Describing self‐care and its associated variables in ostomy patients

Exploring the Impact of a Structured Educational Approach on Peristomal Skin Complications: An Interim Analysis

This study, employing an interim analysis, investigates the effects of the Dermamecum protocol, a structured educational and tailored approach that stratifies ostomy patients into risk paths (green, yellow, red) based on pre-operative and post-operative characteristics. The green path indicates a low risk of peristomal skin complications (PSCs), focusing on sustaining healthy behaviours and basic stoma care. The yellow path represents a moderate risk, emphasizing the need for patients to self-monitor and recognize early signs of complications. The red path corresponds to high risk, requiring stringent monitoring and immediate access to healthcare support. The study aims to reduce PSCs and improve patient outcomes. Methods include the stratification of 226 patients, with significant differences in gender distribution, BMI categories, and stoma types across the paths. Results show an occurrence rate of PSCs of 5.9% in all risk paths (5.7% green path, 4.7% yellow path, and 7.9% red path, p = 0.685), significantly lower than the median rate of 35% reported in the literature. Multiple correspondence analysis validated the stratification, with distinct clusters for each path. Poisson regression models in the exploratory framework of an interim analysis identified male gender as the only significant predictor of PSCs, indicating the need for gender-specific interventions. The findings suggest that the Dermamecum protocol effectively reduces early PSCs, providing a foundation for further research.

Path analysis of self-care amongst community-dwelling pre-ageing and older adults with chronic diseases: A salutogenic model

With the trend towards ageing population globally, the salutogenic model can be integrated in interventions for pre-ageing and older adults to better support healthy ageing. However, there is limited research examining the salutogenic model's pathway amongst pre-ageing and older adults. Hence, this study aims to investigate pathways of the salutogenic model amongst pre-ageing and older adults with chronic diseases. Two hundred and eight pre-ageing and older adults were recruited from 11 Senior Activity Centres in Singapore. Data was collected using a self-reported questionnaire and analysed using path analyses. The indirect pathway from Subjective Cognitive Complaints to self-care abilities via sense of coherence and health practices were significant. Participants with higher sense of coherence may have increased capacities to execute more complex forms of self-care. Future interventions integrating the salutogenic model could enhance pre-ageing and older adults' self-care abilities to cope with chronic diseases and contribute to healthy ageing.

Discharge teaching quality positively predicts quality of life in colorectal cancer patients with temporary enterostomy: The mediating role of readiness for hospital discharge and stoma self-efficacy

OBJECTIVES

This study aimed to examine the mediating role of readiness for hospital discharge (RHD) and stoma self-efficacy (SSE) in the relationship between quality of discharge teaching (QDT) and health-related quality of life (HRQOL) in colorectal cancer patients with temporary enterostomy, and the gender difference of mediating effect.

BACKGROUND

It is not clear how RHD, QDT, SSE and HRQOL interact in colorectal cancer patients with temporary enterostomy.

METHODS

This was a prospective follow-up survey. 221 colorectal cancer patients with temporary enterostomy were conveniently recruited from a general hospital in Southeast China. The Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Stoma Self-Efficacy Scale, and Stoma Quality of Life Scale were used to collect data. Pearson's correlation and structural equation models were used to analyze the data. SPSS 26.0 and Amos 28.0 software were used for analysis the collected data.

RESULTS

Regarding the relationship of QDT and HRQOL, only QDT-T had a direct effect among colorectal cancer patients with stomas (b = 0.233, P<0.001, percentile 95% CI = [0.145, 0.314]). However, both QDT-T and QDT-R can predict HRQOL indirectly through three paths: (1) the mediating role of SSE (b = 0.050, P = 0.009, percentile 95% CI = [0.013, 0.098]; b = 0.077, P = 0.008, percentile 95% CI = [0.021, 0.164]), (2) the mediating role of RHD (b = 0.044, P = 0.004, percentile 95% CI = [0.014, 0.085]; b = 0.044, P = 0.005, percentile 95% CI = [0.010, 0.102]), and (3) the chain mediating role of SSE and RHD (b = 0.030, P = 0.003, percentile 95% CI = [0.011, 0.059]; b = 0.047, P = 0.003, percentile 95% CI = [0.015, 0.103]). The similar chain mediating effect in male stoma patients was also found (b = 0.041, P = 0.002, percentile 95% CI = [0.016, 0.080]; b = 0.046, P = 0.004, percentile 95% CI = [0.011, 0.114]).

CONCLUSIONS

Stoma self-efficacy and readiness for hospital discharge played important intermediary roles in the relationship between quality of discharge teaching and health-related quality of life in colorectal cancer patients with stomas. Health care providers can design SSE-enhancing and RHD-enhancing discharge planning for colorectal cancer patients with temporary enterostomies.

Nursing interventions for the self-efficacy of ostomy patients: A systematic review

BACKGROUND

Self-efficacy interventions, which include the acquisition of skills that enable patients to manage their health on a daily basis, play a key role in ostomy patients, which leads to significant changes in the quality of life of patients. In this context, nursing interventions to increase self-efficacy of ostomy patients are very important. In this context, nursing interventions are crucial to increase the self-efficacy of ostomy patients.

OBJECTIVES

The aim of this systematic review is to describe nursing interventions for ostomy patients' self-efficacy (primary outcome) and the impact of these interventions on patient outcomes (complications, quality of life, satisfaction, psychological resilience, stoma adaptation) (secondary outcomes).

METHOD

As a systematic review, this study included articles published in PUBMED, Web of Science, Science-Direct, TUBITAK-ULAKBIM, and TRDizin databases between January 2013 and January 2023 that included nursing interventions for self-efficacy ostomy patients. This systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The risk of bias was assessed using the RoB2 tool developed by Cochrane.

RESULTS

A total of 1211 articles were retrieved from the databases using Turkish and English keywords. Fifteen studies met the study criteria. These studies found that various interventions, such as training, telephone follow-up, psychosocial support groups, or mobile applications provided to intervention groups, increased self-efficacy, decreased stoma-related complications, improved stoma adaptation, and improved quality of life by increasing patients' knowledge and awareness of stoma.

CONCLUSION

Nursing interventions to improve the self-efficacy and adaptation of ostomy patients are critical. This improvement leads to a reduction in adverse patient outcomes and ostomy complications, shorter hospital stays, and increased patient and nurse satisfaction.

The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness

AIM

To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients.

DESIGN

A cross-sectional multi-centre study was conducted.

METHODS

Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver.

RESULTS

The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours.

CONCLUSION

The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education.

IMPLICATION FOR PROFESSION AND PATIENT CARE

Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours.

IMPACT

Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad.

REPORTING METHOD

STROBE checklist for cross-sectional studies was followed in this study.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in the sample of the study.

Missed nursing care and stoma care: an Italian survey

BACKGROUND

In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date.

AIM

To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses.

DESIGN

Cross-sectional study.

METHOD

The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023.

FINDINGS

A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0-53.8). The most common qualification was a Bachelor's degree (n=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse-patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4).

CONCLUSION

A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients.

Post-discharge health education for patients with enterostomy: A nationwide interventional study

Background

After discharge, patients with enterostomy face problems with poor self-nursing ability and low levels of psychological and social adjustment, which, without timely intervention, seriously affect their quality of life. We delivered health education to discharged enterostomy patients based on a WeChat health management program and evaluated its impact on their ostomy self-care ability and psychosocial adaptation level.

Methods

Based on the WeChat health management program, we conducted continuous health education in the first, third, seventh, 11th, and 23rd weeks after discharge of enterostomy patients/before temporary enterostomy restoration to observe its impact on their self-care ability and psychosocial adaptation levels, as evaluated by an ostomy self-care ability questionnaire and ostomy adjustment inventory-20 checklist.

Results

We included 4201 patients with enterostomy. Our findings showed that the self-care score of patients with enterostomy at discharge (baseline) (mean = 15.23, standard deviation (SD) = 5.22) was lower than that after intervention (mean = 17.71, SD = 1.28) (P < 0.05). The enterostomy psychosocial adaptation score of the enterostomy patients at discharge (baseline) (mean = 44.59, SD = 9.82) was lower than that after intervention (mean = 50.25, SD = 12.97) (P < 0.05).

Conclusions

Health education for enterostomy patients after discharge can improve their self-care ability and psychological adaptation. Future studies could further explore the views and attitudes of this population toward health education based on the WeChat health management program.

Self-care knowledge in patients with intestinal stomas in a selected hospital in the south of Viet Nam: A descriptive cross-sectional study

Background

Intestinal stomas are surgical interventions that have an impact on both physical and psychological health, necessitating patient self-care. Insufficient knowledge regarding peristomal skin care, prevention, and treatment of potential problems can lead to an increase in stoma-related complications.

Objective

This study aimed to assess patients' knowledge of self-care for intestinal stomas and examine the relationship between background information and self-care knowledge.

Methods

A descriptive cross-sectional study was conducted from December 2021 to December 2022 at the Can Tho University of Medicine and Pharmacy Hospital in Vietnam, involving 74 participants with intestinal stomas. A questionnaire consisting of 24 closed-ended questions was used to evaluate participants' knowledge of self-care for intestinal stomas. Descriptive statistics, Chi-square, and Fisher's exact tests were employed for data analysis.

Results

The findings revealed that 54.1% of participants had good knowledge of general self-care for intestinal stomas. The distribution of good knowledge among participants was as follows: basic knowledge (66.2%), self-care practice (56.8%), recognizing and managing complications (31.1%), and dietary knowledge (64.8%). Significant relationships were observed between participants' self-care knowledge and their education level (p = 0.002), marital status (p = 0.017), nurses' education (p = 0.021), and hospitalization (p = 0.001).

Conclusion

The proportion of participants with good knowledge of self-care for intestinal stomas was relatively low, and it was associated with individuals' education level, marital status, nurses' education, and hospitalization. This study highlights the need for ongoing development of educational programs on self-care for intestinal stomas. These programs should be tailored to address the specific needs of each patient and aim to improve their self-care knowledge in a meaningful and sustainable manner. By investing in patient education, healthcare professionals, particularly nurses, can assist individuals with intestinal stomas in achieving better outcomes and preventing potential complications.

eHealth Promoting Stoma Self-care for People With an Elimination Ostomy: Focus Group Study

BACKGROUND

The construction of an elimination stoma has a physical, psychological, and social impact on the person. The development of stoma self-care competence contributes to the adaptation to a new health condition and improvement of quality of life. eHealth refers to everything associated with information and communication technology and health care, including telemedicine, mobile health, and health informatics. The use of eHealth platforms by the person with an ostomy, as a digital application that includes websites and mobile phone apps, can bring scientific knowledge and well-informed practices to individuals, families, and communities. It also allows functionalities that enable the person to describe and identify early signs and symptoms and precursors of complications and to be guided to an adequate health response for their problems.

OBJECTIVE

This study aimed to define the most relevant content and features to promote ostomy self-care integrated into an eHealth platform as a digital app or website to be used by patients for self-management of stoma care.

METHODS

We developed a descriptive, exploratory study with a qualitative approach using the focus group methodology, which was oriented to reach a consensus of at least 80%. A convenience sample of 7 participants consisting of stomatherapy nurses was used. The focus group discussion was recorded, and field notes were taken. The focus group meeting was fully transcribed, and a qualitative analysis was performed. The research question was: Which content and features for ostomy self-care promotion should be integrated into an eHealth platform as a digital app or website?

RESULTS

An eHealth platform, which can be a smartphone app or website, for people with ostomy should provide content aimed at promoting self-care, namely in the field of knowledge and self-monitoring, as well as the possibility of interacting with a stomatherapy care nurse.

CONCLUSIONS

The stomatherapy nurse has a decisive role in promoting adaptation to life with a stoma, namely through the promotion of stoma self-care. Technological evolution has emerged as a useful tool to enhance nursing interventions and promote self-care competence. The development of an eHealth platform aimed at promoting ostomy self-care should include the capabilities for telehealth and help with decision-making regarding self-monitoring and seeking differentiated care.

Perceived Therapeutic Self-Care Ability of Patients in Surgical Units: A Multisite Survey

Assessing patients' therapeutic self-care ability allows nurses to initialize care and implement interventions to enhance their self-care abilities. However, sociocultural beliefs and determinants can affect patients' self-care practices. This study determined perceived therapeutic self-care ability of patients in surgical units in Pakistan. A survey was conducted using a purposive sample 511 patients admitted to surgical units for at least 24 hours. Data were collected using the Urdu version of Therapeutic Self-Care Measure. The mean self-care ability score was 20.05 ± 4.3. Patients felt more prepared to take their medications, but less prepared to respond to any unforeseeable physical changes. Significant difference was found between self-care ability of male (20.68 ± 4.15) and female (19.18 ± 4.27) (p < .001) patients. A weak negative correlation was found between patient age and self-care ability (r = -0.15, p = .001). Self-care ability assessment should be included in routine discharge planning, and nurses should provide more tailored self-care discharge education to surgical patients.

Predictors of Adjustment to Living with an Ostomy: Results of a Cross-sectional Study

OBJECTIVE

To describe predictors of adjustment to living with an ostomy among Italian adults with an enterostomy or a colostomy.

METHODS

A multicenter, cross-sectional design was performed, sampling 403 patients with an ostomy in three different outpatient clinics of northern Italy between April 2018 and December 2020. Data were collected by stoma therapists in ambulatory settings using the Italian version of the Ostomy Adjustment Inventory-23 and patient medical records.

RESULTS

Acceptance was lower among women, patients who underwent emergency surgery, those with a urostomy, and those with a body mass index of less than or equal to 25 kg/m2. Negative feelings were associated with higher body mass index, colostomies, shorter length of time of living with an ostomy, and emergency ostomy creation.

CONCLUSIONS

Being young and having a high level of education are protective against psychosocial problems and help promote acceptance and social engagement. The findings of this study help identify patients who are likely to be more vulnerable and need greater support through specific educational and motivational interventions.

Nursing Interventions to Promote Self-Care in a Candidate for a Bowel Elimination Ostomy: Scoping Review

Objectives: To identify nursing interventions, their characteristics, and outcomes for promoting self-care in candidates for a bowel elimination ostomy. Materials and methods: A scoping review was carried out based on the Joanna Briggs Institute’s recommendations. For this, studies published in Portuguese, English, and Spanish on the Web of Science, CINAHL, and Scopus databases and without a time limit were selected on November 9, 2020. Results: Of 2248 articles identified, 41 were included in this review. We identified 20 nursing interventions associated with the self-care of patients with an ostomy; most of them have gaps in their content, method, and frequency or dosing. More than 30 indicators were identified to assess the impact of nursing interventions; however, most of them were indirect assessments. Conclusion: There is scarce evidence regarding the different aspects that must be involved in nursing interventions for patients with a stoma. Moreover, there is no standardization in methods, frequency, or dosing of intervention. It is urgent to define the content, method, and frequency of nursing interventions necessary to promote self-care in patients with a bowel elimination ostomy and to use assessment tools that directly measure stoma self-care competence.

Effects of continuous care on health outcomes in patients with stoma: A systematic review and meta-analysis

Objective

Continuing care, which is an extension of post-discharge care, is recognized as a crucial element of high-quality health services and is essential to patients. This systematic review aims to identify the effectiveness of continuing care for patients with stomas.

Methods

PubMed, EMBASE, Cochrane Trial Register and Web of Science databases were searched. Study selection and quality appraisal were performed independently by two reviewers. We calculated the mean differences (MD) or the relative risk (RR) with 95% confidence intervals and assessed heterogeneity.

Results

Nine studies (1134 participants) met the inclusion criteria. This meta-analysis revealed that, in the continuous care group, the stoma self-efficacy (MD ​= ​6.46; 95% CI ​= ​3.81–9.11; P ​< ​0.001; I² ​= ​0%), and the quality of life (MD ​= ​7.48; 95% CI ​= ​5.13–9.82; P ​< ​0.001; I² ​= ​0%) increased significantly 1 month after discharge; stoma adjustment and care satisfaction also showed a trend toward improvement while stoma complications (RR ​= ​0.71; 95% CI ​= ​0.58–0.87; P ​= ​0.001; I² ​= ​25%) decreased significantly. Continuing care did not decrease hospital readmission rates or medical costs.

Conclusions

Continuing care showed beneficial effects in improving health outcomes and care satisfaction for patients with stomas compared with routine care. We proposed an integrated continuing care program with different elements and recommendations for its implementation.

Sociodemographic characteristics and self-care management knowledge of patients with an ostomy

BACKGROUND

An increasing number of patients worldwide are living with an ostomy. Among them, self-care management skills and stoma self-care abilities are associated with better quality of life.

AIMS

To identify the sociodemographic and clinical characteristics of Italian ostomy patients and investigate their knowledge of stoma management.

METHODS

A questionnaire was used to gather the sociodemographic and clinical data of 433 adult patients. Participants responded to a nine-item survey assessing their knowledge of stoma management.

FINDINGS

Respondents reported having received extensive or adequate information in 64.4% of cases, and the remaining 35.6% reported receiving little or no information at any time. The health professional who imparted at least adequate information was a stoma nurse specialist in 32.1% of cases, usually during admission (24.0%) or before and during admission (19.6%).

CONCLUSION

This study demonstrated that most patients received adequate information regarding the ostomy.

Empowerment-Based Education in Urological Patients: A Scoping Review

Prostate, kidney, and bladder cancer are the three most frequently diagnosed urological cancers. Educational programs could teach patients to become experts in disease management. The aim of this scoping review was to explore the literature to identify the educational requirements and strategies for improving and implementing educational processes for urological patients undergoing surgery. We searched several databases, including PubMed, CINAHL, Embase, Scopus, PsycINFO, and Cochrane Library. All adult patients undergoing urological educational interventions were included in the review. Of 3,197 initially identified articles, 42 were retained. Urological patients undergoing prostatectomy, cystectomy, and nephrectomy require cognitive, psychological, and functional support. For each level of support, several methods exist to provide support, including informational brochures, preoperative counseling, telephone support, online content, educational videos, support groups, individual stress management interventions, peer support, online interventions, partner support, and various educational programs that help the patient manage negative effects associated with the urological intervention.

Caregiver contribution to self-care and its associated variables among caregivers of ostomy patients: Results of a cross-sectional study

AIMS AND OBJECTIVES

To describe caregiver contribution (CC) to ostomy self-care and identify its associated variables among caregivers of ostomy patients.

BACKGROUND

Self-care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self-care behaviours. So far, the CC to ostomy self-care has not been investigated thoroughly.

DESIGN

This is a cross-sectional and multicentre study conducted at seven outpatient clinics of two Italian regions.

METHODS

We recruited 252 caregivers between February 2017-May 2018. The Caregiver Contribution to Ostomy Self-Care Index (CC-OSCI) was used to measure CC to ostomy self-care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study.

RESULTS

The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self-care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self-care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self-care management.

CONCLUSIONS

We found a variety of sociodemographic factors associated with CC to ostomy self-care.

RELEVANCE TO CLINICAL PRACTICE

Sociodemographic variables associated with CC to ostomy self-care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging.

The Quality of Life of Patients with Colorectal Cancer and a Stoma in China: A Quantitative Cross-sectional Study

OBJECTIVE

To explore quality of life (QOL) in patients with colorectal cancer and a stoma and factors associated with their QOL.

METHODS

A quantitative cross-sectional study was carried out in the stoma and wound care clinic of a cancer hospital in China. Participants were recruited from clinic patients. Investigators collected demographic data and clinical information; QOL was measured using a Chinese version of the stoma-QOL scale.

RESULTS

In total, 359 participants took part; 161 (44.8%) had an ileostomy, whereas the others had a colostomy, and about half of the participants (46.5%) had a permanent stoma. The mean age was 57.86 ± 11.92 years. The QOL scores of most participants were poor, with a median value of 49.44. Participants whose stoma was cared for by others had a significantly lower QOL score than those who cared for their own stomas (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.05-2.38; P = .029). Participants with a temporary stoma had a lower QOL score than those with a permanent stoma (OR, 2.08; 95% CI, 1.275-3.40; P = .004). Further, participants with a complication had a lower QOL score than those without (OR, 1.62; 95% CI, 1.07-2.43; P = .022).

CONCLUSIONS

These findings suggest a need for well-developed interventions to improve the QOL of these patients. This study provides valuable insights to inform the development of future clinical practice and research in this area in China and beyond.

Psychometric Properties of New Subscales of the Ostomy Adjustment Scale: A Cross-Sectional Study

BACKGROUND

The Ostomy Adjustment Scale (OAS), which consists of an overall sum score along with 34 single-item scores, has been frequently used to measure self-reported adjustment to life with an ostomy. However, it is unknown whether the OAS can be divided into meaningful thematic subscales that may make it easier to administer and to apply in a clinical feedback system.

PURPOSE

The purpose of this study was to specify thematic OAS subscales and evaluate their psychometric properties.

PATIENTS AND METHODS

A cross-sectional study was conducted with 302 patients across Norway having colostomy, ileostomy, or urostomy. The OAS items were divided into different subscales by expert nurses and patients based on clinical and theoretical considerations. The overall structural validity of this analysis of the OAS was examined using robust confirmatory factor analysis. We evaluated the overall goodness of fit using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker-Lewis index (TLI). Factor loadings from the confirmatory factor analysis were used to calculate composite reliability values for the new OAS scales.

RESULTS

The OAS was divided into seven subscales. The overall structure validity was acceptable with RMSEA = 0.053 (90% CI, 0.045-0.060), CFI = 0.913 and TLI = 0.904. The composite reliability values of all scales were >0.70.

CONCLUSIONS

The OAS can be divided into seven clinically meaningful subscales with acceptable psychometric properties.

TRIAL REGISTER

ClinicalTrials.gov Registration Number: NCT03841071. Date 18. February 2019 retrospectively registered.

Immediate postoperative experiences before discharge among patients with rectal cancer and a permanent colostomy: A qualitative study

PURPOSE

Patients with rectal cancer with a permanent colostomy often have issues in physical, psychological and social domains. Since discharge is an important transition period, the patient experience at that time is worthy of attention. The aim of this study was to explore the immediate postoperative experiences before discharge among patients with rectal cancer and a permanent colostomy in China.

METHODS

A qualitative design was used. Semi-structured interviews were conducted with 18 patients newly living with colostomy in China, who were asked open-ended questions about their postoperative experience. The thematic analysis approach was used to analyze the data.

RESULTS

Four themes and twelve sub-themes were identified from the interviews: (1) psychological reactions (stoma self-acceptance, negative emotion and social isolation), (2) daily life concern (daily life misunderstandings, sexual life compromise and work restriction), (3) stoma care consideration (strong stoma self-care willingness, decreased stoma self-care confidence and access to high-quality stoma care), and (4) support from others (enterostomal nurses, family members and stoma friends).

CONCLUSION

Colostomy patients experience various obstacles in physiological, psychological, and societal aspect. Nurses should provide effective discharge guidance to correct misunderstandings about the stoma, refer patients to psychological care, and promote transitional care.