EH 101 : Reflective Essay : Planning And Nursing Implications

Analysis of the learning experiences:

From my experience of wearing a colostomy bag for an entire day, I have understood that apart from the different challenges that are actually associated with wearing a stoma bag, the most impactful hurdle is the adjustment to this new change in life. As mentioned by Finlay, Sexton and McDonald (2018), the impact of a surgical procedure is deliberating and exhausting on the psyche of the patient, the need for wearing a stoma bag often acts directly as an irritable restriction that is associated with negative body images as well. I have felt more embarrassed than uncomfortable in the beginning stage when using the stoma bag, hence, for patients that have to wear stoma bags in public, must also face similar embarrassment which can easily lead to loss of sense of self-worth and hopelessness as well. Hence, there is need for empowerment for these patients to be able to wear these stoma bags without having to hide them due to lack of negative body image and social acceptance (Davies et al., 2015).

Another very important aspect discovered during this my experience of wearing the stoma bag for the entire day had the physical discomfort associated with itching and lack of clear understanding of what to expect, how it might feel while wearing for extended period of time and exactly how to clean it or wear it comfortably. As per my personal experience of wearing the device, feeling lack of appetite for the full feeling of wearing the stoma bag, constant fear of somehow leaking the bag, restricted mobility and flexibility due to the fear of leaking the bag and an incomplete feeling due to wearing the bag. Hence, wearing a stoma bag restricts a variety of different activities that a person might do and in its place instils a fear of proper handling of the device and leaking it which in turn will expose the need of wearing the bag and in turn expose the patient with his or her disease oriented disabilities (White, 2018). It also has to be mentioned in this context that wearing a stoma bag made me wear loose clothes just to hide the fact that I was wearing the bags, hence the impact of wearing a stoma bag is associated with forced changes in appearance as well which might lead to the feeling of emptiness or incompleteness in life which I had been feeling as well. As per Thorpe, Arthur and McArthur (2016), the impact of wearing a device such as a stoma limits the ability to participate in certain activities of life and requiring constant assistance which might lead to a sense of dependability. In my case as well, my inability to pull the trolley while grocery shopping which I generally do and requiring my husband’s help in doing so enhanced my sense of dependence. Hence, this dependence and inabilities might lead to sense of incompleteness in life and lead to depression and irritability which can only be eradicated with empowerment and respect based care assistance and patient education. Along with that I believe the aid of collaborative decision making in planning out the care and the lifestyle activities in general can help a patient cope better with the experience of wearing a stoma bag. In most cases, the patients do not feel a part of the care decision making and it also adds a considerable psychological burden on them. If the care planning encompassed a collaborative decision making between both the patient, their immediate family and care providers, this burden can be eased and the patient satisfaction will enhance (Barnwell, 2015).

Planning/Nursing Implications:

The fourth and final step of the Kolb’s cycle is for discussing the implications of the learning in nursing practice and how it might influence the nursing practice (Kolb, 2014). As mentioned by Tao et al. (2014), the fear of leakage is one of the greatest challenges that patients experience while wearing stoma and it has also been reported to affect their daily activities by limiting their range of motional and flexibility. Along with that, patients also have been seen to avoid getting out of the house for the discomfort and embarrassment of wearing a stoma bag in public, the restrictions associated with leaking and itching. Hence, there is definitely need for better patient education and awareness to enhance the handling knowledge of stoma bags in patients and along with that there is need for individualized care planning that will minimize the impact of these fears and challenges of wearing stoma bags.

It also has to be mentioned in this context that wearing a stoma bag made me wear loose clothes just to hide the bag, hence the impact of wearing a stoma bag is associated with forced changes in appearance as well which might lead to the feeling of emptiness or incompleteness in life which I had been feeling as well. As per White (2018), the impact of wearing a device such as a stoma limits the ability to participate in certain activities of life and requiring constant assistance which might lead to a sense of dependability. In my case as well, my inability to pull the trolley while grocery shopping which I generally do and requiring my husband’s help in doing so enhanced my sense of dependence. Hence, this dependence and inabilities might lead to sense of incompleteness in life and lead to depression and irritability (Davies et al., 2015). It can be clearly stated from this experience and available literature that stoma bags have a deeper psycho-social impact as well which is interlinked with negative body image and lack of empowered living. Hence, the changes that I would like to incorporate in my practice to help patients cope with wearing stoma bags will focus more on psychological challenges of wearing stoma bags, other than just physical issue. I would focus on educating and empowering the patients with knowledge all the while encompassing collaborative decision making, best practice evidence and peer support to evolve the perceptions of wearing a stoma bag from embarrassment to a necessity just like any other medical treatment.

Conclusion:

On a concluding note, stoma bags are a very common treatment intervention and a large variety of patients are required to wear stoma bags after a surgical procedure. Along with physical challenges associated with wearing it, there are pressing psycho-social impacts of wearing the device as well. This experience has helped me understand the extent of this impact and it can be hoped that it will help in improving my practice further so that I can address the issues of wearing stoma bags effectively.

References:

Barnwell, A. (2015). Advanced nursing practice in colorectal and stoma care. Gastrointestinal Nursing, 13(1), 42-48.

Davies, L., Brereton, K., Cranfield, A., & Monterosso, L. (2015). Stoma for two days-what staff can learn: National Stomal Therapy Awareness Week 2015. Journal of Stomal Therapy Australia, 35(4), 8.

Finlay, B., Sexton, H., & McDonald, C. (2018). Care of patients with stomas in general practice. Australian Journal of General Practice, 47(6), 362.

Kolb, D. A. (2014). Experiential learning: Experience as the source of learning and development. FT press.

Lim, S. H., Chan, S. W. C., & He, H. G. (2015). Patients’ experiences of performing self-care of stomas in the initial postoperative period. Cancer nursing, 38(3), 185-193.

Tao, H., Songwathana, P., Isaramalai, S. A., & Zhang, Y. (2014). Personal awareness and behavioural choices on having a stoma: a qualitative metasynthesis. Journal of clinical nursing, 23(9-10), 1186-1200.

Thorpe, G., Arthur, A., & McArthur, M. (2016). Adjusting to bodily change following stoma formation: a phenomenological study. Disability and rehabilitation, 38(18), 1791-1802.

White, M. (2018). Stoma care: choosing the right appliances and accessories. Nursing And Residential Care, 20(5), 190-193.