Keywords
Issue: Volume 65 - Issue 8 - August 2019 ISSN 2640-5245
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At a time where words matter more than ever before, we need to use the correct phrases and terminology and avoid inappropriately interchanging words so that we do not create and/or perpetuate confusion and misinformation. When discussing ostomies, words matter, especially with regard to the question as to whether an ostomy is a wound. The words used affect how people with ostomies see themselves and are seen by the greater community, including the persons who provide their care. This misunderstanding is evident in the calls received by the United Ostomy Associations of America (UOAA). For example, one caller informed the organization that an assisted living facility in Connecticut would not change a resident’s ostomy wafer because “it is an open wound,” and according to facility policy, only a family member could perform the necessary care.
Learning you need an ostomy is often overwhelming; most patients have had little to no first-hand experience or knowledge of what living with an ostomy entails. Ostomies are not temporary or permanent wounds. The inaccuracy and confusion that may be part of patient-provider conversations adds to the stigmas and myths often associated with ostomies and the persons’ who live with them.
Anyone with a connection to ostomies probably knows that nursing professionals who are certified to provide support to patients with a colostomy, ileostomy, or urostomy are integral in helping patients before and after ostomy surgery. These clinicians include Ostomy Management Specialists and Ostomy Care Associates but especially certified wound ostomy continence nurses (CWOCNs). Their support might include not only offering clinical advice and assistance, but also helping the patient find the right appliance products (wafers/bags and skin care products) for their body type, stoma shape, and skin needs and providing resources and comfort as patients adjust emotionally to this new way of living. However, the fact that often it is a wound care nurse who provides the necessary clinical services has led some people to consider the ostomy a wound and not the result of a life-saving surgical procedure performed to address disease, cancer, or structural problems.
First, to help provide a better understanding, the eleventh edition of the Merriam Webster Collegiate Dictionary defines a wound as an injury to the body (as from violence, accident, or surgery) that typically involves laceration or breaking of a membrane (such as the skin) and usually damage to underlying tissues. The surgical procedure to create an ostomy is defined as an operation to create an artificial passage for bodily elimination — that is, the surgical redesign of the body to divert the intestinal tract and reattach the intestine to the outside of the body through the creation of an opening in the body (the stoma) through which bodily fluids can pass. This surgery is performed when traditional elimination methods and/or the associated organs are no longer viable or functional.
The association of the stoma with skin care also connects the concept of wound care with the ostomy process and where we need to be mindful in ensuring terms are used correctly. Sometimes, the skin underneath the ostomy appliance gets irritated and a wound can develop, requiring the attention of a trained nurse to find the patient a better appliance system to support the size and shape of the stoma or help determine which topical medicinal creams, powders, or skin protection to use on the skin under the wafer. The wound care is provided to the skin surrounding the stoma, not the ostomy/stoma itself. Just as a patient with diabetes might develop leg ulcers and need wound care support to help keep the wounds clean and to heal compromised skin, a patient with an ostomy needs to be sure the skin under and around the stoma and appliance remains clean and free from irritation and infection.
A wound and an ostomy are the result of 2 distinctly different phenomena. In the very literal sense, creating a stoma involves the breaking of the membrane (skin), but it is neither an accidental creation nor is it created to cause damage to underlying tissues; it is created to rectify damage caused by illness or injury and does not fit the literal meaning of a wound. An ostomy is a surgical procedure and needs to be understood and treated as such, and wounds need to be seen as what they are, no matter the cause or location on the body.
An ostomy is not a wound and should not be referred to as a wound in the medical field. It is not a type of accidental damage that needs to be rectified; it is not a wound that needs to be healed! Every ostomy needs to be recognized as a life-saving surgical procedure and the reason millions of people are alive and thriving.
The opinions and statements of the clinicians providing Upfront With Ostomies are specific to the respective authors and not necessarily those of Wound Management & Prevention, or HMP. This article was not subject to the Wound Management & Prevention peer-review process.
