Colostomy

[ABRN2012]

*Admin please dont post on social media*

Do any of you have colostomies in your schools? If so do you train staff to manage and empty them? Do you change them or can staff do it?

I have one and no the student is not capable of emptying it. This student is special needs and actually rips the bag off daily for attention. It is always a clean up job and usually I am tied up with other students or at another school when this happens. I have 1500 students and travel between two schools. The parents think I am dodging the situation but as you other fellow nurses know airway, bleeding, insulin, meds, seizures ect come way before poop. I empty it twice a day and the student is here for less than 6 hours. The parents change the bag daily and want me to change the entire system if the student picks around the seal. Ive tried to explain that colostomies are supposed to last at least 3 days and changing too often causes skin problems. The teachers refuse to empty it even though the care plan states they empty and I only change when bag malfunctions (which bag is never the problem its that the student opens it.) I am called to the room at least 4 times a day to "check for leaks" that the student causes plus the times I empty it. I feel like its all being thrown off on me and its really starting to get to me. Yes the parents think the only reason I am at this school is for their child. They are now requesting a personal assistant or a personal nurse because quote "The new nurse just doesnt want to do her job". I actually go above my job and empty it! The child is already in a special ed room with a teacher and two assistants.

Also does anyone have any ideas on covers. We have tried just a bag cover and that didnt work, we have tried a cover that goes around the abdomen but the student picks thru the material and opens it. I finally told SPED director that I am a school nurse and not a medical equipment engineer.

[MrNurse(x2), ADN]

Maybe an oversized abdominal binder with velcro in the back? This is an administration problem. The AP should be reiterating to the staff that it is unpleasant, but part of the expectations of their position. So sorry you have to deal with this, it has to be frustrating.

[Amethya]

I have 1 student with that, he's in Kinder, but I have not have to do anything for him at all. His mother does everything before school and he rarely needs me, which surprises me. In the beginning I thought he was going to be a difficult student to care for, but no! He's very sweet and good kid, and the only times he visited me was for a band-aid. :3

The only thing I was told and trained on is to change a small gauze around the area of the tub and stomach because it tends to get wet and hurt him. But as I said, nothing needed for him. I do have his home nurse on call in case of an emergency.

[ABRN2012]

Maybe an oversized abdominal binder with velcro in the back? This is an administration problem. The AP should be reiterating to the staff that it is unpleasant, but part of the expectations of their position. So sorry you have to deal with this, it has to be frustrating.

We tried the binder and the student can get thru to it. At our meeting our principle literally did not speak a word. I was so mad. He wouldnt empty it if it needed to be emptied so he says the teachers shouldnt have to. Well the care plan from the dr says otherwise. Their reasoning is that they dont know how to assess a stoma. Yes teachers you are right that is my job! You just empty it and I will deal with assessing stoma and changes that are from a bag problem. But a behavior problem is what we have. Thank you though for your comment. Sometimes I feel so alone in this job. Its nice to hear that other people think its not all on me.

[grammy1]

In our district that would fall on the teaching assistants, not the nurse.

[ABRN2012]

I have 1 student with that, he's in Kinder, but I have not have to do anything for him at all. His mother does everything before school and he rarely needs me, which surprises me. In the beginning I thought he was going to be a difficult student to care for, but no! He's very sweet and good kid, and the only times he visited me was for a band-aid. :3

The only thing I was told and trained on is to change a small gauze around the area of the tub and stomach because it tends to get wet and hurt him. But as I said, nothing needed for him. I do have his home nurse on call in case of an emergency.

I wish this mother was easy to work with but its the opposite. She came to pick the student up the other day. I had already emptied it twice. It was a day where the stool was very watery and coming out frequently. So I literally could have emptied it 5 min before she got there and it would have had something in it anyway. She came down the hall requesting for someone to find me. "That nurse needs to empty this!" Um no! You are here now and I quickly showed her the bathroom and she took it from there.

[Amethya]

I wish this mother was easy to work with but its the opposite. She came to pick the student up the other day. I had already emptied it twice. It was a day where the stool was very watery and coming out frequently. So I literally could have emptied it 5 min before she got there and it would have had something in it anyway. She came down the hall requesting for someone to find me. "That nurse needs to empty this!" Um no! You are here now and I quickly showed her the bathroom and she took it from there.

Yeah I have parents like that but I explain that if they are here, then they can take care of it. Their child is in their jurisdiction now.

[swimrun78]

I had a student like this for two years, almost identical situation. I feel your pain. This student would intentionally loosen his bag to get out of class or go home. There was one assistant the first year who would empty his bag or help me change it, but after she left it all fell on me. Parents were very difficult, sometimes he did not even have a spare bag, even after numerous calls to mom that he was out! Unfortunately I cannot offer much advice, except that if the teacher caught him loosening the bag there were consequences, but this was hard because sometimes the bag would loosen on it's own. The other thing that kind of helped to keep the bag on was to use a hair dryer on low, and the heat would help keep the bag on his skin. That was a tip given by his mom. I just wanted to let you know that I feel your pain and I am sorry. This was so hard because caring for him and cleaning him was so time consuming and I also have students with asthma, diabetes, plus all the other injuries and illness I get! Sometimes he would have to wait in poop because I had to prioritize. I hope the situation gets better for you.

[NutmeggeRN, BSN]

Maybe the district should consider hiring a 1:1 LNA or CNA?

[ABRN2012]

I had a student like this for two years, almost identical situation. I feel your pain. This student would intentionally loosen his bag to get out of class or go home. There was one assistant the first year who would empty his bag or help me change it, but after she left it all fell on me. Parents were very difficult, sometimes he did not even have a spare bag, even after numerous calls to mom that he was out! Unfortunately I cannot offer much advice, except that if the teacher caught him loosening the bag there were consequences, but this was hard because sometimes the bag would loosen on it's own. The other thing that kind of helped to keep the bag on was to use a hair dryer on low, and the heat would help keep the bag on his skin. That was a tip given by his mom. I just wanted to let you know that I feel your pain and I am sorry. This was so hard because caring for him and cleaning him was so time consuming and I also have students with asthma, diabetes, plus all the other injuries and illness I get! Sometimes he would have to wait in poop because I had to prioritize. I hope the situation gets better for you.

Thank you! At least I dont feel alone now!

[swimrun78]

No problem, I felt very alone too, and even though he was a sweet kid, I am glad he is no longer here!

[Avill, BSN, RN]

Haven't had a student like this in my school, but I agree with one of the comments that the aide and the teachers should help out. At my school I don't even help students with toileting, the SPED teacher does it. She is great though!