Patient-Centred Concerns: Enterostomal therapy
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Take a careful history and assess each patient’s risk factors for skin barrier disruption. | Level of Evidence Not Assessed |
| Address Patient-Centered Concerns | ||
|---|---|---|
| 2 | Provide appropriate preoperative education about the surgery and life changes involved in life with an ostomy for the patient and, if appropriate, for the family. | Level of Evidence Not Assessed |
| 3 | Schedule routine follow-up visits to assess stoma and self-care techniques and to determine what additional support would be helpful. | Level of Evidence Not Assessed |
| 4 | Provide the new ostomate with resources and support to facilitate adjustment. | Level of Evidence Not Assessed |
| Provide Local Care | ||
|---|---|---|
| 5 | Develop and implement an individualized plan to restore, maintain and/or prevent barrier impairment. | Level of Evidence Not Assessed |
| 6 | Ensure use of gentle cleansers and routine skin miniaturization | Level of Evidence Not Assessed |
| 7 | Implement appropriate management of stoma drainage and draining fistulas with assistance from specialized clinicians. | Level of Evidence Not Assessed |
| 8 | Provide postoperative education and training in self-management for new ostomates. | Level of Evidence Not Assessed |
| 9 | Prevent delayed wound healing, infection, and wound enlargement by maintaining wound moisture and bacterial balance and protecting periwound skin. | Level of Evidence Not Assessed |
| 10 | Reassess skin barrier function regularly and modify the clinical approach as necessary. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 11 | Facilitate healthcare professionals to gain relevant knowledge and skills to offer appropriate advice and information. | Level of Evidence Not Assessed |
Background
Living with an ostomy can have a significant effect on quality of life. The support and understanding of healthcare professionals, family and friends can increase adjustment and improve the quality of life for ostomates. Appropriate preoperative education can provide insight into the implications for everyday life of a stoma and help prepare the patient for the challenges of adjusting to this life change. Patient-centred concerns generally fall into the following categories:• Concerns about surgery: Pre- and postoperatively, attitudes can range from regarding the surgery as a solution to a serious problem to seeing it as a devastating event.
• Psychological issues: The permanent and significant changes to bodily appearance and function as a result of stoma surgery can provoke feelings of loss and grief. Body image and self esteem may suffer.
• Concerns about ostomy care and skin care: These concerns can be addressed by reassuring the new ostomate that appropriate education will be provided and that he/she will develop the ability and confidence to manage self-care. Involving the patient in ostomy care as soon as possible helps the individual regain a feeling of control. Adjustment to life with an ostomy is improved by helpful preoperative education.
• Dealing with complications: Experiencing complications makes the process of adapting to life with a stoma more complex. Postoperatively, further education and practice in techniques with the assistance of a healthcare professional with expertise in managing a stoma can build patient confidence in their ability to manage the stoma.
• Managing stoma output: Stoma bags with gas filters may be important for ostomates who travel by air, as cabin pressure changes may significantly increase the passage of flatus. Medications may sometimes be necessary to modify bowel transit time. Ileostomy patients usually need to increase their water and salt intake to compensate for lack of absorption in the large bowel. Dietary changes and restrictions can help in managing stool consistency and reduce flatus, loose stools and odour. It is however, important for ostomates to eat a varied diet and to develop confidence about eating with friends and in restaurants as part of rehabilitation.
• Relationship concerns: Ostomates may be unsure of who to tell and how much to reveal. Participating in a support group can provide answers from others who have experienced and worked through the same dilemmas.
• Workplace issues: These issues include uncertainty about coping in the workplace and interacting with co-workers. Employability and insurability may also be concerns.
• Sexuality: Sexual partners of new ostomates may have anxieties about their partner, due to a lack of information. An open discussion with the partner is important to the couple’s adjustsment. For single people, it may often be difficult to know when to tell a potential sexual partner about the ostomy.
References
| Essential Publications |
|---|
| 1 | Enterostomal therapy nurses |
Quality Indicator
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Type: Retrospective Analysis |
| Harris C, Shannon R. An innovative enterostomal therapy nurse model of community wound care delivery: A retrospective cost-effectiveness analysis. JWOCN 2008;35(2):169-183. | |||
| The cost-effectiveness of enterostomal (ET) nurses in the treatment of both acute and chronic wounds in a community setting is analyzed in this retrospective study. The researchers found that ET nurses were associated with reduced costs. This was mainly due to faster wound healing times. The expertise of the ET nurses and their nursing care model was credited with reducing healing times. The researchers conclude that the involvement of ET nurses either directly or indirectly through the use of their nursing care model should lead to reduced costs and healing times. | |||