Introduction
The client, Mr. Kaminski, is a 45-year-old married man with two children living on a small ranch, which provides abundant physical activity. His long history of Crohn’s disease has recently resulted in the removal of his large bowel. Consequently, the patient got an ileostomy, which he struggles to utilize appropriately. Additionally, the patient reports having body image issues despite his BMI of 23, indicating normal weight.
Mr. Kaminski will be able to improve his overall quality of health and life with a reasonable, specific strategy that focuses on health education related to his ileostomy. Mr. K’s case serves as a significant learning tool for future nursing practice, as it highlights the importance of educating patients about self-care. This experience is crucial to flesh out the accuracy and method of patient education for individuals with severe gastrointestinal conditions and body image struggles.
Assessment Data & Learning Needs
First Learning Need
Mr. Kaminski is concerned about lifestyle changes following the removal of the large bowel. As stoma maintenance requires consistent care, the patient must learn to adjust his lifestyle accordingly. It is essential to teach him how an ileostomy works, the importance of maintaining his external ostomy, and the resources available to ensure that the disadvantages of managing waste excretion do not interfere with his health management. In addition, Mr.
Second Learning Need
As Crohn’s disease is often associated with rapid weight loss, malnutrition, and severe diarrhea, the patient must be taught proper body composition and weight management to maintain a healthy BMI. Educating him about adjusting his nutrition according to his condition would help stabilize his body weight, improve his perception of his physique, and prevent much of the potential damage associated with digestive system inflammation.
Priority Learning Need and Diagnosis
Nursing Diagnosis
The patient’s reluctance to frequently discharge the stoma shows that the knowledge deficit is directly connected to the client’s increased risk of complications associated with his disease. To reduce the risks of further complications, the ignorance of the detrimental effects Crohn’s disease could have on his health and well-being should be eliminated, and the importance of self-care should be correctly and thoroughly emphasized and understood.
Goal
Provide Mr. Kaminski with clear, detailed, and intelligible explanations and examples to help him practically integrate acquired knowledge into his daily life, while encouraging him to approach self-care responsibly, facilitate recovery, and prevent complications from his disease.
Expected Outcome (SMART Criteria)
The patient will demonstrate how to use the external stoma efficiently, including regular emptying and changing the appliance system. Mr. Kaminski is expected to comply with the daily standard of a minimum of six pouch discharges, with minor adjustments made as needed. In one month, the stool consistency will improve, becoming soft and allowing for comfortable passage, while the client will demonstrate proficiency in stoma management.
Domains of Learning
Since Mr. Kaminski is disadvantaged by having to carry the stoma pouch, focusing on cognitive and affective learning domains would be a reasonable approach. Demonstrating the proper use of the external appliance system would promote cognitive processing, which is essential for achieving the client’s independence and well-being (Potter et al., 2019). Engaging the affective domain would improve the patient’s emotional well-being. The affective domain is exciting because the patient risks developing a disturbed body image due to changes in body weight and composition (Ackley et al., 2020).
Client Barriers
Reluctance to comply with established standards for the frequency of appliance system discharge and change is of utmost concern, as learning to manage the apparatus properly is crucial to prevent complications and accelerate recovery. Additionally, distractions such as abundant physical activity on the ranch and marital and parental duties may lead the patient astray from responsibly fulfilling self-care routines. Moreover, Mr. Kaminski might perceive the complexity of the research required as overwhelming and abandon learning altogether.
Teaching Plan
Educational Content
The educational program will emphasize the significance and provide practical knowledge of living with a stoma. Mr. K should be trained to independently care for the appliance system to full proficiency before discharge (Berti-Hearn & Elliott, 2019). The patient must be informed about medication restrictions, nutritional considerations, and common stoma and peristomal complications. Consideration of medicine choice is crucial, as taking inappropriate drugs might lead to severe dehydration (Berti-Hearn & Elliott, 2019).
Teaching Methods
Mr. K must comprehend and learn to independently conduct the procedure of changing and emptying the appliance system. Berti-Hearn and Elliott (2019) recommend training patients to perform a series of steps to care for their stoma independently. Firstly, Mr. K will participate in step-by-step demonstrations of pouch replacement set in a domestic environment. He will have to reproduce the actions performed by a professional in front of a mirror, while being observed by a trainer. The sessions will take place 6 times a day and last 30 minutes each.
Secondly, he must know the importance of preparing necessary supplies before removing an expired pouch and carefully approaching daily practices such as showering. Furthermore, Mr. K should note that other authors also emphasize the importance of nutritional education for individuals with Crohn’s disease (Yamamoto et al., 2017).
Teaching Resources
Mr. Kaminski will be provided with educational handbooks and practical training in pouching system management, such as the resource by Berti-Hearn and Elliott (2019). Additionally, brochures will be provided for on-site guidance on nutritional choices. These resources will reinforce the cognitive learning domain by promoting active engagement with and memorization of theoretical material. To reinforce the affective domain, creating a hospitable environment is crucial to create a positive response to an ileostomy. As seen in the study by Morris and Leach (2017), “participants are more accepting of Crohn’s post-ileostomy because the symptoms are easier to deal with, which means less stress within their lives” (p. 38).
Evaluation of Learning
Mr. Kaminski’s perception of health and well-being will be measured on a scale of 1 to 10 on a weekly basis, which will refer to the affective domain. Furthermore, an objective measure of his health will involve assessing such factors as the frequency of replacing the pouches, consistency of stool, and the gauge of learning material. Mr. K will be asked to record and preserve the independent management of the stoma and nutritional behavior. Active efforts to solidify practical and theoretical knowledge of the self-care process will engage the cognitive domain of learning. The patient will be encouraged to initiate conversations with professionals and family members regarding intimate subjects such as body image alterations and sexual dysfunctions related to the condition (Berti-Hearn & Elliott, 2019).
Analysis of the Teaching Process
Importance of Teaching
As discussed above, patients with ileostomy must be trained to carry out care independently before discharge. Securing their independence is crucial to prevent complications and worsening the condition. Due to the risk of body image disturbance, patients need to be educated and thoroughly supported by clinicians and relatives (Morris & Leach, 2017). Moreover, managing an ileostomy is a complicated process that requires much practical and theoretical knowledge to be carried out successfully. To secure remission, clinicians ought to provide the patients with much-nuanced information on numerous topics, while patients must commit to active learning and self-care.
Strengths & Challenges
An educational plan’s primary strength is providing a systematized and scholarly-supported course of action (Potter et al., 2019). However, since it is the patient’s decision whether to follow the advice presented, they may relapse into deteriorating health. The advantage of this plan also lies in its merit for assessing the patient’s psychosocial status. The challenge would be Mr. K’s deteriorating self-esteem and possible reluctance to converse on the sensitive topic. Solving issues connected to body image can be challenging as changes might be too drastic to cope effectively (Ackley et al., 2020).
Benefits
Knowledge about conducting precise self-care practices is necessary for patients who do not stay in hospitals for long. A systematized and reliable education plan facilitates the patients’ learning and thus secures their recovery. According to Ackley (2020), “client education needs to be centered on the needs of the client, addressing behavior-changing techniques to accomplish the defined goals” (p. 105). Addressing cognitive and affective domains of learning reinforces both learning and emotional growth. Mr. Kaminski’s case will help improve nursing practice concerning Crohn’s and ileostomy patients.
Conclusion
This educational plan for Mr. Kaminski prepares him for independent self-care after an ileostomy. To adjust to drastic lifestyle changes following his large bowel removal, Mr. K will have to comprehend and implement large amounts of medical information to improve his health and psychosocial state. To achieve that, he must commit to extensive learning of self-care principles related to his condition. If the patient follows the plan, he is expected to experience considerable improvements in his physical and mental health.
References
Ackley, B. J., Ladwig, L. B., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care. Elsevier.
Berti-Hearn, L., & Elliott, B. (2019). Ileostomy care: a guide for home care clinicians. Home Healthcare Now, 37(3), 136-144.
Morris, A., & Leach, B. (2017). A qualitative exploration of the lived experiences of patients before and after ileostomy creation as a result of surgical management for Crohn’s disease. Ostomy Wound Manage, 63(1), 34-39.
Potter, P. A., Duggleby, W., & Astle, B. J. (2019). Canadian fundamentals of Nursing (6th ed.). Elsevier Canada.
Yamamoto, T., Shimoyama, T., & Kuriyama, M. (2017). Dietary and enteral interventions for Crohn’s disease. Current Opinion in Biotechnology, 44, 69-73.