Relationship between psychosocial adaptation and health-related quality of life of patients with stoma: A descriptive, cross-sectional study.

OBJECTIVE: To investigate the relationship between psychosocial adaptation and quality of life of patients with ostomies and to provide reference data for clinical care practice. BACKGROUND: Surgical enterostomy impacts the life of patient. Most patients are transferred to home or community hospital after discharge and require long-term nursing care. These patients typically face problems with physical, psychological and social adaptation. DESIGN: Descriptive, cross-sectional study. METHODS: Between March 2017-June 2017, the following questionnaires were electronically administered to 1,053 patients with enterostomy residing in 22 provinces, 4 autonomous regions for ethnic minorities and 4 direct-controlled municipalities in China: Social Support Revalued Scale, validated Chinese version of Ostomy Adjustment Inventory and Stoma-Quality of life-Chinese. Univariate analysis, correlation analysis and hierarchical regression analysis were used to assess the relationship between adaptation level and quality of life of patients with enterostomy, in order to provide reference data for clinical care practice and further improve the quality of life of these patients. The STROBE checklist was used in reporting this study. RESULTS: The mean score for psychosocial adaptation was 43.13 ± 13.09, which corresponded to a medium level; the mean score for quality of life was 56.54 ± 16.87. The level of psychosocial adaptation and each dimension showed a positive correlation with the quality of life of patient and each dimension (r = 0.349-0.890, p < 0.01). Univariate analysis revealed a signification association of quality of life with education level, medical payment method, area of residence, peristomal complications, regular defecation, occurrence of leaking, ability for self-care of stoma, communication between patient and medical staff, and knowledge and skills pertaining to care of stoma. Results of hierarchical regression analysis indicated that psychosocial adaptation level was a predictor of quality of life (R2  = 0.708; p < 0.001). CONCLUSIONS: In this study, the quality of life of patients with enterostomy was generally of a medium level. The level of psychosocial adaptation of the patient was closely linked to quality of life. During clinical care, concerted efforts should be made to encourage the patients to deal with the stoma positively and to help the patient and their families accept the stoma and change of image to reduce the adaption course and improve the quality of life. RELEVANCE TO CLINICAL PRACTICE: Patients tend to take a long time to adapt to the stoma after ostomy formation. Facilitating the adjustment of patients with enterostomy may improve their quality of life. Medical care providers should focus more attention on patients who have lower ostomy adjustment scores.

A Descriptive, Cross-sectional Study Among Chinese Patients to Identify Factors that Affect Psychosocial Adjustment to an Enterostomy.

Physiological, psychological, and social problems may affect adaptation to living with a stoma. A descriptive, cross-sectional study was conducted between March 2017 and June 2017 among patients culled from a manufacturer's database to identify factors that influence psychosocial adjustment in Chinese patients with an enterostoma. Patients with a history of ostomy surgery ≥1 month prior and who were ≥18 years of age, completed a primary school education, and able to communicate in Chinese were eligible to participate unless they had a history of psychosis, cognitive impairment, or participation in other research programs. After providing informed consent, participants completed a questionnaire that addressed demographic (age, gender, employment, educational level, marital status, medical payment method, living status, and area of residence) and stoma-related (date of surgery, preoperative stoma siting, ostomy appliance type, peristomal complications, regular defecation, stoma self-care ability, stoma-related communication with medical staff, level of understanding regarding stoma knowledge and care skills, appliance change knowledge/experience, and leakage history) factors. Social support was assessed using the 10-item Social Support Revalued Scale (SSRS), and 3 dimensions of adjustment (acceptance, continuous worry, and positive life attitude) were assessed using the 20-item Chinese version of the Ostomy Adjustment Inventory (OAI). Questionnaires were administered via an online survey platform. Data were analyzed descriptively, and single-factor analysis and stepwise multiple linear regression were applied to identify the factors that influenced the adjustment level. Incomplete (missing >2 questions), incorrect, or hastily completed (within 600 seconds) records were excluded from analysis. Of the 1109 persons who returned the questionnaire, 1010 (91.1%) completed the entire survey (564 men [55.8%] and 446 women [44.2%], mean age 56.62 ± 15.62 years); 823 (81.5%) had a colostomy and 187 (18.5%) had an ileostomy. The OAI dimension continuous worry was negatively and significantly associated with all 3 dimensions of the SSRS, including subjective support (r = 0.259), objective support (r = 0.259), and utilization of support (r = 0.289), while the dimension acceptance was positively associated with both subjective support (r = 0.082) and objective support (r = 0.074) (all P values <.05). Using multiple linear regression, residence area, peristomal complication, regular defecation, leaking, self-care ability, communication with medical staff regarding ostomy, understanding knowledge or skill needed for stoma care, utilization of social support, and total score of social support were found to be significantly associated with ostomy adjustment level (all P values <.05). Patients living in an urban area, with no history of peristomal complications, who had regular defecation, had not experienced leaking, had better self-care ability, frequently communicated with medical staff, had a high level understanding about knowledge or skill of stoma, and had higher social support scores had higher adjustment scores. Knowledge of the factors that enhance or hinder adaptation of the patient to the ostomy is an important tool in the clinician's care armamentarium.

Incidence and risk factors of incontinence-associated dermatitis among patients in the intensive care unit.

OBJECTIVE: To investigate the incidence of incontinence-associated dermatitis (IAD) among patients in the intensive care unit (ICU) and to identify potential risk factors to establish a reference for clinical nursing work. BACKGROUND: Patients in the ICU are susceptible to IAD. IAD is painful, reduces the patient's quality of life and adds to the workload of clinical medical staff. However, risk factors associated with IAD may differ between countries and healthcare settings. DESIGN: Prospective cohort study METHODS: From November 2016 to November 2017, a prospective cohort study was conducted among109 patients in three Class 3, Grade A hospitals (comprising 9 ICUs in total) in Beijing. The Incontinence-associated Dermatitis and Its Severity (IADS) instrument in Chinese was applied to assess IAD. Univariate and multivariate logistic regression analyses were performed to identify risk factors for IAD. RESULTS: The study population had 29 community-acquired and 80 nosocomial infections, and 26 (incidence: 23.9%) of these had IAD. On univariate analysis, a significant difference was observed between patients with and without IAD with respect to the following indices: Barthel index, Braden scale score, Nutritional Risk Screening 2002 (NRS2002) score, serum albumin level, occurrence of infection, faecal incontinence, frequency of faecal incontinence, stool property and double (faecal and urinary) incontinence and perineal assessment tool (PAT) score (p < 0.05). Multivariate logistic regression analysis showed that three factors entered the regression equation-that is, the Braden Scale Score, serum albumin level and double incontinence. Of these, the Braden Scale Score and serum albumin level were protective factors for IAD. Thus, the higher the Braden Scale Score, the lower the risk of IAD (OR = 0.678, 95% confidence interval [CI] = 0.494-0.931); a higher level of serum albumin implies a lower risk of IAD, provided it is within the normal range (OR = 0.884, 95%CI = 0.797-0.981). Double incontinence was an independent risk factor for IAD (OR = 10.512, 95% CI = 2.492-44.342). CONCLUSION: A higher morbidity of IAD is seen in the ICU. Specific preventive and nursing measures are required to maintain the skin integrity of critically ill patients in daily nursing practice to improve patient quality of life and the quality of nursing care. RELEVANCE TO CLINICAL PRACTICE: Incontinence-associated dermatitis is characterised by inflammation and tissue damage due to prolonged/repeated exposure to urine and/or stool. Not every patient with urine and/or stool incontinence develops IAD. Medical staff can use research-based evidence to identify ICU patients at risk of IAD to reduce morbidity and improve health outcomes.