It is important for stoma holders (ostomates) to live a normal life with minimal handicap, and stoma care requires lifelong follow-up. Mie Iigatani (pictured), Deputy Chief of the Nursing Department (certified nurse for skin and excretion care) who is consulting with ostomates at the outpatient department of stoma care at Yuai Memorial Hospital (Koga City, Ibaraki Prefecture) I asked about issues such as issues for improving QOL. Also, at the end of the sentence, I summarized the role of dealers, which are familiar to ostomates.
The number of ostomates is said to be 200,000, but it is said that there are many patients who do not receive proper stoma care and suffer from stool leaks and associated skin disorders and odors. To avoid such troubles and live with peace of mind, Yuai Memorial Hospital has been holding a stoma outpatient clinic every Tuesday afternoon for 20 years. It targets gastrointestinal and urinary ostomates, but most are said to have undergone gastrointestinal stoma construction at the hospital. In the outpatient department, Mr. Iigatani, who has a qualification as a certified skin and excretion care nurse (WOCN), takes about an hour to consult with each patient about equipment replacement, skin care, and problems in daily life. According to.
On the day of the outpatient, the patient should bring the orthotic device and replace it, and check the trouble situation including observation of the skin area around the stoma.
Most of the consultations are about problems related to daily care such as peeling of equipment, leakage of excrement, and sores on the skin around the stoma.
As a recent trend, Mr. Iigatani points out that "with the aging of the population, the number of patients who have great anxiety about stoma management is increasing." For example, as the elderly age and the strength of the fingertips weakens, it may not be possible to fit the two-piece orthotic device (two-item system) in which the face plate and the stoma bag are separated. In such a case, it is said that it will consider changing to an adhesive type that sticks with a tape instead of pressing with a finger. Elderly people using old orthotic devices do not seem to be informed of new information. In some cases, it becomes difficult for patients to manage themselves due to old age or dementia, and family members are asked to help. Especially when living alone or both husband and wife are elderly, it is difficult to assist them, and "we provide information and intervene so that we can utilize home-visit nursing care," says Mr. Iigatani. It is expected that the number of ostomates who receive care at home will increase in the future, and it is required to improve the quality of stoma care at home. To that end, it is essential to strengthen cooperation with local care workers and care managers.
Mr. Iigatani said, "If an elderly person has a medical examination due to a problem with the orthotic device, we will consider continuing with the orthotic device that he or she is accustomed to. I feel that the patient has a strong intention to do so. I try to add one ingenuity as simply as possible. "
The cause of skin trouble is the adhesion of excrement to the face plate and the excrement sneaking into the gap between the face plate and the skin. It will happen. In such a case, advice such as cutting the smart hole of the face plate according to the stoma size is given.
Changes in body shape with weight gain and loss and aging cause changes in abdominal pressure and skin tension. As a result, the shape of the stoma may change, wrinkles and dents may occur, and there are many consultations that the equipment does not fit. In such cases, consider including a review of the equipment. For permanent stoma patients, each municipality can receive benefits based on the social security system as a daily living tool. It depends on the municipality, but in Koga City it is about 8,000 yen a month. Improvements in orthotic devices have progressed, and recently skin-friendly orthotic devices have been developed.
The Japan Ostomy Association, a public interest incorporated association, is engaged in activities to support ostomates, and is working to enhance the welfare system, such as the benefit system for ostomy equipment and the spread of ostomate-compatible toilets. The location of ostomate-compatible toilets can also be searched on the website. The association's website has useful information for patients, so Mr. Iigatani says, "I want you to make good use of it."
In addition to WOCN, ostomate fittings are often consulted with dealers, and it can be said that ostomates are familiar with them. In the case of Kyowa Medical Corporation, Ltd. (Shizuoka City, Shizuoka Prefecture), the content of consultations from ostomates covers a wide range of issues, such as how to replace the brace, troubles in everyday life, etc., and it is said that they try to find solutions through conversations with patients. . In addition, in Shizuoka City, where I live, there is a payment system for ostomy products (once every five years, maximum amount of 50,000 yen) as an earthquake disaster prevention tool in addition to the daily life equipment payment system. providing.
On the other hand, Kuribara Medical Instruments Co.,Ltd. (Ota City, Gunma Prefecture) offers free home visits by its staff in order to deal with problems with appliances that occur at home after stoma construction. It is said that they also provide support for procedures such as how to use the braces and the daily life equipment benefit system, and introduce patients' associations. For skin problems, we recommend seeing a stoma outpatient clinic. Subsequent consultations are handled by the company's dedicated ostomy toll-free number, which is handled by call desk personnel. It receives about 300 calls a day.
Both companies visit medical institutions on a regular basis and strive to share patient information with WOCN, playing a part in supporting ostomates.
Ostomy system
Example of ostomate toilet
The National Art Center, Tokyo's ostomate-friendly toilet
source: From the Ministry of Internal Affairs and Communications news material
Equipment mark for ostomate
source: An example of a mark related to people with disabilities (Cabinet Office)
Coverage cooperation
Mr. Yoshimi Sagami, Director of Benessere Shizuoka, Kyowa Medical Kyowa Medical Corporation
■ Ms. Yuko Iwasaki, General Manager, Home Medical Support Sales Department, Kurihara Medical Kuribara Medical Instruments Co.,Ltd. Healthcare Business Headquarters
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