The Ostomy Files: The Power of Knowledge

    One of the most pivotal aspects of ostomy rehabilitation is teaching. The patient, the patient's family or significant others, paid caregivers, and other healthcare professionals (HCPs) must be taught 1) how to care for the stoma and peristomal skin, 2) how to accommodate changes in lifestyle resulting from ostomy surgery, 3) where to find necessary resources, and 4) to seek the "right" pouching system.¹

However, teaching fellow HCPs is sometimes viewed as a threat by WOC or other specialized nurses. Specialized nurses, like other professionals, view their knowledge as a source of wealth and are frequently hesitant to part with it² for fear of losing their job. In today's healthcare arena, this perceived threat could not be further from the truth.

    Dawson² refers to "knowledge transfer" as teaching peers/clients to be better at what they do. If the expert nurse is teaching the non-specialized nurse to be better at her job, it is unlikely the expert nurse will be replaced by the non-specialized nurse, because the two job descriptions are polar opposites. In fact, refusing to transfer knowledge is a totally unsustainable position in today's healthcare delivery system. The bottom line is that the patient will pursue the missing knowledge until answers and solutions are found. Sooner or later, another expert HCP will provide the knowledge and the patient will continue to return to that HCP, recognizing that offering knowledge is part of the service the HCP provides. Those who share knowledge will never find themselves without a job.

    Patients are told about ostomy "bags" and usually do not know about pouching options other than the system they wore home from the hospital. An analogy to a similar scenario would be if a physician tells a patient to take a particular drug without explaining what the drug is, why it is indicated, and any of its potential side affects. The patient is told nothing more than to take the drug. Today's healthcare consumers want more. They want knowledge. They want options. They seek HCPs who explain their diagnoses in terms they understand as well as why the condition occurred, what the treatment plans are, and what they can to do stay well and improve the quality of their life once their condition has improved.² Ostomy patients want to know what other pouching systems and new technologies are available that might be more comfortable, aesthetically pleasing, help improve their self-confidence and body image, or even change their lives. Sharing this kind of knowledge reflects the HCP's genuine consideration for the patient's wishes and an interest in meeting patient-defined needs.

    In addition to adjusting to a different type or brand of ostomy pouching system, the new ostomy patient finds nothing more unsettling than to be discharged from the hospital to home and have the self-care skills that were taught in the hospital disrupted by home care nurses who issue a different set of instructions. Such inconsistencies and setbacks delay rehabilitation. Knowledge transfer between patients and HCPs helps hone self-care skills, improve the patient's quality of life, and establish continuity between caregivers and patients.

    Mrs. B was a 65 year-old widow with a sigmoid colostomy secondary to colon cancer. She lived alone, was active in her community, and had managed her colostomy for the previous 5 years with daily irrigations. After suffering a stroke, she lost partial use of her left side, used a wheelchair, and was no longer able to perform daily irrigations. She was switched to a drainable pouch, which her daughter emptied every day on her lunch break and changed once a week. This proved to be an unsustainable situation for the daughter, and the family began discussing nursing home placement. Mrs. B had been an extremely independent person and the idea of living in a nursing home was unbearable. The home care nurse listened carefully to the family's dilemma, re-evaluated the pouching system, and concluded that a closed-end pouch might help Mrs. B remain in her house if her daughter would agree to continue weekly visits to change the system. Mrs. B was taught how to remove and apply the two-piece closed-end pouch with her "good" hand. Once she was able to demonstrate proficiency in this task, Mrs. B simply removed the pouch when it became soiled, discarded it, and applied a clean closed-end pouch to the skin barrier wafer. The daughter continued her weekly visits to change the wafer and Mrs. B was able to remain in her home.

    Knowledge transfer as it relates to ostomy means that the HCP has a working knowledge of basic ostomy care, the types of pouching systems available, and the ability to translate their unique features and benefits into a pouching solution that meets a particular patient's stated need. To ensure continuity and consideration, healthcare professionals should willingly share knowledge with patients, as well as other care providers. 

The Ostomy Files is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ

1. Turnbull GB. The ostomy assessment inventory: a data-gathering process to enhance appropriate pouching system selection. Ostomy/Wound Management. 1998;44(2):28-37.

2. Dawson R. Developing Knowledge-based Client Relationships: The Future of Professional Services. Boston, Mass.: Butterworth Heinemann;2002.