Can rectal irrigation improve quality-of-life for patients who have bowel dysfunction?

Mrs Lisa  Richards1, Mrs Cheryl Penter1
1St John Of God Hosptial, Subiaco, Ardross, Australia

Colorectal surgeons are more skilled now than ever. This has led to surgical resections as low as ultra low anterior resections with hand sewn coloanal anastomoses and temporary loop ileostomy to rest the anastomosis.

Following stoma reversal many of these patients suffer bowel dysfunction known as low anterior resection syndrome (LARS). This results in clustering, frequency and urgency of bowel actions and can be debilitating for many.

At St. John of God hospital Subiaco we have been teaching our patients how to perform rectal irritation in an attempt to give these patient more predictable bowel functionality.

Anecdotally these patients have been reporting a much improved bowel function and improved quality of life.

This inspired us to commission a research project with the aim being to determine if rectal irrigation can improve this cohort of patients quality of life.

The research was extended to not only include LARS sufferers but any patients with bowel dysfunction and is being measured using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire.


Biography:

Lisa Richards has worked as a registered nurse at St John of God Subiaco since 1987. She has been a Clinical Nurse Consultant in Stomal Therapy for the past 10 years.

Lisa is the current Vice President of the WA Branch of the AASTN and has been an active committee member for the past 8 years.

Cheryl Penter is the Clinical Nurse Consultant/Research Nurse at St John of God Hospital, Subiaco working as a member of the Subiaco Colorectal Unit a position she has held for 12 years.

This role encompasses a specialist nurse position with a strong focus in management of all cancer patients through the unit, collating data for both neoplasia and benign databases, coordinating the collection of biological specimens within the CRC unit and hospital based research projects.

Lisa and Cheryl work closely as part of a cohesive multidisciplinary team at St John of God, Subiaco and are both committed to the advancement of nursing excellence in order to achieve optimal patient outcomes.

Granulomas what they are, how they affect ostomates and methods of treating them successfully

Mrs Cheryl Jannaway1
1Act Health, Monash, Australia

Granulomas  are small areas  of granulation tissue, that can be painful, bleed easily and cause problems with stoma appliances sticking leading to leakages.

My presentation is looking at the different methods I used to  treat granulomas and the results I obtained. I have seen a number of ostomates in stoma clinics in the ACT with granulomas and found difficulty finding information on how to treat them successfully.

The purpose of my presentation is to describe what granulomas look like, how they develop, what are the causes and the affect they have on an ostomate. I began by researching the different methods used by stoma nurses in Australia,  the UK and the USA by studying their clinical guidelines and research papers.

The goal of my presentation is to explain the treatments I used to treat granulomas and present case studies on  2 patients I treated and the results of the methods I used.

It is hoped that the experience I have gained from treating granulomas, explaining the methods I used and the outcomes, that clinicians will be able to use this information in their own practice.


Biography:

My name is Cheryl Jannaway and have worked in the position of Clinical Nurse Consultant Stomal Therapy Nurse for 3 years. I have worked as a Community Nurse for ACT Health for the last 9 years.  I completed the stomal therapy course in 2010 at the College of Nursing in Sydney and became a Registered Nurse 21 years ago in the UK. I travelled to Australia 14 years ago with my husband and 3 children and now have 3 grandchildren. I have been elected as the President of the ACT AASTN for the last 5 years.

Preoperative stoma marking in the general surgery population.

Dr Linda Vu1, Mrs Deborah Sinclair1, Mrs Laura Hughes1, Dr. Mary Theophilus1
1St. John Of God, Subiaco, Australia

Purpose: Preoperative stoma site marking is supported by research and professional organisations as an intervention that can reduce the incidence of stoma complications. This study investigates the application of this research into practice in an Australian metropolitan hospital. The aim was to achieve 100% preoperative stoma marking for elective patients and determine the rate of preoperative stoma marking in the emergency population.

Methods: A retrospective review of prospective collected data was conducted. Data from January 2018 to October 2018 was reviewed. The end point was the rate of preoperative stoma marking. Descriptive analysis examined the percentage of patients marked preoperatively in the elective and emergency setting, stoma complications, the relationship between preoperative length of stay (LOS) and sited emergency patients.

Results: A total of 67 patients underwent a surgical procedure that resulted in a faecal ostomy over a 10 month period. In total 59.7% (40/67) were emergency patients and 40.3% (27/67) elective. The median age was 64 (Range 26-91), 53.7% (36/67) females and mean BMI of 27.1 (SD = 7.16). In all, 52.2% (35/67) of the stomas were sited. Of the elective patients, 77.8% (21/27) were sited compared to 35% (14/40) emergency patients. Of the emergency population, median LOS preoperatively for non-marked patients was 0 (Range 0-6) compared to 2 (Range 0-10) for marked patients.

Conclusions: At this metropolitan hospital three quarters of the elective population are marked preoperatively and only one third are marked in the emergency setting. This rate is partly contributed to by only having 2 stoma trained nurses and lack of communication about surgery dates.

Reference: Hendren S, Hammond K, Glasgow S,Perry B. Clinical Practice Guidelines for Ostomy Surgery. Diseases of the Colon and Rectum. 2015; 58:375-387.


Biography:

Dr. Linda Vu is an unaccredited surgical registrar from WA. She graduated from the University of Notre Dame in 2014. She completed a Masters of Science in 2018 looking at risk factors in anastomotic leaks. She has worked in different general surgery and colorectal units for the last 3 years. She has a keen interest in colorectal surgery, patient outcomes and holistic multidisciplinary care.

Overcoming problems with stoma site placement and improving quality of life after urinary diversion

Mrs Patricia Walls RN. STN.1
1St Vincent’s Northside Brisbane, Queensland, Australia, ,

Stoma placement requires careful assessment preoperatively. However, post-operatively, changes in body contours can occur that cause problems with stoma  management. Complications after any major surgery can be distressing for a patient and inhibit recovery and rehabilitation particularly if leakage occurs. In 2014 in Australia, there were 2,748 new cases of bladder cancer diagnosed1. In 2015, radial cystectomy was associated with high morbidity (50%) and mortality (8%). In Australia, length of hospital stays (LOS) for radical cystectomy ranges between 10 to 20 days with an average LOS of 14 days. Prolonged length of stay (>14 days) is not uncommon2. Approximately 75 to 80% of patients experience one or more complications despite improvements in surgical techniques, ostomy appliances and ostomy care3,4. The predominant complications are peri-stomal skin related. The challenge for the stomal therapy nurse is to provide a patient-centered care approach as well as the implementation of practical stomal therapy ‘tricks of the trade’ when ostomy problems arise to ensure the best possible outcomes for patients. The case study will outline the care of an elderly patient who underwent a radical cystectomy and creation of an ileal conduit. ‘Tricks of the trade’ used to overcome problems associated with constant leakage and his subsequent loss of self-esteem will be discussed.


Biography: 

Patricia Walls is a Clinical Nurse Consultant, Stomaltherapy and Wound Management,  St Vincent’s Northside , Brisbane .

Pat completed the Stomal therapy course at the Princess Alexandra Hospital in Brisbane in 1982 and a Graduate Certificate in Wound Management at the University of Central Queensland in 1999. Her Stomaltherapy experience has covered community, paediatric and in the acute care setting.

Pat is actively involved with Stomal therapy nursing, participating at National and International  conferences.

The man behind the woman: Rupert B Turnbull Jr – father of Stomal Therapy

Mrs Naomi  Houston1
1Nepean Blue Mountains Local Health District, Kingswood, Australia

Formation of an abdominal stoma is a relatively straightforward procedure in contemporary medical practice. Minimal complications result and patients are able to return to a comparatively normal life.  Yesterday was different. Between days of Hippocrates (400 BCE) right up until the middle of the 20th century, intestinal surgery, especially of the small bowel, resulted in poor survival outcomes.

Between 1950 and 1970, key milestones were made surgically and also in the area of stomal therapy. Norma Gill, the lady known as the ‘mother of stomal therapy’ plays a key part and so does her surgeon, Rupert Turnbull Jr. However, little is known about Rupert Turnbull.  Who is this man and why is he so significant? This presentation briefly explores Rupert Turnbull’s life and why he is so significant to the stomal profession.


Biography:

Naomi Houston is a stomal therapy nurse for Nepean Blue Mountains Local Health District and is based at Nepean Hospital.

Before coming to Nepean she worked as a Health and Community Care Instructor at Mission Employment for 10 years training long term unemployed basics in nursing skills. Such a role equipped students to work either as an Assistant in Nursing or pursue further education.

She completed her nursing training at Royal Prince Alfred Hospital. She has a post Graduate degree in Family Health and a Masters in Primary Health Care – University of Western Sydney.

Tu Meke te Peke Ki Ahau – the bag is great to me

Mrs Anna Veitch1, Mrs Lorraine Andrews2
1Tairawhiti District Health Board, Riverdale, New Zealand, 2Omnigon, Epsom, New Zealand

A fistula is defined as a connection between two epithelialized surfaces.  Although rare in general practice, colovaginal fistulas are not uncommon in stomal therapy nursing.  Such a presentation is often post initial review by a gynecology service.

This distressing condition is often accompanied by a significant psycho-social morbidity. That morbidity can be demonstrated as social dis-engagement or intentional social isolation, lower quality of life (QOL) and interpersonal stress in relationships.

This poster follows the care of Mary (pseudonym) who struggled with a colovaginal fistula and all it’s consequence for many years before seeking treatment involving a stoma.  In spite of  her dread of having a stoma in her life and the challenges it presented  the bag was great to her.


Biography:

Anna first qualified as a Registered Nurse in 1987 and completed her Post Graduate Certificate in Stomal Therapy though the New South Wales College of Nursing in 2006.  She works across the hospital community interface in Gisborne provided continuity of care for both continence and ostomy clients.

Anna believes that stomal therapists are in the unique position and privileged position of being able to provide care across the life span and often for the whole life.  She is passionate about making a difference for this client group which often includes facilitating recovery and rehabilitation to a new normal.

Nothing prepared us for Mr M

Mrs Rachel Pasley1, Mrs Lorraine Andrews2
1Northland District health Board, Whangarei, New Zealand, 2Omnigon, Epsom, New Zealand

A significant portion of Rachel’s client base are from a lower soci-economic group having high health care needs with limited resources and low heath literacy skills. Rachel remains passionately committed to delivering a high quality service utilizing outstanding advocacy skills.

Accounting for 8% of ostomy skin issues granuloma lesion are a relatively common finding in stomal therapy practice.  While not always problematic , once established if not treated the commonest pathway is for them to enlarge until they cause pouching issues, skin damage and bleeding.  Remarkably ostomates will often tolerate hypergranuloma lesions without reporting them until bleeding becomes an issue.

This poster will present the care we provided to Mr M, who presented once he was desperate and experiencing significant bleeding from what were initially un-identified lesions.

Nothing prepared us for the issue Mr M revealed when he removed his appliance.


Biography:

Rachel is a community STN practicing in the culturally diverse region of  Northland.  She delivers stoma care to over 400 clients spread over a wide geographical area.  Rachel initially registered as an Enrolled Nurse in 1989 before completing her Registered Nurse program in 1994.  She completed the Post Graduate Certificate of Stomal Therapy Nursing in 2008.

 

Finding the right fit

Ms Kate Brereton1
1St John Of God Murdoch , West Leederville, Australia

A demonstration of pre-surgery assessment of a prospective colostomy patient using expert clinical skills to determine the appropriate stoma pouch selection.

Mrs S, a 64-year-old woman, was to have an elective abdominoperineal resection.

On meeting Mrs S a severe tremor in her hands, and altered gait was obvious. Mrs S stated the reason for her foot drop and upcoming colostomy surgery was  complications of spinal surgery that had led to her becoming incontinent of urine and faeces. Her tremor was due to Parkinson’s disease. She presented as eager for information about colostomy as she was obviously distressed about the faecal incontinence and the impact this had on her life and particularly on her husband. Mrs S looked forward to having a stoma to control her faecal incontinence and was motivated to be independent and self-caring post-surgery. She was keenly interested in the education provided and welcomed to opportunity to view stoma appliances and “try them out”.

The patient and the stomal therapist seized the opportunity for pre-surgery assessment and evaluation of the patient’s physical capabilities and limitations. Mrs S was given a variety of appliances with explanations about the key features each product. The STN assessed her ability to utilise these stoma appliances while she manipulated them, to predict which stoma appliance could work best for her.

Assessment post-operatively revealed a soft abdomen with an imperfect stoma, plus her marked tremor, which highlighted the importance of identifying essential features of the stoma appliance in order for the patient to achieve independence with stoma management.


Biography:

As a stomal therapist for 7 years I have a passion and an interest in the education an appropriate counselling for my stoma patients. I work as a stomal therapist at a large private hospital in Perth Western Australia that provided services to both metropolitan and rural clients.

 

 

PEG in – PEG out

Mrs Lorraine Andrews1, Mrs Theresa Needham2
1Omnigon, Epsom, New Zealand, 2Taranaki District Health Board , Westown, New Zealand

Percutaneous endoscopic gastrostomies represent the intentional creation of a fistula connecting the stomach to the skin.  The definition of the word stoma is literally “a hole” yet the fistulas and skin complications associated with PEG’s seldom preset to the stomal service.

This series of two posters presents the care of Vanessa (PEG in) and Charles (PEG out).

Vanessa has lived with PEG feeding for 5 years.  Over the that time  she has been tormented by persistent tube site leaking resulting in a deeply eroded / ulcerated site which is extremely painful and reduces her quality of life. Vanessa’s poster demonstrates what can be achieved when patients and nurses work as a team, have good product knowledge and are willing to think outside the usual practice parameters.

After 25 months of PEG feeding and now post device removal Charles lives with persistent gastrocutaneous fistula causing consistent leakage, painful eroded skin and reducing his ability to complete his remaining life goals.  Living very rurally and with limited access to professional care Charles and his wife have demonstrated a high level of innovative skill in restoring his QOL.

Hoping that their experiences with help others both Vanessa and Charles contributes to the posters.


Biography:

Theresa currently works as a community District Nurse in rural Taranaki.  She transitioned into community nursing from in hospital surgical  nursing concerned that she would lose clinical skills and be under challenged. The reality of community nursing has proven to be the exact opposite requiring high level assessment and intervention planning.

Theresa believes she is blessed to have found her ideal job while serving her community.  She practices from a holistic patient focused prospective and passionately believes in continued learning and sharing of knowledge.

As well as nursing Theresa assists in managing a farm with her husband.

Stoma education for the older person is about keeping it simple as 1, 2, 3

Mrs Rebecca Howson1
1Alfred Health, Bayswater, Australia

Australia’s aging population presents unique hurdles when planning, providing care and educating new ostomate’s; and these variations to care differ greatly depending on the individual. Whilst there are many predictors to flag potential issues, and well planned out pathways for the stoma’s physical journey; this is aimed at highlighting the often overlooked and under documented complexities encountered as we navigate patients in the transition to home. This is an example of how not all complications and barriers to discharge are due to the stoma, the output, or any medical issue. It is about the patient’s ability to self-manage. This follows the journey of a non-English speaking background patient transferred from the acute setting to Rehabilitation. She was struggling to manage her colostomy appliance, which could put her and her husband with dementia into residential care. The ability to self-manage a stoma is often the defining factor to an aged person’s ability to return to their lives at home or placed into formal care. Her motivation to prevent placement was demonstrated by her readiness to learn. As a Stomal Therapy Nurse, it is our responsibility to identify the barriers to self-care, adapt product selection and implement the most achievable goals. The patient’s specific goals and the interventions produced to achieve these; were individualized so that she is able to return home to continue to live her life; and not dictated by her new stoma. This idea meant that the concept of self-care had to be as simple as 1, 2, 3.


Biography:

A registered Nurse since 2011 working in the Colorectal ward at the Alfred and Enrolled Nurse since 2007, in aged care; I have always had an affiliation with working with the older person and patients with Stomas. This history meant when i was looking to continue with my Studies that Stomal Therapy seemed like an appropriate choice.

Since completing The Graduate Certificate in Stomal Therapy in 2016, I have been working as the Stomal Therapy C.N.C in Caulfield Hospital, a Sub-acute Rehabilitation center which includes: slow stream(Aged Care), Fast stream, aged psychiatry and a specialized Acquired Brain Injury unit.

 

12

AASTN

This conference is proudly hosted by the Australian Association of Stomal Therapy Nurses: www.stomaltherapy.com

One of the Association's major objectives is the promotion of quality care for a wide range of people with specific needs. These needs may be related to ostomy construction, urinary or faecal incontinence, wounds with or without tube insertion and breast surgery.

Patients/clients across the life span are provided with preventative, acute, rehabilitative and continuing care as required. Another objective is the maintenance and improvement of professional standards in relation to Stomal Therapy Nursing Practice to the highest degree possible. Recognition of the need for and encouragement of the development of specialist expertise in the field of Stomal Therapy Nursing underpins the Standards for Stomal Therapy Nursing Practice.

Conference Managers

Please contact the team at Conference Design with any questions regarding the conference.

© 2015 - 2019 Conference Design Pty Ltd