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Avoid bony prominences and pendulous breasts as this may hinder vision of the stoma.

Avoid the waistline or belt areas, as the patient’s clothing may put pressure on the stoma which may lead to leaks or trauma of the stoma.

Ideally the patient should be able to see their stoma as this will make postoperative self-care easier.

All these factors need to be carefully considered and discussed with the patient whilst siting the stoma. Patient involvement is important as it allows the patient control and enhances their coping strategies. Make sure that you get the patient to adopt various positions before making a final decision on the stoma site, for example lying flat, sitting, standing, bending, as this sometimes changes the decision based on skin creases and patient comfort. Consideration must be given to any bending or lifting involved with the patient’s work and any other activities in which the patient partakes. Account must also be taken of any weight gain or loss in the postoperative period, as this may change the contours of the abdomen and hence the position of the stoma.

Once the site has been chosen, it should be clearly marked with a permanent marker pen, preferably a few days before the surgery. Offering the patient a bag to wear prior to surgery allows them time to adapt to their proposed surgery. This procedure should then be documented in the medical notes, stating any complications or issues discussed.

Psychological

Psychological preparation of the individual facing stoma surgery should begin as soon as surgery is considered, preferably by utilizing the skills of a trained stoma care nurse. It is important that the information and discussions are tailored to the individual’s needs, taking into account their level of anxiety and distress (Borwell 1997).

It is important that patients meet all members of the multidisciplinary team who are involved in their care and that they fully understand the need for the stoma surgery. This needs to be explained in order to obtain informed consent. It is beneficial if the patient is met in preassessment or at home prior to surgery to discuss the implications of stoma care and the patient’s role in rehabilitation. At this point it is also helpful to provide the patient with written information and access to self-help support groups.

Stoma counselling is often best carried out by the specialist stoma care nurse involved in the patient’s care. This provides an ideal opportunity to discuss issues such as:

body image

family relationships

sexual relationships

depression and anger

fears and concerns.

It is often beneficial to provide patients with some patient information/literature to take home. This gives them an opportunity to digest the information and write down any questions that they have. There are many different aids available, such as information booklets, samples of various products, diagrams, DVDs and internet websites. These help to reinforce and clarify the verbal information given to the patient.

Specific patient preparation

Patient education

Patients undergoing stoma formation have to make major physical and psychological adjustments following surgery. If surgery is elective, patient education should begin in the preoperative period (O’Connor 2005). Adequate pre- and postoperative support is mandatory to improve quality of life for stoma patients (Bloeman et al. 2009). Individual holistic patient assessment is key as it is important to identify appropriate teaching strategies for each patient. One of the most important ways in which a nurse can support the patient is to teach them stoma care, ensuring independence before discharge (Burch and Sica 2005). It is important that the patient is able to independently change their stoma bag, recognize problems and obtain support and supplies once discharged home. Providing patients with adequate information and input helps to promote patient decision making by allowing them control (Henderson 2003).

You will wear gloves when changing an appliance. This practice should be explained to patients