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Journal of Wound, Ostomy & Continence Nursing:
doi: 10.1097/WON.0b013e3182233ff9
Ostomy Literature Review

Ostomy Literature Review 2010

Mueller, Susan BSN, RN, CRRN, CCM, CWOCN; CONTRIBUTOR

Section Editor(s): Fellows, Jane A. MSN, RN, CWOCN;

Free Access
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General Concepts in Ostomy Care

O1. Management of the Patient With a Fecal Ostomy Best Practice Guidelines for Clinicians

Goldberg M; Ostomy Guidelines Task Force. Journal of Wound, Ostomy and Continence Nursing. 2010;37(6):596–598.

Article Type: Integrative review

Description/Results:

* In 2007 the Wound, Ostomy and Continence Nurses Society leadership commissioned the Ostomy Guidelines Task Force for the purpose of creating a clinical guideline for care and management of the person with a fecal ostomy. In 2010 The Management of the Patient With a Fecal Ostomy Best Practice Guideline for Clinicians debuted at the Joint International Conference of the WOCN Society and World Council of Enterostomal Therapists.

* This article highlights the components of the guideline: ostomy education, stoma site marking, pouching options and basic ostomy management, complications that may accompany an ostomy, health-related quality of life, and research recommendations.

What does this mean for me and my practice?

This guideline provides evidence of the most current standards for ostomy care practice.

O2. Content Validation of a Standardized Algorithm for Ostomy Care

Beitz J, Gerlach M, Ginsburg P, et al. Ostomy Wound Management. 2010;56(10):22–38.

Article Type: Research

Description/Results:

* This article describes the process of validating an ostomy algorithm developed by ConvaTec, Inc. The tool includes 11 areas of assessment including type of ostomy, abdominal contours, stoma construction and output, and peristomal skin condition.

* The subjects were 166 WOCNs self-identified as having expertise in ostomy care who were surveyed online for 6 weeks in 2009. Using a cross-sectional, mixed-methods study design and a 30-item instrument with a 4-point Likert-type scale, the participants were asked to quantify the degree of validity of the Ostomy Algorithm's decisions and components. The algorithm's content validity index (CVI) was 0.95 (out of 1.0) supporting a strong content validity for use by WOCNs.

* Using the comments made by the WOCNs, qualitative data analysis revealed themes of difficulty associated with algorithm formatting, especially orientation and use of the Studio Alterazioni Cutanee Stomali (Study on Peristomal Skin Lesions [SACS™ Instrument]) and the inability of algorithms to capture all individual patient attributes affecting ostomy care. Positive themes included content thoroughness and the helpful clinical photos.

What does this mean for me and my practice?

This Ostomy Algorithm may facilitate common language among WOCNs and possibly standardize practice patterns in facilities and agencies to avoid some pouch selection errors and the resultant cost. There are plans to validate the tool with staff nurses to see if it could provide a source of education and practice guideline along the continuum of care especially when WOCNs are not available.

O3. Starting and Maintaining a Hospital-Based Ostomy Support Group

Cross H, Hottenstein P. Journal of Wound, Ostomy and Continence Nursing. 2010;37(4):393–396.

Article Type: Integrative review

Description/Results:

* The authors speak of the experience of a hospital-based ostomy support group which has existed at their 500-bed hospital for 30 years, with ostomates whose ages range from 4 to 90 years.

* They identified and discussed the advantages to the participants, the WOCN's, and the hospital.

What does this mean for me and my practice?

Have you wanted to participate in ostomy teaching beyond the limits of acute care? This article discusses the benefit of participating in the continuum of the adjustment process. Do you want to start an ostomy support group? This article presents some of the strategies utilized by this successful group.

O4. Does Chewing Gum Shorten the Duration of Postoperative Ileus in Patients Undergoing Abdominal Surgery and Creation of a Stoma?

Hocevar B, Robinson B, Gray M. Journal of Wound, Ostomy and Continence Nursing. 2010;37(2):140–146.

Article type: Systematic review

Description/Results:

* The following outcome measures were evaluated: (1) time to passage of flatus, (2) time to passage of stool, or (3) length of hospital stay. Three meta-analyses and 4 studies met inclusion criteria.

* Chewing gum was consistently found to reduce time to passage of flatus and stool. There was insufficient evidence to support that length of hospital stay was reduced.

What does this mean for me and my practice?

Chewing gum has no significant adverse effect and may have a positive effect in decreasing the discomfort of a postoperative ileus in selected patients. A careful nursing assessment of the patient should be done to assure that there is minimal aspiration risk. This should include mental status, dentition, and ability to swallow.

O5. Testing a Computer-Based Ostomy Care Training Resource for Staff Nurses

Bales I. Ostomy Wound Management. 2010;56(5):60–69.

Article Type: Research study

Description/Results:

* Staff nurses (n = 103) in a Midwestern hospital completed 2 surveys, each comprising the same eight statements about providing ostomy care. The surveys were completed before and after training with a computer-based program that included pictures and descriptions of basic ostomy care.

* Nurses reported a statistically significant increase in knowledge of ostomy care and increased confidence in their ability to provide care after completing the program.

What does this mean for me and my practice?

Providing easily accessible ostomy care training may improve patient care. Additional research studies or quality improvement projects in which methods of training are most effective are needed.

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Stomal and Peristomal Skin Complications

O6. Early Peristomal Skin Complications Reported by WOC Nurses

Ratliff CR. Journal of Wound, Ostomy and Continence Nursing. 2010;37(5):505–510.

Article Type: Research study

Description/Results:

* The purpose of this study was to describe peristomal skin complications seen by WOC nurses over a one-year period using a standardized data collection tool and using the peristomal complications terminology developed by the WOCN society.

* Twelve WOC nurses saw a total of 89 ostomy patients over a 12-month period. The subjects had a median age of 61 years (range, 1–91 years). The sample included 46 females and 43 males. All patients were seen in the central Virginia area. Thirty-two patients were seen in the hospital, 31 were seen in a home health setting, and 26 were seen in an outpatient clinic.

* Forty-seven percent of the patients had peristomal complications. Of these 42 patients, 31 had irritant dermatitis, 5 had mechanical injury, 4 had Candida infections, 1 had an allergic reaction, and one had pyoderma gangrenosum.

What does this mean for me and my practice?

This study is important because it demonstrates the feasibility of the collection of data on peristomal complications using a standardized data collection tool and defined terminology. The tool is useful to WOC nursing practice as it helps to organize your approach to assessing peristomal complications. The article literature review also provides an overview of additional approaches to peristomal complications.

O7. External Stoma and Peristomal Complications Following Radical Cystectomy and Ileal Conduit Diversion: A Systematic Review

Szymanski K, St-Cyr D, Tarik Alam R, Kassouf W. Ostomy Wound Management. 2010;56(1):28–35.

Article Type: Systematic review

Description/Results:

* A review of English-language literature from 1996–2008 was conducted to 1) describe and compare external stoma and peristomal complications with ileal conduit diversion following radical cystectomy, and 2) summarize commonly used prevention and management strategies.

* Fourteen publications (mostly retrospective, single-center studies) met inclusion criteria. The reported incidence of complications ranged from 15% to 65%. The most commonly reported stomal complications are parastomal hernia, stoma prolapse, stenosis, and retraction. The peristomal skin changes reported are chemical injury: irritant contact dermatitis, pseudoverrucous lesions, and alkaline crustations; mechanical injury: pressure ulcers, skin stripping injuries, mucocutaneous separation; infection: candidiasis, folliculitis; immunologic disorders: allergic contact dermatitis. Disease-related lesions included varices, pyoderma gangrenosum, and malignancy.

* A lack of consistent definitions and standardized tools may cause these conditions to be underreported bring into question the accuracy of assessment of stomal and peristomal complications.

What does this mean for me and my practice?

This article provides a thorough review of stomal and peristomal complications and pictures to illustrate these conditions. This material may be helpful as a review for the WOC nurse and could be used when developing staff and patient education materials.

O8. Primary Adenocarcinoma in Peristomal Skin: A Case Study

Al-Niaimi F, Lyon CC. Ostomy Wound Management. 2010;56(1):45–47.

Article Type: Case study/series

Description/Results:

* A 37-year-old man with a history of ulcerative colitis and ileostomy surgery 18 years prior presented with an asymptomatic polypoid lesion at the mucocutaneous junction. Initially diagnosed as pyogenic granuloma, the lesion was treated using topical silver nitrate. This did not resolve the problem and a biopsy was done revealing the malignancy.

* Surgical removal of the stoma with an ileal-anal J pouch was successfully performed.

What does this mean for me and my practice?

This tumor is a rare occurrence but is reported in the literature as occurring many years after stoma surgery. WOC nurses should consider a biopsy for any stomal or mucocutaneous lesion that does not heal with standard treatment.

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Colostomy Irrigation

O9. Positive and Negative Aspects of Colostomy Irrigation

Carlsson E, Gylin M, Nilsson L, Svensson K, Averslid I. Journal of Wound, Ostomy and Continence Nursing. 2010;37(5):511–516.

Article Type: Research Study

Description/Results:

* A questionnaire was sent to 89 WOC nurses in Sweden posing questions about their practice regarding colostomy irrigation (CI). 69% of the nurses returned questionnaires. Additionally, 39 patients with colostomies who practiced CI were interviewed to determine their perspective of the CI experience and how they practiced CI.

* 97% of the colostomates reported positive benefit from colostomy irrigation. 95% of these respondents were informed about CI by a WOC nurse, 5% by a surgeon. 64% of the WOC nurses said they always informed patients about CI technique; 35% said that they did not regularly teach patients to perform CI.

* The study concluded that since 97% of the patients with colostomies reported positive benefit that all appropriate colostomy patients should be provided information about colostomy irrigation. The researchers recommended future studies to inquire about factors that influence whether WOC nurses teach CI to potential colostomy irrigation patients.

What does this mean for me and my practice?

This study provides the perspective of a sample of colostomy irrigation practice in Sweden from the WOC nurse point of view and that of the patient. WOC nurses teaching colostomy irrigation will find the additional data (ex. water temperature and amount used, traveling practice, and appliance use between irrigations, etc) interesting and helpful.

O10. Ensuring Effective Technique in Colostomy Irrigation to Improve Quality of Life

Perston Y. Gastrointestinal Nursing. 2010;8(4):18–22.

Article Type: Integrative review

Description/Results:

* This article provides a thorough review of the literature and a complete description of the efficacy and method of irrigation for persons with colostomies.

* In looking at quality-of-life literature the author finds that lack of bowel control and need to empty and dispose of pouches are factors negatively impacting quality of life. Effective irrigation may provide a method of management that can improve quality of life.

What does this mean for me and my practice?

This article provides practical information about irrigation and educating patients. Since anecdotal evidence suggests that irrigation is done less frequently by patients in the US than it was previously, this information may be helpful especially for newer WOC nurses.

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Quality of Life Following Ostomy Surgery

O11. Concerns and Quality of Life Before Surgery and During the Recovery Period in Patients With Rectal Cancer and an Ostomy

Carlsson E, Berndtsson I, Hallén A, Lindholm E, Persson E. Journal of Wound, Ostomy and Continence Nursing. 2010;37(6):654–661.

Article Type: Research study

Description/Results:

* This study involved patients with a diagnosis of rectal cancer undergoing surgery at a university hospital in Sweden. The goal was to study the concerns, using the Inflammatory Bowel Disease Patient Concerns questionnaire (with an open question to express additional concerns) and health-related quality of life (HRQOL) using the 36-Item Short Form Health Survey. The patients answered the questionnaires preoperatively and at 1-, 3-, and 6-month intervals postoperatively. The sample comprised 57 people, with a median age of 66 years, 35 men and 22 women. 28 subjects answered all the questionnaires throughout the study period.

* Surgical management of rectal cancer influenced the HRQOL (decreased SF-36 scores) during the immediate postoperative period and improved gradually over the next 6 months. Patients expressed concerns for being a burden on others preoperatively and during the first 6 months postoperatively. Patients reported concern related to the uncertain nature of rectal cancer and fear of what their new life would entail. The presence of an ostomy was not perceived as the major problem during the recovery period; instead, concerns were associated with the cancer diagnosis and surgery for rectal cancer.

What does this mean for me and my practice?

The patients in the study had more concerns and decreased HRQOL in the first month postoperatively. This finding would support a plan for provision of postoperative services during the first month.

WOC nurses providing pre-operative and post-operative teaching will benefit from the insight provided by this study; specifically the impact of the cancer diagnosis and surgery rated as a larger concern than the presence of an ostomy.

O12. Quality of Life for Patients Living With Ostomies: Influence of Contact With an Ostomy Nurse

Aronovitch SA, Sharp R, Harduar-Morano L. Journal of Wound, Ostomy and Continence Nursing. 2010;37(6):649–653.

Article Type: Research study

Description/Results:

* The purpose of the study was to determine whether or not contact with a WOC nurse improves quality of life for ostomy patients. Three hundred and fifty surveys were sent from 8 participating hospitals, 15 home health agencies and a large durable medical equipment supplier, with a 36% response rate (n = 126).

* The majority of subjects (84%) reported being seen by a WOC nurse. More than 50% of the study sample participants reported satisfaction with the healthcare services they received regardless of whether services were provided by a WOC or a nonspecialist nurse. Since the subjects were relying on recall when reporting if they received services from a nonspecialist or specialty certified nurse, the authors did not feel they could definitively determine the influence of noncertified with certified nurses.

What does this mean for me and my practice?

More research is needed to determine the effectiveness of certified ostomy nurses. Ways to increase the knowledge of the general public regarding the role of specialty nurses are needed.

O13. A Prospective, Longitudinal, Multicenter, Cohort Quality-of-Life Evaluation of an Intensive Follow-up Program for Patients With a Stoma

Quintana Jiménez P, Pastor Juan C, Prados Herrero I, et al. Ostomy Wound Management. 2010;56(5):44–52.

Article type: Research study

Description/Results:

* A prospective, 3-month multicenter study was conducted to evaluate stoma patient quality of life among volunteers receiving standard clinical follow-up (S) and those receiving intensive follow-up via telephone (I). There were 187 subjects in the S group and 149 in the I group with mean age 63 years, 65.85% male; the majority (64.3%) had a colostomy.

* The Stoma Quality of Life Index (SQLI) score was determined at the initial and final visits. Patients in the I group showed a positive but not statistically significant change in three subscales of the SQLI questionnaire; the I group presented slightly lower differences in the percentage of complications related to the stoma, need for emergency assistance, and for hospitalization.

* Preoperative ostomy nurse care was found to be associated with a greater probability for improvement in select SQLI subscales.

What does this mean for me and my practice?

While the results of this study do not demonstrate a strong statistically significant change in scores between the S and the I groups, the small changes reported in patient satisfaction and improved QOL may be clinically significant and support the importance of the ostomy nurse in the pre- and postoperative period for persons with stomas.

O14. Going With the Flow Quality-of-Life Outcomes of Cancer Survivors With Urinary Diversion

Gemmill R, Sun V, Ferrell B, Krouse RS, Grant M. Journal of Wound, Ostomy and Continence Nursing. 2010;37(1):65–72.

Article Type: Research study

Description/Results:

* This study described health-related quality of life concerns among cancer patients with incontinent and continent urinary diversions. The City of Hope Health Related Quality of Life-Ostomy (COHHRQOL-O) questionnaire was mailed to 2,890 individuals with 1600 returned, of which 307 indicated that they had a urinary diversion and a diagnosis of cancer. The questionnaire mailing list was developed from the California Ostomy Association and two California cancer treatment centers.

* 73.6% of the respondents had incontinent diversions and they reported less activity, were more likely to belong to a support group, and were more likely to change their clothing type and diet after their diversions than respondents with continent diversions. 75% of the patients with incontinent diversions also reported difficulty adjusting to their urinary diversions and problems with urinary leakage.

* The HRQOL questionnaire was a 4-dimension model (physical, psychological, social, and spiritual well-being). Mean scores for the dimensions and overall quality of life were physical well-being 8.2, psychological well-being 7.3, social well-being 8.0, spiritual well-being 7.4, and overall quality of life 7.7. Each item was scaled from 0–10 with 0 being the worst and 10 being the best.

What does this mean for me and my practice?

This study provides additional information for WOC nurses about long-range adjustment of people with both continent and incontinent urinary diversions. More studies are needed comparing quality of life outcomes between people with continent and incontinent diversions.

O15. A Feminist Perspective on Sexuality and Body Image in Females With Colorectal Cancer

Li C-C, Rew L. Journal of Wound, Ostomy and Continence Nursing. 2010;37(5):519–525.

Article Type: Integrative review

Description/Results:

* The authors report on a literature search regarding changes in sexual function following surgery for colorectal cancer, specifically emphasizing the effect of this surgery for women. The researchers then used radical feminist theory to guide their interpretation and conclusions.

What does this mean for me and my practice?

* WOC nurses must consider the impact that colorectal surgery has on the sexuality of individuals and incorporate that knowledge into their teaching. This article offers a comprehensive view from a radical feminist perspective.

O16. A Descriptive, Interventional Study to Assess the Impact of Surgical Stomas on Individuals' Sleep Perceptions and Response to Sleep Hygiene Intervention

Vorbeck E, Willette-Murphy K, Meiers S, Rudel R, Alakhras M. Ostomy Wound Management. 2010;56(1):36–44.

Article Type: Research study

Description/Results:

* This study was conducted to 1) assess subjective sleep quality perceptions and objective sleep measurement in adults with stomas, 2) determine if there is a correlation between subjective and objective measurement of sleep in this group, and 3) implement a stoma-specific sleep hygiene intervention to improve these sleep quality perceptions.

* Subjective assessment focused on sleep subset questions from the Stoma Quality of Life Index (SQOLI) and the Pittsburgh Sleep Quality Index (PSQI). Respondents' (n = 26) subjective sleep scores were 7.23 mean global score on seven questions.

* Scores showed that adults with stomas have increased sleep disruption and poor sleep quality. Five respondents who met intervention enrollment criteria participated in an objective sleep assessment using actigraphy, overnight oxygenation studies, and a 4-week sleep hygiene intervention. Mean PSQI score improved by 1.20 but the difference was not statistically significant probably due to the small sample size.

What does this mean for me and my practice?

It is important to understand the factors affecting healing and recovery after ostomy surgery. Sleep deprivation can certainly impair both physical and psychosocial adjustment to living with a stoma. The WOC nurse can be instrumental in exploring whether sleep deprivation is causing decreases QOL for patients and make an appropriate referral for care.

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Fistula Management

O17. Summary of Best Practice Recommendations for Management of Enterocutaneous Fistulae From the Canadian Association for Enterostomal Therapy

McNaughton V; Canadian Association for Enterostomal Therapy ECF Best Practice Recommendations Panel. Journal of Wound, Ostomy and Continence Nursing. 2010;37(2):173–184.

Article Type: Integrative review

Description/Results:

* The Canadian Association for Enterostomal Therapy developed a comprehensive resource, summarizing current literature to support the care of the person with an enterocutaneous fistula (ECF).

* The panel assembled to develop the recommendations was composed of enterostomal (ET) nurses experienced in ECF care. The resulting 10 Best Practice Recommendations were extracted from existing research, expert opinion, and case studies with documentation of the supporting levels of evidence.

What does this mean for me and my practice?

The goal of the Best Practice Recommendations was to answer the question “What is the best way for the nurse to manage an adult patient living with an ECF?” The recommendations not only answer this question, they also comprehensively address the goals of fistula management with supporting rationale for care, providing direction for organizational policy.

O18. The Suction Pouch for Management of Simple or Complex Enterocutaneous Fistulae

Franklin C. Journal of Wound, Ostomy and Continence Nursing. 2010;37(4):387–392

Article Type: Case study/series

Description/Results:

* This article describes the use of a suction pouch to manage 4 cases of patients with challenging enterocutaneous fistulae (ECF). The author briefly reviews previously published strategies for ECF management and discusses the frequent role of the WOC nurse in this process.

* The technique described is easy to follow and is supplemented with pictures.

What does this mean for me and my practice?

This technique of using readily available supplies to construct a suction pouch to manage the exudate of ECF is a welcome addition to the tool chest of any WOC practice whether you are exposed to ECF frequently or rarely. The author addresses common practice concerns such as how the technique holds up to the transition to homecare and the impact on hospital length of stay.

O19. Management of an Enterocutaneous Fistula in a Patient With a Gastrointestinal Stromal Tumor

Woodward L. Journal of Wound, Ostomy and Continence Nursing. 2010;37(3):314–317.

Article Type: Case study/series

Description/Results:

* This case study informs the audience of this very rare tumor, and the specifics of the disease with medical and surgical management.

* The role of the WOC nurse in successfully pouching the fistula and educating the family to perform pouch changes enabled this patient to achieve an important personal goal.

What does this mean for me and my practice?

Although gastrointestinal stromal tumors are rare, the identification of the impact of a successful fistula pouching systems on this patient's quality of life and for patients with a poor prognosis is significant.

The study further concluded that individual and detailed education regarding the pouching system assisted the patient and family to make the scheduling accommodations necessary for the lengthy pouch changes.

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International Perspectives

O20. Factors Affecting Ostomy-Related Complications in Korea

Sung YH, Kwon I, Jo S, Park S. Journal of Wound, Ostomy and Continence Nursing. 2010;37(2):166–172.

Article Type: Research study

Description/Results:

* This study is a retrospective analysis of 1,170 patients who had surgery to create end colostomies at Samsung Hospital from October 1994 to February 2005. The goal of the study was to determine the type and incidence of ostomy-related complications and identify associated factors in Korean ostomy patients. WOC nurses are responsible for preoperative stoma site marking and follow-up postoperatively and postdischarge.

* The study indicated that approximately 40% of people undergoing ostomy surgery will experience 1 or more stomal or peristomal complications. Gender, age, the nature of the operation, body mass index (BMI), and ostomy type were associated with a higher incidence of stomal and peristomal complications.

* It was felt that WOC nurse interventions are needed to reduce the incidence of these complications.

What does this mean for me and my practice?

This study introduction notes that the prevalence of colorectal cancer has increased to the extent that it now is one of the 10 most common forms of cancer in Korea. The study authors report that it is hypothesized that changes in dietary habits of modern Korean society have led to the surge in the prevalence of colorectal cancer. This is noteworthy for WOC nurses treating Korean immigrant populations as the population has a limited history of colorectal cancer and stoma surgery which may influence the WOC nurse approach to risk education. This study supports the importance of WOC nurse intervention and follow-up.

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Professional Practice

O21. Direct Supervision Requirements and Incident to Services: A Primer for the WOC Nurse

Vargo DM. Journal of Wound, Ostomy and Continence Nursing. 2010;37(2):148–151.

Article type: Integrative review

Description/Results:

* This article discusses the criteria necessary for nurses to deliver nurse visits incident to physician services and the US Centers for Medicare & Medicaid Services (CMS) regulations that apply to these visits and the services rendered.

* These regulations define how these services may be reimbursed and what types of charges may be made for the services.

* It also describes the exceptions to these rules for underserved areas.

What does this mean for me and my practice?

These regulations are important to understand for WOC nurses providing care for patients outside the hospital setting.

Copyright © 2011 by the Wound, Ostomy and Continence Nurses Society

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