NurseClickStomal therapy nursing: from theory to practice

By Genevieve Edney MACN

Mr X was a young, vibrant man who had primary school aged children. He was in his 40s, having successfully migrated to Australia. At the time he was working towards arranging the necessary visa for his family to join him in Australia when he received news that he had bowel cancer. The surgery resulted in him having a colostomy formed. But the prognosis remained poor. Despite having a colostomy, he was still given only months, if not weeks to live. What made the situation challenging was that the stoma opening started not only to recess back into the abdomen but to narrow, resulting in stenosis.

As a newly qualified stoma therapy nurse (STN), this is one of the many encounters stomal therapists face, and it is important to stress how crucial it was that I had completed the postgraduate certificate in stomal therapy via the Australian College of Nursing. In doing so, it prepared me for the role and gave me the theoretical foundation on which to develop further knowledge and expertise to grow into this very specialist field.

Knowledge is of no value unless you put it into practice

– Anton Chekov

As part of the course I was aware of the clinical practice guidelines and assessment processes undertaken by a STN. It was through this module that I learned, studied and researched about peristomal disorders and their management. Through this study I was then able to translate theory into actual practice. I was prepared to look out for how he presented, the stomach pains, diarrhoea, passing more flatus than normal and thin bowel motions. With the help of his hospital based stomal therapy nurse, he was urgently referred back to his colorectal surgeon who advised that nothing more could be done. Surgical revision at this late stage of his disease was no longer a viable option. The recommended management therefore was digital dilatation which was proving very difficult for him. It was at this stage that I suggested using stoma dilators and arranged with his hospital STN to have these delivered to his home. The patient was happier using these dilators as he found them easier to apply. However, my knowledge and training did not stop there, as only using dilators can help up to a point. To maximise the management of his stomal stenosis, Mr X was also advised to keep to a good diet, adequate hydration and stool softeners. The use of the correct stomal appliance was equally important. I visited Mr X regularly to check on his progress and in doing so, ensured that reassurance was given and that, more importantly, he was now coping. When time is of the essence, the last thing he needed was not being able to take control of his ostomy.

What this achieved, at that most critical period in his life when he was arranging for his family members to successfully immigrate to Australia to look after his children, was more time, control and comfort. He accomplished this before he passed away not long after their arrival.

Without furthering my passion in stomal therapy by undertaking a postgraduate certificate in this field, I would not have been able to assist people like Mr X. That I could be, in a small way, instrumental in prolonging his life that little bit more so that he succeeded in what he desperately wished to do.

Furthermore undertaking the stomal therapy graduate certificate allowed me the opportunity to be an alumni representative in the course advisory and industry review process for the new graduate certificate in stomal therapy nursing. My contribution allowed me to have a voice in maintaining a student-centred approach and clinical focus.

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