Date of Award

2024

Degree Name

Master of Nursing by Research

Schools and Centres

Nursing and Midwifery

First Supervisor

Professor Leanne Moterosso

Second Supervisor

Dr. Gail Ross-Adjie

Third Supervisor

Professor Keryln Carville

Fourth Supervisor

Dr Max Bulsara

Abstract

Background

An ostomy is a surgically created opening and can be performed to divert faecal effluent by exteriorisation of a segment of the small bowel otherwise known as the ilium, or from the large bowel otherwise known as the colon. A urinary diversion of effluent generally involves exteriorisation of a segment of ileum into which the ureters have been anastomosed. The exteriorised segment of bowel is referred to as a stoma and individuals who have had a stoma created often refer to themselves as an ‘ostomate’. The skin surrounding a stoma is referred to as peristomal skin.

Peristomal skin complications (PSCs) in the immediate post-operative period are commonly reported and largely preventable and affect overall wellbeing and impairs quality of life (QoL) in addition, the costs of treatment can be significant and readmission to hospital is often required. The motivation for this study arose from the prevalence of PSCs experienced by the researcher in clinical practice and the experiential knowledge that they are largely preventable.

Aim

The aim of this study was to describe the number, type and aetiology of PSCs experienced by a cohort of ostomates in the first 12 weeks post-discharge from hospital following surgery to create a faecal or urinary stoma and the perceived impact on the QoL of ostomates.

Method

Stomal therapy nurses (STNs) collected baseline data from 19 patients who underwent surgery that resulted in formation of a stoma, in two large tertiary hospitals in Perth, Western Australia (WA). Baseline data was collected at commencement and prior to discharge. In person or telephone assessments for peristomal skin complications using the PRAT occurred weekly for 4 weeks then fortnightly until 12 weeks following discharge. Peristomal skin inspection was conducted, and photographic images taken by the ostomate or STN which were then forwarded to the researcher for assessment. Participants’ QoL scores were measured using a validated instrument at baseline and each time a PSC was identified at any of the reviews.

Results

Nineteen ostomates were recruited however, two withdrew leaving 17 who were followed through to 12 weeks or reversal of their stoma if prior to 12 weeks. One hundred percent of ostomates presented with one or more PSCs, 74%(n=14) were attributed to irritant dermatitis, which was directly related to a leaking appliance. Fifty three percent (n=10) of ostomates had PSCs which were classified as ‘bruising’. Ostomates were more likely to have a PSC with stomas less than 20mm in height, none were classified as severe with many ostomates not recognising that they had a PSC. The greatest effect on QoL was the ostomates fearing that their PSCs would get worse.

Discussion

The results from this study align to the PSCs reported in the international literature and highlight the importance of regular postoperative STN follow-up especially in the early post-operative period. The study has identified the main contributing factors for PSCs which can be used to identify ostomates at high risk of developing PSCs and guide prevention strategies.

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