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Abstract
This article revisits the various issues that surround the nurse caring for a patient with a stoma (colostomy, ileostomy or urostomy). Understanding the basic anatomy, reasons for stoma formation and the surgical operations, including variations such as continent stomas, can assist the nurse in caring for this patient group. The article discusses briefly the various stoma appliances that can be used by the nurse or ostomate (person with a stoma). Practical tips on pre- and postoperative nursing care of the patient with a newly-formed stoma are provided for the nurse. In some cases, unfortunately, complications may occur following stoma-forming surgery; these are discussed and nursing advice provided. One of the most important ways in which the nurse can support the patient is to teach the patient his/her stoma care, ensuring independence before discharge and showing empathy and compassion.
Key words: * Nursing: role * Stoma care * Surgery: patient care
Astoma is a Greek word meaning mouth or opening (Williams and Ebanks, 2003). The current total number of people with stomas in the UK is approximately 100000 (Williams and Ebanks, 2003), a number that has changed little over the decades (Lee, 2001). It is not accurately known how many people have stomas, as there is no stoma patient database. Last year approximately 20 000 stomas were formed and about half of these were temporary (IMS Hospital Group, 2004). The most frequent temporary stoma was an ileostomy, but the most common permanent stoma remains a colostomy (IMS Hospital Group, 2004).
In 1959, Norma Gill, an ileostomate, established the first training courses for stoma therapists in the USA (Elcoat, 2003). Barbara Saunders at St Bartholomew's Hospital, London, was the first to commence a training course for stoma therapists in the UK 10 years later (McCahon, 1999). There are thought to be over 400 stoma care nurse specialists in the UK. Within the UK there are now a variety of support groups which include: for colostomates, the British Colostomy Association (BCA); for ileostomates, the Ileostomy and Internal Pouch Support Group (id); and for urostomates, the Urostomy Association (UA).
Anatomy
The gastrointestinal (GI) tract stretches from the mouth to the anus (Figure 1). Through the GI tract people gain their nutritional requirements and pass indigestible waste. Absorption...