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Colostomy Irrigation

Current Knowledge and Practice of WOC Nurses

Cobb, Martha D.; Grant, Marcia; Tallman, Nancy J.; Wendel, Christopher S.; Colwell, Janice; McCorkle, Ruth; Krouse, Robert S.

Journal of Wound Ostomy & Continence Nursing: January/February 2015 - Volume 42 - Issue 1 - p 65–70
doi: 10.1097/WON.0000000000000075

PURPOSE: This study builds on the authors' previous studies that demonstrate that persons living with a colostomy who practice colostomy irrigation (CI) experience quality-of-life benefits. Studies also reveal that patients may not be taught about CI. The purpose of this study was to determine current knowledge, attitudes, and practices of WOC nurses on CI.

SUBJECTS: The target population was ostomy nurses who were members of the Wound, Ostomy and Continence Nurse's Society. Nine hundred eighty-five nurses out of a possible pool of 4191 members responded, providing a response rate of 24%. Their average age was 53 years (range, 25-79 years). Respondents averaged 12 years' experience as a WOC nurse (range, 1-40 years) and 90% (n = 875) were certified. Participants practiced in a variety of settings, including acute and long-term care facilities, home health, and ambulatory clinics. They saw an average of 37 ± 60.5 (mean ± SD) ostomy patients per year (range, 0-1100).

METHODS: A 1-time online survey (SurveyMonkey) of members of the Wound, Ostomy and Continence Nurses (WOCN) Society was conducted. In addition to demographic and educational information, questions also included (1) CI advantages and disadvantages; (2) CI content routinely taught; (3) challenges in assisting patients to learn CI; and (4) where preparation was received for teaching this procedure. Nurses were asked whether they believe CI is evidence-based.

RESULTS: More than half identified irrigation as an evidence-based practice (59%), but half indicated they do not routinely teach CI. Multiple factors correlated with nurses' decisions to teach CI, including years of experience (P = .03), specific CI education (P < .001), and considering the intervention evidence-based (P < .001).

CONCLUSION: Factors influencing CI instruction are multifactorial; they include nurses' attitudes, experience base, education, medical indications, setting characteristics, and patient interest and physical abilities. Education on this procedure is urgently needed for ostomy nurses unprepared and/or unfamiliar with CI, as well as staff nurses in acute care units who could offer accurate information and additional resources to patients to increase their informed decisions.

Martha D. Cobb, MS, CWOCN, Certified Wound, Ostomy and Continence Nurse, University of Arizona College of Nursing, Tucson.

Marcia Grant, RN, PhD, Professor, Division of Nursing Research and Education City of Hope National Medical Center/Beckman Research Institute, Duarte, CA.

Nancy J. Tallman, BSN, WOC Nurse, Unaffiliated, Tucson, Arizona.

Christopher S. Wendel, MS, Research Instructor, University of Arizona College of Medicine, Tucson; and Southern Arizona Veterans Affairs Health Care System, Tucson.

Janice Colwell, MS, CWOCN, Advanced Practice Nurse, Ostomy Care Services, University of Chicago Medicine, Chicago, Illinois.

Ruth McCorkle, RN, PhD, Florence Schorske Wald Professor of Nursing; Professor of Epidemiology, Yale School of Nursing, New Haven, Connecticut.

Robert S. Krouse, MD, Professor of Surgery; Staff General and Oncologic Surgeon, University of Arizona College of Medicine, Tucson; and Southern Arizona Veterans Affairs Health Care System, Tucson.

Correspondence: Robert S. Krouse, MD, Southern Arizona Veterans Affairs Health Care System, Surgical Care Line, 2-112, 3601 S 6th Ave, Tucson, AZ 85723 (

The authors declare no conflict of interest.

© 2015 by the Wound, Ostomy and Continence Nurses Society.