Midwest WOC Nurse Perceptions of Ostomates Patient Outcomes with Shortened Length of Stay

Purpose: This qualitative descriptive study collected interview data from Wound, Ostomy, Continence Nurses (WOC Nurses) regarding their perceptions of ostomate patient outcomes related to changes in surgical practice such as laparoscopic-assisted surgery. 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 nationally to obtain perceptions of patient outcomes, complications, patient questions and changes in their practices. Analysis included content analysis of interviews. Common themes were identified

Results: Twenty-three WOC nurses caring for new ostomates participated in interviews. They identified themes related to patient outcomes related to shortened length of stay such as ability to manage the ostomy, fluid and electrolyte imbalances, psychosocial adjustment, and the ability to find appropriate referrals. A common theme was that patients with new ileostomies were frequently re-hospitalized for high output with dehydration and electrolyte imbalances. There was concern for older patients without family support. The lack of education for patients having surgery on Fridays and discharged over the weekend was noted. WOC nurses noted using written patient education materials as a major source of patient education. The need for return appointments was noted.

Conclusions: WOC nurses were concerned about the ability to meet the needs of hospitalized patients with shortened length of stay and increased outpatient needs. There was a perception that patients with new ileostomies were especially vulnerable. 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. A lack of expertise in rural and outpatient settings was identified.