NSG 315 Skills Lab
Bowel Diversion/Ostomy Reflection Assignment
The purpose of an ostomy diversion is to allow a person to pass stool safely from the body when experiencing a diseased part of the bowel, or a segment of the bowel is removed due to injury or disease, to allow the bowel to heal adequately. If the diagnosis is severe, it can be permanent in some cases. An individual living with an ostomy diversion faces many physical, emotional, and psychological challenges that many people are unaware of because most have not experienced this life-changing event. Therefore, the purpose of our assignment was to wear an ostomy pouch filled with materials that mimic fecal matter so that we, as students, can better understand and experience what it would be like to be an individual living with an ostomy appliance.
Prior to wearing the ostomy appliance, I was aware of its importance for an individual’s physical well-being. However, I was unaware of the multiple challenges an individual encounters with an ostomy for bowel diversion. For instance, my previous personal perception of the challenges one would encounter primarily pertained to managing the ostomy appliance itself, including the physical discomfort of the appliance, preventing a breakdown of the skin surrounding the stoma, and the need to empty or change the ostomy pouch frequently. But, of course, as a nursing student, I was aware of the psychological impact an ostomy may have on an individual. Still, I was not consciously aware of how impactful it could be on their daily living experience. Therefore, wearing the pouch for only a day was an insightful experience for me and one I am grateful for because this simulation raised my awareness of a person’s challenges physically and emotionally. When an individual undergoes an ostomy, they have to function in a new way, which can be an uncomfortable adjustment. As a result, it raises serious concerns, including maintaining good hygiene, managing daily routines, and dealing with the stigmas involved. Thus, as a nurse, I will ensure that I not only care for the physical needs of a patient with an ostomy appliance, but I will also pay great attention to their psychological and emotional needs. This critical experience gave me an understanding of how difficult the transition is for a new patient with an ostomy device. Each person is unique in their experience; as a result, this insight will help me provide the best care possible for my future patients.
The minute I put on the ostomy appliance, I had so many questions. Will anyone see the pouch under my clothes? Will there be a smell? Can I resume normal activities? The questions were endless, and I understood how a patient undergoing an ostomy could feel awkward and uncomfortable due to the overwhelming changes in their life. I can only imagine how challenging it must be for a patient to have to learn to look at the stoma, apply and empty a pouch, maintain proper skin care and hygiene, and manage any complications related to the device. The new responsibilities for caring for themselves are daunting and scary. I felt a little sad initially for anyone facing this experience. Although I was part of a simulation, I realized this could realistically happen to me, a family member, or any of my future patients, and I needed to completely grasp the whole experience.
Admittedly, I was very self-conscious on the first day I wore the ostomy appliance. I thought everyone was looking at me and could see my ostomy appliance and realized this is how my patients will feel. I wore a loose-fitting shirt over my yoga pants and rested my arm over the pouch so no one could see it. It was not only that I was self-conscious, but the bag itself was uncomfortable under my tightly fitted stretch pants. I realized clothing is key to comfort both physically and emotionally.
Regarding the physical experience, the first day wearing the bag caused my skin to feel itchy and irritated, especially when it got wet after my shower. Thus, this observation will allow me to adjust my nursing care priorities, interventions, and client education based on this knowledge. In addition, I will encourage my patients to keep the stoma clean and the skin around the stoma dry to prevent skin breakdown and irritation. Also, I will educate my patients to empty the drainage bag when it is one-third full to prevent it from leaking, which can further prevent skin irritation. Aside from the physical discomfort, I did not feel like myself for the first few hours and wanted to avoid my regular activities, such as seeing my boyfriend, going to the gym, and grocery shopping, because I was embarrassed by the ostomy appliance. I felt like it was so obvious I was wearing it. Like many new patients with an ostomy appliance, I was experiencing facets of a disturbed body image. I felt anxious, and I was frustrated with the way in which it was impacting my life, and I wanted to withdraw from my daily activities. Because of this experience, I have gained a greater understanding of the emotional impact the ostomy appliance will have on my patients, which will allow me to provide improved client care and education in the future. I now recognize that one of the most critical care considerations I must employ as a nurse is to identify how drastically an individual’s perception of their body image is impacted. I will ensure to emphasize that coming to terms with a new stoma and ostomy appliance is a vital part of the healing process, but too, I will be sure to validate their feelings of concern and empathize with their fears. From my experience of only a day, I was extremely discouraged initially. My world was completely different and if I had an ostomy appliance attached for months while I healed, I know I would need support to adjust to my new situation. Thus, I will reassure my patients that adapting may not happen quickly and I will reiterate that learning to accept their new body is a gradual and sensitive process. As needed, I will encourage patients to seek support from loved ones and join support groups with others who are experiencing the same journey.
After wearing the ostomy appliance for several hours and adapting to it a little more, I realized that I could do many of the same activities before wearing it. For example, although hesitant to go to the gym at first, later that evening on the first day, I attended a local gym near me, Planet Fitness. I felt confident in my skin with the proper clothing, and it was physically more comfortable. Nevertheless, it was a difficult adjustment. Due to the weight of the ostomy appliance on my stomach, I chose to walk for a few miles on the treadmill instead of running. I also chose pants with a band to support the ostomy bag on my stomach as I feared it would fall off as I walked on the treadmill. After a mile or so, it did start to feel more comfortable. I was also fearful that individuals around me could smell an odor from the ostomy appliance. However, I learned the fear of going to the gym was far worse than my experience.
Furthermore, this experience at the gym gave me further insight into client care and education. In the future, as a nurse, I can share with my patients how to make accommodations to raise their confidence, as did the clothing that helped me to adjust to wearing the ostomy appliance. If they are able, I would recommend non-tightly fit clothing, such as stretch pants, yoga pants, or athletic shorts for the first few days if the patient feels uncomfortable with their new ostomy appliance. I would also address foods available that help prevents gas and odor of the ostomy appliance to ease their concerns. Eating a lot of leafy greens and avoiding gassy foods, such as broccoli, Brussel sprouts, cabbage, and gum, can be highly beneficial. I wondered what I could eat and learned that I could eat anything, but as with any food, they digest differently, and a patient should treat food like they would typically to lead an active life. For example, suppose spicy food, for example, bothered them digestively before the ostomy it will bother them afterward. So, if they have special activities planned, I can suggest they may want to avoid such foods to avoid a negative digestive experience just like they would have in the past. This would be something I would gently teach my patients as I would with recommending other adjustments.
Additionally, when I was wearing the ostomy pouch, I started thinking about how my future days would be affected if I continued to have the ostomy appliance. Since it is summer now, I immediately became concerned about going to the beach and swimming, something I love doing in the warmer months. It was a bit heartbreaking knowing, at least for me, that this was an activity I would avoid doing while wearing the bag because there would be no way to hide it. Then it dawned on me that I could wear one-piece bathing suits rather than a two-piece. At this moment, I immediately tried on my one-piece bathing suit to see how it would feel and look. Truthfully, it hid my ostomy pouch very well, and I would suggest this helpful tip when educating my patients.
In conclusion, this valuable simulation raised my awareness that there is a level of self-consciousness that comes with wearing the ostomy pouch, and I know as a nurse, I will have to be incredibly supportive and empathetic with my patients who undergo ostomy procedures and that helping them with planning will be critical and beneficial to them. This experience will help me become a better nurse because I have been able to gain perceptions regarding nursing care priorities, nursing assessment, nursing interventions, and client education. Although it was only a simulation, this event gave me insight that will transfer to my nursing protocol, including assisting patients with their body image and how to manage their situation best while validating their concerns about their bodies and the reactions of others. As mentioned earlier, I was extremely uncomfortable with the new adjustment at first. My advice to future students and patients, who may have an ostomy appliance, is that it takes time, and everyone adjusts differently. To adjust emotionally, a person needs to do what is best for them. I realize that everyone is unique. Every procedure and the experience of wearing the ostomy appliance will be different for each patient, and I understand that everyone will go through various trials and tribulations. I can use this experience in other areas of nursing as well because any changes a patient may experience that alter their lives are challenging. Therefore, I will not only be there to assist them with their physical adjustments, but I will be there for their emotional challenges as well.
