Ostomy

guidelines

ostomy nurses

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Manuscripts recently submitted to Wound Management & Prevention (and many published in recent years) address research regarding the effects of living with a stoma. The respective authors conducted studies to examine the stigmas associated with and ostomy1 and the effects of a stoma on the lives of patients’ spouses.2 Although direct evidence to support conducting a quality-of-life (QoL) assessment for persons who anticipate or live with a stoma remains limited,3 we know a whole lot more about what it means to have a stoma — and what it means to live with a person who has a stoma — than we did just a few decades ago. Case in point: a quick search of the literature showed QoL for persons with a stoma finally is starting to receive the attention it deserves. After a search of all abstracts in EBSCO for the terms ostomy and quality of life, 30 publications between 1986 and 1999, 186 publications from 2000 to the end of 2009, and 443(!) publications between 2010 and 2019 were identified. Using the same search criteria for  Proquest, 16 scholarly articles published between 2000 and the end of 2006, 44 publications from 2007 to 2013, and 108 publications between 2014 and September 2019 were found.

Ostomy care nurses and persons with a stoma and their partners have known all along that a stoma can negatively affect a person’s sexual life and that stoma and peristomal skin complications can profoundly affect QoL. Now there is ample evidence1-8 to support these observations and subsequently, sufficient reason to consider and address peripheral clinical concerns (eg, the noise associated with a functioning ostomy, the chagrin of inflicting the need for help with ostomy care on a spouse). Available research examining the relationships among having a stoma, stoma complications, and QoL led the Wound Ostomy and Continence Nurses Association to recommend inclusion of health-related QoL in preoperative education and QoL monitoring8 and led the Registered Nurses’ Association of Ontario3 to strongly recommend that: 1) health service organizations provide access to nurses specialized in wound, ostomy, and continence as essential members of the interprofessional team for all persons who anticipate having or live with an ostomy, 2) health service organizations implement an internal, expert-guided, standardized ostomy care program that is developed using an interprofessional, team-based approach, and 3) health providers assess QoL in persons who anticipate having or live with an ostomy. With respect to the latter, it is recommended that health care professionals focus on psychological distress (anxiety and depression) and self-identity (sexuality and body image).

If recent history is a predictor of our future, research to identify the impact of QoL assessments that establishes unambiguous evidence-based guidelines for assessment methods and their frequency should be available in the not-too-distant future. This will help to firmly establish a new era of holistic ostomy care, facilitate provision of said care, and supply more evidence that the holistic approach of ostomy care nurses is, and has been, what every person with a stoma deserves.