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.
Like grammy1 said above, this falls into the umbrella and responsibility of the special ed department. They receive funding specifically because of these kids. This isn't an invasive procedure and the special ed aides, who get paid for other toileting procedures in the department, must be required to take care of it. You don't go change diapers in life skills do you?
Like grammy1 said above, this falls into the umbrella and responsibility of the special ed department. They receive funding specifically because of these kids. This isn't an invasive procedure and the special ed aides, who get paid for other toileting procedures in the department, must be required to take care of it. You don't go change diapers in life skills do you?
No I dont change diapers. And they get a diaper supplement but refused to empty the bag and went to principle about it. He told them it was just like a diaper and their responsibility so the teacher told him if its just like a diaper then you come and empty it and he said he would not and to call the nurse if I am here. The SPED dept has no clue of what to do. I told the director that I am out of ideas and that I am a nurse and this goes above my pay grade. I follow the IHP to a tee and beyond that but this constant call to the room because they smell something is wearing on me. Everyone is trying to throw it off on me and in all honesty I am the only person that is doing what the care plan states. I am not a SPED nurse so I think I am going to discuss it with my boss which is asst superintendent and show him what it says.
No I dont change diapers. And they get a diaper supplement but refused to empty the bag and went to principle about it. He told them it was just like a diaper and their responsibility so the teacher told him if its just like a diaper then you come and empty it and he said he would not and to call the nurse if I am here. The SPED dept has no clue of what to do. I told the director that I am out of ideas and that I am a nurse and this goes above my pay grade. I follow the IHP to a tee and beyond that but this constant call to the room because they smell something is wearing on me. Everyone is trying to throw it off on me and in all honesty I am the only person that is doing what the care plan states. I am not a SPED nurse so I think I am going to discuss it with my boss which is asst superintendent and show him what it says.
Don't know how far you want to go, but I bet there is a special ed director or equivalent that you can petition. Not cool to your Principal, but he is wrong.
Could you bring in an ostomy care nurse to educate them? I'm sure you are perfectly capable of educating them but perhaps if the heard from an outsider, they would be more willing. For what it's worth, the special ed teacher and aides in my school won't even assist with toileting. It's a battle I lost years ago. Fortunately the couple I have that need assist with transferring and wiping don't take up too much time, but no one will budge on the issue.
There is absolutely no reason why the aides in the classroom can not be trained to empty the bag and even change it. I had a PK student last year with one and I had to assess/empty Qhourly and change if broken. She would also peel the adhesive back just to get out of class, which got old and as you can imagine, her skin suffered.
Emptying the bag is no different than changing a diaper/toileting, so if the aides in this class are doing that, they can empty the bag and learn to change it as your backup.
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
How about some sort of smock (you might have to make it yourself or get creative) that would restrict access?
I'm imagining a binder over the top of the shirt, with a smock over the top of that. The student would be unlikely to be able to peel back the wafer adhesive through all the layers of smock, binder, and shirt. (and please tell me these are one-piece appliances, so the student can't just pop off the bag!)
The smock would have to fit around and between the legs like a leotard so it couldn't be raised up, and fastened in the back where the student couldn't undo it.
I'm imagining a large adult t-shirt (could be in colors or with designs on the front to provide some "fashion" or individuality/creativity) that gets modified to turn it into a onesie of sorts, with the sides/arms taken in so that the student can't pull the arms in and access that way. Or take appropriately-sized shirts and sew additional material onto the bottom to form the around/between the legs portion of the smock.
It would require some sewing skills -- maybe your district's home economics teacher could help out, perhaps make it a class project if you need to make several spares? And you'd probably have to launder them yourself, since it doesn't sound like the mother is willing to take any responsibility for the child. But it would be worth doing an extra load of laundry every week versus having to deal with being called to the room every thirty minutes every single day!
Please post back and let everyone know how this gets handled in the end -- because surely someone else will come across this same problem in the future.
Yes I thought about a 1 piece shirt idea. But mother is totally against any kind of cover. We basically told her she had to try the abd band because we were out of options and it had to be covered. She is against really everything I suggest. The Sped director is the one asking me to come up with ideas. So no help there. Maybe they will get him a 1:1 next year but I doubt it. Every time my phone rings I know who it is and what they want. "Um can you come look at this bag, we smell something". It basically a case of dont try to be nice and go above you duties because everyone will take advantage of your kindness. This student has been in school for 6 years so someone was taking care of it before when the nurse wasnt here.
I know the parent is against having certain clothing as a barrier, but there has to be a solution. The bottom line is that it sounds like the student isn't getting a 1:1 aide in the very near future. Perhaps a meeting with the parent to determine what she is doing at home for this issue - oh wait - i'm SURE he NEVER does this at home. Another thought that comes to mind, mom's not going to like it - overalls with a shirt over top in addition to a regular shirt beneath. The combo of the extra shirt and the overalls should hake it harder to get to his colostomy without someone noticing what it happening. It shouldn't be as distracting to him as the binder could potentially be and it should just look like jeans and a shirt. The only draw back, an extra layer to take contend with to get to the colostomy.
I know the parent is against having certain clothing as a barrier, but there has to be a solution. The bottom line is that it sounds like the student isn't getting a 1:1 aide in the very near future. Perhaps a meeting with the parent to determine what she is doing at home for this issue - oh wait - i'm SURE he NEVER does this at home. Another thought that comes to mind, mom's not going to like it - overalls with a shirt over top in addition to a regular shirt beneath. The combo of the extra shirt and the overalls should hake it harder to get to his colostomy without someone noticing what it happening. It shouldn't be as distracting to him as the binder could potentially be and it should just look like jeans and a shirt. The only draw back, an extra layer to take contend with to get to the colostomy.
Oh he does this at home. Pretty much he takes the bag off and plays around in it during the night and they give him a shower in the morning and sing his praises all the while doing it. There is the problem! Learned behavior.
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Is mom against him wearing a smock to protect his clothing from art class? If not, my "onesie" idea can be called a "clothing protector"... because it's keeping poop from getting all over his clothing!
Do you need mom's permission to put Peter Poop-player in the smock? It can be an "only at school" garment... put it on when he gets there, take it off before the dismissal bell.
Oh he does this at home. Pretty much he takes the bag off and plays around in it during the night and they give him a shower in the morning and sing his praises all the while doing it. There is the problem! Learned behavior.
This is definitely a behavior issue, not medical. I don't know what kind of charting system you use, but SNAP allows me to pull the amount of time I've spent with a student (aka missed instruction time) and that has saved me time and time again when trying to explain things to my admin team. Seeing that I've been with a student for 600 minutes this year makes a bigger impact than me explaining what I do with that same student.
Is there an IEP in place? I would push that there needs to be a plan put into place with consequences for the student's negative behaviors that are causing him to miss instruction time. It's amazing what missing recess or chromebook time can do.
Do you need mom's permission to put Peter Poop-player in the smock? It can be an "only at school" garment... put it on when he gets there, take it off before the dismissal bell.
This makes me laugh because we have two student who have "only at school" garments (one shoes and the other suspenders)
OldDude
1 Article; 4,787 Posts
Like grammy1 said above, this falls into the umbrella and responsibility of the special ed department. They receive funding specifically because of these kids. This isn't an invasive procedure and the special ed aides, who get paid for other toileting procedures in the department, must be required to take care of it. You don't go change diapers in life skills do you?