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

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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
could approach for this. I spoke with other nursing colleagues, I spoke to one of the company representatives of stomal products and I spoke to the treating team (4, 5, 6, 7, 8.1). Throughout this I maintained open communication with the patient and their family to give them a feeling of acknowledgement and active participation (6.6). Throughout my stomal training it has become more evident as I continue this journey that patients and family first (PAFF) play a major role (2.1). I have only just become aware of this term but realised when I heard it how much it impacts on stomal therapy nursing (2.1, 8.3). The patient discussed earlier with the leakage issues is a good example of PAFF. I actively sought out her family and made my visits at corresponding times when they would be present. Education was given to both the patient and the family. I believe this support and involvement from her family enabled her to cope more effectively, especially when we were dealing with the leakage issues. When I first began this course I had ward experience of dealing with stomal patients and very limited experience of the actual role of the stomal nurse. At the beginning I thought it was defined as just caring for patients with stomas. I remember while I was on clinical placement with the stomal therapist and a ward ringing her to ask advice about a dehisced suture line that was having heavy output. I asked the stomal therapist why they would call her and not the wound team especially as there was no stoma involved. As she explained the rationale to me my whole conception of the role of a stomal therapist nurse changed. That moment made me realise how diverse the role is and how much it could offer me. I believe I am now practising as an expert practitioner. This is defined by Benner 6 as having an intuitive grasp of situations and not requiring analytical rules or guidelines to facilitate this understanding. Important traits I attribute to an advanced practising nurse or expert practitioner is someone who uses their resources to their advantage. It is not a nurse who knows all the answers but one who recognises their own knowledge deficits and is comfortable to ask for direction and clarification as required. It is a nurse who is active in self-reflection. On my reflection and from taking into account the feedback I obtained from my clinical placements and working with various clinical nurse specialists, I have identified some areas I wish to further develop (9.6). Firstly I would like to become more proactive in the area of stomal therapy by attending conferences and seminars (12.1). I have taken a small step towards this by attending an education session about new stomal products outside work time (12.1). By doing this in my own time it demonstrates commitment to my ongoing education. I would also like to further develop my interpersonal skills with members of the multidisciplinary team and clients (11.1, 11.2). I believe this is an area in which I can always improve and as I do it will give me more confidence to interact with others. I feel by the development of these skills that I will be better equipped to be a role model for others. I hope to participate in more education on a larger scale in the future as well. This will be beneficial to my educational needs and those of others. coNcluSIoN This reflective essay has enabled me to conclude my journey. The course has been an enjoyable experience by allowing me to rediscover interests I wasn’t aware of or perhaps would not have considered. At times it has been challenging and my optimism wavered, but the feeling of achievement and completion always won in the end. I am glad I have completed this course as it opens many new opportunities for my career now and in the future. refereNceS 1. Australian Nursing Federation. Competency standards for nurses in general practice. Advanced registered nurses. Melbourne, VIC: ANF, 2005, pp. 2–7. 2. Blackley P. Practical stoma wound and continence management. Australia: Research Publications, 1998. 3. Carville K. Wound care manual, 5th edn. Australia: Silver Chain Nursing Association, 2007. 4. Bird K. Clinical leadership. The Journal of Stomal Therapy Australia, 2009; 29(3)6,8–9. 5. New South Wales College of Nursing. Graduate certificate in stomal therapy nursing: course information book. Burwood: The College of Nursing, 2009. 6. Benner P. Interpretation of data. In: From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, California: Addison-Wesley, 1984, pp. 17–34. AASTN MEMBERSHIP RENEWALS & REcEIPTS The AASTN Executive Committee would like to notify and/or remind all members: • Membership fees are due by the 31st December of each year (AASTN Constitution 2003). • Membership ceases if in arrears for 60 days. ie: 1 March. (AASTN Constitution 2003). • Please note from 2011 AASTN will implement the late fee charge ($20) for members who renew later than 1 April. • Late fees DO NOT APPLY to new members applying after 30th March. • AASTN’s preferred method of fee payment is by direct banking. Please consider this payment method. Your membership ID (MID) and surname should be included in the payment description for easy identification. • from 2011 receipts will not be issued unless the request is indicated on the renewal form. Preferred format of issue will be via email. Please ensure your provided email address is current. This notification by The Executive Committee has been prompted by the large number of AASTN members renewing late into the membership year, and increasing postage costs. Thank you for your understanding and cooperation. � Journal of Stomal therapy australia – Volume 30 Number 4 19
Page 1 and 2: Print Post Approved PP 642521/00041
Page 3 and 4: aaStN Code of Ethics The Journal of
Page 5 and 6: President’s report Sharmaine Pete
Page 7 and 8: ConvaTec (Australia) Pty Limited. A
Page 9 and 10: Management Vacuum assisted closure
Page 11 and 12: Try the NEW Moderma Flex 1 piece po
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Page 15 and 16: ALL THINGS UROSTOMY! Flexima Urosil
Page 17 and 18: not the vagueness of nursing know-h
Page 19: Reflective essay Katie Jane Bird IN
Page 23 and 24: SenSura 1-piece system Recommend Se
Page 25 and 26: *HOS-GON - NO-SMELLS! Nursing Homes
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Page 37 and 38: Ray Garske presented with certifica
Page 39 and 40: familiar to us and it was great to
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