Healthcare professionals’ experiences of providing care for patients with enterocutaneous fistula in hospital and in homecare: A qualitative study

Abstract

Background Enterocutaneous fistula is a rare but complex and serious condition that is both physically and psychologically demanding for the person affected. Infection, fistula dressing problems, electrolyte and fluid imbalance and malnutrition render the individual in need of long periods of in-hospital care and homecare. This place great demands on patients, families, and healthcare professionals. More research is needed to bridge the gap between hospital and home-based healthcare services. Aim To explore healthcare professionals’ experiences of providing care for patients with enterocutaneous fistula in hospital and in homecare. Material and methods A qualitative descriptive study design based on five focus group interviews involving 20 healthcare professionals. Data was analysed using content analysis. Results Three categories with seven corresponding subcategories were developed; 1) Providing care for patients with enterocutaneous fistula in the hospital and at home was complex and time and resource consuming. Participants were struggling with practical issues and lacked disease-specific knowledge and skills; 2) Caring requires an integrated approach but it was challenging to work interprofessionally and cope with barriers in collaboration between providers; 3) Building long lasting relationships with patients and their families was fundamental to the caring process. Participants needed to hide their own feelings related to smell and appearance of the fistula as well as frustration when the fistula dressing did not hold without leaking. The healthcare professionals expressed that the involvement of the patient and their close family was important when proving care, likewise, to have a great understanding of the patients’ suffering. Discussion The care of patients with enterocutaneous fistula is complex and means engagement for long periods, both in hospital and in home-based healthcare. Regular team meetings of the multidisciplinary team, careful planning before discharge and providing person-centred care can facilitate the care process.

Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

“…The participants struggled with derangements of fluids and electrolyte balances, malnutrition, requiring increased analgesic usages, difficulty hiding feelings when changing the stoma bags, difficulty in handling sepsis, wound leakages, skin excoriations, increased fistula output, and difficulty in containing the fistula effluent. The study conducted by Härle et al 10 demonstrated similar results that the demands of ECF patients are time‐consuming and can cause physical and emotional exhaustion. The condition's complexity and complications require multidisciplinary teamwork.…”

“…The complexity of ECF complications demands a multi‐disciplinary team approach 10 . A triad of complications poses challenges for CCNs, including fluid and electrolyte abnormalities, sepsis, and malnutrition 11 .…”

“…4,9 The complexity of ECF complications demands a multi-disciplinary team approach. 10 A triad of complications poses challenges for CCNs, including fluid and electrolyte abnormalities, sepsis, and malnutrition. 11 Patients with ECF become dehydrated and present with derangements of electrolytes such as sodium, potassium, and magnesium.…”

Engineered Regenerative and Adhesive Hydrogel for Concurrent Sealing and Healing of Enterocutaneous Fistulas

“…1 ECFs can occur due to various reasons, such as surgical complications, infection, perforated peptic ulcer, inflammatory bowel disease, abdominal injury, or Crohn's disease. 2,3 Approximately 60% of all ECFs tend to heal on their own within two months. However, for the remaining 40%, surgical intervention is usually required.…”

“…However, for the remaining 40%, surgical intervention is usually required. 2 Despite this, the surgery is often postponed for six to 12 months after the ECF appears due to inflammation, nutritional concerns, and the need for the abdominal area to recover. This situation can be challenging for patients, their families, and medical staff.…”