Part 3 The Shero Family
3.3 Shero family case study 2: Medya needs a temporary stoma
Lucy Shinners
Introduction to case study
Learning Objectives
By the end of this case study you should be able to:
- Understand the organisations that support stomal management in Australia
- Consider the implications that health complications have on a person’s identity and their family
- Understand how you can support them as a healthcare professional
Scenario
Medya spends two weeks in hospital suffering ulcerative colitis. She loses a considerable amount of weight and does not respond well to the medicines prescribed to treat her symptoms. The gastrointestinal surgeon decides that for Medya’s bowel to rest and heal, a temporary stoma must be formed so that she can put on some weight, get stronger and return to her family.
Hedjar stays with his mother to act as her interpreter. He finds most of the staff polite and patient once he explains that she does not understand much English. Medya tells Hedjar she is very worried about the children and does not want surgery. Hedjar reassures her that the doctors said it was very important and that if they did not operate, she may become unwell or even die. The stomal nurse visits Medya and her son to talk about how to care for the stoma after the operation.
The stomal nurse documents that Medya seems overwhelmed by the concept of surgery. Although her son Hedjar is very engaged and communicates well, the nurse records that the family will need ongoing support once Medya is discharged home. She talks with Hedjar about contacting a community nurse who can visit them regularly when they get home. Hedjar agrees that this is a very good idea.
Case study questions
- What is the role of the stomal nurse throughout the journey of care?
- How can you ensure that post-discharge care decreases psychological distress, promotes quality of life and prevents complications?
- To deliver culturally safe care to Medya, what do you understand about the Shero family’s social and cultural needs? Who else needs to be involved in the care of the Shero family?
The journey of care
It is common for inflammatory bowel disease (IBD) sufferers to require a temporary stoma if their symptoms cannot be managed, and the patient becomes unwell. The Australian Council of Stoma Associations represents 21 regional stoma associations nationally which support as many as 46,000 people living with a stoma or ostomy in Australia.
Like most health disruptions, a person who is given a stoma for the first time may be shocked by its impacts on many aspects of their life, such as their diet, living habits, travel arrangements, body image, sexuality and even clothing. Stress is a key contributor to poorer health outcomes for people who undergo stomal surgery (Ang et al., 2013). Modifiable factors such as family support, maintenance of social networks, education, spirituality, exercise and financial stability can all help to improve the quality of life of ostomy patients and reduce stress (Alenezi et al., 2021; Nam et al., 2019). As a registered nurse you can influence the patient’s journey from when they have surgery, through recovery, and learning to care for themselves.
Postoperative care
While the journey of care is likely to commence in a tertiary organisation such as a hospital, the priority for postoperative education is to assist the patient to prepare for self-care (Ang et al., 2013). Within a short period of time, they must be taught all the practical skills required for stomal care. A good education program will be comprehensive and respectful of the person’s age, health literacy, cultural differences and personal preferences.
Thinking points
Watch these patients’ experience of this type of surgery:
Read this article which describes the stressors related to psychological health following stoma surgery:
- Ang, S. G. M., Chen, H.-C., Siah, R. J. C., He, H.-G., & Klainin-Yobas, P. (2013). Stressors relating to patient psychological health following stoma surgery: An integrated literature review. Oncology Nursing Forum, 40(6), 587–594. https://doi.org/10.1188/13.ONF.587-594
Post-discharge care
Once they are discharged from hospital, stomal patients are sent home with a vast amount of literature and samples, which can be confusing. If a patient’s discharge has been poorly planned or rushed, it can create issues for them once they get home (Richbourg et al., 2007). Community-based nursing care is very important for a person with a stoma and is key to enhancing self-care, independence and a healthy recovery. Follow-up by a stomal nurse should aim to decrease psychological distress, promote quality of life and prevent complications (Schluter & Sinasac, 2020).
Thinking points
Based on these recommendations, consider the skills you will require as a registered nurse. How will you adjust these skills to meet the needs of an older person or a person like Medya who is culturally and linguistically diverse? The Journal of Stomal Therapy Australia offers many insightful publications about this specialty, the experiences of people with a stoma and the clinical practices required to support them.
Teamwork and technology
The interdisciplinary team is essential to a healthy rehabilitation process. Stomal patients are faced with a variety of challenges when they recover from surgery at home. They may need to adjust what they eat, start an exercise rehabilitation plan, change their clothing style or be unable to drive or work for a period of time. For most people this requires the support of a range of healthcare professionals once they get home.
New technology presents us with innovative ways to communicate with our patients at home. Telehealth can connect with patients in our regional and remote communities (Weinstein et al., 2021). Mobile applications offer a way to monitor patients remotely or support patients to be independent in their decision-making (Wang et al., 2018; Zhang et al., 2020).
Thinking points
Make a list of the health disciplines that could be involved in Medya’s care, given her background.
Companies like Convatec have developed mobile applications that can provide real-time information and support to patients with stomas. How do you think technology could support Medya and her family?
Case study 2 summary
The journey of care post-stomal surgery can be complex and challenging. As a registered nurse, either in the hospital or in the community, you can improve the journey of someone like Medya by understanding how to prepare them before they leave the hospital setting and effectively support them at home. Innovations and interdisciplinary models of care are key to successful rehabilitation in the future.
References
Alenezi, A., McGrath, I., Kimpton, A., & Livesay, K. (2021). Quality of life among ostomy patients: A narrative literature review. Journal of Clinical Nursing, 30(21-22), 3111-3123. https://doi.org/10.1111/jocn.15840
Ang, S. G. M., Chen, H.-C., Siah, R. J. C., He, H.-G., & Klainin-Yobas, P. (2013). Stressors relating to patient psychological health following stoma surgery: An integrated literature review. Oncology Nursing Forum, 40(6), 587-594. https://doi.org/10.1188/13.ONF.587-594
Nam, K. H., Kim, H. Y., Kim, J. H., Kang, K. N., Na, S. Y., & Han, B. H. (2019). Effects of social support and self‐efficacy on the psychosocial adjustment of Korean ostomy patients. International Wound Journal, 16(Suppl. 1), 13-20. https://doi.org/10.1111/iwj.13038
Richbourg, L., Thorpe, J. M., & Rapp, C. G. (2007). Difficulties experienced by the ostomate after hospital discharge. Journal of Wound Ostomy & Continence Nursing, 34(1), 70-79. https://doi.org/10.1097/00152192-200701000-00011
Schluter, J. E., & Sinasac, P. A. (2020). Community stomal therapy services: A needs analysis and development of an evidence based model of care. The Journal of Stomal Therapy Australia, 40(1), 8-13. https://doi.org/10.33235/jsta.40.1.8-13
Wang, Q. Q., Zhao, J., Huo, X. R., Wu, L., Yang, L. F., Li, J. Y., & Wang, J. (2018). Effects of a home care mobile app on the outcomes of discharged patients with a stoma: A randomised controlled trial. Journal of Clinical Nursing, 27(19-20), 3592-3602. https://doi.org/10.1111/jocn.14515
Weinstein, R. S., Holcomb, M. J., Mo, J., Yonsetto, P., Bojorquez, O., Grant, M., . . . Cidav, Z. (2021). An ostomy self-management telehealth intervention for cancer survivors: Technology-related findings from a randomized controlled trial. Journal of Medical Internet Research, 23(9), e26545. https://doi.org/10.2196/26545
Zhang, X., Gao, R., Lin, J. L., Chen, N., Lin, Q., Huang, G. F., . . . Li, H. (2020). Effects of hospital‐family holistic care model on the health outcome of patients with permanent enterostomy based on the theory of ‘Timing It Right’. Journal of Clinical Nursing, 29(13-14), 2196-2208. https://doi.org/10.1111/jocn.15199