The study was conducted by nurses and nurse faculty in Spain at two university hospitals and one public hospital in Spain. Twenty-one adult ostomy patients were asked for their insights before and after their ostomy surgery.

Fourteen of the patients had a gastrointestinal stoma due to cancer, six due to inflammatory bowel disease, and one due to familial polyposis. About 48% of the sample had an ileostomy and 52% had a colostomy. More than half (62%) had a permanent stoma, while 38% had a temporary stoma.

Criteria for the patients chosen for the study included: (1) a disease that led to the need for the ostomy (e.g., cancer, ulcerative colitis); (2) type of operative intervention (e.g., urgent or scheduled); (3) duration of the stoma (e.g., temporary or permanent); and (4) sociodemographic data (e.g., age, gender).

Structured face-to-face interviews were conducted by the same researcher without anyone else present. Written or verbal consent of the patients was obtained. And, to preserve confidentiality and anonymity of the participants, fictitious names were used.

The patients identified three main categories of concern:

  1. Healthcare received
  2. Healthcare management
  3. Patient needs and suggestions for improvement

Healthcare Received

The patients clearly identified that they considered stoma care nurses “the experts” on stoma care, and the nurses played a “key role” in their education and in obtaining information about stoma care. The guidance from the stoma care nurse resulted in absolving their feelings of uncertainty and their fear of not knowing the things they needed to know in order to return to their normal lives.

One participant stated, “When I left the hospital, I was lucky as I was told that, in the hospital, there was indeed a stoma care nurse … Just after meeting her, I felt stronger, otherwise, I wouldn’t have known what to do. I started to take care of myself, I found out about the work.”

The knowledge that the patients could contact the stoma care nurses when they had questions or concerns about their care was calming for them.

Follow-up care was essential in order to build a sense of self-sufficiency in the sample.

Healthcare Management

Problems identified in the interview group concerning their care included waitlists for care, lack of healthcare during holiday periods, and a lack of resources and professionally trained staff to provide stoma care.

For instance, one study participant said, “I went to a community doctor to prescribe some bags, and he didn’t know anything about this. He looked at me like saying ‘I don’t know. I know what a colostomy is but I don’t know what we can do about it.’”

Patient Needs and Suggestions for Improvement

A necessary requirement of some of the patients was that a stoma care nurse be involved in all healthcare stages. The more information received, the more they identified the decrease in negative feelings and the potential to decrease post-discharge complications.

One participant described the difficulties of learning about stoma care this way: “When you are discharged, they should give a manual for ostomized patients because the time you take to learn or to know anything you need on this manner is a very hard time.”

Another stated, “I would like you to please give more specific information, especially within the preoperative and postoperative process because it is very complicated to have doubts because you always tend to think of the worst … Just to make you see the goal you a can reach and know that you will be able to live well afterwards….”

The importance of including the family in their care, from the initial diagnosis and need for surgery to post hospitalization care, was stressed.

The topic of post-surgery sexual relations also was identified as information that would help with resuming a normal life after surgery.

Implications for your Stoma Care Nursing Practice

This study clearly indicated the crucial role nurses have in stoma care and in the successful adjustment of the patients to their stoma.

Though the role of the stoma nurse is certainly important, there are potential legal ramifications should your care not meet expected standards of care.

It is essential, therefore, that you meet those standards without fail by providing non-negligent care, keeping up to date with new clinical developments, and expanding your credentials by becoming certified and seeking additional degrees.

The group also identified the immense need for patients to have information about their stoma, its care, and what they were to expect concerning the adjustment to its presence.

Patient and family centered teaching has always been a nursing responsibility. It also can be a potential area of liability, including the omission of required information about self-care, the negligent assessment of the patient’s teaching needs, and teaching in a manner not understood by the patient or family.

There are solutions to avoid such allegations such as using the teach-back method, which asks the patient to demonstrate the care you provided to the patient or asking the patient to tell you in his or her own words what you just discussed regarding their stoma care. You can read more solutions here.

Become an ostomy specialist and help patients with stomas through the physiological and emotional challenges they face. Start right here with our Ostomy Management Courses.

Nancy J. Brent, MS, JD, RN

Nancy J. Brent, MS, JD, RN, our legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

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