Nursing: Research and Reviews
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Psychosocial adjustment among patients with ostomy: a survey in stoma clinics, Nepal This article was published in the following Dove Press journal: Nursing: Research and Reviews 29 August 2016 Number of times this article has been viewed
Sital Gautam 1 Surya Koirala 2 Anju Poudel 1 Dipak Paudel 3 1 Department of Nursing, Nepal Medical College, 2Department of Nursing, Institute of Medicine, Tribhuvan University, Nursing Campus Maharajgunj, 3Department of Medicine, People’s Medical College, Kathmandu, Nepal
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Correspondence: Sital Gautam Mid Baneshwor-34, Kathmandu, Nepal Tel +977 9 841 676 324 Email
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Introduction Ostomy has a pervasive impact on every aspect of a patient’s life; however, the major long-term impact is on psychological and social functioning. These kinds of extensive surgeries are often necessary to manage a variety of gastrointestinal or genitourinary etiologies such as colon or rectal cancer, injury, inflammatory bowel disease, peritonitis, obstruction, radiation enteritis, ischemia, fistula, and perianal sepsis.1 Although ostomy is a lifesaving surgery, there is strong evidence of psychosocial maladjustment in ostomates globally. One of the first efforts to examine the range of postsurgical adjustment difficulties in ostomates was put forward in a very early 13
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Nursing: Research and Reviews 2016:6 13–21
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http://dx.doi.org/10.2147/NRR.S112614
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Background: Ostomy changes the overall lifestyle of a person, and ostomates have been identified as a chronic illness population frequently experiencing adjustment problems. Purpose: The aim of this study was to determine the psychosocial adjustment and its predictors among patients with ostomy in Nepal. Patients and methods: A descriptive cross-sectional study was conducted in two stoma clinics of Nepal. Patients who had a colostomy, ileostomy, or urostomy, visited the selected stoma clinics during the data collection period, and who had ostomy for at least 6 months before data collection were included in the study. A total of 130 patients were included in this study. Data on sociodemographic and clinical variables were collected. Psychosocial adjustment score was measured using Ostomy Adjustment Inventory-23. Results: A total of 130 patients (80 males and 50 females) were included in the study. The mean age of the patients was 51 years, ranging from 23 to 78 years. The study findings revealed that mean ±SD adjustment score was 41.49±13.57, indicating moderate impairment in the psychosocial adjustment among ostomates, and the mean ±SD scores of acceptance, anxious preoccupation, social engagement, and anger were 22.01±6.99, 8.75±3.89, 5.38±3.41, 5.35±1.62, respectively. Four variables contributed significantly to the final model, explaining 46.8% of variance in the psychosocial adjustment score (R2 =0.468, F(4, 125) =27.53, P5 years Mean duration, years (SD), min, max Treatment Under treatment Not under treatment Type of treatment (n=48) Chemotherapy Chemotherapy + radiotherapy Pharmacotherapy Radiotherapy Complication related to ostomy Present Absent Type of complications (n=50) Pain and discomfort Dermal irritation Bleeding Constipation Comorbidity Present Type of comorbidity (n=34) Hypertension Diabetes mellitus Respiratory problems Migraine Difficulty in obtaining supplies (n=130) Present
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Characteristics Frequency (%) 33 (25.4) 55 (42.3) 42 (32.3) 51.04 (15.55), 23, 78 80 (61.5) 50 (38.5) 74 (56.9) 56 (43.1) 102 (78.5) 28 (21.5) 16 (12.3) 114 (87.7) 99 (76.2) 31 (23.8) 83 (63.8) 47 (36.2) 85 (65.4) 15 (11.5) 30 (23.1) 109 (83.8) 21 (16.2) 3.04 (4.25), 0.5, 25 48 (36.9) 82 (63.1) 29 (60.4) 11 (22.9) 5 (10.4) 3 (6.3) 50 (38.5) 80 (61.5) 20 (40.0) 17 (34.0) 9 (18.0) 4 (8.0)
Frequency (%)
Reasons for difficulty in obtaining ostomy supplies (n=72) Long distance to reach clinic 42 (58.33) High price of the ostomy supplies 15 (20.83) 12 (16.67) Long distance + high price Inadequate number of supplies provided 3 (4.17) Self-care efficacy (n=130) Can care for oneself totally 81 (62.3) Can care for oneself partially 32 (24.6) Needs someone else completely 17 (13.1) Abbreviations: max, maximum; min, minimum, SD, standard deviation.
p sychosocial adjustment among ostomates, and the mean ±SD score of acceptance, anxious preoccupation, social engagement, and anger were 22.01±6.99, 8.75±3.89, 5.38±3.41, and 5.35±1.62, respectively. Further analysis of the response to each subscale revealed various concerns.
Acceptance subscale Approximately 38% of the ostomates strongly agreed that they felt recovered after the stoma operation. More than half (56.2%) agreed that life was meaningful even with stoma, and 45.4% agreed that they accepted stoma as part of their body. However, only 23% strongly agreed that they enjoyed food and drink as much as before the surgery. Regarding sleeping difficulty, only one-quarter strongly agreed that they could sleep well without worrying about stoma. The majority of ostomates (65.4%) agreed that they had accepted the changes in their appearance caused by stoma. Similarly, less than half (41.5% and 49.2%) of them agreed that they were grateful that stoma had given them new life and that their life was worthwhile, respectively; yet, very few (3.1%) agreed that they could participate in a variety of activities despite stoma.
Anxious preoccupation subscale Approximately 37% of ostomates agreed that they will always be a patient due to stoma. Similarly, the majority of them (66.9%) strongly agreed that they were always conscious that the stoma may leak, smell, or be noisy. Almost an equal number (33.8% and 33.1%) of ostomates agreed that they felt less sexually attractive and were always anxious about stoma, respectively.
34 (26.2) 16 (47.0) 12 (35.3) 4 (11.8) 2 (5.9) 72 (55.4)
Social engagement subscale It was revealed that a similar number (45.4% and 46.9%) of ostomates strongly agreed that stoma made it difficult for them to bath, and it was not easy for them to mingle within society, respectively. Similarly, 33% agreed that they do not have control over their life. Likewise, less than half of the
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ostomates (46.9%) strongly agreed that they had restricted activities due to stoma.
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Anger subscale Very few of the ostomates (1.5% and 3.5%) strongly agreed that they did not like touching or seeing the stoma and they cannot get over the shock of having stoma, respectively.
Research question 2: Does the psychosocial adjustment score differ by selected sociodemographic and clinical characteristics? To find out the difference in the psychosocial adjustment score in the subgroup of patients according to sociodemographic and clinical characteristics, independent sample t-test and one-way analysis of variance (F-test) were employed. Moreover, the strength of the relationship between the psychosocial adjustment scores and continuous variable (time since surgery) was determined by using Pearson’s correlation coefficients (r). Table 2 shows the association between selected sociodemographic and clinical variables with mean scores of psychosocial adjustment. Patients who were unemployed (t=2.042, P=0.04), perceived lack of family support (t=4.093, P
