Description: decision. The main reason she made her informed

Description: On a
home visit I met Miss CB- a 64 year- old lady. She recently had an ileostomy to
give for severe constipation which she has been suffering with for 4 years. She
felt the reason for having severe constipation was due to a hysterectomy she
had 17 years ago. She believes that the surgeon in charge made a mistake in the

She underwent a couple of treatments for her severe constipation
before making a permanent stoma the final decision. The main reason she made
her informed decision to have a stoma is to avoid the impacts on daily life of
taking medications.  

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Despite the newly improved quality of life, she feels “gutted
and embarrassed” having a stoma bag. It doesn’t restrict her in ways of living however
dietary changes were required which involved the inclusion of leafy vegetables
and plenty of fruit.  She perceives
herself as not “normal” with a bag. Furthermore, she feels uncomfortable changing
it in public toilets.

Feelings: I was
taken aback when she was certain that the cause of her severe constipation was
due to a mistake conducted by the surgeon in charge of her hysterectomy. The
time gap between the two is so long for an understood connection to be present.
It came across to me by her body language that since health practioners couldn’t
find a conclusive aetiology for her newfound ill-state, she found a personal cause
herself for it to make sense in her mind.

I felt sympathetic towards the new unexpected changes she observed
in her social interactions with her grandchildren which disappointed her.  This helped gain a perspective that social
exchanges between familial members can have a huge importance to an individual.
 I was concerned that she was socially
isolated and couldn’t engage with the community due to the stigma associated
with the smell and the visibility of the bag. This could have adverse effects for
her mental health because she feels she is “different”. I was moved to learn the
shifting dynamics of having social interactions on her physical wellbeing and mental
health due to the daily struggles of living with a chronic disease.   

Reflection: It changed
my personal perception to witness a different personal patient narrative on
living with a chronic disease. I understood her feelings and I felt I could
relate because I personally would feel the same if I had to undergo an
ileostomy. I learnt a great deal about the patient’s condition from her viewpoint
and she told me how helpful the doctors and nurses have been in assisting her
to make her quality of life better to cope with everyday tasks.

More notably she explored the ideas of compliance that I haven’t
thought of before such as taking medication all the time which was overwhelming
for her.  It made me realise as a future healthcare
professional the importance of presenting all treatment options for the patient
to make an informed decision as different people have varied views on what they
feel is best for them.  

I approached the GP later regarding the association for
having severe constipation and she believed there is no connection for there is
no evidence to say otherwise. However, she let Miss CB carry on thinking this
because she would think her symptom is
caused by a serious disease and worry unnecessarily. This wouldn’t be sensible for
her mental health since she’s had episodes of depression and anxiety during her

Conclusion: This consultation
with the patient highlighted the importance of reassurance. Reassurance is said
to be the elimination of uncertainties and fears (Traeger et al. 2017).  It is common
for patients trying to find within themselves a reason for reassurance either
in their treatment or in the aetiology. Concerns about
the presence of a serious illness is a usual phenomenon among patients
and in cases where the disease is idiopathic, patients like to make sense of it
themselves (Cooper 1996). Therefore, as a healthcare professional we should be aware
of communication tactics that are effective in varied scenarios where comfort
is needed. A study was conducted to investigate the ways general practitioners
should use to reassure their patients. It was discovered that the integral method
was by influencing the patient’s emotions by promoting a sense of security, safety
and trust (Giroldi et al. 2014). This has been considered to supportive itself to the
patient, due to being given information that they can comprehend. In cases when
treating idiopathic diseases patients
adhere and comply better if healthcare practioners acknowledge their presence with
respect (Sabo et
al. 2000).

Action plan: If a
situation arose in the future where I would need to reassure the patient for
them to respond better to the treatment, I would feel more confident to
implicate the methods researched above in consultations. It is important that
the patient is understood, and their opinions are valued for them to make an
informed decision that they feel is right for them.

Some of these articles mentioned addressing the mental health
of the patient so their adherence to treatment is improved. Therefore I would
like to read how social cohesion and isolation impacts on an individual (Cornwell and Waite 2009). Sometimes the psychological side
to living with a chronic disease can be overlooked therefore I would like to
read how from a healthcare professional perspective can we address it from this
article (Turner and Kelly 2000). I would like to achieve these
two objectives by two months.