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While many stomas do not develop any problems, up to 55% of them do. Stoma accessories are often used to either prevent stoma problems or resolve them, but there is a potentially baffling array of products available. This article provides an overview of the accessories currently available, to assist the community nurse in the care of patients with stomas.
There are a reported 100,000 people in the UK with a stoma (McCahon, 1999), and it is thought that about 20% of them will have experienced clinically significant psychological problems following their stoma-forming surgery. This article examines some of the most common problems encountered, and offers suggestions for nurses in the community in their management.
This article discusses the function of the gastrointestinal system in relation to diet and fluid absorption and how this will alter after the formation of a stoma. The different types of stoma are discussed to enable the community nurse to understand how this may lead to changes in dietary requirements for the ostomate (a person with a stoma). The function of the nutrients in the diet is discussed and how the ostomate can best obtain these into their diet.
Sexual function: Understand the degree of excision that has taken place. Make sure that the patient fully understands the outcome of surgery. Be confident with your own sexuality. Be prepared to refer the patient if you cannot help. Do not wait for the patient to tell you about their sexual activity-they will not. Know what type of contraception would be best for the patient. Understand the possible problems of the homosexual patient after surgery. Ethnic minorities: Know where the patient comes from and which religion they follow. Understand how major religious fasts or feasts may affect the patient. Appreciate the patient's need for prayer at set times, which may be disruptive to ward routine. Understand dietary considerations. Be aware that translation may be needed and, if so, make sure that translator is acceptable to the patient. Find out about the patient's ethnic, cultural and religious background.
A collaborative strategy between a college of nursing and a specialist nursing service was devised using outcomes driven by the ENB Higher Award. The successful implementation of this strategy has shown that the expectations of increased clinical-based innovation, resulting from this new approach to practitioner development, are achievable.
Much is written about the scope of nurses' professional practice. This article examines the ways in which clinical nurse specialists in stoma care may strive to extend their practice without losing sight of their ideals.
This article explores issues of particular relevance to nurses involved in stoma care, including formal additional education and preparation, and continuing professional development for those already in practice.
Problems of living with an altered body image following stoma surgery have long been recognised, but the specific needs of homosexual patients undergoing such surgery have been largely disregarded. This article examines the ways in which nurses can support their homosexual stoma clients.
Skin often becomes vulnerable in incontinent patients or following the use of aggressive adhesive tapes and dressings. Until recently the only products available for use on such skin have been ointments, creams and alcohol-based products. 3M Health Care has launched a range of no sting barrier film applicators that provide skin protection in many scenarios, but in a product that does not sting or cause pain on application.
Teaching patients practical skills in stoma care is a complex process and although, arguably, at the very heart of stoma care nursing practice, has been largely ignored in the literature. Teaching principles are based upon social learning theory and educationalists provide guidelines on the most effective way to teach a practical skill. These guidelines have been utilized by nurses when teaching patients with newly formed stomas how to change a pouch. The process of adapting to a stoma and its daily management takes time. Psychologically, however, some patients will adapt more easily than others and researchers have attempted to identify factors which may account for this. Studies have demonstrated that patients who are satisfied with the amount of preoperative information they receive are less likely to develop psychological problems. Psychological adjustment may be affected if patients feel that they have developed insufficient pouch changing skills or have problems with leakage from their pouch or sore skin around their stoma. Studies have also demonstrated that cognitive factors, such as patients feeling in control of their illness and stoma, have been found to play a role in psychological adaptation. Clinical nurse specialists in stoma care are in an ideal position to target these cognitive factors using a variety of strategies including effective practical teaching to empower patients, thus facilitating psychological adaptation following stoma surgery.
The inclusion of children with medical issues, such as stomas, in schools has caused much disruption and anxiety in the past. Many of the problems have been the result of misconceptions and lack of understanding of the issues involved, along with an often irrational fear of 'bodily fluids'. By developing closer links with the education department and opening up clear lines of communication it has been possible to raise awareness and reassure school staff regarding related issues. This article discusses the inclusion of a child with ulcerative colitis, following stoma formation, into mainstream school, and demonstrates how appropriate staff training and the development of a structured individual care plan enabled inclusion to proceed smoothly.
Stoma care nurse specialists are valued for their diverse expertise, but it is essential that all practitioners who regularly care for people with stomas have the opportunity to develop professionally and influence this important area of practice. The vision of a clinical and educational team from Suffolk and south Norfolk led to the development of innovative web-based learning material. The aim is to inspire nurses to engage actively with people who have a stoma. 'Professional care of the person with a stoma' is about caring for the whole person, physically and emotionally, from the period before surgery, to their continuing care in the community. An overview of four aspects of stoma care is presented here as a way of sharing with a wider audience the expert practice harnessed during the development of this web-based module.
Patients undergoing stoma formation have to make major physical and psychological adjustments following surgery. Research indicates that the early promotion of stoma-management skills is, therefore, a critical concern for the hospital-based stoma care nurse. This article aims to explore how the stoma care nurse specialist can best utilize teaching opportunities in the pre- and post-operative periods. Teaching should be approached in an organized manner, underpinned by sound principles of teaching and learning using teaching plans where appropriate to ensure that no vital aspects are omitted. Realistic learning outcomes should be established in consultation with the patient according to his/her readiness and ability to learn. An organized exchange of information between hospital and community will ensure that teaching and support are continued following discharge from hospital promoting positive adjustment to stoma formation and thus facilitating successful rehabilitation.
The aim of this article was to investigate the frequency, severity and diversity of peristomal skin disorders among individuals with a permanent stoma in a community population. All individuals with a permanent stoma (n=630) in a Danish community population were invited to participate in a cross-sectional study. A total of 202 individuals (101 men; 101 women) agreed to participate. Data were collected through questionnaires and clinical examinations. It was found that peristomal skin disorders were higher for participants with an ileostomy (57%) and urostomy (48%) than in those with a colostomy (35%). Of the diagnoses of skin disorders, 77% could be related to contact with stoma effluent. Only 38% of diagnosed participants agreed that they had a skin disorder and more than 80% did not seek professional health care. The study revealed a high frequency of peristomal skin disorders. Participants frequently failed to perceive that they had a skin irritation and did not seek help. This suggests that more education and perhaps regular, annual follow-up visits at local stoma care clinics are needed.
The aim of this research was to explore community nursing staff's understanding and perception of the role of the community stoma care nurse and make recommendations to develop a closer working relationship. Prior to this research it was assumed that community nursing staff had little understanding of the community stoma care nurse role and saw the role as one that deskilled community nurses. Findings of this research revealed that community nursing staff have a good understanding of the role and view it as a valuable resource that supports patients and nursing staff and offers an expert service. Recommendations based on this study are that, even though community staff have a good understanding of the community stoma care nurse role, both still need to improve communication so that the teams work more effectively and efficiently for the benefit of patients.
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BACKGROUND: Portal hypertension develops in 15-20% of patients with benign bile duct stricture. Hepaticojejunostomy in such patients is associated with considerable morbidity and mortality. Preliminary portosystemic shunting has been suggested to reduce intra-operative bleeding. We present our experience without preliminary shunting in such patients. PATIENTS AND METHODS: Fourteen consecutive cases of biliary stricture with portal hypertension over a 13-year period (1989-2001) were retrospectively analysed. RESULTS: Thirteen patients were operated upon. One patient had a preliminary portosystemic shunt. In another patient, shunt was attempted. One stage hepaticojejunostomy was possible in 11 patients. There were no intra-operative deaths. Nine of the 13 survived and were available for follow-up. One patient had cholangitis. Another had jaundice related both to chronic liver disease and a strictured hepaticojejunostomy. The remaining 7 patients are asymptomatic and anicteric although alkaline phosphatase levels remain elevated in 5 of them. CONCLUSIONS: Hepaticojejunostomy without preliminary portosystemic shunting is possible in patients with portal hypertension and benign biliary stricture with acceptable morbidity and mortality rates.
OBJECTIVES: The objective of this study was to explore the experience of patients who had stoma surgery to treat cancer in order to explicate why problems associated with stoma surgery are not decreasing despite technical improvements in stoma care. DESIGN: A longitudinal design was used in order to capture the process of preparing for surgery and dealing with its aftermath. Participants were interviewed using a semi-structured protocol on three occasions; 1-2 weeks before surgery (eight participants), 1-2 weeks after surgery (seven participants), and 3 months after surgery (four participants). METHOD: Transcripts were analysed guided by the procedures of grounded theory. This involved developing categories from the data and linking them together to form a conceptual understanding of our participants' experience. RESULTS: Lowered personal control was the most important concept to emerge from the analysis. We identified perceived causes of lowered control, its mitigating factors, the strategies used to manage this experience and the consequences of these processes. CONCLUSIONS: We make three recommendations based on the conclusion that improvements could be implemented in the psychological aspects of stoma care and, in particular, the enabling of patient perceived self-efficacy. First, improvements could be made in doctor-patient communication with doctors becoming more aware of their psychological impact on patients. Second, specialist stoma care nurses could be trained to recognize patients with dysfunctional self-efficacy beliefs and/or delayed psychological adaptation. Finally, we identify a need for more prolonged practical and emotional support for at least some stoma out-patients.