Gregory Coote

Department of Nursing, University of New England

Nursing 353: Adult Health 2

Professor Kemper

June 8, 2023

Ostomy Reflection

Introduction:

            An ostomy is a rerouting of stool and creating an alternate exit as the patient is unable to pass excrement out of their rectum.  A stoma is created by surgical means, which involves taking a portion of the intestine and outpouching it through the abdomen.  The Ostomy bag is attached to the stoma and will collect all excrement.  The types of Ostomies include ileostomy, urostomy, and colostomy and is dependent on the patients’ conditional needs.  The Ostomy as it changes the digestive process it creates a new process and how the patient works with their new digestive process.  This new device can have a mental impact on the patient and presents challenges to their daily life.

Experience:

            To gain the insight in a “to talk walk in the shoes” type of situation is very important.  While this could not replicate exactly the experience of an ostomy it was able to give us enough to be thought provoking and stimulate the imagination.  Adhering the Ostomy was straight forward, using a synthetic stoma to gauge size we practiced cutting the bag while considering a proper fit for a real situation.   Sticking it on and filling with some pudding snacks went smoothly, but I could imagine the difficulties around a real stoma.  I was able to wear the ostomy for about 28 hours.  During that time, I took a nap, showered, went for a walk, went to class, and got a full night’s sleep.  I wore my everyday clothes that I would normally and had no issues.  The ostomy was about 1/8 full throughout the entire experience.  I would ask friends and classmates if they could see it, as I was self-conscious.  I was curious as to whether people in public would be able to see it.  Would they wonder what I had hiding?  Did they know what an ostomy is?  Would they be “grossed out” by it?  I haven’t been to physically active lately, but it was a concern of mine while wearing the ostomy.   It was on my mind that if I made too aggressive of a movement that it might break open.  I also thought about this while I napped, I often lay on my left side where the ostomy was placed.  Would I sleep too hard on the ostomy and force it open?  Would I make a pudding mess in my white sheets?  I feel like these are concerns that patients have and it without a doubt takes some mentally getting used to. 

Considerations:

            Wearing an ostomy poses stress to a patient coupled with their medical condition they are at risk of depression and anxiety.  When working with the patient a therapeutic approach is a must.  Giving support by being empathetic, encouraging, and supportive will provide the mental care that the patient needs.  Teaching the client about changing the bag when it is 1/3 full will help prevent disasters, if the bag becomes too full and dislodges there will be more severe consequences.  Leakage is one of them, this could cause infection to the site and affect the health of the stoma.  Frequently inspecting the stoma for health is key, one should know that a beefy red color means healthy.  If the stoma becomes black that means necrosis and could result in another surgery to create a new stoma.  The skin around needs to be assessed for infection any erythema or warmth is a sign of infection and the provider should be notified immediately.  As I learned by adhering the bag a hole about 1/8” larger than the stoma should be cut, having an appropriate fit will hopefully avoid leakage.  Teaching the client about warning signs, proper technique, and care will help set the client up for success during this potentially daunting experience.  One thing that I learned during the removal, that stood out because of how painful it was, was the adhesion.  The glue on the ostomy bag is strong as it should be.  I wish I had prepped a little and removed the hair from the area it was placed.  I used the technique of firmly holding the skin and pressing while peeling the bag away.  I eventually used a swab with rubbing alcohol and swiped as I gently pulled the bag away.  With prolonged and frequent adhesion skin integrity can be an issue.  Taking the care to do the removal properly will help maintain the health of the skin surrounding the stoma.

Conclusion:

            To gain experience and to see through the lens of a patient is an important part of our roles as student nurses.  Although this exercise required imagination to see the full effect it was a positive experience.  Empathy is a foundation in nursing and any opportunity we have to strengthen that is welcomed. The mechanics of this exercise was also useful as it strengthened our knowledge about proper technique and what to consider when working with someone and their ostomy.

References:

United Ostomy Association of America (n.d.). What is an Ostomy. Ostomy.org. Retrieved May 8, 2023, from https://www.ostomy.org/what-is-an-ostomy/

M. C. S. (n.d.). Ostomy: Adapting to life after colostomy, ileostomy or urostomy. Mayoclinic.org. Retrieved May 8, 2023, from https://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/ostomy/art-20045825

Overbaugh, J.L.H.K.H.C. K. (2021). Lippincott CoursePoint Enhanced for Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer Health. https://bookshelf.vitalsource.com/books/9781975186722