Journal of Community Nursing - page 73

JCN
2013,Vol 27, No 4
73
STOMA CARE
A
s the government encourages
community nurses to
provide care closer to home
(Department of Health [DH, 2013]),
more and more community nurses
are likely to encounter people who
have a stoma, both those that have
been created recently as a result of
surgery, as well as those people who
have ongoing management needs.
Because stomas essentially involve
maintaining a permanent breach of
the skin, nurses must work hard to
ensure the integrity of the peristomal
skin, a task made harder by the wide
range of stoma products available
(Brewster, 2004).
The crucial skills in managing
people with a stoma come mainly
at the point of cleansing and
changing. It is at this point that
The importance of peristomal skin
care in the community setting
skin integrity is at risk, both from
stripping due to the adhesives used
to apply stoma products, and the
leakage of urine and faeces onto the
skin, which has well-documented
corrosive effects (colonic stomas
produce less aggressive effluent, but
spillage can still cause excoriation
[Brewster, 2004]).
Good stoma and skin
management can have a dramatic
effect on the life of the individual,
who may feel a tremendous sense
of shame around his or her stoma
due to the stigma attached to the
procedure (Swan, 2010). These
negative feelings can result in a
marked decrease in the individual’s
quality of life (Swan, 2010).
This article takes an in-
depth look at the issue of stoma
management, with particular
reference to community nurses’
responsibility to maintain patients’
peristomal skin integrity.
STOMA
There are three main types of stoma
— a colostomy, which is the most
common and is formed from the
colon (large bowel), an ileostomy
and a urostomy, which are both
formed from the ileum (small bowel).
A urostomy is often used to treat
bladder cancer and mainly deals with
the removal of urine into the attached
stomal pouch, whereas colostomies
and ileostomies generally carry faeces
and flatus.
Black (2009) reported that 102,000
people had a stoma in the UK and a
large proportion of those will have
experienced some sort of stomal
complication or peristomal skin
problem. Medical conditions that
require stoma surgery include
(Swan, 2010):
Colon/rectal cancer
Bladder cancer
Ulcerative colitis
Crohn’s disease
Diverticulitis
Faecal and urinary incontinence
Trauma.
STOMAL COMPLICATIONS
AND PERISTOMAL SKIN CARE
Stomal complications, such as
leakage, maceration and skin-
stripping on removal, are common
and will often occur soon after the
stoma has been fitted (Lynch et
al, 2008). There may be problems
with the initial fit of the stoma
and flange, which creates the
opportunity for leakage, damaging
the surrounding skin.
The tissue surrounding the newly
created stoma may become inflamed
or oedematous shortly after surgery,
and the fit of the flange may need
adjustment as the surrounding tissue
returns to normal. Problems with skin
creasing around the stoma may also
cause leakage (Burch, 2013).
Skin stripping
Many factors contribute to the
susceptibility of the peristomal
Jackie Stephen-Haynes, Professor and Consultant
Nurse in Tissue Viability, Birmingham City
University and Worcestershire Health and Care
NHS Trust
With government reforms increasingly bringing care into patients’
homes, community nurses will inevitably encounter more and
more people who have a stoma. Stomas essentially involve the
maintenance of a permanently open breach of the skin, therefore,
the site requires expert skin care as it is vulnerable to stripping and
break down. This article looks at the use of silicone-based adhesive
removers, which improve quality of life and can also reduce
healthcare costs as they prevent the escalation of peristomal skin
dysfunction. These products also help to prevent costly ongoing
treatment for the effects of stripping on sensitive peristomal skin.
KEYWORDS:
Skin care
Ostomy
Skin stripping
Cost-effectiveness
Jackie Stephen-Haynes
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