Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Special Needs and Care Strategies
Client with Special Needs Care Strategy/Device/Learning Resource
Pediatric
  • Toy or doll wearing an ostomy pouch
  • Photographs of other children with an ostomy
  • Storyboards, websites, ‘chat-rooms’
  • Youth support groups

(Bray & Saunders, 2006)

Impaired Vision
  • Large print
  • Audio instructions
  • Customized lighting, stands and magnifying mirrors to visualize stoma
  • Two-piece pouch with ‘snap’ for auditory cueing of application
  • Tape on abdomen to mark skin barrier placement
  • Pre-cut ostomy skin barrier or pouch
  • Tactile cueing of stoma location and skin barrier placement

(Benjamin, 2002)

Wheelchair Bound
  • Pre-operative marking while client is in the wheelchair
  • Closed versus drainable pouch to manage access to the toilet
  • Drainage tube extensions for urostomy and high output fecal ostomy
  • Extended-wear skin barrier products

(Turnbull, 2007)

Pregnancy
  • Collaborative antenatal and postnatal care between OB/Gyn and GI
  • Customized lighting, stands and magnifying mirrors to visualize stoma
  • Flexible skin barrier and/or pouch to accommodate growing abdomen
  • Extra adhesive or skin barrier film to secure pouch because of ‘nonstick’ hormonal skin changes
  • Pre-cut skin barriers to avoid stoma trauma and bleeding due to increased vascularity of the stoma
  • Adjust skin barrier stoma opening frequently to accommodate size of stoma with growth of abdomen
  • Abdominal belt for additional support

(Aukamp & Sredl, 2004)

Learning Disabled, including illiterate
  • Makaton pictures, signs and symbols for communication
    www.makaton.org/about/ss_how.htm
  • Use of real objects and photographs to convey message
  • Speech pathologist, play therapists, drama therapist to assist with the translation of the information

(Black & Hyde, 2004)