Stoma nursing is a specialised area of healthcare, where nurses will care for patients with a colostomy, ileostomy or fistula before, during and after surgery. There are many reasons why a patient may require the surgery, for example they may need to manage Crohn’s disease which affects the digestive system or if they have experienced an injury, such as a gunshot wound, to the colon or rectum. It can affect young and old patients, and many will find it a difficult transition. The stoma bag is used to collect waste that would normally be processed and passed through the colon and must be worn externally. Nurses are at the forefront of care for these patients and deliver an essential role in helping the patient manage their condition.
Melissa Smith is a newly qualified nurse who decided to pursue a career in nursing after caring for her grandmother who herself had to have a stoma close to the end of her life. Her experience has been that many nurses are nervous about working with patients who have stomas, but having trained nurses in this area of healthcare, she knows that the job can be highly rewarding, as long as nurses know the basics of the job and approach it with compassion and kindness.
What does stoma nursing entail?
Melissa explains that nurses deal with patients at every stage of the stoma process and a vital part of the role is teaching patients to clean and change their stoma bags. As the shape of the stoma can change, nurses will make new bag templates to fit an individual’s specific stoma. Once it has stopped changing shape, the patient can order pre-cut bags and be confident in changing them themselves.
“Nurses need to prepare patients before they have their stoma fitted as well. We need to tell them what to expect and to help them come to terms with what is happening to them. For some, this is very difficult. Many do not want to even touch their stomas in the beginning.”
This makes the role of the nurse a two-sided one – to firstly teach the patient and help them manage their condition; secondly to act as a kind of counsellor that provides emotional support.
“Patients can feel worried about many things, particularly their diet and sex life. We need to be there to show them that by making small changes to their diet, for example avoiding foods such as sweetcorn and coconut that are known to block the stoma bag, can have a big difference on their experience. In terms of their sex life, we must reassure them that although the bag will always be present, this doesn’t mean they can’t have a healthy sex life and be comfortable in their own skin.”
Having trained other nurses in stoma care, what did you need to cover in the training session?
While Melissa was qualifying as a nurse, she was approached by her tutor to train her peers. This formed part of the Peer Tutor Programme – initially developed for manual blood pressure training, during her first year of study, it branched out to include many areas of healthcare, including stomas. She prepared a training session to pass on vital knowledge to others and delivered a presentation and interactive activities.
“It was really important to me to make sure that the other students knew the basics of stoma care. When my grandmother was ill, I was aware that many nurses caring for her didn’t know much about stomas and didn’t clean or change her bag as often as they should have done. Nurses need to know how to do this and to also understand that it is not a great challenge once you know what you’re doing.”
Melissa showed the students how to change and clean the stoma bag. The interactive activity formed a big part in this, as students had to first fit a bag to themselves (the role of the self-caring patient) and then fit a bag to someone else (the role of the nurse).
“I also told them about the different kinds of stomas, as they can be required for many different reasons. Nurses need to be aware of the different approaches to treating different stomas and to understand that every patient is an individual who may require different care. It is also necessary to know that sometimes things can go wrong and you need to be prepared for this.”
Find Part Two of the blog here.
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