Improving Care for People Living With Stomas and Ostomies

Welcome to the June issue of Advances in Skin & Wound Care, which features numerous articles on ostomy and peristomal skin care that present new evidence addressing various aspects related to individuals living with a stoma/ostomy, as well as the caregivers and nurses caring for them. CHALLENGES FOR PERSONS WITH DISABILITIES LIVING WITH A STOMA The Clinical Management Extra article highlights a topic that has received limited attention in ostomy literature: the experiences of individuals with disabilities living with a stoma. It also explores how seven wound, ostomy, and continence (WOC) nurses perceive and manage patient care. Three major themes emerged from the qualitative descriptive phenomenological design involving seven persons living with a stoma: (1) change, (2) stoma education, and (3) challenges in home care. Nurses also identified three themes: (1) concern due to a lack of experience, (2) disability-appropriate training, and (3) compassionate care. Depending on the disability, having a stoma can impact an individual’s quality of life both positively and negatively. The authors recommend that nursing education programs include content addressing the unique challenges and needs of this patient population. JOB SATISFACTION AMONG WOC NURSES Research from Turkey by Aydin and colleagues found that job motivation and the perception of a pleasant work environment enhanced job satisfaction among WOC nurses. They urge institutions to establish supportive work environments and promote motivational strategies to improve WOC nurse job satisfaction. EDUCATIONAL NEEDS OF PATIENTS WITH AN OSTOMY Other articles examined the educational needs of patients with an ostomy. United States researchers Novy and Prasun collected online responses from 319 individuals about their ostomy education. Less than half (48.6%) received preoperative education, whereas slightly more (52.7%) received education post-discharge. Important topics for patients included stoma appearance (54.2%), skin irritation (51.7%), and lack of ostomy product knowledge (51.4%). More than three-quarters (77.1%) reported learning best through hands-on practice. In a separate Turkish study of 60 patients with a colostomy, Çetin and van Gıersbergen concluded that in their study of 60 persons with a colostomy, their personalized education led to higher fulfillment of patient needs in areas such as medications, life activities, society, follow-up, feelings about disease conditions, treatment complications, and quality of life (P <.05). PATIENT CONCERNS: LIVING WITH AN OSTOMY Authors from five countries contributed findings on this topic. Chinese investigators Chen and colleagues surveyed 663 patients with a stoma from 22 hospitals, revealing a positive correlation between bathing care and quality of life (r=0.434, P<.05). Singapore authors Lim and colleagues studied patients and their caregivers who underwent colorectal resections with stoma formation. Most patients (80%) were highly satisfied with stoma care, with more than 90% feeling well supported and informed and 83.8% feeling confident in managing their stoma post-discharge. Five key themes identified were 1) visual and physical limitations, 2) emotional and psychological barriers, 3) difficulty with independent care, 4) health care system/ appliances challenges, and 5) unmet learning/training needs. The authors concluded that it was essential for structured post-discharge education and patient support resources. Turkish colleagues Taylan and colleagues conducted a meta-analysis of randomized controlled trials examining nursing interventions for patients living with a stoma. They concluded that education incorporating technological tools, especially for patients with cancer, provided effective patient support. Hsu et al conducted a prospective study of 113 patients in Taiwan, finding that weight loss of >5% within 1 month after surgery was a risk factor for stoma-related complications. They recommend monitoring patient weight pre- and post-operatively. Australian authors Norman et al reported on peristomal skin site complications (PSC) in a cohort of 17 patients during the first 12 weeks after stoma formation. All patients experienced at least one PSC: 74% (n=14) had irritant dermatitis related to leaking appliances, and 53% (n=10) had bruising. Not all PSCs stem from leakage resulting in irritant dermatitis or adhesive contact dermatitis. Melnychuk et al from the United States reported a case of bullous pemphigoid (BP) initially localized around the stoma, which progressed to a generalized eruption on the trunk and extremities. The photos and literature review in this article on BP are helpful for identifying this unusual cause. NEW INTERNATIONAL OSTOMY GUIDELINES The Chinese year of the fire horse is one of collaboration. Both editors attended the Joint Congress of the World Council of Enterostomal Therapists (WCET) and Nurses Specialized in Wound, Ostomy, and Continence Care (NSWOCC) in Vancouver, Canada, where the 3rd edition of the international ostomy guideline was launched. This guideline is a collaboration between the WCET, the International Society of University Colon and Rectal Surgeons (ISUCRS), and the patient support group International Ostomy Association (IOA). These three groups evaluated the ostomy evidence base to produce the guideline. You can access a free copy of the summary of 25 recommendations and good practice statements at https://wcetn.org/ or http://internationalostomyguideline.com/.