Abstract
Objective
To explore the application and effect of a new type of ostomy chassis measuring scale in the nursing care of patients with ileostomy.
Methods
Forty-two patients with ileostomy who met the inclusion criteria (first ileostomy performed without surgical complications, age ≥ 18 years, and voluntary participation with informed consent) were enrolled. The patients were randomly assigned to the control group (Group A, n = 20) and intervention group (Group B, n = 22) according to their hospitalization number. Group A used the conventional ostomy chassis measurement method, while Group B used a new type of ostomy chassis measuring ruler. The leakage rate of the ostomy chassis, time spent cutting the ostomy chassis, number of nurse teaching sessions needed to master the correct cutting method, and differences in self-efficacy and discharge readiness scores were compared between groups using t-tests and chi-square tests, with significance set at p < 0.05.
Results
The leakage rate of the ostomy chassis in Group B was significantly lower than in Group A (18.2% vs. 55.0%, χ² = 6.185, p = 0.013). Group B also had significantly shorter cutting time (8.45 ± 1.67 min vs. 12.30 ± 2.98 min, t = -4.667, p < 0.001) and fewer nurse teaching sessions required (2.30 ± 0.98 vs. 3.45 ± 0.60, t = -4.196, p < 0.001). Furthermore, self-efficacy (113.95 ± 15.76 vs. 77.00 ± 8.52, t = 10.262, p < 0.001) and discharge readiness scores (159.45 ± 18.81 vs. 110.10 ± 27.95, t = 6.723, p < 0.001) were significantly higher in Group B compared to Group A.
Conclusion
The application of the new ostomy chassis measuring scale can effectively reduce the time required for ostomy care, enable more accurate cutting of the ostomy chassis, and decrease complications such as leakage. This improvement enhances patients’ quality of life and reduces the nursing workload. We recommend adopting this measurement method in clinical practice to improve ostomy care efficiency and patient outcomes.
Clinical trial
Not applicable.
Keywords: Ileostomy, Ostomy care, Health education, Patient discharge, Self efficacy
Background
In recent years, the widespread adoption of anal preservation surgery for low rectal cancer has led to an increased clinical use of protective ileostomy, as it effectively reduces the risk of anastomotic fistula in these patients [1]. However, the management of ileostomy and associated ostomy care remains challenging. Studies have shown that improper fitting of ostomy appliances, particularly inaccurate cutting of the ostomy chassis in shape or size, contributes to complications such as peristomal skin irritation, leakage, and decreased patient comfort [2]. Moreover, prolonged time and difficulty in accurately cutting the chassis negatively affect patients’ and caregivers’ ability to learn proper ostomy care, which is crucial for improving quality of life, discharge readiness, and self-efficacy [3]. Despite these known issues, there is limited research on practical tools or methods to improve the accuracy and efficiency of ostomy chassis measurement. To address this gap, we developed and implemented a novel measuring scale for the ostomy chassis. This innovation not only improved the efficiency and accuracy of ostomy care but also received a national utility model patent (ZL20202266670008), reflecting its practical value and positive outcomes in clinical application.
Data and methods
General information
A total of 42 patients with ileostomy treated from March 1 to September 31, 2022 were selected as the study objects.
Inclusion criteria: ① The first ileostomy was performed without complications related to the procedure (e.g., bleeding, infection, anastomotic leak, or early stoma necrosis); ② ≥18 years old; ③ Voluntary participation in the study and informed consent.
Exclusion criteria: ① Patients with diagnosed dysfunction of major organs (e.g., heart, liver, kidneys) identified through medical history and clinical evaluation to avoid confounding factors affecting ostomy care and recovery; ② Patients with mental illness or cognitive dysfunction confirmed by medical records or clinical assessment, as these conditions may impair the patient’s or caregiver’s ability to understand and perform ostomy care effectively, potentially impacting study outcomes.
The participants were randomly assigned to the control group (Group A, 20 cases) and the intervention group (Group B, 22 cases) using a systematic allocation method based on their hospitalization numbers (e.g., odd numbers to Group A, even numbers to Group B). Allocation was performed by an independent staff member to ensure concealment. Due to the nature of the intervention, outcome assessors were not blinded. Due to the total sample size and the method used, an exact equal distribution was not achieved. However, baseline characteristics between the two groups were statistically comparable, minimizing potential bias. This study was approved by the hospital Ethics Committee.
Method
Both the group A and the group B used a unified enterostomy replacement process, that is, to change the ostomy bag according to the process of uncovering-checking-wearing. Both groups used cutting two-piece ostomy bag, not special enterostomy care products. When the ostomy bag is 1/3 full during using, it should be dumped in time. On the 1st, 4th, 7th and 10th day after operation, the nurses taught the family members of the patients designated for enterostomy to change their ostomy bag correctly. However, the measuring rulers of the enterostomy chassis used by the two groups are different, as follows.
Group A measured the diameter and length of the stoma in different directions by using the enterostomy measuring paper ruler provided by Coloplast Company, and then cut the stoma chassis directly according to the measured value. The stoma chassis needed to be constantly compared to the stoma and cut until it was fully fit.
Group B followed the steps below:
The novel stoma chassis measuring ruler (Fig. 1) was placed directly over the stoma. The paper section overlapping the stoma mucosa was folded along the base of the stoma to capture its contour, and the paper template representing the actual stoma shape was removed (Figs. 2 and 3).
Caregivers placed the stoma-shaped paper template onto the chassis surface, traced the outline with a pen, and cut along the marked line. To ensure proper fit, an additional 1–2 mm was added to the traced outline before cutting, as shown in Fig. 4.
The resulting chassis cutout matched the stoma’s shape and size, enabling a secure fit and reducing the risk of leakage (Fig. 5).
Fig. 1.
Novel enterostomy chassis measuring ruler
Fig. 2.
New enterostomy measuring ruler overlapping the stoma, with the paper folded along the mucosal base to capture its contour
Fig. 3.
New enterostomy measuring ruler after folding, showing the captured shape of the stoma base
Fig. 4.
The enterostomy chassis overlapping with the folded stoma measuring ruler and being cut, with 1 ~ 2 mm added to the cut line
Fig. 5.
Completed stoma chassis after cutting according to the measured shape
Evaluation index
Leakage rate and cutting time: The leakage rate of the enterostomy chassis was calculated as the proportion of patients experiencing ostomy bag leakage during the study period. The time spent cutting the enterostomy chassis was recorded in minutes for each session. Additionally, the number of teaching sessions conducted by nurses to instruct family caregivers in mastering the correct cutting method was documented. To minimize variability, all teaching and measurements were performed by a consistent group of experienced nurses with specialized training in enterostomy care. The nursing staff collected and recorded these data during routine care.
Self-efficacy: Patients’ self-efficacy was assessed using the Stoma Self-Efficacy Scale (SSES) [1], a validated questionnaire consisting of 28 items that measure two dimensions: enterostomy care self-efficacy and social self-efficacy. Responses use a 5-point Likert scale, ranging from 1 (no confidence) to 5 (complete confidence). Total scores range from 28 to 140, categorized as low (≤ 65), medium (66–102), and high (≥ 103) self-efficacy. The Chinese version of the SSES has demonstrated high reliability, with a Cronbach’s α coefficient of 0.96 overall, and 0.95 and 0.93 for the two subscales respectively [2]. Patients completed the questionnaire themselves, with assistance from nurses when needed to ensure comprehension.
Discharge readiness: Discharge readiness was evaluated using the Readiness for Hospital Discharge Scale (RHDS) [3], which includes 18 items covering disease knowledge, expected support, personal status, and coping ability. Each item is scored from 0 to 10, for a total possible score of 0 to 180. Scores are classified as low readiness (0–60), medium readiness (61–120), and high readiness (121–180). The RHDS has demonstrated good validity and reliability, with an overall Cronbach’s α coefficient of 0.923 and subscale coefficients ranging from 0.806 to 0.947. Patients completed the RHDS questionnaire at discharge with support from trained nursing staff as needed.
Statistical method
Statistical analysis was performed using SPSS 20.0 software. The normality of continuous variables was assessed using the Shapiro-Wilk test before applying t-tests. Independent samples t-tests were used for normally distributed data, while the chi-square test was applied for categorical variables. A significance level of α = 0.05 was set for all tests. Additionally, effect sizes (Cohen’s d) were calculated for t-tests to evaluate the clinical relevance of significant findings.
Results
The general demographic data of patients in both groups are summarized in Table 1. There were no significant differences between Group A and Group B in any baseline characteristics (all P > 0.05). Similarly, the demographic data of the designated family caregivers responsible for ostomy care are shown in Table 2, with no significant differences observed between the two groups (all P > 0.05).
Table 1.
The comparison of general data between the patients of two groups
| Group A (n = 20) | Group B (n = 22) | |
|---|---|---|
| Age (years)* | 68.60 ± 13.39 | 62.75 ± 15.19 |
| Sex ratio (M: F) | 9:11 | 11:11 |
| Education level | ||
| Illiterateness | 3 | 3 |
| Primary school | 6 | 7 |
| Junior middle school | 7 | 8 |
| Senior high school | 3 | 2 |
| College or above | 1 | 2 |
| Medical payment methods | ||
| Self-payment | 2 | 2 |
| Medical insurance | 10 | 12 |
| Agricultural insurance | 8 | 8 |
| Occupations | ||
| Worker | 2 | 2 |
| Household worker | 1 | 2 |
| Farmer | 3 | 4 |
| Retiree | 11 | 8 |
| Clerk | 1 | 2 |
| Freelancer | 2 | 4 |
| Number of children* | 2.30 ± 1.08 | 1.65 ± 0.99 |
*Values are mean(s.d.)
Table 2.
The comparison of general data between the caregivers of two groups
| Group A (n = 20) | Group B (n = 22) | |
|---|---|---|
| Age (years)* | 56.80 ± 13.43 | 52.05 ± 13.94 |
| Sex ratio (M : F) | 11:9 | 10:12 |
| Education level | ||
| Primary school | 8 | 8 |
| Junior middle school | 7 | 7 |
| Senior high school | 3 | 4 |
| College or above | 2 | 3 |
| Occupations | ||
| Worker | 1 | 0 |
| Civil servant | 0 | 1 |
| Farmer | 4 | 6 |
| Retiree | 6 | 4 |
| Clerk | 4 | 5 |
| Freelancer | 5 | 6 |
*Values are mean(s.d.)
Table 3 presents the comparison of leakage rates of the enterostomy chassis between the two groups. Group B, which used the new measuring scale, had a significantly lower leakage rate (18.2%, 4 out of 22 patients) compared to Group A (55%, 11 out of 20 patients) that used the conventional measurement method. This difference was statistically significant (χ² = 6.185, p = 0.013), indicating that the new measuring scale effectively reduced the incidence of leakage.
Table 3.
Comparison of leakage rate of enterostomy chassis between two groups
| Group | Sample (n) | Number of leakage cases of enterostomy chassis (%) |
|---|---|---|
| Group B | 22 | 4(18.2) |
| Group A | 20 | 11(55) |
| χ 2 | 6.185 | |
| P | 0.013 |
Table 4 compares the time spent cutting the enterostomy chassis and the number of nurse teaching sessions between the two groups. Group B, using the new measuring scale, had a significantly shorter cutting time (8.45 ± 1.67 min) compared to Group A (12.30 ± 2.98 min) (t = -4.667, p < 0.001). Additionally, Group B required fewer nurse teaching sessions to master the correct cutting method (2.30 ± 0.98 times) than Group A (3.45 ± 0.60 times) (t = -4.196, p < 0.001). These results suggest that the new measuring scale improves efficiency in ostomy care.
Table 4.
Comparison of cutting time of enterostomy chassis (minutes) and number of nurse teaching sessions for enterostomy care between the control group (Group A = 20) and intervention group (Group B = 22) (mean ± SD)
| Group | Sample (n) | Time of cutting enterostomy chassis (min) | Number of professors (times) |
|---|---|---|---|
| Group B | 22 | 8.45 ± 1.67 | 2.30 ± 0.98 |
| Group A | 20 | 12.30 ± 2.98 | 3.45 ± 0.60 |
| t | -4.667 | -4.196 | |
| P | 0.000 | 0.000 |
Note: “Number of professors” refers to the number of nurse-led teaching sessions provided to family caregivers for enterostomy care
Table 5 shows the comparison of self-efficacy and discharge readiness scores between the two groups. Patients in Group B demonstrated significantly higher self-efficacy scores (113.95 ± 15.76) compared to Group A (77.00 ± 8.52) (t = 10.262, p < 0.001). Similarly, discharge readiness scores were significantly greater in Group B (159.45 ± 18.81) than in Group A (110.10 ± 27.95) (t = 6.723, p < 0.001). These findings indicate that the intervention using the new measuring scale positively influenced patients’ confidence in ostomy care and their readiness for hospital discharge.
Table 5.
The scores of self-efficacy and discharge readiness of the two groups 
| Group | Sample (n) | Self-efficacy | Discharge readiness |
|---|---|---|---|
| Group B | 22 | 113.95 ± 15.76 | 159.45 ± 18.81 |
| Group A | 20 | 77.00 ± 8.52 | 110.10 ± 27.95 |
| t | 10.262 | 6.723 | |
| P | 0.000 | 0.000 |
Discussion
The new measuring ruler of enterostomy chassis can reduce the leakage rate of enterostomy chassis and reduce the nursing duration of enterostomy
This study demonstrated that the new measuring ruler for the enterostomy chassis significantly reduces the leakage rate, cutting time, and the number of nurse-led teaching sessions required for caregivers to master the correct cutting method. Similar findings have been reported by Gray et al. (2019), who noted that accurate fitting of ostomy appliances reduces peristomal skin complications and improves patient comfort [8]. Leakage of ostomy output is a well-known irritant to the skin; previous studies have shown that contact of effluent with the skin for as little as one hour can cause erythema and, over time, lead to erosion, bleeding, and itching [4]. This increases the frequency of ostomy appliance replacement and imposes an economic burden on patients, consistent with findings by Doctor et al. (2016) [9]. Tailoring the enterostomy chassis properly is therefore critical. Overly large openings expose peristomal skin to effluent, causing damage, whereas too small openings can constrict the stoma, causing friction, bleeding, or leakage under the chassis [5]. Traditional measuring methods require multiple comparisons and adjustments due to the stoma’s irregular shape, increasing time and difficulty, as well as nursing workload, a challenge also described by Gilpin et al. (2024) [10]. The new measuring method addresses these issues by capturing the stoma’s exact shape, facilitating precise cutting without repeated measuring. This innovation reduces leakage rates and nursing time, lowers ostomy replacement frequency, and eases the economic burden, aligning with findings from Brady et al. (2024) who emphasized the benefit of tailored ostomy care devices in improving clinical outcomes [11].
It should be noted that the sample size of this study was relatively small, and the average age of participants exceeded 60 years. Importantly, the cutting of the enterostomy chassis using the new measuring ruler was primarily performed by family caregivers, with guidance and supervision from nursing staff, ensuring appropriate sizing and fit. This practical involvement of caregivers supports the usability and feasibility of the tool in real-world settings, particularly for elderly patients who may have limited self-care capacity. Future studies with larger sample sizes are warranted to confirm these findings across diverse populations.
The new measuring ruler of enterostomy chassis can improve the self-efficacy and discharge readiness of enterostomy patients
This study shows that the new measuring ruler of enterostomy chassis can improve the self-efficacy and discharge readiness of the patients. Self-efficacy is an individual’s ability to judge a particular behavior in a particular situation [6]. The degree of discharge readiness refers to the degree to which patients have the ability to leave the hospital, return to society and further recover physically, psychologically and socially [7]. These findings are consistent with those of Xu et al. (2018), who reported that interventions improving ostomy care skills and confidence positively affect self-efficacy and readiness for discharge [2]. Enterostomy changes the original defecation mode of patients and causes inconvenience in their daily lives. If skin complications around the stoma occur due to improper cutting of the enterostomy chassis or other factors, it can increase patients’ discomfort, add psychological burden, and negatively affect their quality of life [2], an effect supported by Bekkers et al. (1996) [1]. The new measuring ruler of enterostomy chassis can accurately measure the shape and size of enterostomy, reduce the occurrence of skin complications around enterostomy, effectively shorten the time of replacing enterostomy chassis, and bring convenience to patients’ enterostomy nursing. It can make it easier for patients and their families to correctly grasp the methods of enterostomy nursing, have a correct understanding of enterostomy nursing, and perceive the life of enterostomy in advance, so that patients can acquire the self-management ability of enterostomy nursing, obtain the corresponding sense of behavioral achievement [12]. It can also help patients stimulate the belief that they can correctly manage enterostomy and minimize adverse consequences, and enhance the ability to return to society in physical, psychological and social aspects, which is helpful to improve patients’ readiness for discharge and self-efficacy.
Study limitations
This study has several limitations that should be acknowledged. First, the sample size was relatively small and drawn from a single hospital, which may limit the generalizability of the findings to broader populations. Second, the randomization method based on hospitalization number, while systematic, may not fully eliminate allocation bias. Third, the study duration was short, and long-term outcomes such as sustained self-efficacy and complication rates were not assessed. Additionally, although efforts were made to standardize nursing skill levels, subtle differences in nurse experience or teaching style could have influenced the results. Finally, patient-reported outcomes like self-efficacy and discharge readiness were based on self-administered questionnaires, which may be subject to response bias. Future studies with larger, multicenter samples and longer follow-up periods are recommended to confirm and extend these findings.
Conclusion
The application of the new measuring ruler for the enterostomy chassis enables patients and their families to quickly, simply, and accurately replicate the shape of the stoma, thereby avoiding improper cutting of the enterostomy chassis. Compared to the control group (Group A), patients in the intervention group (Group B) experienced a significantly lower leakage rate, reduced time required for cutting the chassis, fewer nurse-led teaching sessions, and higher scores in self-efficacy and discharge readiness. This innovation effectively minimizes waste of ostomy bags and chassis, shortens ostomy care duration, and improves overall quality of life. Additionally, it helps reduce the economic burden on patients and decreases the workload for nursing staff. Given these benefits, this measuring ruler has significant potential for widespread clinical adoption in enterostomy care. Future studies should explore its long-term effects, applicability in diverse healthcare settings, and integration with patient education programs to further enhance ostomy management and patient outcomes.
Acknowledgements
All funding sources, including appropriated funds, are reported, to meet funding disclosure requirements.
Author contributions
Z.Z contributed to the conceptualization, methodology, formal analysis, data curation, and original draft preparation. T.L was responsible for investigation, data collection, and review and editing of the manuscript. X.W provided resources, project administration, and validation. W.Z supervised the study, contributed to methodology development, and participated in manuscript review and editing. X.F supervised the project, secured funding, and contributed to manuscript review and editing. All authors read and approved the final manuscript.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data availability
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The study protocol was approved by the Ethics Committee of Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College. All procedures involving human participants and data were conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants or their legal guardians prior to enrollment in the study.
Consent for publication
All authors have read and approved the final manuscript and consent to its publication.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
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Contributor Information
Wanru Zhang, Email: zhangwanru0222@163.com.
Xiexi Fang, Email: yanw33243@163.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.