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Stoma
An artificial permanent opening especially in the abdominal wall made in surgical procedures.
Part 2: Assessment and Management of Stomal Complications: A Framework for Clinical Decision Making
Assessment and management of stoma complications are often the responsibility of nurses across the continuum of care. These complications can occur at different times based on their etiology - immediately postoperatively or even several years after surgery - and often require modifications in a person's daily stoma management. This article presents a conceptual framework to help categorize types of stoma complications based on either etiology or location and offers management options to facilitate quality care. The five major categories of complications include Poor Siting, Stoma Proper, Peri-Intestinal Area, Mucocutaneous Junction, and Iatrogenic. Most of these suggested approaches to care are the recommendations of certified ostomy nurses based on their educational training, expert opinion, and successful experiences. Although these recommendations have often solved the specific problems and greatly improved the quality of life for the person with stomal complications, much research is still needed to confirm and/or improve these nursing approaches. KEYWORDS: stoma complications, stoma assessment, stoma management, pouching techniques, pouching modifications
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Part 1: Assessment and Management of Stomal Complications: A Framework for Clinical Decision Making
Assessment and management of stoma complications are often the responsibility of nurses across the continuum of care. These complications can occur at different times based on their etiology ? immediately postoperatively or even several years after surgery ? and often require modifications in a person?s daily stoma management. This article presents a conceptual framework to help categorize types of stoma complications based on either etiology or location and offers management options to facilitate quality care. The five major categories of complications include Poor Siting, Stoma Proper, Peri-Intestinal Area, Mucocutaneous Junction, and Iatrogenic. Most of these suggested approaches to care are the recommendations of certified ostomy nurses based on their educational training, expert opinion, and successful experiences. Although these recommendations have often solved the specific problems and greatly improved the quality of life for the person with stomal complications, much research is still needed to confirm and/or improve these nursing approaches. KEYWORDS: stoma complications, stoma assessment, stoma management, pouching techniques, pouching modifications
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Quality of Life in Patients with Stomas: The Montreux Study
Ostomy surgery profoundly affects a person's life. To determine the extent of the effect, the Stoma Care Quality of Life Index instrument was developed from a quality-of-life index. After ascertaining its validity and reliability, the instrument was used to measure patient quality of life in a European-wide study (16 countries). Six hundred, eighteen (618) stoma care nurses recruited 4,739 patients following stoma surgery. The self-administered questionnaire was completed immediately following surgery and after 3,6, 9, and 12 months. The mean age of patients was 61.6 years (+/- 13.4 years), 53.7% were men, and the majority (66.5%) had a colostomy. Stoma Care Quality of Life Index scores were fairly consistent in all patients throughout Europe immediately following surgery. While scores improved steadily over time, only the difference between the postoperative and 3-month scores was significant (P < 0.001). Stoma Care Quality of Life Index scores were significantly higher in patients who were satisfied with the care received than in those who were not satisfied. Similarly, patients who had a good relationship with the stoma care nurse and felt confident about changing the appliance had significantly higher Stoma Care Quality of Life Index scores than those who did not have a good relationship or feel confident. The results of this study suggest that stoma patient quality of life can be assessed, that it changes over time, and that patient access to specialist ostomy care nurses is particularly important during the first 3 to 6 months following surgery.
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Preparing the Patient for Colostomy Care: A Lesson Well Learned
Measuring the Stoma and Applying the Correct Wafer Size To prevent skin problems and stool leakage from the pouch system, the wafer must fit properly onto the peristomal skin. The cut-to-fit wafer needs to be cut to the correct size before use. Another wafer option is the convex style.
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Correlating the Fecal Incontinence Quality-of-Life Score and the SF-36 to a Proposed Ostomy Function Index in Patients with a Stoma
Quality of life is affected by the creation of a stoma. To assess the validity of the Ostomy Function Index in patients with a stoma, a prospective survey was conducted from July 2000 to September 2001 among patients participating in local United Ostomy Association chapters (N = 99; 55 with a colostomy and 44 with an ileostomy). The Short Form 36 general health survey, Fecal Incontinence Quality of Life Scale, and the proposed Cleveland Clinic Florida Ostomy Function Index were used to assess general health and stoma function in patients with an ostomy. The average proposed function index score (7 = excellent function, 35 = poor function) was 11.97 (range 7 to 22). The proposed function Index correlated with the Fecal Incontinence Quality of Life Scale and the physical and mental component scales of the SF-36 (P <0.05). The correlation between the proposed function index and the Fecal Incontinence Quality of Life Scale was stronger in colostomy than in ileostomy patients. With the exception of the SF-36 role-emotional domain in ileostomy patients, the function index correlated with all SF-36 scales (P <0.05) in both patient groups. The results of this study suggest that ostomy function is variable and correlates with quality of life and that the Fecal Incontinence Quality of Life Scale offers a limited assessment of quality of life in colostomy patients. The Cleveland Clinic Florida Ostomy Function Index offers an objective assessment of ostomy function that reflects on quality of life. Additional studies to refine measurement of quality of life in stoma patients are warranted. KEYWORDS: fecal incontinence, ileostomy, colostomy; quality of life, ostomy
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Peristomal Skin Complications: Prevention and Management
Peristomal skin complications are the most common reason ostomy patients visit an outpatient wound, ostomy, and continence nursing service. Prevention and management of peristomal skin complications are critical components of ostomy care. Identifying risk factors for the occurrence of peristomal skin complications according to types of injury and clinical features can help optimize assessment and management approaches. Treatment can further be addressed based on etiology - chemical injury (irritant contact dermatitis, pseudoverrucous lesions, and encrustations); mechanical injury (pressure/shear, stripping, mucocutaneous separation, mucosal transplantation); infection (Candidiasis, folliculitis); immunologic disorders (allergic contact dermatitis); and disease-related lesions (varices, pyoderma gangrenosum, malignancy). The importance of prevention and the impact of having access to knowledgeable care providers cannot be over-emphasized. KEYWORDS: skin care, ostomy, contact dermatitis, pyoderma gangrenosum, candidiasis, peristomal skin
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Quality of Care after Ostomy Surgery: A Perspective Study of Patients
Ostomy surgery affects life on a variety of levels. Clinicians need to facilitate the patient?s adaptation to life with a stoma and provide information and support to ease the transition. To prospectively assess ostomy patients? perceptions of the quality of care received as well as the importance they ascribe to care conditions, 49 patients from nine Swedish hospitals completed a postoperative ?Quality of Care from the Patient?s Perspective? questionnaire modified to include stoma care variables. The questionnaire consists of 49 items covering 17 quality dimensions factors that address medical-technical competence, physical-technical conditions, identity-oriented approach, and socio-cultural atmosphere. The modified version contains an additional 13 ostomy-specific items that have demonstrated face validity. Responses to questions were provided using 4-point scales to assess perceived reality and subjective importance. ?Medical treatment? received the highest score on the perceived reality scale; ?interest in view-of-life,? ?care-room characteristics,? and ?participation? received the lowest scores. On the ostomy-specific section, patients were satisfied with most aspects of care received; ?where to get advice and support concerning the ostomy? received the highest score. ?Talking about sexuality with the ET nurse? received the lowest score on both perceived reality and subjective importance scales. Although the majority of patients regarded most aspects of care as important and were highly satisfied with the care they received before and following their ostomy surgeries, periodic follow-up will most likely enhance satisfaction and long-term follow-up results may differ from those obtained shortly after surgery . KEYWORDS: ostomy, quality of care, care conditions, patient perceptions Ostomy/Wound Management 2005;51(8):40?48
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The Position on Preoperative Stoma Site Positioning
What is in the literature, however, substantiates what we have long recognized in clinical practice: The procedure positively influences clinical and financial outcomes for patients with stomas. - Reviewed by Catherine R. Ratliff, PhD, RN, CWOCN, CS Follick et al1 examined the range of postoperative adjustment difficulties in a survey of 131 ostomy patients. Where ...
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Prescription for Excellence: An Ostomy Clinic
Individuals scheduled for ostomy surgery and those with a new or established stoma benefit from the services of a Certified Ostomy Care Nurse or Certified Wound Ostomy Continence Nurse provided in an ostomy clinic. The clinic can provide pre- and postoperative services as well as long-term holistic care. Developing a clinic requires an organized and well thought-out plan that identifies unmet patient needs to justify the importance of this ambulatory service to facility administrators. The plan should include configuring and preparing the area where care will be provided, advertising the services offered, and determining hours, staff, policies, and procedures with particular attention paid to facility and regulatory specifications. After establishing a clinic in a large, urban, acute care hospital, patient visits averaged 33 per month and the scheduled 6 hours per week of clinic time needed to be expanded to meet the needs of those requesting appointments. Once established, patient outcomes and provider satisfaction should be recorded. Certified Ostomy Care Nurses and Certified Wound Ostomy Continence Nurses have a responsibility to inform their patients about the ostomy clinic option when it is available and clinic clinicians should continue to share the results of their efforts to proliferate the ostomy clinic concept. KEYWORDS: ostomy clinic, stoma clinic, education, marketing, ambulatory care Ostomy/Wound Management 2005;51(9):32?38
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Student Author Award Submission? Self-Esteem Disturbance in Patients with Urinary Diversions: Assessing the Void
Self-esteem can be affected by any change in health, appearance, or emotional status ? change that can affect quality of life. A decrease in self-esteem is especially evident in people with urinary diversions. A review of the literature, conducted to demonstrate self-esteem problems related to this population, revealed that body image and sexuality changes related to urinary diversions are frequently discussed in the current literature but studies that focus directly on self-esteem in the urinary diversion population have not been published. However, self-esteem may be compromised in people with urinary diversions more frequently than the literature reflects. Patients with urinary diversions, whether continent or incontinent, may be at risk for self-esteem problems. Future research and exploration are needed to expand knowledge of self-esteem with regard to urinary diversions in order to further understand the issue. KEYWORDS: incontinent urinary diversion, continent urinary diversion, body image, self-concept, self-esteem
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