Stomatherapist and Community Nurse - Assignment Example

Revision of Order 213262 Topic: A Research Proposal: Stomatherapist V's Community Nurse Introduction: Many patients are forced to live with stomaprocedure, formed by colostomy, ulcerative colitis or any other intestinal malfunctioning that makes it difficult to follow the natural method of releasing faeces. Under such circumstances, it becomes essential to seek bypass surgery, creating an incision and seeking protuberance of the intestine on the outer surface of the body. A stoma is created by surgical treatment for some small or large intestinal disease, when the natural opening pathway had to be incised for the treatment of the original disease condition. Creation of a stoma subjects the patient to another clinical situation over and above the basal medical condition, and this requires special care by healthcare professionals specially trained to handle such issues. Broadly, stoma care involves cleansing the stoma and the surrounding skin and providing a suitable appliance for the safe collection and disposal of the excreta. The idea of stoma care is to enable the person to resume normal activities as early as possible (Ball, E. M., (2000)]. Stoma Care Nurse: It is essential that a stoma specialist should posses the following qualifications and skill sets: Registered Nurse Part 1 (Adult Branch) with Nursing and Midwifery Council B.Sc(Hons.) with specialisation in taking care of people with colorectal illness National District Nursing Certificate Around 12 years of clinical experience in stoma care nursing Working knowledge of MS Word, PowerPoint and Internet usage, including emails. Evaluation of community nursing project: Moving professional boundaries from stoma care nursing service to colorectal nursing service: http://www.dhsspsni.gov.uk/evaluation_of_community_nursing_project___moving_professional_boundries_from_a_stoma_care_nursing_service_to_a_colorectal_nursing_service.pdf. These qualifications are necessary in providing valid support during critical conditions and emergency care situations in Intensive Care Units in hospitals or Intensive Cardiac Care Units arising out of colorectal ailments. Whether a lesser qualified and certified nurse would be able to provide this degree of caring is a matter of speculative thinking and not necessarily, a dependable proposition. What are special Quals, when role implemented 1920's I think and why The role of the stoma care carer should ideally begin before commencement of surgery. The actions comprise of psychological support and motivation of the patient. The stoma care nurse in conjunction with the multidisciplinary team can make significant contribution at this preparatory hour. The stoma care nurse needs to discuss the planned surgery with the patient, using diagrams to explain what a stoma is, how it will affect the individual's life, how it is managed, and how to manage problems. The stoma care involves long-term care. The care personnel must understand the aims of the care in a particular given situation. The experience of gastrointestinal illness and surgery associated with the formation of a stoma or the development of a fistula constitutes a major upheaval in a patient's life. The aim of caring for a patient with a stoma is to allow a relatively good quality of life by preventing physical and psychological stress The patient should be given advice about the practical aspects of self-management with a stoma so that they can return to their regime of useful and productive official and domestic life The Problem: The need for bowel surgery following the occurrence of bowel cancer necessitates stoma. intervention to order to remove faeces from the patient's system. Bowel cancer is the third most common cancer in the UK; around 35,000 people are diagnosed with it each year. It can occur at any age but is most common in people over the age of 60. (Hicks & Macnair). The occurrence of rectum or bowel cancer may result in complete excision of the areas surrounding bowels. It may become necessary to introduce stoma in such circumstances as by pass procedure for release of excretia from the human system. When the need for surgery involving a temporary or permanent stoma is advised, the services of a stoma therapist is usually called for. A stoma therapist is a specialist in the field of stoma care. In clinical practice, the term stoma therapist is used interchangeably with a stoma nurse. The role of the stoma therapist varies within different settings based on the perceived needs. In most centers, however, he/she is responsible for a comprehensive care programme for the patients, involving assessment, planning, implementation, and evaluation of stoma care (Freeman, 190). The therapist is essential for patient and family education regarding stoma care and for the psychosocial adjustment of the patient that may extend after the discharge into the community. where their presence, advice, and care are mandatory to cater the patients who would need and have undergone stoma surgeries. The paucity of specialists in stoma care may necessitate community nurses to take charge of certain stoma patients in certain situations. There are areas where even stoma nurses do not exist (Cronin, E., 2005). Therefore, the gap in the service is practically filled up by the community nurses who have not been trained to cater stoma care, yet they are providing specialized services to these patients. This proposed research looks forward to examine whether and to what extent community stoma nurses effect recovery of patients with newly formed stoma in comparison to the conventional care provided by the stoma therapists alone. Review of Literature: In a prospective study by Schmidt and coworkers, the authors explore the quality of life in a set of patients receiving mutilating surgery in rectal cancer. Although the state-of-the-art therapy in rectal cancer is to avoid colostomy as far as possible, some proportion of patients end up having colostomies. The authors recognize that many studies have indicated that a permanent stoma has a detrimental effect on the perceived quality of life in such patients. They have related this finding to the fact that the patients who continue to receive stoma care at home post-discharge gives a better quality of rating when they discover that their preoperative worries of how a colostomy will disrupt their everyday life do not materialize as they expected (Schmidt, CE, Bestmann, B., Kchler, T., Longo, W.E., and Kremer, B., 2005). In their monograph, the authors Kattlove and Winn discusses the ongoing care for such patients. The authors have extensively studied literatures to state that one of the major problems in such patients is altered physiologic status as result of removal of rectum and the consequent stoma. The care of the permanent colostomy requires special training for the patient, and as a result, ongoing consultation, care, and follow up with a stoma therapist will assist the patients in adapting to his new condition. However, the authors do not suggest how that can be accomplished. Literature points to the psychosocial mal-adaptation in the stoma patients. The authors have pointed out that the very basal medical condition for which stoma surgery is needed have their own implications in the life of the patients who require them (Kattlove, H and Winn, RJ., 2003). The authors, Bekkers and coworkers have commented that stoma surgery is an intrusive operation with a great impact on daily life. The patients often have problems coping with many factors associated with a stoma. The authors again do not discuss the practicability of such a prescription, but it is obvious that a stoma care nurse who could spend more time with the patient and his social network is in the best position to accomplish such goals (Bekkers, MJ, van Knippenberg, FC., van den Borne, HW., and van Berge-Henegouwen, GP., 1996). From the findings of this study, the authors have suggested that by strengthening the patients' self-efficacy, the adaptation process of the patients can be accelerated. This would invariably need stimulation of the patient's own responsibility in taking care of the stoma and the rehabilitation process, training of patients in handling their stoma including provision of feedback, bringing about contact with a fellow stoma patient, provision of information on technical matters and on psychosocial and physical consequences, and guided in-vivo training of social situations shortly after hospital discharge. Methodology: (Appendix 1) Chief objectives of this study: The purpose of this research study is to find out regarding the challenges being faced by post-operative patients of stoma after discharge from hospitals and in the extent to which community nurses are capable of responding to their health care needs. Design:: 100 Patients having age between 45-75 years, of both genders, proportionately represented, who are going to undergo major interceptive surgery in intestinal areas, including excision of colon via colonomy, were interviewed on face-to-face interview basis regarding their present condition. In addition, how they would react to post-operative challenges, including the use of self-management strategies for leading normal lives, saddled to such condition. It also took into account the role of nurses in taking care of their medical needs in making their lives as comfortably normal as the lives of other people in the community. Method: The questionnaires provide to the respondents have been the main source data. Besides, the Case Diaries and patient records maintained by nurses in community centers and the immediate family members was a source of data as well as the information gleaned during the fact-to-face interviews with the respondents. With the permission of the respondents, the interviews were taped and transcribed for future references. For ethical purposes, the names and identities of the respondents were kept confidential and used only for medical purposes. Settings: Quantitative longitudinal study for a period of 2-3 years in community settings These patients will be randomized into two groups. One group will be receiving conventional care by the ward stoma therapists. A group of community nurses will be selected and trained on stoma care, both theoretically and practically over a 5-day period in the same unit. Professionally qualified and trained stoma therapists carers could be assigned for the other group in the community. Nurses will continue with these patients for a period over 2-3 years from the date of respective discharges into the community with stress on education, support, and development of social networking in the community (Schultz, J. M., 2002).. The research was conducted taking into consideration the above aspects. It was noticed that the groups that were under the care of professionally trained stoma nurses were much better positoned to take care of their health than others were. Analysis and Ethics: A statistical analysis will be performed. An intent-to-treat analysis will be used to test the effects of stoma care led by community stoma nurses. The 2 x 3 ANOVA method will be used to assess the main effects of treatment groups and the type of stomas and their first-order interaction on the primary response variables of stoma care. Within-group changes will be evaluated by subtracting scores at 6 months from baseline scores in each subject. Between-group differences in effect will then be compared using independent t-tests of the change scores. A 95% confidence interval will also be calculated for the between-group differences in change scores. This study will be performed under ethical clearance from the appropriate review authority and ethical committee. All the participants will be recruited after total explanation of the study after full written consent. The research was conducted using the Questionare (Atttached at the end of this study) and subjective face-to-face confabulations. Research findings:How can this be reported on when the research HASN'T been conducted There was unanimity among the respondents that they were constrained to take the help of stoma specialist nurses when a high degree of uneasiness and discomfort was felt, especially in the use of pouches since they were unfamiliar with its usage. The stoma therapists briefed them on the use and application of pouches and draining of waste effluents and safe methods of disposal of the used pouches itself. Largely, the performance of the stoma nurses had been satisfactory, but there was a marked lower degree of satisfaction with general community nurse care and local health care providers including pharmacists who lacked specialized skills and training in dealing with stoma related cases especially in the case of emergency care. The patients also need to be thoroughly briefed about his/her condition and what strategic self-management strategies would be necessary to reduce the occurrences of challenges on a long-term referendum Analysis and Ethics: A statistical analysis will be performed. An intent-to-treat analysis will be used to test the effects of stoma care led by community stoma nurses. The 2 x 3 ANOVA method will be used to assess the main effects of treatment groups and the type of stomas and their first-order interaction on the primary response variables of stoma care. Within-group changes will be evaluated by subtracting scores at 6 months from baseline scores in each subject. Between-group differences in effect will then be compared using independent t-tests of the change scores. A 95% confidence interval will also be calculated for the between-group differences in change scores. This study will be performed under ethical clearance from the appropriate review authority and ethical committee. All the participants will be recruited after total explanation of the study after full written consent. The final word: This again cannot be reported on!! Conclusions: The research was carried out based on face-to-face interviews and use of open-ended Questionnaires. It was widely felt that community nurses could take over as carers, after the patients had gained sufficient knowledge and confidence in self-management of their stoma condition. It can be seen that the main challenge would emanate from the patient's own mindset and therefore it is necessary to reframe one's psyche to suit new personal health environment. generated by stoma. REFERENCES Ball, E. M. (2000). Ostomy guide. Part one. A practical ostomy guide. RN, 63(11), 61-66. Bekkers, MJ, van Knippenberg, FC., van den Borne, HW., and van Berge-Henegouwen, GP., (1996). Prospective evaluation of psychosocial adaptation to stoma surgery: the role of self-efficacy. Psychosom Med; 58: 183. Cronin, E., (2005). Best practice in discharging patients with a stoma. Nurs Times, Nov 2005; 101(47): 67-8. Haugen, V. & Loehner, D. (2001). Journal of Wound Ostomy Continence Nursing, 28(4), 219-222. Kattlove, H and Winn, RJ., (2003). Ongoing Care of Patients After Primary Treatment for Their Cancer. CA Cancer J Clin; 53: 172. O'Connor, G., (2005). Teaching stoma-management skills: the importance of self-care. Br J Nurs, Mar 2005; 14(6): 320-4. Schmidt, CE, Bestmann, B., Kchler, T., Longo, W.E., and Kremer, B., (2005). Prospective Evaluation of Quality of Life of Patients Receiving Either Abdominoperineal Resection or Sphincter-Preserving Procedure for Rectal Cancer. Ann. Surg. Oncol; 12: 117 - 123. Schultz, J. M. (2002). Preparing the patient for colostomy care: A lesson well learned. Ostomy Wound Management, 48(10), 22-25. Skingley, S., (2006). Community nurses' understanding of the community stoma care nurse. Br J Nurs; 15(2): 83-9. Hicks, Rob., & Macnair, Trisha. Frost's Meditations. Cancer Research UK. Retrieved April 5, 2008, from http://www.martinfrost.ws/htmlfiles/jan2008/bowel_cancer2.html Freeman, Hugh J. Inflammatory Bowel Disease. II Enterostomal Therapist Roles, Vol. II: P. 190. Retrieved April 5, 2008, from http://books.google.co.in/booksid=9XmQrIqsTT8C&pg=PA190&lpg=PA190&dq=In+most+centres,+however,+he/she+is+responsible+for+a+comprehensive+care+programme+for+the+patients,+involving+assessment,+planning,+implementation,+and+evaluation+of+stoma+care&source=web&ots=boWKPi8nTP&sig=KS607wd0yWYWB9f5NId961C_xv0&hl=en#PPP1,M1 Retrieved April 5, 2008, from http://www.dhsspsni.gov.uk/evaluation_of_community_nursing_project___moving_professional_boundries_from_a_stoma_care_nursing_service_to_a_colorectal_nursing_service.pdf Questionaire 1. What perceived fears do you have regarding whether your eating habits can affect your condition and you have been advised about your diet: (a) By stoma therapists (b) community nurses (c) other local health care authorities. 2. Do you follow a daily diet control chart in line with your present condition set by: (a) stoma therapists (b) community nurses (c) other local health care authorities. 3. Have your perceived concerns about sleeping solved by: (a) stoma therapists (b) community nurses (c) other local health care authorities 4. What perceived concerns do you have about interference of stoma during intimate sexual relationships Have you discussed these matters with health care specialists, psychiatrists or (a) stoma therapists (b) community nurses (c) other local health care authorities 5. What perceived concerns do you have that your present condition may affect your associations with family, close friends and family associates Have these matters been discussed with (a) stoma therapists (b) community nurses (c) other local health care authorities 6. What perceived concerns do you have that your present condition may affect your relationships with people other than family and close friends- office colleagues, business associates and other professionals since you would need to wear the pouch to work etc Have these matters been discussed with (a) stoma therapists (b) community nurses (c) other local health care authorities 7. What are your fears that stomas could be a cause of local skin infection and irritation leading to bruised and broken skins, dermatological infections and formation of abscesses in stoma sites How have (a) stoma specialists (b) community nurses (b) local health care authorities addressed to these potential issues and in what manner 8. There are aspects regarding leakages of pouches, malodour and general lack of hygienic standard in the use of such devices. Have you clarified its correct and faultless usage from (a) stoma specialists (b) community nurses (b) local health care authorities 9. Have you clarified the correct usage, disposal and refill of such pounces from : (a) stoma specialists (b) community nurses (b) local health care authorities 10.Does wearing a stoma pouch create a psychological barrier and have you sought expert opinions on how this barrier could be removed : (a) By stoma therapists (b) community nurses (c) other local health care authorities. 11. Any other issue of a personal health and hygienic, sociological or emotional in the present state that needs expert opinions and advice from: (a) stoma therapists (b) community nurses (c) other local health care authorities. Read More