Credit goes to the original authors of the following excerpts.
A component of the role of the Clinical Nurse Specialist (CNS) in stoma care, is to provide an ongoing long term specialist nursing service to patients who have or are going to undergo surgery resulting in the formation of a stoma. A stoma is an artificial opening on the abdomen to divert the flow of feces or urine into an external pouch. This procedure may be temporary or permanent. More information on stomas can be found at reference below1. The patients involved in this audit have undergone a colostomy, ileostomy or urostomy. There are around 50 CNSs in Scotland based at 30 hospitals looking after approximately 2200 new stoma patients per year. 1
Much is written about the scope of nurses’ professional practice. This article examines the ways in which clinical nurse specialists in stoma care may strive to extend their practice without losing sight of their ideals. 2
A day or two after surgery, if a bag has been applied in theatre it will be removed by a trained nurse. The stoma and surrounding skin is then cleaned with warm water and a soft wipe. A new bag is then applied after being cut to fit the stoma. The nurse will make a template of this size, so it can be used as a guide to cut out further bags. 3
Abstract;The final goal of stoma care instruction is to get patients with stomas to accept the inconvenience of defecating and to get them to feel that life is not worse than before, by getting excellent stoma care handling techniques and training. Nurses who teach patients stoma care must have a lot of knowledge not only about technical problems of stoma care but also enough knowledge of the mental problems associated with losing normal anal functions. It not only dose not consider differences of individual patients but also differences in the knowledge and abilities of individual nurses who teach the patients. 4
The SecuriCare stoma care nursing service is committed to continuous quality improvement measures. As part of this commitment - and actively linking in with the Government’s plans for clinical governance - regular patient and staff surveys are carried out. 5
In 2-3 days after the operation you must get of the bed and start rebuilding your muscles because they need exercise. At the beginning you must try to walk, making small steps 4-6 minutes at a time. During the next days you’ll probably do better and as a matter of fact you must do better, because if you do not move your body you can create problems for yourself that you don’t want like blocking you muscles. Don’t go there! And keep in mind never to exaggerate. Be patient and don’t start “running around” as soon as you can. Be mature and calculated. And never forget the golden rule: Do exactly as the doctor recommends.This is the fastest way in healing. If you start feeling pain ask for pain killers because there is no problem with that. 6
Dry the stoma and apply bacitracin ointment to the outer edges. Check the stoma frequently using a flashlight. Remove secretions promptly to avoid the formation of crusts. Mucous plugs or crusts may be removed using a LARGE tweezer or forcep. Never use a small instrument that may fall into the stoma. The skin around the stoma may be washed with mild soap and water, then wiped dry. Avoid using cotton balls that may stick to the stoma edges. 7
Teaching parents to safely care for the infant with a tracheostomy at home requires careful planning and systematic education. The parents must acquire a unique set of technical skills demonstrating competence and comfort in providing stoma care, suctioning, and tube changes. Parents must be prepared to initiate cariopulmonary resuscitation (CPR) and need to understand alterations in CPR techniques in infants with a tracheostomy. They also need to develop critical thinking skills to handle emergency situations. A safe transition to the home can be accomplished by using a multidisciplinary approach to coordinate all facets of care. 8
It is vital that good communication is established between the discharging hospital ward and the district nursing team who will be managing the patient at home. Larger hospitals may even have a critical care team who follow individual patients through their journey from intensive care unit and provide guidance to ward nursing staff through to discharge. 9
Discharge planning should be preferably discussed 1-2 weeks prior to discharge to allow for adequate preparation, organisation and delivery of equipment to the patient’s home. The patient and carer will need to be taught by the ward nursing staff/critical care team and physiotherapist how to care for the tracheostomy and perform suction competently. Well-informed patients are more likely to follow instructions and manage their care better than those with little or no understanding (Hyland & Donaldson, 1989). 10
Wherever possible a full-time member of the district nursing team should visit the ward to meet the patient and also familiarise themselves with the type of tracheostomy tube being used as well as being present when the tube is changed prior to discharge from the hospital. It will also be beneficial to the patient and carer if they have previously met a member of the community team to help alleviate their anxiety and build their confidence, especially if going home for the first time with a tracheostomy tube. 11
Young people in their teens and twenties with inflammatory bowel disease are most likely to have an ileostomy. However, patients who have a mid to low rectal cancer (3-10cm from the anal verge) may also have a temporary ileostomy while the anastamosis heals. These patients are most commonly over the age of 55 years. Patients with bladder cancer tend to be over 60 and those requiring a cystectomy and ileal conduit (urostomy) are often much older than 60 at the time of surgery. 12
Many of the types of stoma appliances used to manage faecal or urinary effluent are listed in the Drug Tariff. They vary depending upon the type of stoma the patient has, the patient’s preference for management,5 and suggestions from stoma care nurses. Table 3 provides a summary of the range of appliances available. A one-piece appliance is an appliance with an adhesive attached and a two-piece appliance is one where the adhesive flange and pouch come separately. One-piece and two-piece appliances can be drainable, closed or can have a tap. Drainable appliances are for semi-liquid or liquid effluent and have a clip fastening. Closed appliances have a sealed pouch for solid or semi-solid effluent and usually have a flatus filter. 13
During the patient’s recovery period and managing their care, the nurse may need to demonstrate a great deal of empathy and understanding to allow the patient to come to terms and accept the tracheostomy and their altered body image. Caring for a patient with a tracheostomy in the community is both demanding and challenging. It does not just involve nursing care of the stoma and tube but also a great deal of psychological support and lifestyle adaptation. The community physiotherapist, speech and language therapist and dietician may need to also be involved in the patient’s management. 14
The frequency cleaning the stoma site will very much depend on the individual patient and the amount of secretions. It is important to remember, however, that a tracheostomy stoma is a surgical would and prevention of infection is paramount. 15
Posted on June 24th, 2008 by Neil
Filed under: Bladder Cancer - Background, My Cancer
Thanks for posting the article, was certainly a great read!