JSTA December 2010 - Australian Association of Stomal Therapy ...

Reflective essay
Stomal therapy nurse: a year in the making
Sally Langford-Edmonds
When making the decision to embark on this study, I never
thought it would be so enlightening, opening such a plethora
of experiences and knowledge bearing in so many directions. I
have been nursing since 1981 in a range of settings, providing
opportunity for varied clinical experiences. Throughout these
years I have really enjoyed the personal growth and challenge,
working with remarkable people and providing care for a great
variety of wonderful and, at times, testing clients.
I’m currently an after-hours hospital nurse coordinator
employed by a metropolitan private hospital and I find myself
in a fantastic position, being able to manage, continue hands-on
clinical care, role model and troubleshoot in my work. I trained
in the hospital system, general and midwifery, then enjoyed
working in rural and metropolitan hospitals, later undertaking
a BHSc(Nursing) and working in rural domiciliary nursing and
aged care. We have no specialist stomal therapy nurse (STN)
on staff, so embarking on further study would fulfil my own
interest in the areas of continence, wound management and
stomal therapy and ultimately benefit my employer. Working
after hours in a busy hospital has its own set of idiosyncrasies,
so undertaking clinical experience was going to be an enormous
adjustment; to begin with I would be working in daylight hours.
I was unsure what to expect from my clinical experiences. I
was lucky to ultimately gain this experience in several different
environments: the majority with an STN in a private hospital,
a continence advisor in a public adult hospital, a continence
advisor in a public continence clinic, an STN in a major
metropolitan, adult, public hospital and an STN in a private
hospital wound clinic. What I really needed to know was what
was involved and how do they accomplish their role as an STN?
It was most interesting to discuss all areas of stomal therapy
practices, clinical practices, policy, process, education,
job descriptions, autonomy and resources. Each venue had
slightly different requirements but work practices were very
similar. Observing how all these preceptors functioned was
most interesting. They were autonomous, relaxed, friendly,
informative, appreciative and professional. Their individual
responses to the constantly changing demands of the job was
inspiring and something I would like to achieve. No single
day could be replicated; the variety of clinical situations was
continual. One client may present for preoperative education
to have a stoma sited, to be prepared, full of questions with
a support person. Another may present for exactly the same
reason, but have spent an exhaustive day alone having tests and
finding out they need to have immediate stoma surgery and are
so fragile, closed and distraught that it is not possible for them to
be dealt with the same way. Yet ultimately they will have similar
needs. In the next moment you find yourself assessing pressure
14 Journal of Stomal therapy australia – Volume 30 Number 4
areas, teaching self-catheterisation or discharge planning to
find a client along with their family with totally unrealistic
expectations of their health management. They have not come
to accept their change in health status and believe community
services should do all the work, despite having shown great
progress in learning to manage their changed health status.
The STN’s level of advanced practice in their speciality role was
evident when they slipped easily from one role to another. The
scope and complexity of these roles was extensive, revealing to
me the multifaceted skills I needed to achieve including:
• advanced clinical knowledge, caring for any wound
presentation, skin affliction and continence issues
• stoma management expertise
• teaching and sharing of related knowledge in a variety of
setting to clients, community, family, peers and students
• counselling and negotiating
• keeping up to date with research, sharing and undertaking
relevant studies.
The role of the STN includes being:
• an appliance expert, requiring creativity to find the most
successful appliance
• an administrator, ensuring that their service is accountable,
appropriate and complies with corporate requirements
• a consultant, using the opportunity as a specialist nurse to
consult and refer as necessary
• a resource person or mentor to those less experienced
• an advocate for those who require support and have the
courage to speak up when required and finally; change
agent.
I was impressed to see how different institutions approached
tasks, used varied paperwork and products, each influenced
by their own philosophies and practices, backed by research
to form evidence-based care protocols. As an example, one
hospital based their pressure sore management on the Waterlow
Pressure Sore Prevention/Treatment Policy as cited in Carville 1 .
Some of these tools and approaches alerted me to changes that
could be beneficial in my workplace if adapted to suit. I also
noted that the STN office library in the public hospital was
magnificent and I thought how lucky those STNs were to have
such accessible resources available, whereas my access was very
limited in hands-on resources. I had never really thought about
evidence-based practice in any depth and am now so much
more aware of the necessity for nurses to be accountable for
their practice, knowing why they are performing a task or using
a certain product and that their reasons are based on evidence