Registered Nurses' Association of Ontario

Practice Recommendations

CORE RECOMMENDATIONS

RECOMMENDATION

LEVEL OF EVIDENCE

1

Develop a therapeutic relationship with the client and family.

III

2

Perform a comprehensive assessment of the client/family that includes: a) history and physical; b) psychosocial (coping and adaptation, altered body image, impaired quality of life, sexuality and sexual concerns); and c) cultural, spiritual and religious norms.

III

3

Consult with interdisciplinary team members for assessment and intervention as needed for all clients requiring, or who already have, an ostomy.

IV

4

Design a mutually acceptable plan of care between the client/family and all health-care providers, which optimizes health and self-efficacy in ostomy management.

III

PRACTICE RECOMMENDATIONS: PRE-OPERATIVE PHASE

RECOMMENDATION

LEVEL OF EVIDENCE

5

Pre-operative education should be provided to all clients and families requiring ostomy surgery.

Ib

6

Stoma site marking should be performed on all clients undergoing ostomy surgery.

IIa

7

Explore the potential impact of ostomy surgery on intimacy and sexual functioning with the client/partner.

Ia

8

Progressive Muscle Relaxation Therapy (PMRT) should be offered to clients undergoing ostomy surgery as part of routine care.

Ib

PRACTICE RECOMMENDATIONS: POST-OPERATIVE PHASE

RECOMMENDATION

LEVEL OF EVIDENCE

9

Assess the stoma immediately post-operatively and the stoma/peristomal skin condition with each appliance change using a validated classification tool to monitor for complications.

IV

10

Identify risk factors that influence stomal and peristomal complications.

III

11

Review the client’s medication profile to ensure that maximum absorption and effectiveness will be achieved in relation to the type of ostomy.

IV

12

Avoid insertion of a glycerin suppository into a colostomy in order to aid evacuation of effluent.

Ib

13

Counselling by a Registered Dietician should be performed for clients with an ostomy who are at risk for, or who develop, nutritional complications.

IIa

14

Prepare the client and family by teaching the minimum skill set specific to their needs prior to discharge from hospital.

IV

15

Discharge the client and family with home care support.

Ib

16

Ensure that the ostomy plan of care is individualized to meet the needs of the client and family.

IV

17

Assessment and follow-up by an Enterostomal Therapy Nurse (ETN) are recommended for the client and family after ostomy surgery to decrease psychological distress, promote optimal quality of life and prevent complications.

IIb

18

Educate client and family members to recognize complications affecting the stoma and peristomal skin.

IV

19

Colostomy irrigation may be implemented as a safe and effective method for the management of descending or sigmoid colostomies for select adult clients.

III

Chronic Disease
Ostomy Care and Management
Practice Recommendations