It is important for nurses to be able to find and understand evidence. Finding evidence can be difficult when writing an assignment, updating patient information or submitting an article to be published. The local librarian can be useful within this process to help locate the right information. Courses can be undertaken to better understand research at all levels, including modules undertaken within the university setting. Nonetheless, it can be difficult to incorporate research into the working day without careful structuring and scheduling of time. Subscription to journals such as the British Journal of Nursing (BJN) and associations such as the Association for Stoma Care Nurses UK (https://ascnuk.com) can also be a useful way to keep up-to-date and source reliable and peer-reviewed evidence.
Critically appraising evidence
Before being able to determine if evidence should be included in clinical practice, the nature and reliability of it needs to be critically appraised. Useful assessment tools for critical appraisal of research are the checklist available from the Critical Appraisal Skills Programme (https://casp-uk.net/casp-tools-checklists). When looking at evidence, it is important to consider a few points, such as why the study was conducted and what implications it may have for future practice. In stoma care, it is common for stoma product manufacturers to research their new stoma products before marketing them. If a company undertook a project to promote their new stoma product, it would contain a greater level of bias than one written by an objective author. This does not mean that the results are incorrect or fake, but nurses should be able to understand why the research was undertaken when reading it.
Author credentials should also be appraised, to ensure that they understand, and are qualified to discuss, the topic that they are investigating. Nurses should ask themselves:
It is also necessary to consider what the author has written as a conclusion. An important factor to consider when appraising research is: do the findings match the stated conclusions? It is necessary to ensure that the authors have not made sweeping assumptions without evidence to support their conclusions. Additionally, it is important to consider the number of participants included in the study. If only a small sample was included, this may not be representative of all people living with a stoma.
Examination of patient demographics is also vital before the research results can be presented to a wider audience. Critical appraisal is necessary to determine if the results are different or similar to patient demographics within the clinical nurse specialist in a stoma care clinical environment. An example of this is to consider dietary advice for people living with a stoma. Nurses who care for people living with a urostomy will explore different dietary advice to people living with an ileostomy. As there are limited changes to the gastrointestinal tract following formation of a urostomy compared to formation of an ileostomy, some research critique requires more careful consideration before they can be integrated into the clinical area.
Implementing in practice
Before research findings can be implemented in clinical practice, nurses should consider several factors:
Types of evidence
Research and audits are important parts of the stoma care nurse's role (Royal College of Nursing (RCN), 2009). Evidence in stoma care can be gained through reading journal articles and attending conferences. There is a hierarchy in terms of quality of evidence, with single case studies being less immediately valuable than systematic reviews. Jamshidi and Pati (2023) explore research hierarchy and discuss the importance of ensuring that evidence is credible and valid.
Case studies
A case study can be used to describe an individual patient who presents with an unusual condition or uses a new treatment for example (Van der Ham, 2016). The study can be used to illustrate a point, highlight a clinical issue or describe how care was provided. Case studies can use photographs to highlight changes before and after treatment. They also have associated limitations. As they often describe the condition of one patient, their findings may be subjective and not be generalisable to a wider cohort.
A dated example of a case study is from Williams (2006), who explored stoma care in relation to sexual health. They reported a case study that highlighted issues faced by a patient who required surgery to remove his rectum and how this would affect his subsequent sex life. Sexual issues are infrequently published in nursing literature, so the article could have been constructive in helping readers to consider the topic. This might then resonate with the clinical nurse specialist in stoma care, if they encounter a similar scenario.
Case studies can also be used to detail unusual situations. McCormack and Skelly (2014) published a paper about a patient they encountered with peristomal ulceration. In this situation, the ulceration was related to the medication nicorandil used to treat angina (Joint Formulary Committee, 2025). As a result of publishing their findings, other stoma care nurses were able to discover that their patient had ulceration because of nicorandil, and have been able to use alternative medications to prevent or manage the angina.
Alternatively, case studies can be used to solve problems in new situations, such as when new stoma products are introduced; for example, a case study about new stoma products might explore how the product can be used to resolve skin issues. When the use of convex stoma products was less mainstream, McKenzie and Ingram (2001) described a case study using a convex stoma appliance. This case study was used to highlight when and how convexity can be used.
Opinion articles
Opinion articles include the author's opinion, backed up with references that support the discussion. Opinion articles that are published in nursing journals such as Gastrointestinal Nursing and BJN can be peer reviewed, which ensures that discussions and opinions are appropriate and accurate. Opinion articles can be useful to inform practice when there is limited other evidence available, although gastrointestinal nurses should ensure they follow up with more robust evidence when available.
Literature reviews
A literature review is used to search for papers on a particular topic using key words or search terms to select relevant articles from databases, such as CINAHL. Access to databases can be available from libraries such as those in hospitals, universities or the RCN. Depending on its aims, the literature review could examine all literature on a topic, or focus on select research papers (Dekkers et al, 2022). Literature reviews can help to strengthen the results from individual studies, which may have only included a small sample range.
For example, Ayaz-Alkaya (2019) examined psychosocial issues experienced by people with a stoma. Their literature review examined the findings of 27 research papers on the topic. Most studies included discussed key themes, including psychosocial issues, emotions, adaptation to the stoma and quality of life. Studies also identified negative themes, including poor body image and depression.
Consensus documents
There are an increasing number of stoma-related consensuses available. A consensus is developed by a group of experts on one topic, with the aim being to produce a greater understanding. While some consensuses might aim to produce a document of shared ideas, trying to gain agreement within a group can be difficult. Consensus documents can be useful when there is a lack of other available evidence to guide care.
Two example of stoma-related consensus publications focused on stoma siting. Salvadalena et al (2015a; 2015b) and Roveron et al (2016) each produced a consensus statement on stoma siting. Each present differently. Salvadalena et al (2015a; 2015b), based in the USA, show abdomens of people who have a body mass index above normal. In contrast, Roveron et al (2016), from Italy, shows siting images of abdomens of a normal body mass index. Critical appraisal is necessary to determine if these consensuses are useful in clinical practice, or if the national guidance from the Association of Stoma Care Nurses UK (2025) would be more appropriate.
Questionnaires
The use of questionnaires to collect data is usually undertaken using a pre-determined tool, such as a set of questions (Parahoo, 2008). Questionnaire data are usually classified as quantitative data and presented as numbers, for example ‘100 out of 150 participants agreed with a specific question’. Questionnaires can be undertaken orally, by post and online; the latter two methods enable data to be collected from large groups. There are several pros and cons related to using a questionnaire in nursing research, and the content of questionnaires need to be carefully considered (NHS England, 2018).
A small pilot study is usually conducted with a sample group to ensure the questionnaire is understandable. Once data have been gathered, potential issues that may arise include:
Several questionnaire tools have been developed to collect data from people living with a stoma. One of these examines quality of life for people with a faecal output stoma (Prieto et al, 2005). A benefit of using a validated tool enables results to be compared over time or across different settings. A more recently devised tool is the stoma acceptance questionnaire, developed by Bagnasco et al (2017). The questionnaire was developed in Italy following discussion with 350 clinical nurse specialists in stoma care.
Cross-sectional, snapshot questionnaires are useful for recording data on the perspectives of individuals at a particular time. Hubbard et al (2017) asked people living with a stoma what they thought were the most important topics to undertake stoma-related research on. The results from over 200 respondents showed the three main topics were leaking appliances, appliance-related problems and parastomal hernias. A further questionnaire by Hubbard et al (2019) on support garments, answered by over 1400 people living with a stoma, showed that patients used support garments to manage their parastomal hernias. The authors were able to use their findings to reliably advise stoma care nurses that patients were interested in learning about the benefits of garments to help adjustment to bodily change.
Guidelines
Guidelines within stoma care are available from several sources, including local hospital guidelines and the Association of Stoma Care Nurses UK (2025). Guidelines are useful tools for promoting evidence-based practice and are usually written by experts who have undertaken a consensus or a literature review to consider the available evidence before devising the guidelines (National Institute for Health and Care Excellence (NICE), 2024). Guidelines can be useful to standardise care and enable benchmarking with other hospitals.
Interviews
Interviews in research are used to illicit information through discussion. Interview data are classified as qualitative data, which is used to characterise data in a non-numerical manner (Hinton and Ryan, 2020). Interviews allow participants to answer questions in their own words to provide new perspectives on a topic (NHS England, 2017).
Dated interview data undertaken by Barbara Wade is still used to guide current stoma care. Wade (1990) was involved in over 200 interviews with people living with a colostomy to determine their psychological adjustment to their stoma. This research underpinned the importance of information provision to aid adaptation to life with a stoma. This provides a basis for pre-operative and postoperative stoma care information provision.
Clinical trials
There have been limited clinical trials undertaken in stoma care. An example of a small clinical trial involved 28 people living with an ileostomy eating marshmallows to reduce their ileostomy output (Clarebrough et al, 2015). Results showed that most people (20/28) had a reduction in their ileostomy output. However, approximately a fifth (6/28) had an increase in their faecal output, while two people were unchanged. When critically appraising these results, it shows that effects were varied, and not all people benefitted from eating marshmallows to improve their ileostomy output. The authors further elaborated on their findings, stating that eating marshmallows resulted in a median reduction of 75 ml per day. When critically exploring this information, 75 ml does not initially sound like a significant reduction. However, when considering the average output of the control group was 742 ml per day, 75 ml is a 10% reduction. More importantly, the average number of times the participants emptied their ileostomy appliance reduced from six to five times per day.
While an interesting study, how this information is translated into clinical practice needs to be carefully considered. With such small numbers and variation in results, there is no definitive conclusion that can be drawn. Additionally, the effect of the sugar needs to be considered for people with diabetes, as well as consideration of oral hygiene. Nonetheless, it could be suggested that eating marshmallows might be beneficial in some situations to reduce an ileostomy output. However, it is necessary when offering this suggestion to provide information about positive and negative evidence to enable an informed decision to be made by the person living with an ileostomy.
Conclusions
There are many different sources that can be used to guide care provided by the stoma care nurses. This article has explored some of the different research methods and provided examples for each. Case studies can provide information on unusual or rare occurrences. Questionnaires can be used to gain the opinions of larger groups. Specialist stoma care nurses need to use evidence to guide their care, and must be involved in future research to continue to enable the specialty to develop.