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

causes a decrease in gastrointestinal motility 19 , the desired effect
in this case. This was explained to the ward nurses so that they
understood the aim of treatment (14.1). When the desired result
was apparent, the Loperamide was ceased because the Codeine
produced a more satisfactory outcome (1.7). The faecal output
was thick enough to facilitate management of the colostomy
without leakage and the stoma continued to function. When she
was ready for discharge, the stents were still in place. I contacted
the urologist to inform him of the pending discharge (5.7)
and was asked to remove the stents 17 after giving intravenous
antibiotic cover. I worked with the ward nurse to ensure the
antibiotics were given (5.5). I removed the stents according to
instructions given on previous occasions (6.3). A graduate nurse
who was working in the area asked to observe the procedure.
I explained to her the principles as I worked (13.2). I also
explained to the patient that she should observe for continued
drainage of urine from the urostomy to ensure the ureters
remained functional and to report fever, back pain, feeling
unwell or blood in the urine (4.3). I documented the orders and
signed for removal of the stents in the patient’s chart (3.1).
During my development from clinical colorectal nurse to student
STN, I have attended conferences, workshops and product
launches (6.1, 6.2, 6.3). A very professional case study was
presented by a fellow student at one meeting, which impressed
me with the quality and depth of knowledge displayed (10.5).
I compared my own knowledge and realised the need to
continually strive for improvement (2.2). However, the best
learning experiences have been when I have been asked to
provide education for others. I have given a presentation titled
Stoma Products. Diverse Uses at a wound management course
conducted yearly at our hospital by my mentor (STN ) (12.1).
The basics had been formulated by another STN with whom I
have worked. I expanded on this by adding some information
and photographs of my own. I acknowledged her contribution
(11.1) to the audience, which consisted of RNs and enrolled
nurses (ENs) from our organisation and others, as well as the
community, and sales representatives (13.1). This activity helped
me gain confidence in my own knowledge and ability. I have
recently given a presentation at a vascular workshop consisting
of 40 delegates. My contribution was a 40-minute lecture on
leg ulcers (13.2). This was an ideal learning experience for me,
as I undertook extensive literature searches and compared our
treatments with those described in the literature to ensure that
the information I was giving was factual and relevant (10.2).
I have also given an informal presentation relating to stoma
care and the expectations placed on the ward EN to a group of
student ENs on placement in my workplace (14.2). My aim is to
always be sure of the facts so that teaching others comes more
easily.
An issue of importance to me has been my integration into
the profession of STNs. A continuous process of development,
internal discussion and external feedback shapes a profession’s
current identity 20 . This is evident in every meeting of these
nurses. Mantzoukas and Jasper 21 believe that there still exists
an unequal relationship between RNs and doctors. However,
every day I witness the respect in which the STN is held
by the consultants with whom we work. I feel proud to be
accepted into this group and am committed to upholding this
image. Hornby and Atkins 20 state that just as an individual
needs to have a satisfying self-image, a profession needs to
establish, promote and protect a strong, cohesive and satisfying
professional image with which its practitioners can identify. The
Standards of Stomal Therapy Nursing 1 include in the philosophy
“a responsibility to share their knowledge and skills with others,
including those in the health profession”. I have experienced this
firsthand. Ideas are regularly shared and support offered.
The area of research is a weakness in my practice which I intend
to change. I have been involved in only minor areas of research,
such as evaluation of products. I have helped collect data
for evaluation of intravenous site dressings and new ostomy
products (9.2). I have participated in the use and evaluation of
alternative negative pressure wound devices. I realise that when
qualified, as a member of the AASTN it is imperative that I
become active in the association and participate in maintaining
the high standards already set. This will necessitate an ongoing
commitment to education. Newhouse, Dearbolt, Poe, Pugh
and White 22 state that the move towards informed professional
practice requires evaluation of existing practice, synthesis of
current available evidence, and incorporating the best new
evidence into practice.
As a clinical nurse working in the colorectal ward at my
organisation, I was responsible for producing the clinical
pathways for general and colorectal surgery (12.2). It was also
my responsibility to teach staff how to record variances and to
audit these variances (9.2) for quality improvement 23 . Currently
at my workplace the STN is involved in product evaluation,
pressure area prevention and monitoring of all reports of
skin tears to ensure protocols are followed and patient safety
is maintained (9.6). At this stage of my development I am
participating in some of these areas but have not taken part in
the product evaluation group.
Assessing my development during this course, I believe I
now have a better grasp of the theory behind the day-to-day
practice. Although I have taken advantage of the available
journals and texts, particularly those of Blackley and Carville,
literature search for assignments has taught me to look further
afield also. Bawden and McKinnon 24 imply that the dynamic
nature of learning means that it is never really completed. I
do not consider myself an expert STN. I believe that I am at
the proficient stage as described by Benner 25 . I have had the
experience over time but must still at times resort to analysing a
situation before deciding on a correct course of action.
refereNceS
1. Australian Nursing Federation. Competency standards for nurses in
general practice. Advanced registered nurses. Melbourne, Vic: ANF,
2005, pp. 2–7.
2. Oxford Dictionary. Accessed 4 April 2008, askoxford.com/results/
?view=searchresults&freesearch=reflection&branch=&textsearchtyp
e=exactuseaskoxford.com
3. Ghebrehiwet T. Doing what’s right: The ethics of nursing. Helping
nurses make ethical decisions. Reflection on nursing leadership.
Third quarter (Feature six), 2005. Accessed 28 February 2006, www.
nursingsociety.org/RNL/RNL3rdQtr.pdf
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