PURPOSE:The purpose of this study was to explore clinical practice and decisions made during ostomy pouching system changes and procedures performed by nurses with different nursing credentials using a validated metric-based clinical simulation procedure. DESIGN:Explanatory sequential mixed methods design. SUBJECTS AND SETTING:The study population comprised 24 participants with different nursing credentials: 6 were certified ostomy care nurse specialists, 8 were registered nurses working in acute care, and 10 were senior baccalaureate student nurses. Data were collected between September 2021 and February 2024 at the Clinical Learning and Research Center within the Clemson University School of Nursing (Clemson, SC, USA). METHODS:This study used a validated metric-based clinical simulation procedure to assess tasks performed during ostomy pouching system changes, task duration, and supplies used. The simulated experience was followed by administration of the System Usability Scale and a structured debriefing interview. Two-way repeated-measure ANOVA, mixed-effects logistic regressions, and single factor ANOVA were used to analyze quantitative variables according to variable type. Content analysis was used to analyze debriefing interviews and comments made by the participants during the simulated experience. RESULTS:Certified nurses with expertise in ostomy management (CWOCN, CWON, COCN) spent significantly longer performing ostomy and peristomal skin care and pouching system changes tasks when compared with registered and student nurses. Differences between the nurse groups were observed for product selection, skin barrier sizing and adhesion, ostomy and peristomal skin care, along with infection control task categories. Scores on the perceived usability of ostomy pouching systems were above average for ostomy care specialists and registered nurses. Certified nurses with expertise in ostomy care had significantly higher perceived usability scores when compared with student nurses. CONCLUSIONS:Variability in psychomotor and critical thinking tasks were observed among 3 groups nurses with different credentials. This knowledge provides targets for expanding training of nurses in ostomy care.
PURPOSE:The purpose of this study was to compare nighttime urine capture, safety, and participant preference between a male external catheter connected to a vacuum-assisted collection system and a male condom catheter in community-dwelling older men who previously used incontinence products at night. DESIGN:Prospective, open label, randomized, 2-phase crossover pilot study. PARTICIPANTS AND SETTING:Fifteen older men (≥65 years) requiring nocturnal urine management were enrolled across 2 US outpatient research sites (Greenacres, FL; Hamilton, NJ). Data were collected March-June 2025 in participants' home setting. METHODS:Participants were randomized 1:1 to device sequence and used each device for 7 consecutive nights separated by a ≥2-day washout. Primary outcomes assessed mean nightly urine capture rate (performance) and device-related adverse events requiring medical intervention (safety). Secondary endpoints included device preference, dislodgement, and tolerability, whereas changes in the PROMIS Sleep Disturbance scale before and after the use of each device were captured as exploratory endpoints. Analyses were descriptive with paired comparisons and beta regression for capture rate. RESULTS:Fifteen participants completed both 7 night usage periods. Mean (SD) overall capture rate was 98.5% (1.7) with the study device (MEC) versus 98.1% (2.6) with the comparator (sheath; LS mean difference 0.5%, 95% CI -0.8 to 1.7). No device-related adverse events requiring medical intervention were reported. Device dislodgement occurred infrequently for both devices and was numerically higher for the male external catheter, with events primarily occurring during the first treatment phase and driven by repeated dislodgements in a single participant. Preference favored the study device (13/15, 86.7%). The PROMIS Sleep Disturbance scale decreased (improved) from baseline in both periods (mean change -8.6 and -6.3). CONCLUSIONS:In older men requiring nocturnal urine management at home, the male external urine collection device demonstrated capture performance and safety comparable to a sheath-style catheter, with strong participant preference for the external collection device.
ABSTRACT PURPOSE: The purpose of this systematic review was to determine the clinical and economic impact of using a silicone multilayer foam dressing in the prevention of sacral pressure injuries (PIs) in at-risk patients. METHOD: Systematic literature review and meta-analysis. SEARCH STRATEGY: Literature was obtained through EMBASE, PubMed, and Cochrane Library between January 2010 and October 2023. Inclusion criteria were randomized controlled trials that compared a silicone multilayer foam dressing with standard prevention (SP) care in the intervention arm, or SP alone as a comparator in the control arm. Study quality and risk of bias were assessed using the Risk of Bias 2 (RoB2) instrument. FINDINGS: A total of 781 records were identified, and data were extracted from 3 studies. The pooled sample comprised 589 participants receiving SP versus 561 patients receiving SP plus multilayer dressing across various hospital settings. Meta-analysis revealed a 66% reduction in the odds of PI among patients receiving SP plus the dressing when compared with SP alone (odds ratio, 0.34, 95% confidence interval, 0.22-0.54). Subanalysis of stage 1 and stage ≥2 PIs confirmed the stability of these findings and resulted in an estimated cost saving of $1,925 per patient; this finding was stable under both one-way and probabilistic sensitivity analyses. IMPLICATIONS: Findings from this meta-analysis supports the clinical and economic benefits of implementing multilayer foam dressings into existing care bundles in the prevention of PIs in at-risk patients.
ABSTRACT PURPOSE This project aimed to implement a new advanced practice provider (APP) protocol to reduce 30-day postoperative dehydration rates for patients with new ileostomies. PARTICIPANTS AND SETTING Adult patients (n = 21) with new ileostomies from a large academic urban medical center within the colorectal surgery clinic in eastern North Carolina. APPROACH Using a pre/post-test quality improvement approach, new ileostomy patients were scheduled for a follow-up visit with an APP within 7 business days of hospital discharge from May to July 2023. Postoperative complication rates were collected and compared with the American College of Surgeons (ASC) National Surgical Quality Improvement Program (NSQIP) data that provide benchmarks to other medical facilities to determine postintervention complication rates. OUTCOMES The comparison period (January-March 2023) complication rate was 10.3%; the implementation period rate was 2.8%. The relative reduction was 72.8%, thus exceeding the goal of 10%. IMPLICATIONS FOR PRACTICE Project findings support the importance of a protocol with the follow-up period being conducted earlier (within 1-week postoperative) for new ileostomy patients to identify those patients at a risk of dehydration and postoperative complications. More patient education on monitoring their intake and output should be incorporated into preoperative teaching.
