A multiagency model is proposed in order to address the problems of nursing staff mobility and unequal distribution of evaluation resources in an urban area. Included in this model are: a) the development of a clinical management protocol with criteria that reflect appropriate nursing process and desired patient outcomes; b) the implementation of a continuing education course to improve nursing care, and c) the evaluation of actual and recorded nursing process and patient outcomes. The project focuses on nurses caring for patients with colostomies from cancer of the colon or rectum. Program impact is evaluated across six institutions by determining: Aims 1 and 3 - pre to post program improvements in actual and recorded nursing process. Aims 2 and 4 - pre to post program improvements in actual and recorded patient outcomes. Aims 5 and 6 - pre to post program improvement in the predictive relationship between process and outcomes. Aims 7 and 8 - a comparison of the quality of actual versus recorded nursing care delivered and patient outcomes. Aim 9 - pre to post program costs of care in the hospital and home. Aim 10 -participant evaluations of feedback workshops regarding the findings from this research project. Approximately 104 RNs from the six participating agencies who are involved in the care of patients with colostomies will be evaluated before and following the continuing education course. Along with this nursing sample, 90 patients with colostomies will be evaluated before program implementation; a second group of 90 will be evaluated following program implementation. These aims will be measured by evaluating actual and recorded nursing process and patient outcomes with a mapping audit technique based on clinical decision making. Additional tools include: Patient Perception of Hospital/Home Care, Patient Attitudes Toward Self and Stoma, Patient Satisfaction and Cost of Care.