Checklist for Etnep Content Draft 2 January 2002

W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g CHECKLIST FOR ETNEP CONTENT

1 THE ET NURSE CLINICAL ROLE z i e r u n e r u o q y

i t u d s r c t e s l u o e c e r

l t a t u e

r k s u l c u h t

o m u s N s l g t c d i o i a a c e T e u d v x b

HEORY l t T : c

a e i E l k c

1ai m t i n o t e r N i o o o t d i STOMAS & CONTINENT DIVERSIONS, DRAINING WOUNDS, FISTULAS & TUBES o c o n T u m d d

r N W o

, - e E s f A e a l D s d s r e a u r a l l S u c P C n N I

Anatomy and patho/physiology Of gastro-intestinal (GI) system           Of genito-urinary (GU) system           Of respiratory system Conditions requiring stomas: congenital, acquired, infective, metabolic, neoplastic, traumatic           Procedures for diagnosis: endoscopic, laparoscopic, radiographic and surgical           Procedures for treatment: endoscopic, laparoscopic, radiographic and surgical           Operative procedures resulting in a           Stoma (including humid and perineal stomas)           Pelvic pouch           Continent diversion           Types of stomas Temporary/permanent           By anatomy tracheostomy, oesophagostomy, jejunostomy, caecostomy, ileostomy, colostomy mucous fistula & urostomy           By procedure: continent, divided, double-barrel, end, loop           Pre-operative period Stoma counselling           Stoma site selection           Pre-operative bowel preparation           Post operative period Stoma and skin care           Appliance selection           Counselling           Teaching           Management of stoma complications: ischemia, bleeding, mucocutaneous separation, hernia, prolapse, retraction,           1 trauma, stenosis, granulomas, ulceration, oedema, ileus, ileostomy blockage Management of skin problems: irritation, erosion, allergy, folliculitis, pyoderma gangrenosum,           hyperplasia, urinary crystals, dermatitis and pseudovaricose lesions, mucosal implantation

2 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g CHECKLIST FOR ETNEP CONTENT z i e r u n e r u o q y

l t a t u e

r k s u l c u h t

HEORY l t T : c

a e i E l k c

r N W o

Problem solving Early post op care           Long term care           Management of specific conditions ie short bowel syndrome, dehydration           Paediatrics Specific paediatric stoma considerations:           Stoma types,           medical conditions,           surgical intervention,           products,           parent counselling, ongoing care           Sexuality Counselling, body image, self concept           Pharmacology Constipation, diarrhoea, flatus, high output stoma           Nutrition and fluid balance For person with stoma, fistula – oral, parental, enteral           Fistulae GI: salivary, gastric, biliary, pancreatic, small bowel, large bowel, lymphatic, urinary           GU: bladder/vagina, bladder/rectum, recto-vaginal etc           Other e.g. thoracic           Fistula complications and management          

Skin care related to drain and tubes           Long term stabilisation           Drain/tube management           Feeding tubes and buttons:           3 Feeding gastrostomy, jejunostomy problem solving           Tracheostomy

4 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g CHECKLIST FOR ETNEP CONTENT z i e r u n e r u o q y

l t a t u e

r k s u l c u h t

HEORY l t T : c

a e i E l k c

r N W o

Human development & diversity across the life span/Quality of life: Paediatric, adult, geriatric special needs           Dying           Paraplegic, quadriplegic           - Limited dexterity           - Impaired understanding, illiterate           - Blind, deaf           - Cultural differences – religion, customs, language           Cancer Staging           Radiotherapy and chemotherapy           Management of radiation and chemotherapy related problems          

Products General product information – availability, cost, type           Ostomy company information re resources, representatives etc           Associations Ostomy Association information           Ostomy visitor program details           Documentation Written resource information i.e. booklets, diagrams, audiovisuals           Other resources Community support group information           Community nurse information           Financial resources availability           Government programs          

5 CHECKLIST FOR ETNEP CONTENT –

e t s r i l t t e a o c p e a n x d r

e p y m e

s l s a l i r e d

t x a v e o c e s b r t

l r e r v s d e a t r p e c v b

o d g r i

n p i d e t e u v l LINICAL RACTICE u s C P e n a h o i c s S

t t e r l v s 1aii n t d e r p O u i

o TOMAS ONTINENT IVERSIONS RAINING OUNDS ISTULAS UBES e S & C D , D W , F & T d u c e t s d p o N r i S e u u m r D d t

S e u d a n n l n e r o o c o

i v e i t t n r d t i I i a e e t t s L u c t a b i l a o s r u p m i s Pre-operative period, Counselling,         Interviewing         Communicating         General counselling skills         Sexual counselling         Grief counselling ( loss of body part, cancer, etc.)         Ability to provide accurate information about:         1. Operation         2. Stoma         3. Associated ostomy issues         Knowledge of printed or audio visual aids for patient         Stoma site selection         Bowel preparation         Post-operative management Assessment of stoma / skin / function         First 24 hours         First week         Following discharge from hospital         Management of post-op complications: ischaemia, bleeding, mucocutaneous separation, hernia, prolapse, retraction,         trauma, stenosis, granulomas, ileus, ileostomy blockage, ulceration, oedema Management of skin problems: disease, infection, chemical, allergic, trauma         Established stoma – ongoing care and problem solving         Management of continent diversions         First 24 hours         First week         Following discharge from hospital        

6 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g

Teaching ostomate self care         Providing discharge from hospital to home information        

e t s r i l t t e a c o p e a n x d r

e p m y e

s s l a i r l e d

t x a v e o c e s r t b a i

l e r r v s d a t e r p e c b

v h i e

d o d g r i

n p d i e t e u v l e LINICAL RACTICE u C P s n a h o i s c S

t t e s r l v 1aii n t d e r u p O i

o e TOMAS ONTINENT IVERSIONS RAINING OUNDS ISTULAS UBES c S & C D , D W , F & T d u e s t d p o i N r S e u u D m r d t

S e d u a n n l e n r o o c v o

i e i t r t n d t i I e i a e t s t L u c t b a i l a o s r u p m i s Product selection for Conventional stomas         Difficult stomas: bridges / rods, odd shapes         Drain tubes         Fistulae         Draining wounds         Procedures Stoma intubation – digital examination, enema, suppository         Specimen collection from ileal conduit         Feeding gastrostomy / jejunostomy – management of skin problems, leakage, feeds, skin level         devices and tubes Draining gastrostomy / jejunostomy - management         Colostomy irrigation/ obturator teaching         Distal bowel washout through loop stoma         Lavage (ileostomy)         Tube stabilization without skin suture         Long term drain tube management         Ante grade continent enemas (ACE) management         Appliances Appliance selection for:         Colostomy,         Ileostomy,         Urostomy         Tracheostomy Fistula         Drain & tubes         Large draining wound         8 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g

Self made appliance         Skin protection products         Accessory products for the ostomate         Education Patient education         Staff education        

9 CHECKLIST FOR ETNEP CONTENT z i e r u n e r u o q y

i t u d s r c t e s l u o e c r e

l t t a u e

k r s u l c h u t

o m u s N l s g t c d i o a i a c e T e u d x v b l t c

e - a e i E l k c

HEORY OUNDS KIN d r e m

1Bi T : W & S t i n o t e r i N o o o t d i o c o n T u m d d

r N W o

Anatomy and pathophysiology of the skin           Factors affecting wound healing - Skin assessment Endocrine           Cardiovascular           CNS           Immunosuppressive           Nutritional           Tools for skin assessment Altered tissue / skin integrity Prevention           Risk assessment tools, protocols           Assessment and grading           Wound healing phases           Management           Types of altered tissue / skin integrity Enzymatic           Friction           Maceration ( perspiration, urine, wound drainage)           Infectious ( herpes, monilia)           Neuropathic: diabetic foot (including other neuropathic lesions according to the country’s   reality such as Hansen disease)         Pressure/shear           Radiation therapy           Traumatic (accidental, excoriation, skin tears)           Vascular: arterial / venous           Others ((include other lesions according to the country’s reality such as Sickle-cell disease (SCD), also known as sickle-cell anaemia; Leishmaniosis; Negligent Diseases and others) Intervention for altered tissue/skin integrity: causative, local, systemic Nursing           Medical: growth factors, hyperbaric, pharmacologic           10 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g

Surgical           Products – ie special beds, other aids           Others: Vacuum- Laser- Hydrotherapy, Electrical stimulation , ozone therapy etc           Counselling (including sexuality, self-esteem and body image)          

e p m y e

s s l a i r l e d

v h i e

d o d g r i

n p d i e t e u v l e u s n a h o i s c S

t t e s r l v 1Bi WOUNDS AND SKIN PRACTICE n t d e r u p O i

o e c d u e s t d p o i N r S e u u D m r d t

i e i t r t n d t i I e i a e t s t L u c t b a i l a o s r u p m i s Prevention Assessment of risk         Assessment of skin         Assessment of wounds         History of altered tissue/skin integrity Pharmacological         Physical         Psychosocial         Diagnostic data         Hydration/nutrition         Wound/skin documentation         Procedures Ankle/brachial index - Doppler         Compression application         Culturing         Debridement         Wound cleansing         Products Product selection         Ostomy appliances for wound care         Skin protection techniques         Compression product selection         Pressure reduction/relief aids         Wound care multidisciplinary team         Education Patient education         Staff education         12 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g

13 CHECKLIST FOR ETNEP CONTENT z i e r u n e r u o q y

i t u d s r c t e s l u o e c r e

l t t a u e

k r s u l c h u t

o m u s N l s g t c d i o a i a c e T e u d x v b l t c

e - a e i E l k c

HEORY ONTINENCE d r e m

1Ci T : C t i n o t e r i N o o o t d i o c o n T u m d d

r N W o

Anatomy& physio/pathology of continence: function/dysfunction, acquisition/loss, risk           Epidemiology           Interventions for stooling dysfunction Medical/pharmacologic           Nursing           Surgical: including pull through procedure           Interventions for voiding dysfunction Medical/pharmacologic           Nursing           Surgical: including augmentation procedures           Types of stooling dysfunction Constipation           Diarrhoea           Fecal and urinary incontinence           Enuresis & encopresis           Types of voiding dysfunction Environmental           Reflux (detrusor hyperreflexia)           Urge (detrusor instability, detrusor hyperactivity with impaired contractility)           Overflow/retention           Stress           Continuous           Specific interventions Biofeedback           Pelvic muscle exercises           Electrical stimulation           Dietetics           Clean intermittent catheterization           Toileting programs: faecal/urinary           Counselling (including sexuality, self-esteem and body image)           14 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g

15 CHECKLIST FOR ETNEP CONTENT UPDATED –

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t t e s r l v 1Cii PRACTICE CONTINENCE n t d e r u p O i

i e i t r t n d t i I e i a e t s t L u c t b a i l a o s r u p m i s Assessment of continence Diary-elimination         Diary- hydration/nutrition         History of continence Financial, pharmacological, physical, psychosocial         Diagnostic data stooling : ie motility/ imaging/manometry/endoscopic         Diagnostic data voiding: ie urodynamics         Physical exam Abdominal         Rectal         Vaginal         Urodynamics procedures Flowmetry with electromyogram and residual urine         Pressure-flow studies         Specific intervention Biofeedback         Pelvic muscle exercises         Electrical stimulation         Clean intermittent catheterization         Toileting programs: faecal/urinary         Counselling         Product selection male/female Fecal incontinence         Urinary incontinence        

16 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g CHECKLIST FOR ETNEP CONTENT

2 THE ET NURSE EDUCATOR ROLE z i e r u n e r u o q y

l t a t u e

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o m u s N s l g t c d i o i a a c e T e u d v x b l t c

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HEORY d r e

2i T m t i n o t e r N i o o o t d i o c o n T u m d d

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Principles of teaching-learning           Developing educational programs           Client education           Designing patient education materials           Checking literacy levels           Colleague education           Writing for publication           –

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t t e s r l v 2ii PRACTICE n t d e r u p O i

i e i t r t n d t i I e i a e t s t L u c t b a i l a o s r u p m i s Design/use audio visuals: overheads, slides         Design/use education program:         17  ostomy          drain tube          wounds          skin care          continence        

3 THE ET NURSE RESEARCH ROLE z i e r u n e r u o q y

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HEORY ESEARCH d r e

3i T R m t i n o t e r N i o o o t d i o c o n T u m d d

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Types           Evaluation           –

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t x v a e o c e s r t b a i

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n p d i e t e u v l e u s n a h o i s c S t t e s r l v 3ii PRACTICE RESEARCH n t d e r u p O i

e c u d e t s d p o i N r S e u u D m r d t

i e i t r t n t d i I e i a e t s t L u c b t a i a l o s r u p m i s Literature review         Research proposal        

19 20 W o r l d C o u n c i l o f E n t e r o s t o m a l T h e r a p i s t s ( W C E T ) w w w . w c e t n . o r g CHECKLIST FOR ETNEP CONTENT

4 THE ET NURSE ADMINISTRATOR ROLE z i e r u n e r u o q y

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HEORY DMINISTRATIVE d r e

4i T A m t i n o t e r N i o o o t d i o c o n T u m d d

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Critical thinking / dilemmas / decision making           Ethical issues           Policy issues / trends, legal issues / regulation           Financing: cost accountability           Practice standards           Reimbursement           Team building          

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t x v e a o c e s r t

h v i e

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n p s i e t e u v e l u s n s a h o i c S

t t s e r l v 4ii ADMINISTRATIVE PRACTICE n u t d e r p O i

c o e d u e s t d p o i N r S e u u D m r d t

S e d u a n n e l n r o o c v o

i e i r t t n d t i e I i a e s t t L u c b t a i l a o s r u p m i s Advocating         Communicating         Consulting / networking         Evaluating products         Managing/maintaining an ET nursing service         Cost accounting / budgeting         Developing new programs         Keeping records         Marketing         Developing a fee schedule         Contracting/negotiating / justifying         Functioning as a specialist nurse         Grant (submission) writing         Maximizing computer use         Setting up an ET nursing service         Writing a job description        

5 ET NURSE PROFESSIONAL PRACTICE ROLE z i e r u n e r u o q y

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History of profession           Professional accountability           Continuing professional development           Participating in consumer organizations           Participating in legislative forums           Participating in professional organizations           Joining (or establishing) local ET nurse association           Joining WCET           Attending ETN, Wound, Continence conferences           ETN Association details           WCET information          

Updated February 2016