Discharge and Community Care

Successful rehabilitation of the stoma patient back to the community that he or she came from is an essential part of the nurse's job, whether it be the ward nurse or the nurse specialist in stoma care in liaison with the ward team, preparing the patient for a new phase of his or her life (Black, 1990). In a study by Pringle et al. (1997) it was suggested that the poor quality of life and stigma that stoma patients felt appeared to be affected by the level of support available to them once they were discharged. As far back as 1987, Rubin and Devlin suggested that the passage from hospital to home was the weak link in the chain of continuing care and support.

Successful rehabilitation of the stoma patient in the community depends on several factors:

• Understanding the type of stoma and whether it is temporary or permanent.

• Understanding which is the correct type of appliance.

• The correct prescription and supply of appliances, whether from the local chemist or via a delivery service.

• Contact numbers for support from the stoma care nurse in the community, the community nurse or the appropriate voluntary organization.

Often the skills that the patient has learnt in hospital in self-care will have to be adapted to the home situation. With the worry of discharge, often much of the practical management in stoma care is forgotten and the worry of perhaps living on one's own or with an ill spouse brings the stark reality of learning to live with a stoma without medical back-up.

Wade (1989), in her study of stoma care nurses and their patients, looked at the formal support for stoma patients in the community, once they have left hospital. Wade found that, in districts where there were stoma care nurses, up to 93% of patients had received a home visit in the 10 weeks after surgery. Only 7% of patients in non-stoma care nurse districts had received a visit at the same stage. Often, in these areas, the contact with a stoma care nurse had been through their spouse actively trying to find some support for the patient. The full impact and the consequences of stoma surgery are often not felt until patients return home and realize that they have to cope on their own. Often the only contact that patient may have will be with his or her GP, almost invariably at the patient's insistence, and the GP may have little knowledge or time to deal with the practical and psychological problems that the stoma patient may encounter.

One of the biggest anxieties of the stoma patient on leaving hospital is how and where to obtain the appliances. On discharge from hospital, the nurse will have given the patient 2 weeks' supply of the correct appliance for their stoma and, if necessary, the nurse can aid the patient by cutting the appliance to the correct size if a ready-cut appliance is not suitable, either because of the shape of the stoma or because the stoma has not shrunk to its final size after surgery. Normally the patient will be given a choice of a delivery service of appliances to the home or to go to their local chemist and collect the supplies. A prescription from the GP will have to be obtained regardless of the type of service that the patient opts to use. If the patient is 60 years or over, male or female, there is no cost for the prescription. If the patient is under 60 years a form will have to be obtained from the post office or the stoma care nurse that allows the patient an exemption from prescription charges.

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