My Scope of Practice: The Patients Who Change Our Lives

Certain moments in life cause us to reflect on where we’ve come from and where we’re going; patients also can inspire such contemplation. For Chilean-born Heidi Hevia-Halabi, RN, BSN, ET, 2 patients changed her career path. 

Soon after completing her nursing studies at the Pontificia Universidad Católica de Chile in 1985, Heidi began working at a private clinic. She encountered a woman who was undergoing abdominal perineal resection (on her birthday, no less). The doctor hadn’t explained to the patient what the surgery entailed or that it would result in having an ostomy. “The doctor asked me to educate the patient on self-care for her stoma,” Heidi says. “Thankfully, she had a good relationship with her husband and she was able to master self-care at home.” Heidi’s second life-changing patient had an ileostomy in a fold where it was impossible to fit a bag that would contain the corrosive, liquid stools. “I knew I needed to increase my knowledge in order to be able to help patients like these,” Heidi says. 

Heidi learned of a center at Saint Mark’s Hospital, London, UK, where coloproctologists trained under the direction of the Dean John Nicholls. “I wrote to him and asked permission to intern at the hospital,” Heidi says. “He invited me to study at his facility and to attend stomatherapy courses free-of-charge for as long as necessary to acquire the knowledge I needed. He put me in touch with Barbara Sedwell, who became like a mother to me. She was in charge of the Stomatherapy department and guided my ostomy training at different hospitals in York, Essex, Oxford, and Cambridge, to name just a few. I also specialized in burns, pressure ulcers, and intestinal fistulas.” Peter Hurren, the director of an ostomy supply company, arranged Heidi’s participation in a stomatherapy course at the Universidad Complutense in Madrid; she started in September 1988 as the only foreign student and obtained her certificate as an expert in stomatherapy. 

In 1990, Heidi returned to Chile, a pioneer in stomatherapy (an unknown concept in her country). She volunteered at the public hospital in Santiago de Chile, San Borja Arriarán. Dr. Jaime Contreras, the head of the department at that time, encouraged her to prove how the involvement of specialized nurses makes a difference in the care of patients with an ostomy. “Over the 5 years I volunteered at the hospital, I slowly introduced the idea of stomatherapy, teaching and assisting at health congresses and different courses within and outside of the country,” Heidi says. “I have been a member of the World Council of Enterostomal Therapists (WCET) since 1992 and I became a member of the Wound Ostomy Continence Nurses Society around 2000.” 

In 2008 and 2012, Heidi helped develop clinical guidelines on the management of colon cancer and rectal cancer in Chile, defining the role of specialized nurses in the care of patients before and after ostomy surgery. With additional input from the Health Ministry, this document was published in 2013. Heidi also worked on revising the WCET International Guideline, published in June 2014, as well as a guideline for skin tear supplies. That year Heidi also participated on a consensus document on incontinence-associated dermatitis.  

During the last 5 to 10 years, Heidi has been teaching university classes about the care of patients with stomas, injuries, and incontinence. Last year, after many years of work and with the help of the WCET and Vera Santos, PhD, MSN, BSN, CETN, (TiSOBET emeritus), the first postgraduate program on the care of patients with stomas, injuries, and incontinence commenced. Also in development is an intensive, 3-month enterostomal therapy nursing education program for Spanish-speaking, Latin American nurses. 

Heidi, also a wife and mother, dedicates her spare time to her family and to running. “I currently run 10K, but my goal is to be able to run 21K by the end of the year,” Heidi says.

Still moved by her patients, Heidi tells of a pregnant 19-year-old woman with peritoneal carcinomatosis who underwent a colostomy. She was able to give birth to a daughter, but due to her advanced cancer, she was in poor health and her life was cut short. “When she passed away, her father told me the ostomy was never the problem because of how relaxed we were with the stoma,” Heidi says. “I am filled with gratitude to be able to support patients with advanced cancer, to be with them in their last living moments. Although I have many friends in Heaven, it warms my heart to know I had helped them feel better and brought joy to my scope of practice.” 

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