References
Overview of stoma care for community nurses
Abstract
This article explores nursing care for stoma patients, with a focus on colostomies, while providing some broader information covering a multitude of topics that relate to any type of stoma. Nurses must be aware of various factors when caring for stoma patients, as the latter will not always be in touch with their specialist stoma nurse. Therefore, if a community nurse visits more often, they can make a difference with their knowledge and care. Complications are not uncommon, and it is important the correct advice is given on diet, exercise, avoiding complications such as parastomal hernia through certain techniques, medications and aids and appliances. SecuriCare and the Royal College of Nursing have produced clinical nursing standards for the stoma nurse, and these are also relevant to community nurses. A pharmacist can give more specialist advice on medications, a GP can prescribe for infections, and a stoma nurse can provide specialist expertise to the nurse and patient alike, but the community nurse is at the frontline with a community patient. Therefore, they should be equipped with the knowledge and care expertise, so they can know when to act by referral to the appropriate professional, or give the appropriate care and advice. The patient will also have psychological needs to consider, which may require referral if these are beyond the specialist stoma nurse's or community nurse's abilities.
For nurses, it is common in the acute ward and community environments, as well as in palliative care, to care for patients with a colostomy. Therefore, it is important to have an overview of its use and any complications.
A colostomy is needed to treat conditions such as bowel cancer, Crohn's disease, diverticulitis; anal, vaginal or cervical cancer; bowel incontinence; and/or Hirschsprung's disease (NHS, 2017). Colostomy and ileostomy are the most common forms of stoma but a gastrostomy, jejunostomy, duodenostomy or caecostomy may also be performed (National Institute for Health and Care Excellence (NICE), 2020). The present article focuses on colostomies but also provides general information about the care of the stoma site and other factors that are relevant across all types of ostomies, such as medications, complications, diet and exercise.
A colostomy is made after a section of the colon has been removed and the bowel cannot be rejoined. It can be required if the person cannot pass stool through the anus because of illness, injury or a problem with the digestive system. A colostomy may be temporary and followed by a colostomy reversal at a later date, or may be permanent. Surgeries include loop colostomy, whereby the patient has two stomas, or end colostomy, where the patient has only one stoma.
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