Stoma Care Nurses Research Articles

Raising the voice of specialist stoma care nurses: a call for a national strategy in stoma care

Specialist stoma care nurses (SSCNs) are highly educated professionals who play a critical role in the care of people living with a stoma. However, they experience some unique challenges. Currently in the UK, stoma care has no national standards, targets or best practice pathway, resulting in significant variation and an undervalued service. As members of an evidence-based profession, SSCNs need to demonstrate their value. Specialist nurses in cancer care and inflammatory bowel disease are supported by nationally, with pathways, targets and standards of care, as well as career and education frameworks. This system could be used for SSCNs. A national approach is needed to develop an evidence-based best-practice pathway, commissioned and implemented across the UK for all stoma patients and with SSCNs at its heart. SSCNs need to demonstrate their value through data and evidence. Working with Getting it Right First Time, a taskforce aims to review the evidence and establish minimum standards of care for all stoma patients. SSCNs should be co-ordinators and drivers of change at the highest level of national innovation, policy and decision-making. The work of SSCNs should be is recognised and valued because what they do matters.

Importance of stoma care nurses in preparing patients for stoma surgery and adjustment to life with a stoma

Importance of stoma care nurses in preparing patients for stoma surgery and adjustment to life with a stoma

Ostomy Care Nurses' Knowledge and Practice Related to Prevention and Management of Parastomal Hernias in Adults: A Nationwide Survey of UK Stoma Care Nurses.

The purpose of this study was to describe the knowledge and practices of ostomy care nurses related to the United Kingdom's Association of Stoma Care Nurses (ASCN) 2016 guidelines for prevention and management of parastomal hernia (PSH) in adults. Cross-sectional descriptive study. The target population was approximately 300 stoma care nurses; 120 useable responses to the survey were received, reflecting a response rate of approximately 40%. A 31-item questionnaire was developed for the purposes of this study, consisting of multiple choice and short answer questions grouped into 2 sections; demographics, and knowledge and practices. The questionnaire was distributed to members of the ASCN who work with adults via an online survey platform with the aim of reaching as many respondents as possible. The Chi-square test was used to determine relationships between the nominal demographic data and the nominal knowledge and practices data. Almost two-thirds of respondents (65%, n =78) rated their knowledge relating to prevention and management of PSH as good or excellent. Nevertheless, 79.8% (n=95) indicated they needed additional education to improve their knowledge and practice related to prevention of PSH. Those who rated their knowledge as excellent or good were significantly more likely to be aware of the guidelines compared to those who ranked their knowledge as average or poor. Study findings suggest variability in knowledge among UK stoma care nurses, along with a desire for additional education in this area of care.

The Effect of Stoma Site Marking on Stomal Complications: A Long-term Retrospective Study.

To identify the effect of stoma site marking on stoma-related complications. The study sample included 639 individuals with stomas who were followed up in a stomatherapy unit in Turkey between January 1, 2017, and June 20, 2021. Researchers collected patient data from nursing records. Data were evaluated using number, percentage, χ2, and logistic regression tests. Of the individuals with stomas, 60.6% (n = 387) were men, and 72.6% (n = 464) had a cancer diagnosis. Their mean age was 60.16 (SD, 14.81) years. The stoma site was marked preoperatively in of 67.1% of patients (n = 429), and 17.1% (n = 109) developed stoma-related complications. The complication rate was higher in individuals with unmarked stoma sites (25.7%; P = .000), emergency surgeries (25.0%; P = .006), colostomies (23.9%; P = .042), and permanent stomas (28.3%; P = .002). The three most common complications were peristomal skin problems (56.9%), mucocutaneous separation (13.8%), and edema (9.2%). The incidence of stoma-related complications in the postoperative period was higher in individuals with unmarked stoma sites. The authors recommend that stoma and wound care nurses mark the stoma site in individuals for whom stoma creation is planned.

The use of a convex light appliance and mouldable rings for patients with an ostomy and effluent leakage in the early postoperative period

Background/aims: Patients with digestive ostomies frequently experience effluent leakage in the early postoperative period, leading to complications and reduced quality of life. The convex appliance and adaptable rings in ostomy (CONAN) study investigated a new combined treatment strategy for reducing leakage and improving patient satisfaction. Methods: This prospective, multicenter study involved 244 patients with digestive ostomies and early effluent leakage across 54 stoma units in Spain. Patients were treated with the CONAN strategy, using a light convex ostomy appliance (Easiflex Confort Convex Light) and a flexible ring (Brava moldable). Stoma care nurses collected data on leak episodes per day and patient satisfaction (0–10 scale) at baseline and 2–3 weeks post-discharge. Multivariate analysis identified patient characteristics associated with greater treatment benefit. Results: Patients experienced a significant reduction in mean leak episodes per day (3.4 ± 5.2 to 1.3 ± 2.3, p<.0001). Mean patient satisfaction significantly increased post-treatment (5.1 ± 2 to 7.2 ± 1.7, p<.0001). Multivariate analysis revealed the following factors were associated with high patient satisfaction (≥ 8 over 10): shorter hospital admission, programmed surgery (vs. emergency), closed ostomy appliance (vs. open) and multi-piece appliance systems. Conclusions: The CONAN strategy, combining a light convex ostomy appliance and flexible rings, effectively reduces leakage and improves satisfaction in patients with digestive ostomies and early effluent leakage. Patients with longer hospital stays, emergency ostomy surgery, open ostomy systems and single-piece appliances may benefit most from early intervention with this strategy.

Enhancing Stoma Care Education for Junior Doctors: A Comprehensive Teaching Series.

Introduction Colorectal stomas are prevalent in surgical wards and demand careful medical attention, particularly in stoma management. Junior doctors play a vital role in this care, but their limited exposure and training may hinder their ability, impacting patient care. Given the dearth of literature, we aimed to assess junior doctors' stoma care knowledge and the efficacy of a specialized teaching course in boosting their confidence and skills. Methods The research, conducted at the West Suffolk Hospital NHS Trust in the UK, engaged 60 junior doctors, predominantly from Foundation Year 1 and Year 2, from August 2021 to December 2022. To ensure effective management and assessment, participants were divided into four groups, each comprising 15 doctors. A pivotal aspect of the study was implementing a structured stoma teaching series delivered by a panel of seasoned surgical experts. This series, conducted every Friday for three weeks, comprehensively covered all facets of stoma care. Both before and after the teaching series, assessments were administered to measure the impact of this educational intervention on the participants' understanding of stomas. The study meticulously adhered to ethical guidelines, with all participants providing informed consent, and measures were implemented to guarantee anonymity, thus safeguarding the privacy and confidentiality of all individuals involved. The primary objective of this investigation was to evaluate the efficacy of the stoma teaching series in augmenting the knowledge and comprehension of stomas among junior doctors. The findings of this study hold significant potential in guiding healthcare professionals toward developing more efficacious stoma education programs, ultimately leading to improved patient care outcomes. Results The study involved 60 junior doctors categorized into four groups from August 2021 to December 2022. It aimed to assess their understanding of colorectal stomas, focusing on complications and their knowledge about stoma appliances and care nurses. A questionnaire was used to evaluate their knowledge in these areas at the start of their surgical rotation, which showed significant knowledge gaps among participants. Of the 60 participants, 48 (80%) expressed slight or no confidence in basic stoma care, while 54 (90%) admitted unfamiliar with managing stoma complications. Astonishingly, all 60 (100%) participants lacked awareness of fundamental stoma care concepts. Significant improvements were observed following a comprehensive stoma teaching series covering basic stoma knowledge, its complications and management, and practical stoma care. Feedback from the course revealed positive outcomes, with 54 (87%) doctors feeling confident or very confident in basic stoma knowledge and 48 (80%) reporting increased familiarity with managing stoma complications. Remarkably, all 60 (100%) doctors indicated comfort with stoma care concepts after the sessions. Participants emphasized the course's value in medical education and professional development, citing enhanced practical skills such as communication and teamwork. Conclusion Our study revealed junior doctors' limited stoma knowledge, emphasizing the need for a dedicated teaching program that significantly improves their understanding.Focused stoma education is vital for junior doctors to deliver optimal patient care, necessitating hospitals to promote awareness for improved patient outcomes.

Missed nursing care and stoma care: an Italian survey.

In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date. To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses. Cross-sectional study. The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023. A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0-53.8). The most common qualification was a Bachelor's degree (n=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse-patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4). A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients.

Development of a leakage impact assessment for patients with a stoma, who may be impacted by leakage.

For people living with a stoma leakage is unpredictable. Despite advances in stoma products, leakage can lead to soiling and this, along with worrying about leakage, can significantly affect patients' everyday lives and impact their quality of life. It is also associated with excessive product use and increased healthcare resources. Leakage therefore remains a major unmet need for many people living with a stoma. To address this, Coloplast Ltd in collaboration with the authors and a broader group of stoma care nurses have worked together to develop a first version of the Leakage Impact Assessment. This assessment is intended to identify patients who struggle with leakage and leakage worry, and who might benefit from the reassurance that a new digital leakage notification system, Heylo™, can provide. This article reviews the evidence for leakage and its impact on people living with a stoma and outlines the development process for the assessment.

Exercise and physical activity after stoma surgery: EXPASS recommendations.

No formal published recommendations exist about exercise and physical activity after stoma surgery and there is no consensus on advice among health professionals. Numerous difficulties after stoma surgery cause physical activity and exercise levels to decrease. Health professionals can feel ill equipped to advise, leaving patients confused and unsupported. Formal recommendations for exercise and physical activity are to be established. An expert panel is working under the auspices of the Association of Stoma Care Nurses (ASCN) UK to review existing literature, explore clinical practice and develop formal Delphi consensus recommendations. The document will be aimed at health professionals but will also be available to individuals undergoing surgery. The formal document will be published by the end of 2024 through ASCN UK. The scope of the EXPASS recommendations will cover adults (aged ≥16 years) with any stoma. It will offer peer-reviewed Delphi guidance on physical activity and exercise before and immediately after surgery as well as for long-term living with a stoma. After peer review, the document will provide clarification, consensus and practical recommendations based on the expert panel's evidence, research and clinical opinion.

Hernia Support Garments for Parastomal Hernia Following Ostomy Procedure

What Is the Issue?
 
 Parastomal hernia is a common complication that can occur following ostomy surgery. They can have a negative impact on a person’s quality of life, affecting them both physically and psychologically. One intervention that may be used to help prevent or manage parastomal hernias are hernia support garments.
 To help inform decisions about the most appropriate use for hernia support garments, it is important to understand the current best practices as well as potential benefits and harms of using these garments.
 
 What Did We Do?
 
 We searched for clinical and cost-effectiveness literature comparing hernia support garments to alternative hernia prevention or management strategies or no intervention. We also searched for evidence-based guidelines that provide recommendations about the use of hernia support garments for the prevention or management of parastomal hernias.
 An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2013, and November 1, 2023.
 We engaged with an individual who has lived experience of an ostomy and parastomal hernia and who wears a hernia belt regularly. He shared his thoughts on the physical and psychological benefits, impact on quality of life, and challenges of using a hernia belt. This gave CADTH a more nuanced understanding of the literature.
 
 What Did We Find?
 
 We did not find any studies directly evaluating the clinical or cost-effectiveness of hernia support garments versus alternative hernia prevention or management interventions or no treatment that met the inclusion criteria for this review.
 Three evidence-based guidelines made recommendations related to using hernia support garments to prevent and manage parastomal hernia. One guideline recommends that individuals with an ostomy should be assessed to determine the type and level of support required to prevent or manage hernia. Another guideline recommends that health providers provide postoperative education on using support garments. The third guideline recommends that stoma care nurses provide lifestyle advice about support garments to individuals with a stoma. This guideline also recommends that these nurses should be available to advise on non-operative management options for parastomal hernias more generally.
 
 What Does This Mean?
 
 Decision-makers might wish to consider ways to ensure that individuals who have had or are scheduled to have an ostomy surgery have timely access to parastomal hernia risk assessment, education, and advice on the use of hernia support garments from nurses specialized in wound, ostomy, and continence care. They may also want to consider out-of-pocket costs that may be a barrier to this care.

Assessing and documenting dark skin tones in stoma care

The stoma care nurse (SCN) assesses peristomal skin during each patient intervention. Living in a diverse multicultural society, the SCN needs to consider dark skin tones and how these are documented. This article looks at how the literature on peristomal skin assessment and available tools discuss skin colour, and compare this with the tissue viability literature. Stoma care and peristomal skin literature features very little about skin colour. Registered nurses are often unaware of the differences when assessing light skin tones versus dark skin tones. The article discusses how to assess for, identify and document problems around peristomal skin with patients who have dark skin tones. The differences in skin breakdown between light skin tones and dark skin tones are highlighted. There needs to be further research and development of tools to assist clinicians in identification and documentation relating to skin tone, thus providing consistency in assessment.

EHS Rapid Guideline: Evidence-Informed European Recommendations on Parastomal Hernia Prevention-With ESCP and EAES Participation.

Background: Growing evidence on the use of mesh as a prophylactic measure to prevent parastomal hernia and advances in guideline development methods prompted an update of a previous guideline on parastomal hernia prevention. Objective: To develop evidence-based, trustworthy recommendations, informed by an interdisciplinary panel of stakeholders. Methods: We updated a previous systematic review on the use of a prophylactic mesh for end colostomy, and we synthesized evidence using pairwise meta-analysis. A European panel of surgeons, stoma care nurses, and patients developed an evidence-to-decision framework in line with GRADE and Guidelines International Network standards, moderated by a certified guideline methodologist. The framework considered benefits and harms, the certainty of the evidence, patients' preferences and values, cost and resources considerations, acceptability, equity and feasibility. Results: The certainty of the evidence was moderate for parastomal hernia and low for major morbidity, surgery for parastomal hernia, and quality of life. There was unanimous consensus among panel members for a conditional recommendation for the use of a prophylactic mesh in patients with an end colostomy and fair life expectancy, and a strong recommendation for the use of a prophylactic mesh in patients at high risk to develop a parastomal hernia. Conclusion: This rapid guideline provides evidence-informed, interdisciplinary recommendations on the use of prophylactic mesh in patients with an end colostomy. Further, it identifies research gaps, and discusses implications for stakeholders, including overcoming barriers to implementation and specific considerations regarding validity.

Importance of stoma care nurses in preparing patients for stoma surgery and adjustment to life with a stoma.

Stoma surgery is a life-changing event and patients must subsequently make significant adjustments to their lives. The study set out to understand the level of interaction between patients and stoma care nurses (SCNs) in relation to preparing patients for stoma surgery and in adjustment to life with a stoma. Retrospective, self-reported questionnaires for patients and SCNs. Most patients (98%) with planned stoma surgery had pre-operative consultations with health professionals in contrast to 36% of patients with unplanned surgery, who did not. One third of patients with unplanned surgery did not feel prepared for life with a stoma based on the information provided during their hospital stay. Two thirds of the nurses reported having sufficient time to prepare patients for stoma surgery and to life with a stoma. SCNs are key in preparing patients for surgery and for life with a stoma. Variations in care were experienced by patients having planned versus unplanned surgeries.

Parastomal hernia: an overview.

Parastomal hernia (PH) is one of the most frequent ostomy complications, and the reported incidence in the literature is highly variable. As highlighted by the Association of Stoma Care Nurses UK, this complication develops mainly in children and older men over 70, but many predisposing factors are related to the individual patient and surgery. There is no standardised system for assessing PH. The main assessment techniques include objective examination, ultrasound scan and computed tomography. Prevention is based on various interventions by surgeons and stoma care nurses (SCNs). The SCN's primary interventions include accurate patient evaluation, pre-operative ostomy siting, education about body weight management and advice on appropriate exercises. The treatment of PH can be conservative or surgical, and the choice is based on the patient's clinical condition. Ostomy can significantly impact on a patient's quality of life (QoL), and the presence of PH can further aggravate the situation. This overview of PH considers the incidence, aetiology, prevention, treatment and impact on QoL.

The role of the clinical nurse specialist in stoma care: a scoping review.

Rapidly evolving roles in nursing require exploration and description. This review aims to examine the role of the clinical nurse specialist (CNS) in stoma care from the UK perspective. A scoping review was undertaken using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data were synthesised using content analysis to derive meaning units and themes. Three electronic databases were used to conduct the search: Embase, AMED and Ovid Medline. Additional sources identified through the reference lists of included studies and guidelines were also included. Two reviewers undertook the search for articles that described the role of the stoma care CNS in the UK. Any disagreements were to be resolved through discussion. Seven papers met the eligibility criteria. Analysis resulted in 184 unique meaning units. Meaning units were grouped into themes reflecting the four pillars of advanced practice: advanced clinical practice; leadership; facilitation of education and learning; and evidence, research and development. The fewest meaning units were attributed to the evidence theme (n=13) and the most related to advanced clinical practice (n=107) such as having specialist knowledge and skills to manage complications. The stoma care CNS role reflects the four pillars of advanced practice. These practitioners are valuable, carrying out a complex role that involves high-level, specialist decision-making skills. The results from this scoping review could be useful in service development; they will be used to inform the Association of Stoma Care Nurses UK modified Delphi consensus to examine the views of stoma care CNS practitioners.

Stoma care accessory products: an overview

Stoma care is complex and challenging and can result in complications that can cause psychological distress and negatively impact ostomates’ quality of life. These include appliance leakage, contact dermatitis, mucocutaneous separation and parastomal herniation. Flange extenders, adhesive removers, barrier films, support garments, discharge solidifying agents, powders, seals, protective and adhesive pastes and deodorants aim to prevent or reduce these. By drawing on assessment tools and guidelines and patient preferences in combination with patient education, stoma care nurses can help patients identify and correctly use the most appropriate accessories for them. Incorrect use of a product can worsen or result in further complications.

The role of the clinical nurse specialist in stoma care: a scoping review

Aim: Rapidly evolving roles in nursing require exploration and description. This review aims to examine the role of the clinical nurse specialist (CNS) in stoma care from the UK perspective. Design: A scoping review was undertaken using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data were synthesised using content analysis to derive meaning units and themes. Data sources: Three electronic databases were used to conduct the search: Embase, AMED and Ovid Medline. Additional sources identified through the reference lists of included studies and guidelines were also included. Methods: Two reviewers undertook the search for articles that described the role of the stoma care CNS in the UK. Any disagreements were to be resolved through discussion. Results: Seven papers met the eligibility criteria. Analysis resulted in 184 unique meaning units. Meaning units were grouped into themes reflecting the four pillars of advanced practice: advanced clinical practice; leadership; facilitation of education and learning; and evidence, research and development. The fewest meaning units were attributed to the evidence theme (n=13) and the most related to advanced clinical practice (n=107) such as having specialist knowledge and skills to manage complications. Conclusion: The stoma care CNS role reflects the four pillars of advanced practice. These practitioners are valuable, carrying out a complex role that involves high-level, specialist decision-making skills. The results from this scoping review could be useful in service development; they will be used to inform the Association of Stoma Care Nurses UK modified Delphi consensus to examine the views of stoma care CNS practitioners.

1246 High Output Stoma Management Audit

Abstract Aim High output stomas lead to a myriad of complications for patients including dehydration, electrolyte imbalances, poor skin integrity & altered bowel function. However, this issue is not well recognised amongst junior doctors. This audit’s aim was to improve awareness of high output stomas including their implications and management according to the Association of Stoma Care Nurses’ (ASCN) national guidelines amongst junior doctors. Method An electronic survey was distributed to 20 junior doctors working in General Surgery at Southend University Hospital, assessing their knowledge on recognition and management of high output stomas. A checklist summarising the ASCN guidelines was then created. A post-intervention survey was then distributed to assess for improvement in knowledge and application of ASCN guidelines as well as use of the checklist. Results Overall, 51% answers were correct in the first survey compared to 72% answers correct in the post-intervention survey, and 83% of participants used the checklist. There was improvement in use of IV fluids (50% to 100%), monitoring fluid balance (80% to 91%), fibre restriction (37% to 70%), fluid restriction (50% to 70%), checking & replacing Mg (65% to 87%) & use of regular codeine (70% to 77%), as well as moderate improvement in appropriate doses of loperamide being given (5% to 30%). Conclusions The above audit resulted in an improvement of knowledge and application of evidence-based guidance provided by ASCN, with ultimate intent to improve patient outcomes. Further work includes distribution of the checklists throughout the hospital and to other hospitals.

Convex Light Appliance and Mouldable Rings for Ostomy Patients: Who Benefits Most?

Aim The aim of this study was to evaluate the effectiveness of a combined treatment strategy involving the use of a light convex ostomy appliance (Easifiex Confort Convex Light) and a fiexible ring (Brava moldable) in reducing the number of leak episodes and improving self-reported satisfaction in patients with digestive ostomies and early effiuent leakage. Methods A multicenter prospective study was conducted across 54 stoma units in Spain, with 257 patients screened and 244 completing the study. Clinical data were collected at baseline (V1) and 2–3 weeks after discharge (V2) by specialist stoma care nurses. The primary outcome was a reduction in the mean number of leak episodes per day. The secondary outcome was a change in self-reported satisfaction on a scale of 0–10. A multivariate analysis was conducted to identify the patient profile that benefited the most from the treatment strategy. Results The results showed a significant reduction in the mean number of leak episodes from 3.4±5.2 at baseline to 1.3±2.3 at the end of the study (P<0.0001). Additionally, the mean self-reported satisfaction with the device increased from 5.1±2 at baseline to 7.2±1.7 at the end of the study (P<.00001). A predictive model with an area under the curve of 0.74 was developed to identify the patient profile that benefited the most from the treatment strategy. Conclusions The study confirmed that patients with ostomy and early effiuent leakage benefit from convex light ostomy appliances and fiexible rings. To improve satisfaction, those with worse outcomes and higher needs should be treated early with the CONAN strategy (convex system and a seal) if they exhibit leakage, longer hospital stays, emergency surgery and previous use of open system and single-piece appliances. This combined treatment strategy can improve outcomes and satisfaction in patients with digestive ostomies and early effiuent leakage.

Convexity in stoma care: developing a new ASCN UK guideline on the appropriate use of convex products

One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. However, the use of a convex appliance should be considered only after a thorough assessment has been undertaken by a specialist SCN. Professionally, stoma care nursing has advanced greatly in recent years and there has been a realisation that there is a need for clinical guidelines to direct practice and offer a process for the novice SCN to follow. This realisation has been the catalyst behind the development of the new guideline for the assessment and use of convexity by the Association of Stoma Care Nurses UK, which was published this year ( https://ascnuk.com/ ). This article explores the concept of convexity and how the guideline can assist the practice of specialist SCNs, as well as that of ward and community-based nurses who wish to gain more information on using convexity within the specialist sphere of stoma care.