An ostomy diversion is a surgical procedure done where a section of a patient’s GI tract, usually part of their intestine, is broken up and rerouted through to their abdominal wall where they will be able to eliminate wastes. This is done normally when a disease, for example rectal cancer, makes it impossible to dangerous for a patient to eliminate feces through the GI tract normally. Before this assignment I hadn’t put much thought into ostomies or the impact it would have on a patient. I imagined that they would be uncomfortable and embarrassing, but I didn’t think of all the different aspects of a person’s life that would get impacted by having an ostomy procedure done. While I do think that part of this assignment was to make us more familiar with ostomies and the procedures that go along with sizing and placing an ostomy bag on a patient; I believe the real “meat” of the assignment was to help empathize with patients who have ostomies. While it’s easy to read from a textbook or even a blog from someone who has an ostomy, having to personally wear an ostomy bag is a different experience. While wearing an ostomy bag with beans in it for a few days is almost incomparable to someone who has to handle the challenges as part of their everyday life, it at least gives us a snapshot into their prospective.
In terms of my physical experience with the ostomy bag, I didn’t notice any major issues with putting it on wearing the device. The only discomfort came with removing the device. While I did try removing it after spending some time in the shower to loosen up the adhesive, I had hair on my stomach that was getting ripped out as I tried to remove it. I talked to the wound nurse who ran the station and she mentioned that they would normally have patients shave the area around the site before the surgery to avoid this issue. She also mentioned that they encourage patients to shave the area regularly while they have the ostomy. I didn’t notice any redness while I was wearing the ostomy or any lasting redness after I removed it.
I don’t know if this is considered a malfunction with the bag, but the bag opened when I didn’t mean for it to and I got beans on my clothes. I was not super happy about that. I told my girlfriend that I would take her to her booster appointment on the Friday I got the bag. This was the first time I had seen her since I came back from lab that morning so I was talking to her and her roommate about it when I lifted up by shirt to show them. My girlfriend’s roommate (who is also a nursing major) told me that I had the beans all over the front part of my pants. I hadn’t noticed it earlier because I had on my winter coat but I had the beans on the inside of my jacket, shirt, and pants. I wasn’t extremely embarrassed by the situation because my girlfriend and her roommate both knew about the assignment but I was certainly uncomfortable. I ended up making her late for her appointment because I had to run back and change my clothes. As much as I didn’t like what happened, all I could think of was at least it was only beans and that made me more appreciative of my situation. This event did make me a lot more cautious of the types of activities I was doing with the ostomy bag, and I was more careful from then on in checking it for any openings.
Like I said, psychologically I was more cautious and anxious throughout my day than I would normally would be but I think I had a lot of supportive friends throughout the experience. One exception to this would be one of my roommates asked me if I was still wearing my “shitbag” which seemed rather callous. Me and my friends joke around a lot but that comment seemed out of place for him. It also threw me off because he’s a pre-med major so theoretically he could be dealing with patients who have an ostomy themselves. It just struck me as unempathetic and actually made me sort of glad that I was doing this assignment.
I will admit that there were activities that I just didn’t do for the days that I was wearing the ostomy bag. Like I didn’t do a few activities at the gym like leg presses and squats at the gym because I didn’t want the bag to get caught and put extra pressure on it. At this point the bag was mostly empty because of the blowout from earlier, but I was still concerned. On the Saturday after I got the bag it snowed a lot so there wasn’t much for me to do so that made it easier. I spent most of the day doing homework or reading.
Like I said earlier, my girlfriend’s roommate is also a nursing major and she told her about the ostomy assignment before I did. So, while I didn’t have to go through informing a significant other about having an ostomy bag, that didn’t mean that it didn’t complicate our relationship. I was pretty self-conscious about the device, and it seemed like I was more worried about it than she was. Even just watching a movie together made me worried that she might lean into the device and cause another issue like I had when I tried to take her to her booster appointment.
I can imagine that it is very jarring for patients to have to deal with a new stoma. Any change can be hard but having to adjust to the challenges of having a piece of your GI tract sticking through your abdomen might take a lot of time to adjust to. I think it would be hard for patients to make sure they are able to clean the entire site properly if they can’t see beneath the stoma to remove any remaining fecal matter. Stomas are not pretty, and not many patients looks forward to getting an ostomy diversion. On top of that everytime they empty or replace the bag it can smell. All of these may serve as barriers to patient participation in the care of their ostomy, especially while the stoma is new. For some patients, it might be necessary for the nurse to take over these actions initially until the patient has had more time to cope with any disturbed body image issues. This will ensure that the patient’s self care needs are being met. It might be helpful as a nurse to include the patient in the process while he/she is doing the ostomy care, such as explaining what they are doing or encouraging the patient to look at the ostomy and watch.
Nurses who are more familiar with ostomy devices might be able to help with some common complications. In lab we talked about putting in an aspirin to help with gas buildup, or emptying the bag when it is a third full. Helping the patient understand and prevent issues such as the bag bursting or being overwhelmed by the smell can save them from some embarrassment and improve the patient’s experience.
I would say that my overall experience with an ostomy device was that they are not pleasant but it wouldn’t be the end of the world live with one. In terms of transitioning this experience to my practice as a nurse I think I will be much more proactive about making sure that any care related to the ostomy is provided, either by the patient (if they can) or by someone who is capable of providing adequate care. Being in a hospital can be distressing for patients, an ostomy bag would only add to that. A patient shouldn’t have to worry about their ostomy needs being met on top of everything else. I also became more familiar with how a healthy stoma is supposed to look which can help my assessment skills when working with a real patient. I think I would be more comfortable making my patient education more hands on with sizing the bag and with the general care of the stoma than I would have been without this activity.
My advice to future students would to be willing to be uncomfortable with the assignment. I think it would be pretty easy to either not do the assignment or stay inside for most of the days they were supposed to complete the assignment, but I think I got the most out of this assignment when I was out doing things. I didn’t do everything I would have done without the bag during the weekend but I felt like I was more immersed in the project when I was with people who knew I had the bag on, whether that was my roommates, friends, or girlfriend.
References
Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
UpToDate. (n.d.). Www.uptodate.com. Retrieved February 8, 2022, from https://www.uptodate.com/contents/overview-of-surgical-ostomy-for-fecal-diversion
