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B Janis E. Harrison, RN, BSN, CWOCN, CFCN
My husband was insistent that I go home the first night he was on the surgical floor. He had a roommate, therefore the hospital policy forbade me to stay the night with him.
They were feeding him full liquids but his appetite was worsening and he was sleeping more. Daryl's stomach was showing signs of becoming distended and he had no output in his ostomy pouch. As an ileostomate, this was unusual; he would normally have liquid output within an hour of liquid intake. By 11:00 pm he insisted I go home to get a good night's sleep, since I couldn't stay at his bedside anyway.
As I left, I told his nurse to call if Daryl needed me and I would come right back. They told me not to worry and to get some rest.
As I drove the 45 miles to our home, a million things went through my head and I just kept thinking about his abdomen and his output. Not every nurse realizes the output differences between colostomies and illeostomies. I decided to call the nurses one more time before going to bed and they told me they had just checked on him and he was sleeping comfortably. They "poo-pooed" me when I brought up the idea that his abdomen looked distended. Once again they told me not to worry and stated, "We will see output by tomorrow."
I decided since it was Easter Sunday that I would go to sunrise service, to pray my "thank yous," then head for the hospital and take Daryl his favorite Easter candy. I walked in the door to his room that morning and held up the bag of candy to be greeted with, "Get me the trash can!"
I grabbed the bath basin on his bed stand and he began to have violent projectile vomiting. Yep, they were right, we saw output. The output just kept coming and to this day the man still winces at the sight of green Jello. The on-call doctor came in the room and stated he needed a nasal gastric tube but Daryl thought he was done vomiting, felt better, and rejected the tube idea. The doctor was a friend of the family and stated he was going to church but if Daryl changed his mind, he was to be called.
Within an hour the vomiting started again as violent as ever. I told the nurse to call the Doctor for NG placement. The charge nurse said the doctor would be in church with his family and did not want to disturb him. I overheard her very rudely say to another nurse, "If the wife wants the doctor called, she can do it herself." I did call him myself and he said he would call the Charge nurse and take care of her and the orders.
Oh so many ups and downs, then add rudeness to the mix and what do you get?
Both of us will always remember Easter 2003.
Wound and ostomy nurses know how to teach the patient that is soon to undergo a surgical procedure that will leave them with a stoma. All nurses are given some type of simple education to help the individual with an ostomy with their pouch. But, how much does the patient retain before surgery? We go through the usual information and mark the abdomen for placement of the stoma. The books tell us to teach no longer than an hour because anything longer becomes mist in the mind. We give the patient literature and we hope they will take the time to at least give it a glance. We provide or sign them up for pouching starter kits for surgery and for practice. The whole time, their minds are racing with thoughts of major surgery, body image changes, and spousal acceptance all while they are sorting the bombardment of information. Yet, we the nurses, have so much to do and so little time to do it as these patients are usually out of the hospital in 3-4 days
After surgery the patient is still medicated with anesthesia and analgesics. Numerous doctors and nursing staff are moving in and out of the room. The patient looks down at their abdomen and there are dressings of thick padding, tape, and a plastic pouch peeking from under the dressings. The patient is left to wonder the size of the incision and how badly it has distorted their stomach. In some cases the patient awakens to drain tubes, IVs, and has a urinary catheter. None of these devices were mentioned and now we want them to practice on an empty pouch!
Think about the patients' expectations. Imagine the stress of an emergency colectomy on patients that have no teaching prior to surgery. We see these types of patients often enough that it becomes easy to forget our compassion. Are they whiny, or are they frightened out of their minds with the most horrible event in their personal lives?
Many of the ostomy patients I work with in the rural areas are of advanced ages and come from simple backgrounds with little education. They have surgery in the larger urban hospitals, receive some teaching and some Home Health care. I find they return home having retained little and are still trying to recover much of their memory lost to anesthesia. How do we replant that ostomy information in a manner that patients can understand and retrain themselves as needed?
Many of the ostomy supply companies send written, pictorial, and video instructions in their pouching starter kits. This makes it possible for the patient or caregiver to re-instruct themselves repeatedly. This may be the best information you give that patient along with their follow-up appointment.
About the Author
Janis Harrison is the CEO and owner of Harrison WOC Services, LLC, which offers contractual Wound, Ostomy and Continence (WOC) services for hospitals, long-term care facilities and home health across Northeast Nebraska. Harrison has had numerous poster published, is a writer for Advanced Tissue's newsletter and is currently involved in developing health care documentation applications for WoundRight Technologies, LLC.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.