These guidelines are not binding on nurses, other health providers, or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses' Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury, or expense arising from any such errors or omission in the contents of this work.With the exception of those portions of this document for which a specific prohibition or limitation against copying appears, the balance of this document may be produced, reproduced, and published in its entirety, without modification, in any form, including in electronic form, for educational or non-commercial purposes. Should any adaptation of the material be required for any reason, written permission must be obtained from RNAO. Appropriate credit or citation must appear on all copied materials as follows: Registered Nurses' Association of Ontario. Supporting adults who anticipate or live with an ostomy. 2nd ed. Toronto (ON): Registered Nurses' Association of Ontario; 2019.This work is funded by the Ontario Ministry of Health and Long-Term Care. All work produced by RNAO is editorially independent from its funding source.# Table of Contents

# Table of Contents
Supporting Adults Who Anticipate or Live with an Ostomy -Second Edition Purpose and Scope Purpose RNAO's BPGs are systematically developed, evidence-based documents that include recommendations on specific clinical, healthy work environment, and health system topics that are intended for nurses, members of the interprofessional team, educators, leaders, policy-makers, researchers and persons and families with lived experience. BPGs promote consistency and excellence in clinical care, education, and administrative practices and policies with the aim of achieving optimal health outcomes for people, communities, and the health system as a whole.
This BPG replaces the RNAO BPG Ostomy Care and Management, which was released in 2009. The purpose of this BPG is to provide nurses and the interprofessional team with evidence-based recommendations for the most effective strategies to support adults (18 years and older) who anticipate or live with an ostomy that will (a) promote self-management G (b) enhance access and delivery of care, and (c) lead to positive health outcomes. For this BPG, persons who anticipate an ostomy are those who are in the preoperative phase and awaiting an ostomy surgery. This BPG recognizes that adults who anticipate or live with an ostomy and their support network G are experts in their health and decision making; collaboration among the interprofessional team, the person anticipating or living with an ostomy, and their support network (if needed) therefore is essential for achieving improved health outcomes.
In October 2017, RNAO convened an expert panel to determine the scope of this revised BPG and to develop recommendation questions to inform the systematic reviews G. The RNAO expert panel included persons with lived experience and was interprofessional in composition, comprising of individuals with knowledge and experience in clinical practice, education, research, and policy across a range of health service organizations, practice areas, and sectors. These experts shared their insights on supporting and caring for adults who anticipate or live with an ostomy across the continuum of care (e.g., acute care, rehabilitation, community, and primary care). A systematic and comprehensive analysis was completed by the RNAO Best Practice Guideline Development and Research Team and the RNAO expert panel to determine the scope of this BPG and to prioritize recommendation questions for its development (see Appendix D).
To determine the scope of this BPG, the RNAO development team conducted the following steps:
 Reviewed the previous RNAO BPG, Ostomy Care and Management (2009).  Conducted a guideline search and gap analysis.
 Undertook a scoping review G of the literature to determine the depth of peer-reviewed studies in the area of pediatric populations (younger than 18 years) living with an ostomy.
 Conducted six key informant interviews.
 Held two virtual focus groups with experts in the field, including front-line health providers G researchers, and persons with lived experience.
The analysis informed the scope of this BPG. This BPG will focus on adults (18 years and older) who live with or anticipate an ostomy. The scoping review identified a lack of peer-reviewed studies addressing pediatric populations living with an ostomy. It was thus concluded that a separate search for evidence and approach to guideline development was warranted to address this population.
 Regulated health provider: In Ontario, the Regulated Health Professional Act, 1991 (RHPA) provides a framework for regulating 23 health professions, outlining the scope of practice and the profession-specific controlled or authorized acts that each regulated professional is authorized to perform when providing health care and services (5).
 Unregulated health provider: Unregulated health providers fulfill a variety of roles in areas that are not subject to the RHPA. They are accountable to their employers but not to an external regulating professional body (e.g., College of Nurses of Ontario). Unregulated health providers fulfill a variety of roles and perform tasks that are determined by their employer and employment setting. Unregulated health providers only have the authority to perform a controlled act as set out in the RHPA if the procedure falls under one of the exemptions set out in the Act (6).

# BAC K G R O U N D
Supporting Adults Who Anticipate or Live with an Ostomy -Second Edition Ostomy care program: An organization-level approach to standardize care for persons who anticipate or live with an ostomy. The ostomy care program includes structured treatment, management, and follow-up strategies developed by an interprofessional team, which may consist of NSWOCs, nurses, surgeons, physicians, social workers, dieticians, and pharmacists (among others).
Parastomal hernia: Occurs when one or more loops of the bowel protrude through the abdominal wall, creating a bulge around the peristomal skin G (7).
Topics Outside the Scope of this Best Practice Guideline
The following conditions and topics are not covered within the scope of this BPG:
 Pharmaceutical interventions for the prevention and management of ostomy-related complications.
 Surgical procedures in the creation of a stoma.
 Surgical interventions for the prevention and management of ostomy-related complications.
 Pediatric populations anticipating or living with an ostomy.

# Recommendation Questions
Within the determined scope defined above, the following priority recommendation questions and outcomes were developed by the RNAO expert panel and informed the development of this BPG:
Outcomes: Psychological health status and self-identity.
Note: These priority recommendation questions are condensed versions of the more comprehensive PICO G (population, intervention, comparison, outcomes) research questions developed by the RNAO expert panel to guide the systematic reviews and development of this BPG. For the PICO research questions and the detailed process of how the RNAO expert panel determined these priority questions and outcomes, see Appendix D.

# BAC K G R O U N D
Supporting Adults Who Anticipate or Live with an Ostomy -Second Edition
Recommendations in this BPG address access to the appropriate specialist to support comprehensive care (i.e., NSWOCs G, the need for a standardized ostomy care program within health service organizations, guidance on the prevention of parastomal hernias, and quality of life assessments in adults who anticipate or live with an ostomy. The evidence-based recommendations in this BPG are applicable to all practice settings where adults who anticipate or live with an ostomy are accessing services (such as, but not limited to, acute care, long-term care, community settings, and rehabilitation settings).
In this BPG, no recommendation questions were identified that addressed the core education and training strategies required for curricula, ongoing education, and professional development of nurses or the interprofessional team in order to support adults living with or anticipating an ostomy. Please refer to Appendix C for education statements G that educators, managers, administrators, and academic and professional institutions can use to support the uptake of this BPG.
Note: Recommendations in this BPG were developed for adults who anticipate or live with an ostomy, but in some cases, recommendations also may be applicable to adults with continent diversions G (bowel or urinary).

# RNAO Guidelines and Resources that Align with this Best Practice Guideline
Other RNAO guidelines and other resources may support implementation of this BPG. See Appendix B for RNAO guidelines and other resources on the following related topics:
 Client centred learning.
 Culturally sensitive care.
 Implementation science, implementation frameworks, and resources.
 Interprofessional collaboration.
 Person-and family-centred care.
 Self-management of chronic conditions.
 Therapeutic relationships.