WOC Nurse Perceptions of Problems Experienced by Ostomates with Shortened Length of Stay

Purpose: This descriptive study collected interview data from Wound, Ostomy, Continence Nurses (WOC Nurses) regarding their perceptions of changes in practice and patient outcomes of patients having laparoscopic-assisted surgery resulting in a bowel ostomy. Laparoscopic techniques and evidence-based practices have reduced the length of stay to approximately 2 days.

Methods: Data were gathered from WOC nurses using semi-structured interviews with WOC nurses at three national sites of a major medical center to obtain perceptions of patient complications, questions, and issues and changes in their practices. A review of WOC nurses medical records was completed abstracting information from post-discharge outpatient visits and phone calls for 6 months during the current year and for the corresponding 6 months 3 years prior. Analysis included content analysis of interviews, descriptive data of record abstraction, and comparison of reasons for contact between current and past year.

Results: Seven WOC nurses participated in interviews. They identified themes related to educational outcomes for those patients with shortened length of stay such as ability to manage the ostomy, fluid and electrolyte balance, psychosocial adjustment, and the ability to find appropriate referrals. The lack of education for patients having surgery on Fridays and discharged over the weekend was noted. Medical record abstraction did not show significant changes in purpose of calls or visits over the 3 year period, post-discharge calls and visits confirmed the concerns of the WOC nurses.

Conclusions: WOC nurses were concerned about the ability to meet the needs of hospitalized patients with shortened length of stay and increased outpatient needs. The change in length of stay appears to have shifted workload from the hospital setting to the outpatient setting increasing the need for qualified referrals. Lack of change in outpatient visits may have been mediated by increases in staff and the increased effort to see hospitalized patients each day.