The purpose of a bowel diversion is to assist individuals who have a medical condition that impairs them from using their colon properly. The treatment requires a surgical opening in the abdominal wall which results in a stoma (Hinkle et al., 2022). The fecal matter is diverted and discharged through the stoma rather than the original route after the procedure (Hinkle et al., 2022). The ostomy bag is used to cover the stoma and collect any fecal matter that is voided from the stoma. Diverticulitis, inflammatory bowel disease, and a colon injury are some medical conditions that may require an ostomy. The care of an ostomy bag is crucial as we want to reduce the risk of infection and make the patient as comfortable as possible. This assignment allowed me to see the ostomy bag in a different perspective. I am now more aware of how it may affect a patient emotionally. Personally, I have noticed that it is easy to be so caught up on a patient’s physical health, the emotional health of a patient slips my mind at times. The purpose of this assignment was to take off our nursing shoes and step into the shoes of our patients for two days. This assignment improved my insight on the device which will help my thought process when creating a care plan for patients with an ostomy bag. Although the assignment may have not been ideal, neither is it for patients.

            The first difficulty I faced with the ostomy bag was in class when we put them on, I was not wearing clothes that made placing it on easy. My shirt was too tight on the bag, and it was uncomfortable due to how tight it was. I had to go to the bathroom and accommodate my clothing to the ostomy bag, I unclipped the body suit therefore it would not be as tight on the bag. Another physical difficulty I experienced was skin irritation, I have eczema which I think reacted to the adhesive. It began to make my skin itchy and as a solution I did take it off one day after putting it on. This moment made me reflect on my patients, if their skin becomes irritated or itchy, they aren’t able to take it off like I am. Although doing this assignment did help me gain better insight, we still do not experience how our patients truly feel. This includes actions such as having to empty the pouch or reapply the ostomy bag. I imagine having to become comfortable with daily ostomy hygiene takes more of a psychological toll on the patient. Looking at the stoma daily, irrigating the ostomy if needed, and stoma care are all important responsibilities that are life changing to the patient. All of this change happening at the same time along with healing from the surgery is a lot on the patient mentally and physically.  I struggled more with the psychological aspect of the assignment because we did not have to go through as much of the physical process as patients do.

            The psychological aspect of the assignment had the biggest impact on me. I gained more empathy and sympathy for individuals who must wear this device daily. The biggest psychological shock for me during this experience is when I went to get shower and I forgot I had it on. Seeing it when fully undressed made me feel insecure and I was the only one in the room. I put my clothes back on and did not shower because I did not want to accidently get the bag wet, and I became discouraged. As the night went on I became anxious to sleep with the ostomy bag on. I did not want it to open while I was sleeping and get all over my bed. As I reflect on my emotional health throughout the process I kept thinking to myself that I only have to deal with this for two days, I know it gets to come off. Patients around the world who wear an ostomy bag don’t have the option to take it off when it gets irritated, or not shower because their nervous. As a patient they not only have to physically heal but also mentally heal and cope with a new object that is attached to them.

            This experience gave me the opportunity to observe firsthand some of the difficulties an ostomy bag may cause. I observed irritation on my skin after one day of wearing it. The skin integrity of a patient who has to constantly change their ostomy bag is at risk for more irritation. This observation changed how I would prioritize nursing interventions. I would prioritize skin integrity and patient education on how to keep the skin healthy. Educating the patient on how to properly remove the punch and cleanse the skin will ensure the skin around the stoma stays intact for adherence (Hinkle et al., 2022). The patient should never pull, the goal is to keep the skin healthy and not irritated. Nursing interventions would include gently cleansing the skin with soap and water then patting the skin dry which will aid in preventing skin damage and minimize irritation (Hinkle et al., 2022). I would teach the patient to monitor for signs and symptoms of inflamed skin therefore when discharged they can maintain healthy skin integrity and use a barrier if needed. I would modify my patient care by utilizing interprofessional collaboration to create a treatment plan specific to the patient (Hinkle et al., 2022). The nurse can collaborate with social work, or psychiatrist to provide emotional support. The most pivotal observation I made during this experience was the psychological aspect and how much of a toll an ostomy has on body image. My nursing priority would include offering words of affirmation and encourage the patient to express their feelings. I would include more nursing considerations regarding the patient’s emotional health because this assignment pushed me to look at the ostomy bag holistically and not focus solely on their physical health.

Although ostomy care requires various hygiene interventions and physical demands, as the nurse we also must keep in mind how the patient must feel. I was initially close minded about the assignment but by the end I was thankful for it. It feels like a burden to our daily lives for the two days, but it made me grow an awareness for the individuals who must wear it long term. My advice for future students is to not be closed minded and negative about the experience but rather embrace it. You will gain insight from this experience that will help shape your future care plan for patients with an ostomy bag. This experience has enhanced my learning and perspective on ostomy bags.

Reference

Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Management of the patient requiring an ostomy. In Brunner & Suddarth’s textbook of Medical-Surgical Nursing (pp. 1318–1322). essay, Wolters Kluwer Health.