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

Reflective essay
Colleen Pope
This article was written as an assignment for the Graduate
Certificate in Stomal Therapy Nursing and it may help other
student nurses as an example of how to write a reflective essay.
The Australian Nursing Federation Competency Standards for
the Advanced Registered Nurse 1 will be applied throughout
with the competency standard identified in bold and in brackets
following the related action.
Reflection is defined as a serious thought or consideration
and to be reflective is to be thoughtful 2 (Oxford Dictionary).
An important part of my practice is considering my actions
in relation to patient outcomes and my responsibility towards
the implementation of effective treatments, in my role as a
stomal therapy nurse (STN) and in all my nursing roles (8.3,
8.4). The Code of Ethics for Nurses states that fundamental
responsibilities are to promote health, to prevent illness, to
restore health and alleviate suffering 3 . Sometime during my
initial education I was taught that the aim should be: to do good
not harm, and I have adopted this as my personal philosophy.
This requires being informed with the latest best practice
information and acknowledging the person you are treating and
their expectations.
An experience during my clinical placement was food for
thought. A male paraplegic, Indigenous person had suffered a
full-thickness burn to his foot. He suggested that if amputation
would hasten his discharge, that would be his option because
his mate was at home alone. When asked about “his mate” he
told us it was his dog, his only friend in the world. His wound,
although important to us, was less significant in his life (1.4).
The evaluation of clinical practice is a pivotal part of delivering
quality patient care and provides assurance that patient needs
have been met 4 . “To act confidently, competently and creatively
we need to reflect on our caring intentions, the ends we have
in mind and the means we might choose in order to achieve
them” 5 . Daily experiences build on an individual’s body of
knowledge and comparing these outcomes with those of others
is a way of learning and evaluating. I often compare myself
unfavourably and sometimes wish I was less critical of myself
in work situations. I want to be as successful as my fellow STNs
and feel competent in their company.
I have been working for some time relieving the STN in the
hospital in which I am employed. I have made every effort to
employ evidence-based practice because that is part of “doing
good” ( 1.6 ). However, I felt that the time had come to legitimise
my practice by undertaking a formal course in stomal therapy
nursing and subjecting myself to peer review (2.1, 2.2). “The
STN evaluates and reflects on own practice and engages in peer
review” 6 . I have been fortunate in being mentored by a STN who
22 Journal of Stomal therapy australia – Volume 30 Number 4
has the appropriate attitudes as outlined by Pellatt 7 , “mentors
are accountable for both the safety of patients and clients and for
the development of student competence”. There also needs to be
a high degree of trust between mentor and mentee.
During my clinical placement for this course, my preceptor
has facilitated and supervised my clinical experience, a role
described by Busen and Engebretson 8 , showing me the same
accountability and professionalism. I realised that there is
a difference of available resources between the private and
public hospital systems and often a slightly different approach
is required. The lower socio-economic situation of the patients
(during my placement) caused me to re-evaluate my approach
to patient education (1.10, 1.11). In the private sector, we have
the luxury of time to provide education postoperatively for
our stoma patients. A man whom I sited for a non-functioning
ileostomy would spend only 2–3 days in hospital after his
surgery. This meant that the preoperative education I provided
had to be more intense. I had to ensure more extensive written
information was given at the pre-admission visit so that my
patient could begin to process this information before the
anaesthetic and surgery took effect (4.1). Johnson and Porrett 9
advise that patients might find it useful to have written
information. A folder with leaflets and brochures relating to:
stoma function, diet, skin care, sexual activity and appliance
scheme was given as well as a demonstration of available
products (4.7). His previous history of inguinal and umbilical
hernia and the need to wear a hernia support garment were also
discussed (6.5). His wife was included in this education session.
I felt relieved that the patient had not come alone, as support
at home would be essential with the reduced hospital stay. I
reflected on how I would address his postoperative education
and realised that the ward staff must be well educated as
they would play an important role in his education (3.1, 13.2).
Norman and McCaughan 10 discuss education of clinical nurses
to perform after-hours patient education and stoma siting. This
method could be used to educate ward nurses to teach pouch
emptying and changing, for the patient after hours. Our stomal
therapy department has a specific nurse-orientated instruction
page for patients who are treated outside the colorectal ward.
This is effective. I have experienced this type of situation
myself as a ward nurse who provided after-hours siting, and
troubleshooting for difficult to manage stomas (8.2).
A female mental health patient presented with extensive ulcers,
which were exacerbated by the fact that she had not been
brought to the clinic for her previous appointment. The ulcers
had gone untreated for five days. The bandages were soiled,
and due to the bottle shape of her legs, were inappropriate and
had slipped down around the ankles cutting into the already