Ostomy care: foundation for teaching and practice

Current approaches to ostomy management evolved from the extensive experience of surgeons, enterostomal therapy nurses, staff nurses, patients, and manufacturers. Advances in surgical techniques in the 1950's led to decreased morbidity and mortality previously associated with ostomy surgery. With these advances, a corresponding demand emerged to meet the rehabilitative needs of these patients by providing significant physical and psychological support. The birth of enterostomal therapy in 1958 focused interest, energy, and resources on this important area of patient care. Today's tradition-based practice continues to go a long way in meeting the physical and psychological needs of individuals undergoing ostomy surgery. However, in this era of managed care, shrinking healthcare dollars, and standardized guidelines, care practices not derived from evidence or consensus may jeopardize a patient's access to appropriate interventions and supplies. An exhaustive review of the literature revealed a paucity of ostomy-related research. The effectiveness of preoperative stoma site selection, prevention, care, and treatment of peristomal skin problems; and pouch selection and wearing times revealed a wealth of empirical evidence, but little or no objective data supporting commonly accepted interventions. The care of individuals with urinary and fecal diversions is both an art and a science. Evidence-based practice is needed to provide a firm foundation from which the art of individualized patient care can flourish. Research related to pre- and postoperative care and rehabilitation of individuals with ostomies can only serve to improve education, continuity of care, reimbursement, and most importantly, optimize patient care.