Journal of Wound Ostomy and Continence Nursing最新文献

There is insufficient conclusive evidence to provide definitive guidance for the use of clean versus sterile technique in the management of chronic wounds. This article reviews the evolution of evidence and practices for sterile versus clean management of chronic wounds. It is an update of documents developed in 2001 and updated in 2012. It summarizes the work of a task force of APIC and WOCN members and provides an evidence-based perspective on the ongoing debate between clean and sterile techniques in chronic wound management.

Purpose: The aim of this study was to examine care burden among family members of persons living with an ostomy; we also examined the relationship between care burden and spiritual well-being.

Design: Descriptive, quantitative, and cross-sectional.

Subjects and setting: The study was conducted in an ostomy clinic located in Tehran, Iran. This sample comprised 250 family caregivers of patients with an intestinal ostomy. Convenience sampling method was used.

Methods: Participants completed a questionnaire that included items querying demographic and relevant clinical data; the questionnaire also contained 2 validated instruments that were used to measure caregiver burden (CB) and spiritual well-being (SWB). The Guest and Novak Caregiver Inventory was used to assess CB; possible scores for this validated instrument range from 24 to 120. Higher scores indicate a higher level of family CB. The Paloutzian and Ellison Spiritual Well-Being Scale was used to assess participants' SWB. Scores obtained from this scale range from 20 to 120; higher scores indicate a higher level of SWB.

Results: The sample comprised 250 respondents; their mean age for caregivers was 35.1 (SD 7.6) years. More than half (n = 143, 57.2%) were men. The mean score of the CB was 85.4 (SD 3.9). The mean score of SWB was 82.3 (SD 10.5). Pearson correlation coefficient revealed an inverse and significant correlation between the mean score of CB and the mean score of their SWB (r = -0.308; P = .001).

Conclusion: Caregivers of patients with ostomy experience a high level of burden that is related to their SWB level. A caregiver with a higher level of SWB reported a lower level of burden.

Purpose: The purpose of this study was to evaluate the effect of an intervention focused on pelvic floor muscle exercises (PFME), traditionally referred to as Kegel exercises, on the severity and related characteristics, along with the impact of daily life, in elderly women with urinary incontinence (UI).

Design: Randomized controlled trial design.

Subjects and settings: The sample comprised 60 elderly women (intervention = 30, control = 30) with UI receiving home care in Antalya, Turkey.

Methods: Women in the intervention group received PFME training during visits to their homes. The frequency of UI, the amount of urine leaking, and the impact of UI on daily living were assessed with the International Consultation on Incontinence Questionnaire Short Form and questions on the assessment of the perceived impact at the onset of the study (baseline) and follow-up home visits paid at 6 and 12 weeks after the intervention.

Results: When compared to control participants, women performing PFME experienced a significant decrease in the level of UI, an increase in the level of quality of life, and a decrease in complaints about UI at both 6 and 12 weeks following the intervention. In addition, almost three-quarters (73.3%, n = 22) of the intervention group participants stated that they continued to perform PFME daily.

Conclusions: Study findings indicate that PFME learned through one-to-one training and frequent home follow-ups reduced the frequency of UI and amount of urine leakage and alleviated the negative impact of UI on daily life.

Purpose: The study aimed to describe a 9-month adjustment trajectory post ostomy surgery in a group of community dwelling persons with an ostomy and explore 9-month outcomes against personal and clinical characteristics.

Design: Questionnaire-based longitudinal survey.

Subjects and setting: Participants were enrolled by Enterostomal Therapy Nurses from 11 Australian hospitals (metropolitan and regional). Initial enrollment was 849 participants; 735 (86.6%) ultimately underwent ostomy surgery and 272 (32.0%) were followed to the 9-month end point. Participants were enrolled over a 2-year period from October 2017 to December 2019.

Methods: Respondents completed a questionnaire comprising the Ostomy Adjustment Inventory (OAI-23) and an inventory of demographics. Data were collected at 5 time points from discharge to 9 months post-discharge.

Results: Trend analyses suggested significant improvement in anger and worsening in anxious preoccupation domains by 9 months. No significant changes in acceptance and social engagement domains were identified. Multiple linear regression analysis suggested that younger age and not being culturally and linguistically diverse (CALD) background were the strongest predictors of adjustment at 9 months, with younger age retained by all 4 domain-based predictive models, and CALD status retained by 3 of 4 models. Elective (vs emergency) surgery was associated with improvement in both acceptance and anger, and the presence of incontinence on baseline was associated with improvement in anger. Self-reported peer support activity was associated with better social engagement.

Conclusions: Significant improvement by 9 months was noted in only 1 of the 4 OAI-23 domains (anger). This outcome highlights the time required for the adjustment process. Younger age and non-CALD background were both shown to be advantageous. The finding regarding involvement in peer support is encouraging. Further study about peer support as an assistive factor should be pursued.

Purpose: The purpose of this quality improvement project was to implement and evaluate an algorithm for management and prevention of diaper dermatitis (DD) embedded in a scoring tool. The specific aim of the project was to decrease DD occurrences with a severity score of 3 to 4 by 25%.

Participants and setting: Quality improvement participants comprised 164 neonates; 89 were cared for prior to project implementation and 75 post-implementation. Data were collected over a 3-month period. The setting of this quality improvement project was a 98-bed, Level IV neonatal intensive care unit (NICU) located in the Midwestern United States (Oklahoma City, OK). The NICU is part of a freestanding children's hospital affiliated with a university.

Approach: Diaper dermatitis occurrences and severity scores were collected prior to and 3 months after the protocol was implemented in the NICU. We collected pre-implementation data, followed by staff education concerning the DD protocol. We also provide guidance for protocol implementation at the bedside and in our Electronic Medical Record. Data on DD rates and severity were provided during the National Database for Nurse Quality Indicators (NDNQI) prevalence days the 4th quarter of 2020 and the 1st quarter of 2021. We compared data before and after protocol implementation to evaluate its effect on DD rates and severity.

Outcomes: Analysis before and after implementation of the protocol showed no significant differences in DD occurrences or severity scores. The unintended introduction of water-based cleansing wipes was identified as a confounding factor that we believe influenced outcomes. The DD scoring system and algorithm were permanently implemented for DD score quantification, DD management and treatment guidance, and ease of DD documentation with interventions, despite non-significant group differences.

Implications for practice: Next steps for this project are to implement the water-based cleansing wipes facility wide, along with the scoring tool and DD prevention protocol.