Purpose and scope
The purpose of this best practice guideline (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,
(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 will address the most common types of ostomy which include:
- colostomy
- ileostomy
- urostomy
This BPG is to be used by nurses across the continuum of care and in all domains of practice—such as clinical, research, education, policy, and administration—and members of the interprofessional team.
Get started
Registered Nurses’ Association of Ontario. Supporting adults who anticipate or live with an ostomy. 2nd ed. Toronto (ON): Registered Nurses’ Association of Ontario; 2019.
Recommendations
Recommendation 1.1: The expert panel recommends that health service organizations provide access to nurses specialized in wound, ostomy, and continence as essential members of the interprofessional team for all persons who anticipate or live with an ostomy
Recommendation 1.2: The expert panel recommends that access to nurses specialized in wound, ostomy, and continence includes the following support within the ostomy care continuum:
- Performing preoperative stoma site marking.
- Providing perioperative education and counselling.
- Providing ongoing follow-up consultation and management.
- Involving persons who anticipate or live with an ostomy and their support network in all steps of care, as appropriate.
Recommendation 2.1: The expert panel recommends that health service organizations implement an internal expert-guided, standardized ostomy care program that is developed using an interprofessional, team-based approach.
Recommendation 2.2: The expert panel recommends that health service organizations include the following interventions within a standardized ostomy care program:
- Preoperative education and counselling on ostomy surgery, daily living, and self-care.
- Postoperative education regarding stoma self-management and potential complications.
- Discharge planning that is based on a readiness criteria and includes follow-up information.
- Scheduled home visits and telephone follow-up within the first four weeks.
- Access to nurses specialized in wound, ostomy, and continence perioperatively and on an ongoing basis, as necessary.
Recommendation 3.1: The expert panel suggests that health providers implement the following interventions to prevent parastomal hernias for persons who anticipate or live with an ostomy:
- Conduct a risk factor assessment related to body mass index and waist circumference.
- Provide expert advice on weight management, as needed.
- Perform stoma site marking preoperatively.
- Provide postoperative education related to:
o abstinence from heavy lifting postoperatively.
o consideration of lightweight support garments.
o abdominal exercises beginning within three months of surgery.
Recommendation 4.1: In order to guide person-centred care, the expert panel recommends that health providers assess quality of life in persons who anticipate or live with an ostomy. Specific areas of focus should include the following:
- Psychological distress (anxiety and depression).
- Self-identity (sexuality and body image).
