Este mes en... International Journal of Urological Nursing
Sumarios de Revistas
Este mes en... International Journal of Urological Nursing:
Knowledge gaps in prostate cancer treatment between physicians and clinical nurse specialists
Delphi consultations, a method of gaining consensus by gathering expert opinion, were conducted in order to understand the role of degarelix as a treatment option for advanced hormone-dependent prostate cancer. During the Delphi consultations, differences were identified between physicians and clinical nurse specialists in terms of their knowledge of therapeutic developments. We argue that disparities in knowledge between physicians and nurse specialists could limit the effectiveness of multi-disciplinary teams in providing optimal patient care. When such situations arise, communication between patients and nurse specialists, often the patient's primary point of contact, may conflict with information they have received from the physician. This could lead to confusion and uncertainty among patients about whether they are receiving the best possible care. Time and resources should be provided to address the continuing educational needs of nurses, which will ultimately result in the improved care and experience of patients.
The use of chewing gum for postoperative ileus prevention in patients undergoing radical cystectomy
Does the postoperative use of chewing gum in patients undergoing radical cystectomy (RC) facilitate intestinal motility recovery, reduce intestinal recanalization times and decrease length of stay? Postoperative ileus is a temporary impairment of intestinal motility and a frequent complication after RC. It is characterized by abdominal distention and absence of bowel functions, with symptoms including nausea, vomiting, pain and cramps. This results in an increase in length of stay, patient discomfort and costs. Different studies investigated the efficacy of chewing gum use, as a form of simulated feeding, in accelerating the resolution of ileus after several abdominal surgical procedures. Considering the lack of specific studies, some other conducted in similar abdominal procedures were included in this literature review. Despite the diversity of type of surgery, all considered studies show for patients who received chewing gum, a significant reduction in the time of first flatus and faeces, a reduction in the time of first bowel movements; not all included studies instead have found a significant decreasing in morbidity and length of stay. The chewing gum use seems to be a simple and inexpensive way to enhance recovery of bowel function, although it is probably still a little known procedure. It is possible recommending the administration of chewing gum in patients after cystectomy, monitoring the effectiveness, upon the recognition of possible conditions that might contraindicate its use.
The impact of oral nutrition in patients after radical cystectomy: an overview
Nutritional status is considered a significant factor determining the post-operative outcomes after RC. The aim of this literature review is to describe the impact of early oral nutrition on functional outcomes in patients underwent cystectomy. Usually, these patients are not fed orally until the return of gastrointestinal function, because early oral nutrition is often perceived as detrimental for the anastomosis integrity and is believed to cause nausea and vomiting. This phase of nutritional deprivation may vary from a few days to a few weeks, depending on the return of bowel movements. In clinical practice, patients are fed on a substitutive nutritional support based on the use of total parenteral nutrition or enteral nutrition, which have not demonstrated positive effects on bowel function recovery time, infection complication rates or length of hospital stay. The early introduction of oral feeding seems to allow early mobilization and to lead to an improvement of post-operative outcomes: bowel functions, pain, complications, patient's comfort and length of hospital stay. The early implementation of oral diet after cystectomy is associated with an improvement of considered outcomes, allowing an early recovery of patient's general conditions and reducing length of hospital stay.
Voiding diary: proposal and assessment of a tool
Can voiding diary be a primary tool to assess urinary symptoms, being accessible and easier to fit into patients' lives and their family or caregiver? The nursing care to neurogenic bladder patients reveals the daily need for standardized patient assessment tools that support the treatment process. The aim of this study is to propose and assess a voiding diary for use with intermittent bladder catheter users and their caregivers. Voiding diary is important tool for patients and their caregivers to use to help both parties understand the functioning of the urinary tract and identify urinary symptoms. Research developed at a Rehabilitation Center of a university hospital. After characterizing the population, the voiding diary was constructed based on the literature review and then subject to expert face and content validation. Each participant received a diary, a graded plastic flask and a data collection instrument, between June and October 2013. The data were analysed using descriptive statistics. Among the 44 (100.0%) participants, 28 (63.6%) were caregivers and 16 (36.4%) patients. The best assessed items regarding the diary were ‘Importance of the tool,’, ‘Explanation of the orientations’ and ‘Clarity of the Figures.’ The good adherence level to the tool was highlighted, as well as the importance of appropriate orientations before completing the diary.
Identifying reasons, gaps and prevalence of diaper usage in an acute hospital
Are diaper usage overused in acute hospital settings? Are there ways to avoid unnecessary diaper usage? This study aimed to identify the prevalence of diaper usage and the reasons of using diaper as well as to suggest strategies to avoid unnecessary use of diaper. Diaper is widely used for patients in hospitals worldwide but is seldom to be report its prevalence. Some patients with medical issues need to use diaper but some who do not have those problems are still given a diaper to wear once admitted. This is a cross-sectional prevalence survey study from 24 wards covering 3 major departments between 19 and 26 October 2016. Data were sourced from different means such as documents and interviewing patients/relative, nursing and nursing supporting staff. The study was approved by cluster general manager (nursing) who supported the study to improve patient care. The overall prevalence rate of diaper usage during admission was 37·9%. The top four reasons of diaper usage in all departments were faecal/urinary incontinence, poor patient condition, confusion and poor mobilization which accounted for 38, 15, 10 and 8% respectively. A total of 53 patients of those who had not used diapers before admission but were given diapers to wear, reported reasons as having poor mobilization and lower limb weakness. This is the first study ever to explore the prevalence and reasons of diaper usage in Hong Kong. Different reasons to use diapers after admission but patients did not use diaper upon admission could be identified in various department. A clinical guideline on proper use of diaper that identified some gaps of the prevailing practice and possible solutions was suggested to improve clinical practice.
Frequency of urinary incontinence among Turkish women, effective factors and its effect on quality of life
What is the frequency of urinary incontinence in Turkish women and how does it affect their quality of life? The aim of this study is to determine the frequency of urinary incontinence among Turkish women, effective factors and its effect on quality of life. Urinary incontinence, a health problem that is commonly seen among women, leads to primarily social and hygienic problems, and affects the physiological, psychological and economic aspects of individuals who are effected. This cross-sectional study was conducted in the gynaecological outpatient clinics of a Turkish hospital, between 01 August 2014 and 26 December 2014. The population of the study consisted of 155 women aged 19 and over who applied to the gynaecology outpatient clinics for reasons other than pregnancy. The entire population was included in the study without selecting a sample. The data were collected by using a 16-question questionnaire and King's Health Questionnaire (KHQ). A total of 67·7% of the women were found to suffer from urinary incontinence problem. A significant correlation was found between the age groups and incontinence problems. While pollakiuria was observed more in the age group of 20–29 years (37·3%), urge incontinence (35·6%), stress incontinence (36·2%), and enuresis nocturna (31·6%) were observed more in the age group of 30–39 years. Quality of life of women with bladder problems was significantly impaired. When the women with stress incontinence were compared with women who suffered from other incontinence problems, all sub-scale mean scores obtained by the women with stress incontinence from KHQ were higher and the quality of life of these women was seriously impaired.
Management and implementation of intermittent catheterization in neurogenic lower urinary tract dysfunction
As a considerable heterogeneity in the procedure of intermittent catheterization (IC) was identified by a questionnaire survey conducted in hospitals and institutions for the treatment of patients with spinal cord injury in 2010, it became necessary to standardize the IC procedure (i.e. self-catheterization and assisted catheterization). These guidelines were developed within a structured consensus process (e.g. several consensus conferences and nominal group process) by members of the working group on neuro-urology and the working group on nursing of the German-speaking Medical Society of Paraplegia and were published as guidelines of the German Society of Urology (DGU). The guidelines developer group was a multiprofessional group. Firstly, the indications for IC are presented and concepts such as sterile, aseptic and hygienic catheterization are defined. The materials necessary for the IC are presented in detail. The disinfection and catheterization techniques are described and a detailed explanation of the potential complications and their management is given. Finally, the legal aspects and issues of eligibility of catheter materials are discussed. The purpose of this consensus is to contribute to the standardization of IC. It should remove uncertainty and offer assistance to users (i.e. patients, staff and care providers). A particular focus is placed on practical instructions for carrying out the IC. The intention is to support the realization of IC in various settings (e.g. hospital, rehabilitation, long-term care institutions and home-based care). A wide implementation of the guidelines should lead to a reduction of the risks and complications of IC.
Evaluation of a multidisciplinary allied health prostate cancer clinic
Prostate cancer is the most common male cancer, with increasingly longer survival, and many treatment options for advanced disease. Men with prostate cancer report a high level of unmet supportive care needs. To evaluate unmet needs of a small cohort of Australian men with advanced prostate cancer, and their partners, and to assess the impact of attendance at a multidisciplinary allied health clinic on meeting these needs. Fifty patients were referred to the clinic by their treating specialists. Prior to their clinic consultations patients and partners completed study questionnaires to determine their unmet needs, prostate cancer and treatment related quality of life, levels of anxiety and depression, exercise patterns and prostate cancer-related functional status. Questionnaires were completed again 1 month post-clinic attendance, and pre-and post-clinic scores were compared. Patients reported unmet needs in several domains including psychological and sexuality needs. These showed a small reduction when assessed post-clinic. Partners also reported needs in the psychological and emotional, and information domains. Thirty-two percent of patients reported clinical levels of distress when assessed pre-clinic attendance, reduced to 8% reporting the same level of distress 1 month post-clinic. The identified high levels of unmet needs and levels of distress of this group of patients and partners highlights the necessity for additional resources to assist these men. A multidisciplinary allied health care prostate clinic as described here may further assist in the comprehensive care of these men and their partners.
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