The role of stoma nurse specialist is multifaceted; they have many challenges on a day to day basis.
This assignment aims to identify the role of the stoma nurse specialist; it will give a brief explanation on the nursing specialist role, how this was adapted into hospital settings in Great Britain, and identifies the number of stoma nurses/ nurse specialists in the United Kingdom. It will describe the three different kinds of stoma’s and where they are sited. It will discuss the statistics of people requiring a stoma. Within this assignment it will discuss clinical, hospital and community care that the patient will receive from the stoma nurse specialist. Preoperative care for the newly diagnosed patient will be identified, giving the rationale for surgical requirements. Post operative acceptance, depression, care of the stoma and changes to body image will be discussed. Community settings, for example, the patient’s own home will be discussed for advice on activities, sexual intercourse and everyday living patient/nurse boundaries will be discussed in this section. It will also explain the teaching role that the stoma nurse specialist has for patient, patient’s relatives and staff members in caring for the surrounding skin, and identifying when the patient needs to be referred to the stoma nurse specialist. This assignment will also discuss the cost to the National Health Service, whether under this financial climate the Stoma nursing specialist is a necessity, or if general nursing staff are knowledgeable enough to care for a stoma patient without the need to consult the stoma nurse specialist. There are many roles that the stoma nurse specialist has to perform, and for the purpose of this essay the aforementioned will be discussed.
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The stoma nurse specialist is an expert in their field of nursing. It has been noted that in most hospital wards/ community settings that the author has been on in placement, that there has always been a patient either requiring the stoma operation or have a stoma insitu. Although it was noted that the primary care district nurse team are adequately knowledgeable about the care of a patient with a stoma, in some ward settings some of the nurses were more reluctant to deal with the basic care of the stoma site. For this reason the rationale behind the choice of stoma nursing specialist for this project is to gain the advanced knowledge to give the highest care possible to the newly diagnosed patient, following through the care until the patient’s stoma has been reversed, or continuation of the stoma patient throughout their adaption to their life with a stoma (Chaney, 2007. Belling et al. 2009).
Biddulph (1976) states that the first clinical nurse specialist in Great Britain was employed in the mid 1970’s, commencing in The Manchester Royal Infirmary. Since then there has been a shift in the nurses’ role and positions. Information Services of NHS Scotland (ISD) (2004) reports that in the year 2003 there were 1258 Nurse specialists working within NHS Scotland. Nurse specialists are all specialists in their chosen field of nursing. Mills et al. (2002) suggest that nursing specialists are a vital aspect in managing patients with both chronic and acute illnesses. The International Council of Nurses (2005) agrees and suggests that all nurse specialists need to be a registered nurse who has acquired an expert knowledge based on their particular aspect of nursing; they have to have a high standard of clinical ability and must have multifaceted skills to expand their practice. They also state that the nurse specialist requires to be educated to an advanced level, for example, have or are working towards their Masters Degree level.
In the NHS today there are approximately 600 Stoma Care Nurses; included in this are 26 stoma nurse specialists in Scotland (I SD 2004). Employing a holistic approach, by looking at the whole person, this is achieved by identifying the psychological/ emotional needs, physical changes in body image, spiritual and family issues and needs of every patient (Hollinworth et al. 2004). Castledine (2004), Rust (2009), found that patients who see a stoma nurse specialist are more knowledgeable about their condition, preoperative care and treatment, hospital stay and postoperative care and treatment.
(Elcoat et al.2010) suggests that In the United Kingdom there are approximately 100,000 people living with a stoma and approximately 20,000 new stomas cases per year. Waller (2008) States that there are approximately 40-100 new paediatric stoma patients per year in the United Kingdom and in Ireland. Half of all stomas sitings are reversible.
Speirs, (2007) defines a stoma as an artificial opening on the abdomen to redirect the surge of faeces or urine into an external pouch. This is located outside the body. The three different types of stomas that will be discussed are colostomy, ileostomy and urostomy. Colostomy is described as an opening into the colon, usually sited on the lower left side of the abdomen, or a transverse colostomy, which is positioned above the waist. Ileostomy is an opening into the ileum, which is usually sited on the lower right side of the abdomen, and a urostomy is described as an opening into the urinary tract, which is also usually sited on the lower right side of the abdomen (Speirs, 2007).
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Stoma patients experience a multitude of difficult and debilitating symptoms and problems that affect quality of life. Cottam and Richards (2006) states that there are many reasons a patient will require a stoma, examples are, diverticular disease, Crohn’s disease, ulcerative colitis, colorectal cancer, Ischemic bowel, fistulae, pelvic abscess, perforated colon, faecal incontinence, anastomotic leak, anastomotic stricture, post radiation, volvulus, strangulated hernia, multiple sclerosis, renal cancer, Ovarian cancer, trauma, familial adenoma polyposis, anal fissure mega rectum and birth injury.
Stoma care has a massive impact on the National Health Service (NHS) budget as it is estimated that the cost to the NHS is well over £200,000,000. This covers stoma appliances, example of such are, stoma bags, skin creams and cleansing wipes Mahjoubi et al. (2010). This does not include surgery, medication or hospital stays.
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