How to Provide Effective Stoma Care in Nursing

Stoma care in nursing is a critical skill that requires precision, empathy, and ongoing education. At Nursed, we understand the challenges healthcare professionals face when providing care for patients with stomas.

This guide offers practical steps and expert insights to help nurses deliver effective stoma care, manage complications, and support patients’ physical and emotional well-being.

What Are Stomas and Why Are They Created?

Understanding Stomas

Stomas are surgically created openings on the abdomen that allow waste to exit the body when normal function is impaired. These openings play a vital role in managing various medical conditions and improving patients’ quality of life.

Types of Stomas

There are three main types of stomas:

1. Colostomies: Created from the large intestine, typically producing formed stool.
2. Ileostomies: Involve the small intestine, with output tending to be more liquid.
3. Urostomies: Divert urine from the bladder or kidneys.

The Australian Ostomy Association provides support and information for individuals living with stomas through their journal, which is published three times per year and available free to every member.

Common Reasons for Stoma Creation

Medical professionals create stomas for various reasons:

• Bowel cancer (the third most commonly diagnosed cancer in Australia, with around 16,000 new diagnoses estimated in 2019)
• Inflammatory bowel diseases (e.g., Crohn’s disease or ulcerative colitis)
• Diverticulitis
• Trauma to the abdomen

Some stomas are temporary, allowing the bowel to heal after surgery. However, many are permanent, which requires long-term management and care.

Impact on Patient Life

Living with a stoma significantly affects a person’s daily life. It’s not just about managing waste; it’s about adapting to a new body image and lifestyle. Healthcare professionals must be sensitive to these changes and provide comprehensive support.

A study published in the Journal of Wound, Ostomy and Continence Nursing explored health status, illness perceptions, coping strategies, and psychological morbidity in stoma patients.

The Role of Healthcare Professionals

As healthcare professionals, we must:

1. Educate patients about their specific type of stoma
2. Teach proper stoma care techniques
3. Address concerns about body image and lifestyle changes
4. Provide ongoing support and follow-up care

Our focus should be on empowering clients with stomas to lead full, independent lives. We must provide tailored support and education to help them navigate this change confidently.

The next chapter will explore the essential steps in providing effective stoma care, including proper hygiene practices and assessment techniques.

How to Perform Effective Stoma Care

Effective stoma hygiene forms the cornerstone of ostomy care. We’ve developed a comprehensive protocol for stoma care that ensures optimal outcomes for our clients.

Maintain Impeccable Hygiene

The first step in stoma care is to maintain strict hand hygiene. Use an alcohol-based hand rub or wash hands with soap and water for at least 20 seconds before and after any stoma-related procedure. This simple yet important step significantly reduces the risk of infection.

When you handle stoma equipment, always use non-sterile gloves. Change gloves between tasks to prevent cross-contamination. A clean environment is essential for successful stoma management.

Assess Stoma Health

Regularly assess the stoma and surrounding skin. A healthy stoma should be pink or red, moist, and slightly raised above the skin level. The Australian Association of Stomal Therapy Nurses recommends daily inspections to catch any changes early.

Look for signs of complications such as:

• Unusual colour changes (pale, dark, or bluish tints)
• Excessive colour changes
• Swelling or retraction
• Skin irritation or breakdown around the stoma

Early detection of these issues allows for prompt intervention, preventing more serious complications.

Clean Properly

Clean the skin around your stoma with water, as it works best. Avoid using soaps, wipes, or products containing alcohol, as these can irritate the skin.

Pat the area dry carefully, ensuring no moisture remains. Leaving the skin damp can lead to skin breakdown and increase the risk of infection.

Master Stoma Bag Application

Apply and change stoma bags with skill (this improves with practice). Measure the stoma size regularly, as it can change over time, especially in the weeks following surgery. Use a stoma measuring guide to ensure a perfect fit.

When you apply a new bag, ensure the skin is completely dry. Apply any prescribed barrier products to protect the skin. Warm the baseplate between your hands to improve adhesion. Align the hole in the baseplate precisely over the stoma, smoothing outwards to remove any air bubbles.

Monitor Output

Empty and measure stoma output to assess hydration status and overall health. For ileostomies, output should be between 400-800 ml in 24 hours and is usually of a porridge-like consistency. Colostomy output varies but should be consistent with the patient’s normal bowel habits.

Record the volume, consistency, and colour of the output. Significant changes may indicate issues such as dehydration or infection and should be reported to the healthcare team immediately.

Emphasise the importance of thorough documentation. Accurate records of stoma care procedures, observations, and any concerns raised by the client are essential for continuity of care and early detection of potential issues.

The next chapter will explore common complications that can arise with stomas and how to manage them effectively, ensuring comprehensive care for individuals with stomas.

How to Handle Stoma Complications

Skin Irritation and Breakdown

Peristomal skin problems affect up to 73% of ostomates. To prevent and manage skin irritation:

1. Use skin barrier products to protect the skin from stoma output.
2. Ensure the stoma appliance fits correctly to prevent leakage.
3. Change the appliance regularly (typically every 3-7 days for colostomies and every 2-3 days for ileostomies).
4. If irritation occurs, consider using a convex appliance or stoma powder to promote healing.

Leakage Prevention and Odour Control

Leakage is a major concern for many ostomates. To minimise this risk:

1. Measure the stoma regularly and cut the appliance to fit precisely.
2. Use additional adhesive products like barrier rings or strips for extra security.
3. Empty the pouch when it’s one-third to half full to prevent overflow.

For odour control:

1. Use deodorising drops or tablets in the pouch.
2. Avoid foods known to cause strong odours (such as eggs and certain vegetables).
3. Ensure the appliance is sealed properly after each emptying.

Stoma Prolapse and Retraction

If prolapse occurs:

1. Apply a cold compress to reduce swelling.
2. Use a larger pouch to accommodate the increased stoma size.
3. Seek medical attention if the stoma appears discoloured or painful.

For stoma retraction:

1. Use a convex appliance to create a better seal.
2. Consider using stoma belts for additional support.
3. Consult a stoma nurse for possible surgical revision if retraction is severe.

Dehydration and Electrolyte Imbalances

Dehydration is a significant risk, especially for ileostomy patients. To prevent this:

1. Encourage patients to drink at least 2-3 litres of fluid daily.
2. Monitor urine output and colour; dark urine indicates dehydration.
3. Recommend electrolyte replacement drinks if output is high.

Psychosocial Support

The psychological impact of living with a stoma can be profound. We prioritise holistic care:

1. Offer counselling services or support group referrals.
2. Provide education on body image and intimacy concerns.
3. Encourage patients to gradually resume normal activities to boost confidence.

Regular follow-ups and open communication are key to identifying and managing issues early.

Final Thoughts

Effective stoma care in nursing demands a comprehensive approach that combines technical skill, empathy, and continuous education. Nurses must maintain impeccable hygiene, assess stoma health regularly, and master proper cleaning and appliance application techniques. Individualised care stands as the cornerstone of successful stoma management, with each patient requiring a unique care plan tailored to their specific needs.

Patient education empowers individuals to manage their stomas confidently and maintain independence. Nurses should provide clear, practical information and ongoing support to help patients adapt to life with a stoma. Regular assessment and adaptation of care plans ensure long-term success, as patients’ needs evolve over time.

We at Nursed understand the complexities of stoma care and its impact on patients’ lives. Our team of dedicated professionals commits to providing personalised support and enhancing the quality of life for individuals with stomas. We strive to help our clients lead fulfilling lives through comprehensive care, community integration, and fostering independence (despite the challenges they may face).