The Low Anterior Resection Syndrome (LARS) session

Chair: Donna Heggie

Donna Heggie RN, STN, Grad Cert Clinical Teaching, Continence Management Certificate.  Centre Manager, Continence Foundation of Australia in NSW Inc.

Donna has a long nursing career specialising in Stomal Therapy and Continence/ Colorectal Nursing at Royal Prince Alfred Hospital, Sydney.  Currently she manages the CFA in NSW Inc. Office in Newington. A position held since February 2015.  Donna is also a member of the CFA National Bladder Bowel Collaborative Steering Committee.

 


Six 15 minutes presentations followed by discussion and question time.


Anatomy and physiology of the surgery and why is it done

Professor Chris Byrne

A/Prof Chris Byrne is a colorectal surgeon at Royal Prince Alfred Hospital, Lifehouse and the Mater Hospitals. He has clinical practice and researched in advanced pelvic cancers, minimally invasive and robotic colorectal surgery as well as pelvic floor pathology.

 

Statistics and research findings on LARS

Dr Danette Wright

Danette is a colorectal surgeon currently completing a further fellowship in Intestinal Failure and Inflammatory Bowel Disease at Salford Royal Foundation Trust, Manchester, United Kingdom. Danette completed her general surgical training at the Royal Prince Alfred Hospital and Concord Hospital and colorectal fellowship at Westmead Hospital and The Austin Hospital in Melbourne. Throughout her training Danette has had a keen interest in understanding the pathophysiology of pelvic floor disorders and is the penultimate year of her PhD in anterior resection syndrome.

 

Diagnosis and anorectal physiology studies

Dr Caroline Wright 

Clin A/Prof Caroline Wright is a Colorectal Surgeon at the Royal Prince Alfred Hospital, Sydney. She completed her medical training at St Mary’s Hospital London and, after moving to Australia in 1988, did her general surgical training in Brisbane. Following 2 years of research and clinical work attached to the Royal Brisbane Hospital, she completed her post-Fellowship training at RPAH. Her clinical interests include pelvic floor disorders and the genetics of colorectal cancer. She was instrumental in establishing the multidisciplinary OASIS Clinic at RPAH, and is keen to increase the clinical awareness of, and facilitate a more collaborative approach to, the management of complex functional defaecatory disorders.

 

 

 

Conservative management of LARS

Janet Candido 

I work in the NSW Biofeedback and Continence Centre, also known as the Anorectal Diagnostic Facility. I work at RPAH as a CNC in disorders of defecation. RPAH is a large teaching hospital with a big colorectal department. I work with 9 colorectal surgeons with a variety of sub specialties and interests and one other CNS. I see patients with constipation, diarrhoea, incontinence, obstructive defecation, haemorrhoids fissures pruritus’ ani. Any patients that are struggling with bowel function post operatively. I have a keen interest in Lars syndrome as its quite difficult to deal with. We see between 1300-1500 patients a year for biofeedback and follow up consults either face to face or via the telephone to both metropolitan and rural patients. We perform approx. 430-450 Anal physiology  studies per year with some of the colorectal surgeons. We are also running an advanced GI program over three years in conjunction with all the other colorectal G/I discipline’s.

I think I am one of the luckiest people around as I have enormous job satisfaction. I may not be able to cure but I can certainly improve peoples quality of life.

 

 

Transanal irrigation treatment of LARS and surgery for a second stoma

Colleen Mendes, Stomal Therapy CNC, Royal Prince Alfred Hospital, NSW

Colleen Mendes is a Clinical Nurse Consultant in Stomal therapy at Royal Prince Alfred Hospital, Sydney, She has a 25 year nursing career, with 10 years specialising in this field. Colleen has extensive experience in stoma, wound, continence, antigrade colonic irrigation, sacral nerve neuromodulation programming and anorectal physiology.

 

Colorectal Cancer Support Group formation and outcomes

Ian Whiteley, Nurse Practitioner, Stomal Therapy and Wound Care, Concord Repatriation General Hospital, Sydney

Ian Whiteley is the Nurse Practitioner in Stomal Therapy and Wound Care at Concord Repatriation General Hospital in Sydney, a position he has held since 2005. The Stomal Therapy Department coordinates the care of both in-patients and out-patients with abdominal stomas. The service includes a nurse-led out-patient clinic.

Ian has academic affiliation as a Clinical Senior Lecturer with the University of Sydney Nursing School & Concord Clinical Medical School, Discipline of Surgery. He is a member of the Australian Association of Stomal Therapy Nurses and is a preceptor for nurses undertaking the Graduate Certificate in Stomal Therapy Nursing. He has published in national and international journals on a variety of topics.

The scope of the community wound burden and costs to care

ABSTRACTS & BIOGRAPHIES

Benchmarking time and costs of healing community wounds

Prof. Keryln Carville1,2, Ms Cate Maguire1, Ms Joanna Smith1

1Silver Chain , Osborne Park, Australia, 2Curtin University, Bentley, Australia

Aim:

To describe the client demographics, the number and types of wounds managed, and time and costs to healing community wounds.

Methods:

All nurses employed by a community organisation in Western Australia enter wound assessment and management data onto tablets or smart phones at point of care. Ongoing audits are conducted to ensure completeness and accuracy of data. Analysis allows for reporting of: types and numbers of wounds; length of stay; consumables used, nurse time taken to perform the procedures and time and costs to heal.  Data collected in 2017 provides the benchmark for ongoing analysis of wound healing outcomes and costs in 2018.

Results:

The 6-month project identified 16,925 wounds attributed to 8,789 clients and 80.3% (n=10,510) of wounds healed.  There were equal numbers of males (53%) and females and males were younger (63.4 versus 67.2 years; t(8787)=8.67, p <0.0001). The mean cost to heal females was $306 and males $288 with significant maximum variances amongst wound types. Comparisons with elderly and Indigenous wounded clients managed over 12-months demonstrated 79% of these wounds healed. This data was used to benchmark 2018 wounds and their outcomes.

Discussion:

On average 2,500-3,000 wounds are managed daily in the WA community service. Provision of products and best practice demonstrates reduced costs and time to healing, and affords national benchmarking opportunities. The benefits of which will be outlined.

Biography:

Keryln was awarded Life Membership of the AASTN in 2015. She is the Co-coordinator of the Curtin University postgraduate Wound, Ostomy and Continence Practice Program.  She is Chair of the Wounds Australia Wound Standards Committee and Chairs the Pan Pacific Pressure Injury Alliance. She is the Evidence Chair on the International Wound Infection Institute. Keryln was appointed a Fellow of the Australian Wound Management Association (now Wounds Australia) in 2006 and the inaugural award for Life Time

Achievement in Nursing in WA in 2010.


Efficacy of monofilament pad, microfibre pad and gauze debridement

Ms Anne  Capes1, Ms Jenny  Faithful1, Prof Keryln Carville1

1Silver Chain, Osborne Park, Australia

Aims:

To investigate the efficacy and cost-effectiveness of commercially available monofilament and microfibre debridement pads as compared to standard gauze for mechanical wound debridement.

Methods:

A quality improvement pilot study was conducted amongst a convenience sample of 150 clients with leg ulcers (50 each randomised group). Clients who meet the inclusion criteria presented with slough, necrosis or local infection (suspected biofilm) in their ulcer.  The wounds were randomised to either monofilament pad, microfibre pad or gauze debridement method.  Descriptive statistics will be undertaken using ComCare® Wound Module data to determine post-debridement outcomes.  Total cost of wound debridement and management interventions will be determined and compared with other mechanical debridement, methods, conservative sharp debridement and low frequency ultrasound debridement (LFUD).  Quantitative and qualitative questions in the satisfaction survey will be analysed to determine staff satisfaction with debridement methods.

Results:

The study will be completed in December 2018 and the results presented.

Discussion:

Debridement is an important component of wound bed preparation.  Mechanical debridement using the study devices is simple and can be performed by all nurses, and is relatively inexpensive as compared to LFUD.

Biography:

Anne Capes works as a Clinical Nurse Consultant Manager and STN for Silver Chain Group in Perth. Anne is Chair of the Wounds Interest Group, Silver Chain WA and a past vice president and current committee member of the AASTN WA Branch. Anne is committed to the advancement of nursing excellence and optimal patient outcomes.


NPWT: A cost and treatment analysis in acute wounds managed in the community

Mrs Gordana Petkovska1, Mrs Keryln Carville1, Mrs  Cate Maguire1, Mrs Joanna Smith1

1Silver Chain Group, Perth, Australia

Aims:

To determine the effectiveness and costs of NPWT in acute wounds in comparison to conventional therapies.

Methods:

Nurses employed by a community organisation in Perth enter wound assessment and care plan data onto tablets or smart phones, which is uploaded at point of care the ComCare® Wound Module database.  Rigour is ensured by daily monitoring of data and follow up should discrepancies occur.  A 6-month study with data collected 1 January to 30 June 2018 is used to determine the prevalence, type of acute wounds, healing times, consumables used and costs to heal.  Acute wounds with NPWT as part of the treatment regime was compared to wound without the advanced therapy.

Results:

A 6-month study found 18,482 wounds of all types and acute wounds comprised 7229 or 39% of the total. Males comprised 55% with females being significantly older (58.2 versus 56.7; t(4316)=2.3956; p=0.0166).  The length of stay for acute wounds was 44 days.  The mean cost to heal an acute wound was $328 with the total spent for the 6-month period was $1,642,624.  NPWT was used in only 189 acute wounds with a mean cost of $1323. The total cost of acute wounds with NPWT was $311,563 and accounted for 18% of the acute budget.

Discussion:

Shorter hospital length of stay has led to increased numbers of acute wounds being managed in the community.  Wound healing outcomes and data on costs to heal has informed organisational protocols, practice and resourcing.

Biography:

Bio to come


Scoping the burden of lower extremity ulcers in the community

Ms Margaret Edmondson1, Dr Keryln  Carville1, Mrs Cate  Maguire1

1Silver Chain, Osborne Park, Australia

Aims:

To determine the effectiveness of treatment and costs to heal lower extremity ulcers in the community.

Methods:

All nurses employed by a community organization in Perth enter wound assessment and care plan data onto tablets or smart phones, which is uploaded at point of care on the ComCare® database.  A 6-month study completed in 2017 forms the benchmark for determining ongoing prevalence, the type of lower extremity ulcers, healing times, consumables used and costs to heal.  This data is used t benchmark 12-month data  prospective data collected in 2018 to determine the efficacy and costs of treatment.

Results:

The 2017 study found 16,925 wounds of all types attributed to 8,789 clients and lower extremity ulcers comprised 20% overall. There were 1,688 leg ulcers (venous, arterial, mixed aetiology, atypical) from 1,109 individuals. Venous leg ulcers comprised the greatest number of these.  Females comprised 54% and they were significantly older than males (78.7 versus 72.8; t(1,107)=7.0679; p<0.001). There were 976 foot ulcers (neuropathic, ischaemic, neuro-ischaemic, unknown aetiology) from 665 individuals.  Males comprised 65% while females were significantly older (t(663)=3.2832); p=0.0011).Lower extremity ulcers had the greatest length of stay.  The mean cost to heal a leg ulcer was $372 and a foot ulcer $336.  This data will be used to benchmark the 2018 data.

Discussion:

Benchmarking of lower extremity wound healing outcomes and costs to heal has informed organisational protocols, practice and resourcing and is anticipated to inform national health agendas.

Biography:

Margaret is a Nurse Practitioner in wound/ostomy with Silver Chain Group WA. She has over 25 years’ experience caring for clients with wounds and stomas in the community setting holding clinical, management and educational roles. Margaret  has held both national and state positions with the AASTN and Wounds Australia.

 


Time and costs to heal skin tears

Ms Pam Morey1, Professor Keryln Carville1,2, Ms Cate Maguire1

1Silver Chain, Osborne Park, Australia, 2Curtin University, Bentley, Australia

Aims:

To determine the effectiveness of treatment and costs to heal skin tears.

Methods:

All nurses employed by a community organisation in Perth enter wound assessment and care plan data onto tablets or smart phones, which is uploaded at point of care on ComCare® Wound Module database.  A 6-month study completed in 2017 forms the benchmark for determining ongoing prevalence of skin tears, the STAR classification, healing times, consumables used and costs to heal.  A 12-month’s project benchmarks prospective data collected in 2018 to compare the efficacy and costs of treatment.

Results:

The 6-month study found 16,925 wounds of all types attributed to 8,789 clients and skin tears comprised 15% (n=2,497) of these wounds.  There were 2,247 skin tears from 1,230 individuals. Females comprised 52% and were significantly older than males (83 versus 80 years; t(1228)=5.7358; p <0.001).  Most skin tears occurred on the legs (75%) as compared to the arms for hospitalised patients¹.  STAR classifications were reported as 1a = 15%, 1b = 16%, 2a = 14%, 2b = 23% and 3 = 32%.  The mean length of stay was 25 days and the mean cost to treat was $171. This data will be used to benchmark the 12 month data collected in 2018.

Discussion:

Skin tears are a common wound amongst the elderly and they can convert to significant wounds.   Wound healing outcomes and costs to heal has informed organisational protocols, practice and resourcing of prevention and management strategies for skin tears.

Reference:

Mulligan S, Prentice J & Scott L. WoundsWest wound prevalence survey 2011 state-wide overview report. Perth WA, Australia: Ambulatory Care Services, Department of Health, 2011.

Biography:

Pam is a Wound/Ostomy Nurse Practitioner with extensive experience in acute and chronic wound care. Pam has contributed to the development of national and state guidelines related to pressure injury prevention and wound management; held executive positions for the Australian Wound Management Association, and was awarded an AWMA Fellowship in 2012.


The impact of pressure injuries in the community

Ms Jenny Faithful1, Ms Anne Capes1

1Silver Chain , Osborne Park, Australia

Aims:

To determine the client demographics, the number and types of wounds managed, and time and costs to healing community wounds.

Methods:

The significant wellbeing and fiscal impact of pressure injuries on individuals and health providers is well appreciated. Yet in the 21st century, pressure injuries continue to exert serious clinical and economic challenges irrespective of advances in knowledge, technology and clinical setting.   All nurses employed by a community nursing organisation in Western Australia enter pressure injury assessment and management data onto tablets or smart phones at point of care. Ongoing audits are conducted to ensure completeness and accuracy of data. Analysis allows for benchmarking pressure injury prevalence across teams and reporting of client outcomes.

Results:

A 6-month project conducted 1 November 2016 to 30 April 2017 identified pressure injuries comprised 7%  (n=1,257) of wounds, over 12 months in 2017 they comprised 8% (2,749) of wounds and during the 6-months 1 January – 30 June 2018, 7% (14,10) of wounds. The outcome of these wounds in regards to their complexity, treatments, care outcomes and time and cost to discharge will be reported in this presentation.

Discussion:

Pressure injuries are largely preventable wounds. However, in the community they pose additional challenges in regards to access and equity in service delivery and resourcing. They contribute to increased length of stay and impacts on wellbeing and the heath cost burden.  Accurate data on community pressure injuries informs best practice outcomes for prevention and management.

Biography:

Jenny Faithful works as a Clinical Nurse Consultant Manger and STN for Silver Chain Group in Perth.  She is the secretary of the AASTN WA Branch and is committed to the advancement of nursing excellence and optimal patient outcomes.

Prospective measurement of the trajectory of adjustment outcomes among new stoma patients

The OAI-23, a validated 23 item measure of adjustment which reduces to four domains of interest: Acceptance, Preoccupation, Social Engagement and Anger;

and including

An inventory of clinical and personal demographics.

Time series analyses was conducted to explore the adjustment trajectory over a nine month post stoma formation period. Cross sectional analyses (utilising clinical and personal demographics against adjustment trajectories) was also conducted to explore the relative influence of key patient descriptors.

This is a collaborative study conducted by 10 centres lead by Prince of Wales Hospital Sydney. It has lead to 7 clinical papers looking at different aspects of the data collected thus far. The other centres taking part in this study are: The Wollongong Hospital, Shoalhaven, The Sutherland Hospital, Royal Hospital for Women, St Vincent’s Hospital, Concord hospital, Royal Prince Alfred Hospital, Hunter/ New England, John Hunter Hospital and Newcastle Private.

Potential benefits

The study will contribute an important descriptive and cross-sectional analysis which is largely missing from the literature. This has service planning ramifications in relation to the psychological supports which this group of patients contemporarily need. Study participants will be afforded the opportunity to reflect on and relate how they are feeling, following their stoma surgery, and may be better positioned to access more help should they require it.

Reference: Simmons K, Smith J, Maekawa A (2009) Development and Psychometric Evaluation of the Ostomy Adjustment Inventory‐23 Journal of Wound Ostomy & Continence Nursing 36(1): 69-76.


ABSTRACTS & BIOGRAPHIES

Prospective measurement of the trajectory of adjustment outcomes among new stoma patients

Ms Carol Stott1, Mrs Lisa Graaf1, Mrs Julia Kittscha2, Mr Greg Fairbrother3

1Prince Of Wales Hospital, Randwick, Australia, 2The wollongong Hospital, Wollongong, Australia, 3Sydney Research, Sydney LHD, Sydney, Australia

Background:

Psychological distress among patients requiring both temporary and permanent stomas is increasingly common. Little prospectively collected data exists that describes a trajectory of ostomy adjustment over time.

Aim:

This proposed project seeks to utilise the Ostomy Adjustment Inventory [OAI-23] (Simmons et al, 2009) as a primary adjustment outcome tracking instrument in a prospective descriptive study of the adjustment trajectory among new stoma patients.

Method:

Design: Prospective descriptive study with cross-sectional elements.

Sample: Consecutively enrolled new stoma patients (both temporary and permanent) from eleven metropolitan and regional NSW Local Health Districts

Protocol: A questionnaire instrument was offered to study participants at five points of measurement: i) pre-discharge, ii) two weeks post-discharge, iii) three months post-discharge, iv) six months post-discharge, v) nine months post-discharge.

Measurement: The instrument comprises:

  1. i) the OAI-23, a validated 23 item measure of adjustment which reduces to four domains of interest: Acceptance, Preoccupation, Social Engagement and Anger;
  2. ii) An inventory of clinical and personal demographics.

Analysis: Repeated measures analyses were conducted to explore adjustment trajectories over a nine month post stoma formation period.

Results

Adjustment trajectories for the four OAI-23 domains from the first 2 years of data collection for the agglomerated multisite sample will be described and discussed.

Reference: Simmons K, Smith J, Maekawa A (2009) Development and Psychometric Evaluation of the Ostomy Adjustment Inventory‐23 Journal of Wound Ostomy & Continence Nursing 36(1): 69-76.

Biography:

Carol has worked as a CNC in Stomal Therapy & Wound Management for over 30 years. She has presented at many national and international conferences and has published papers on many aspects of stomal Therapy & Wound Management. She has been an active member of AASTN & WCET and has held several positions over the years including journal editor of the Journal of Stomal Therapy Australia. She is currently a member of the WCET education committee


Adjustment to stoma: Comparing metropolitan and regional/rural experiences

Mrs Brenda Christinasen1

1Illawarra Shoalhaven Local Health District, Nowra, Australia

It could be perceived that patients living in a metropolitan area would adjust better to stoma surgery than their counterparts living in regional/rural areas, based on access to services. The accessibility of stomal therapy nurses and outpatient clinics in metropolitan areas can seem to be better than regional and rural areas. It is unclear if the stomal therapy nurse to patient ratio is different between the areas or whether the distance patients have to travel to see a stomal therapy nurse in regional/rural areas is greater, and thus a barrier to access.

A literature review was conducted and revealed scant information relating to this topic. This identifies a significant gap in evidence related to adjustment to stoma between metropolitan and regional/rural areas.

Using the data collected from the Stoma Adjustment Study (SAS) this paper will evaluate adjustment to stoma in patients living in metropolitan versus regional & rural areas. The early data from the study shows adjustment (in terms of stoma acceptance) among patients at 6 months after discharge to be greater in regional areas compared to that of those living in metropolitan areas. Such findings have service planning ramifications in relation to the psychological supports which this group of patients contemporarily need.

This paper will report further on similarities and differences using demographic and adjustment scores using the OAI-23 validated 23 item measure of adjustment, thus seeking to bring evidence to the fore regarding the metropolitan/regional & rural divide in stomal therapy service.

Biography:

Brenda Christiansen is employed as a Stomal Therapy CNC based in the community of a regional centre in the IIlawarra Shoalhaven Local Health District. The service covers 3 sites including acute, rehabilitation and  paliative care. This service sees the client from the preoperative phase, through the acute hospital stay and follow-up after discharge.


Outcomes following stoma surgery for bowel management for faecal incontinence

Mrs Lisa Graaf1, Ms Carol Stott1, Mr Greg Fairbrother2

1Prince Of Wales Hospital, Randwick, Australia, 2Sydney LHD, Sydney, Australia

Colostomy formation is increasingly used for bowel management for patients with faecal incontinence to improve their Quality of life (QOL).  There are several reasons why people have faecal incontinence and they include spinal cord Injury (SCI) and anterior resection syndrome. Also, temporary or permanent stomas are also used when a person has a pressure injury to divert the faecal stream so as to aid and enhance wound healing.

Literature suggests that QOL can be improved for this group after stoma formation, though the subgroup of patients with SCIs is complex and presents stomal therapy nursing with some unique challenges.

Patients enrolled in the Stoma Adjustment Study (SAS), a prospective multi-site follow up of patients following stoma creation were coded for whether the stoma had been formed for bowel management purposes. The Ostomy Adjustment Inventory (OAI-23) was offered to study participants at six points of measurement:  pre-operatively, pre-discharge, two weeks post-discharge, three months post-discharge, six months post-discharge and nine months post-discharge.

: Repeated measures analyses which were conducted to explore adjustment trajectories over the follow up period were assessed against the ‘stoma created for bowel management’ code. It was noted that the ‘Anxious preoccupation’ and ‘Anger’ domains of the OAI-23 were consistently higher for bowel management patients. This was not the case for the ‘Acceptance’ and ‘Social Engagement’ domains of the instrument. Also of note was that bowel management patients were highly represented among the group of patients who refused involvement in the study.

Biography:

Lisa has worked as a Stomal Therapy & Wound CNC for over 20 years. She has presented papers at many national conferences and is the authors of papers published in national and international journals


Qualitative feedback at six months and nine months post discharge from the patients participating in the Stoma Adjustment Study (SAS)

Mrs Katherine Wykes1

1Prince Of Wales Hospital, Randwick, Australia

Background:

Patients coping with formation of a new stoma face many challenges post discharge. Current literature confirms that quality of life in relation to usual daily activities and relationships can significantly contribute to adjustment to life with a stoma. We sought to gather qualitative data about barriers to recovery from our multi-centre prospective study.

Method:

The multi-centre trial utilises a questionnaire instrument [based on the Ostomy Adjustment Inventory [OAI-23]) as a primary adjustment outcome tracking measure. Open-ended questions were also included in order to gain textual data describing participants’ subjective experience of adjustment from study participants. We reviewed and thematically analysed the qualitative responses collected so far at six and nine months with a focus on adjustment to employment, social activities, hobbies, sleeping, intimacy, communication within relationships and barriers to recovery generally.

Findings:

Qualitative data collected from a sample of participants that have reached six and nine month follow up suggests that barriers to recovery include the ongoing frequent task of stoma maintenance and considerations around social activities, hobbies and exercise.

Conclusion:

Returning to usual or modified daily activities within the participant’s anticipated timeframe maximises adjustment to life with a new stoma. Regaining intimacy in relationships and communicating with family members and/or support person aids acceptance, can relieve anxiety and contributes to improved adjustment outcomes. The qualitative responses received so far from participants in the Stoma Adjustment Study support many of the OAI-23 sourced quantitative findings about adjusting to life with an ostomy.

Biography:

Katherine Wykes is a Clinical Nurse Consultant in Stomal Therapy and Wound Care for both adults and neonates across a teaching hospital campus in Sydney, Australia She has also gained recent experience working within a specialised Anorectal Physiology nursing department in Sydney. Katherine has studied in both the UK and Australia and holds a Masters in Clinical Nursing, Graduate Certificate in Stomal Therapy Nursing and a Diploma in Higher Education in Nursing. She has previously spent a year as a Colorectal Cancer Specialist Nurse at a London teaching hospital before returning to her passion in Stomal Therapy nursing within Australia. Katherine continues to develop her skills, knowledge and experience by working alongside a team of experts and fantastic role models within these fields. This has given her opportunity to preceptor students, partake in research projects and professionally develop by presenting at national conferences.

 


Two stomas and the trajectory of ostomy adjustment among this uniquely challenging group of patients

Ms Colleen Mendes1

1Royal Prince Alfred Hospital, Camperdown, Australia

Pelvic exenteration surgery is highly invasive, offering the only treatment option for locally advanced pelvic cancer. These patients may have two stomas formed. There is a lack of prospectively collected data that describes the trajectory of ostomy adjustment over time, particularly among this very complex cohort of patients.

This presentation aims to describe an adjustment trajectory for patients who have two stomas, both patients with one and two new stoma creations. A description of subjective feedback provided by these patients about the adjustment-related challenges they have faced will also be presented.

This is a multicentre prospective descriptive study, which is enrolling patients undergoing formation of a new stoma. A questionnaire instrument (the OAI-23, a validated 23 item measure of adjustment which reduces to four domains: Acceptance, Preoccupation, Social Engagement and Anger)is offered to study participants at six points of measurement: pre-surgery, pre-discharge, two weeks post-discharge, three months post-discharge, six months post-discharge and nine months post-discharge.

Findings among this uniquely challenging group of patients with two stomas will be compared with the wider group of new stoma patients in the sample. Differences and challenges will be discussed.

Biography:

Colleen Mendes is a Clinical Nurse Consultant in Stomal therapy at Royal Prince Alfred Hospital, Sydney, She has a 25 year nursing career, with 10 years specialising in this field. Colleen has extensive experience in stoma, wound, continence, antigrade colonic irrigation, sacral nerve neuromodulation programming and anorectal physiology.


How important are demographics, stoma permanence and stomal therapy nurse follow up as stoma adjustment-related factors?

Mr Ian Whiteley1

1Concord Repatriation General Hospital , Concord , Australia

Studies of adjustment and quality of life (QOL) following stoma creation are relatively scant. Those that have been conducted have used differing tools and have focused on different independent predictors over differing follow up periods. In most cases they demonstrate low QOL post-surgery with variable QOL recovery over time.  Findings regarding predictors of long term QOL or adjustment recovery are not yet conclusive.

This paper reports preliminary findings of an ongoing multicentre study being conducted across 10 health care facilities in NSW. The study investigates how people adjust to having a stoma over time and utilises the Ostomy Adjustment Inventory (OAI-23). Clinical and personal demographics are also collected. The aim of this presentation is to describe differences in adjustment in relation to whether the stoma is temporary or permanent. The role of key personal demographics such as partnered status will also be described. As well, intensity of follow up by stomal therapy nursing is a potentially important associate of adjustment and results from the study regarding this will be presented.

To date we have found evidence in favour of the OAI-23’s ‘acceptance’ domain being better for those with permanent stomas, at least up until the 3 month follow up point. Those who were partnered were found to have better adjustment scores than un-partnered participants across multiple OAI-23 domains. The character of STN follow up has so far also found to be important.

Biography:

Ian Whiteley is currently employed as the Stomal Therapy & Wound Care Nurse Practitioner at Concord Repatriation General Hospital in Sydney. He began his nursing career in 1998 and has worked in Stomal Therapy & Wound Care since August 2005.

Ian has a sustained record of research productivity using diverse methodologies. He has 24 publications in national and international peer-reviewed journals and six published case studies that demonstrate his commitment to clinically focussed research dissemination.  Ian is first author on 83% of these publications.


Pre-operative stoma site marking and adjustment to stoma: Connecting the gaps

Mrs Julia Kittscha1

1Illawarra Shoalhaven Local Health District, Wollongong, Australia

Pre-operative stoma education and stoma site marking by a trained professional is deemed best practice. In Australia this is commonly performed by the Stomal Therapy Nurse but may also be conducted by trained Registered Nurses or surgeons. Appropriate stoma location is reliant on appropriate stoma site marking pre-operatively, however this is not always achievable in an emergency situation.

Evidence supports a reduction in postoperative stoma complications in the presence of pre-operative stoma site marking and pre-operative education/counselling by a Stomal Therapy Nurse. This has also been shown to increase health related quality of life (HRQOL) in the postoperative period. However, this evidence base is small and many studies lack prospective study designs.

Stoma site marking was recorded as part of the data collection for the Stoma Adjustment Study (SAS) using the OAI-23, a validated 23 item measure of adjustment, to establish whether it was a factor in adjustment to stoma surgery over time.  The main findings relating to the association between siting and adjustment were noted to have occurred in the ‘anxious preoccupation’ (AP) domain of the OAI-23, where those who were sited were significantly lower on AP scores at all-time points. ‘Social engagement’ scores were also better for those who were sited, but the relationship was not as strong. This trend was not the case for ‘anger’ nor ‘acceptance’.

Although too early to draw conclusions, the study results so far support stoma site marking as a positive factor in adjustment following stoma surgery.

Biography:

Julia Kittscha has been a Clinical Nurse Consultant in Stomal Therapy for 20 years. Her current role at Wollongong Hospital in NSW Australia encompasses the acute setting, nurse led clinic, periphery hospitals and community. She is passionate about Stomal Therapy Nursing and relishes sharing her skills to empower others.

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.

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