Julia Williams

Using a risk assessment tool for parastomal hernia prevention

All patients with a stoma are at risk of developing some degree of parastomal herniation given enough follow-up time. Based on current evidence, preventive measures are strongly advised to minimise the incidence of a parastomal hernia forming. This article explores the evidence for consistency in care and management of parastomal hernia, focusing on the development of a risk assessment tool, taking into consideration the patients and the nurses perspective.

Celebrating advancing practice

Julia Williams, Senior Lecturer-Adult Nursing, Postgraduate Diploma Programme Lead, Buckinghamshire New University, julia.williams@bucks.ac.uk.

Does education for specialist practice need refining

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The Kock pouch reconsidered: an alternative surgical technique.

The psychological impact stoma surgery can have on an individual is well documented within the literature (White and Hunt, 1997; Borwell, 2009; Williams, 2005; Brown, 2005). For many years, surgeons have explored and developed innovations in surgical techniques, in particular restorative procedures with a view of preventing permanent stoma formation; ileal anal pouch (IAP) now being the surgical procedure of choice for treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, high morbidity rates are associated with pouch longevity (Castillo et al 2005; Nessar and Wu, 2012) and once removed can lead to a high-output ileostomy with risks of electrolyte imbalance and malabsorption. This then creates the dilemma of whether the Kock pouch (KP) should be offered as a surgical option. This article offers a historical perspective of the KP and its place in the surgical management of UC and FAP. This article also presents results from a recent audit funded by the Ileostomy Association (IA), highlighting how patients manage their KP and the importance of maintaining bowel control and being free of an incontinent stoma as a means of coming to terms with their condition.

Ongoing clinical audit: proactive, not reactive

Printed in Great Britain by Pensord Press Limited, Blackwood, Gwent NP2 2YA Ongoing clinical audit: proactive, not reactive Welcome to the first 2012 edition of the BJN stoma care supplement. We are delighted to bring this biannual supplement to you as a result of the collaboration between the BJN and the World Council of Enterotherapists (WCET). We are extremely grateful to the BJN for recognizing the significance of stoma care nursing as a specialist practice, and appreciate the timely publication of the October supplement to correspond with the yearly National WCET conference. And, there’s more...the BJN have kindly agreed to provide every WCET UK member with a free BJN stoma care supplement. We are sure you would agree that this is of huge benefit to us, as we continually recognize the need to disseminate and share information, and the importance of challenging and enhancing our field of evidence. This year is an exciting one for WCET, as the specialist forum of stoma care nurses are relaunching the organization to promote the speciality, and improve the quality of professional life to the members as well as continuing to contribute to the needs and education within Third World countries. In conjunction with the relaunch, the sharing of new and innovative ideas is a key element that identifies nurses as effective leaders and experts in their field. New ideas in clinical practice offer opportunities to improve the patient experience; however, how can we constantly ascertain new and innovative ideas ensuring best practice is upheld? One way to do this is through the process of audit. Essentially, the audit process is all about checking whether best practice is being followed and whether improvements are being made. Time and time again we hear the term best practice, but at what point can we determine what we are doing is best practice? The answer to this is with some difficulty, as ongoing research and development ultimately changes our immediate practice. Therefore, it is essential that audit becomes part of our daily practice as stoma care nurses. A good audit will identify or confirm predicaments within practice, and findings should lead to improved patient care. Clinical audit should be seen as a cyclical process that is ongoing. Many nurses become tired of this seemingly foreverending cycle, as it can be a slow process with little immediate change; ‘another box ticked’, we hear you say. Those involved can be reassured that change takes time, and that audit can only be for the good of ensuring quality patient care. Many nurses feel that audits just add to an already heavy workload, and therefore are often seen as a low priority; however, in the current climate, we need to be seen as proactive rather than reactive if changes are to be made. So, is it not better that we are a part of this changing process? WCET UK is about to embark on an audit entitled ‘Demonstrating the Value of Stoma Care Nurses’. With many stoma care nurse specialist posts currently under scrutiny, now is an ideal time for progression. It is hoped that this audit will reflect the true value of the stoma care nurse, and will be available to all WCET UK members as a means of supporting their role in practice. The information generated will focus on preventing prolonged hospital stay, preventing readmission, reducing the workload of our colleagues, and ensuring the provision of nurse-led services. We hope that you will also see the value of this audit, and become actively involved in the review of our specialist service. To end this editorial, we would like to introduce you to the five members of the sub-committee who have come together to work towards this supplement. Alison Crawshaw is Chair of the WCET, and is also a Stoma Care Nurse Specialist for Lothian NHS, Julia Williams is a Senior Lecturer in Gastrointestinal Nursing at the Burdett Institute of Gastrointestinal Nursing (Bucks New University and St Mark’s Hospital), Julie Barwell is the Clinical Nurse Specialist in Stoma Care for Hollister Ltd, with hospital and community caseloads, Alison McDonald is a Stoma Care Clinical Nurse Specialist at Ayr Hospital in Scotland, covering both surgical and urology patients, and Marion Haskin is a Clinical Educator/Practice Development Coordinator at Northumbria University. And, finally, the consultant editor of this supplement is Wendy Osborne, Charter Healthcare Nurse Manager, Ostomy Care, for Coloplast Ltd, who has over 20 years of stoma nursing experience. BJN

Keep calm and carry on

Markets experienced their third “mini-surge” in volatility this year as tensions ratcheted up between the United States and North Korea. Our standard playbook for geopolitical risk analysis leans on market history. As shown in the exhibit below, geopolitical events tend to have a shortlived impact on the financial markets. Whether you consider Iraq’s invasion of Iran in 1980, the Bay of Pigs crisis in 1961 or even the Asian currency crisis of 1997, bull markets tend to recover from crises relatively quickly. So how could the playbook be wrong this time? Because the severity of the risk (North Korea acquiring a nuclear missile) is substantial and the diplomatic path is unclear. Our current view is that it will take a relatively extreme outcome (such as a trade war with China or actual military engagement) to justify a change in tactical asset allocation policy. However, we will continue to recalibrate this view as developments take shape. We don’t expect the current level of ambiguity to last more than 12 months.