Psychological issues affecting patients living with a stoma

Stoma surgery, be it temporary or permanent, it is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate post-operative and recovery period, but for the rest of their lives. There are changes in bodily function, altered body image, physicality and personal care needs (ref). These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient’s needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue through the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the last three decades there has been increasing recognition that Quality of Life (QoL) which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to healthcare professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. The transition process by professionals from active care to post care treatment using a long term health plan that not only takes the patient through the first five years (accepted time span if there has been a cancer) can be critical to wellbeing for the rest of their life. This article examines some of the previous research into QoL and looks at stoma patients perceptions of their outcomes from recent research

Covid-19 One year on: The challenge for low-middle income countries

History has shown that epidemics are a story of inequalities [1]. In early 2020, the World Health Organisation (WHO) described the Covid-19 pandemic as a public health emergency of international concern [2]. In many countries this meant the demand for critical care services has exceeded availability in terms of workforce, resources and equipment. Since the start of 2021, there has been a significant increase in infections in Africa, with new and different variants of SARS-CoV-2. However, little has been published on the impact of Covid-19 in low-resource settings and role of critical care nurses and services. This critical commentary is partly based on our reflections as members of a health partnership in Zambia, to capacity build Emergency, Trauma and Critical Care Nursing and also utilises current available evidence

COVID-19 disease: Resusitation

Resuscitation is arguably one of the most physically and mentally challenging tasks that a healthcare professional can undertake. Patients admitted due to COVID-19 have an increased propensity for rapidly progressive respiratory failure, necessitating critical care admission [1], and it is essential that early consideration should be made for advanced care planning. It is important to establish with the patient and the people that are important to them what treatments are likely to be of benefit. This includes discussing the implications of critical care admission and resuscitative treatment. Therefore, this article focusses on the impact of the additional stressors and challenges that must be considered when delivering resuscitative treatment during the COVID-19 pandemic. It reviews the evidence and guidance that has been developed to help health care professionals carry out resuscitation procedure

COVID-19 disease: Acute respiratory distress syndrome and prone position

Patients who develop severe COVID-19 disease can develop respiratory failure and subsequently Acute Respiratory Distress Syndrome (ARDS). However, it has to be noted that these patients may not follow the typical ARDS disease trajectory. The causes of this paradox are complex and not yet fully understood, with the result that varying pathophysiological hypotheses have been proposed. This article describes ARDS in COVID-19 patients and the use of the conscious and unconscious prone position as an intervention to improve oxygenation

The ‘sleeping elephant’, the role of mentorship of critical care nurses in Zambia

Aim: To develop and evaluate a Zambian context specific mentorship model that supports registered nurses completing emergency, trauma and critical care programmes in Zambia. Background: In Zambia, emergency and trauma and critical care nursing are relatively new specialities, with education and training programmes less than a decade old. A train the trainer mentorship programme was developed and delivered at two Colleges of Nursing. Ethics approval was gained in both Zambia and the UK. Sources of evidence: Documentary data analysis and focus groups were used. Focus groups included stakeholders and nurses in practice who had completed the train the trainer programme and were using the mentorship model. Discussion: The critical review of the literature revealed there was a paucity of evidence on the role of mentors in critical care. While national documentation identified that most post basic education programmes are at Diploma Level with limited content that focuses on bedside teaching, mentorship and assessment content. Conclusion: Feedback from representatives attending the stakeholder workshops and focus groups which included participants who had completed the training programme enabled the mentorship model and workshop to be developed and evaluated. Implications for nursing practice: Nurses are the backbone of healthcare systems in Africa and the world. Mentorship and assessment in practice enables nurses to develop the competence and skills to lead practice, support peers and junior colleagues. Implications for nursing policy: This paper has identified the need for a context specific formalised mentorship model to support specialist practice and this project has provided the foundations for mentorship of emergency, trauma and critical care nurses in Zambia

Effectiveness of training programme on nurses wound care competencies after one year of implementation

This study aims to review the impacts of the nursing training programme on the knowledge, skills and attitude among nurses working in seven clinical departments at Viet Duc University Hospital one year after the interventional programme has been conducted. It was carried out in 2014 and 2015 with a sample size of 145 nurses. The data collection tool included a wound care observation checklist to measure two indicators - the mean score and effects of training on wound care competencies. Data was analysed with SPSS 18.0. The study results showed that the post training rate of nurses with adequate practice competencies increased from the pre-training survey (p < 0.001). The effectiveness indicators relating to the competencies of identification, planning, plan implementation and evaluation were 31.9%; 43.3%; 71.3% and 28.3% (p < 0.001). Wound care training programme based on nursing competencies standards has proved to be effective

Marketing specialist practice to managers and purchasers

Specialist nurses need to find a way of describing their practice that leaves managers and purchasers in no doubt about the level of service they offer and the contribution they make to the provision of high-quality care. This article suggests how they might market their expertise. </jats:p

Oral contraception scare has reduced confidence in medical services

So, here we go again on the seesaw of changing medical advice! It only seems like yesterday that women taking oral contraception were told to change to new ‘safer’ pills (e.g. Femodene, Mercilon, Minulet, Marvelon, etc). However, having obligingly changed, they now find out that they were wrong to change in the first place and that they need to go back to where they started. </jats:p