The Stoma Care Nurse
The Stoma Care Nurse is a senior registered nurse who has undertaken a special course in the care of people with stomas. Most of the larger hospitals have a stoma care nurse; many of the smaller hospitals employ a nurse in a part-time dual position.
The role of the Stoma Care Nurse Specialist is often described as multifaceted, acting not only as a clinician but also an educator, researcher, consultant and clinical lead. Prior to the arrival of the stoma care nurse specialist in the late 1960â€™s, the patient with a newly formed stoma was heavily reliant upon the surgeon, appliance manufacturer and/or self help groups for support, information and advice. Whilst these resources are still available the stoma care nurse specialist has brought about remarkable improvements in the quality of life for those patients with new and established stomas. As well as managing clinical issues, they have encouraged surgeons in developing surgical techniques, for example, the size and shape of a colostomy or ileostomy. They took over the pre-operative siting of
stomas ensuring the stoma is created in the optimal place on the abdomen for the patient.
They also take part in product evaluation, offering feedback to manufacturers so that research and development of stoma appliances can take place.
You can contact your stoma nurse and also get details of outpatient clinic times through the hospital or community nursing service. It may be necessary to make an appointment for a consultation, but a phone call may be all that is needed to get an answer to that query you have.
A stoma nurse is able to help with teaching you all aspects of stoma care and is there to ensure that you are using the appliance that best suits you. Stoma nurses will arrange for ongoing supplies, and are there if you have any problems with the management of your stoma. A surgeon may request the stoma care nurse to site the stoma prior to surgery; consideration is given to the selection of a flat area of the abdominal wall, identification of skin folds, creases, scars and other irregularities which will be avoided to ensure the optimal position for the stoma. Advice may be given to the patient re weight gain or loss, if this is indicated for successful appliance management.
If at some time you consider changing to a different appliance, this should always be done in consultation with your stoma nurse.
It is generally advised that ostomates are checked annually to ensure that all is well and that the most suitable appliance is being used.
Scope of practice of the stoma care nurse specialist:
The key components of specialist practice are considered to be the provision of expert clinical care, education, research and consultancy and service management (Porrett and David 1999). These parameters are central to stoma care nursing. More specifically the role is seen as assisting the stoma patient to rehabilitate and regain the quality of life known prior to stoma surgery (Salter 1997). This will include;
> Pre-operative information giving / counselling
> Siting of the stoma
> Stoma appliance and accessory information
> Post-operative management
> Discharge planning
> Alternative stoma management â€" colostomy irrigation, colostomy plug
> Enterocutaneous fistula/wound management
> Manage stoma complications
> Psychological support
> Internal pouch care
> Pediatric stoma care
> Health education/promotion - diet, exercise, travel, returning to work, family planning, pregnancy
> Nurse - led follow-up clinics
> Nurse prescribing
> Measuring and fitting support garments
> Self help groups - national and local
> Liaising with the multi-disciplinary team involved in the care of the stoma patient