UNIT 325: 1.1 Describe Types of Change They May Occur in The Course of An Individual's Life
UNIT 325: 1.1 Describe Types of Change They May Occur in The Course of An Individual's Life
1.1 Describe types of change they may occur in the course of an individual’s life
Different types of changes can occur in a person's life. Some may be positive, some negative, some
may be sudden, some may occur over a long period of time. There are changes related to the
choices made by one person, while others are independent of the will of the individual. Some
changes are temporary, and some are permanent.
For a person cared for in a care home, the changes can be many and of different types. Changing
health or behaviour with age or due to the worsening of a disease is common. Limiting the degree of
independence or the appearance of some disabilities or diminishing some abilities represent other
changes. In the case of a person with dementia, for example, even the visit of a loved one can have
negative effects, generating agitation and anxiety. The loss of a friend or the death of a family
member is another change that can severely affect an individual. Changing the room, the care
worker or the daily routine can affect a person. The last period, the one dominated by Covid,
brought many changes in the lives of the residents in the care homes. Restricting visits, outdoor
walks, were changes that negatively affected many people. On the other hand, the relaxation of
safety measures and the resumption of the routine were a positive change. There may be changes in
the lives of some residents with a major positive impact. The birth of a grandchild, for example, the
success of close family members, is good news. What is certain is that changes occur daily, some
minor, some major, and it is important that they are approached in a positive way, so that the
impact of the changes on a person does not affect their physical or mental well-being.
1.2 Analyse factors that can make the change process positive or a negative experience
Changes in a person's life are inevitable. However, it is important that these changes turn into
positive experiences or, when this is impossible (for example, the death of a loved one or the news
of an incurable disease), at least the severity of the situation is minimized. Sometimes, even positive
changes can create stress and have negative consequences. Regardless of the type of change -
positive, negative, or neutral, it is important that they are approached in a positive, person-centred
way. For a change to turn into a positive experience, it is first necessary to support the person
dealing with the change. Supporting the person, communicating with them, detailing the effects of
the change and its consequences are factors that can make the change a positive experience.
Helping and supporting the individual to focus on his or her ability to control change is another
factor that can make change a positive experience. Another factor is how change is viewed and
analysed. Supporting a person to change the perspective of change may lead the individual to
conclude that, in fact, change is a positive experience. Taking steps to manage the stress of change,
celebrating positive change, even if it is small, can lead to a positive experience. Also, the call for
specialized support or support groups can turn a change into a negative experience.
On the other hand, the lack of support and communication, the attempt to convince a person that
<this is life> makes a change to be a negative, traumatic experience, with long lasting effects.
Minimizing the feeling a person experiences, neglecting stress or symptoms of anxiety or depression
that can result from a change make it turn into a negative experience. Even the good news, passed
quickly and without prior training, to a person with a mental illness, can turn into a negative
experience.
1.3 Describe approaches likely to enhance an individual’s capacity to manage change and
experience change positively
To enhance a person's ability to manage change and experience change positively, a person-centred,
communication-based approach is needed. The approach must be to find the preferred mode of
communication of the individual, to discover and encourage their skills to cope with change. Also,
the situation must be approached so that the person subject to change feels that they have control
over the events that take place and are involved in controlling the change. When it comes to a
change with long-term effects, the approach must be based on a plan that takes into account how
the individual feels, the effects of the change on the person and the risks that may occur. If
necessary, the approach can be made taking into account the advice of professionals. In order to
manage change in a positive way, we must approach it taking into account not only the practical
support, but especially the emotional one. Practical support can include assistance from
professionals in various fields (doctors, social workers, advocates, for example), while emotional
support can be largely based on communication and the development of the individual's skills and
self-confidence. the face of change in a positive way.
Regardless of the situation, the approach must be made in such a way that the individual is given the
necessary time to adapt to change at their own rhythm and by supporting their independence.
2.4 Describe the importance of both practical support and emotional support during a time of
change
Practical and emotional support for a person during a change is essential. With support, the person
can maintain their physical and mental well-being and can perceive change as a positive experience.
Practical support is essential because it aims at the well-being of the person, so that they are
protected from deprivation, neglect, illness, or aggravation of existing ailments. By providing
practical support, we make sure that the person going through the change has a safe place to stay,
benefits from proper nutrition, hydration, and medication, that they generally have everything they
need. Providing practical support can help a person feel confident, respected, and appreciated. Thus,
the individual will feel that they have control over their own life and will face change in a positive
way. Emotional support is essential so that the person undergoing change does not suffer from
anxiety, depression, agitation, or other unwanted mental states. Emotional support begins with
communication, so that the person is supported, listened to, and encouraged to maintain
independence, get involved and control change.
3.5 Describe how and when to seek additional expertise and advice when supporting an individual
through change
We need to ask for additional expertise and advice when we support a person through change when
we feel that we cannot support the individual enough, both practically and emotionally. This can
happen when our knowledge is exceeded, when there is no information in the care plan to help us,
when the situation is serious or there may be risks for the person through change. We can ask for
additional expertise from more experienced colleagues, from the manager, from the GP,
professionals, therapists, the emergency service, advocates, social workers, the NHS, support
groups, or various associations. In many situations, depending on the change a person is going
through, we may turn to web pages that offer advice (such as healthtalk.org, stlukes-hospice.org,
actionforcarers.org.uk, The Alzheimer's Society, macmillan.org.uk, etc.).
UNIT 337
1.1 Describe the agreed ways of working related to assessment for and undertaking stoma care
There are agreed ways of working to assess and maintain the stoma. The evaluation of the stoma is
done periodically, and the result of the evaluation is noted. This way you know if the stoma looks
right, if it works or if there are abnormalities that need to be reported immediately. A record must
be kept of the replacement or emptying of the stoma and the appearance of faeces or urine.
Another agreed way of working is the way in which the stoma is replaced, starting with the personal
protective equipment used and up to the bag in which the used bag is placed and where it is thrown.
The agreed working methods also include the hygiene measures that must be applied: washing
hands, using gloves, detaching the used bag with a special spray, removing excess dirt from the
stoma and the surrounding skin with a dry swab or wipes, washing stoma and surrounding skin with
warm water and drying the skin. Also, a bag with a size corresponding to the stoma should be used.
It is also important to explain to the person step by step what we do and ask for their consent for
each action.
1.2 Explain own responsibilities related to assessment for and carrying out stoma care
When we take care of a person's stoma, we have special responsibilities so that everything goes
smoothly. First of all, hygiene measures must be maintained so that neither we nor the person with
the stoma are exposed to the risk. We also have the responsibility to make an assessment of the
stoma, to see if there have been any abnormalities that require the intervention of professionals. If
the stomach looks good, we have the responsibility to prepare all the necessary materials to replace
the bag in strict hygienic conditions. We will make sure we have everything we need, including the
bag the size needed for the stoma, as well as all the necessary hygiene materials. Once the stoma
replacement is complete, we are responsible for the safe removal and storage of the bag.
The stoma is an opening in the body (in the abdomen), created by surgery, which, being connected
to the digestive system or urinary system, allows the elimination of urine or faeces from the body,
when it cannot occur naturally. The word stoma comes from the Greek, the language in which stoma
means mouth.
2.2 Describe the anatomy of different types of stoma formation, their position and functions
There are three different types of stomata, two formed in the digestive system and one in the
urinary system. The stoma formed in the large intestine is called colostomy, the one created in the
small intestine - ileostomy, and the one formed in the urinary tract is called urostomy.
The stoma looks like a circular piece of pink flesh that opens on the abdomen. A colostomy or
ileostomy can be temporary (for example, when it takes a part of the colon or small intestine to
heal) or permanent, in the case of urostomy.
In the case of colostomy, the colon is brought to the abdominal wall and sutured to the skin.
Colostomy can form anywhere in the colon but is usually positioned on the left side of the abdomen.
Ileostomy is similar to colostomy, the difference being that it is created in the small intestine.
In the case of urostomy, a piece of the small intestine is used, which has the shape of a tube and to
which the two ureters are connected, the tube opening in the abdomen like a stoma.
The role of colostomy and ileostomy is to help eliminate faeces when due to congenital diseases or
malformations their elimination cannot be done naturally.
Urostomy is used to remove urine from the body when, due to an illness, the bladder is not
functioning properly.
2.3 Identify the reasons why the different types of stoma may be formed
Colostomy and ileostomy may be formed temporarily to help the large or small intestine heal.
However, these types of stoma can also be permanent in the case of congenital malformations or
diseases such as obstruction, blockage or perforation of the intestine, colon cancer, removal of the
intestine, diverticular disease, ulcerative colitis, Crohn's disease.
Urostomy is formed in cases of bladder cancer when the bladder is removed or does not work or in
cases of congenital malformations.
2.4 Describe stoma abnormalities and actions to take when these are identified
Normally, the colour of the stoma is pink, the skin around the stoma is intact, it is normal in size and
does not bleed, although there are many cases when drops of blood can appear when the stoma is
washed and dried. We can talk about abnormalities when the stoma is either dark or pale, when the
surrounding skin is inflamed, ulcerated, or broken or sore or when rashes appear in the stoma area.
Also, another abnormality is when the stoma bleeds from inside or too much blood appears when
the stoma is washed or dried. Also, if the stoma becomes inflamed, it is an abnormality. Also,
constipation or diarrhoea, blood in the faeces is abnormal, and in the case of urostomy - cloudy, dark
or concentrated urine or lack of urine.
If we notice an abnormality of the stoma, we must call the nurse, GP and, if the situation is serious,
the emergency service must be notified immediately.
Potential consequences of contamination of the stoma drainage system include irritation or even
infection of the skin around the stoma. Due to contamination of the drainage system, fungi present
in the gastrointestinal tract can affect the surrounding skin. Itching, redness, heat, even bleeding
may occur. In the case of urostomy, due to repeated urine leakage, the area around the stoma may
become thinner. The intestine is inhabited by a variety of micro-organisms, which can cause disease
if they enter the body elsewhere, for example through a wound or urinary tract. On the other hand,
many micro-organisms live on the skin, which, in case of poor hygiene, can enter the body through
the stoma, triggering diseases.
In general, people with stoma have no dietary restrictions, but the diet may differ from one
individual to another, depending on the preferences and how the body reacts. The diet should
include diversified foods, fibre, vegetables, and fruits. However, it should be borne in mind that
certain foods, such as spicy foods, can cause diarrhoea, while foods high in iron can cause blockage.
People with a stoma should be careful about and avoid dried fruits, nuts, fruit peels, mushrooms,
and celery.
In the case of people with stoma, it is necessary to consume 8-10 cups of different liquids - water,
tea, coffee, milk, juice. In fact, fluid intake also prevents urinary tract infections. For people with
ileostomy, a salt intake is also necessary.
In the case of people with stoma, light exercise can help the functioning of the intestines and
regulate intestinal transit.
People with a stoma should be careful when taking medications because they may affect them. In
general, some medications can cause constipation or, conversely, diarrhoea. However, when the
stoma does not work properly, medications may be prescribed. If pain occurs, paracetamol may be
recommended. In case of constipation, laxatives may be recommended if increasing the amount of
water and fibre does not work. However, caution and the administration of a small dose of laxative
are recommended, among the usual medications in cases of constipation being senna. Laxatives may
be recommended for colostomies, being contraindicated for ileostomy, as it can lead to rapid loss of
water and electrolytes.
In other cases, medication for diarrhoea may be needed. Patients with stoma may also be
recommended medications to reduce gastric acid secretion, which reduces stoma production.
People with a stoma may experience various unpleasant physical sensations or even pain. The pain
generally appears after the stoma has been created, but disappears in time, but the cases in which it
appears without any reason are not excluded either. Discomfort can also occur due to the feeling
that someone is pulling something from the body of the person with the stoma. Skin irritation may
occur due to skin contact in the stoma area with urine, faeces, or adhesives used to attach a bag to
the stoma. Some people are bothered by the smell emanating from the contents of the bag or the
fact that flatulence can occur whose noise is uncontrollable. Also, in more severe cases, a
parastomal hernia may form. An unpleasant physical sensation can be generated by the leakage
from the stoma, but also by the bleeding that can occur during the cleaning or drying of the stoma.
The existence of a stoma can have a great negative psychological impact on a person, thus reducing
their quality of life. First of all, a person with a stoma not only has no control over the elimination of
urine or faeces, feeling helpless, but also lives with the fear of leakage. They are individuals whose
self-esteem decreases considering that their body image is deformed. This feeling leads to social
isolation, anxiety and even depression. Other people feel stigmatized or angry at having a stoma.
Decreased self-esteem and self-confidence lead to embarrassment in the case of sexual function,
whose quality decreases. There are people who have a low mood and feel uncertainty about the
future. Many people are worried that they emit odours and noises that make them different from
other people. In fact, in many cases, the existence of the stoma is the cause of a disease, which itself
causes concern.
A person living with a stoma may experience difficulties that discourage them from leading a normal
life in the family and in society. The formation of a self-image according to which the body would be
deformed especially affects sexual relationships. Even in the family, there is embarrassment towards
others, fearing that leaks or odours cannot be controlled. A person with a stoma may feel guilty
about other family members, which affects relationships with them. In terms of daily activities, there
will always be a fear that the stoma bag will need to be changed when the person is away from
home, that there may be uncontrollable leaks or flatulence. For this reason, many people with a
stoma are reluctant to leave their homes and isolate themselves, sometimes even from family
members. Stoma can also be an obstacle to recreational activities. A walk, attending a concert, a trip,
even shopping is conditioned by the fact that there may be a need to change the stoma bag. The
non-existence of a special place, in which the person with a stoma can change the bag in conditions
of maximum hygiene, makes it avoid certain spaces and recreational activities.
3.4 Explain the importance of promoting individuals’ independence to manage their stoma
As long as a person can manage their own stoma, that person can maintain their independence and
health. It is very important for a person to know how to proceed in stoma management. An
individual who manages their own stoma will know how to proceed so that they are not at risk of
infection. Promoting the independence of people with stoma will help them socialize, not isolate
themselves. A person who can manage their own stoma will be able to go where they want, because
they will know how to proceed, in conditions of maximum hygiene, if it is necessary to change the
stoma bag. This independence will restore the person's confidence and self-esteem and will help
them to lead a normal life.
3.6 Describe the importance of follow up support for individuals with a stoma
People with stoma receive support and supervision from the moment it is decided that a stoma is
needed. It is very important for the person to be explained what a stoma means and how they will
have to manage it after the operation. This starts in the NHS system. After the operation, the person
with the stoma receives assistance and advice in the hospital. The nurse or carer will repeat the
procedure to replace the stoma bag until the patient is able to care for themselves under the
necessary hygiene conditions. This support is essential because once the person learn how to
proceed, they will gain confidence and become independent again. Prior to discharge, the stoma
care nurse will be notified and the person with the stoma will be given the contact details of the
stoma care nurse. The patient will be provided with supplies for 2 weeks to be taken home,
depending on the type of stoma. Thus, the patient will have everything they need to take care of
their stoma before the first prescription is processed and handed over to the person. It is equally
important that the person be notified that they can access the GP or District Nurse outside of
working hours if a problem occurs. After discharge, there will be telephone discussions, stoma care
nurse visits, which will ensure that the stoma works, and the skin heals. All this support is important
for the recovery of the person with the stoma. Equally important is the support provided by various
charities, which provide not only material support, if any, but also emotional support. If the person
with stoma feels the need they can be mentally supported by various organisations, NHS, support
groups. All these support activities, together, help the person with the stoma to overcome the
obstacles from the beginning - fear, embarrassment, guilt, anger, to lead a normal life and to benefit
from physical and mental well-being.