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Purpose: In a large academic medical center, a new bed tower opened in December 2020. The colorectal department was a newly formed team, and the nursing staff expressed through an online learning needs assessment, a lack of competency, and confidence in caring for patients with ostomies. The nurses reported a lack of knowledge and skills in the management of new and existing ostomies leading to a lack of confidence with this patient population. The reported gaps included changing of pouches, assessing for signs of stoma insufficiency and stoma measurement. An intra-professional team designed an evidence-based ostomy education program. The course objectives included the anatomy and physiology of the surgical procedures, ostomy types, stoma management, protection of the skin around the stoma, and selection of the correct ostomy appliances and supplies. The goal of this teaching course was to equip front-line nurses with the knowledge, skills, and confidence in managing new and existing ostomies.
Description: The in-person course was delivered by a certified wound ostomy continence nurse (WOC nurse). We registered up to five nurses per class and offered the classes weekly. A total of 30 registered nurses completed the course. The didactic portion was 2-hours in length and focused on ostomy management, peri-stomal complications with interventions, and provided an opportunity for hands on with plastic ostomies and appliance selection and application. Upon completion of the didactic portion, the participants were assigned to shadow a WOC nurse for 4-hours to apply the skills and lessons learned.
Evaluation/outcome: A survey was built in Redcap to measure the participant’s confidence levels in both pre- and post-class using a 5-point Likert scale. Confidence levels were evaluated in four areas: educating patients with ostomies, assessing skin and ostomies, preparing peri-stomal skin, and selecting the correct ostomy appliance. Pre-course more than 50% of the time participants ranked as not or slightly confident; post-course scores for the four areas scored at moderately confident or above. Post-course outcomes show increases in confidence levels ranging from 30% to 77% higher than pre-course. The innovative ostomy class has shown dramatic increases to the nurses’ confidence levels in providing care to patients with ostomies. The WOC team reports lower number of WOC consults for ostomy-related care. The implementation of evidence-based educational programs can bridge care gaps, leading to an increase in confidence levels among the nursing staff and improving patient care on these types of patients.
Evidence-based references 1. Stelton S. CE: Stoma and Peristomal Skin Care: A Clinical Review. Am J Nurs. 2019 Jun;119(6):38-45. doi: 10.1097/01.NAJ.0000559781.86311.64. PMID: 31135430.