Telehealth offers an evidenced-based approach to providing cost-effective care, education, and timely communication at a distance.1 The concept has been brought to the forefront due to the devastating effects of coronavirus (COVID-19) on the United States and the urgent need to find alternative ways for patients to receive care. Telehealth is now seen as an essential solution to provide access to care and limit exposure to others; health care was transformed overnight, and telehealth virtual visits via computers and smartphones are occurring globally.
Although its situation is not unique, the ostomy population is struggling to receive care. Many hospitals in the US do not employ a certified ostomy clinician. Research shows that between 20% and 70% of ostomates have complications; as much as two thirds of patients will experience pouching and/or peristomal skin difficulties. Most complications occur within 3 weeks of ostomy creation.2
In addition, the impact of having an ostomy may affect the patient’s physical, psychological, social, and spiritual wellbeing.3 Frequently, ostomates feel they do not receive enough education on how to properly care for their ostomy. Chronic skin issues, stress, and depression are inevitable without the proper education and treatment. Family and hired caregivers are typically inexperienced, relying on home care agencies who also have limited connections to certified ostomy nurses.4 The patients report not having access to supplies, ostomy nurses, and support group literature. Countless ostomates are known to isolate themselves, fearing embarrassing situations. Dating, sport activities, intimacy, and working often are halted, leaving ostomates frustrated and yearning to live their normal lives again.5
Telehealth is Closing Gaps
In an effort to close the gaps between patient care and access to medical professionals, telehealth is one modality that can successfully engage patients in their own care. Telehealth technology has been in use since 1905 when cardiac care physicians began monitoring patient heart sounds over the phone.6 In the twenty-first century, this technology is being utilized in almost all clinical specialties and for many different circumstances.
The American Telemedicine Association7 provides standards and guidelines to encourage effective and safe delivery of quality health care. These rules and regulations have been endorsed by several states in which medical professionals practice. As this technology expands, it is important that it is accepted by patients, clinicians, and researchers and that they realize that telehealth is essential.
Telehealth ostomy care is a unique niche in which health care clinicians can provide timely quality care. One way of introducing telehealth is to connect the home health nurses with a certified ostomy nurse who has knowledge and expertise in finding solutions for those with stoma complications.5 Access to a specialized ostomy nurse is the patient’s right and is essential throughout the whole journey, starting before surgery and following through postoperatively.8 Telehealth can mediate some challenges that occur. This is especially important for ostomy patients living in rural areas who may have limited access to clinics and/or inadequate transportation.9 With telehealth, a virtual ostomy nurse can be available 24/7. The virtual experience allows patients to use interactive discussions and activities through their smartphone, iPad, or computer from home to ensure that they understand how to utilize their prosthetic system. The utilization of telehealth technology, along with the services of certified ostomy nurses and wound, ostomy, and continence advanced practice nurses, will enhance quality of care, safety, and privacy.2 Adopting telehealth as an ostomy care delivery system can empower ostomates to live their life with confidence.
Ostomates’ Stories: Adopting Telehealth
Wonderful care at home. Diane has lived with an ileostomy for 12 years and made these comments after her telehealth visit. “I felt relieved, optimistic, comforted, and confident after my video session with a certified ostomy nurse. I showed the nurse my stoma and reddened irritated skin on the video camera and she showed me how to take care of it. It was so simple I couldn’t believe it. I was so relieved to find a solution to my problems that no one else could fix. The ostomy nurse made me feel optimistic that I could continue to live a healthy active life with an ostomy. The visit gave me comfort that my issue was not serious and that there was a quick solution. The one-on-one virtual session gave me confidence that if I have issues, I have someone I can go to immediately for help. Lastly, the most beneficial part was I did not have to take off from work or leave my comfy home for this wonderful care” (personal communication, March 2020).
Learning about resources. Theresa, who had a radical cystectomy and now has a urostomy explains, “My face-to-face video meeting with an ostomy nurse gave me confidence that we will find solutions to my leaking pouch and skin problems. I felt I had a person who cared and understood my unique situation. The ostomy nurse offered resources that I would have never known if I didn’t meet with her. Video conferencing was very new to me. I was worried initially, but now this is the way I will be receiving my ostomy care” (personal communication, January, 2020).
Decreasing anxiety. According to Pastor Tim, who has a new colostomy, “The most complicated thing was changing the pouch. Not being familiar with the supplies was very overwhelming. The telehealth ostomy nurse was able to decrease my anxiety by addressing all of my questions. My wife and I were able to learn how to cut the appliance to fit my stoma and apply it on our own through video demonstration. This was awesome! I didn’t have to leave my home. The ostomy nurse was very professional and made me comfortable when I was frustrated trying to figure out this bag system by myself. She gave suggestions—for example, using a full-length mirror to apply the pouching system, which helped tremendously. The best part was I didn’t have to go to a clinic, hospital, or primary care doctor to get expert ostomy care. Telehealth ostomy nurses were all of that and much more. I would recommend this portal of care to anyone” (personal communication, November 2019).
Call to Action
According to Strehle and Shabde,10 telehealth means, “healing at a distance.” Now more than ever, it is essential to educate the public on how telehealth is an acceptable choice for providing quality of care through secure platforms. Even though only a few current studies explain how telehealth can benefit ostomy patients, virtual visits have shown increased access to care, decreased health care expenses, and reduction in readmissions.3 With a new focus on adopting telehealth-related practices, the issues surrounding time management, lack of surgeons focusing on ostomy-related problems, and shortage of certified ostomy nurses can be mitigated exponentially.
Telehealth is a remedy for ostomates who are seeking specialized ostomy nurses. Certified ostomy nurses are experts, educators, and advisors, collaborating with ostomates regarding health care needs. New ostomy telehealth services are available to bridge gaps in health care. For telehealth resources and information on who specializes in ostomy care, please visit the United Ostomy Associations of America webpage Ostomy Healthcare Resources at www.ostomy.org. Technology is best when it brings people together. It is not just a tool—it can give a patient a voice they may have not had before.
This column was not subject to the Wound Management & Prevention peer-review process.
Author: Gina Day, BSN, RN, CWON
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