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.

[smartnurse1982]

A colostomy and its care is not in the scope of a Cna or home health aide in my state.

I could understand why a teacher would not want to deal with it.

How would they know how to assess the site?

This kid needs a one on one nurse.

[ABRN2012]

A colostomy and its care is not in the scope of a Cna or home health aide in my state.

I could understand why a teacher would not want to deal with it.

How would they know how to assess the site?

This kid needs a one on one nurse.

The assessment and changing of it is my job. All they are responsible for is emptying it and in my state that can be delegated. They do not have to do any care to it other than emptying and we see that the same as changing a diaper which they already do.

[NutmeggeRN, BSN]

A colostomy and its care is not in the scope of a Cna or home health aide in my state.

I could understand why a teacher would not want to deal with it.

How would they know how to assess the site?

This kid needs a one on one nurse.

They cannot change a bag? What happens in LTC?

[grammy1]

A colostomy and its care is not in the scope of a Cna or home health aide in my state.

I could understand why a teacher would not want to deal with it.

How would they know how to assess the site?

This kid needs a one on one nurse.

You can't delegate that? Wow. LOL at trying to get a one on one nurse for that!

[WineRN]

They cannot change a bag? What happens in LTC?

It must be different state to state, because I definitely both emptied and changed bags as a CNA. If there was ever any issue during the change I'd let the nurse know.

As I said earlier, based on what the OP is posting, the fact that the student has a medical condition doesn't excuse his behaviors. I don't see the main problems of him messing around with own bag AND his parents not being onboard with working to stop that behavior being fixed with a 1:1 nurse.

[KelRN215, BSN, RN]

A colostomy and its care is not in the scope of a Cna or home health aide in my state.

I could understand why a teacher would not want to deal with it.

How would they know how to assess the site?

This kid needs a one on one nurse.

A 1:1 nurse for the possibility that a colostomy bag might need to be changed at some point throughout the school day? Ha. Nowhere in the world is going to pay for that. There's not a continuous skilled nursing need throughout the school day to justify a 1:1 nurse like there would be with, for example, a kid on a vent who needs frequent suctioning and O2 monitoring.

No one is talking about CNAs or HHAs but aides in classrooms. I think a 1:1 aide could be justified for this kid since there's a behavioral element as well but not a 1:1 nurse by any stretch of the imagination.

[smartnurse1982]

In my state the school nurses do not deal with colostomy bags nor gtubes.

I know kids with only gtubes who have one on one nurses in school.

[smartnurse1982]

They cannot change a bag? What happens in LTC?

When I worked LTC I was told by numerous facilities it was not in the Cna's scope of practice to empty and change colostomy bags,so I had to do it.

Nj has a very strict Nurse Practice Act,one of the most restrictive in the country.

The BON does not even oversee Cna's in my state. The Dept of Health and Senior Services does.

[NutmeggeRN, BSN]

When I worked LTC I was told by numerous facilities it was not in the Cna's scope of practice to empty and change colostomy bags,so I had to do it.

Nj has a very strict Nurse Practice Act,one of the most restrictive in the country.

The BON does not even oversee Cna's in my state. The Dept of Health and Senior Services does.

Yikes!

[MrNurse(x2), ADN]

Nj has a very strict Nurse Practice Act,one of the most restrictive in the country.

I always joked they were another country, the more I see, maybe I am right.

[lifelearningrn, BSN, RN]

You can't delegate that? Wow. LOL at trying to get a one on one nurse for that!

Right? In our district, the nurse can train ULP to change the bags, as it's NOT an invasive procedure. I'm more uncomfortable with ULP being trained for T1D and insulin, but we can also train and delegate that.

Just because their is an 'ick' factor to colostomies with teachers/aides, doesn't mean they can't be trained to responsible for changing them!