This qualitative study aimed to clarify the difficulties experienced by partners of patients with a temporary stoma by conducting semi-structured interviews with five partners of temporary ostomates for a descriptive analysis. As a result, three categories were selected for investigation: “Difficulties experienced as the partner of a stoma patient”, “Difficulties experienced as the partner of a patient whose life may be in danger,” and “Difficulties experienced as an ordinary under these circumstances.” The category, “Difficulties experienced as the partner of a stoma patient” was divided into six sub-categories: “I find it difficult to deal with the stoma and defecation issues,” “I make sure that other members of the family do not see the stoma,” “I find the equipment to be intrusive,” “I am worried about skin trouble around the stoma”, etc. “Difficulties experienced as the partner of a patient whose life may be in danger” was divided into three sub-categories: “I am conscious of the possibility of my partner’s death,” “I can’t relax until I know the results of tests or operation,” and “I continue to worry about whether the disease will return even after operation.” For “Difficulties experienced as a person living in this situation,” the respondents mentioned their need to look after other members of the family besides the patient. This study suggested the need of the partners of patients with a temporary stoma, who frequently experience the difficulties described above, for the active support and consideration of nursing staff.
Purpose: The purpose of this qualitative study was to clarify the factors contributing to resilience, or the ability to process and overcome difficulties, among ostomates. Subjects: The subjects were 13 patients with a stoma. The subjects’ responses in a semi-constitutive interview were analyzed to extract the elements contained in Grotberg’s framework on resilience: “I have”（support from surroundings）,“ “I am”（personal strength）, and “I can”（ability to deal with difficulty）.” Results: This study succeeded in extracting the following factors in patient resilience: ’supportive family who understand what it is to have a stoma,’ ’a mentally and physically supportive medical practitioner,’ ’friends who accept me as I am’ and so on, corresponding to the ’I have’ category in Grotberg’s framework; the categories including ’coming to terms with my stoma, ’being true to myself despite having a stoma,’ and ’understanding my own strength,’ and so on corresponding to the ’I am’ category; and the three categories of ’being able to look after myself independently,’ ’being able to co-exist healthily with the stoma,’ and ’being able to maintain mental stability’ corresponding to the ’I can’ category. Patients exhibiting resilience were able effectively to integrate their own strengths with the support provided by their family, social networks, and health care professionals to achieve psychological stability conducive to a successful regimen of stoma self-care.
The purpose of this qualitative and descriptive study was to determine how wound, ostomy and continence nurses charged with performing particular medical procedures（TN）assured patient safety in the course of performing their tasks and contributed to the functioning of the chronic wound team. The subjects were six wound, ostomy and continence nurses who completed their training during 2011-12 in the physical assessment, pathophysiology, and clinical pharmacology of chronic wounds organized by the Japanese Nursing Association. Each subject was studied for one week during the day shift. The study found that the "TNs were performing their medical tasks competently based on the WOCN principles of wound management and cooperation in such a way as to assure safe, minimally invasive, comfortable care for the patient." In particular, the TNs were found to be employing their non-technical skills as well to be 'coordinating patient care in order make way for appropriate treatment' and 'providing a safe and comfortable environment for patients.' Furthermore, the aspect of this study examining 'the minimization of invasiveness and pain' in medical procedures indicated that the TNs' actions enhanced patients' independence, safety, and comfort.
Background: Incontinence-associated dermatitis（IAD）is a common problem in incontinent elderly patients. The aim of this study was to investigate the relationship between the quality indicators used in nursing care, institutional structures, and the prevalence of IAD in long-term care facilities. Methods: Nurse managers responded to a survey conducted in the long-term medical facility wards of a certain prefecture. Quality indicators were selected from previous studies on the basis of Donabedian’s model. Results: Responses to the survey were obtained from 83 of the 141 wards surveyed（Recovery rate: 58.9%）. The prevalence of IAD was 5.9%. Multivariate logistic regression analysis revealed that 'the use of water and cleaning agent’ alone independently affected the presence of IAD（odds ratio, 0.134; 95% confidence intervals, 0.025-0.707; P = 0.018）. Conclusion: The prevalence of IAD in longterm medical facilities was found to be 5.9%. Use of water and a cleaning agent significantly reduced the likelihood of patients with IAD within a ward, suggesting that skin care may play a role in the development of IAD.
Introduction: We developed a new, on-site system to measure and visualize plantar pressure and shear force inside footwear to educate diabetes sufferers in the appropriate selection of footwear to prevent callus formation leading to foot ulceration. The purpose of the present study was to assess the system's reliability and validity. Method: Measurement insoles containing sensors at the first metatarsal head were inserted into athletic footwear provided to healthy subjects, who were then instructed to walk the length of a hallway three times. Further, subjects who arrived wearing footwear with a heel length of 3cm or more were asked to walk the length of the hallway once with sensors inserted in an identical manner. The mean peak pressure and peak absolute shear force were calculated per trial. For reliability, the coefficient of variance（CV）and intraclass correlation coefficient（ICC）were calculated. For validity, values in the third trial with athletic shoes and with heeled shoes were compared by paired t-test, considering that walking with heeled shoes normally increase pressure and shear force. Result: Ten participants（eight females）were recruited. The CVs ranged from 6.8-14.1% and the ICCs ranged from 0.94-0.97. The following were the mean values when walking with athletic shoes vs. heeled shoes: left peak pressure was 400 vs. 781 kPa（p = 0.04）, right peak pressure was 476 vs. 694 kPa（p = 0.03）, left peak shear force was 16.3 vs. 31.9 N（p = 0.02）, and right peak shear force was 11.2 vs. 24.8 N（p = 0.02）. Discussion: Our system showed high reliability and validity, demonstrating its suitability for educating diabetes sufferers on-site in how to select shoe appropriate to their medical condition.
Objective: Long-term use of indwelling catheters induces UTIs and decreases walking ability in hospitalized elderly patients. This quasi-experimental study evaluated the efficacy of a comprehensive continence care program for the removal of indwelling catheters. Method: Participants were elderly patients with indwelling catheters in an acute hospital（intervention group: n=202, control group: n=165）. Intervention was comprised of early catheter removal, tailored ultrasound-assisted prompted voiding, and intermittent catheterization, and was based on the individual's bladder volume as monitored with an ultrasound device and a voiding diary. The control group received existing continence care. Result: The incidence of UTIs in the intervention group was lower than in the control group（5.0% vs. 10.9%, p ＝ 0.032）. Patients who used indwelling catheters for more than 9 days comprised 27.1% of the intervention group as compared with 36.4% of the control group（p=0.059）. The percentage of patients confined to bed for more than 3 days tended to differ between the two groups（42.5% vs. 53.4%, p=0.040）. No differences in falling, pressure ulcers, or walking ability at discharge were noted in the two groups. After adjustment for other factors, intervention was shown to decrease the incidence of UTIs（adjusted odds ratio 0.375 ［95% confidence interval 0.134-0.959］, p=0.040）. The length of hospital stay for patients with UTIs was significantly longer than for patients without UTIs（45.0 ± 22.5 vs. 22.1 ± 20.8, p<0.001）. Conclusion: This study demonstrated that comprehensive continence care aimed at the removal of indwelling catheters lowered the incidence of UTIs by reducing the number of days elderly patients use indwelling catheters.