Many ostomates (people with a stoma) are affected by the complication of a parastomal hernia. The ostomate does not only need to adjust to the stoma but also to the presence of the parastomal hernia and its effect on the stoma function, appliance choice, and skin condition; moreover, it affects the ostomate's ability to manage his/her daily activities. The NHS spends over £1 million in the provision of support garments. While this is a cheaper management option compared with surgery to repair or refashion the stoma, it is important that the most appropriate type of garment is chosen. Selecting the most appropriate garment not only ensures that the person with a stoma can manage the garment easily but also avoids costly trial and wastage of NHS resources. Having knowledge of the type and range of support garments available enables the nurse to advise and assist people in the management of parastomal hernias.

Stoma siting is often regarded as the most important part of preoperative preparation. Marking the abdominal skin at the proposed stoma site takes place after a period of assessment, discussion, observation, consideration and evaluation that will have begun on the first meeting between the patient and the nurse. The siting procedure is a joint decision made between the patient and the nurse about the most suitable place for their stoma. The position of the stoma should allow the patient to manage it independently and to resume their normal activities after recovery. The success of the stoma can depend on the site and its condition. The purpose of this article is to describe and discuss the siting process and how it benefits the patient. Community nurses should gain a greater understanding of the issues involved, as well as the considerations for both the nurse and the patient. This article is intended to help the community nurse feel more aware of the issues involved in siting, and feel more prepared to assist the patient to prepare for and begin their life with the stoma. The outcome and effects of a 'poorly' or 'less than ideally' sited stoma (e.g. formed during emergency surgery), and its care and management will also be discussed. Illustrations have been included to assist the reader through the process of siting.

Stoma care nurses are in a unique position to offer support and advice to enable ostomates to achieve their optimum quality of life, allowing them to fulfil their family, work and social duties and return to the relationships, activities, sports, hobbies and lifestyle that they enjoyed before their surgery. Stoma care nurses use their expert knowledge and skills to offer such support, and have an in-depth knowledge of the appliances and accessories that can assist people to not only maintain healthy skin, but to feel confident and secure when wearing their pouch and allow them to function as independently and to achieve as much as possible. This article discusses some of the accessories that may be useful for those requiring additional support, to enable them to return to their usual lifestyle or enhance their quality of life.

For most patients, being discharged from hospital is an important milestone in their recovery. Having come through surgery, they have completed their early recovery, are well enough to leave the safe confines of the hospital and have reached the natural end point of what should be a well coordinated episode of care with a satisfactory outcome, where the discharge is as important as the admission. However, although most are naturally pleased to be going home, patients will have many fears and anxieties about how they are actually going to manage. This includes not only coping with their recovery, but also managing their lives, returning to their usual activities and lifestyle and coping with their new stoma. Knowledge information and support, nursing interventions and experiences in hospital are valuable and will be put to good use at home. This article identifies the key issues that may arise during this time, the level of knowledge and skill required for a successful transition home and the support required by the patient to adapt to their changed circumstances.

As the population ages and the number of people living with a long-term condition grows, it is likely that community nurses may be presented with increasing numbers of people requiring assessment, support, and advice for complex needs. Many of the long-term conditions affect the patient's ability to live and manage aspects of daily life independently and may affect the ability to manage a stoma. The purpose of this article is to consider how long-term conditions affect daily living and stoma care, and make practical suggestions for stoma management. Sources of further help and information for people living with a stoma (ostomates) and a long-term condition have also been included. It is hoped that by reading this article, the nurse will become more familiar with the difficulties with dexterity associated with long-term conditions experienced by ostomates, and how they can be assisted in managing and living as independently as possible.