The Devil You Know…

by Heather Orsted RN, BN, ET, MSc
(from Ostomy Canada Magazine – Winter 2013: Volume 21, Number 2)

As a person with a urostomy for over 50 years (holy cow), I have been a child, a young woman, wife, mother and now a grandmother with an ostomy. I have also been a student and a teacher, a nurse and an ET and everything in-between! Over the years many of my experiences of living with an ostomy have been challenging while providing continual learning and personal growth.

Moving forward in spite of life’s challenges is what supports growth. We encounter many of the same challenges as others, but as persons with ostomies we have some that are unique to our situation such as leakage and odor relating to stool and/or urine drainage, peri-stomal skin breakdown, as well as changes to our self-and body-image. These unique challenges create not only physical but social and psychological challenges that can add great stress to our life.

As one often does, in times of challenging situations, I have often remained stuck in a negative situation rather than try something new, fearing it could make the situation even worse. The result is I have often, unnecessarily, lived with a problem (the devil I knew)!

First Example:
I have had an ostomy since the age of six (1959-1960) and have had a variety of appliances over the years. Growing up in rural Manitoba I never discovered an appliance that would actually stick to my skin till I moved to BC in 1968 when I was 15. This new appliance had an adhesive backing which allowed me to drop the application of a nasty skin bond glue I had used for years, but there was still no protective skin barrier. Almost twenty years later when I became an ET and saw, recommended, and used modern appliances with protective skin barrier wafers on all my patients I still used that same appliance (the devil I knew). It was not until my appliance leaked at work and I did not have a spare that I looked into my ET cupboard and tried a two piece appliance with a barrier wafer that I had been recommending to my patients. Wow – what a difference! Later that day I went into my pharmacy to obtain and switch to the new appliance; they all laughed saying they had a bet on how long it would take me to change. CHANGE IS DIFFICULT!

Second Example:
My early appliances did not connect to night drainage and as a result I had never used one. Once I became an ET and recognized the importance of the drainage system I made sure all my urostomy patients used them at night. However since I had never used them I continued with my life-long habit of getting up at night and emptying my appliance (the devil I knew). What I did not realize is that as time went on and I aged I was causing undue reflux into my ureters and kidneys. After years of chronic flank pain and recurrent kidney infections I realized the devil I knew was causing significant damage to my left kidney. I had surgery to open a closed uteter and began using night drainage. The flank pain disappeared, I actually slept better… and most importantly I have not required oral antibiotics since. CHANGE IS DIFFICULT.

Third Example:
I had a terrible itchy peri-stomal rash for several years relating to both the tape and wafer on my appliance (the devil I knew) however I was still able to get a great seal…. meaning no leakage. When I looked at changing to another appliance that would be less irritating to my skin they either were too short or had a drainage system that I did not like… there was always something. I finally found one that I thought could work and what did I do…. I let it sit in my cupboard for almost a year. Finally I tried it and the rash started to clear… but it leaked after one day! I tried it again and the rash got better but it leaked after two days. I tried it again and the rash was gone but it still leaked. OK, now I was real happy to see the rash disappear so I continued to HOPE it would work and finally it held three days with no leakage. Now I am using this appliance; no rash, no leakage and I get four to five days wear time. CHANGE IS DIFFICULT!

Supporting Change
Remember by changing nothing… nothing changes (T. Robbins). For example if you do your hair the same way everyday don’t expect it to look different when you look in the mirror. It can be scary but I have learned that we need to confront what is not working (the devil we know) and try to make change happen. Be aware that the change process is not always smooth and outcomes need to be evaluated to determine if the change that is occurring is really what we had planned. If we follow a process that supports strategies for change it will enable us to reach the positive change we want to achieve.

Action Process for Change

  1. Describe and appreciate the full scope of problem you are having (for example a peri-stomal skin rash)
  2. Think about what will happen if you do not take any action (for example peri-stomal skin rash persists or gets worse or may even lead to an infection)
  3. Identify what the change is and what the outcome needs to be (for example peri- stomal skin rash resolves and does not reappear)
  4. Explore some options that will lead to positive change
    a) Review your current practice or care strategies (for example are you using care products that are irritants?)
    b) Explore new appliances and products (for example are you using an appliance that is the irritant?)
    c) Visit your healthcare professional (for example visit an ET for solutions to the problem)
  5. Select an option for change that minimizes your risk (for example it may be the easiest, the cheapest or the one closest to your previous practice or care)
  6. Act on the selected option for change (for example trial a new appliance)
  7. Identify a time to evaluate your action to determine if the change has corrected the problem (for example reassess the rash next appliance change to determine if the rash is resolving)
  8. Decide if the change was effective to manage the problem (for example did the new appliance support healthy skin)
  9. Adopt the change into your everyday practice or care (for example order the appliance that supported the resolution of the rash)
  10. Continue to be vigilant for the opportunity for change and re-initiate the process for change (watch for any other problems that need to be addressed by the change process)

So my recommendation to you, my fellow ostomates, is don’t be complacent with your problems (the devil you know). Enhance your wellness and TAKE CHARGE by using a systemic PROCESS TO SUPPORT CHANGE.

Heather is a member of the Calgary Ostomy Society.

“The Devil You Know…” first appeared in the Winter 2013 edition of Ostomy Canada. You can become a subscriber to our glossy, full-colour publication of Ostomy Canada by joining Ostomy Canada Society. Find out more here.

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