When a person is faced with the possibility of removal of the large bowel or intestine (stoma surgery), it is a daunting prospect. Not only do they have to deal with the anxieties of their diagnosis and surgery but also with the loss of control of normal body function.

In Ireland, stoma surgery is carried out at most major hospitals. When the surgeon has explained your diagnosis and surgery, you will then be referred to the stoma care nurse (SCN). The stoma care nurse is a senior, qualified nurse who has specialist training and qualifications to deliver a holistic and comprehensive service of care to you. The nurse may also be referred to as clinical nurse specialist stoma care or clinical nurse specialist coloproctology/colorectal.

In Ireland there are 24 full-time and four part-time nurses. Most of them are based in hospitals, while some are in the community. Unfortunately this means that not every patient has access to this vital service within their own area.

There are many facets to the role of the stoma nurse, that of expert clinical nurse, teacher, counsellor, researcher and manager. As an expert clinical nurse, she provides expert individual care for as long as required, to enable you to achieve maximum rehabilitation and regain your place in society within the limits of your diagnosis and prognosis.

On your first meeting with the SCN (perhaps as an outpatient or on your admission to hospital), it is recommended to have a family member or close friend present. This enables you to clarify and confirm some of the issues that you have discussed. Topics discussed will involve:

• Disease.
• Diagnosis.
• Explanation of the proposed surgery.
• Pre- and post-operative care.
• What a stoma is.
• The type of stoma and its management.

Life style issues that are of greatest concern to people include:

• Work.
• Sport.
• Social situations.
• Travel and holidays.
• Sex and pregnancy.

These issues will be discussed individually, as some adjustments may be needed, such as talking with your employer about returning to work part-time initially, or assuming a less physical job.

You will also be shown the stoma appliances (bags) which you will wear following surgery and going home. In Ireland there are approximately six manufacturers supplying appliances which gives you a wide and varied choice and your nurse will give you help and advice on choosing what is suitable for you to wear.

All appliances and accessories are available from your chemist or via a direct delivery service. The cost is covered by either the medical card or the drugs repayment scheme.

A vital aspect for you is where your stoma is sited, as this will ensure you will enjoy optimum quality of life following surgery. This depends on what type of stoma you will have.

Colostomy
A colostomy is an opening into the colon (large bowel) and is usually sited on the lower left side of the abdomen.

Transverse Colostomy
A transverse colostomy is an opening into the transverse colon (large bowel) and is usually sited above the waist. It can be on the right or left side.

Ileostomy
An ileostomy is an opening into the ileum (small intestine) and is usually sited on the right lower side of the abdomen.

Urostomy
A urostomy is an opening into the urinary tract and it is usually sited on the right lower side of the abdomen.

Sometimes the stoma has to be sited differently because of scarring from previous surgery, stomas or skin problems. This is an issue which will require discussion between you and your nurse.

The stoma nurse will guide both you (and your family or carer if you wish), through the basic principles of managing your stoma while you are recovering from your surgery. They will also help you to recognise potential and actual problems such as:

• Skin irritation.
• Leakage.
• Odour.
• Flatus.

The nurse will advise you on the relevant contacts if you are having difficulties.

Stoma nurses are involved in the education of other health care professionals regarding the needs of a person with a stoma. The nurse’s own education is also ongoing to keep abreast of all current developments and advances in surgical management within the field.

Most SCNs have experience as counsellors and many have attended counselling courses. They have the skills to recognise and anticipate the difficulties of adjusting and coming to terms with your disease, diagnosis and adapting to your altered body image. They will give you support to help minimise the trauma of stoma surgery. Where appropriate, the nurse will recommend you attend a professional counsellor or psychotherapist.

Stoma nursing care practices are all based on research. Many SCNs today are involved in ongoing research in the areas of nursing practice, appliances and accessories, and quality of life of the person with a stoma. From this research it is hoped to identify the areas of greatest concern so that it can be acted upon to enhance your care and quality of life.

Most SCNs work with a high level of autonomy in the management and development of the service, working within agreed policies and protocols to bring you the best possible care and management within the service.

The role of the stoma care nurse is very diverse and their knowledge and expertise is a valuable resource for you and your family.

Rehabilitation must add life to years as well as years to life. (Zeiter 1969)

Written by Grace McEvoy, Stoma care nurse, St Vincent’s University Hospital, Elm Park, Dublin.