This study investigated whether the rectus abdominis muscle width for stoma site marking could be more reliably determined by nursing students using a diagnostic ultrasound imaging system（ultrasound） or palpation. The subjects were divided into two groups by the technique（ultrasound, n=34; palpation n=39） used to determine rectus abdominis muscle width. For the rectus abdominis muscle width measurement, a mark was placed on the abdominal wall at the lateral border of the rectus abdominis muscle on the horizontal line from the navel of the simulated patient using each technique with a pen, and the distance from the navel to the mark was measured with a ruler. The rectus abdominis muscle width measured by a faculty member proficient in ultrasound using the same technique as the students in the ultrasound group was compared with the rectus abdominis muscle width measured by students. The analysis calculated the intraclass correlation coefficients and used Bland-Altman analysis to determine the presence of a fixed and a proportional bias. The intraclass correlation coefficients were .62 in the ultrasound group and .41 in the palpation group. There was no fixed bias in both groups, but a proportional bias was present in the palpation group. These results indicate that students’ determinations of rectus abdominis muscle width were more reliable using ultrasound, suggesting that ultrasound is useful for stoma site marking.
The present study was based on a semi-structured interview of six patients with a colostomy to clarify the process of psychologically adjusting to having a permanent stoma. The data were analyzed using Saiki’s grounded theory approach. As a result, 14 categories were extracted, and the psychological adjustment process was found to proceed from a “regenerative” to a “mature” phase. Further, three aspects of the psychological process, including “living with a stoma, ” “ containing sadness, ” and “concentrating on maintaining quality of life” were found. In the regenerative phase, the process of learning to “ live with a stoma” involved patients gaining psychological strength and accepting their stoma through sharing their experiences of hardship in their efforts to overcome cancer recurrence. Thereafter, they accepted the necessity of the stoma for their survival and experienced an “ awakening of human growth” through the support provided by other patients with a stoma. In the mature phase, the patients reported physical acclimatization to the stoma and worked on individual ways of coping with it. On the other hand, during the regenerative period, the patients either concentrated on maintaining their quality of life through careful management of the stoma or were preoccupied with “ containing their sadness” as they struggled to cope with resurgences of despair caused by the loss of normal rectal function. Thus, in neither of the latter two processes did patients engage in the search for the meaning indicative of a more mature level of adjustment. These findings suggested that talking about the experience of loss and supporting patients over the long term to help them achieve a quality of life appropriate for their current psychological state are crucial to staving off feelings of hopelessness.
A telenursing support system（support system）based on ABCD-Stoma® care was developed, which incorporated consultations with wound, ostomy, and continence nurses（WOCNs）using information and communication technology. The purpose of this study was to examine the recovery rate of peristomal skin disorders of ostomates in hospitals without WOCNs and the cost-effectiveness of using the support system. The subjects were inpatients with stomas at four hospitals without WOCNs. The subjects were divided into two groups, the pre- and the post-support system groups, and the observation period for each group was three months. The general characteristics of the subjects, the severity and outcome of the skin disorders, and stoma-related cost of care were compared, and the cost-effectiveness ratio was calculated. There were 12 subjects in the pre-support system group（pre-SSG）and seven subjects in the post-support system group（post-SSG）. There were no significant differences in the backgrounds of the subjects between the pre-SSG and post-SSG. The median ABCD-Stoma® score at the start of the study for both pre- and post-SSGs was two points. The recovery rate of the post-SSG was 71.4%, significantly higher than the recovery rate of the pre- SSG at 16.7%（p=0.045）, and an effect size was 0.55. The total cost of care for one patient in the pre-SSG was 10,804 yen, compared to the post-SSG cost of 28,656 yen. The cost-effectiveness ratio was 64,822 yen for the presupport system and 40,118 yen for the post-support system. The introduction of the support system improved the recovery rate of peristomal skin disorders and reduced the cost-effectiveness ratio.
Objective: Factors affecting skin tears include dialysis history, skin dryness, and medical tape use. All dialysis patients are evaluated for skin-tear risk. However, many dialysis patients are unaware of the fragility of their skin; therefore, a simple and accurate skin-tear screening index is required. We herein elucidated the difference in the characteristics of skin with and without skin tears. Method: The present, cross-sectional study enrolled outpatients and inpatients on dialysis. Information on risk assessment items was collected. Transdermal moisture transpiration and skin viscoelasticity were objectively assessed. For visual evaluation, photographs were used to compare the two groups. Result: Ten patients in the skin-tear group and 30 patients in the non-skin-tear group were analyzed. Purpuric mottling was detected in 90% of the skin-tear group and 6% of the non-skin-tear（p < 0.01）. Thin skin with sagging occurred at significantly different rates between the skin-tear group（90%）and the non-skin-tear group（30%）（p < 0.01）. The median measurement of viscoelasticity differed significantly between groups, at 0.16（range: 0.06-0.34）in the skin-tear group and 0.26（0.15-0.73）in the non-skin tear group（p < 0.01）. Discussion: Thinning skin with sagging, purpuric mottling and reduced viscoelasticity was found in the skin-tear group. This finding was consistent with the findings of previous studies demonstrating that decreased viscoelasticity due to photoaging weakens the skin, leading to skin tears. Conclusions: Skin-tear risk screening is indicated for dialysis patients with thinning skin with sagging and purpura associated with reduced viscoelasticity.