Implementation of an Ostomy Care Pathway for Homebound Patients: A Quasi-Experimental Study

Background and Purpose: Persons with new ostomies are a vulnerable population which require complex care management. In addition to having to learn stoma management during their convalescent period, they often experience significant and frequent impairment of their psychosocial well being, which can effect adjustment to the stoma and hamper efforts to learn self-care. As nurses employ various interventions to assist the patient and caregiver to overcome challenges, a wide range of patient outcomes are reported, indicating a need for comprehensive tools to help manage these patients.

Purpose: The aim of this study was to evaluate new ostomy patients’ psychosocial adjustment after receiving instruction with an ostomy care pathway. 

Method: A quasi-experimental research design was utilized to evaluate outcomes of a convenience sample of adults (n=49) with a new fecal or urinary diversion, who were discharged to home from an acute or skilled nursing facility.  An ostomy care pathway applying evidence based practices was developed and implemented to support patient recovery by nurses from one office at a homecare agency - nurses at another office delivered traditional teaching based on professional experience. The Ostomy Adjustment Inventory 23 (OAI-23), a 23 item self-report survey designed to measure ostomy adjustment in adult persons with an intestinal ostomy, was administered to every participant once self-care was achieved.

Results: A Mann-Whitney U test was used to compare mean rank scores across experimental and control groups. Participants who were taught ostomy care using the ostomy care pathway ranked higher in adjustment scores (p<.001). In addition, married participants scored significantly higher in adjustment than single participants (p=.033). 

Conclusion: Utilization of an evidence based ostomy care pathway assisted patients to achieve higher adjustment scores, and married person’s attained higher adjustment scores than single persons.