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The Ostomy Files: There’s No Place Like Home
Regardless of the reason for hospital admission, patients eagerly await discharge. They cannot wait until the day they get to return to their loved ones and the comfort, familiarity, and security of their own surroundings. During hospitalization, access to the expertise of various healthcare professionals is only a button push away – medical questions can be quickly answered and physical problems promptly resolved. During this time, patients may not have the physical strength or knowledge required to be independent in care; consequently, they become dependent on hospital staff for most of their needs during what is commonly a very short length of stay. The person who comes into the hospital for ostomy surgery is not the same person who leaves. Dramatic physical and emotional changes have occurred. Before discharge, ostomy patients are instructed on self-care (stoma and incision) through demonstration and may adequately verbalize their understanding and demonstrate their ability to perform self-care or at least participate in it. On the day of discharge, they are given a written discharge sheet. But once patients are home, unanticipated problems and complications may arise. Gone is the security of instant professional assistance and intervention. Consider the patient with a colostomy who is taught how to irrigate during hospitalization but whose home lacks running water or an indoor toilet.
The literature tells us a considerable proportion of people with a stoma will experience at least one (if not several) complications related to their stoma or the peristomal skin.1 A recently published patient survey2 conducted at a North Carolina Hospital revealed five common problems ostomy patients experienced at home after hospital discharge: peristomal skin irritation, pouch leakage, odor, reduction in previously enjoyed activities, and depression and anxiety. The average number of problems per patient in this study was 3.6. These findings mirror similar problems identified by earlier studies of postoperative issues for persons with a stoma.
The challenge for health professionals caring for patients with a stoma is to take all measures to prevent the development of anxiety-producing, depressing, isolating, and costly complications. Such measures include providing adequate patient information (written and verbal) to assist patients facing challenges at home after discharge.
Pieper et al3 conducted a literature review on the information surgical patients need after hospital discharge. What became evident is something healthcare professionals have known for years: patients do not retain all the information they are provided in the hospital. The literature3 also supports patients’ desires to have more indepth, “nitty gritty” practical information about how to identify and prevent complications, integrate back into their daily life (work, sex, sports), manage their surgical wound, and obtain additional information and support. The importance of having adequate information about their individual situation increases significantly at home.
One of the most crucial aspects of ostomy rehabilitation from both a psychological and physical perspective is the provision of a reliable, leak-proof, easy-to-use ostomy pouching system. One of the biggest fears ostomy patients experience is that the pouch will leak. If the fear of leakage becomes overwhelming or leakage actually occurs, it can cause social withdrawal, isolation, and depression. Depression in ostomy patients is quite common,2,4,5 sometimes affecting as many as 50% of the patient population, and is frequently ignored or left untreated.
Leakage and poorly fitting or inappropriate ostomy skin barriers lead to peristomal skin irritation, creating a cycle of leakage, skin irritation, and more leakage. Because the stoma changes size and shape as postoperative stomal edema subsides and the patient regains strength and increases activity, experiencing leakage from poorly sized or improperly shaped ostomy skin barriers is a particular risk during this initial postdischarge period. Newer technologies and improvements to ostomy skin barriers can be valuable tools in avoiding leakage secondary to changes in stoma shape and size.
The challenge is to provide adequate, practical, in-depth information in the short time ostomy patients are exposed to the expertise of healthcare professionals. Patients need more detailed information about how the surgery could affect their ability to participate in sexual activity and how feeling depressed after surgery may be a normal part of recovery. The need for more broad-based information and follow-up is paramount. Differences in language, literacy, economic status, and education indicate the continuing need for reinforcement of teaching, both verbal and written. The person with a new ostomy who is armed with a reliable, leak-proof pouching system and crucial information on how to manage and trouble shoot at home will be the person who more quickly moves toward integrating the stoma into everyday life.
The Ostomy Files is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ. This article was not subject to the Ostomy Wound Management peer-review process.
1. Colwell JC, Beitz J. Survey of wound, ostomy, and continence (WOC) nurse clinicians on stomal and peristomal complications. J WOCN Nurs. 2007;34(1):57-69.
2. Richbourg L, Thorpe JM, Rapp CG. Difficulties experienced by the ostomate after hospital discharge. J WOCN Nurs. 2007;34(1):70-79.
3. Pieper B, Sieggreen M, Freeland B, et al. Discharge information needs of patients after surgery. J WOCN Nurs. 2006;33(3):280-290.
4. Pringle W, Swan E. Continuing care after discharge from hospital for stoma patients. Br J Nurs. 2001;10(119):1275-1288.
5. Wade BE. Colostomy patients: psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma care nurses and districts which did not. J Adv Nurs. 1990;15(11):1297-1304.
