How stoma care nursing has changed over the course of one nurse's career.

Pat Black, Associate Lecturer, Birmingham City University and previously Senior Lecturer, St Mark's Institute for Gastrointestinal Nursing, looks back at the origins of stoma care nursing and ponders what the future might hold.

The use of flange extenders to support patient care.

Pat Black, Senior Lecturer, St Mark's Institute of GI Nursing, St Mark's Hospital, explores one option for stoma care nurses to consider that could help improve patient confidence and comfort.

Caring for stoma patients with arthritis and mental incapacities.

Mental incapacities in the form of dementia, Parkinson's disease, Huntington's disease, and the physical incapacities of arthritis are difficult hurdles for an older patient who has to undergo stoma surgery, irrespective of the stoma being temporary or permanent. The loss of intellectual and physical function can cause significant deterioration in the patient's ability to carry out day-to-day activities and can also manifest itself in changes in social behaviour. Caring for these patients in the community will require the nurse to adjust the patient's care accordingly, and provide a holistic and more individualised care package that includes the support of the carer or spouse. This article discusses the ways in which community nurses can help the older stoma patient and carer.

The role of accessory product in patients with a stoma.

Intact skin provides a barrier between the body and its environment, and it follows that damage to the peristomal skin can be a significant problem for the person with a stoma. As many as one-third of colostomy patients and two-thirds of ileostomy and urostomy patients will be affected. Usage and opinions about accessory products in stoma care vary enormously and patients can identify accessory products as being necessary for their physical and psychological wellbeing.

Managing physical postoperative stoma complications.

Stoma surgery often changes a person's lifestyle and body image permanently, and can negatively influence recovery. Literature consistently demonstrates the profound impact that stoma formation can have on a person, bringing about not only physical changes, but also affecting psychological recovery. For the person who encounters additional problems with their stoma post-surgery, their recovery and return to their normal life in the community may be hindered and never fully complete. The complications associated with a stoma may be categorized into two areas: physical and psychological. For people who experience physical complications after stoma surgery, such as parastomal hernia, prolapse, retraction, obstruction and stenosis, their long-term recovery and adaptation will be hindered. This article explores the physical complications that may occur in people with a stoma and discusses the ways that healthcare professionals can help.

Stoma care nursing management: cost implications in community care.

Successfully rehabilitating the stoma patient in the community means continuing the care provided by the hospital and preparing the patient for this new phase of life. It is well documented that this transition from hospital to home can often be a difficult time for the stoma patient and that home visits and ongoing support from the district nursing team are needed for many patients in the long term. This article aims to help community nurses understand the needs of the stoma patient in their homes and looks at the current situation, including costs, of supplying stoma appliances in the community.

Cultural and religious beliefs in stoma care nursing.

Health-care delivery does not happen in a vacuum. Health is very much part of a persons life that also incorporates upbringing, culture and faith. One challenge in stoma care is to achieve a high level of care that meets the needs of all patients in a multicultural society. Knowledge of cultural differences is essential if sensitivity and competence are to be provided. The way people feel about themselves and others and their openness to learn about different cultures are central to cultural sensitivity. Cultural diversity is a fact of life. As the world responds to easier and faster global travel it is inevitable that nurses will meet and care for people from different countries. In a multicultural, multi-faith society, it is essential that care is offered in a way that respects and accommodates everyone's cultural and religious needs.

Choosing the correct stoma appliance.

Surgery to the bowel or bladder that results in a stoma, whether temporary or permanent, is designed to improve the patient's current situation in removing disease, reducing pain and improving health. Adaptation to a stoma is assisted by selection of the most appropriate appliance. Today there is an extensive array of stoma appliances available in the Drug Tariff, but many health-care professionals will have little knowledge of what to prescribe for the stoma patient. This article will look at choosing the correct appliance for the patient with a bowel or bladder stoma.

Peristomal skin care: an overview of available products.

Intact skin provides a protective barrier between the body and its environment. The frequent application and removal of stoma appliances can damage skin by stripping away the epidermal layer. Hydrocolloid flanges in either a one- or two-piece appliance hold moisture in the mass and are therefore more skin friendly than older appliances with acrylic adhesives, making hydrocolloid the choice for ostomy appliance manufacturers. Peristomal skin problems are a significant problem for the stoma patient. As many as one third of colostomy patients and more than two thirds of ileostomy and urostomy patients will be affected (Lyons and Smith, 2003). The correct and judicial use of barrier creams, gels, lotions, sprays and wipes in peristomal skin care can play an important role in giving the stoma patient a good quality of life.

Assessing the value of silicone and hydrocolloid products in stoma care.

Intact skin among many other functions provides a protective barrier between the body and its environment, which is critical in regulating transepidermal water loss (Wilkinson and Moor, 1982). The frequent application and removal of adhesives can damage skin by stripping away the outer epidermal layers. Older people, very young children and those with an underlying skin disorder may be particularly at risk (Gibelli et al, 1999; Lyons and Smith, 2003). Hydrocolloid adhesives, which hold moisture in the adhesive mass, are more skin friendly than the acrylic adhesives they now replace and have now become the material of choice for ostomy flanges and flange extenders (Smith et al, 2007). To understand stoma care nurses' awareness of the value of technologically advanced silicone and hydrocolloid products, the authors undertook a nationwide postal survey. The survey, commissioned by four companies in the United Kingdom, who make silicone and hydrocolloid products that can be used in stoma care, were keen to evaluate the awareness of these products to confirm their importance to the patient and why they should be appropriately categorized for reimbursement by the Department of Health.

Predictors of adherence to latent tuberculosis infection therapy in Latino immigrants.

Adherence to Latent Tuberculosis Infection (LTBI) therapy is a continuing community problem. The purpose of this study was to examine the predictors of adherence to LTBI therapy in Latino immigrants at a public health clinic. A descriptive study was conducted to examine 153 randomly selected records from a population of Latino immigrant clients who had received a recommendation for 9 months of Isoniazid (INH) therapy. Most of the clients were women (64%), the mean age was 26.1, and the mean time in the U.S. was 4.58 years. The majority came from El Salvador, Bolivia, or Guatemala. Adherence dropped off in a linear fashion from month 1 (84%) to month 8 (34%). None of the demographic factors predicted adherence. Implications for community health nursing are discussed.

Caring for people with a learning disability, colorectal cancer and stoma.

Longevity in people with learning disabilities has increased substantially over recent years and as life expectancy increases for this population so does the risk of colorectal cancer. Today, with the transition from institution to the community for people with learning disabilities, conscientious and competent medical and nursing care is a necessity. This article examines autonomy, consent, treatment, palliative care and death relating to people with profound learning disabilities and challenging behaviour, who also have colorectal cancer and stomas. Lack of written information, knowledge, and organizational planning need to be addressed to bring cancer services for the patient with learning disabilities to the level that it is for the general population.

The importance of palliative care for patients with colorectal cancer.

In Westernized countries colorectal cancer is a very common form of cancer, with over 30,000 cases registered annually in the UK (Taylor et al, 2002). Cancer of the large bowel is the second most common cause of cancer death, with over 17,000 cases per year (Cancer Research Campaign (CRC), 1999). Bowel cancer is related to age, with as many as 80% of cases in people who are 60 years or over. Eighty per cent of patients undergo surgery with curative intent but recurrence will occur in half of these cases (National Cancer Institute, 2001). Palliative care is a person-centred approach that provides essential support to patients with bowel and colorectal cancer with an emphasis on symptom control, and psychological and social support. Care for this group of patients depends on an interdisciplinary approach with mutual respect for all the team members and good communication that enables the patient, where possible, to be involved in any decision-making about care and treatment.