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Volume 30, Number 7 April, 2003
POSITIVE IMAGE OF OSTOMATES?
By: Pat Murphy, RN, CETN, Via: No. Suburban Chicago’s New Outlook & Via: Rose City Ostomy News, Tyler, TX.
Each of us can make life better—for ourselves and for those we meet who might someday have to face ostomy surgery for their own good. I’d like to suggest two ways to do this:
First, support the United Ostomy Association— not only financially but also giving volunteer help in your local chapter. Your involvement will keep the chapter strong and make it more interesting and fun.
Second, become aware of the image of an ostomate that you project to others. Be sure it’s a positive one!
Whether an ostomate or not, everyone at some point in life chooses between life and death. You can tell which one people have chosen by observing their attitudes and lifestyles. We are advised to choose life. And that involves projecting a positive image to others.
President Bush’s son, Marvin, said in a recently published article that his ostomy surgery had given him a “second chance” to live. What a marvelous thing to be able to have —a second chance! To be able to live, enjoy family, friends and work or play, is the greatest joy.
Marvin Bush wrote how grateful he was to have a second chance to live. We should all feel this way, because we have chosen life. Sometimes, though, we can get on a negative track and focus on our problems instead of being grateful.
Look at yourself today. Have you been focusing on your complaints and problems? What kind of image do you project to others? Here’s a simple plan to help us all become more positive and project a better image:
Watch yourself for a few days; see if negative thoughts and feelings keep repeating.
Replace negative thoughts with thankful thoughts. You can’t just remove negative thoughts; that leaves an empty spot, and they’ll just come back. You must put positive thoughts in their place.
Express your thankfulness to those around you. Be optimistic in what you say, instead of saying, “I’m so busy, I don’t know what to do,” for example, you could say, “I have so many interesting challenges I don’t know which one to take on first.” Make thankfulness a habit. If you do, you will project a wonderful, powerful, positive, attractive image to all you meet. This will help others to choose life—or an ostomy, if need be—in their future.
WHAT IS A CWOCN?
Ex-
Cerpted from Holmes Regional Medical
Center publication Via: S. Brevard FL Ostomy
Newsletter
CWOCN is an abbreviation for Certified Wound-Ostomy-Continence Nurse. A CWOCN is a Registered Nurse (RN) who has received extensive training in managing conditions related to complicated wounds, ostomies, or problems related to fecal and urinary incontinence. Some RNs choose to become specialists in only one of these areas.
A CWOCN has at least a Bachelor’s degree in Nursing. In addition, the CWOCN has received extensive training in anatomy and physiology; wound, ostomy, and continence management, patient teaching, prevention of complications; appliance fitting and refitting; evaluation and consultation. The CWOCN must pass a certifying examination for each area of specialty, and become certified by the national organization. The CWOCN must also attend relevant continuing education sessions each year, and be re-certified every five years. Here’s how a CWOCN can help. The CWOCN:
1. Consults with the physician to recommend treatment for complicated wounds.
2. Can teach the patient and family how to manage wounds, ostomies, and continence after they leave the hospital.
3. Can evaluate and fit ostomy appliances. This is helpful for new ostomates, and for long-term ostomates who can no longer find the appliances they have been using.
4. Has received training to assist the surgeon in locating the best site on the abdomen for the ostomy to be placed during surgery. This is important to make certain the ostomy is not put in a location, such as a crease or fold, that could complicate pouch-wearing.
5. Can help identify the causes of incontinence, and help manage it effectively while in the hospital and at home.
6. Is an expert at preventing skin irritation and pressure ulcers, and consults with doctors and other nurses to recommend the best approach for each individual situation. CWOCNs are available not only in hospital, but in outpatient settings, and when appropriate, in the home. Such services are usually covered by insurance, but normally only when referred by your physician. Home services are not provided by hospital CWOCNs, but if the patient is covered, some home health agencies have CWOCNs on their staffs.
A LOVING WIFE SPEAKS OUT
Sandie Storer, Warner Robins, GA. Via: Ostomee News, Hamilton Fairfield Ohio Chapters
Family members experience a period of adjustment to ostomies just as ostomates do. I would like to share the process of adjustment I’ve undergone as a spouse, in order to encourage others.
I hope other spouses or other loved ones can benefit from knowing the process of change I have experienced concerning my husband, Gene’s ileostomy and that they will realize any guilt or pain will pass to brighter days.
The change in our lives seems so much smaller than it did a year and a half ago when my husband had ileostomy surgery. Looking back on the process of acceptance, I can see different stages much as one experiences in bereavement.
DENIAL—For the year prior to Gene’s surgery, we both denied its necessity. I tended to slip back and forth between denial and anger. I was angry that he was denying the inevitable– then I would deny it. When he actually had the operation, I tried to act like nothing had happened. I refused to look at his stoma and wanted nothing to do with the Ostomy Association. This was a mistake. Now I see there were avenues of emotional support the Association had to offer; but I was pretty stubborn.
ANGER– I had little support here in our home community as we were fairly new in the area and I got into some pretty traumatic emotional problems. I became very angry and withdrawn and had to rely on professional help to bring me around to the bargaining stage.
BARGAINING– I was angry with Gene for something he had no control over. Once I admitted that, I was willing to talk with him about compensating for his stoma. I was expecting him to somehow be a better husband to make up for “what he was putting ME through”. When I could have been a staunch support for him, I was expecting HIM to consider ME. Thank goodness he had his ET nurse, the doctors, and the Ostomy Association to help him.
DEPRESSION– I finally reached the depression state and spent a lot of time sleeping. It was difficult to do housework. I started to feel guilty about not giving him more support and for being so upset with the procedure that would put an end to the dreaded ulcerative colitis he had suffered for ten years, a procedure which would probably save his life.
ACCEPTANCE– Now I am more accepting of his ileostomy. I will someday make some fancy pouch covers-maybe a Santa Claus!
Seeing how well other ostomates get along in the world has been encouraging to me. What has happened is not something
thing terrible, but something life giving and wonderful.
LOOK PEOPLE-THINGS CHANGE
By: Barb Campbell, Winnipeg Ostomy Association & Cleveland Ostomy Assoc.
We who have had ostomy surgery know about change.
We are challenged by new “change” after our surgery. The challenges of change are big, but our capacity to respond is almost endless. We must make changes that are timely and which also provide long-range strength and health.
Change is constant. Times change, things change and circumstances change, so we must and do change, adjust, make new plans, turn in another direction, take a different path. We are adept at being adaptable.
We re-evaluate priorities and tend to take less for granted. We learn much about ourselves and much about how precious life and people are. We learn to say good things that count now and don’t wait until later because we are acutely aware that later may never come. This changes us and it changes our relationships with others. We hopefully become better people.
Change is with us forever– in more ways than one! The following are quotes that are rather timely:
“Change amuses the mind.” Johan Wolfgang Goethe
“Change is the law of life. And those who look only to the past and present are certain to miss the future.” John F. Kennedy
“There is nothing permanent except change.” Heraclitus
“All our resolve and decisions are made in a mood or frame of mind which is certain to change.” Marcel Proust
“Never underestimate the ability of a small dedicated group of people to change the world; indeed it’s the only thing that has ever changed the world.” Margaret Mead
“Change is such hard work.” Billy Crystal
“The only person who truly welcomes change is a wet baby.” Mary Francis Henry
DISCHARGE PLANNING & FOLLOW-UP CARE REDUCES RE-HOSPITALIZATION
By: Bill Capman, Worcester MA New Diversions, Via: Hemet San Jacinto, CA
One of the current and more frustrating problems facing a new ostomate today is the shortened hospital stays that are part of the cost control efforts of today’s “new” health care system. The “get-them-in/get-them-out” procedure is barely enough time to come out of the anesthesia, wake up, and realize what’s been done, let alone get help, training and an understanding of an ostomy and its care. This is very unfair to the patient and his or her family. The medical establishment must find a better way. Based upon the following, perhaps they have found the “better way”.
A recent news release from the National Institute of Health, entitled “Transitional Care from Hospital to Home Improves the Health of Elderly Medical and Surgical Patients”, highlighted by a study of a more intense program of discharge planning and transitional care for the elderly.
Older people with common medical and surgical problems who were discharged from the hospital realized significant improvement in their health, at reduced costs to the health care system, according to research published in the February 17 issue of the “Journal of the American Medical Association”. The article tested a model of transitional care. It was led by Mary Naylor, Ph.D, RN, FASN, of the University of Pennsylvania’s School of Nursing, and supported by the National Institute of Nursing Research (NINR). Although this study focused on the elderly, it could, and should, be applied to everyone discharged from the hospital after any serious surgery.
The study used a multidisciplinary team and involved comprehensive discharge planning, including determination of patient care needs outside the hospital, and follow-up in the home by advanced practice nurses specializing in geriatrics. Findings revealed that six months after discharge, only 20% of the intervention group was re-hospitalized, compared to 37% for traditional discharges. Per patient days in the hospital were fewer for the intervention group– 1.53 vs. 4.0 for the traditional group, and the cost of post-discharge health services was about $600,000 lower.
According to Dr. Naylor, “The traditional care model is in sharp contrast with current practice, which leaves most patients, once discharged, on their own, to obtain necessary follow-up care.” (Anyone who has had recent surgery can attest to that.) In other NINR-supported studies, the model has been tested with highly favorable results in patient populations ranging from pregnant women with diabetes, to women undergoing hysterectomies.
Let’s hope that this study gets the attention of the health care professionals, and appropriate changes are made soon.
COPING WITH INFECTION...FACTS AND FALLACIES
Via: Kankakee, IL, & Loraine County
It is true that our bodies contain many normal bacteria; we do not live in a sterile world. We humans have a natural immunity to many of these organisms; some are even helpful in keeping down growth of more harmful bacteria.
Infection occurs when the number or organisms exceeds the body’s ability to handle them. Some of the first signs of infection in the area of a wound are redness, swelling, pain on touch, and often fever. It is important to report such symptoms to your doctor before it becomes serious. He may want to culture the drainage to determine what organisms are present.
Besides local cleaning of a wound, an antibiotic is often prescribed to treat any infection that might be in your system. The same thing does not work for everything...the good news is that with today’s drugs, infections are more easily cured.
Many ostomy patients worry about bacteria. Those with colostomies and ileostomies ask if their stomas will become infected from the discharge of stool. THIS IS A MYTH!! The stoma is accustomed to the normal bacteria in the intestine.
* Keep the skin around the area clean and be careful of adjacent wounds.
* Keep the fecal drainage away from the incision.
* Don’t worry about the ostomy becoming infected from the normal discharge…our bodies are accustomed to certain bacteria
IF YOU ARE HOSPITALIZED AGAIN
Via: Solona Ostomy News, GB News Review & Space Coast Shuttle Blast, Cocoa, FL.
First, take all your ostomy supplies with you that you will need during your hospital stay. The hospital may not have the type of equipment that you are using.
Prepare yourself to do some expert communicating, especially if you go to a hospital where ostomy patients are not seen too often, or if you go for a condition not related to your ostomy. Do not assume that all hospital personnel are knowledgeable about ostomies.
Do not submit to procedures, which you think may be harmful to your stoma. If you are in doubt about any procedure, refuse to have it performed, and talk to your doctor. IT IS YOUR RIGHT!!!
Notify your ET nurse, no matter what the reason is for your hospitalization. Give her your room number immediately. Do not leave this important part of your hospital stay up to the nurse in your unit. Regular nurses often are not trained in the care of ostomates.
NUTRIENT ABSORPTION
Via: The Lifesaver, LEE County, FL & Southern MD County Chapters
Food is absorbed in the intestines; I.e., the small and the large intestines. The small intestine is about 22 feet long, and is comprised of three sections: the duodenum, the jejunum and ileum. The duodenum is about 10 inches long and attaches to the lower part of the stomach. The duodenum is followed by the jejunum, about 8 to 10 feet long. The ileum, about 12 feet long, completes the small intestine and continues into the large intestine, about 5 to 6 feet long.
Normally, most digestion and absorption occurs by the time the food reaches the middle jejunum. The ileum is capable of absorbing these substances but acts mainly as a reserve capacity. Vitamin B-12 absorption takes place only in the lower portion of the ileum, with a large ileal resection, a Vitamin B-12 deficiency may thus result. Amazingly, the small intestine’s absorptive capacity is equivalent to the size of a tennis court. The small intestine also serves to maintain water and electrolyte balance and has the absorptive capacity of 11 to 13 liters of water per day, or 95% of the total capacity.
Most of the digestion and absorption are almost completed by the time food arrives in the large intestine. Some of the functions of the large intestine include absorption of water and electrolytes and movement of bowel matter. However, only 0.5 to 1.5 liters of water are absorbed in the colon or only about 5 percent of total capacity. The large intestine is responsible for only about 4 percent of nutrition absorption.
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