| ObjectiveTo determine the suitable and sensitive indicators of the enterostomal therapists’ stoma care practice, and evaluate the effects of enterostomal therapists on ostomy patients’ medical outcomes.MethodsThis study includes two stages.1.The first stage:qualitative research.Adopting purposive sampling to find the enterostomal therapists, then collecting data by semi-structured in-depth interviews, the main content of interview includes enterostomal therapists’stoma care practice、the evaluation of work performance. The sample size is determined on the basis of data saturation. Adopt Colaizzi’s 7-stept method to analysising the data. Researcher translated the audio data into text transcription, then analysised deeply to determine the suitable and sensitive indicators of the enterostomal therapists’ stoma care practice.2.The second stage:a prospective cohort study.Researcher have followed up 136 ostomy patients during Mar.2013 to Mar.2014, and divided the patients into different groups (control group and observation group) on the basis of the different stoma care practice that the patients have received after enterostomy. The control group received surgical routine care performed by surgical ward nurses. The observation group not only received surgical routine care, but also received stoma care practice leaded by enterostomal therapists. Enterostomal therapists trained the ward nurses about the knowledge and skills of stoma care. The trained ward nurses then implement one-to-one stoma care and skills guidance for the patients and their families. Following up patients respectively at the time point about 7-10 days after surgery、a month after discharged、two months after discharged、three months after discharged. Collecting the relevant information about the evaluation indicators. Using SPSS17.0 software to entry and collate data. Adopting chi-square test^ two independent samples t testn two independent samples nonparametric test、 stepwise multiple regression analysis to do statistical analysis.Results1.The results of the first stage.Researcher has interviewed 7 enterostomal therapists in all during Sep.2012 to Dec.2012, received an audio data of 400 minutes and a transcribed text of one hundred thousand words. Researcher has obtained 13 meaningful codings after in-depth analysis of the transcript. Researcher integrated the encoded contents in accordance with the classification of patients’ medical outcomes, then extracted three themes:enterostomal therapists’ effect on patient’s clinical outcomes, including professional health education can prevent complicationsn professional judement can block the expansion of complications; enterostomal therapists’ effect on patient’s functional outcomes, including psychological counseling can promote the patient’s psychological adjustment、continuity of care can improve patient’s quality of life; enterostomal therapists’effect on patient’s medical expenses, including the guidance of stoma care can reduce the replacement frequency of ostomy bag、proper education can help patients reasonably choose the suitable stoma products.According to the results of interview and literature review, reasearcner has determined the stoma peripheral skin proplems rate as the evaluation indicator of the patients’clinical outcomes, the stoma peripheral skin proplems mainly includes stoma peripheral mucocutaneous separation、stoma peripheral irritant dermatitis、stoma peripheral atopic dermatis、stoma peripheral skin’s folliculitis^ stoma peripheral granulation hyperplasia、stoma peripheral skin’s pain and manure leakage. Reasearcner has determined patients’quality of life、self-efficiency, stoma self-care level as the evaluation indicator of the patients’functional outcomes, patients’stoma products cost as the evaluation indicator of the patients’medical expenses.2.The results of the second stage.(1)The stoma peripheral skin proplems rateThere is no difference in the incidence of stoma peripheral mucocutaneous separation, stoma peripheral atopic dermatitis, stoma peripheral skin’s folliculitis, stoma peripheral granulation hyperplasia between observation group and control group at the time point about 7-10 days after surgery、the first month after discharged、 the second month after discharged、the third month after discharged(p>0.05).There is no difference in the incidence of stoma peripheral irritant dermatitis between observation group and control group at the time point about 7-10 days after surgery(p>0.05):the observation group’s incidence of stoma peripheral irritant dermatitis is much lower than the control group at the time point about the first month after discharged、the second month after discharged, the third month after discharged (p<0.05).Whin three months after discharged, there is no difference in the incidence of stoma peripheral mucocutaneous separation stoma peripheral atopic dermatitis、stoma peripheral skin’s folliculitis between observation group and control group(p>0.05); the observation group’s incidence of stoma peripheral granulation hyperplasia is lower than than the control group(p<0.05), the relative risk (RR) between observation group and control group is 0.081; the observation group’s incidence of stoma perpheral irritant dermatitis is much lower than the control group(p<0.05), the relative risk (RR) between observation group and control group is 0.545.(2)The manure leakage rateThe observation group’s incidence of manure leakage is much lower than the control group at the time point about 7-10 days after surgery、the first month after discharged、the second month after discharged、the third month after discharged (p <0.05).Whin three months after discharged, the observation group’s incidence of manure leakage is much lower than the control group(p<0.05), the relative risk (RR) between observation group and control group is 0.459.(3)The stoma perpheral skin pain rateThe observation group’s incidence of stoma peripheral skin pain is much lower than the control group at the time point about 7-10 days after surgery-. the first month after discharged、the second month after discharged(p<0.05); there is no difference in the incidence of stoma peripheral skin pain between observation group and control group at the time point about the third month after discharged(p>0.05).Whin three months after discharged, the observation group’s incidence of stoma perpheral skin pain is much lower than the control group(p<0.05), the relative risk (RR) between observation group and control group is 0.492.(4)Quality of lifeThe observation group patients’quality of life is much higher than the control group patients at the time point about a month after discharged、three months after discharged(p<0.05).(5)Self-efficiencyThe observation group patients’ self-efficiency is higher than the control group patients at the time point about a month after discharged(p<0.05):but there is no difference between observation group and control group at the time point about three months after discharged(p>0.05).(6)Stoma self-care levelThe observation group patients’stoma self-care level is much higher than the control group patients at the time point about a month after discharged (p<0.05); but there is no difference between observation group and control group at the time point about three months after discharged(p>0.05).(7)Stoma products costThe observation group’s stoma products cost is higher than the control group at the time point about 7-10 days after surgery, a month after discharged(p<0.05); but there is no difference between observation group and control group at the time point about two months after discharged, three months after discharged(p>0.05).Conclusion1. Enterostomal therapists’stoma care practice can help the patients and their families to learn the relevant knowledge and skill of stoma care, reduce the incidence of manure leakage, and tower the stoma peripheral irritant dermatitis rate during the early period of postoperation, to control the symptoms of stoma perpheral skin pain. The stoma peripheral irritant dermatitis rate, the manure leakage rate, the stoma peripheral skin pain rate are the suitable and sensitive indicators of the enterostomal therapists’stoma care practice.2. Enterostomal therapists’stoma care practice not only improve the patients and their families’stoma care skill, but also help patients to establish confidence to return to the society, help patients to improve their mental state and enhance patients’ self-efficiency, and improve their quality of life. The patients’quality of life, self-efficiency, stoma self-care level are the suitable and sensitive indicators of the enterostomal therapists’stoma care practice.3. Enterostomal therapists’stoma care practice doesn’t take obvious effect on the patients’ stoma products cost. It needs to do more research to determine if the stoma products cost is a suitable and sensitive indicator of the enterostomal therapists’stoma care practice. |
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