NEW OSTOMIES affect patients in different ways. Some patients are devastated, and others are overjoyed. Nurses too are affected by a patient with an ostomy—either positively or negatively, depending upon the nurse's comfort level.

Many nurses don't have the opportunity to care for ostomates, or they shy away from doing so because of inexperience, lack of formal training, or insecurities. The nurse's personal feelings toward ostomies, time constraints, and/or inadequate supplies all play a role in patient outcomes. This article is meant to be a guide to provide nurses with basic information needed to care for the most frequently encountered ostomy patients.

PATIENT POPULATION Diseases that require surgical procedures resulting in an ostomy include carcinomas of the bowel, bladder, and female reproductive organs. Other disease entities that can require an ostomy are inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis.

PHYSICAL/EMOTIONAL ASSESSMENTS Nurses must assess patients for physical and emotional disabilities that may have an impact on the ability to perform ostomy care. Patients can have comorbidities that hinder coordination and function, such as post-stroke weakness, Parkinson's disease, post-amputation, or severe arthritis, to name a few. Visual acuity also must be evaluated so that problems can be identified and the plan of care modified. Even overwhelming frailty and fatigue can render ostomates too weak to perform the basic skills for self-ostomy care.

The emotional burden of dealing with an ostomy can be devastating, and some patients have great difficulty coping. Ostomates face incredible changes in body image, self-esteem, sexuality, quality of life, role function, and so much more. These issues can prevent or delay the acceptance of the stoma. Patients must be encouraged to express fears, concerns, worries, disgust, and embarrassment regarding their ostomies. The ostomy patient needs patience, support, and sometimes permission to "hate" his or her stoma.

It is crucial that the appropriate referrals are made to various departments, such as social work, psychiatry, occupational therapy, physical therapy, and the wound ostomy continence nurse (WOCN). In some cases, visitor programs exist, in which a new ostomy patient can be visited by an experienced ostomate for additional support.

Nurses may refer ostomy patients to support groups within local hospitals and to the online United Ostomy Associations of America at http://www.uoaa.org/; the site has active discussion boards for various types of incontinent and continent diversions, along with youth, adult, and parent networks. The Wound, Ostomy and Continence Nurses Society has a Web site at http://www.wocn.org/, where patients and families can find information and locate a local WOC nurse as a resource.

TYPES OF INCONTINENT DIVERSIONS Ostomy refers to the surgical procedure to divert a piece of bowel through the abdominal wall to the skin, either for urine or stool. An ostomy is an incontinent diversion.

"Stoma" originated from the Greek word meaning "opening" or "mouth," and refers to the piece of intestine pulled through and sutured to the skin.

Colostomy is developed when a piece of the large intestine (colon) is brought through the layers of the abdomen and sutured to the skin as a stoma. Portions of the large or small intestine may be removed, depending upon the type of surgery performed.

Basic large bowel diversions:

• Transverse loop colostomy
• End colostomy Hartman's pouch
• Sigmoid colostomy—Abdominal Perineal Resection (rectum removed)
• End sigmoid colostomy with mucous fistula
• Effluent is waste from the ostomy; urine, stool, mucous.
• Mucous fistula is a stoma that allows decompression; usually is active for mucous.