Introduction

Patients admitted to a general surgical ward have a short-term stay of a few days or a longer stay of a week or more, depending on the type of surgery and whether any perioperative complications occur. In this chapter, we explore the care of a patient who has had a medical diagnosis of cancer of the bowel, identified following the NHS over-60s bowel screening initiative (NHS Bowel Cancer Screening Programme 2009). It is beyond the scope of this book to cover everything with regards to caring for someone after major abdominal surgery. It is advisable, therefore, that you supplement the information in this chapter with that in other chapters plus relevant further reading.

As with the other case studies, it is important to consider them as ‘insights’ into possible learning experiences in practice placements, where you may meet the patient at any stage in that journey. It is important to learn about the whole of a patient’s journey and experience in order to be able to help them at the stage at which you meet them.

Introduction to patient and clinical problem

Mrs Nadira Ahmad is a 62-year-old woman who responded to the over-60s bowel screening initiative after seeing an advert for it at her local hospital. A test kit was sent to her and she found this helpful as it meant she could do it in the privacy of her own home, even though she still found it embarrassing. She had been concerned as she had experienced some rectal bleeding and had not told anyone, but she knew from information in her GP centre that ‘something was not right’ – the poster in the hospital had triggered further inquiry when she realised she could do something without alerting too many people, especially her family. She had been experiencing a change in her normal bowel movements and some discomfort on the right side of her abdomen which she had put down to ingesting the wrong kind of food and ‘wind’. She had also been very tired which she had put down to her age.

Two weeks later, Nadira Ahmad receives a letter telling her that she needs to contact the screening service

Activity

Access the NHS Cancer Screening site and read the information about the initiative and the process prior to the patient receiving the screening test kit. See the link to the information and the kit instructions. A short animated film can also be found there as well as instructions in different languages:

http://www.cancerscreening.nhs.uk/bowel/ (accessed December 2011).

Information for GPs is also available for this initiative as they are not directly involved in the delivery of the programme:

http://www.cancerscreening.nhs.uk/bowel/ipc-pack.html (accessed December 2011).

to make an appointment to see a specialist nurse. She is informed that her GP has been sent a letter as well explaining why she needs to contact the nurse. If she prefers, she may go to her GP who knows her and her family as well as her health history.

She is now very concerned. She has asked her daughter, who she eventually confided in, to look for any information on the Internet, and a link from the cancer screening programme site led them to video information about the bowel, polyps and possible investigation of colonoscopy for cancer. This is in her own language of Urdu, which helps her: http://www.remedica.com/bowel/default.aspx (accessed December 2011).

Activity

In order to help patients such as Nadira Ahmad, you need to understand the physiology of the gastrointestinal tract as well as the nature of polyps and why they can turn cancerous.

If you are in a day surgery unit or an outpatient department where colonoscopies are carried out, you will need to communicate effectively with patients and be mindful of different cultural and religious backgrounds as well as your own communication skills.

View the online explanation for the physician about polyps and colonoscopies on the same site:

http://www.remedica.com/bowel/default.aspx (accessed December 2011).

See Box 12.1 for an explanation of what the NHS screening site states about colonoscopy for service users and the general public.

Box 12.1 What is a colonoscopy?

A colonoscopy is an investigation that involves looking directly at the lining of the large bowel. A thin flexible tube with a tiny camera attached (a colonoscope) is passed into the back passage and guided around the bowel. If polyps are found, most can be removed painlessly using a wire tube passed down the colonoscope tube.

(From NHS Bowel Cancer Screening Programme 2009:8)

Activity

Read the definition in Box 12.1 and compose a more detailed explanation in order to teach another student what happens in a colonoscopy. What would you say differently? For example, would you use the term ‘back passage’ in your explanation or would the word ‘rectum’ be more appropriate?

Do not forget how important words are. In some languages, direct translation is not possible, so other non-verbal explanations or illustrations might be required. Again, this is a skill that is transferrable to other situations.

There are references to physiology textbooks throughout this book and you may have one that you have a personal preference for. To help patients like Nadira Ahmad, it is important that you are fully prepared to answer any questions you feel confident to answer within your sphere of knowledge and responsibility. Being knowledgeable about how the bowel works and what happens in a colonoscopy is essential both pre- and postoperatively should she require major surgery.

Communicating with her in a culturally appropriate way is also very important, as it is with all patients.