A qualitative exploration of the transmission of knowledge and skills by specialist stoma care nurses to facilitate the needs of patients adapting to a newly formed stoma.

摘要

Aim: To identify the knowledge and skills required by the specialist stoma care nurse to facilitate the needs of patients adapting to a newly formed stoma in order to inform specialist nurse education. Background: Advances in surgical techniques, drug therapies, bowel screening and patient recovery programmes have offered those with colorectal disorders, a potential increased life expectancy and improved disease management. For the specialist nurse, there is the constant challenge to keep abreast of these advances and provide more formal, precise and accurate information, facilitating individualised patient need. In response, an education curriculum needs to foster a comprehensive knowledge base in order to equip and support the nurse to become confident and competent in clinical practice. How knowledge is translated from the classroom into clinical practice is a key feature of this study; in particular the role of the specialist stoma care nurse in facilitating the adaptation of patients following stoma surgery.Method: A qualitative approach was chosen to fulfil the aim and objectives of this two-staged study. Phase one took a phenomenological approach and phase two a focus group methodology approach. Eight patients were interviewed in phase one. This offered insight into the experiences of living with a newly formed stoma. Vignettes (total 18) were created from the patients’ narratives. These were used to stimulate discussion among nurses at the focus groups within phase two of the study. The complexities of translating specialist knowledge and skills among thirty-nine specialist stoma care nurses were explored through one of a series of seven focus groups. The analysis for this study was undertaken in 3 stages; stage 1, thematic analysis of phase 1, stage 2, thematic analysis of phase 2 and stage 3, further analysis of phase 2 using Mayer and Salovey (1997) emotional intelligence theoretical framework.Findings: Phase one highlighted a variety of challenges faced by patients and recognised their coping strategies as they adapted to a newly formed stoma. Six themes emerged from the thematic analysis; seeking assurances, permanence versus reversibility of stoma, anticipated stigma, psychological projection, worthwhile sacrifice and sense of achievement. The thematic analysis of phase two identified five comparable themes; skilled know-how, understanding self, hurdles to accommodate, communication skills and uncertain ground. A further examination through an alternative lens was considered to distil the pedagogy. Mayer and Salovey (1997) emotional intelligence framework guided the third stage of analysis. Five key concepts emerged, forming the essential components to specialist nursing practice; the influence of emotions on critical thinking and clinical decision-making, the use of empathetic and intuitive skills in clinical judgements, the ability to balance true self alongside professional self, the need to foster cognitive activity, good communication and creativity and preserving a conscious awareness of self so to develop personal growth.Conclusion: Individual experiences of patients adapting to a newly formed stoma evidently differed. Both the challenges faced and coping strategies of the patients were revealed. The specialist stoma care nurse is ideally placed to facilitate meeting the patients’ needs as they adapt. The five essential components to specialist practice are identified. Educational strategies for cultivating critical thinking and communication skills, developing self and emotional conscious awareness and nurturing personal growth need to be considered for integration into specialist nurse educational curriculum.