With over 20 years' experience working in a tertiary colorectal centre of excellence I remain passionate about my job and strive to provide the best care – not only for my patients but also for my team of nursing and other health professionals. The wellbeing of my staff has always been my priority, as without a robust team, it is impossible to deliver the care expected at a specialist institution. I believe the judges in the BJN Awards 2023 recognised my nursing and leadership skills, especially during the pandemic, when I helped to ensure that patients requiring emergency stoma-forming surgery or planned operations for bowel cancer or inflammatory bowel disease, continued to receive expert, uninterrupted treatment across five different hospital sites, simultaneously ensuring my team were also kept safe.
Flexible working
As clinical appointments were limited due to lockdown restrictions, staff shortages and shielding requirements, it was paramount to allow patients access to nursing support. In order to work effectively in different locations, raise team morale, protect vulnerable staff and still provide an acceptable level of care and access to services, I introduced novel opportunities for remote and flexible working.
Stoma care nursing has always been viewed as a ‘hands-on’ profession, where remote or home working was not deemed possible, due to the physical nature of the role and the fact that a proportion of patients may not be proficient with information technology or have access to digital equipment. To be able to provide this service, I acquired state-of-the-art digital technologies such as personal computers with integrated cameras, encrypted laptops, mobile smartphones and an iPad, allowing us access to patients anywhere in the country or world. We were also able to bring families together to engage in stoma teaching with their relatives on the wards during periods of lockdown, using the iPad on secure networks to reach patients in their homes using virtual clinics.
Feedback from this was encouraging and we were able to prevent delays in discharge without compromising patient safety. These novel ways of working allowed rotation of the staff allocated to care for COVID-19-positive stoma patients on the wards, providing respite from the stress and discomfort of wearing personal protective equipment, as well as avoiding physical exhaustion and prolonged exposure to the COVID-19 virus.
The IT superusers
Staff had to be trained and supported to become confident in using new technologies. This was challenging but with encouragement and teamwork we were able to ensure everyone was confident. ‘Superusers’ were introduced internally to support staff who were struggling. These were nurses who had excellent IT skills and knowledge as well as the patience to train others who may not have used some of the technology before. The superusers within the team were able to come to me to highlight challenges with the use of technology so we were able to fine tune the way we were using systems or processes, so as not to overwhelm the team.
With the superusers' assistance I also introduced four new database systems, allowing comprehensive record keeping for audit, maintaining standards and quality control. With so many changes to the service and within the workforce, it was paramount to prevent miscommunication and make systems as easy as possible to navigate. Therefore, digital handovers and documentation templates were designed and implemented with the increased use of laptops and telephones to co-ordinate and communicate effectively. As a result, patients' needs were addressed in a timely manner with less room for error, and fewer clinical incidents or patient complaints being raised. Workforce planning was also easier to co-ordinate because daily meetings were set up, not only to assist with co-ordination of patients but to check on staff wellbeing during the pandemic as most of us had not worked at some of the sites we were covering or used public transport around London, which added extra challenges at the time.
Disseminating information
As well as introducing novel ways of working, we were also able to audit 200 patients who accessed our virtual clinics and evaluate the way these were delivered to improve patient experience and access. I disseminated this information by publishing an article on the use of virtual clinics in stoma care with two colleagues, highlighting the benefits as well as the obstacles, so other teams could improve efficiencies and gain confidence in this method of care delivery (Oliquiano et al, 2021). Publishing an article in a nursing journal with members of the team who had not previously published allowed me to continue to support the academic needs of individual staff members at a time when formal educational programmes were suspended.
As a confident contributor to nursing and medical journals, with experience of writing and editing books, I quickly realised there was a disparity in the information stoma patients received, with some patients reporting not only a lack of information but also conflicting advice. With the help of colleagues, I co-authored a 182-page handbook, Stoma Care - A Guide for Patients, (Marinova et al, 2021) to help patients confidently self-manage their stoma when specialist nursing support was limited during the pandemic and beyond. This book has been distributed worldwide and complements my original patient handbook, Ileo-Anal Pouch Surgery for Ulcerative Colitis - A Guide for Patients (Perry-Woodford, 2018).
The department's website and business cards were also updated and a QR code generated so patients could have immediate access to current information and direct contact details for our service. The use of a QR code was novel and allowed patients easy access to updated information posted on the website, especially as there was so much disruption to care and services at the time.
Education for staff and patients
Education has always been high on my agenda, as has links to innovation and research. In order to provide high-quality care, stoma care nurses need to be proficient in conditions that result in stoma formation, surgical options, types of operations and possible surgical complications, as well as developing an awareness and understanding of an array of stoma appliances and accessories in order to manage stoma and peristomal complications. Our team needed to be better equipped to communicate and support the ward nurses and multidisciplinary teams with stoma education so they could support our patients out of hours, on bank holidays and weekends.
It was vital to bridge the gap between theory and practice and with so many educational programmes or updates being postponed or with long waiting lists, it was paramount to reinstate stoma care learning. In line with making our services digital, we introduced stoma care training on a virtual platform via the Trust intranet. This was essential training for nurses and other health professionals in contact with stoma patients to ensure they were proficient in basic stoma care. The programme included not only the theory but a video-recorded presentation of a stoma bag change which would assist practical stoma care on the ward. This in turn increased the number of staff who could access learning and prevented further delays to stoma care education.
It was also important to continue to empower patients to self-care, so I ensured we were able to run webinars for our local and national patient support groups to reach vulnerable patients who were likely to be house-bound or restricted during lockdowns.
Research and innovation
The challenges of the pandemic highlighted some of my leadership skills and ability to be proactive and resourceful; however, some of the work I did for this award was pre-pandemic. While on secondment, I undertook one of the largest patient and stoma nurse surveys in England. However, halfway through my secondment, COVID-19 struck and I decided to terminate my secondment prematurely and return to front-line services to support my team better and stream-line services. It was my mission to ensure the significant work completed on my secondment was not abandoned and therefore I published a series of articles and reports which were disseminated locally and in international nursing journals. Data from these surveys were informative and encouraging but also highlighted multiple areas which needed improvement.
A consistent theme from the nursing and patient surveys which required review was the lack of structured follow-up for stoma patients. Armed with this research, I updated our current stoma patient pathway to include a stoma closure pathway and more structured annual reviews, which involved engagement with our community stoma nurses. It was also an opportunity to share feedback to my team from patients who requested more psychological support, product information and prescription management in order to enhance patient experience with a stoma following hospital discharge.
This evidence also supported me in collaborating and piloting a local prescription management service for stoma products. The aim was to use experienced stoma nurses, who were also qualified prescribers, to relieve the burden on local GPs when prescribing stoma products.
It was an incredible yet humbling experience winning the Gold Award in the Nurse of the Year category of the BJN Awards 2023 in recognition of this work.