Teaching Polytrauma Brain Injured Active Duty Patients Ostomy Care
Current changes in the global and political climate have lead to increases in polytrauma injuries to active duty soldiers in Iraq. The use of Kevlar helmets and body armor has reduced the frequency of penetrating injuries to the head and vital organs, but this proactive gear offers little protection against nonpenetrating injures from blasts and higher impact falls. In addition, advances in emergency medicine are increasing the survival rates of patients with injuries that previously would have been lethal. The changes in weapons, protection and technology have resulted in an emerging pattern of patients with multi-system trauma. The term polytrauma has been coined to describe this new and increased population of patients (Lew, 2005). The increase in the number of active duty polytrauma patients with ostomies created a teaching challenge for the WOCN. It was difficult for patients to develop a rapport with the WOCN that they cannot remember. Patients would exhibit anxiety each time the nurse entered the room making it difficult to build a trusting relationship with the patient. Learning ostomy care is a big step for the fully cognizant person, but the stress and anxiety for this group of patients was even greater.
A story board was created for each patient with an ostomy. The first picture was of the WOCN. A picture of each step was taken daily and posted on the patient's story board. Each time the nurse entered the room, she was able to refer to her picture on the story board. The nursing staff and the family referred to the story board when assisting with any ostomy care. Prior to discharge the pictures were removed, labeled and placed on a large ring that the patient was able to take home and keep in the bathroom near his supplies.
The patient that understands what is expected and has the proper resources can often learn to independently care for their ostomy. It is the responsibility of the WOCN to help direct his learning, provide support as needed and act as a resource after discharge.