One thing I learned from this experience was that when working with a group of fellow student nurses (or later in life other healthcare professionals) it is extremely important to not only actively listen to the patient, but also the other people around you conducting the assessment/interview of the patient. When working with other nursing students in order to work well with each other we needed to listen to the questions being asked by others in order to formulate the next set of questions that went off of what the person  before you previously said. This is so important for cohesiveness and in order to not confuse the patient by changing the topic every time a new person speaks. We all had to work together to find out crucial things about the patient but also tried to make it as cohesive as possible as well. One challenge that our group struggled with occasionally was trying to fit a suicide assessment naturally into conversation. We found it was easiest to bring this up when they are talking about things they struggle with or things that upset them because it gives a good segue to the suicide assessment. It is uncomfoortable in conversation to bring up the suicide assessment after talking about protetive factors or other uplifting things for the patient. 

The most important thing we learned about mental health assessments is there is seriously no way to tell how the conversation will pan out. You can plan all you want about questions you would like to ask the patient about their diagnoses, medications, history, and experiences, but the conversation is going to be run by the patient and the nurse needs to adapt their questions to the flow of conversation and base everything off the answers that the patient is giving you. There is no script! Some questions you may not be asked or may not be answered fully but that is okay because you could always go back to the patient and ask or maybe the conversation just never flowed to those topics and went a totally different direction but that is okay. It is all about making the patient comfortable and giving them a safe space to talk about their experiences and whatever else they want to talk to healthcare staff about! I feel as though I do a good job of rolling with wherever the conversation takes us and never getting caught off guard. I am good at adapting and letting the patients steer the direction of the conversation. After the first simulation I felt ready for clinical and after the second simulation and after having clinical I feel like my conversational skills with patients and my therapeutic conversation skills have improved greatly.

 Ostomy Reflection

            Fecal diversions are sometimes indicated for patients with colorectal cancer, inflammatory bowel disease, and diverticulitis. A patient can receive a fecal diversion in their small intestine, which is called an ileostomy, or in their colon which is called a colostomy. The diversions also may be temporary or permanent. Regardless of the longevity of the device, patients need to be provided with education about how to care for their ostomy bags. Nurses work with patients to teach them how to attach and remove bags, how to care for stomas, how to empty the bag, and more. Nurses also need to assess if the patient has any risk factors such as risk for altered skin integrity or risk of disturbed body image (Overbaugh, 2021).

I really enjoyed having the opportunity to experience what patients go through when they have ostomy diversions. The best way to accurately see what other people go through is to experience it as well. I know that it was not nearly the same experience without a stoma or a filled bag, but I did learn a lot from this experience. I can understand why patients would have a hard time accepting that they have an ostomy on their body after first getting it because it just felt like something attached to me and not something that was part of me. I do wonder when that shift would occur for patients, when they would feel comfortable enough with it that it felt like naturally a part of their body. I am sure that it takes a lot of coping and acceptance to reach that point and that can be hard for people that are uncomfortable with change and dealing with new challenges. Experiencing something yourself will always give more insight to what others are going through more so than just learning about it second hand.

While wearing the ostomy bag I kept forgetting that it was on me, and I would turn slightly or reach a little too far and it would pull and tug on my stomach and I would abruptly be reminded of its presence. It was nice that it fit inside my sweatpants or loose sweatshirts but wearing jeans with it was uncomfortable. It was easy for me to avoid wearing uncomfortable clothes with it for two days but that is not possible for a patient that has an ostomy bag for an extended period. I think something important that I realized is that looking in a mirror at the device on your body is important. Something that will stick with me if I ever must provide patient education about risk of disturbed body image, is that it is important to visualize it as a part of you instead of a foreign object.

I went to Planet Fitness after the lab to work out and I had to change in the locker room with the ostomy bag on. I automatically felt embarrassed, but quickly realized that people with real ostomy bags must feel even more embarrassed than I did. It felt weird to have it out in the open as I changed, and I felt like I needed to hide it from others in the room to not be judged. It was also hard to do some exercises with it such as crunches or walking on the stair stepper because it pulled on my abdominal skin. I felt how real the risk of altered skin integrity was becoming for me because I had sensitive skin and when I sweat around the device it did not feel good. Patients must have a hard time adjusting their everyday lives when they are constantly reminded of a new device residing on their abdomen. It felt distracting almost, like I wanted to stop thinking about it, but it was hard to.

Another thing that I spent a lot of time reflecting on and thinking about was how patients must feel about the smell of the contents in the bag and the sight of their stoma. I am obviously a nursing student so the sight of a stoma or fecal matter would not bother me at all, but if it was a patient that is squeamish or cannot tolerate bad smells well, it would probably be an extreme struggle for them to get used to. I think it is important for nurses to really get to know patients to tailor their education toward each person individually because one person that is super confident and not squeamish might adjust well to caring for their own ostomy whereas it could be the opposite for the next patient. It is important to keep in mind that everyone can react differently to major life changes such as a new bowel diversion, but it is a nurse’s job to provide the best care possible and ensure that the patient is adequately educated so that they can care for themselves successfully and continue to be as healthy as possible after discharge.

References

Overbaugh, J.L.H.K.H.C. K. (2021). Lippincott CoursePoint Enhanced for Brunner &

Suddarth’s Textbook of Medical-Surgical Nursing. [CoursePoint]. Retrieved from https://coursepoint.vitalsource.com/#/books/9781975186722/