Practice Tip of the Week | Ostomy Awareness Day

 What I Learned When the Patient Was My Friend

By Marissa Hudler MSN, RN, WCC, CFCN, OMS, in collaboration with the TNA Nursing Practice Committee

A friend of mine needed emergency surgery a few years ago and woke up with an ostomy. There was no warning and no time to prepare. The hospital stay was a blur. The education was fast, the teaching sessions were short, and they went home with a stack of handouts. A few days after they got home, they were both frustrated and overwhelmed. They didn't know how to clean the skin around his stoma or how to apply the appliance correctly to stay on longer than a few hours. Showering, dressing, and sleeping all felt like new problems.

The bigger questions were when can I go back to work? Could I do my job normally? The consistent worry about a leak never ceased. Another concern was how to change the appliance in a public restroom.

I supported them at home through those first weeks and months. That gave me a front row view of what happens after discharge, and it was hard to watch.

I teach new ostomates weekly, and I had to admit that what they expressed about the education provided was a lot like how I taught. It covered the content, and after my experience with my friend I thought I could do better and start preparing my ostomates to learn to live with an ostomy.

Ostomies Impact More than you Think

The United Ostomy Associations of America (UOAA) estimates that 725,000 to 1 million people in the U.S. live with an ostomy, and more than 100,000 ostomy surgeries are performed each year. Every one of those patients goes somewhere where they or a caregiver must manage on their own. The stakes are measurable. Patients with a new ileostomy had a national 30-day readmission rate of 25 and 30%, and dehydration caused 37-43% of those readmissions (Plonkowski et al., 2023). Peristomal skin problems are even more common than dehydration. 

Emergency surgery makes this harder. These patients get no preoperative teaching or stoma marking, and they have no time to adjust before they wake up and are expected to learn how to function with a stoma. 

My Practice as the Nurse and Friend

 Watching my friend struggle changed my approach with new ostomates and how I practice as a nurse. No matter where you are or what you are doing, the “nurse” in you follows you. There are a few personal tips I used even in the role of “friend.” 

• I break every skill into single steps. Skin cleansing, measuring, cutting, applying, and emptying each get their own step, so patients don't face one long demonstration.
• I use demonstration and return demonstration. I show the step, then the patient or caregiver does it while I watch. If they can't do it, we repeat it.
• I use teach back every time. "Tell me what you'll do if your pouch starts leaking at work." The answer shows me what they understand.
• I teach for real life, and we talk about work, clothing, sleep, intimacy, and changing a pouch in a public restroom. These are the questions patients lie awake at night with.
• I include the caregiver. Caregivers need the same hands-on education as the ostomate.

Handouts still have a place and back up the teaching; they can't replace the hands-on teaching.

Practice Implications

American Society of Colon and Rectal Surgeons guidelines recommend pre- and postoperative ostomy education involving a specialized provider such as a wound ostomy continence nurse, when possible (Davis et al., 2022). Frontline nurses teach most of these patients, especially after emergency surgery, so our education model has to work for them. Use the suggestions listed above and break down each step and allow for demonstration and teach back.

Call to Action

Look at how your unit teaches new ostomates. Ask one question: could this patient change a pouch alone, at home, tomorrow? If you aren't sure, they aren't ready. Break the steps down. Watch them do it. Ask them to teach it back. Talk about their life, not just their stoma.

Being personally involved changed my perspective. I don't want it to take a friend's experience to change yours.