Med surg RN needs help with the taboo subject

[liljsmom02]

I am a med surg nurse who recently had a patient come in with abdominal pain. Her cat scan showed something on her ovary. The surgeon did an exploratory lap with the expectance of either a lap appi or a lap oophrectomy. The case ended with a lap resection with a temporary colostomy. The patient was a fairly young married woman. I worked hard with this patient on ostomy care as were the other nurses. When I went in the other night, she wasn't my patient but I had a minute to drop in to see how her recovery was going. While we were talking she passed flatus through her ostomy and was quite embarassed. At that point it dawned on me that this woman was a young married, sexually healthy person. So I asked her if she is worried about her sexual health. I apologized to her for not having any answers in advamce but assured her that as a women I could only imagine how difficult it must be. She was thankful and relieved that someone finally mentioned the elephant in the room. She thanked me over and over again for seeing her as a person and not just the bowel resection in room ......

So my question is how do you deal with intamacy questions.

[oldiebutgoodie, RN]

I googled "ostomy" and "sex", and found a few sites with info that is semi-helpful:

http://www.uoaa.org/ostomy_info/

http://www.bigeye.com/sexeducation/ostomy.html

http://www.outsiders.org.uk/leaflets/sex-and-ostomy

Oldiebutgoodie

[Ariesbsn]

I hope you are patting yourself on the back. You did a great thing!

Regardless of the age of my patients (or gender), if they have a new ostomy, I start my ostomy chat with my first assessment. I am an ICU nurse and use my q 2 hour (at a minimum) assessments as a reason to bring up ostomy related topics. I then work my way up to intimate issues. With my first assessment, I comment on how good the ostomy looks (haven't had a bad one yet) and ask them if they have looked at it yet. I also ask if an ostomy nurse talked with them before the procedure and if they have been by since the procedure.

As I build a rapport with the patient, I ask questions that are a bit more personal with each assessment. I ask them what they talked about with the ostomy nurse, if they have practiced emptying the ostomy yet, and if they have talked with their S.O. about the ostomy.

I also just offer info. I am very respectful, but nonchalant with the information. If they see that I am comfortable with it, it really does seem to help them open up and start asking questions about the more personal aspects of things.

What I have found is that a good number of the patients don't ask the ostomy nurse questions. I can't figure out if the ostomy nurse doesn't talk about things like showering, noise, smells, sex life issues, and body image issues until way after they leave ICU, if the pts just don't remember it, or if the ostomy nurse says "Do you have any questions about ____" and just let it drop when the pt says "No."

The other thing is, if the patient doesn't want to talk about any of it, I don't push the issue. I just let them know that if they have any questions, I will do my best to answer them.