Management of stoma complications

More than 100,000 people in the UK have a stoma and most experience problems at some point. This article gives an overview of some of the more common complications and possible solutions. Treatment often involves using stoma accessories, which are products used in conjunction with stoma appliances. Nurses or patients can also contact the stoma specialist nurse in their local hospital for further help and advice.     

Stoma care accessories: an overview of a crowded market

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.     

Resuming a normal life: holistic care of the person with an ostomy

A community nurse may often encounter an ostomate (person with a stoma) but may not be regularly involved in their stoma care. This article explains the main types of stoma, stoma appliances and indications for some operations. Explanations are provided on some of the stoma appliances and accessories and when these might be useful to the community nurse and the ostomate. Stoma care is explained, including how to undertake a basic stoma appliance change. Issues that community nurses might be questioned about, such as diet and driving, are explored to assist the community nurse in providing holistic care for ostomates.     

Stoma care nursing: what the community nurse needs to know

The transition from hospital to home can be a worrying period of time for a patient with a newly formed stoma. It is well documented that community care is important, however this transition has been seen as a weak link in the care for a patient with a stoma (Allison 1996). In most cases following discharge from hospital, the nurse specialist in stoma care will visit the patient at home as a means of maintaining continuity of care. It is also important that the patient's GP, district nurse and other relevant community services are introduced to ensure a cohesive approach to the patients care at home (Taylor, 2003). This article therefore aims to offer the community nurse an overview of stoma care nursing in order to provide the continuity of care much needed by this group of patients.     

Teaching the stoma care routine to a patient with low vision

Teaching the patient with a newly formed stoma but who also has low vision to manage his/her stoma independently can be a difficult task. This case study shows how a nurse taught a patient with low vision to become independent in relation to his newly formed stoma, with a view to being discharged home successfully. At the time the stoma care nurse used her past experience and common sense in achieving this aim. After the event the stoma care nurse researched the literature and discovered that there are accessories/devices available to assist patients with low vision to manage their stoma and help improve their vision. On reflection, the stoma care nurse felt she did not have sufficient time preoperatively with the patient, which prevented her from being able to change the course of action. She has now improved her knowledge, which will assist her in the future if she has to care for another patient with low vision who has had a newly formed stoma.     

Teaching stoma-management skills: the importance of self-care

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 pre- and postoperative nursing care for patients with a stoma

This article revisits the various issues that surround the nurse caring for a patient with a stoma (colostomy, ileostomy or urostomy). Understanding the basic anatomy, reasons for stoma formation and the surgical operations, including variations such as continent stomas, can assist the nurse in caring for this patient group. The article discusses briefly the various stoma appliances that can be used by the nurse or ostomate (person with a stoma). Practical tips on pre- and postoperative nursing care of the patient with a newly formed stoma are provided for the nurse. In some cases, unfortunately, complications may occur following stoma-forming surgery; these are discussed and nursing advice provided. One of the most important ways in which the nurse can support the patient is to teach the patient his/her stoma care, ensuring independence before discharge and showing empathy and compassion.     

Peristomal skin care and the use of accessories to promote skin health

Stomas are frequently encountered by nurses. Common complications include problems with the peristomal skin-the skin around the stoma. It has been reported that up to 80% of people with a stoma, who are termed ostomates, are affected. The three main types of stomas are colostomy, ileostomy and urostomy; all these come with a risk of sore peristomal skin. These stomas pass faeces or urine, which are collected in a stoma appliance that adheres to the peristomal skin. It is essential to ensure that this skin is free from breaks or soreness as this might lead to appliance leakage. This article is aimed at ward nurses and will focus on some of the stoma accessories that are used to treat, protect or 'level' peristomal skin. Accessories, such as barrier creams or films, can be used to protect skin. Filler paste, seals and convex appliances, for example, can be used to resolve creases in the skin or to treat a retracted stoma. The situations in which stoma accessories might be useful in resolving peristomal skin problems or retaining its integrity are numerous.     

Nurse prescribing in practice: patient choice in stoma care

In the first of a new series, Janice Lee examines the choices facing nurse prescribers when selecting items for stoma management. Studies have estimated that there are up to 100,000 people with a stoma in England and Wales, and stoma care therefore forms a significant part of community nursing caseloads. The enormous range of available items means that both patient and prescriber are likely to have difficulty selecting the correct device. Patient preferences, comfort and pricing all play a part in stoma appliance selection.     

Clinical nurse specialist: a facilitator for clinical research

The role of the clinical nurse specialist is continuing to expand to include participation in clinical research. There is, however, a lack of clinical researchers available to conduct nursing research. A clinical nurse specialist with a joint appointment between a clinical and an academic setting can facilitate clinical research through collaboration. Such collaborative efforts can result in improved patient care and nursing practice. This article describes several major collaborative models used to join the academic and practice settings and discusses their strengths and weaknesses. It also describes in detail a collaborative approach in which the clinical nurse specialist play a more pivotal role by acting as a facilitator for the collaboration. We discuss the formation of the collaborative team, the roles of the participants, and the research plan of the team. Suggestions for implementing this model in other settings are offered.     

Developing adolescent services in general practice

BACKGROUND: Adolescence is recognised as a time of risk-taking behaviour, yet it is also a crucial time for laying down the foundations for future health. This literature review examines current adolescent healthcare provision in the community, particularly general practice. The role of the practice nurse in meeting adolescents' healthcare needs is also explored. CONCLUSION: Although health professionals and teenagers see general practice as an appropriate location for health promotion activity, generally it is not the first choice for health information for young people. There is no consensus on effective interventions in teenage health care, as different methods work in different areas. The stigma of adolescent healthcare provision, where young people are seen as a difficult group that requires specialist provision, should be removed. However, there should be specific healthcare provision for this age group.     

Discharge planning in rehabilitation following surgery for a stoma

Discharge planning and establishing goals for rehabilitation after stoma surgery is an ongoing process, which should be preceded by an holistic assessment, ideally carried out by a specialist practitioner with knowledge and experience in this area. The practitioner needs to have effective listening skills to ensure that both practical and psychological care are patient-centred. The patient and his/her carers must be involved in all aspects of care planning and establishing goals for rehabilitation. The specialist practitioner should adopt an evidence-based approach to care, ensuring that important aspects of care, such as the early teaching of stoma management skills, are not neglected. The specialist practitioner may not be able to meet all the patient's needs and should refer on to other specialist staff where these services are available. Such multidisciplinary input, utilizing appropriate problem-solving approaches with the involvement of patients and their carers, can only enhance the quality of care delivered and optimize the process of rehabilitation.     

The specialist palliative care nurse: a qualitative study of the patients' perspective

BACKGROUND: Relatively little is known about patients' perceptions of the work and role of the specialist palliative care nurse. Understanding the patients' perspective can help to evaluate services, improve quality of care, and identify misunderstandings. OBJECTIVES: To explore the experiences of those who said that they had a 'terminal illness', focusing on patients' perceptions of the work and role of these nurses. DESIGN: Qualitative study with narrative interviews. SETTING: England and Wales. PARTICIPANTS: Forty-one people recruited through those working in hospices, community nurses, general practitioners, support groups, a national newspaper, and a conference on palliative care. Twenty-five people talked about the work of specialist palliative care nurses. METHOD: Interviews were fully transcribed; followed by a thematic analysis with constant comparison. RESULTS: Patients valued the nurses' work, particularly their advice on practical matters, information given about their disease, emotional support, advice on symptoms, and help with communication. They were glad that help was readily available. However, some patients who had been referred to the service did not realise that specialist palliative care nurses may be involved at a relatively early stage in a person's illness, and sometimes felt distressed by an early referral. One woman felt she had not had the emotional support she needed and another knew of women who had been upset because these nurses had discussed topics such as place of death 'too early'. However, people recognised the difficulties nurses faced in their work. CONCLUSIONS: Although our study differs from other studies, particularly in the way people were recruited, our findings support previous studies that have shown that specialist palliative care nurses are highly valued by those who have a terminal illness. It is important for people to understand that these nurses may be involved from the time of diagnosis and that roles have changed.     

Nurse specialist led follow-up in lung cancer: The experience of developing and delivering a new model of care

Data from an earlier paper reporting on a study comparing conventional medical follow-up with nurse specialist follow-up of patients with lung cancer demonstrated that follow-up by nurse specialists is safe, effective and can lead to greater levels of patient satisfaction. The process and experience of developing a nurse specialist role in lung cancer follow-up care has not yet been described. The aims of this paper are to describe the preparation and development of a model of nurse led follow-up care, identify key nursing interventions provided within nurse led follow-up care and provide insights into the experiences of nurse specialists providing follow-up care. Data were collected from nurse specialists' patient case-records and from meetings held with the study team. Semi-structured interviews were conducted with the nurse specialists providing follow-up care and the study coordinators. The nature of the nursing role in lung cancer follow-up care is described. In addition, four themes relating to the process of developing a nurse led follow-up role are identified. These are: 'training', 'becoming credible', 'emotional burden' and 'making a difference'. Managing follow-up care for patients with lung cancer can be rewarding for nurse specialists. However, it can also be emotionally demanding. Training and support for such roles is vital and requires further in-depth research.     

The stratified-population-at-risk (SPAR) model for psychogeriatric nursing: a paradigm for the third millennium?

There is warning of a coming epidemic of older people with psychiatric problems. However, there are already too few specialist nurses to ensure that all older people receive care concordant with accepted professional standards. This problem is an obstacle to the World Health Organization health for all by 2000 objective. The Stratified Population at Risk (SPAR) model is a proactive paradigm for planning psychogeriatric nursing services that includes mental health promotion. The SPAR model assumes that-under certain conditions-all people are vulnerable to psychiatric problems, but differ in their level of risk. The model includes an innovative role for psychogeriatric nurse specialists.     

The basics of ostomies.

Basic ostomy care can be intimidating because nurses don't often see colostomies, ileostomies, or urostomies. While there are as many different ostomies as there are people who have them, there are some commonalities in the care of the stoma. These can be generalized to all stomas, regardless of the type of output. Some care, however, is specific to the placement of the stoma and the type of effluent flowing from the opening. This article will provide the gastroenterology nurse an overview of the basic features of ostomies as well as routine ostomy care.     

The management and care of people with stoma complications

There are a variety of complications that are associated with stomas. These are described and their causes explained. A number of solutions are presented and advice that the nurse can give is offered. Some of the complications are commonly seen by the nurse, such as sore skin, whereas others are rare, such as an allergy to the stoma appliance. There may be sexual dysfunction after surgery, which may be temporary or permanent. These and many other potential problems are elaborated upon to aid the nurse when caring for people with stomas.     

Role development of the clinical nurse specialist within the Indian Health Service

The clinical nurse specialist is employed in many health care facilities to improve patient care. One service unit of the Indian Health Service has expressed interest in the development of this role. At the present time, there are no advanced practitioners within this facility. Development, as well as implementation of the role, must be based on the cultural and health care needs of the Indian people. This paper discusses development of the role of perioperative clinical nurse specialist, based on personal experience, at a service unit providing health care to a large tribe of American Indians in the Southwestern United States. Examples of care incorporating cultural practices, are used to illustrate the practice of the perioperative specialist within the Indian Health Service. The nursing process is used to organize the development of the role.     

Lack of individualized perspective: a qualitative study of diabetes care for immigrants in Sweden

This study describes the care provided by a diabetes nurse specialist, and the care needs expressed by people with type 2 diabetes mellitus and an immigrant background. Clinical encounters between a diabetes nurse specialist and 10 people diagnosed with type 2 diabetes mellitus were observed and analyzed by means of qualitative content analysis. One theme, "the diabetes nurse specialist as the conductor of the visit", and four categories emerged from the findings, illustrating the power imbalance between the patients and the diabetes nurse specialist, as well as the lack of an individual perspective. Shifting from a medical perspective to one of openness towards the people's experiences provides a possibility for caregivers to empower patients suffering from type 2 diabetes mellitus. The medical perspective seemed to steer the visit towards curative activities. Thus, technique-centered care should be developed by including individualized care.