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The Ostomy Files: Using Education to Increase Self-Care for the Person with an Ostomy
It is impossible to care for people who have undergone ostomy surgery without considering the psychological and physical impact the surgery will have on their lives.1 Due to shortened length of hospital stays, clinicians often have limited time to address more than ostomy “survival skills”2 before the patient is discharged. Post-discharge follow-up is frequently provided by non-specialized home care nurses who also may focus more attention on stoma management than on what is happening to the patient “between the ears.” White1 speculates that most psychological problems for these patients are related in some way to the individual’s inability to perform self-care and that an improvement in this area could have a positive affect on psychological well-being.
Preoperative counseling and patient teaching have been shown to yield many positive psychological and physical benefits to patients.3 Preoperative teaching should cover not only what is going to happen before, during, and after surgery (eg, anesthesia, nasogastric tube, urinary catheter, IV, coughing, and deep breathing), but also how the body will be changed physically and the anatomical ramification of those changes (ie, sexuality, activities of daily living, elimination), as well as how the individual will manage the ostomy (ie, pouching systems, skin barriers, skin care). Before discharge, the patient also should receive instruction on some of the potential common problems that may arise after hospital discharge (eg, irritant dermatitis, folliculitis, food blockage), steps to take at home, and when to contact a medical professional.
The questions that always arise regarding patient education are, “How much information is too much information?” “When is it appropriate to discuss post-discharge problems?” Fifty years after the establishment of Enterostomal Therapy, hundreds of North Americans with an ostomy still do not have access to the services of a WOC Nurse or an ET Nurse. When these underserved patients seek information, they often turn to the Internet, where they may find unsubstantiated or erroneous information. Clinicians caring for ostomy patients should visit some of these sites or simply type in “ostomy” on an Internet browser and examine the quality and quantity of information available.
This situation easily lends itself to providing as much clinically correct information as possible to the patient while he/she is under the care of a healthcare professional, even if that exposure is short. Because patients are unable to retain much of what they are told during hospitalization or an office visit, written materials should be provided as reinforcement to what was taught and discussed. Written materials should have easy-to-read, step-by-step instructions in large font generously illustrated with photographs and graphics.
Providing information is not only an ethical issue — in most countries, it is also a legal issue. The American Medical Association defines informed consent as “. . .more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention.”4 A patient’s family also should be involved in the teaching and urged to acknowledge how the patient feels rather than concentrating on the altered body, the illness, or the stoma.
Ideally, patient education begins before surgery and continues after hospital discharge until the individual can perform self-care to his/her maximum functional and cognitive ability. The goal of patient teaching is for the patient to transfer the information presented and the skills practiced to everyday life. Smith5 states, “Patient education is the single most important action toward independence, confidence, and rehabilitation for the patient.” Teaching cannot be left to chance. Again, the question: Can you provide a new ostomy patient with too much information? Probably not.
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. White CA. Ostomy adjustment. In: Colwell JC, Goldberg MT (eds). Fecal & Urinary Diversions: Management Principles. St. Louis, Mo; Mosby;2004:326–336.
2. Turnbull GT. Is there a gap in ostomy rehabilitation? Ostomy Wound Manage. 2006(52)1:19–20.
3. Johnston M, Vogele C. Benefits of psychological preparation for surgery: a meta-analysis. Ann Behav Med. 1993;15:245–256.
4. The American Medical Association. Informed consent. Available at: www.ama.assn.org/ama/pub/category/4608.html. Accessed August 7, 2006.
5. Smith DB. Psychosocial adaptation. In: Hampton BF, Bryant RA (eds). Ostomies and Continent Diversions: Nursing Management. St. Louis, Mo; Mosby Year Book;1992:1–28.
