Larsen Cecilie, Borglit Trine Bolette, Leinum Lisbeth Roesen, Dreyer Pia, Krogsgaard Marianne
Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark.
Department of Surgery, Zealand University Hospital, Koege, Denmark.
J Clin Nurs. 2025 Jul;34(7):2591-2624. doi: 10.1111/jocn.17671. Epub 2025 Feb 14.
BACKGROUND: Parastomal hernia or bulging is a long-recognised complication in relation to a stoma. Around half of patients develop a parastomal bulge and up to 75% experience symptoms. Only a minority is offered surgical treatment; thus, most patients manage the bulge on their own or by interventions provided by stoma care nurses. AIMS AND OBJECTIVES: To identify and present the available information on nursing interventions for the management of symptoms caused by the parastomal bulge. METHODS: This scoping review followed the framework by the Joanna Briggs Institute, conducting searches in 11 databases and through stoma organisations. Literature on nursing management of parastomal bulges was included. Two authors independently screened and selected the studies, with data-charting performed by one author and verified by another. The PAGER framework depicted the state of the evidence and the PRISMA-ScR checklist guided the process. RESULTS: Of 8361 screened publications, 44 were included. Management of the parastomal bulge and related symptoms were described in eight nursing interventions: appliances, support garments, irrigation and regulation of stool, strangulation, disguise and intimacy, physical activity, support and education, record keeping, follow-up and referral. Most evidence was based on expert opinion with only ⅓ of papers using study designs, such as cross-sectional, qualitative, review, before and after study, Delphi and RCT. CONCLUSION: This scoping review highlights the complexity of providing nursing interventions for parastomal bulging. It shows that one intervention can manage multiple symptoms and potentially several symptoms simultaneously, whereas several interventions may be needed to address a single symptom. Therefore, decisions on interventions must be based on the underlying cause of the problem. Due to the limited number of studies on the effects of nursing interventions, more rigorous research is needed in the future. RELEVANCE TO CLINICAL PRACTICE: The results can be used as an inspirational guide for clinical practice.
背景：造口旁疝或隆起是与造口相关的一种早已为人所知的并发症。约半数患者会出现造口旁隆起，多达75%的患者会出现症状。只有少数患者接受手术治疗；因此，大多数患者自行处理隆起问题，或接受造口护理护士提供的干预措施。 目的：识别并呈现有关护理干预措施以管理造口旁隆起所致症状的现有信息。 方法：本范围综述遵循乔安娜·布里格斯研究所的框架，在11个数据库以及通过造口组织进行检索。纳入了关于造口旁隆起护理管理的文献。两位作者独立筛选并选择研究，由一位作者进行数据图表绘制并由另一位作者核实。PAGER框架描述了证据状况，PRISMA-ScR清单指导了该过程。 结果：在8361篇筛选出的出版物中，纳入了44篇。八项护理干预措施描述了造口旁隆起及相关症状的管理：器具、支撑衣物、粪便冲洗与调节、绞窄、伪装与亲密关系、身体活动、支持与教育、记录保存、随访与转诊。大多数证据基于专家意见，只有三分之一的论文采用了横断面、定性、综述、前后对照研究、德尔菲法和随机对照试验等研究设计。 结论：本范围综述突出了为造口旁隆起提供护理干预措施的复杂性。它表明一种干预措施可以管理多种症状，甚至可能同时管理多种症状，而解决单一症状可能需要多种干预措施。因此，干预措施的决策必须基于问题的根本原因。由于关于护理干预措施效果的研究数量有限，未来需要更严格的研究。 与临床实践的相关性：研究结果可作为临床实践的启发指南。
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