My Scope of Practice: The Change Facilitator

“Nine tenths of education is encouragement.” — Anatole France, French novelist and poet

  Five years ago, Lynn DeMartyn, RN, BSN, CWOCN, was asked to see a patient who had an ostomy for 40 years. The gentleman came to clinic with a tote bag and a small folding table. He went to the restroom; she waited for him at bedside. “I waited about 35 minutes for him to come out, so I could start to assess his needs,” Lynn says. “I approached the door and called to him to make sure he was all right, and he said he would be finished removing the appliance in another minute or two.” When he emerged from the bathroom, Lynn was surprised to see he had a faceplate, a rubber ostomy bag, and several products to remove glue and adhesive residue from his skin. “We started the assessment, and I discovered through conversation and questions regarding his ostomy that he no longer traveled or went very far from home,” she says. “His skin had a leathery cobblestone appearance. After assessing the skin and stoma, I made a plan for a new, updated ostomy appliance. I gathered supplies from my office, printed out instructions, and began teaching my patient a new ostomy regimen.” The patient — anxious, fearful, and leery of any changes to the ostomy appliance — left wearing the new appliance. He promised to call Lynn each day with a report of how it was holding. “Day one, he called and was pleased that it held overnight,” Lynn says. “Day two, he called again and was thrilled that it held for 2 days. After 3 days, he was bubbling with excitement and awe that something was holding so long. That appliance held for 7 days. The next week, he called to tell me he and his wife were leaving for a trip they had always longed to take. That is what is so rewarding.”

  Lynn never thought she wanted to be a wound, ostomy, and continence nurse. She made that decision during her enterostomal therapy rotation in nursing school. Some of her colleagues remember her stating she “would never do that type of nursing.” Lynn maintained that resolve for 3 years. Then she began working more closely with ostomy patients in the home health care sector. “It was during this period of my nursing career that I met Susan Appleby, BSN, RN, CWOCN, during a consult for one of my new ostomy patients,” Lynn says. “Her caring attitude, enthusiasm, and the knowledge she was able to provide so inspired me I knew this was my calling. Sixteen years later, I am still providing care to ostomy patients who look for comfort, support, and a way to continue after this life-changing surgery. I encourage all nurses to look into becoming a WOC nurse. Never say never.”

  As a certified WOC nurse, providing emotional support to ostomy patients is just as important to Lynn as providing physical care. Encouraging ostomates in self-care and independence while adapting to radical changes in body image is a very important part of the WOC nurse role. Lynn says focusing on assisting her patients return to a normal and active lifestyle imparts a strong patient-oriented skill set to this specialty. Offering education and management of the ostomy includes stoma site marking before surgery, selection of ostomy appliances, measuring and placing appliances, ordering supplies, and providing advice on skin care and care related to skin complications. Imparting dietary and hydration information is equally important to the successful transition from the hospital to home.

   “These are persons faced with extreme changes in their lives, in how they perceive their body image, and in how they will look and function in today’s world of glamour, fashion, and perfection,” Lynn says. “One of the most gratifying aspects of my nursing specialty is seeing the ‘I’m-still-me smile,’ the confidence, and a sense of independence return when the patient with an ostomy discovers he or she is still the same person they were before the ostomy and capable of self-care and autonomy.”

  Lynn has been employed with the Pinnacle Health System (Harrisburg, PA) for the past 14 years as one of three CWOCN consultants. She has used this time to build on her relationships with colleagues and patients, creating an environment that nurtures physical and emotional healing. In order to facilitate further education, 4 years ago Lynn started an ostomy support group in the Harrisburg area through the healthcare system that has provided an open forum for concerns related to these conditions.

  Lynn’s desire to help patients face change and regain a sense of independence after ostomy surgery led her into the WOC specialty. Her devotion to improving her patients’ physical and emotional quality of life keeps her fulfilled in her scope of practice. This article was not subject to the Ostomy Wound Management peer-review process.