ser difícil, custoso e exigir muitos recursos. A gestão requer uma abordagem multidisciplinar, um forte apoio da comunidade, acesso a médicos experientes e uma compreensão das mudanças dinâmicas do fluido linfático com a terapia de compressão.

Métodos Um estudo de um caso de uma mulher de 33 anos com linfedema grave da perna esquerda relacionado com uma trombose venosa profunda (TVP) anterior e um índice de massa corporal (IMC) elevado. Os seus cuidados eram complicados devido a doença mental e a uma grande ferida crônica na canela esquerda. Durante anos, a paciente foi tratada sem sucesso na comunidade com um invólucro de compressão de duas camadas e sofreu de inchaço progressivo da perna, debilidade, aumento do tamanho da ferida e episódios recorrentes de celulite. Em 2022, foi internada num hospital. Foi avaliada pelas equipas de Medicina Interna, Doenças Infecciosas, Cirurgia Plástica, Cirurgia Vascular e pela enfermeira da WOC. A intervenção cirúrgica (o procedimento de Charles) foi considerada, mas os riscos ultrapassaram os potenciais benefícios. Foi seguido um plano de tratamento individualizado, incluindo NPWT, matriz extracelular, compressão de Velcro ajustável na altura coxa e cuidados de enfermagem 24 horas por dia para manter o nível de compressão.

Resultados Com compressão consistente e ajustes frequentes para compensar as mudanças dinâmicas do fluido linfático, verificou-se uma melhoria acentuada. A circunferência da panturrilha passou de 88 cm para 55 cm e o da coxa de 118 cm para 76 cm em seis semanas. A ferida sarou. A sua qualidade de vida melhorou. Após a alta, o seu linfedema estabilizou e ela conseguiu aplicar o vestuário de compressão ajustável de forma autônoma.

Conclusão/Decorrência Destacamos a redução do fluido linfático, a cicatrização de feridas e a melhoria da qualidade de vida após a aplicação de um sistema de compressão ajustável de Velcro na coxa.

Palavras-chave linfedema, compressão, velcro.

Referências

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.

Estudo de caso: A experiência vivida por um jovem com necessidades médicas complexas, transplante de intestino delgado, NPT e um estoma, a história de Linda

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

Metas/Objetivos 1. Identificar três desafios do transplante do intestino delgado. 2. Identificar as necessidades psico-socioculturais e educacionais de uma criança com uma doença potencialmente mortal. 3. Identificar duas estratégias para melhorar a qualidade de vida de uma pessoa dependente de NPT com um estoma.

Motivo e Antecedentes O transplante do intestino delgado, um dos transplantes mais complexos, apresenta desafios em termos de ferida, estoma, enfermagem e cuidados médicos. Esta apresentação de caso contará a experiência vivida por Linda. Nasceu com a doença inclusiva de microvilosidades, o seu percurso ao longo de 19 anos de hospitalizações, 13 cirurgias abdominais de grande porte, transplante de intestino delgado, três ileostomias, regresso a casa, complicações do transplante, rejeição crônica, ex-plantação, abandono familiar, cuidados complexos com o estoma, hospitalização de longa duração e dependência de NPT.

Métodos Este é um estudo de caso, explorado como uma experiência qualitativa vivida por uma criança/adolescente, registrada e relatada pelo autor, um investigador qualitativo experiente.

Resultados Os cuidados prestados a um bebê, criança ou adolescente com um transplante de intestino delgado, estomas e TPN a longo prazo estão incluídos, incluindo viagens com TPN e um estoma, serão exploradas questões relacionadas com problemas psicossociais a longo prazo, de desenvolvimento, educativas, nutricionais, de transplante e médicas, bem como as lições aprendidas e as implicações para a prática, educação e investigação. Serão discutidas as complicações, incluindo feridas, problemas periestomais e erros médicos.

Conclusão/Decorrência Este caso é um exemplo de uma criança/adolescente extraordinária, cuja resiliência, tenacidade e força a ajudaram a sobreviver, contra todas as probabilidades, até aos 19 anos de idade; e o seu legado, que dissipa mitos de proibições (incluindo viagens), e a experiência de profissionais inovadores e atenciosos que criaram e melhoraram a qualidade da sua vida e a vida de outras crianças e jovens adultos que sofriam de doenças potencialmente fatais, ostomia, feridas e complicações cutâneas.

Palavras-chave transplante de intestino delgado, estomas, TPN, criança.

Referências

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

Tornou-se uma parte de mim: viver com a síndrome de ressecção anterior baixa após a reversão da ostomia

Catherine Buergi, MScN
Enfermeira de Ostomia e Continência, Hospital Universitário de Zurique, Suíça.

Metas/Objetivos Compreender profundamente as necessidades da vida cotidiana dos pacientes com síndrome de ressecção anterior baixa (SRPA), a fim de prestar um apoio mais adequado.

Motivo e Antecedentes Embora se saiba que a qualidade de vida das pessoas com LARS é limitada e que sofrem de sintomas, existe pouca informação disponível sobre a sua experiência de vida cotidiana mais de um ano após a reversão do estoma e sobre as suas necessidades. Este estudo foi realizado com o objetivo de preencher esta lacuna e de contribuir para o conjunto de conhecimentos existentes que descrevem os seus desafios e necessidades.

Métodos Foram realizadas entrevistas com sete pacientes (2 mulheres, 5 homens), doze a 42 meses após a reversão do estoma. Todas as entrevistas foram gravadas em áudio, transcritas e analisadas utilizando a Abordagem Fenomenológica Interpretativa.

Resultados A análise revelou três categorias centrais que abordam o fardo de viver com LARS: Interiorizar as novas condições de vida; planejar ativamente uma nova vida cotidiana; e conhecer o corpo e controlar os sintomas. a "imprevisibilidade" surgiu como o principal desafio. Ser informado com antecedência sobre os problemas que se espera que surjam, ter a possibilidade de falar sobre os problemas, bem como receber apoio dos colegas, foram identificados como meios de aliviar os desafios dos pacientes quando vivem com LARS. No entanto, no total, faltaram aos cuidados posteriores à estrutura.

Conclusão/Decorrência Doze a 42 meses após a reversão do estoma, os participantes tinham interiorizado as suas novas condições de vida. O seu nível de aceitação da sua situação era substancial. Há indícios de que uma cultura de informação aberta antes da reversão da ostomia contribuiu para estar mentalmente preparado para a situação após a cirurgia. Falar abertamente sobre os seus problemas ajudou os participantes a organizar a sua vida quotidiana. A fim de melhorar a qualidade de vida, um acompanhamento estruturado por enfermeiros e outros profissionais de saúde poderia abranger a informação necessária sobre os potenciais problemas após a reversão do estma e sobre a forma de lidar com a imprevisibilidade até se estabelecer uma rotina normal. Além disso, deve ser providenciado o acesso a grupos de apoio.

Palavras-chave síndrome da ressecção anterior baixa, câncer colorrectal, reversão do estoma, qualidade de vida, ressecção retal.