Iran Journal of Nursing

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Khachian A, Fazeli M, Sabour H, Haghani H, Akhoondian G. Effects of Smartphone-based Nutritional Education on the Biochemical Indicators of Patients with Ileostomy. IJN 2019; 32 (118) :78-92
URL: http://ijn.iums.ac.ir/article-1-2912-en.html

Background & Aims: Ileostomy is a surgically made opening that connects the ileum to the abdominal wall after gastrointestinal surgeries to help the improvement and eliminate inflammations in the part of the intestine that has undergone an anastomosis. The type of diet and eating habits change following losing the normal defecation path after ostomy surgery of the bowel. The stool should start draining from the stoma about 72 hours after surgery. Early high output from an ileostomy is common and attention should be paid to the input and output fluids in order to maintain a balanced electrolyte level in the patient. Given the output of liquid or semi-liquid effluent from the stoma, it is possible to detect fluid and electrolyte abnormalities, decreased absorption of fats, vitamins, calories and minerals, and malnutrition in the patient. Therefore, patients who undergo ileostomy need to learn the proper nutritional management method using novel techniques. One of the uses of smartphones is teaching proper, rational, and principled nutrition to patients. However, this type of education should be continuous and be applied for a long time. Results have shown that education via smartphones can improve education to patients, prevention of diseases, and decrease medical costs. In addition, apps installed on smartphones are a new way to present information to patients to eliminate barriers to learning and increase participation in health education courses. Different types of social media (e.g., private and smartphones) are common in the fact that they are audience-centered, are always available to the person, and their content is produced by people, which can play an important role in transferring knowledge and information to the person. This study aimed to determine the effect of smartphone-based nutrition training on biochemical indicators of patients undergoing ileostomy.
Materials & Methods: This quasi-experimental clinical trial was performed with a control group on 72 patients aged 18-60 years undergoing ileostomy in 2018. Sampling was carried out continuously for five months due to the fact that the research was limited to one center and there was a limited number of clients. The participants were divided into two control and test groups by the non-random allocation method. It is notable that the first 36 people were assigned to the control group and the rest were assigned to the test group to prevent information leakage. Both groups received routine nutrition education provided by the personnel of the ward following undergoing ileostomy. In addition to this training, the subjects in the test group received education by the researcher using smartphones on the third and fifth days before discharge. First, the app was installed and used in the education sessions. This was an android app written with Java programming language and 2.1.4 android, provided to patients offline, and included four main parts; “what is an ileostomy?”, “what to eat? What not to eat?”, “body mass index (BMI)?”, and “fluid balance”. Data were collected using demographic characteristics and biochemical indexes (white blood cells, total lymphocyte count, hemoglobin, albumin, transferrin, C-reactive protein, and serum total protein) questionnaire. In addition, the biochemical indexes were assessed in two stages; one day before ileostomy in the hospital and three weeks after the surgery on the day of visit to the clinic by bloodletting from peripheral blood vessels of patients. In total, three ccs of blood were collected from each patient, 0.5 ccs of which was poured into a test tube containing K3 ethylenediaminetetraacetic acid (EDTA) anticoagulant to check the complete blood count (CBC) and 2.5 ccs was collected in a normal test tube with no anticoagulant to collect serum and perform blood clotting process for biochemical tests. Data analysis was performed in SPSS version 16 using descriptive (frequency distribution tables and numerical indexes) and inferential (Chi-square, Fisher’s exact test, independent t-test, and analysis of variance) statistics. In addition, a P-value of 0.05 was considered statistically significant.
Results: In total, 12 subjects were excluded from the research and 30 participants per group were assessed. The majority of the participants were male and married, had a diploma degree, no history of drug use, an acceptable economic status, living in urban areas, and in the age range of 51-60 years. In addition, more than two-thirds of the patients were diagnosed with rectum cancer and had a history of chemotherapy and radiotherapy before the surgery. There was no significant difference between the groups regarding biochemical indexes before ileostomy. Nevertheless, a significant difference was observed between the groups three weeks after the surgery only in terms of the CRP index. In this regard, the CRP index was significantly higher, compared to the test group. The changes in the indexes of the two groups demonstrated an increase in albumin and total protein indices in the test group, compared to the control group, and an increase in the CRP index of the control group.
Conclusion: While changes in the biochemical indexes of the participants were significant, they were clinically insignificant, and we could not express that using smartphones for nutrition education improved biochemical indexes in patients undergoing ileostomy. Therefore, it is recommended that training be carried out for longer periods, and patients with rectum cancer be assessed separately in the fourth week after ileostomy due to the onset of chemotherapy. In addition, it is suggested that further studies be conducted on larger populations to make the final decisions about the applicability of this type of training. By doing so, an important step would be taken toward improving the biochemical indexes of patients.