clinical digest Clinical digest

A brief overview of recently published articles on wound, ostomy and contience care

Renata Batas, Enterostomal Therapist, Community Health Centre Ljubljana, Slovenia (renata.batas@gmail.com)

Comparison of face-to-face education and multimedia software education on adjustment of patients with intestinal ostomy: a randomized controlled trial

Heidari-Beni F, Esmaeilian S, Yousefi F et al. J Wound Ostomy Continence Nurs. 2022;49(2):152–157. https://doi.org/10.1097/WON.0000000000000854

Colorectal cancer is a major health concern worldwide, and its treatment often involves the creation of an intestinal ostomy. According to Heidari-Beni et al (2022), approximately 30 000 Iranians undergo ostomy formation annually for the treatment of colorectal cancer. The procedure can lead to physiological and psychosocial issues, including depression, anxiety, altered self-image, reduced self-esteem, sexual problems, denial, loneliness and stigmatisation, which may impair adjustment to the new ostomy.

Patients undergoing ostomy formation require preoperative and postoperative education, as well as ongoing follow up and support. Face-to-face education is a traditional and effective method that allows for the development of rapport with the patient through verbal and nonverbal communication. However, it can be time-consuming and its effectiveness may be impaired by anxiety and pain. Multimedia education is a newer method that uses multiple formats, such as text, audio and moving or still images, to transmit simple to complex concepts and content. It can be designed to impart knowledge and teach skills while encouraging engagement in self care.

The objective of this study was to compare the impact of face-to-face versus multimedia education on patients’ adjustment to a new ostomy. The sample consisted of 135 patients aged 18–70 years with new ostomies, who were randomly assigned to three groups: control, face-to-face and multimedia education. Data were collected from November 2018 to May 2019 at Rasul-e Akram and Imam Khomeini Hospitals in Tehran, Iran. The control group received no additional ostomy education, while the face-to-face education group received individual education in the hospital environment during four 3-hour sessions delivered over four consecutive days. The multimedia group viewed a multimedia educational program using a laptop. Data were collected at baseline and 3 months after the intervention using a demographic questionnaire and the Ostomy Adjustment Inventory-23 (OAI-23). The OAI-23 has 23 items divided into four domains: acceptance (nine items), anxious preoccupation (five items), social engagement (four items) and anger (two items). Responses are scored using a Likert scale, where a score of four indicates ‘strongly agree’ and a score of 0 indicates ‘strongly disagree’. Higher scores indicate better adjustment to an ostomy.

The results of the study report that before the intervention, the mean OAI23 adjustment score did not significantly differ among the three groups (P=0.752). Three months after the intervention, the mean adjustment score in the multimedia software group was significantly higher than those of the face-to-face and control groups (P=0.000). In addition, the mean score of adjustment of the face-to-face education group was significantly higher than that of the control group (P=0.002). The findings of this study indicate that multimedia education was associated with higher levels of adjustment when compared to face-to-face teaching. In addition, both the multimedia and face-toface education groups experienced a more effective adjustment to a new ostomy when compared to a control group that received no additional education.

However, some studies have reported no significant difference in the efficacy of face-to-face education versus multimedia education. For instance, Feizalahzadeh et al found no differences in health-related quality of life between patients undergoing hemodialysis who received multimedia education versus face-to-face education. These differences in clinical efficacy may be partly attributed to the follow up provided after the initial educational intervention.

A limitation of this study was the lack of a power analysis to determine the minimal sample size required. Additionally, data were collected at a single site, which may limit the generalisability of the findings. Further research should be conducted in multiple locations around the world to compare the effectiveness of multimedia and face-to-face education

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

Buergi C. Wound Ostomy Continence Nurs. 2022;49(6):545–550. https://doi.org/10.1097/

WON.000000000000091

Anterior resection is a well-established surgical procedure for the management of colorectal cancer. To protect the anastomosis, a temporary ostomy is often created. However, after ostomy reversal, up to 70% of patients may experience diarrhoea, frequent bowel movements, fecal incontinence and clustering, collectively referred to as low anterior resection syndrome (LARS). While these symptoms tend to subside and stabilise after 1–2 years, long-term studies have reported the presence of adverse symptoms up to 15 years after low resection, with a prevalence of fecal incontinence varying from 0–71% and rectal dysfunction from 12–74%.

According to Buergi (2022), patients who experience anal urgency and incomplete evacuation following stoma reversal may face unpredictable bowel symptoms and elimination patterns that can reduce their ability to perform daily activities and negatively impact their health-related quality of life.

Further research exploring the lived experience of patients with LARS after ostomy reversal is needed. The purpose of this study, which used a phenomenological approach, was to explore the challenges experienced by individuals living with LARS 1 year or more after ostomy reversal and formulate a greater understanding of their needs.

The study sample consisted of five men and two women who had undergone low anterior resection at a Swiss university hospital’s comprehensive cancer center. The participants’ mean age was 66 years (ranging from 61–71 years), and they were interviewed 12–42 months after ostomy reversal. Data were collected through one-on-one, in-depth interviews using a standardised interview guide with open-ended questions. An interpretative phenomenological analysis was conducted to interpret the data.

The results of the analysis revealed three central categories that addressed the burden of living with LARS: ‘internalising new living conditions’, ‘actively planning a new everyday life’ and ‘knowing the body and controlling symptoms’.

The key challenge that emerged was unpredictability. To ease the difficulties of living with LARS, participants suggested being informed in advance about expected problems, having the opportunity to discuss problems and receiving peer support and structured aftercare.

Respondents differentiated days with and without LARS-related symptoms. Bothersome symptoms included diarrhoea, constipation, feelings of incomplete bowel evacuation, fecal incontinence and bowel-related pain. Despite the presence of these symptoms, participants indicated they had accepted these changes and internalised them as part of themselves. Participants indicated that adapting everyday life to LARS-related symptoms was a slow process.

The respondents described experiencing unpredictable symptoms such as diarrhoea, fecal incontinence, obstipation (inability to pass hardened stool) and pain as a result of their resection. All participants reported episodes of incontinence, both at home and in public, and developed strategies to prevent bothersome symptoms and feel some degree of active control over their LARS. They observed what they should eat when not at home and what they should avoid altogether. Participants also engaged in measures to evacuate their bowel and modified food intake one or two days in advance of activities requiring less predictable access to a toilet.

The sudden and unpredictable nature of the symptoms was a major challenge that profoundly affected their everyday life. Study participants also reported feeling emotionally distressed because of their physical symptoms, including bowel-related pain, flatulence and discomfort associated with diarrhea. Six out of seven participants stopped working outside the home following ostomy reversal, with one stating, ‘It was no longer possible. I had to run to the toilet all the time’. Talking openly about their problems and symptoms with friends and in public had a positive effect on participants’ everyday life. It also helped in their social environment understand how to support them and make things easier for them. As one respondent stated, ‘I was able to talk openly with my employer. He offered me a workplace near the toilet’. Participants emphasised that talking with peers who had also experienced LARS was particularly helpful for them.

Participants had internalised their new living conditions 12–42 months after stoma reversal, and their level of acceptance of their situation was substantial. There were indications that a culture of open information before ostomy reversal contributed to their mental preparedness for the situation after surgery. Talking openly about their problems helped participants organise their everyday life.

Nursing practice related to intermittent catheterization: a cross-sectional survey

Gray M, Wasner M, Nichols T J. Wound Ostomy Continence Nurs. 2019;46(5):418–423. https://doi. org/10.1097/WON.0000000000000576

Intermittent catheterisation (IC) involves the regular insertion of a catheter into the bladder via the urethra or surgically created tract, followed by drainage of intravesical contents and removal of the catheter. According to Gray et al (2019), clean intermittent catheterisation is currently used for a variety of indications, including neurogenic bladder dysfunction, non-neurogenic bladder disorders such as prostatic enlargement resulting in urinary retention (with or without incontinence), drainage of urine following augmentation enterocystoplasty, management of nocturia in persons with incomplete bladder emptying and prevention of recurrent urethral strictures.

The purpose of the study was to describe nursing practice and clinical decision-making related to IC. A total of 343 nurses participated in this cross-sectional survey, resulting in a low error rate of 5.3%. The majority of participants (70%; n=240) were registered nurses and 15.6% stated they were advanced practice nurses (nurse practitioners or clinical nurse specialists). Most nurses (75.9%; n=260) held at least one certification in rehabilitation, wound, ostomy and continency, or urologic nursing. Additionally, 70.5% (n=242) of the nurses indicated having 11 or more years of experience in their speciality practice.

The data were collected through an electronic questionnaire consisting of 50 items, which took approximately 35–40 minutes to complete. A total of 10 items queried demographic data and professional background, 13 queried facility policies and practice patterns related to the use of IC, and 27 focused on various aspects of decision-making