As some restrictions start to ease, and some services start to return to normal, we thought it would be interesting to share with you how our own team of wonderful Community Specialist Stoma Nurses’ (or SCNs’) roles changed during lockdown, and how their roles are changing once more as they start to go back into the hospitals and community.
Our Lead Nurse, Alison, has written the below blog post to explain how the nurses have been working, and what being a Stoma Nurse looks like for them at the moment:
Hi everyone, my name is Alison, I am the Nurse Team Leader for the Respond Nursing Team. The Nursing Team consists of 9 Nurses who are all fully qualified and who have specialised in Colorectal and Stoma surgery, or caring for any age group of patient that requires bowel surgery resulting in them wearing a pouch (or bag) on their abdomen to collect waste. I cover two hospitals in Birmingham and in the community seeing and counselling patients before they have surgery, and then teaching them how to look after their stomas and change the pouch or bag. This is in any area from intensive care, to the hospital ward and then at home in the community or in clinics.
The community service that the Respond Nurses provided before lockdown meant that we contacted patients within one working day of them going home, we then saw patients at home within 7 days of being discharged from hospital. Our pathway then meant that we offered home visits 2 weeks & 4 weeks afterdischarging them, and then 3, 6, and 12 months following that. Sometimes we saw patients more often if they experienced management problems or required palliative or end of life care. We wore conventional nurses uniforms (see picture of our nurse, Christine, on the right) and in an average day could see 5 or more patients at home.
Within the Hospital at the end of February we were obviously aware that the COVID-19 virus was approaching. All visitors were stopped in the hospital and this still stands (at time of publication). All clinic appointments were done by telephone, and the Consultants are still doing clinics this way but looking to hold clinics in different areas.
By mid-March one of the 25 bedded wards had been turned into a fully equipped ITU (Intensive Care Unit), with 25 extra ventilators and all the equipment needed to nurse the COVID patients. There was an eerie expectation that the virus was on its way and COVID patients started to be admitted quite quickly. The Respond Nurses were advised to put all community visits on hold during lockdown, so the service we provided seeing patients in their own environment soon after discharge from hospital,and offering support to them as they adjusted to life changing surgery over the initial months, ceased in the way we all knew.
Nursing is a very tactile role, we maintain eye contact and close physical contact such as an arm around a shoulder whilst patients are given life changing news of possibly cancer and surgery. We teach patients how to care for their stomas, again this is very practical and involves us being very close to patients, and we are very privileged to share their experiences with them and help them psychologically and physically to adapt.
We had to learn a new way of nursing – a way that Florence Nightingale herself advocated 200 years ago.
So since lockdown the Respond Nurses have provided an excellent community nursing service proving how versatile we can be. We still contacted patients the next working day after going home, and kept in frequent contact with them by telephone or virtually. The contact we made was more frequent and regular as we weren’t seeing them face to face. We have telephoned, video called, WhatsApp messaged, emailed, texted and used Microsoft Teams to meet with out patients. We have posted samples to try, offered a virtual shoulder to cry on and given PowerPoint teaching sessions to care agencies. We have advised on things non stoma as we are seen as available and approachable which is important, such as symptoms of COVID, anxiety that the pandemic caused in patients already anxious from surgery, self isolating and shielding and where best to do their shopping! Patients who were being discharged from hospital all had emergency surgery as all elective surgeries were cancelled, this in itself makes it more difficult for patients to come to terms with their stoma as they didn’t receive timely counselling due to the nature of emergency surgery.
During our new way of working we received many interesting photographs via text, WhatsApp and email, we have video called patients and guided them through their pouch care and also guided relatives on how to help change the pouch. This completely different way for nurses to work has proved successful, the patients have continued to receive an excellent nursing service and the nurses have diversified with professionalism and compassion.
Following risk assessments the nurses are now returning to work in the Community or patient’s homes. This isn’t the same hands on nursing we did before, and with more PPE on! We telephone the patients within one working day of being discharged from hospital and arrange either a visit or another phone call, we maintain contact with them frequently and regularly as we did in the earlier lockdown period. We are still using the telephone and virtual methods to contact patients, but where patients are having management problems that they may experience when they go home from hospital, we can now offer a visit at home. We are doing limited priority visits of one per day only to reduce the risk of cross infection between homes. Patients are rung on the way to see them to check they haven’t developed any symptoms. We are screening them by asking questions such as do they feel unwell, do they have a temperature, have they developed a new persistent cough or lost their sense of taste or smell. We wear full PPE so this is scrubs (loose fitting tunic and trousers) that can be washed at 60 degrees to kill any infection on them. At each patient’s home we put on clean aprons, gloves, face masks, visors and over shoes. When I work in the hospital I wear scrubs and PPE and then change into clean scrubs before I go into the community, I do one visit in full PPE then go home changing in the garage so as not to take any infection to my family.
Here are pictures of some of our nurse team, Alison, Chrstine, Ruth and Lynette, in their PPE equipment:
COVID patients are still being admitted to designated hospitals and work is underway to keep some hospitals as clean for elective surgical admissions with patients self isolating and being swabbed before admission. The virus hasn’t gone away, it has just eased slightly. COVID hospitals are still taking emergency surgical patients as these can’t self-isolate before admission due to the nature of their illness. Sadly some patients still aren’t going home. Given the right conditions we may face another spike in numbers of sufferers of the virus and also deaths. Please can I use this opportunity to remind you that social distancing and hand washing are still imperative, wearing masks in confined areas is very important and even now within the hospitals all the staff have to wear masks all day, even if they are walking from ward to ward in the corridor or sat in the offices. Symptoms to observe for are high temperature, new persistent cough and change or loss of taste and / or smell.
I hope this has given you an insight into our change in nursing practice. All the nurses have ever wanted to do is nurse, and we know at times this involves being in challenging situations and exposed to a variety of infectious diseases, but we still want to care for people and have shown we can do this with professionalism, expertise and diversity.
We hope you have enjoyed our latest blog post and found it insightful to the way the nurses have been working, and continue to adapt to work in these challenging times. We would like to take this opportunity to thank all of the wonderful NHS and Key Workers, including our own team of nurses, for all they are doing to keep us safe and well during these times. Make sure to take care of yourselves and your loved ones during this time, to continue to socially distance and follow government guidelines.
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