Teaching patients practical skills in stoma care is a complex process and although, arguably, at the very heart of stoma care nursing practice, has been largely ignored in the literature. Teaching principles are based upon social learning theory and educationalists provide guidelines on the most effective way to teach a practical skill. These guidelines have been utilized by nurses when teaching patients with newly formed stomas how to change a pouch. The process of adapting to a stoma and its daily management takes time. Psychologically, however, some patients will adapt more easily than others and researchers have attempted to identify factors which may account for this. Studies have demonstrated that patients who are satisfied with the amount of preoperative information they receive are less likely to develop psychological problems. Psychological adjustment may be affected if patients feel that they have developed insufficient pouch changing skills or have problems with leakage from their pouch or sore skin around their stoma. Studies have also demonstrated that cognitive factors, such as patients feeling in control of their illness and stoma, have been found to play a role in psychological adaptation. Clinical nurse specialists in stoma care are in an ideal position to target these cognitive factors using a variety of strategies including effective practical teaching to empower patients, thus facilitating psychological adaptation following stoma surgery.

This paper will discuss the importance of performance appraisal and staff development for graduate nurses. It argues that these strategies assist newly graduated nurses to enhance and consolidate knowledge and practice skills. Further, the net benefit for employers is improved quality outcomes, increased job satisfaction by staff and cost-effective usage of resources. The limitations of performance appraisal and staff development, however, occur when management and staff do not understand the principles of performance appraisal and the need for consultation with staff about staff development activity.

A review of the types of enterocutaneous fistula and their management

Crohn's disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract from mouth to anus. In this article, Chris Metcalf examines the clinical features, investigations, medical treatment and surgical management, as well as the psychological aspects, of the disease.

This article discusses how nurses can effectively utilize listening skills during interactions with patients. Listening is a core skill for all healthcare professionals with studies demonstrating that nurses perceive themselves to be much less skillful in the use of facilitative interpersonal skills which involve listening than practitioner centred authoritative ones. Listening effectively allows nurses to respond more completely to patients' needs but there are many obstacles which unfortunately can interfere with this process. Stoma care nurses utilize listening skills to ensure that both the physical and psychological needs of their patients are met. The author suggests that listening skills can enhance intuitive nursing practice.