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

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

Thinking outside the box: lessons from reverse innovation

For nurses, Covid-19 has radically challenged how they deliver care, with existing resources continually being stretched well beyond normal usage. The result is that innovative approaches are essential to redress shortages, support the continuance of services and maintain patient safety. As nurses who have had the opportunity of working with various Low Middle Income Countries (LMIC), we believe nursing has been adversely affected by a missed opportunity, to recognise the knowledge and expertise seen and learned by nurses who have worked internationally. There is little evidence of how the lessons learnt have been transferred and adapted for application in a high income country (HIC) at any time never mind during the pandemic

Evaluation of an international health partnership to capacity build emergency, trauma and critical care nurse education and practice in Zambia: An experience from the field

Aim: To evaluate an international health partnership project to capacity build emergency, trauma and critical care nurse education and practice in Zambia. Background: Zambia continues to face a significant workforce challenge and rising burden of communicable and non-communicable diseases, compounded by the COVID-19 pandemic. In response to these, the Zambian Ministry of Health is investing in specialised nurses. Emergency, trauma and critical care nursing education and training were seen as one of the solutions. North–south partnerships have been identified as a force for good to capacity build and develop emerging specialities. Sources of evidence: We use an evaluative approach, which includes desk research, a rapid literature review and documentary data analysis from published papers, government reports and project documentation. Ethics committee approval was sought and gained in both Zambia and the UK. Discussion: A critical review of the evidence identified three key themes: challenges with changing education and practice, developing Zambian faculty for sustainability and the effect of an international health partnership project on both Zambia and UK. The outcomes from this project are multifaceted; however, the main achievement has been the implementation of emergency, trauma and critical care graduate programmes by the Zambian faculty. Conclusion: This experience from the field outlines the benefits and limitations of a north–south partnership and the importance of transparency, shared ownership and collegiate decisions. It has facilitated knowledge exchange and sharing to capacity build emergency, trauma and critical care nursing. Implications for nursing practice: Lessons learned may be applicable to other international nursing partnerships, these include the need for deep understanding of the context and constraints. Also, the importance of focusing on developing long-term sustainable strategies, based on research, education and practice was noted. Implications for nursing policy: This paper outlines the importance of developing nursing education and practice to address the changing burden of disease in line with Zambian national policy, regional and international standards. Also, the value of international nursing partnerships for national and international nursing agendas was describe

Performing a neurological assessment

Neurological observations are a crucial aspect of patient assessment, which require nurses to collect and analyse information gathered from use of a validated assessment tool such as the Glasgow Coma Scale (GCS). This includes, checking pupil size and reaction, limb movements and vital signs. This article discusses the anatomy and physiology underpinning neurological assessments tools, such as A(C)VPU and GCS, it also explains the rationale for checking pupil size and reaction, limb power assessment and how to correctly record and act on neurological observations

A Review of Enteral Nutrition Practices in Critically Ill Adults in Resource Limited Environments

Enteral nutrition in critical care is a complex area of practice. A resource limited environment includes countries that are identified as low-income and low- middle income. This review describes three themes for its successful implementation of enteral nutrition in a resource limited environment. These include identification of patients at risk of malnutrition, using non-commercial feeds and the urgent need to develop practice. Malnutrition is a serious complication of critically illness and remains a crucial aspect of patient care in order to prevent complications. Further evidence to develop sustainable EN strategies for critically ill patients is urgently required. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health

Performing a neurological assessment

Neurological observations are a crucial aspect of patient assessment, which require nurses to collect and analyse information gathered from use of a validated assessment tool such as the Glasgow Coma Scale (GCS). This includes, checking pupil size and reaction, limb movements and vital signs. This article discusses the anatomy and physiology underpinning neurological assessments tools, such as A(C)VPU and GCS, it also explains the rationale for checking pupil size and reaction, limb power assessment and how to correctly record and act on neurological observations