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香 港 造 瘻 治 療 師 學 會

Hong Kong Enterostomal Therapists Association

Standards in Stoma Care
(July 2001)
All rights reserved. No part of this book may be reproduced in any form without permission of Hong Kong Enterostomal Therapists Association Limited.

07/01) .Standards in Stoma Care (Rev.Content Page i ii iii iv Topic Preface HKETA Standard and Professional Development Committee Members Philosophy of HKETA Code of Practice HKETA Standard in Stoma Care  Assessment before elective stoma surgery  Pre-operative patient counseling related to stoma surgery  Stoma siting for patient awaiting elective stoma surgery  Post-Stoma Surgery assessment  Colostomy Care  Urostomy Care  Ileostomy Care  Colostomy irrigation  Distal Loop stomal washout  Discharge plan for patient with stoma  Patient education  Education to health care team  Promote professional development 1 2 3 4 5 6 7 8 9 10 11 12 13 HKETA .

2001 i HKETA . The HKETA believes that the Standards of Stoma Care will make positive contributions to the quality of care in Hong Kong. Susan Law Chairperson. The panel employed scientific-based evidence and expert clinical judgment for the clinical condition selected. efficient quality service. Hong Kong Enterostomal Therapists Association July. The Standards of Stoma Care was developed by a panel of qualified Enterostomal Therapists from various hospitals in Hong Kong. wound and continence care service to the community. The standards serve as reference to nursing managers in standardising stoma care in the clinical service. 07/01) .Preface The Hong Kong Enterostomal Therapists Association (HKETA) has the mission to enhance quality stoma. It is envisaged that the development of standards of care may be implemented in all hospitals to achieve an uniform.Standards in Stoma Care (Rev.

07/01) . May Law Siu Ming. Winnie Cheng Wing Yee Ho Chi Wai Ip Mei Ha. Susan Lee Wai Kuen Tang Siu Fong. Frances NS (Stoma Care) NS (Stoma Care) Stoma Care Nurse NS (Stoma Care) Stoma Care Nurse NS (Stoma Care) NS (Stoma Care) NS (Stoma Care) NS (Stoma Care) NS (Stoma Care) Yan Chai Hospital (Chairperson & Secretary) Queen Elizabeth Hospital Tuen Mun Hospital Pamela Youde Nethersole Eastern Hospital Alice Ho Miu Ling Nethersole Hospital Princess Margaret Hospital Queen Mary Hospital Kwong Wah Hospital Caritas Medical Centre Prince of Wales Hospital ii HKETA . Wenita Wahjun Sit Kam Yee. Anna Soethantheo.Standards in Stoma Care (Rev.Hong Kong Enterostomal Therapists Association Standard and Professional Development Committee Pang Chak Hau Cheng Siu Wah .

ET NURSES are dedicated to share experience and knowledge with other health care.Standards in Stoma Care (Rev. ET NURSES act competently as consultants to all who are interested and involved in the Enterostomal Therapy. fistulas. 07/01) . psychological. We maintain that Enterostomal Therapists (ET Nurse) are qualified nurses who possess specialized Enterostomal Therapy qualification recognized locally and internationally. iii HKETA . incontinence. ET NURSES are responsible to provide holistic care in order to expedite the physical. enhance and share with other multidisciplinary teams the expertise knowledge of Enterostomal Therapy in the provision of quality patient care. both in the hospital and community. draining wounds.Philosophy of the Hong Kong Enterostomal Therapists Association The Hong Kong Enterostomal Therapists Association (HKETA) is a nursing professional organization devoted to promote. setting and monitoring the standards of care. ET NURSES are experts in the provision of care to clients with abdominal stomas. ET NURSES are responsible to continuously enrich their personal and professional development in order to ever improve the Enterostomal Therapy. ET NURSES are committed to promote the Enterostomal Therapy nursing by participating in research and educational training. social and spiritual well beings of clients with special needs. decubitus and vascular ulcers.

age. ET NURSE refuse to accept any gift. sex. ET NURSE when participating in 'trial' of a product should be under no obligation to persuade the client or him/herself to use the product. colour. values. ET NURSE keeps accurate records on all clients consultation in order to maintain an integral part of the service. He/she avoids the use of professional qualifications in the promotion of commercial products. ET NURSE provides the client with all relevant information about the choice of products available and its suitability to the client's need without prejudice. skill and competence by keeping in alignment with new developments. social status and the nature of the health problem. ET NURSE must uphold and develop own knowledge. He/she takes steps to solve any relevant deficits through the collaborative work among the health care team in order to meet the needs of the clients. interests and well-being of the clients. ET NURSE maintains confidentiality of the client's personal information and shares with others only that information relevant to his/her care. unconditioned by the clients' race. theory and practice of enterostomal therapy care. ET NURSE provide the Enterostomal Therapy service with respect for the clients' belief. iv HKETA . He/she must maintain high standard of care and professional conduct at all times.Code of Practice E nterostomal Therapists (ET) Nurse acts to promote and safeguard the rights. favor or hospitality which might influence the fulfillment of roles. 07/01) . ET NURSE is personally accountable for his/her professional practice and judgment and should recognize any limits of personal knowledge and skill. customs and uniqueness.Standards in Stoma Care (Rev. He/She should bear in mind the need and requirement of the client in the choice of products.

Adequate data / information of patient who will have stoma are recorded and updated.2 Ability to hear.1 Language 1.10 Eye-hand co-ordination.Standards in Stoma Care (Rev.2 Family support 1. visual acuity and manual dexterity Data / information are recorded and updated.3.4 Emotional states & coping strategies 1. Structure criteria Environment: Privacy Staff: ET nurse Equipment: Record Process standard 1. 2. read. speak.8 History of skin allergies 1.6 History and effect of health problem and adaptation to the health situation(s) 1. 07/01) .3.7 Presence of chronic disease states / current therapies 1.1 Home situation / availability of toilet facilities 1.9. The needs of patient who will have stoma after the operation is identified and documented. 2.9. understand 1.3 Supporting system and resources : 1.HKETA Standards in Stoma Care Topic Assessment before elective stoma surgery Standard statement The ET nurse obtains and maintains adequate information to plan care in conjunction with patient /carer. P.9 Ability to communicate: 1.1 HKETA .5 Occupation and life style 1. A care plan is drawn. 3.2 Family history / prior experience and knowledge regarding diagnosis / ostomy 1.1 Social. cultural and spiritual background 1. Outcome criteria 1. Assessment includes but not limited to: 1.

Records are maintained accurately. Outcome criteria 1. concept of stoma and options for stomal management. 5.HKETA Standards in Stoma Care Topic Pre-operative patient counseling related to stoma surgery Standard statement The ET nurse provides information and counselling to patient / patient's family to alleviate fear and anxiety related to the stoma and surgery. 07/01) . Arrange visitor from ostomy association as indicated.1 Level of anxiety 1. 3. 2. P. 3. 2. Structure criteria Environment: Privacy Staff: ET nurse Equipment: Record Process standard 1. Provide individualized support and counseling. Initiate referral to appropriate resource person as indicated. Patient and /or carer verbalizes understanding of planned surgical procedure. fears and concerns. interventions and patient's response. Patient demonstrates manageable level of anxiety as evidenced by verbal and non-verbal indicators. Document assessment. 4.Standards in Stoma Care (Rev.3 Knowledge base and learning needs Encourage patient / carers to verbalize feelings.2 Coping Strategies 1. Assessment of patient includes but not limited to: 1. 6. 7. Provide relevant information as needed.2 HKETA .

siting equipment Process standard 1. Explains reasons and procedure of marking a stoma site.Standards in Stoma Care (Rev. Assesses the abdominal contour for the best site. 3.3 HKETA . The patient is satisfied with the siting of his/her stoma. 4. P. patient's physical ability. social activity. Employs appropriate method to choose a provisional site. 2. 07/01) .HKETA Standards in Stoma Care Topic Stoma siting for patient awaiting elective stomal surgery Standard statement The patient's stoma is correctly sited by the ET nurse. warm. The patient states that he/she has participated in the planning and marking of stoma site. The stoma is correctly sited. Outcome criteria 1. 6. 2. 3. Documents information regarding the stoma site in patient's record. Structure criteria Environment : Privacy. 7. culture. occupation and life-style. good lighting Staff : ET nurse Equipment : Record. Evaluates the provisional site with patient's participation and makes necessary adjustment. 5. Maintains a suitable environment Assesses the type of surgery.

2. surgical procedure.3.3 Condition and function of stoma 1.4 Condition of peristomal skin integrity e. macerated 1.g. Skin integrity. 3.3. A care plan is drawn.2 Colour 1.4 Abdominal contour 1. Adequate data / information of patient who have stoma are recorded and updated.5 Pouching surface available Data / information are recorded and updated 2. Outcome criteria 1.Standards in Stoma Care (Rev. stoma appliances and accessories Process standard 1.HKETA Standards in Stoma Care Topic Post-stoma surgery assessment Standard statement The ET nurse obtains and maintains adequate information to plan care after surgery in conjunction with patient /carer Structure criteria Environment: Privacy.3.2.2 Size 1.4 HKETA . Assessment includes but not limited to: 1.g.2. irritated.3 Consistency and volume of output 1.2. budded.3 Location 1. 07/01) .1 Operative diagnosis.1 Stoma condition e. 1. poor turgor.2 Anatomical location and surgical construction of stoma 1. warmth and good lighting Staff: ET nurse Equipment: Record.1 Type 1.2. P. dryness. flush. Needs of patient who have stoma after the operation is identified and documented. retracted 1.

Explains procedures to patient Maintains a suitable environment Prepares all the ostomy appliances and accessories Positions the patient to facilitate the procedures Provides appropriate colostomy care based on assessment Gives special consideration of the followings: 6. 4.1 Observes the stoma and peristomal skin for abnormalities 6. 3. stoma appliances and accessories Process standard 1. 3. nature and volume of effluent and the date of ostomy appliances changed Patient is satisfied with a secure pouching system. warmth and good lighting Staff : ET nurse Equipment : Record. 6.Standards in Stoma Care (Rev. Records are maintained accurately. 1.HKETA Standards in Stoma Care Topic Colostomy Care The ET nurse provides optimal stomal and peristomal skin care to Standard statement patient with colostomy Structure criteria Environment : Privacy. 5.2 Measures the accurate size of stoma 6. 2. Outcome criteria 2. 07/01) . Abnormalities of stoma and peristomal skin are identified. P.3 Chooses the appropriate appliances and accessories as necessary Documents the condition of stoma.5 HKETA . 7. peri-stomal skin.

4. 3.1 Observes the stoma and peristomal skin for abnormalities 6. 3. 6.6 HKETA . peri-stomal skin.3 Chooses the appropriate appliances and accessories as necessary Documents the condition of stoma.2 Measures the accurate size of stoma 6. P. 07/01) . nature and volume of effluent and the date of ostomy appliances changed Patient is satisfied with a secure pouching system Abnormalities of stoma and peristomal skin are identified Records are maintained accurately 7. stoma appliances and accessories Process standard 1. warmth and good lighting Staff: ET nurse Equipment: Record. Outcome criteria 1. 5. 2.HKETA Standards in Stoma Care Topic Urostomy Care Standard statement The ET nurse provides optimal stomal and peristomal skin condition to patient with urostomy Structure criteria Environment: Privacy. 2. Explain procedure to patient Maintains a suitable environment Prepares ready all the ostomy appliances and accessories Positions the patient so as to facilitate the procedure Provides appropriate urostomy care based on assessment Give special consideration of the followings: 6.Standards in Stoma Care (Rev.

nature and volume of effluent and the date of ostomy appliances changed. Patient is satisfied with a secured pouching system Abnormalities of stoma and peristomal skin are identified Records are maintained accurately 7. 2.2 Measures the accurate size of stoma 6. Explains procedures to patient Maintains the suitable environment Prepares ready all the ostomy appliances and accessories Positions the patient so as to facilitate the procedures Provides appropriate ileostomy care based on assessment Gives special consideration of the followings: 6. P. Outcomes criteria 1. peri-stomal skin.1 Observes the stoma and peristomal skin for abnormalities 6. 3. 5.3 Chooses the appropriate appliances and accessories as necessary Documents the condition of stoma. stoma appliances and accessories Process standard 1. 4.HKETA Standards in Stoma Care Topic Ileostomy Care Standard statement The ET nurse provides optimal stomal and peristomal skin condition to patient with ileostomy Structure criteria Environment : Privacy. 07/01) . 6.7 HKETA . 2. 3. warmth and good lighting Staff : ET nurse Equipment : Record.Standards in Stoma Care (Rev.

4. 2. 07/01) .HKETA Standards in Stoma Care Topic Colostomy irrigation Standard statement The patient’s bowel is cleansed in an effective and safe manner Structure criteria Environment : Privacy. 6. 3.Standards in Stoma Care (Rev. 3. 5.2 Regulate the flow of warm water into the bowel slowly Monitors the patient for any complaints of abdominal pain or distension throughout the procedure Observes. Outcome criteria 1. 2. irrigation appliances and accessories Process standard 1. Explains the reason and procedure to the patient / carer Arranges patient in a sitting position Prepares ready all the irrigation appliances and accessories Pay special consideration of the followings: 4.8 HKETA .1 Temperature of water 4. 4. documents and reports the result and the patient's response The patient’s bowel is cleansed The patient is satisfied with explanation and care given The potential complications are identified and appropriate actions are taken accordingly Records are maintained accurately P. warmth and good lighting Staff : ET nurse Equipment : Record.

2 Temperature of water 4. 4. Prepares the patient in comfort position 3.Standards in Stoma Care (Rev. Explains the reason and procedure for stomal washout to the patient / significance others 2.4 Continues the procedure until fluid passed out is clear 5. 6. The patient’s distal loop of ostomy is cleansed The patient is satisfied with the explanation and care given The potential complications are identified and appropriate actions are taken accordingly Records are maintained accurately P.1 Examines the direction of the distal colon by digital examination 4. Monitors the patient for any complaints of abdominal pain or distension throughout the procedure. Prepares ready all the irrigation appliances and accessories 4. 2.HKETA Standards in Stoma Care Topic Distal loop stomal washout Standard statement The patient’s distal bowel is cleansed in an effective and safe manner Structure criteria Environment : Privacy. 3. documents and reports the result and the patient's response Outcome criteria 1. Gives special consideration of the followings: 4.9 HKETA .3 Regulates the flow of warm water into the distal bowel slowly 4. 07/01) . irrigation appliances and accessories Process standard The ET nurse : 1. Observes. warmth and good lighting Staff : ET nurse Equipment : Record.

4 Support network Provides education on stoma management and potential complications.Standards in Stoma Care (Rev.HKETA Standards in Stoma Care Topic Discharge plan for patient with stoma Standard statement The patient / carer has access to the continuity of care of stoma Structure criteria Environment: Privacy Staff: ET nurse Equipment: Record. information sheet / leaflet Process standard 1. 5. 07/01) .3 Financial 1.10 HKETA . Offers the access to contact the ET nurse and provides follow-up appointment. documents and reports the result and the patent's response. 4. The stoma care nurse / ET nurse identifies the potential needs of the patient in the first visit : 1. 3. 3. The patient/ carer is satisfied with care and advice provided The patient has follow up care from the ET nurse after discharge Records are maintained accurately 2.2 Adjustment process 1. Outcome criteria 1. Assesses patient’s coping strategy and provides appropriate action if necessary.1 Self care ability 1. P. 2. Observes.

Standards in Stoma Care (Rev.11 HKETA . Assesses patient’s learning needs. 2.HKETA Standards in Stoma Care Topic Patient education Standard statement The patient / carer receives a congruent education program on stoma care Structure criteria Environment: Privacy Staff: ET nurse. Evaluates the patient’s / carer’s response to the individualized educational program. Implements education program according to individual needs. 07/01) . carer Equipment: Teaching aids Process standard The Stoma care nurse / ET nurse : 1. Outcome criteria 1. The patient /carer is satisfied with the educational program P. 3.

seminars.3 Implements the teaching program plan The members of the health care team evaluate the teaching program 2. practical demonstration. Practical demonstration P. Outcome criteria The members of the health care team demonstrate knowledge of stoma care through: 1.2 Formulates a teaching program and selects a teaching method e.HKETA Standards in Stoma Care Topic Education to health care team Standard statement ET provides education on the care of ostomates to members of the health care team Structure criteria Staff : ET nurse Equipment : Teaching aids Process standard 1.12 HKETA . group discussion 1. workshops.g.1 Assesses the existing knowledge of the health care team through questioning 1. Verbal / written statements 2. 07/01) . The ET nurse : 1.Standards in Stoma Care (Rev.

Updates knowledge related to stoma care continuously. 2. 3. The ET nurse develops and maintains his/her standard of service. 4.13 HKETA . 07/01) . P. Continuous professional development is maintained. Determines his/her aims and objectives for professional development. Records activities of professional development.Standards in Stoma Care (Rev. Reviews objectives periodically to identify progress and future needs for professional development.HKETA Standards in Stoma Care Topic Promote professional development Standard statement The ET nurse develops and maintains his/her standard of service through continued professional development. Structure criteria Staff : ET nurse Process standard The ET nurse : 1. Outcome criteria 1. 2.