Variability in Procedural Tasks and Decisions Made During Ostomy Pouching System Changes Performed by Nurses With Different Nursing Credentials: A Clinical Simulation Study.

PURPOSE: The purpose of this study was to explore clinical practice and decisions made during ostomy pouching system changes and procedures performed by nurses with different nursing credentials using a validated metric-based clinical simulation procedure. DESIGN: Explanatory sequential mixed methods design. SUBJECTS AND SETTING: The study population comprised 24 participants with different nursing credentials: 6 were certified ostomy care nurse specialists, 8 were registered nurses working in acute care, and 10 were senior baccalaureate student nurses. Data were collected between September 2021 and February 2024 at the Clinical Learning and Research Center within the Clemson University School of Nursing (Clemson, SC, USA). METHODS: This study used a validated metric-based clinical simulation procedure to assess tasks performed during ostomy pouching system changes, task duration, and supplies used. The simulated experience was followed by administration of the System Usability Scale and a structured debriefing interview. Two-way repeated-measure ANOVA, mixed-effects logistic regressions, and single factor ANOVA were used to analyze quantitative variables according to variable type. Content analysis was used to analyze debriefing interviews and comments made by the participants during the simulated experience. RESULTS: Certified nurses with expertise in ostomy management (CWOCN, CWON, COCN) spent significantly longer performing ostomy and peristomal skin care and pouching system changes tasks when compared with registered and student nurses. Differences between the nurse groups were observed for product selection, skin barrier sizing and adhesion, ostomy and peristomal skin care, along with infection control task categories. Scores on the perceived usability of ostomy pouching systems were above average for ostomy care specialists and registered nurses. Certified nurses with expertise in ostomy care had significantly higher perceived usability scores when compared with student nurses. CONCLUSIONS: Variability in psychomotor and critical thinking tasks were observed among 3 groups nurses with different credentials. This knowledge provides targets for expanding training of nurses in ostomy care.