Self Care Ostomy Managment Teaching in the Home Care Setting

Self Care Ostomy Management Teaching in the Home Care Setting

Deborah Saelinger RN, MS, CWOCN

Baptist Home Health: Jacksonville, FL

Following discharge from hospitalization for ostomy surgery, the majority of patients within our health care system require home health support for the completion of their physical and emotional recovery. In conjunction with cognitive and affective learning, the mastery of the psychomotor skills associated with managing their appliance system is one major component of that recovery.¹

In Spring 2009, the four acute care hospitals and five county wide home health agencies within our integrated health system replaced a standard two-piece cut to fit ostomy appliance* with a moldable two piece appliance** offering patients both a flat and convex option. This new system offers distinct advantages for the new learner. The customization of the skin barrier starter opening can be accomplished without the use of scissors; and the need for a secondary paste or barrier ring becomes optional. This reduces two key steps which required good visual acuity and dexterity.

Many of the patients within our agency had their ostomies created following an acute abdomen. The resulting stoma often required convexity. Outlining the patient’s stomal contours on the skin barrier’s plastic release paper facilitates customization .

Breaking down the patient education program into three major sequential steps builds confidence quickly. These steps include (1) molding the new skin barrier; (2) removal of the old skin barrier, and cleaning skin; (3) seating the new wafer and pouch. Being able to resize the barrier once applied over the stoma is invaluable when the stomal contours are disproportionate from stomal surface and the stomal skin margin.

This poster includes an outline of the staff education required to successfully make this transition, as well as an overview of the patient instruction process implemented within the agency. Outcomes such as patient mastery of self ostomy care and nursing implications will be reported.

*SUR-FIT Natura^„¥ skin barriers and pouches

**ConvaTec Moldable Technology^„µ skin barriers

SUR-FIT Natura is a registered trademark of ConvaTec Inc.

ConvaTec Moldable Technology is a trademark of ConvaTec Inc.

1 O’Shea Helen S. RN, PhD. Teaching and the adult Ostomy patient. JWOCN. 28 (1); 47-54. January 2001.