… from a health care professionals point of view!
So as some of you may know I recently did some training at work on stoma competency, which basically was to ensure I could change ostomy appliances on other people. I work in an extra care and support setting and may come across people with ostomies and if they need assistance with this we are to be trained in doing so. Now it may seem silly that I had to do this training but in reality it isn’t.
I had to be trained in administration of medication again even though I have been trained in two other jobs and hold a level two in the administration of prescribed medication, this is because different companies have ever so slightly different policies and procedures. I learnt in this training that you need specialist training when it came to ostomies. Now as you will all know all of our ostomies are different and we have different products. But if you don’t know what you are doing you may cut the appliance too small, too big, not close the bag/put the bung in/get a good seal etc.
These things are the things we learn whilst still in hospital and often take for granted when it comes to others doing it for us. Now I had major reservations about changing someone else’s bag for the fact that could I do it person centred without accidentally going on auto pilot and doing it the way I do mine own. I told my team leader this and I actually rang one of my stoma nurses Judith who was delivering the training and told her my fears and she made reassured me.
Now the day of the training I felt sick; everyone I work with knows that I have a stoma mainly so if I go missing in action due to a leak or the need to empty they don’t think I’m skiving – I was worried that everyone would be watching and I would completely cock up. Now when I got to work I couldn’t find the darn room we were doing it in and I was typically the last there.
Judith had set up a little table with a flip chart, bags for all three main ostomies – colostomy, ileostomy and urostomy. Plus some items people may need such as adhesive remover spray/wipes, barrier spray/seals, dry wipes and flange extenders. She spoke about each type of ostomy and the main reasons for each type and which ones were reversible and why. She was super inclusive and spoke about nephrostomies too which are becoming more common, a nephrostomy is a tube coming out of the kidney – I first heard about these from a midwife who said her dad had one, one of the urostomates I know has had them and there was a talk on them at ASCN. I will be doing a post on the specific talks I saw at a later date I haven’t forgotten!
We all were passed round the different bags which I have to admit I didn’t look at but when you wear an ileostomy bag anyway and have made a urostomy bag by hand and seen colostomy bags I didn’t feel there was much point in me looking. My colleagues even though most of them have seen them before had a good look at them because they are all obviously wanting to keep being person centred and good at their jobs (like they are doing already) We were all given a colostomy bag (which tends to be the most common ostomy the elderly have) to cut to the size of the model’s stoma that had both a colostomy and an ileostomy (think of it like a legless torso of a resussie annie) I obviously cut mine quicker but when you have cut as many as I do it wasn’t really anything of any importance, I remember thinking I would never be quick at doing that when I first got my stoma!
We then each had to remove the appliance and “clean” the area as we would a real persons stoma and place the bag on top. Now I felt sick when it came to my turn, I felt like everyone would be watching me and it is very different doing it on someone/something else than doing it to myself. The viewpoint is completely different as I look down on mine from above ie standing rather than looking over it if someone was laying down. So I was essentially looking at it from the bottom up rather than up down if that makes any sense? Not to mention the fact I just knew it wouldn’t stick correctly for me first time. So I just rolled with it and laughed and said “typical”, I mean it would be the ostomate that messes up a tiny bit!
We also covered things like constipation, blockages, high output, but Judith also mentioned that one thing ostomates say to her is how bad they feel when you can tell the other person clearly isn’t keen on changing the appliance and yeah it’s not nice for all involved as an ostomate you eventually get somewhat used to it, but it was brought up for us to be mindful of our facial expressions and tone of voice. There is nothing worse to be vulnerable and be made to feel worse by a throwaway comment or a look of disgust, that we are all human and sometimes may not even realise we can do. I really like that she mentioned it because it adds the humanity back into a clinical situation, I’ like to think that myself and my colleagues would never do this on purpose but it gave us all some food for thought. Besides we all have some bodily functional we aren’t fans of mine is saliva (which got better when working in my last job) and snot – I really freak internally with both of those and sometimes it is hard to control it so others don’t feel worse.
Now I have only done a competency training course and even though I have personal knowledge and expertise on myself this course does not make myself or my colleagues experts, that is the stoma care nurse team. I know sadly not everyone is lucky to have such caring nurses as I do but they should always be your first port of call if anything changes to the stoma, peristomal skin or output, be it to yourself or a patient (not that the people I support are my patients can I point that out but it sounds better in this context than client or tenant!)
It was interesting having this training from a healthcare professional point of view because it was the first time I have had something so personal to me being taught from a “clinical” if you will standpoint. Also knowing the person doing the training personally in and out of the hospital setting (out because of Hambleton and Richmondshire Ostomy Support Group) made me feel slightly on edge that I needed to get it right and kind of prove myself mainly to myself not to Judith that I am a good advocate and support worker. Sometimes you can feel like a fraud if you are sick and work in healthcare especially when you advocate for something you feel passionate about, luckily for me Judith nor my colleagues and team leader don’t make me feel that way. Oh and if you weren’t sure I thankfully passed my training!
Do you work in healthcare? Is stoma competency training something you have had to do? If you are an ostomate what was it like for you?