Case Study: Colorectal Cancer With a Stoma
For this assessment you will need to select a patient/ service user from a recent placement. Identify one health need experienced by the patient/service user and explore the impact this will have, using a person centred, holistic approach. You will need to include a critique of the care given related to this need using evidence to support your views. This needs to focus on the decisions made by the care team, including any reasoning for interventions and treatment. From the evidence used, you need to offer recommendations for how this care could be enhanced or improved to ensure that the team and nurses provide a person centred, evidence-based care approach.
Learning Outcome 5. “Critique the care, intervention and treatment plan of a given patient across the lifespan with appropriate explanation.”
Assignment Guidelines: Case study structure
- Introduction (150 words) Start with a brief introduction of your chosen patient using 30 – 50 words. You will need to provide more information of the patient in the appendix to avoid being too descriptive here. Present your introduction and ensure it answers these 3 questions:
- What? The introduction needs to clearly explain what this case study is about. This section needs to explain in your own words what is required in the assignment brief given above.
- How? The second part of the introduction needs to outline how this assignment is structured. You need to summarise the details given in the body.
- Why? An introduction needs to articulate why critiquing and evaluation of care is of significance to care delivery (for stoma care).
- Body (1200 words)
- Briefly explain the concept of person-centred care (100words)
- Identify a patient’s health need (patient with colorectal cancer that needs to put a stoma bag) and assess it holistically considering the biological, psychological, and social aspects (For example, how could a stoma affect the patient’s physical/psychological status/quality of life or how might a patient with an OCD diagnosis be impacted by intrusive thoughts and how this will affect this patient considering biological, psychological, and social aspect). Critique (what was good and what was bad) the nursing care that has been delivered for that need, analysing if the identified issues have been addressed and assessing if the actions taken were supported by evidence (For example, if you’re talking about a stoma, you could say that the patient got 15 minutes of stoma education after surgery, but there was no pre-operative education and the education was short. You must back this up with references from the literature. You could say that the patient didn’t get any physiological support and demonstrate the importance of physiological support, and again, you must support with evidence-references.) You will need to support your critique and reasoning with evidence-based practice. (e.g., Clinical guidelines, NICE, books, articles, internal policies, Nursing and Midwifery Council) (800-700words)
- From your critique, identify the recommendations that would be appropriate to introduce to the patient’s care plan, based on the latest evidence-based research / practice. (300-400words) (For example, if you’re talking about stoma, you could suggest good pre- and post-education, having a clinical psychologist help the patient after surgery, or just having the nursing staff talk to the patient and give them emotional support. Again, you should back up all suggestions with evidence-references.)
- Conclusion (150 words)
Put a short concluding statement of approximately 50 words, then summarise the key learning points that have emerged from your critique with appropriate recommendations for future practice. (Do not introduce new information here)
- References
Appropriate referencing is an essential element of academic writing. Ensure that you have used the most up to date UWL referencing guide available from the library. Please be aware that the referencing guide is regularly updated.
- Appendices
Case scenario, you will give more information on your patient/service user with the following information
- Introduce your patient (Presenting complaint /symptoms)
- Past medical history
- Medication
- Intervention/Treatment
- The implemented care planfor the patient’s health need that you will be focusing on.
Do not provide any references in your case scenario. You should simply describe what care plan was carried out for this patient. (For example, if you will talk about stoma, you may have witnessed a patient received i.e., 15 minutes of stoma education after surgery; patient was given leaflets)
Do ensure that all information identifying the patient and the Trust/ Service provider are anonymised.
Hints:
It’s easier to criticise/evaluate bad nursing care than good care.
Make sure you refer (reference, write in brackets (Appendix 1)) to you case scenario as you are discussing in your assignment the care your patient received.
Case Study: Colorectal Cancer With a Stoma
Surgery can be performed on patients with colorectal cancer to remove cancer cells. Mrs. Andrew (not her real name) reported to the clinic complaining of persistent abdominal pain, constant swelling of the abdomen, and unintentional weight loss. She was later diagnosed with colorectal cancer and surgery was recommended, planned, and conducted. After having an ascending colostomy, Mrs. Andrew had to use a stoma bag to collect her stool. She was hospitalized to allow close monitoring during the recovery process. This case study will use the person-centered, holistic approach to critique the care given to Mrs. Andrew to address her greatest health need.
The body of the paper will cover a brief description of person-centered care. It will also describe one health need for Mrs. Andrew by considering the impacts of the stoma bag on her life. The author of the paper will also provide a detailed critique of the nursing care delivered to Mrs. Andrew, analyzing whether her needs were effectively addressed using evidence-based interventions. According to the Nursing and Midwifery Council (NMC) (2018), critiquing and evaluating nursing care for a patient is of significance because it helps to identify gaps in care delivery and establish evidence-based interventions to address them.
Nursing Care for the Patient’s Health Needs
Person-Centered Care
The goal of nursing care is usually to address a patient’s health problems in order to improve quality of life. Person-centered care is a model of care that guides the nurse to change the focus of caring from the illness to the patient (Bru-Luna et al., 2021). It enables the nurse to provide individualized care and empower the patient to contribute to the management of his or her health problems. According to Byrne (2022), person-centered care is a type of care that demonstrates respect for a patient’s values, preferences, and beliefs to effectively respond to existing health needs. Person-centered care has been found to improve the quality of life of patients with a stoma (NasiriZiba & Kanani, 2020). Mrs. Andrew’s quality of life can significantly improve when the nurse utilizes the person-centered and holistic care model to address her health needs.
Analysis of the Patient’s Health Needs and Nursing Care Critique
Having a stoma bag has numerous impacts on a person’s life. It does not only affect the biological, physiological, physical, and social aspects of life but it is also associated with psychological impacts. Biologically and physiologically, a normal person should excrete stool through the anus. In a person who has undergone an ascending colostomy, a stoma is created on the right side of the abdomen and a stoma bag is fitted to collect stool (Forrester et al., 2022). Again, the physical and social aspects of the patient’s life are significantly affected by the presence of the stoma bag as the patient can no longer perform physical activities, move around, or interact with others as before (Stavropoulou et al., 2021). Common colostomy problems which are usually embarrassing include an excessive build-up of gas or flatulence, odor from the stoma, severe skin irritation at the stoma site, and pain. These physiological changes normally cause psychological distress to the patient and negatively affect his or her overall quality of life (Zewude et al., 2021; American Cancer Society, 2022). Mrs. Andrew’s primary health need is limited knowledge of how she can live with her stoma bag without experiencing a deterioration in the quality of life (Collado-Boira et al., 2021). Patients with a stoma bag like Mrs. Andrew can best manage their conditions when they receive adequate pre and postoperative patient teaching.
The nursing care that Mrs. Andrew received did not exhaustively address her health needs. While some of the nursing interventions helped to improve her quality of life, some of them required improvement for them to be able to benefit the patient. For example, the nurse provided pre-operative teaching to inform the patient about colorectal cancer, the need for a stoma, the role of a stoma bag, the complications that are likely to occur after the surgery, and the life challenges associated with a stoma bag. According to Soares-Pinto et al. (2022), preoperative teaching in ostomy helps patients to make an informed decision about the procedure and discuss their concerns with the healthcare provider before the operation is done. The NMC Code outlines the nurse’s role in allowing patients to participate in the decision regarding their care. The nurse must utilize a person-centered approach to empower the patient to make a decision that will address existing health needs (Ajibade, 2021). Providing pre-operative teaching to Mrs. Andrew increased her knowledge about stoma physiology, stoma site selection, the functions of a stoma bag, its complications, and how having a stoma bag will affect her overall quality of life.
The other thing that went well is offering post-operating education about adaptation strategies that will enable Mrs. Andrew to live comfortably with the stoma bag. In collaboration with other healthcare providers, the nurse taught the patient about a number of issues including how to maintain hygiene, taking a bath, clothing, sexuality issues, travel, exercise, medication adherence, intestinal irrigation, and elimination monitoring. A study by Ajibade (2021) revealed that teaching patients with a stoma about self-care following an operation improves their quality of life because it allows the development of a care plan that enhances recovery. The Association of Stoma Care Nurses UK (2018) recommends that the nurse develops an individualized stoma care plan that ensures appropriate health management and minimizes the risk of developing complications. The best way to minimize the risk of complications is to teach the patient about self-care post-surgery (Collado-Boira et al., 2021). According to Tsujinaka et al. (2020), multidisciplinary care helps to optimize the quality of life of patients with a stoma. Patient education involving multidisciplinary teams greatly enhanced Mrs. Andrew’s self-care management abilities and improved her overall quality of life.
The nurse caring for Mr. Andrew failed to provide adequate counseling to address her psychological distress. Changes in body image and the fact that a patient with a stoma will live differently usually cause an emotional disturbance that may affect the patient’s quality of life (Whitehead & Cataldo, 2017). As Collado-Boira et al. (2021) explain, the nurse should provide counseling to enhance psychological adaptation in a patient with a stoma. The patient will experience an improvement in quality of life when the nurse properly identifies psychological stressors and offers counseling to address them. Failure by the nurse to provide adequate psychological support for Mrs. Andrew is a sign of a gap in healthcare delivery that should be filled to ensure a positive prognosis for the patient.
Recommendations for Improving the Patient’s Care Plan
It is important to integrate the Enhanced Recovery After Surgery (ERAS) into the care of Mrs. Andrew to improve her psychological well-being, minimize length of hospital stay, and reduce morbidity as well as readmission rates. According to Moningi et al. (2019), the goal of ERAS is to improve physiological functioning and reduce psychological distress in surgical patients. Hughes et al. (2020) further assert that preoperative counseling is part of stoma training and its integration into the healthcare delivery process for a patient with a stoma reduces length of hospital stay, rates of stoma-specific morbidities, and readmission rates. Integrating the ERAS protocol into the care of Mrs. Andrew will contribute greatly to improving her overall quality of life.
Additionally, it is imperative that the nurse informs Mrs. Andrew about the resources available to provide the support that she needs through recovery. Soares-Pinto et al. (2022) emphasize the importance of informing stoma patients about the available resources from where they can get support. These resources include family members, supportive devices, groups of stoma users, mobile applications, websites, and publications where the patient can discuss personal experiences with others. Knowing the resources that are available for support will empower Mrs. Andrew to approach her problem with confidence and demonstrate readiness to perform self-care management even after discharge.
Conclusion
The person-centered care guides the nurse to provide care that adequately meets the needs of the patient. The application of the person-centered care model in the case of Mrs. Andrew allowed the nurse to develop and implement an individualized care plan. The best way to address the knowledge deficits in patients with a stoma is to provide patient teaching. One of the key learning points that have emerged from the critique is that both pre- and post-operative patient teaching empowers patients with a stoma to manage their conditions with confidence and have an improved quality of life. The other key point learned is that healthcare delivery for a patient with a stoma should aim to address the psychological distress caused by the disease. Therefore, integrating the ERAS protocol into healthcare delivery and informing the patient about the available resources can help to reduce length of hospital stay, rates of stoma-specific morbidities, and readmission rates thereby improving the patient’s quality of life.
References
Ajibade, B. (2021). Assessing the patient’s needs and planning effective care. British Journal of Nursing (Mark Allen Publishing), 30(20), 1166–1171. https://doi.org/10.12968/bjon.2021.30.20.1166
American Cancer Society. (2022). Caring for a colostomy. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/management.html
Association of Stoma Care Nurses UK. (2018). Stoma Care National Clinical Guidelines. https://ascnuk.com/_userfiles/pages/files/national_guidelines.pdf
Byrne L. (2022). Reimagining person-centred care-in the public square. Journal of Patient Experience, 9, 23743735221077508. https://doi.org/10.1177/23743735221077508
Bru-Luna, L. M., Martí-Vilar, M., Merino-Soto, C., & Livia, J. (2021). Reliability generalization study of the person-centered care assessment tool. Frontiers in Psychology, 12, 712582. https://doi.org/10.3389/fpsyg.2021.712582
Collado-Boira, E. J., Machancoses, F. H., Folch-Ayora, A., Salas-Medina, P., Bernat-Adell, M. D., Bernalte-Martí, V., & Temprado-Albalat, M. D. (2021). Self-care and health-related quality of life in patients with drainage enterostomy: A multicenter, cross-sectional study. International Journal of Environmental Research and Public Health, 18(5), 2443. https://doi.org/10.3390/ijerph18052443
Hughes, M. J., Cunningham, W., & Yalamarthi, S. (2020). The effect of preoperative stoma training for patients undergoing colorectal surgery in an enhanced recovery programme. Annals of the Royal College of Surgeons of England, 102(3), 180–184. https://doi.org/10.1308/rcsann.2019.0145
Moningi, S., Patki, A., Padhy, N., & Ramachandran, G. (2019). Enhanced recovery after surgery: An anesthesiologist’s perspective. Journal of Anaesthesiology, Clinical Pharmacology, 35(Suppl 1), S5–S13. https://doi.org/10.4103/joacp.JOACP_238_16
NasiriZiba, F., & Kanani, S. (2020). The Effect of education with a family-centered and client-centered approach on the quality of life in patients with stoma. Journal of Caring Sciences, 9(4), 225–230. https://doi.org/10.34172/jcs.2020.034
Nursing and Midwifery Council’s (NMC). (2018). The Code Professional standards of practice and behaviour for nurses, midwives and nursing associates. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf/
Soares-Pinto, I. E., Queirós, S., Alves, P., Carvalho, T., Santos, C., & Brito, M. A. (2022). Nursing interventions to promote self-care in a candidate for a bowel elimination ostomy: Scoping review. Aquichan, 22(1): e2212. doi: 10.5294/aqui.2022.22.1.2
Stavropoulou, A., Vlamakis, D., Kaba, E., Kalemikerakis, I., Polikandrioti, M., Fasoi, G., Vasilopoulos, G., & Kelesi, M. (2021). “Living with a stoma”: Exploring the lived experience of patients with permanent colostomy. International Journal of Environmental Research and Public Health, 18(16), 8512. https://doi.org/10.3390/ijerph18168512
Tsujinaka, S., Tan, K. Y., Miyakura, Y., Fukano, R., Oshima, M., Konishi, F., & Rikiyama, T. (2020). Current management of intestinal stomas and their complications. Journal of the Anus, Rectum and Colon, 4(1), 25–33. https://doi.org/10.23922/jarc.2019-032
Whitehead, A., & Cataldo, P. A. (2017). Technical considerations in stoma creation. Clinics in Colon and Rectal Surgery, 30(3), 162–171. https://doi.org/10.1055/s-0037-1598156
Zewude, W. C., Derese, T., Suga, Y., & Teklewold, B. (2021). Quality of life in patients living with stoma. Ethiopian Journal of Health Sciences, 31(5), 993–1000. https://doi.org/10.4314/ejhs.v31i5.11
Appendix: Case Scenario
Presenting Complaint and Symptoms: Mrs. Andrew is a 42-year-old white patient who has reported to the clinic complaining of persistent abdominal pain, constant swelling of the abdomen, and unintentional weight loss. After a comprehensive subjective assessment and physical exam, the physician has diagnosed her with colorectal cancer which has caused colon obstruction.
Medical history: Denies a history of surgery or abdominal condition. She cannot remember any childhood illnesses.
Medication: Mrs. Andrew is on Tylenol that she takes to manage abdominal pain.
Intervention/Treatment: Ascending colostomy has been conducted and a stoma bag has been fitted to collect stool.
Implemented care plan: Pre- and Post-operative patient teaching, 30 minutes for each session. The patient was not given leaflets.