I will be developing a Ostomy care teaching plan for client L.J, who is 24 days post operative following a colostomy. This teaching plan will be specific to L.J, taking into account his learning needs, his motivation and readiness to learn and any environmental factors that might influence his learning. The teaching plan will also include visuals for the client, active participation and an evaluation of the goals.
While working with client L.J, I was able to complete a full assessment of the clients characteristics that could potentially affect his learning. L.J is a 77 year old male who is alert, oriented to person, place and time. L.J has a Chinese and Cantonese background and speaks very limited English. L.J is able to understand questions and information provided to him in small portions and done slow, giving him time to understand the information in English. L.J wears glasses to read, he is able to read in English, Chinese and Cantonese. He is also able to ask questions, and answers using broken up English. L.J is very attentive to his health, he uses a holistic approach for pain, such as meditation to overcome pain. He is a soft spoken and a calm individual, who also prefers a quite environment. L.J is ready to learn, he is very eager to understand any new information that involves his care. L.J is very much motivated by his wife and son, they encourage his interest in his care and assist in translating any information he is unable to correctly understand.
Before beginning the teaching plan, I have asked client L.J his understanding of the Ostomy and the care it needs. I have identified that there is insufficient knowledge, this will help me have a better understanding of how much information to include. Client L.J’s learning need is help him have a better understanding of what the ostomy is and how it works, how it is effected by his diet, how to care for the skin, what to look for and how to clean and change the ostomy bag. The goals for the teaching plan, is firstly for client L.J to understand what the ostomy is, how it works and how his diet affects it.
The goal is for the client to successfully explain this information back to me in easy English terms that will be used for him. The Second goal is for the client is to successfully demonstrate back to me how properly care for the skin and how to clean the bag after demonstrating it. I will spend approximately 30 minutes over two days, as to not overwhelm the client with too much information. The first day will be to provide information about the ostomy, also leaving reading material with him. The second day will be to demonstrate proper care and cleaning. I have selected a visual including demonstration and reading materials as my method for teachings, having him follow it in Chinese while I explain in English. To achieve my first goal I will use a pamphlet in both English and Chinese to provide the information.
I will begin first by showing him a picture of the type of surgery he had, explaining to him that it is called a colostomy, it is an opening in the abdomen and they brought up a little section of the colon to top of your skin. While pointing to it I will explain, the opening here is called a stoma, and it lets stool (poop) come out of the body. I will ask the client if they understood, and ask him to explain to me what colostomy is. Second I will explain to him that he will not have control over his bowel movements, his stool (poop) will be the normal or thick (formed) consistency. To avoid having very hard poop, being constipated, eat a lot of fibre, a lot of vegetables, fruits and whole wheat and drink a lot of water, this is important to be healthy. Again I will encourage immediate feedback, checking if he understood the information, asking him to explain it back to me.
At the end of the half of hour with him, I will once again ask if he understood all the information I provided for him in the pamphlet, and if he has any questions. I would encourage that he read the pamphlet, which includes more information on care, so that he would be ready for second day of teaching. Second day of teaching, will include a visual poster on caring for the stoma and a demonstration of changing and cleaning the pouch. I will have him seated on the edge of the bed facing the poster taped on the wall, which will include pictures of unhealthy skin, reddened, swelling labelled as BAD, and a healthy pink and moist skin labled as GOOD. I will ask him what he learned from the pamphlet, than I will begin explaining how to care for the skin stressing the importance of keeping the skin healthy. I will explain that the entire unit should be changed 4-7 days.
First I will show him what materials he needs to change the pouch, which include; a pouch, gauze or wipes, warm water, scissors, pen, measuring guide and a disposal bag. By pointing to the poster I will explain the first step is to remove the old colostomy bag and barrier skin around the stoma and throw it in the garbage. Each time you remove your skin barrier and pouch by starting at the top, gently peel the adhesive off the skin. Use your finger to push skin away from the pouch adhesive look carefully at the skin for swelling, redness or rash and pain, and the stoma should be red and moist which is GOOD. Clean the area around the stoma with warm water and dry very carefully. Client was able to understand and repeat back key terms to me while pointing to the poster.
Third step, measure stoma using the stoma measuring guide, choose the opening which is closest to the size of the stoma and trace that opening on the back of the cutting guide. Next cut the skin barrier being careful not to puncture the pouch. The skin barrier should fit around the stoma without touching it so that all skin will be protected. Centre the opening in the pouch over the stoma. Gently press the barrier to be sure it has made good contact with the skin. Lastly make sure to close off the bag. Since this is such a complex process, the client might not be able to successfully complete it the first time.
Therefore my goal will be reassessed; I will ask the client what he understood, and plan on another teaching session. I will make sure to leave samples of barrier cutting and fake stomas for the client to practice on. For my last teaching I will demonstrate how to clean the pouch, I will explain the bag should be changed when it is 1/3 full. It’s best to empty the bag before you eat because the stoma is less active. The pouch is made odour proof, but it has to be cleaned from the bottom with a squeeze bottle filled with water. I will instruct the client to demonstrate it back to me, repeating the process of opening and closing the pouch. Client will be able to successfully empty and clean his ostomy pouch independently next time.
While take into consideration client L.J’s learning style and language barrier, I believe that the learning method I have developed has been successful. By dividing up the teaching lessons into two different days, I believe that the client will be able to absorb and understand the information better. The long- term behavior change will be for the client to do change his ostomy bag independently and empty and clean his pouch. The teaching plan has been modified to give the client more practice changing the entire unit. The goal has not been fully met, the plan is for to be met before the client is discharged. However, overall plan has been successful .
