Enterostomal therapy (ET) is a specialized field of nursing focused on the rehabilitation and care of patients facing complex health challenges. This specialty focuses on restoring bodily function and maintaining the health of the integumentary system (skin). ET addresses specialized needs related to surgical diversions, chronic wounds, and disorders of bowel and bladder function, aiming to improve independence and quality of life.
Defining Enterostomal Therapy and the Specialist Role
Enterostomal therapy is a clinical specialization focusing on three distinct areas of patient care: wounds, ostomies, and continence. The practitioner is typically a Registered Nurse (RN) who has pursued extensive post-graduate education and clinical training. In the United States, this professional is known as a Wound, Ostomy, and Continence Nurse (WOCN). WOC nurses must complete an accredited education program and pass a national certification examination administered by the Wound, Ostomy, and Continence Nursing Certification Board (WOCNCB). This certification ensures the nurse possesses specialized knowledge for managing complex patient populations, acting as a clinician, educator, consultant, and advocate.
Focus Area 1: Ostomy Management
Ostomy management forms the historical core of enterostomal therapy, addressing the care of patients with a surgically created opening (stoma) that diverts urine or stool. This specialization encompasses the care of colostomies, ileostomies, and urostomies, created to manage conditions like cancer, inflammatory bowel disease, or trauma. The nurse’s involvement begins pre-operatively with marking the optimal stoma site, considering the patient’s body contours and clothing preferences for a secure fit of the collection appliance.
Following surgery, the WOCN provides hands-on instruction on managing the newly formed stoma and the external collection system. This education covers techniques such as applying a skin barrier wafer and pouch, which must be correctly cut to fit the stoma size to prevent waste from irritating the surrounding skin. Patients are taught to empty the pouch when it is approximately one-third to one-half full to prevent the weight from compromising the appliance seal.
A major focus is the prevention and treatment of complications, particularly peristomal skin breakdown, which occurs in many individuals with an ostomy. The nurse assesses for issues like retraction, prolapse, and leakage, which can lead to significant skin irritation. The specialist recommends appropriate pouching systems, pastes, and barrier products, providing the patient with resources necessary for long-term self-care and reintegration into daily life.
Focus Area 2: Complex Wound Care
The WOCN’s expertise extends to the assessment and management of chronic, non-healing, or complicated wounds. This includes wounds resulting from sustained pressure, known as pressure injuries or bedsores, which occur when blood flow is compromised over bony prominences. The specialist also treats chronic lower extremity ulcers, such as venous, arterial, and diabetic foot ulcers, which require advanced knowledge of vascular status and offloading techniques.
Treatment involves detailed wound bed preparation, which may include debridement to remove non-viable tissue and the selection of specialized dressings to manage moisture and promote granulation. The nurse is trained in advanced modalities, such as negative pressure wound therapy (NPWT), which uses controlled suction to remove fluid and stimulate tissue growth. WOCNs also manage complex draining wounds and fistulas (abnormal connections between organs or skin), requiring meticulous containment and skin protection strategies.
Focus Area 3: Bowel and Bladder Continence Care
Continence management addresses the challenges associated with involuntary loss of urine or stool (urinary and fecal incontinence). The WOCN begins with a comprehensive assessment to determine the type and cause of incontinence, which guides the development of an individualized treatment plan.
Conservative management strategies are often implemented first, including behavioral techniques such as bladder training, timed voiding schedules, and pelvic floor muscle exercises. Dietary and fluid modifications are also part of the plan, as excessive fluid intake or consumption of bladder irritants can exacerbate symptoms.
For patients requiring containment, the specialist selects and fits appropriate devices, such as external collection systems or catheters, including teaching clean intermittent catheterization techniques. A primary aspect of this care is maintaining skin integrity around the perineum, where prolonged exposure to moisture can lead to moisture-associated dermatitis and skin breakdown.