Caring Science Integration Paper

Caring Science Integration Paper:
Promoting and Accepting the Expression of Positive and Negative Feelings Hirschsprung disease, or Congenital Aganglionic Megacolon, is a congenital anomaly that comes from a physical obstruction due to the intestines not performing peristalsis. It accounts for ¼ of all cases of neonatal intestinal obstruction. The pathology of HD is because of the absence of ganglion cells in the affected areas of the intestine which results in a loss of rectosphincteric reflex and an abnormal environment of the cells of the infected intestine. The absence of ganglion cells, which are nerves outside of the central nervous system, results in a lack of nervous system stimulation. This decreases the internal sphincter’s ability
to relax. Because there is unopposed sympathetic stimulation, the intestines have increased tone. All of this leads to a contraction of the abnormal bowel, and a lack of movement in the intestines. In normal situations, when stool enters the colon, the sphincter relaxes and a person can have a bowel movement, but with HD, the sphincter does not relax, leading to a backup of stool in the colon. The patient Billy just underwent a colostomy for Hirschsprung disease. Currently the bag is leaking, and Billy’s mother is having difficulty even looking at the large red loop of bowel forming the colostomy stoma.
In relation to the above case, Jean Watson Carita of promoting and accepting the expression of positive and negative feelings (Fundamentals of Nursing, 2016) describes this concept by implementing Intrapersonal communication and Positive self-talk to help patients express their positive and negative feelings towards their condition, this can also be applied to family members and help them adjust to their new caregiving roles and duties.
“Intrapersonal communication focuses on personal needs and can influence a person's well-being. Positive self-talk is internal conversation that provides motivation and encouragement; it may be used to build self-esteem and self-confidence.” (p.43)
Promoting positive self-talk empowers patients and their families to persevere through difficult and uncomfortable situations, such as a new colostomy. Nurses may use positive self-talk to overcome anxiety or discomfort while performing new procedures, such as changing and cleaning the colostomy bag and cleaning the stoma. Watson (2008) elaborates on this Carita stating that the nurse should…
Create a safe environment for expression. Acknowledge healing as an inner journey. Allow for uncertainty and the unknown. Encourages narrative/storytelling as a way to express understanding. Allows for story to emerge, change, and grow. Encourages reflection of feelings and experiences. Offers blessings, prayer, and spiritual expression as appropriate. Helps others see some good aspects of their situation. Actively listens and lets the energy flow through one’s self without being consumed by other’s feelings. Accepts and helps others deal with their negative feelings.
Journal of Wound, Ostomy & Continence Nursing showed a study stating Ostomy surgery performed between the ages of 6 and 12 years can have long-term effects on psychosocial development.
Nurses should promote normalization, teach self-care of the ostomy as soon as possible after surgery, and refer children and parents to mutual support groups as appropriate.” (Erwin-Toth, 2008). It is essential to encourage the parents to give the toddler a diet high in fiber so they can combat the constipation. Offer whole grains, such as whole-wheat bread and reduce refined grains. Encourage fruits, vegetables, and fluid intake. Sugary foods like candy, soda, and fruity drinks are discouraged. It is important to allow the mother to have her feelings acknowledged and allow her to express both positive and negative feelings and give her time to adjust to the stoma and colostomy bag. It is vital to make sure that the child does not have a negative body image correlating with the mother’s reaction to the colostomy. Talking together with the parents and child can help everyone express their feelings openly and the nurse’s role is to encourage participation in care so that the parents and child adapt and become more comfortable with the colostomy. The nurse should continue to reassure the child and promote positive self-talk and self-esteem. The nurse should also educate the mother on what to look for and when to report to the doctor. The nurse can also include resources for the patient and
parents for support groups to help cope with the new colostomy as this can also promote expression and self-esteem.