The pouch acting as a mediator between "being a person with an ostomy" and "being a professional": analysis of a pedagogical strategy.

OBJECTIVE

This study analyzes the process of constructing and reconstructing the meanings of the concepts ostomy, ostomy patient, and the nurse's role in managing an ostomy after the experience of wearing a pouch.

SUBJECTS AND SETTING

Thirty nurses who were students in the Enterostomal Therapy Nursing Education Program in 1992 and 1993 participated in this study. All of the participants were female, ages 20 to 55 years, had graduated from nursing at least 6 years previously, and had been working at acute care hospital units or at outpatient care centers. The research was completed at the Enterostomal Therapy Nursing Education Program in the Nursing College of the University of São Paulo.

METHODS

All participants wore a pouch and lived as an ostomy patient for a 24-hour period and then were interviewed about their experience. Two major themes were identified after analysis: "being a person with an ostomy" and "being a professional."

RESULTS

The experience of wearing a pouch promoted changes in perceived role, self-esteem, body image, sexuality, and social relations. These changes were sometimes perceived as stigmatization and sometimes as enhancing social support. The perceptions caused a crisis that provoked the use of coping and social defense mechanisms that ultimately altered the participants' perceptions of the meaning of "being a nurse." Prior to this learning experience, the participants' management of patients with ostomies was fragmented and marked by a dissociation among activity, thinking, and feeling. Before the experiences, participants defined their management of patients with ostomies as mostly technical, focusing on the ostomy and the pouch. Following the experience, participants proposed changes in practice designed to care for the whole human being, revealing an incorporation of the affective, symbolic, and relational dimensions critical to managing the care of patients with an ostomy.

CONCLUSION

The results showed that having subjects wear a pouch as a pedagogic strategy was successful in directing the participants' thinking about new meanings concerning "being a professional," resulting in some potential profound changes in the future nursing care of their patients.