how are our patients doing? beverley colton member of the ostomy forum group
TRANSCRIPT
How are our patients doing?
Beverley ColtonMember of the Ostomy Forum
group
Participating countries
• Denmark
• England
• Netherlands
• Japan
• Norway
• Poland
• Scotland
• Sweden
Project timelines 2000-2006
• A History Taking Form was developed and tested• A pilot on the Follow-up Form and Observation
Index was undertaken• The Follow-up Form, Observation Index and
guidelines were revised, extended and retested
Revised Observation Index
Revised Observation Index
Guidelines for use
A. Is self-explanatory.
B. All patients may experience pain on intercourse following major abdominal surgery.
Low pelvic surgery and/or Removal of rectum:•Male patients - retention of urine, inability to fully control their bladder function and urinary incontinence are all signs that nerve damage may have occurred at surgery. Erectile dysfunction and ejaculatory problems may be temporary or permanent. Urinary incontinence may have a severe impact on sexuality
•Female patients - Surgery may alter the position of the vagina. Nerve damage may cause vaginal dryness and altered sensation. Resection of the posterior vaginal wall will also cause significant changes. Urinary incontinence may have a severe impact on sexuality
Removal of the bladder •Male patients - There may be no penile sensation or erectile function following excision of the bladder.
•Female patients - there may be altered sensation in genitals.
C. The stoma care nurse must discuss possible sexual and urinary implications pre-operatively, giving short explanations. She must follow this up post-operatively, ensuring that the patient is given opportunities to ask questions and discuss their fears. The patient may wish the stoma care nurse to talk with their partner, either with or without the patient being present.
Guidelines for Sexuality observations
Revised Follow-up form
Revised Follow-up form
Revised Follow-up form
Revised Follow-up form
Methods of investigation
• Standardised Observation index• Follow-up form• Medical outcome study (SF 36)• SAS Version 9.1.2.• A minimum of 10 consecutive patients• Monitored for a maximum of 1 year
MOS
Medical Outcomes: health and general well being
Commitment
Language and Culture
0
0,1
0,2
0,3
0,4
0,5
0,6
0 50 100 150
time (days) post surgery
pe
rce
nt
no
n-n
orm
al s
tatu
s
rem
ain
ing
temporary
permanent
Normal = normal for patient based on HTF
Colostomy Social Assessment: progression to ‘normal’ status
0
0,1
0,2
0,3
0,4
0,5
0,6
0 50 100 150
time (days) post surgery
pe
rce
nt
no
n-n
orm
al s
tatu
s
rem
ain
ing
temporary
permanent
Normal = normal for patient based on HTF
Colostomy Sexual Assessment: progression to ‘normal’ status
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0 50 100 150
time (days) post surgery
pe
rce
nt
no
n-n
orm
al s
tatu
s
rem
ain
ing
temporary
permanent
Normal = normal for patient based on HTF
Ileostomy Psychological Assessment: progression to ‘normal’ status
Psychological Issues and Time from Surgery
0
5
10
15
20
25
301
- 2 w
eeks
3 - 6
wee
ks7
- 12
wee
ks13
- 26
wee
ks
low in spirits
worries aboutdis/dx
worries aboutstomamanagement
body image/selfperception
A stoma means a change of body image
Sexuality
Pre and post-op sexual intimacy
0,00%10,00%20,00%30,00%40,00%50,00%60,00%70,00%
Associations of sexual intimacy
My spouse partner and I are sexually intimate
I desire sexual intimacy
Prior to ostomy surgery
With 26 weeks post-operative
Males r=0.865 r=0.521
Females r=0.791 r=0.703
History• Aug 1978 constipated, rectal
atresia,recto/vaginalfistula.>Rectosigmoidectomy + colostomy• Jan 1978 Colostomy closed• June 1986 Repeat Duhamel for faecal incontinence : London• Oct 1986 Psychiatric help• Jan 1987 Formation of colostomy and taught to irrigate : Bristol• 1993/4 8 month in patient stay at psychiatric unit• June 1997 Gracillis procedure :London• Aug 1997 Colostomy closed • Sept 1997 ACE procedure • Oct 1997 Stricture between ACE and rectum Formation Loop Ileostomy • July 1998 Ileostomy > Colostomy. ACE and stimulator removed distal
bowel oversewn• July 2001 Cholecystectomy+ division of adhesions : Bristol• Jan 2005 Colostomy refashioned • Sept 2006 Colostomy refashioned
Listen – and you will make a difference
• Use of a History Taking Form, standardised Follow-up form and Observation index.
• Review of input and support at 3 months.
• Development of communication, counselling and listening skills.