Interview with Gastro Nurse Amy Scott Smith

Amy is a nurse on a General Surgery/Digestive Diseases ward in Brighton, U.K. I interviewed her about her experience as a nurse, looking after patients and how social media has helped her understand her patients. 

Tell me a bit more about your job as a nurse

Working General Surgery/Digestive Diseases means I see patients who have any form of abdominal surgery, both pre and post op. We are also the ward that looks after IBD patients. I work alongside the Stoma Nurses (who are based on the ward) and the IBD nurses. 

I love the ward for lots of reasons. In regards to stoma patients, being able to help people accept and come to terms with their stoma is always great and rewarding. We do a lot of emergency bowel surgery where many patients aren’t prepared for waking up with a stoma, therefore a lot of emotional support is needed. I come across all age ranges, many different reasons for stomas having to be formed and the various emotions/opinions patients have regarding stomas. 

Why did you become a nurse? 

Funnily enough whenever I’m asked this question I never have an instant answer. I worked in childcare beforehand, so have always been involved in caring roles. My dad is a doctor and my mum works in adult social care, so I think it’s always been embedded in me. 

I’ve always been interested in my dad’s career, medical things and gorey wounds! I decided childcare wasn’t going to take my career where I wanted it to, so did my access to nursing whilst working full time and the rest is history! Now I am a nurse I honestly couldn’t think of doing anything else. So maybe it was my calling without realising.

How many types of stoma (specifically bowel) are there? 

There are two types of stoma that involve the bowel – a colostomy and an ileostomy. 

A colostomy is formed from the colon. It tends to be more flushed to the skin because the output is less irritant and the stool type will be more solid. 

An ileostomy is a stoma formed from the ileum – which is part of the small bowel. This is where a lot of your absorption happens so the stoma output tends to be more liquid. The stoma itself is normally formed a little more spouted from the body because the small bowel contents can irritate the skin. 

Depending on the surgery you’ve have had, both types of stomas can be reversed. 

Any tips on how to look after sore skin around the stoma? 

For sore skin, firstly the bag sprays are great to remove your stoma bag and help avoid your skin getting sore in the first place. There are loads of different products to use such as barrier skin wipes, creams and powders. Always best to ask your stoma nurse for recommendations. 

What will my diet look like immediately post stoma surgery?

Your diet will change post op, and this also depends on what type of stoma you have. Firstly, the hospital should have diet sheets available for you to take home. This puts foods into different categories and explains what to have and what to avoid in the first few weeks/months, make sure you ask if one is available. 

For a while post op it’s wise to avoid bowel stimulating foods/drinks such as coffee, whole grains, fruit and veg, alcohol etc. Your body will need to find a new normal so it is best to take it slow, so it’s best not to go back to the eating habits you had before the operation straight away. 

Try to avoid anything with a skins (any veg that has fibrous skin like potatoes or squash for example). They tend to come out into your bag in the same form they went in. This is also true for some nuts, mushrooms, dried fruit, spicy foods and fizzy drinks. In tthe first few weeks post op, the suggested diet is everything we normally try to avoid. I recommend things such as white bread, full fat cream and cheese, alongside high protein foods, like fish and meat. 

Staying hydrated is really important, especially with an ileostomy. The ileum is the area for absorption, so monitor the foods that change your stoma output and take note of the things that make it more liquidy. If you are struggling with the consistency of your output then eating things like jelly babies and marshmallows are little tricks to help thicken it up. Eating little and often is a good idea in the first few weeks. Your bowels hate being handled so can be very sore after surgery, give them some time to settle. 

Can I exercise after my surgery? Do you have any tips? 

You can’t exercise straight after the operation. Your recovery time will depend on whether the surgery is done via keyhole, or open. 

Both keyhole (laparoscopy) and open surgery (Laparotomy) are big operations but the open surgery in particular is a huge one to recover from. You can start exercising around 6 weeks post op (different for each individual also). You should still avoid heavy lifting of any sort until at least 12 weeks post op. Walking around and doing light activity is fine 2 weeks after the operation but just be careful. 

The thing I always tell my patients is to listen to their body. If you feel tired, you need to rest. You may find you aren’t back to your full energy levels for quite some weeks. Once again your bowels don’t like being man handled, so sometimes they take a while in regards to swelling, appetite etc. Just be sensible. Your surgeon should also advise you on this as they know all details of your surgery and how your body has changed. 

Where can I go for the stoma supplies? 

So after the operation the stoma team will see you. They may have even seen you before the surgery to place your stoma. When it’s a planned surgery, they can spend time going through what you should expect. You will be given a bag of your stoma supplies and the nurses will spend the first few educational sessions ensuring you have the correct bags, fit, accessories etc. 

Once you are competent with your stoma education, the team follow you up at home and give you the information on where to get your supplies. There are various companies we use at the hospital such as Salts and Coloplast, but you will be given info on the brand you’re using and setting up the delivery of your bags. 

You can order them cut to size if you like to save yourself some time. However, there are further brands and suppliers that probably us hospital staff don’t even know about. There are so many sprays, creams and storage bags for your stoma supplies (the hospital ones are a bit bulky). I’ve had patients order decorative bag covers online and all sorts so have a Google around. But if you are in any doubt you will always have the number for the stoma nurses if you need to contact them.

Do you find social media has helped you in your job? 

Even as a nurse I find Instagram very helpful. There are so many people who have stomas that know all sorts of info due to having a stoma themselves, which has lead to testing/trying new products and see what works.

I even introduce my patients to various ostomates to follow on Instagram, to help empower others. I’m aware that no matter how much I see/support people with stomas, not having one myself means I will never fully understand the impact. Therefore showing people that stomas are more common than people know and they are not alone – which I feel is really important.

Where can I go for support? 

Having a support system in life is always important. As a staff member, after your operation if you have any worries then use us! Talk to us and ask any questions. There is always someone who can answer your questions and there is NO such thing as a stupid question. Having big surgery, especially if it’s unexpected, is tiring and emotional. 

Don’t be too hard on yourself and give yourself time to adjust. Be honest if you are struggling with it and know that you are not alone. The stoma team are great support and that continues once you are home. You should use your family members and friends, it’s important for people to be there through this experience in your life. Explaining it to those who don’t understand can also help you process it yourself. For some people this surgery and stoma formation has saved their life or saved them from years of suffering. That’s amazing, so own it. 

In regards to on going support, once again there are so many communities developing for those with IBD etc. There are various charities involved such as Crohn’s and Colitis UK, as well as Instagram and Facebook pages/groups/networks. 

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