Approaching Ostomy Care with Confidence

A first experience of as a nursing student.

I encountered my first stoma as a nursing student and the incident is seared into my memory. It was in the first semester of my medical–surgical nursing course. The patient was a middle-aged man three or four days post-op after a colon resection. I was very nervous, but figured my instructor would know what to do. My stomach dropped when she confessed that she was not all that familiar with stoma care but was confident we’d figure it out with some help from the staff.

Fortunately, the head nurse of the surgical ward (I’m dating myself: yes, it was a ward and yes, her title was head nurse, not nurse manager or patient care coordinator) was very experienced with new ostomy care. She helped both of us gather the correct supplies and briefed us on what to assess and do. We were able to competently change dressings, change the ostomy appliance, and make the patient comfortable. However, I don’t think I encountered another patient with an ostomy until a few years later. By then my knowledge had faded. I had to seek a refresher.

Stoma assessment and common complications.

Photo by Amelie-Benoist / BSIP / Alamy.

I am very pleased that Susan […]

2019-06-11T11:56:29-04:00June 11th, 2019|Nursing|0 Comments
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When Metrics and Testing Replace Listening and Physical Assessment

By Gail M. Pfeifer, MA, RN, AJN news director

Emergency x 2 by Ian Muttoo, via Flickr. by Ian Muttoo/via Flickr

I was appalled as I read the Narrative Matters column by physician Charlotte Yeh in the June issue of Health Affairs, for two reasons. Aside from the compassion I felt for her suffering at being hit by a car on a rainy Washington, D.C., evening in 2011, I was dismayed that most of her story took place in an ED, one of the settings in which I used to work. While there, she met with a series of omissions that included not just medical care omissions but also—though she never explicitly connects the dots—basic and serious nursing care omissions.

It saddens me to think that one of the things I fought so hard to implement on our unit more than 20 years ago—transforming the staff’s automatic labeling of arriving patients (an MI, an MVA, a gunshot wound) into a unique picture of who that patient really was under those traumatic circumstances—has still not come to pass. Yet that change of vision is so important to completing the picture and arriving at an accurate diagnosis. Noting that her care demanded a better balance of necessary […]

2016-11-21T13:04:30-05:00June 13th, 2014|career, nursing perspective|3 Comments
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What Ever Happened to a Good History?

ky olsen/via Flickr ky olsen/via Flickr

By Karen Roush, MS, RN, FNP, clinical managing editor

What ever happened to a good history? We were taught as NP students that the history portion of the exam was as important as the physical. In fact, in most cases it’s what you learn in the history—from asking the right questions and really listening to the patient’s answers—that gives you the information you need to figure out what is going on. The physical findings either support what you’re thinking or lead you to ask more specific questions.

A good history isn’t just listening to the patient’s answers to your questions; it’s listening to all the information they offer. Take for example, the middle-aged construction worker who takes his lunch hour to come in to the clinic complaining of a cold. He lists the usual symptoms, cough, fatigue, a little shortness of breath, and then as you’re starting the exam he casually mentions that he hasn’t been to a doctor in 15 years.

Someone who’s managed to stay out of a doctor’s office for 15 years and now shows up, on his lunch hour, because of a simple cold? So, you ask some more questions and learn about some chest pressure he attributes to the coughing he’s been doing and about […]

2016-11-21T13:05:39-05:00January 10th, 2014|nursing perspective, Patients|4 Comments
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My Supporting Role

In nursing as in acting, connecting is key.

The Actor, by Picasso/Wikimedia Commons

When I graduated from nursing school, I was given a pen, stethoscope, tape, and scissors. In my current practice as a pediatric nurse in acute care, I’ve found that it’s all too easy to let technology with all its conveniences and safety measures take center stage. I have a bedside computer, cell phone, and cardiac monitor, among many other technical tools.

Yet the importance of creating a therapeutic milieu for patients and families has remained unchanged. Now the challenge I have is how best to use technology as a prop and a backdrop and not as the main event, how to prevent data collection from creating a barrier between me and my patient.

Of course technology has many advantages. In the past, I had to spend long stretches of time away from the bedside, creating written medications sheets and care plans. I remember spending hours looking up each medication dose and side effects in reference books. Transcribing written doctor’s orders and medication information was an art form. Now we obtain the most current doctor’s order and medication information in seconds with a click of a button.

Making technology an asset, not an obstacle.

While these conveniences have given me more […]

2020-02-07T11:15:00-05:00September 16th, 2013|digital health, nursing perspective, patient engagement, Patients|3 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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