DAY IN THE LIFE
A stoma care nurse specialist
he role of the stoma care nurse is to support patients adapting to life with a stoma, and this involves physical and psychological challenges for patients.The relationship between the patient and their stoma care nurse is key for the journey to be a success. I have been a clinical nurse specialist (CNS) at the Royal Liverpool and Broadgreen University Hospital Trust for 21 years. We have a busy department staffed by three CNS and one CNS in pouch surgery. I look after patients undergoing formation of a stoma both within the acute trust and their follow-up care within the local community. I start work at 8am by answering messages left on the helpline and checking referrals on the computer that have come in overnight. We have a brief team meeting to discuss any issues from the previous day and distribute the caseload. I have some time to catch up on paperwork, letters to GPs and order stock for patients. During the rest of the morning I spend my time on the wards. My first patient is a woman who has undergone an anterior resection with formation of a loop ileostomy. I liaise with the ward staff to see if they have any concerns before seeing the patient. The patient is doing well but is very anxious about her stoma. I check her stoma to ensure it is healthy and reassure her by answering her questions. My next patient is an 82-year-old man who has had formations of a colostomy. Medically he is ready to go home, but owing to shortterm memory problems he will have a care package to help him with his stoma care. I have already liaised with the care agency regarding the support this patient needs. I check his stoma and parastomal skin and create a template so that I can order his bags in the correct size. The patient manages his own stoma care when prompted. I make sure that he has sufficient supplies for discharge that afternoon and make arrangements for a home visit later in the week. My bleep goes off; it is one of the colorectal surgeons who is taking a patient to theatre as an emergency for a Hartmann’s procedure and formation of a colostomy. I am asked to review the patient preoperatively and site them for a stoma. The patient is on the surgical admissions unit. I introduce myself to her and explain my role. She does not want to know very much at the moment—just to get the operation
Independent ENB 216 Nurse Presciber Royal Liverpool and Broadgreen University Hospital Trust
over with. I mark the site for the colostomy formation and inform her that I will come and see her in the morning. During the rest of the morning I answer my bleep for requests for appliances for patients admitted overnight who have not brought their supplies in with them, and see one of my patients who is having chemotherapy this morning who has some loose stools and sore skin. At lunch time I have a quick sandwich while dealing with phone messages left on the answering machine, faxing GPs and liaising with other members of the multidisciplinary team. A company representative drops off some supplies of a new appliance I want to try on a patient coming to clinic later in the week.This afternoon I have two home visits and a patient to see at our neighbouring hospital. My first visit of the afternoon is to see a woman who has formation of an ileostomy. She has multiple sclerosis and has suffered with constipation for years. She had laxatives and irrigation to help with this problem which had failed, so she opted for a stoma. Her stoma was pink and healthy but she was having a problem with leakage. I had changed her appliances last week and this visit was to check on her parastomal skin and if the new appliances were better. She had no further leakage problems
and now had confidence to go out, as the pain associated with the previous constipation had also abated. I made arrangements for her to be followed up at our stoma clinic at the hospital. My second visit was at the request of the district nurses.The patient is an elderly gentleman who was housebound owing to severe arthritis. He had developed a swelling around his stoma causing his appliances to lift and then leak. He had also reduced the amount he was eating as he thought that reducing his intake would stop the bags working and thus stop the leaks. On examination of his stoma he had developed a parastomal hernia. I resize his stoma appliances so they fit better and arrange for a fitting of a support to help with the hernia. We discuss the importance of a healthy diet and regular meals. I arrange to speak to him by telephone later in the week and to see him the following week at home to check on the appliances and his support garment. I then call in at the urology unit at the neighbouring hospital 3 miles away to see a patient who is undergoing a radical cystoprostatectomy in the morning. The trust is a regional referral centre for patients undergoing major pelvic urology surgery. The patient is a 65-year-old man who is having a cystectomy for bladder cancer following a course of chemotherapy. As I had previously had a referral for this patient, I had arranged for a colleague at a neighbouring trust where the patient lives to see him at home before admission. This gave the patient time to ask questions and trial the appliances in a more relaxed atmosphere. I feel that this is an important aspect of patient care as the patient has already met the stoma care nurse who will look after him on discharge.This helps to reduce anxiety when the patient goes home. I spend some time answering any further questions and site the position for the urostomy. The patient is a keen swimmer and wishes to get back to this hobby as soon as possible. We have a brief chat about waist band position of the stoma and the availability of specialist bathing trunks and clothing. I arrange for stoma supplies to be delivered to the postoperative unit for the patient and arrange to see him later in the week to commence education. No two days are the same, but each one is a great opportunity to make sure we are providing BJN the best possible care for our patients.
© 2015 MA Healthcare Ltd
British Journal of Nursing, 2015 (Stoma Supplement), Vol 24, No 5
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