My Scope of Practice: Not Afraid to Make a Change

Everyone thinks of changing the world, but no one thinks of changing himself. — Leo Tolstoy

  If you ask Cindy Barefield, BSN, RN-BC, CWOCN, what she finds intriguing about ostomy care, she might relate the story of Grandma Mabel, who had ostomy surgery in 1938 and was left with only rags and towels to collect the output. Utilizing his knowledge of horses and a tin can with a belt strap, her husband fashioned a collar around the edge. Or Cindy might tell you about Norma Gill and Dr. Rupert Turnbull, Jr; they opened the first School of Enterostomal Therapists in 1961, where the only requirement was that all trainees have an ostomy. How far the world of wound, ostomy, and continence nursing has come in terms of ostomy management options. How far the role of the WOC nurse has advanced to one of content experts, educators, and advisers in collaborative health initiatives who advocate for the delivery of healthcare to improve patient outcomes.   And how much has changed for Cindy through the years. When she began her nursing career, Cindy never imagined herself in the role of a WOC nurse. She earned her Associate degree and Bachelor degree in the Science of Nursing at the Angelo State University (San Angelo, TX) in the 1980s and began her nursing career in pediatrics. After working for a few years as a staff nurse and a nurse manager in pediatrics and then med/surg, Cindy was ready for a change. She took an opportunity to work in education with the Methodist Healthcare System (Houston Methodist San Jacinto Hospital, Baytown, TX), where one of the activities she particularly enjoyed was providing education to patients and families. “The ability to connect with the patient/family and communicate in a way that allows them to apply the information you have given them in their ‘world’ is as different and challenging as each of these individuals,” Cindy says.

  When Houston Methodist San Jacinto chose Cindy for the newly created position of WOC nurse in 2004, she completed the MD Anderson Wound Ostomy Continence Nurse Education Program (Houston, TX) the following year. “Working with patients and families who had undergone ostomy surgery became a passion of mine and was an easy transition from my initial work in the education department,” Cindy says. “In wound care, if you can help people understand how the components of their everyday life affect their skin integrity and wound healing, it can make a significant difference for them. If they do not understand this or give value to it, they will never make a change. Educating nurses is rewarding because the knowledge they take will be reflected in their patient care.”

  Cindy still works as a WOC nurse with the Methodist Healthcare System at Houston Methodist San Jacinto Hospital. Caring for patients in a hospital setting presents a number of daily challenges, from patients who have troubling financial situations to those who need emergency surgery. “The majority of people I follow had an unplanned ostomy surgery — that is, they had urgent surgery to deal with an urgent medical problem,” Cindy says. “This creates an added level of difficulty for the post-op period. Persons who have time to schedule the needed ostomy surgery will have an option for education regarding the procedure and recovery as well as marking of the stoma site. This decreases anxiety before the surgery and supports the post-op period.”

  Cindy knows her part in the healing process has a big effect on the patient’s outlook, whether surgery was planned or unplanned. “We know from research there is a period of adaptation of about 6 to 12 months for new ostomates to return to work, to become responsible for their care, to recognize problems with their ostomy, and to seek help, as well as try to establish a new quality of life,” she says. “The WOC nurse plays a critical role during this time.” Because the healing process for new ostomates also continues after they leave the hospital, one of the first projects Cindy tackled in the local community was to establish a United Ostomy Association of America support group that has continued to meet since November 2004.

   “Working with patients offers nurses insight into our own futures—to take care now to enjoy life later,” Cindy says. Hopefully, for dedicated WOC nurses, care options will continue to change and improve and new approaches will be proliferated, ensuring many great things ahead in the future in this scope of practice.

This article was not subject to the Ostomy Wound Management peer-review process.