Question

Mr. Jacobs is a 55-year-old college-educated male recently diagnosed with colon cancer. He is scheduled for surgery with formation of a colostomy. Prior to meeting the patient, the nurse reviews the health record and notes that Mr. Jacobs is able to read English, has family support, and is currently not working. Mr. Jacobs’ wife works in retail. Mr. Jacobs is very health conscious, and his goals are to go back to “normal” life. The nurse notes a comment made by Mr. Jacobs that “a colostomy is the one thing I said I would never live with.” Based on the information gathered, the nurse develops a teaching plan for Mr. Jacobs. The plan includes the provision of written material about colon cancer, anatomy and physiology of the gastrointestinal tract, and alterations presented by having a stoma. Options for care of the stoma are also provided in writing. A second visit to demonstrate how the ostomy appliance is fitted, emptied, and changed is planned. A manikin abdomen will be used to demonstrate and practice stoma care with the patient. Mr. Jacobs is in the developmental stage of generativity versus stagnation. When planning for his learning needs, the nurse also uses multiple sources of information to teach Mr. Jacobs according to his level of education but also attends to the fact that psychomotor learning is required. To evaluate the outcome of the educational intervention conducted, the nurse follows up with Mr. Jacobs to determine his competency (both actual and perceived) in performing the necessary skills of care and Mr. Jacobs’ emotional and attitudinal changes related to the ostomy and his illness. Plans are changed and adjusted according to Mr. Jacobs’ progress toward his goals, incorporating family members while Mr. Jacobs becomes ready for this step. Case Analysis In this case, the nurse attended carefully to assessment before beginning the educational process. Because the patient was well educated, the nurse could rely on multiple forms of education, including written materials. The nurse used hands-on practice to incorporate psychomotor skill. By asking about goals and listening to Mr. Jacobs’ feelings about living with an ostomy before initiating the educational plan, the nurse gathers valuable information about perceptions and attitudes. With this information, the nurse is able to incorporate strategies for addressing the affective domain that will be most effective. Including the family members before the patient is ready may hamper education efforts by limiting trust in the nurse–patient relationship. The patient’s desire to return to his normal life tells the nurse that this patient, in Erickson’s stage of generativity versus stagnation, wants to resume a productive life as soon as possible, lending to motivation to learn. This could have been further enhanced by incorporating frank discussions about the impact on Mr. Jacobs’ sexuality into the teaching plan. Failing to attend to the patient during assessment would have resulted in failure of the patient’s educational experience. For example, if the nurse assumed that the patient would want his wife included from the beginning and arranged the educational sessions with Mrs. Jacobs rather than the patient alone, the nurse would have limited the patient’s ability to express his own needs in the educational encounter.

Question 1: How would the nurse best plan to educate Mr Jacobs regarding care of his colostomy bag after surgery?

Question 2: What is another way in which Mr. Jacobs could be assisted in learning to care for his colostomy?

Answer 1

In order to teach patients it is better to have a good knowldege about ostomies. So, prior to the teaching the nurse should prepare s throrough teaching plan.Then the nurse have to check how the patient is comfortable for teaching, whether to include the familymembers or alone. If he wish to be alone then do not compel the patient to include the others but instead develop a trustful relationship with the patient and then can start the session. After identifyinghis psychological thoughts we can start the session indvidually and then moving forward make him to understand the improtance of family memebrs including in the health education. Once he agrees with that , we can include family members in the later stage.

So, at first stage, the nurse should first support the osteomy patient's transition.

Patients facingosteomy surgery and those post operative period with colostomy bag etc,may be overwhelmed.So, sensitivity and apprecaiation of patients emotional state is vey important.They need to understand that their feelings are normal.They may be angry and feel that the body have betrayed them. So, the first thwing that is to be done is help the patients in their grieving process.

Regarding the odor, the nurse can teach that the odor can be effectively managedonce odor spraying is done.Always teach them that the pouch is functional thenn there eill not be any odor. Include the anatomy of the colostomy so thst they can know the importance of colostomy and it's care.

Secondly, while teaching planning control those things that can make teahing more succesful.So, plan pouch changes at a time when the patienthas nothing to eat or dirnk for approximately for 2 hours.

While planning teaching include simple words that is easier to understand.

Teach the patient how to change the osteo,y pouch.

Befroe itslf teach how to get started. that means, ask them to gather all the supplies.with the gathered things gently remove the existing pouch and clean the area. discard the pouch and examine the stoma and the surrounding skin.Clean the stoma and allow them to be dry. Once stoma size is measured then apply the new pouch.

Always make sure that the patient is also included in the tecahing so that they feel much easier.

With each teaching encourge an increasing level of patient involvement.with a goal of complete independence.review the lessons with each visit.

Teach the lifstyle changes. that they have to follow with the new pouch and its care.

Do, these are things that should be included in the stoma care.

2.Another way that could be assited in learning the care of colostomy is dmemostartion with a dummy abdomen and stoma and making the patient or family memebers to teach the care and change of stoma pouch.OR he can be taught with the help of presentation or making him to tak with others who have recovered from this siatutaion which will make him more stress free and confident..