Mary Willis, MS, RN, CWOCN1, Diane Bryant, RN, MS, CWOCN2, Ilene Fleischer, MS, RN, CWOCN3, Elizabeth McGrath, BSN, RN, MHA4, Jacqueline MacNeil, MSN, RN, ACNS5, Ruth McGrotty, BSN, RN6, Audrey Minsky, MSN, RN6, Elizabeth Doane, BSN, RN, PCCN7, Jill Danese, BSN, RN8 and Marie Gibbons, BSN, RN6, (1)Brigham & Women's Hospital, Clinical Nurse Specialist Ostomy & Wound Care, Boston, MA, (2)Brigham and Women's Hospital, Ostomy & Wound Clinical Nurse Specialist, Boston, MA, (3)Brigham & Women's Hospital, Clinical Nurse Specialist in Ostomy & Wound Care, Boston, MA, (4)Brigham & Women's Hospital, Nursing Director, Boston, MA, (5)Brigham & Women's Hospital, Nurse Educator, Boston, MA, (6)Brigham & Women's Hospital, Staff Nurse, Boston, MA, (7)Brigham & Women's, Nurse in Charge, Boston, MA, (8)Brigham & Women's Hospital, Nurse in Charge, Boston, MA
The nursing staff of a medical-surgical unit and the CWOCN CNSs identified that there was an opportunity to enhance and standardize nursing care of patients admitted with new ostomies. Patients with new ostomies predominantly want information on practical aspects of caring for their pouching system and surrounding skin. Patients expect the nurse to be knowledgeable, competent, willing to provide care and necessary information regarding their new ostomy. Increasing nurses’ confidence and knowledge in providing ostomy care had the potential to improve the quality of patient care.
Purpose:
The goal of this practice change was to improve the bedside nurses’ knowledge of products and ostomy accessories, and troubleshooting techniques for pouching systems to lead to successful patient self-care.
Process:
Nursing Staff Education was supported by CWOCN CNSs in three specific approaches:
Observation experiences with the CWOCN CNSs – Staff observed the expert nurse performing the pouching system changes, patient teaching and corresponding documentation.
Correct use of supplies and how to obtain them was reviewed with Staff Nurses.
Biweekly ostomy pouching system changes were implemented – every Tuesday & every Friday to improve consistency in pouch change and patient education.
Findings:
Staff Nurses of the unit have developed their expertise and best nursing practice in management and care of patients with ostomies:
Improved nursing confidence in caring for patients with ostomies & fostered relationships among the health care team.
Development of innovative troubleshooting of pouching systems.
Identify themselves as potential resources for other nurses who are less familiar with care of patients with ostomies.
CWOCN CNSs and Staff Nurses have recognized improved adherence to the nursing “Plan of Care” for ostomy care and pouching system changes.
Nursing accountability for pouching system changes are recognized as a priority of patient care.
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