Congress Abstracts 2003

65

HOME HEALTH VERSUS TELENURSING OUTPATIENT MANAGEMENT OF ONCOLOGY PATIENTS WITH NEW OSTOMIES. Susan Bohnenkamp, RN, MS, CCM, and Pat Mc Donald, RN, MS, NP, CWOCN, CS, University Medical Center, Tucson, AZ; Elizabeth Krupinski, PhD, University of Arizona, Tucson, AZ; and Ana Maria Lopez, MD, Arizona Cancer Center, Tucson, AZ.

Introduction: Patients with new ostomies due to a cancer diagnosis have recognized special needs: 1) The patient must not only adjust to the cancer diagnosis, but also to the ostomy. 2) New psychomotor skills must be learned, coupled with the underlying concern of acceptance by the patient, their family, and society. Patient education outcomes include not only the ability to perform self-care, but also the ability to return to previous activities performed prior to surgery. 3) The follow-up and education may require patients to travel long distances to see enterostomal therapy nurses or clinical nurse specialists. Nurses who specialize in ostomy care and cancer are extremely important to the continuum of care for ostomy patients and their families.

Purpose: The purpose of this study was to measure the impact of telenursing technology on patients discharged with an ostomy related to a cancer diagnosis.

Method: Impact was measured by examining costs, patient satisfaction, adjustment to ostomy, and time to achieve ostomy self care. A quasi-experimental design was used to place 28 oncology patients into one of two groups: (1) traditional home health. (2) The traditional/telenursing combination incorporated home health nursing visits with telenursing technology, allowing an ostomy nurse expert to continue ostomy education with the patient and family. Fourteen subjects were assigned to each group. Data was collected on the number of home health visits or telenursing contacts, dates when ostomy self-care needs were met, supplies used, and distance traveled. Each patient had a 6-week follow-up satisfaction survey regarding each type of visit. At three months, the patients were asked to complete J. Maklebust’s ostomy-adjustment scale. (3) Data were analyzed using correlation, descriptive, and inferential techniques.

Results: Patients indicated a higher satisfaction with the use of telenursing technology. There was one more home health visit for the home health group per patient. An average of three telenursing visits were done on the telenursing group. Cost for the nursing visits for both groups were about equal. The home health group used an average of four more pouches per patient, with an increased cost of $52.00 per patient. The telenursing group agreed more often (100% versus 89%) that the nurse seemed to understand the patients’ problem and the patient was comfortable with what the nurse told them about their ostomy.

Conclusion: The results indicate that home health/telenursing is a viable option to support patients discharged from the hospital with new ostomies related to a cancer diagnosis.