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Ostomy Care Literature Review 2011
General Concepts in Ostomy Care
O1. Fecal Ostomies: Practical Management for the
Home Health Clinician
Jones T, Springfield T, Brudwick M, Ladd A. Home Health Nurse.
2011;29(5):306-317.
Article Type: Integrative Review
Description/Results:
• A complete guide for education of the home care clinicians pro-
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viding ostomy care.
• A comprehensive review of the literature and excellent review of
basic care of fecal ostomies including OASIS-C documentation.
What does this mean for me and my practice?
This is a useful tool for the clinician doing staff education or for
those needing a review of current practice.
O2. Characteristics of the Patient With an Ostomy
Pittman J. Journal of Wound, Ostomy and Continence Nursing.
2011;38(3):271-279.
Article Type: Research Study
Description/Results:
• A descriptive cross-sectional study with 144 subjects with new
ostomies looking at clinical characteristics of the population
and disposition at discharge.
• Patients with advanced age (P ⫽ .047), stoma height at or below
skin surface (P ⫽ .002), and emergent surgery (P ⫽ .005) were
more likely to be discharged to an extended care facility rather
than home.
• Discussion about stoma site marking and potential effect on
complications is also included.
What does this mean for me and my practice?
By examining the demographic and clinical characteristics of our
patient populations, we may be able to develop programs and in-
terventions to decrease the occurrence of complications.
O3. Ileal Pouch Anal Anastomosis: An Overview of
Surgery, Recovery, and Achieving Postsurgical
Continence
Psillos A, Cantanzaro J. Ostomy Wound Management.
2011;57(12):22-28.
Article Type: Integrative Review
Description/Results:
• This article provides an overview on the indications for Ileal Pouch
Anal Anastomosis (IPAA) surgery and postoperative changes.
• A brief summary of quality-of-life pre- and postoperative IPAA re-
vealed an overall improvement in pain and fecal urgency in those
with severe ulcerative colitis. Overall, improvements in health-
related quality-of-life indicators were positive for those with a
functioning pouch compared to those who had pouch failure.
© Copyright 2012 by the Wound, Ostomy and Continence Nurses
SocietyTM.
DOI: 10.1097/WON.0b013e31825dd6a4
S14 J WOCN ■ July/August 2012
Copyright © 2012 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
What does this mean for me and my practice?
This article provides practical information for the ostomy nurse
who provides perioperative education and management to the
IPAA patient. Opportunities for the ostomy nurse include patient
education related to perineal skin care and bowel function manage-
ment with diet and medications; fecal continence retraining tech-
niques and pouch complication management are also provided.
O4. Orthotopic Neobladder Irrigation: Competency
Assessment Through Simulation
Zamora Z, Clark MJ, Winslow B, Schatzschneidder M, Burkhard
J. Urologic Nursing. 2011;31(2):113-120.
Article Type: Quality Improvement Report
Description/Results:
• Provides a thorough discussion of the need for neobladder irri-
gation and documentation of the procedure, knowledge deficit
of the nurses, and use of simulation for teaching.
• After a 1-hour simulation, nurses reported improved satisfaction,
appropriate documentation rose by over 60%, and the need for
physician intervention in irrigation decreased by more than 40%.
What does this mean for me and my practice?
Results suggest that simulation is an effective method of nursing
staff education.
O5. Nutritional Care of the Ostomy Patient
Collins N, Sulewski C. Ostomy Wound Management.
2011;57(1):10-12.
Article Type: Integrative Review
Description/Results:
• A concise review of the effect of ostomy surgery on nutrition
and important teaching points for patients.
• Emphasizes the importance of discouraging patients from fast-
ing or decreasing food intake as this will cause more bloating
and gas than small frequent meals.
What does this mean for me and my practice?
Nutrition education is an important part of postoperative educa-
tion and this article provides some charts about foods that may
be helpful to include.
O6. Relating Knowledge of Anatomy and Physiology to
Peristomal Skin Care
Rolstad BS, Ermer-Seltun J, Bryant R. Gastrointestinal Nursing.
2011;9(9):3-9.
Article Type: Integrative Review
Description/Results:
• In-depth review of anatomy and physiology of skin and the rel-
evance to selection of a skin barrier for ostomy patients.
• Appropriate skin barrier selection will reduce risk of peristomal
skin complications and the added cost of treatment.
What does this mean for me and my practice?
By enhancing the knowledge of the anatomy and physiology of
the skin and ostomy barrier physical/chemical properties, WOC
nurses have an opportunity to provide evidence-based and patient-
centered ostomy care.
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J WOCN ■ Volume 39/Number 4S
O7. Adenocarcinoma of a Colostomy Following
Abdominoperineal Resection for Squamous Cell
Carcinoma of the Anal Canal: A Case Study
Wild J, Ganer J, Skinner P. Ostomy Wound Management.
2011;57(5):38-40.
Article Type: Case Study
Description/Results:
• This study informs the reader of a rare recurrent neoplasm sur-
facing on a colostomy 3 years postabdominoperineal resec-
tion. The specifics of stomal malignancy and second cancer
incidence of anogenital squamous cell carcinomas are
reviewed.
• The importance of stoma assessment for any bleeding, growths,
or ulcerations with prompt reporting to a health care clinician
is reinforced.
What does this mean for me and my practice?
Given the rare incidence of resected anal squamous cell carci-
noma followed by de novo colon adenocarcinoma, patient edu-
cation of stomal complications remains an integral aspect of
ostomy education. Early identification and timely referral of sig-
nificant stomal complications to the colorectal surgeon must be
an active treatment option for the ostomy nurse.
Stomal and Peristomal Skin Complications
O8. The Development and Use of Algorithms for
Diagnosing and Choosing Treatment of Ostomy
Complications: Results of a Prospective Evaluation
Kalashinikova I, Achkasov S, Fadeeva S, Vorobiev G. Ostomy
Wound Management. 2011;57(1):20-27.
Article Type: Research Study
Description/Results:
• The purpose of this study was to evaluate the usefulness of an
algorithm using clinical presentation and pictograms for assess-
ing, diagnosing, and managing ostomy complications by
trained nonspecialty nurses. The complications were divided
into stomal and peristomal skin disorders with initial diagnoses
made by nurses and confirmed by physicians.
• A total of 1427 Russian ostomates were assessed over a 2-year
period; 38.8% presented with at least 1 ostomy-related compli-
cation, and 34.9% had 2 or more. Stoma-related and peristomal
skin complications were 69.9% and 64.2%, respectively.
• Stoma complications included parastomal hernia (25.1%), mu-
cocutaneous separation (18.6%), prolapse (16.8%), retraction
(14.2%), stenosis (7.8%), mucosal hypergranulation (7.8%),
and fistula (4.9%).
• Peristomal skin disorders included contact dermatitis (89.3%),
hypergranulation (6.8%), allergic dermatitis (2.0%), and folli-
culitis, psoriasis, and herpes (1.9%).
What does this mean for me and my practice?
This article provides a structured approach for assessing and
managing ostomy-related complications. It enables the ostomy
nurse to identify when conservative, nursing-managed treat-
ment is appropriate and if a surgical referral is needed for addi-
tional diagnostic testing and management. It reinforces the
specialty practice and unique knowledge base of the ostomy
nurse in preventing and conservatively managing stoma and
peristomal skin disorders. Statistical testing is needed to validate
the algorithm.
O9. Using Chamomile Solution or a 1% Topical
Hydrocortisone Ointment in the Management of
Peristomal Skin Lesions in Colostomy Patients: Results
of a Controlled Clinical Study
Copyright © 2012 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
Ostomy Care Literature Review S15
Charousaei F, Dabirian A, Mojab F. Ostomy Wound Management.
2011;57(5):28-36.
Article Type: Research Study
Description/Results:
• The purpose of this study was to compare the effect of daily
topical steroid use to twice-daily German chamomile compress
applications (active ingredient chamazulene) on peristomal
skin lesions in colostomates. The primary outcome variable
was time to healing (days); itching and pain data were also
collected.
• Two groups of 36 patients were assigned to treatment arms
based on matching variables (body mass index, age, barrier
wear time, peristomal skin history, to name a few). Peristomal
skin was assessed every 3 days with a maximum duration of
28 days.
• Statistical testing to assess reliability of the peristomal skin
assessment instrument as well as interrater reliability was
acceptable.
• The results demonstrated that the chamomile-treated lesions
healed faster than the comparison group (mean, 8.89 days vs
14.53 days, P ⫽ .001). Complete healing time for 100% of the
chamomile group occurred at day 15 compared to 76% of the
hydrocortisone arm at day 21.
• Itching and pain were relieved in both groups; no statistical dif-
ferences were presented.
What does this mean for me and my practice?
This article provides additional evidence supporting the inclusion
of herbal medications, specifically standardized chamomile ex-
tract, to the armamentarium of managing peristomal skin lesions.
The personal and financial burden of increased appliance changes
must be factored into the twice-daily compress treatments.
O10. Untreated Peristomal Skin Complications Among
Long-term Colorectal Cancer Survivors With Ostomies
McMullen CK, Wasserman J, Altschuler A, Grant L, Hornbrook
MC, Liljestrand P, Briggs C, Krouse RS. Clinical Journal of
Oncology Nursing. 2011;15(6):644-650.
Article Type: Research Study
Description/Results:
• Qualitative study of 31 cancer survivors with permanent os-
tomies and their family caregivers.
• Survivors who received help changing the skin barrier around
their stoma had fewer obstacles to detection and treatment of
peristomal skin complications.
• Survivors with spouses who collaborated in their ostomy care
reported that having assistance helped with preventing leaks,
detecting skin changes, and modifying ostomy care routines.
• Those providing care on their own reported more difficulty
with solving problems and seeking help.
What does this mean for me and my practice?
Asking to see the peristomal skin in those with ostomies may lead
to identification of problems not verbally reported especially with
those who have no assistance from unpaid caregivers.
O11. Evaluation of a Cyanoacrylate Dressing to Manage
Peristomal Skin Alterations Under Ostomy Skin
Barrier Wafers
Milne C, Saucier D, Trevelini C, Smith J. Journal of Wound,
Ostomy and Continence Nursing. 2011;38(6):676-679.
Article Type: Case Study/Case Series
Description/Results:
• Topical cyanoacrylate was used for the management of peris-
tomal skin alteration in 6 acute care and 5 outpatients.
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S16 WOCNCB®
• Improved wafer adherence, skin healing, and markedly decreased
pain led to high satisfaction with the product.
What does this mean for me and my practice?
Topical cyanoacrylate may be considered when treating peristomal
skin alterations although the directions for use should be followed
carefully and appropriate patient selection is important, as it is
costly.
Quality of Life Following Ostomy Surgery
O12. Prospective Study of the Impact on Quality of Life
of Cystectomy With Ileal Conduit Urinary Diversion
for Neurogenic Bladder Dysfunction
Julien Guillotreau J, Castel-Lacana El, Roumiguie M, Bordier B,
Doumerc N, De Boissezon X, et al. Neurourology and Urodynamics.
2011;30:1503-1506.
Article Type: Research Study
Description/Results:
• A prospective study of 48 subjects (38 with multiple sclerosis, 7
with spinal cord injury, 3 other neurologic disease) who had a
cystectomy and ileal conduit for complications arising from
neurogenic bladder dysfunction.
• QOL was measured pre- and 6 months postoperatively using 2
self-administered questionnaires (Qualiveen and SF36-v21).
• Surgery improved the urinary QOL (P ⫽ .015) of patients with
neurogenic bladder dysfunction by decreasing limitations (P ⱕ
.001) and constraints (P ⫽ .046) induced by urinary disorders.
There was no positive impact on general QOL, but also no neg-
ative impact.
What does this mean for me and my practice?
Persons with significant negative impact on their work and social
lives from neurogenic bladder dysfunction may benefit from re-
ferral for surgical consideration.
O13. Social Connectivity in Those 24 Months or Less
Postsurgery
Nichols T. Journal of Wound, Ostomy and Continence Nursing.
2011;38(1):63-68.
Article Type: Research Study
Description/Results:
• Data were extracted from the Ostomy Health and Life
Assessment (Hollister, Inc), a cross-sectional survey, and 560
subjects in North America and the United Kingdom were in-
cluded in the study. Subjects were divided into 2 groups, those
describing themselves as socially isolated and those describing
themselves as socially connected.
• The socially isolated group reported poor adjustment to a stoma,
disability due to the stoma, and a significantly lower life satis-
faction score when compared with the socially connected group.
• Social connectivity increased in both groups as time from sur-
gery increased and the WOC nurse relationship played a subtle
but statistically significant role in helping to reestablish social
connectivity, an improved body image, and acceptable life sat-
isfaction after surgery.
What does this mean for me and my practice?
Consideration of a patient’s social resources and helping patients
to seek and accept support during the pre- and postoperative pe-
riod may improve their adjustment to an ostomy.
Culturally Sensitive Care
O14. Understanding Religious Beliefs of Patients
Needing a Stoma
Copyright © 2012 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.
J WOCN ■ July/August 2012
Black P. Gastrointestinal Nursing. 2011;9(10):17-22.
Article Type: Integrative Review
Description/Results:
• Provides a comprehensive look at the religious life of a Muslim
patient and the profound effect that an ostomy has on the abil-
ity to participate in cleansing rituals prior to prayers, fasting,
and participating in the religious community.
• Even if an ostomy is required with bowel surgery or if it is tem-
porary, increased flatus or frequency of bowel movements
makes religious and social activities more difficult.
What does this mean for me and my practice?
It is imperative that WOC nurses are able to help patients under-
stand the effect that their surgery will have on bowel function in
the short and long terms during the preoperative period.
O15. Culture and Psychosocial Function in British and
Japanese People With an Ostomy
Simmons K, Maekawa A, Smith J. Journal of Wound, Ostomy and
Continence Nursing. 2011;38(4):421-427.
Article Type: Research Study
Description/Results:
• The Ostomy Adjustment Inventory–23 (OAI-23) was com-
pleted by 948 subjects (464 British and 484 Japanese) with a
fecal or urinary stoma, and the results were compared to see if
the country of residence made a difference in adjustment to an
ostomy.
• Both groups showed improved adjustment to an ostomy as the
time with an ostomy increased, but the overall adjustment
scores were significantly higher in the British subjects, suggest-
ing that cultural beliefs and response to illness between the 2
groups affect adjustment to an ostomy.
What does this mean for me and my practice?
It is important for WOC nurses to be culturally sensitive by iden-
tifying those persons whose ostomy adjustment problems may be
culturally related and finding ways of providing support.
Fistula Management
O16. Management of Enterocutaneous Fistulas
Schecter W. Surgical Clinics of North America. 2011;91:481-491.
Article Type: Integrative Review
Description/Results:
• Divides fistula management into 3 phases: (1) recognition and
stabilization, (2) anatomic definition and decision, and (3) de-
finitive operation.
• Describes care in each phase with recognition of the impor-
tance of the WOC nurse as part of the team.
What does this mean for me and my practice?
Enhanced knowledge of fistula management from the surgeon’s
perspective is helpful in supporting patients, especially those
waiting for surgical closure.
O17. Enteral and Parenteral Nutrition in the
Conservative Treatment of Pancreatic Fistula: A
Randomized Clinical Trial
Klek S, Sierzega M, Turczynowski L, Szybinski P, Szczepanek K,
Kulig J. Gastroenterology. 2011;141:157-163.
Article Type: Research Study
Description/Results:
• 78 subjects with postoperative pancreatic fistulas were random-
ized to parenteral (n ⫽ 40) or enteral (n ⫽ 38) nutrition. After
30 days, closure rates of pancreatic fistula in groups receiving
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J WOCN ■ Volume 39/Number 4S Ostomy Care Literature Review S17

enteral and parenteral nutrition were 60% (24 of 40 patients)
and 37% (14 of 38 patients), respectively.
• The physiologic reason for these results is that enteral feeding
avoids pancreatic stimulation by creating a negative feedback
control system and thus inhibiting pancreatic secretion.
What does this mean for me and my practice?
The reduced cost and decrease in negative side effects of enteral
nutrition over parenteral nutrition make these results important
to consider in pancreatic fistula management.

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Copyright © 2012 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited.