Stoma care: empowering patients through teaching practical skills

Abstract

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.

The Urostomy Education Scale

“…4 Moreover, functional impairments such as reduced motor function of the hands or impaired vision can infl uence ostomy selfcare. Fear, pain, and nausea infl uence learning, and each must be addressed before effective learning can occur.…”

“…Fear, pain, and nausea infl uence learning, and each must be addressed before effective learning can occur. 4,6,7,10,12 Literature search revealed several relevant educational plans including validated tools concerning skin problems 13 and scales to measure health-related quality of life after cystectomy. 7 , 10 The introduction of fast track pathways in clinical practice has reduced the length of postoperative hospitalization and opportunities for teaching while the patient remains in hospital signifi cantly.…”

Testing inter-rater reliability of the Urostomy Education Scale

“…There is mounting evidence that stoma self-care ability is the most important variable predicting positive adjustment to life with a stoma (Piwonka and Merino, 1999). Confidence in changing the stoma appliance and stoma self-care skills have been suggested to significantly increase the perception of QoL (Brown and Randle, 2005;Geng et al, 2009;Marquis et al, 2003;Metcalf, 1999;O'Connor, 2005;Wu et al, 2007). Generally, education in stoma self-care occurs during the patient's recovery in hospital after surgery.…”

“…However, sessions of reinforcement and follow up are suggested to be limited after discharge and unmet needs are not well described (Mohamed et al, 2014). To improve stoma self-care skills, daily education in stoma care has been recommended (Metcalf, 1999;Vujnovich, 2008) and the literature also demonstrates discussion as to whether stoma care should be managed by well-informed and experienced ward nurses or specialised stoma care nurses (Black, 2009;Brown and Randle, 2005;O'Connor, 2005;Rust, 2007;Wound, 2010). To assure quality of care, standardised supportive care plans should be available that allow for the key areas of care intervention to be identified.…”

“…To assure quality of care, standardised supportive care plans should be available that allow for the key areas of care intervention to be identified. However, the use of standardised care plans is not intended to offer a 'one size fits all approach to care' and patients' individual needs must be considered and used to individualise the standardised plans (Metcalf, 1999;O'Connor, 2005;O'Shea, 2001). So far, there are no available standard care plans although international societies in the field of stoma care have provided practice guidelines and recommendations (Geng et al, 2009;Wound, 2010;Zulkowski et al, 2014) that could assist their construction.…”