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

The next learning curve Mr Kat gave me was when the proximal
end of his abdominal suture line started showing signs of local
infection. Carville 3 gives signs of local infection as pain, heat,
oedema, erythema and exudate, either a change in amount
or type. The proximal end of the wound had increased pain,
erythematic, purulent exudate and was beginning to dehisce
(1.4, 1.11, 4.1, 6.2). I was able to communicate my concerns to
his treating team and they reviewed it straight away (5.2, 5.3,
5.4, 5.5, 5.6, 5.7, 7.2). They removed the staples and opened the
proximal end up. I did an initial wound assessment and took
a swab for pathology, all of which I documented (1.10). The
consultant stated he wanted a vacuum assisted closure (VAC ® )
dressing applied. I felt the wound could be effectively managed
by a hydrofibre dressing like Aquacel packing and explained my
rationale, but the consultant still wanted a VAC ® dressing (1.4,
1.6, 1.11, 3.2, 4.4, 5.4, 6.4, 11.2). I explained the VAC ® dressing
to Mr Kat and applied it to the wound (6.6). Two days later
when I reviewed the wound with the doctor’s agreement, the
VAC ® dressing was discontinued and the wound managed with
Aquacel packing. On reflection, this experience highlighted to
me that I am comfortable expressing and viewing my opinions
with all members of the multidisciplinary team that I work with.
Even if we do not always agree, we have the mutual respect for
each other that allows us to comfortably question each other,
which in turn helps us reflect on our own practice and ensure
best practice is maintained (11.1).
A PoSITIve GAIN
One of the most relevant insights I have had has been about
the role of leadership in general nursing and in the context of
stomal therapy. When asked to submit an essay about a chosen
professional issue in stomal therapy nursing I chose leadership.
I chose leadership because I had a desire to increase my
knowledge in this area as I had always felt it was an important
component of nursing but I could not grasp the concept in
relation to myself (8.1).
My journey began with the learning guide then reading the
applicable resources, and then began the research (8.4, 10.1, 10.2,
10.3). I looked at research that was specific to nursing and other
areas like business and personal growth. The research helped
me to identify traits of leadership in my colleagues, my past
and present employers and, most surprisingly, in myself. The
realisation that I may be viewed as a leader and a role model to
others gave me a positive feeling (8.4).
I began analysing my interactions with others and discussed
the issue with my mentor (whom I view as a leader) (8.4). This
insight impacted my practice by giving me the knowledge that
the things I do in my career will not only affect me but others
around me. It is my responsibility as an advanced practising
nurse to make this a positive effect.
I am also pleased to say my peers read my finished essay, all
enjoyed it and took something from it (12.2,13.1, 14.1, 14.2). It
was also accepted for publication in the Journal of Stomal Therapy
Australia, September 2009 4 , after I submitted it on the advice of
my tutor (12.2).
18 Journal of Stomal therapy australia – Volume 30 Number 4
During my clinical placement I rediscovered the importance
and helpfulness of relating theory to practice. Because the area
of stomal therapy nursing, especially the continence component,
was all relatively new to me it took a while for the theory to fall
into place. Prior to starting my placement with the continence
nurse advisor (CNA) I completed the recommended readings,
worked my way through the learning guide, accessed the
Continence Foundation of Australia website and read the
relevant sections from the prescribed text to help prepare me.
But it was not until I was performing a vaginal examination
and pelvic floor function test that I felt the theory link with the
practice.
Prior to doing the examination I prepared myself by doing the
aforementioned reading, but I also discussed in depth with the
CNA what she felt was best practice in comparison to what I had
read. The CNA helped me identify the gaps in the theory and
gave rationale if she did things differently; we also referred to
the hospital policies and guidelines (7.1, 7.3, 7.4). Because of our
discussions, the CNA identified that she would like to increase
her knowledge and competence with an assessment tool used
for vaginal examination of pelvic floor function.
A truly positive gain throughout this journey has been the
positive recognition from my colleagues (11.1). When I took on
the role of acting stomal therapist, it astounded me how others
readily accepted me in the role and offered support. With the
role came the responsibility to provide safe and accurate advice
and knowledge surrounding all areas of stomal therapy nursing
to my colleagues and patients. During this time I learnt to use all
the available recourses to the greatest advantage (8.1).
Working in this role gave me the opportunity to build therapeutic
relationships based on mutual respect with members of the
multidisciplinary team (11.1). I remember many occasions where
one day I may be asking the consultant about a retracted stoma
and the next day the consultant was asking my advice on a
dehisced abdominal sutra line (11.3, 13.1, 14.2, 15.2). This mutual
respect enabled me to articulate the care requirements for my
patients and to actively advocate for them (5.6).
PAST To PreSeNT
The Graduate Certificate in Stomal Therapy Nursing course
goal is to cultivate excellence in the delivery of nursing care to
people of all ages with a stoma, wound or incontinence, through
the promotion of partnerships, encompassing the client, family/
carer and the multidisciplinary healthcare team 5 . I believe I
have achieved this goal which is evidenced by my self-appraisal
against the educational and occupational outcomes that are
listed alongside the course goal. Since beginning this course, I
have become more aware of my role and others around me and
how I can influence my patient’s outcomes.
I have learnt to collaborate information from many different
sources to enable me to better advocate and assist my patients (5,
6). An example of this is when I was providing care for a patient
post-Hartman’s procedure and we were having multiple leakage
issues with the chosen appliance and her skin integrity was being
compromised. At this early stage of my training I felt I lacked
sufficient knowledge to deal with this issue and at the time I felt
quiet overwhelmed and inadequate. So I decided to ask for help
and I quickly learnt that there were many different areas that I