HLTENN030
Implement and monitor care for a person with a stoma


Application

This unit describes the skills and knowledge required to plan, implement and evaluate holistic care for the person with a stoma, applying the principles of contemporary stoma management.

Enrolled nurses working in stoma care nursing need to hold and apply specialised in-depth knowledge, effectively integrate theory and practice, and make reliable clinical assessments and judgements.

This unit applies to enrolled nurses, registered with the Nursing and Midwifery Board of Australia, seeking specialisation in enrolled nurse work that is carried out in consultation/collaboration with registered nurses and under direct or indirect supervisory arrangements aligned to the Nursing and Midwifery Board of Australia regulatory authority legislative requirements.

The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.


Elements and Performance Criteria

ELEMENT

PERFORMANCE CRITERIA

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element.

1. Contribute to interdisciplinary health care team in caring for the person with a stoma

1.1 Work within scope of practice to support the interdisciplinary health care team in managing the person’s stoma care needs and the needs of their family or carer

1.2 Identify specialist nursing and medical services and community agencies that support and deliver stoma care, and their possible role in long-term management of the person’s stoma condition

1.3 Discuss nursing care management plan regularly with the registered nurse and other members of the interdisciplinary health care team

1.4 Work in partnership with the person and appropriate service providers and agencies to maintain continuity of care

2. Assess health care needs of a person with a stoma

2.1 Perform holistic health assessment of the person using a range of assessment tools relevant to person’s care requirements

2.2 Collect accurate information in accordance with organisation policy and procedures

2.3 Identify physiological, pathological and congenital conditions leading to the person’s stoma creation

2.4 Determine the person’s own knowledge of their condition, therapies and self-management requirements, and how this might impact their care planning and provision

2.5 Identify family or carer’s knowledge of and involvement in the person’s stoma care condition, management and therapies

2.6 Identify possible psychological factors impacting the person with a stoma and their family or carer

3. Perform complex nursing interventions to assist a person with a stoma

3.1 Prepare the person’s nursing care plan to ensure it reflects the care needs specific to stoma care requirements

3.2 Prioritise nursing interventions for the person according to their identified needs, including emergency care of stoma

3.3 Identify principles of contemporary stoma management and apply these within organisation policy and procedures when providing nursing care for the person

3.4 Identify opportunities to provide health education to the person, and promote health and self-management of the stoma

3.5 Provide the person with education to promote health and self-management of the stoma

3.6 Identify responses of the person, family or carer to nursing interventions and their understanding of ongoing management of the person’s condition, including strategies for self-management

3.7 Communicate outcomes and proposed actions to the registered nurse and use a collaborative approach for follow up with interdisciplinary team

3.8 Identify when the acuity of a person is beyond own skills and knowledge and promptly consult with registered nurse and relevant interdisciplinary health care team members

4. Evaluate progress toward expected outcomes of care

4.1 Critically review the nursing care plan and modify according to the person’s progress toward planned outcomes, in consultation and collaboration with the registered nurse and health care team

4.2 Evaluate the person’s understanding of their stoma condition, medications, therapeutic regimes and self-management, and document their uptake of health promotion initiatives

4.3 Evaluate nursing interventions provided and consider identified outcomes against evidence-based best practice in stoma nursing care

4.4 Document outcomes of care and communicate findings to other members of the interdisciplinary health care team in accordance with organisation policy

Evidence of Performance

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

undertaken nursing work in accordance with Nursing and Midwifery Board of Australia professional practice standards, codes and guidelines

undertaken holistic assessment of at least 3 people using a range of assessment tools to identify the physiological, pathological or congenital conditions leading to stoma creation

provided nursing care applying the principles of stoma management to 2 people with a stoma in the workplace including:

replacing a stoma drainage bag

assessing the stoma for signs of obstruction, prolapse, necrosis and impaired integrity.


Evidence of Knowledge

The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:

principles of contemporary stoma management

health promotion activities appropriate for the person with a stoma and associated issues

medical terminology associated with stoma management, including:

ostomy

colostomy

ileostomy

urostomy

stricture

obstruction

prolapse

retraction

parastomal hernia

nursing management of the person with a stoma who is undergoing surgery

anatomy, physiology and pathophysiology related to stoma issues, sufficiently in-depth and specialised to make considered judgements and to make a professional contribution to the health care team

processes for the emergency care of stomas and stoma management including:

pre-operative and pre-procedure bowel preparation

wound care specific to stoma operation perineal wounds:

jejunostomy

gastrotomy

caecostomy

gastrointestinal and genito-urinary fistula

supporting bridge site care

appliance and product selection and management

how to manage skin and peristomal skin conditions

how to manage feeding and drainage tubes

how to manage urinary incontinence

faecal incontinence – its types, causes, assessment and management

skin care and products to assist in managing incontinence

how to make long bags

how to manage constipation, diarrhoea, constipation and flatus

care of high output stomas

odour control

community services and resources for stoma care

issues relating to stoma care including:

altered fluid and electrolyte states

nutrition, hydration

body image and sexuality

psychological and psycho-social considerations

stomal obstruction

peritonitis

necrosis

impaired stomal integrity

prolapse.


Assessment Conditions

Skills must have been demonstrated in the workplace with the addition of simulations and scenarios where the full range of contexts and situations cannot be provided in the workplace. The following conditions must be met for this unit:

use of suitable facilities, equipment and resources in line with the Australian Nursing and Midwifery Accreditation Council’s Standards including:

progressive notes of a de-identified person’s medical history

adult simulation manikin with stoma

stoma drainage bags

organisation policy and procedures on which the candidate bases the planning

modelling of industry operating conditions including access to real people for simulations and scenarios in enrolled nursing work.

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

In addition, assessors must hold current registration as a registered nurse with Nursing and Midwifery Board of Australia.


Foundation Skills

The Foundation Skills describe those required skills (language, literacy, numeracy and employment skills) that are essential to performance.

Foundation skills essential to performance are explicit in the performance criteria of this unit of competency.