Quality of Life of Colostomy People With and Without Plug System Use

Abstract

The purpose of this poster presentation is to share the process used at a 60-bed acute rehabilitation facility to address the individual needs of admitted patients regarding their needs for pressure ulcer prevention and/or treatment. Since nearly all patients admitted (spinal cord injury, brain injury, stroke, and general rehabilitation) are identified as being at risk for pressure ulcers upon admission, it is critical that the team quickly identify and implement measures to prevent breakdown and/or promote healing. Because the average length of stay in rehabilitation is only about 16 days, it is vital to focus both on the quality of care and the efficiency of its delivery. The thorough admission assessment process utilizes a rehabilitation interdisciplinary team consisting of the staff nurse and clinical nurse specialist (CNS), physician, physical therapist, occupational therapist, speech therapist, nutritionist, pharmacist, and psychologist. This admission assessment guides the decision making for type of bed, style of wheelchair and cushion, nutritional interventions, turning schedules, activity schedules, type of bowel and bladder programs and therapy interventions. The patient and family members are included in the assessment and decision-making process to facilitate their learning and follow-through. If a patient is admitted with a pressure ulcer, the rehabilitation CNS evaluates the wound and makes further recommendations for care. The chronic wound team, which includes the rehabilitation CNS, the WOC nurses and a plastic surgeon, are consulted for sharp debridement, for a non-healing ulcer evaluation and recommendations, or for a complicated wound that will need follow-up in the outpatient wound clinic after discharge from rehabilitation.STATEMENT OF CLINICAL PROBLEM: Donor site care and dressing changes often cause discomfort for the patient and create issues related to healing. Using evidence-based practice, healing time and complications can be decreased, and discomfort lessened for the patient. DESCRIPTION OF PAST MANAGEMENT: At our organization, standard of care for donor site dressing changes was iodine impregnated petroleum gauze* applied directly to the donor site in the operating room, along with heat lamp therapy. Dressing changes began several days post-op and consisted of traumatic removal of the gauze with intense pain and bleeding, disrupting healing and new cell growth. There was often confusion by nurses as to the best procedure, as they relied solely on the written physician order that was usually vague and incomplete. CURRENT CLINICAL APPROACH: The involvement of the CWOCNs included review of evidence-based practice and mentoring of the physicians. After utilizing the antimicrobial hydrofiber dressing with silver on several patients resulting in positive OUT-COMES, the physicians were convinced of the effectiveness of this dressing for donor site care. Eventually, the Donor Site Care Orders was formally created, increasing nurse satisfaction related to improved communication and continui...

Quality of life and self-esteem of patients with intestinal stoma

“…It must be emphasized that the process of rehabilitation of ostomized people begins preoperatively and continues with their return home, when a new phase starts, marked by profound biological, psychosocial and economic changes, and whit a new battle which ought be fought by the ostomized person to cope with, and survive to, the new conditions. 3 Quality of life (QOL) is the individual's perception of his/her health status in relation to social, physical, psychological, economic and spiritual aspects. 4,5 The World Health Organization (WHO) defines QOL covering five dimensions: physical health, psychological health, level of independence, social relationships and environment.…”

Representação Social da Qualidade de Vida Após o Estoma Intestinal pelo Paciente com Neoplasia Colorretal

“…O termo "felicidade" significa estado de espírito de quem se encontra alegre ou satisfeito (14) . Os entrevistados referiam ser bastante satisfeitos com sua qualidade de vida anterior ao estoma, sendo necessário que esta qualidade de vida seja vista como um bem maior a ser mantido e/ou recuperado, para que estas possam viver felizes e em harmonia no seu contexto de vida (18) .…”

“…O termo " vergonha" é utilizado para expressar a perda da conotação do corpo de ser e ficar íntegro, passando a ter uma configuração diferente e aspecto de sujo. A presença do estoma provoca alterações da imagem que a pessoa tinha do seu corpo, manifestando assim, o sentimento de vergonha de um corpo alterado e mutilado, com receio de voltar ao convívio familiar e social, interferindo assim nas atividades que realizava antes do estoma (18) .…”

“…Sem dúvida alguma, isso representa um grande desafio, pois necessitam encontrar alternativas para minimizar as situações desagradáveis. Exigindo assim, da pessoa estomizada a adoção de inúmeras medidas de adaptação e reajuste nas atividades do cotidiano, incluindo o aprendizado das ações de autocuidado do estoma e da pele no periestoma, no intuito de evitar ou minimizar possíveis problemas (18) .…”

“…Diversas vezes o indivíduo não sabe como conviver com essas mudanças que ocorrem, principalmente com a aparência corporal, como é o caso da diminuição brusca e acentuada de peso, visto que o mesmo passa por restrições alimentares rigorosas, sendo indispensável o apoio da família nessas ocasiões (15)(16)(17)(18)(19)(20)(21) .…”