The Life-Changing Journey of Persons with Ostomies

Field: Health Professions (Health Sciences)

The World Council of Enterostomal Therapists (WCET) pays tribute to and celebrates Norma N. Gill-Thompson, the first enterostomal therapist, every June 26 in honor of her birthday.1,2 This June, Advances in Skin & Wound Care acknowledges her contributions to skin and wound care, as well as those of her surgeon Dr Rupert B. Turnbull, and all of the nurses worldwide who provide specialized care to persons with an ostomy. Because June is such an important month for ostomy specialty practice, this issue features several articles on ostomy care. The articles encompass a range of subjects, including quality of life in patients with a stoma and colorectal cancer, a new tool to measure damaged peristomal skin, and educational videos for adult patients with ostomies, as well as our continuing education article on the key practice implications from the WCET’s updated 2020 ostomy guideline.3 The guideline and article emphasize the importance of education and nursing scope of practice. An ostomy provider’s journey begins with specialized education based on a competency-based curriculum tailored to local and country regulations. A holistic approach to ostomy care includes the key elements of the Purnell Model of Cultural Competence4 encompassing societal, community, family, and (most importantly) patient-centered concerns. As healthcare providers, we need to move from being unconsciously incompetent (do not recognize our deficiencies) to consciously incompetent (identify a gap in our approach to persons with ostomies) to consciously competent (provide appropriate care for an individual patient) to unconsciously competent (consider every patient’s cultural alignment for living with an ostomy).4 Ideal treatment at the bedside involves preoperative stomal site marking by a specialized nurse, a skill that can prevent later complications.3 Preoperative education should include the patients and their families to prevent or recognize peristomal skin complications (PSCs) early. Taneja et al5 documented that 37% of persons with ostomies developed PSCs within 90 days of stoma creation and 55% of PSCs occurred while the patient was still hospitalized. A recent survey of PSCs during the COVID-19 pandemic6 revealed that 79% of patients reported rash, 38% itching, 21% open skin, 19% bleeding, and 7% other physical signs. In this same study,6 84% did not contact their healthcare professional about their PSCs. Research continues to support that leakage and PSCs impact patient comfort and decrease quality of life.7 Contact dermatitis is the most common PSC; 80% is irritant contact dermatitis (leakage of stomal continents, local heat, and moisture) requiring steroid lotions that do not interfere with appliance adhesion or low-dose intralesional steroid injections. Allergic contact dermatitis presents with a clear, often prominent, outline of the stomal appliance or barrier product around the stoma. Products can be tested for a hypersensitivity reaction alongside a nonreacting comparator on the opposite side of the abdomen with a closed patch for 48 hours to identify and eliminate the cause. Pyoderma gangrenosum is less common but can be painful as well as itchy. For treatment, topical steroid lotions must be used with stomal appliance changes along with higher doses of intralesional steroid injections. Flat (as opposed to convex) appliances cause less pressure on the abdominal skin and will prevent pathergy.8 Providers should maintain suspicion for uncontrolled bowel disease (eg, rectal fragments with active bleeding that may need to be removed surgically).9 Postoperative ostomy care should involve a validated peristomal assessment tool, ostomy barriers, durable containment, and prevention strategy implementation with expert monitoring of the peristomal skin by a specialized clinician.3 Early detection of colon cancer is important, so do schedule your bowel cancer screening! Ostomies are a potentially lifesaving surgery, and providers with specialized education in ostomy care support the patient’s journey. R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN