Shannon Olsen

Professor Kemper, Dr. Law-Ham

Adult Health II

26 February 2023

Bowel Diversion/Ostomy Reflection

Bowel diversions are procedures that allow for stool to safely pass through the body because patients are not able to do so on their own when they have certain injuries or diseases. Conditions such as diverticulitis, Crohn’s disease, ulcerative colitis, and other bowel diseases can lead patients to having bowel diversions or in other words, ostomy surgery. Ostomy surgery involves creating an opening in the abdominal wall and taking an area from inside your body and creating a stoma (Cleveland Clinic, 2023). A stoma is the opening created during an ostomy surgery that allows for waste to be excreted through. Prior to ostomy surgery the nurse must help the client prepare for pre and post operational ostomy care. For pre-operational protocols, the nurse should discuss with the medical team and patient about the location of the stoma, how to care for the ostomy appliance, how to adapt to having an ostomy bag during daily activities, lifestyle changes, etc. In my Adult Health II course, we were required to wear an ostomy bag on our abdomens for 48 hours (Cleveland Clinic, 2023). The purpose of this assignment is to walk in the shoes of someone who has an ostomy bag and to experience all of the challenges this person may come across in their day-to-day life. This assignment will help nursing students to have more empathy and compassion for their patients with bowel diversions/ostomy bag.

Throughout this ostomy assignment, I came across several challenges both physical and psychological. Physical challenges I faced when wearing this ostomy appliance includes clothing issues, keeping the appliance on my stomach/not allowing it to come off, a skin rash, and pain while taking off the appliance. The clothing I wore to class exposed part of my stomach and when I put on the ostomy bag, it hung out of my shirt and was visible to everyone. I kept getting the appliance caught in my jeans or it would fall out. A solution to my clothing problems included tucking in my ostomy bag into my jeans and wearing baggy clothing to cover it up. The sides of the appliance kept coming  up and not sticking to my skin and I tried solving this problem by holding the appliance onto my abdomen with pressure for a few minutes. While wearing the ostomy appliance I began to itch the skin around the edges and found the appliance to be very discomforting. I solved this issue by avoiding itching, avoiding sitting for long periods of time, and distracting myself with other activities. When taking off the appliance, it was sticking and pulling on my stomach hairs which was becoming painful as I took it off. There is no solution to the pain when taking off an ostomy appliance besides properly pulling it off without ripping it off. Once I removed the appliance I noticed a red rash where the appliance once was, and I solved this issue by applying ointment. I experienced psychological challenges while wearing the ostomy bag which included embarrassment, isolation, and refraining from social activities. I was surprised to find that I was a little embarrassed to be out in public after putting on the appliance. I went to Target with my roommates after class with the ostomy appliance on, and I felt as though I was getting stares from people because the appliance was hanging out of my jeans from time to time. I went to my house and stayed in for the night because the appliance began irritating my skin and I also did not want to be seen in public. I ended up removing the appliance before the 48 hours was up because of the skin rash that I received. Reflecting back on this assignment I realize that patients have to be able to look at their stomas, clean them, apply the bags by themselves, check for skin integrity around appliance, burp and empty their ostomy bags and deal with the challenges I faced wearing the appliance everyday of their life. I feel like looking at the stoma and properly fitting the appliance on without getting a rash would be the hardest parts for me. Stomas can sometimes give patients a distorted self-image which would be very hard for many and I can’t imagine how that would make me feel and what that would do to my confidence. I thought this assignment really opened my eyes to the challenges of wearing an ostomy appliance and how frustrating it is to keep the appliance on and intact.

After wearing this colostomy device, I have come up with my own perceptions and nursing considerations for patients that also have to wear these devices. Important observations I have made is that ostomy bags are very visibly obnoxious, can give patients skin rashes, get in the way of clothing, and have to kept on at all times except when reapplying and cleaning the devices. Some of my nursing interventions/perceptions of ostomy care has changed since executing this assignment. For example, allowing the patient to learn and apply the ostomy bag before discharge is crucial to help the patient be independent and more comfortable with their condition. I would also refer the patient to therapy or a support group to help them become more comfortable in their skin and have a less distorted self-image. I would recommend certain ointments/barrier creams to help my patient with skin integrity as well. Putting emphasis on how to clean the device and when to empty it is necessary to maintain skin integrity and good hygiene. I would have the patient be able to assess their own stomas to prevent further complications and know when to call the doctor.

Doing this ostomy bag assignment has changed my perspective on bowel diversions and has changed the way I care for my future patients with ostomy devices.  I will now have more empathy and compassion for my future patients because I now understand how hard ostomy device lifestyles can be. Having empathy and compassion for patients is crucial in order to provide adequate care and provide a trusting relationship. My reaction to this experience is that is was very eye-opening, insightful, and interesting. I would recommend to future nursing students that are required to do this assignment that you do not put on spray tan before, pick a place on your abdomen with the least amount of peach fuzz/hair follicles, try to wear the ostomy device for the full 48 hours to get the full experience unless you start to have a skin rash/irritation. I liked this assignment and would tell future students to look forward to it and to try and get the full ostomy bag experience to provide better care for their future patients.

Works Cited

Cleveland Clinic . (2023, February 14). Ostomy: Definition, types, procedure, Care & Recovery. Cleveland Clinic. Retrieved February 26, 2023, from https://my.clevelandclinic.org/health/treatments/22496-ostomy