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Freda P is a Stomal Nurse Clinical Nurse Consultant!
How did you get into the role of stomal nursing and why do you love it?
It was early in my career where we had to wash stoma bags out with warm soapy water and or Tagg washes, which sounds horrific nowadays. But that was the done thing! Now you would not dare wash them out instead they are replaced. I think it was because no one else wanted to do it and I found it funny or maybe just crazy. It took off from there. I was talking to a patient who was NESB (Maltese) about how to look after her stoma and the Stoma Nurse had heard me and asked me what I was doing and after I explained what I was doing she said “I think you need to do the Stomal Therapy Course. So I did over 13 years ago now.
What is a Stomal Nursing?
A Stomal Therapy Nurse (STN) specialises in the management of patients with faecal and urinary diversions. The STN is an expert in the management of difficult and draining wounds, such as fistulae, gastrostomies, acute and chronic wounds and associated skincare. Stomal Therapy Nurses can assist with advice and management of any stoma and also provide continence advice.
Can you tell us a bit about what a typical day at work looks like for you in Stomal Nursing?
- I start at 0730 checking emails and referrals. The Stomal Therapy Department I work in has to cater three campuses, two very large hospitals, as well as one smaller one.
- Having to see patients before surgery and ‘site them’ (means placing marks on a patient’s abdomen to let the Surgeon know the best place to place the Stoma pouch/Bag).
- Counselling the patients and their family members about the surgery: how life will change, what they think life will be like and how it will differ from what they have heard from other people. The myths about having a bag.
- Then you have to plan your day to see the Inpatients. Liaise with nursing staff that are looking after the patients, maybe new staff members or student nurses.
- All patients will be at different levels, some learn very quickly and others not as fast.
- Prepare the Government documentation, send this off to the appropriate associations and send supplies to their residence. After you have seen your patients, then completing the usual nursing documentation.
- You are always liaising with Consultants and Surgical Doctors as to the progress of the patients.
Post-Acute Care in stomal nursing
- Preparing for patients discharge and coordinating Post Acute Care (PACFU) staff to follow up on patients on discharge at home to ensure they are managing well and catch any hiccups that may occur.
- We all know that being in the hospital some information gets lost as people are bombarded with so much and can be very overwhelming. So our great PACFU nurses take the baton from us and manage very well.
- We are constantly taking calls from patients who have questions or need to be reviewed, wanting to change appliances or any issues of concern.
- Contacting the associations to ensure the right appliances are sent to the right patient.
- Meeting with Company Reps to see the up and coming new products they have to offer.
- Any meetings that may need to be attended such as surgical meetings and or family meetings.
- Prepare for the incoming of patients for the next day.
- Expert care and advice to patients, carers, nurses and medical staff on all aspects of stoma and fistula management
- Pre-operative and post-operative counselling for patients with a stoma
- Ongoing long term education and review
- Assistance and support for patients that have long term drain tubes/fistulae
- Expert advice on acute or chronic wound management
- Advice on continence issues
- Advice on bowel health
A Stomal Therapy Nurse (STN) specialises in the management of patients with faecal and urinary diversions. Can you tell us about the kinds of stomas you see and common reasons they are created?
In my current position, there are 3 types of Stomas that we commonly come across: Ileostomies (Small Bowel), Colostomies (Large Bowel) and Ileal Conduits (the removal of the bladder).
I see patients with cancers of the rectum and bladder. These are now coming in all ages, when I first started I used to see mostly elderly patients in their 70s, 80, and older but now they are as young as 16 and sometimes even younger such as newborns. Older ones mostly have cancers from tumours, diverticulitis, irritable bowel, Crohn’s disease and newborns with Imperforate Anus (the lack of the formation of an anus). There are times where there have been patients that have perforated from foreign objects who may require a stoma.
Most new patients (and some nurses I know) get a little freaked out about changing stoma bags; have you got any advice on how to make the process a little less daunting?
I am an old school nurse you could say, I usually say to my patient’s pre-surgery, “you have a choice, you either have the surgery or you don’t”, what kind of life would you have if you didn’t have the surgery and what kind of life do you want?”
The consultant would not offer you the surgical option if he/she didn’t think you were fit enough to have the surgery. I think it gives them some insight into what their future has for them. I tell them all we are doing is diverting some plumbing; at present we cannot see our anus but tomorrow it will sit on your abdomen, depending on the patients I can make light of the situation.
Their first change is the hardest for them. Their misconceptions on what it will be, compared to what it is can be overwhelming. Like brushing your teeth, no different. You look after your teeth and now you have a bag to look after. No different from going to the bathroom previously, this time these people just need assistance to start. Talk to the patients and staff about what is daunting to them and how we can make them at ease.
How do you think we can improve our practice around stoma care in an acute and non-acute setting?
What we have implemented is that any new Graduate nurse on the ward will spend a day with the stomal Therapy Nurses, So then they can become Stoma Champions and they can be an extension of what we teach. Maybe inspire the next generation of Stomal Therapy Nurses.
When do you think nurses on the ward should be contacting the stomal nursing team for assistance/advice?
We ask anyone to contact us if they are not sure of anything stoma related. If there was an emergency case that came in on the weekend that we are not yet aware off, contact us if a patient has been admitted and didn’t bring his stoma supplies with him. Most things we can sort out on the phone.
What is continence nursing and what is gerontic nursing? You have postgraduate study in both.
Continence Nursing is when you are assessing and assisting patients who have continence issues that could be surgically related, or related to other causes such as stress incontinence. Incontinence prevention, management, education, awareness, information and advocacy are all aspects of the role.
Gerontics is the study of the elderly; our population has been growing as we are looking after our elderly folk much better and in recent times they are also looking after themselves even more.
You have been a registered nurse for nearly 20 years, is there any advice you’d like to give new nurses?
Nursing is HUGE and you have the best opportunities and the best challenges in life. You have whatever you want in your hands, it’s up to you about how far you take it. There are so many different fields; Surgical, Medical, Oncology, Geriatrics, Orthopaedics, Pediatrics. It’s so big, always ask why and challenge yourself. A career in nursing is never boring. You can take your job all over the world. Never Limit yourself. It’s given me the world.
What are some of the misconceptions about the role of stomal nursing?
Stomal Therapy is not just dealing with stomas, it’s all the behind the scenes tasks that are required, such as the government documentation, ordering of supplies, dealing with any “hiccups” that may occur, such as challenging patients with hernias. Most Stomal therapy nurses make it look easy and the comments are “oh yes that’s easy I can do that” until they spend a day with the stomal nursing team.
What are some of the difficult or challenging aspects of the role?
Patients that developed large hernias, large wounds and or a prolapsed stomas.
What are some of the specific aspects of care that you find nursing staff need more education around or find difficulty with?
It’s not just a bag, that there is also a person behind that bag who also has a life and feelings, the struggles mentally they may encounter and how their life has changed.
Why should other nurses consider stomal nursing?
Stomal Therapy I believe is a rewarding career, it’s where you can see a patient come into hospital petrified and then walk out with confidence and a new lease on life. There was a time many years ago some of the establishment would never consider going into stomal therapy as it deals with bodily fluids and did not think it was a great career choice, all this has changed.
If a nurse is interested, what are the resources or links you can suggest they read up on to learn more about stomas / the role of stomal nursing?
Australian Association of Stomal Therapy Inc
The Australian College of Nursing
On the flip side, is there any advice you would like to give nurses that have been in the role a long time?
If you are falling out of love with nursing, find something you are passionate about nursing is such a big universe.
Final words
Healthcare anywhere is overwhelming. Each department thinks theirs is always in need of more funding and it would be very hard to divide funding. We always say why doesn’t the government give us more funding to do this and that, but the cardiology department may say the same thing.
I believe we have one of the best healthcare systems in the world, we bring nurses and doctors from all around the world to learn from us because we are the best. I am not one person, I am a team.
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