|Year : 2019 | Volume
| Issue : 1 | Page : 57-59
Self-efficacy of patients with stoma in performing stoma care
Lyshy Mariam Thomas, Ida Nirmal
College of Nursing, CMC, Vellore, Tamil Nadu, India
|Date of Web Publication||09-Oct-2019|
Prof. Ida Nirmal
College of Nursing CMC, Vellore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Persons with stoma (ostomates) have to contend with substantial changes in bowel functions, dietary habits and body image. Adjusting to these changes could be challenging. Effective management of stoma can help this process. A quantitative study was conducted to assess the self-efficacy of stoma care among patients with stoma. Within a descriptive research design, consecutive sampling was used to recruit ostamates for the study. Data were collected using modified stoma self-efficacy scale. Analysis revealed that 56% had moderate self-efficacy and 43.5% had high self-efficacy. Further studies are needed to generalise the findings. Nurses need to be aware that self-efficacy of stoma care among ostomates can influence their quality of life.
Keywords: Ostomates, self-efficacy, stoma
|How to cite this article:|
Thomas LM, Nirmal I. Self-efficacy of patients with stoma in performing stoma care. Indian J Cont Nsg Edn 2019;20:57-9
| Introduction|| |
There are >1 million patients with stoma all over the world and the number is increasing at the rate of 100,000 per year. Clients with stoma must master multiple psychomotor skills such as removing their pouch, cleaning the stoma and peristomal skin and emptying and disposing the effluent from the pouch. The presence of stoma in an individual affects as much psychologically and socially as it does physically. Therefore, if patients fail to develop the skill required for stoma care, they become dependent on others for stoma care. This affects the quality of life (QOL) of patients.
Cross-sectional studies done among stoma patients reveal a significant positive correlation between the QOL of patients with stoma and stoma care self-efficacy. It is also found that the sooner individual learns stoma care, the better is the long-term QOL. This reflects the importance of education and training on stoma care in the initial period to improve the QOL. Education and training during follow-up by a specialist nurse are found to be ideal.
Stoma care self-efficacy is positively related to stoma adjustment and acceptance, which ultimately improves the stoma-QOL. Implementing specific interventions to improve the self-efficacy of ostomates in the performance of stoma care is one of the vital responsibilities of nurses.
- The objective of the study was to assess the self-efficacy of patients in performing stoma care.
| Materials and Methods|| |
A quantitative research approach with a descriptive research design was utilised for the study. The study was conducted in the surgical wards of a tertiary care centre in South India. The population consisted of 23 patients admitted in the general surgical wards with gastrointestinal stomas, viz. colostomy or ileostomy for <4 weeks. All subjects performed stoma care by themselves. Total enumerative sampling technique was followed.
The instrument used to collect data was Becker's stoma self-efficacy assessment tool. Cronbach's alpha coefficient of the questionnaire was 0.97, which represents good reliability. The tool containing 28 items assesses self-efficacy with regard to diet choice, sexual life, confidence for heavy physical labour, keeping active and stoma self-management. Since our focus was on patient's ability to manage their stoma, 12 items related to stoma self-management and confidence for physical labour were selected and were used in the current study. Respondents opted 1–5 categories ranging from not confident to highly confident. The total score can range from 12 to 60. The level of self-efficacy in terms of confidence was graded as high self-efficacy (>45/54), moderate self-efficacy (30–44.9) and low self-efficacy (<39.9). Descriptive statistics was used to analyse the level of self-efficacy.
The proposal was submitted and approved in the clinical meeting of the department of surgical nursing. Permission was obtained from the head of the department. Verbal consent was obtained from the subjects before data collection and confidentiality of information was ensured. Data were collected by the investigator through direct interview with the ostomates for 2 weeks.
| Results and Discussion|| |
Majority of the participants with stoma (56.5%) had moderate level of self-efficacy with regard to stoma care. 43.5% of the patients had high self-efficacy of stoma care. None of the participants had low self-efficacy [Figure 1].
|Figure 1: Level of self-efficacy of stoma care among patients with gastrointestinal stomas.|
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Majority of the subjects expressed that they were fairly confident with many aspects of self-efficacy of stoma care. None of them reported high level of confidence in any of the aspects measured. Several studies report that usually, patients with stoma do not have very high level of self-efficacy., In the current study, most of the patients (86.95%) expressed that they were only fairly confident in applying their stoma appliance. The proportion in this study finding is much better and higher than the finding by the study done by Marquis et al., which revealed that only 113 out of 1091 (10.35%) responded with a high confidence rating when answering the question “How confident are you about changing your appliance?”
The present study also showed that patients had low confidence in certain aspects of stoma care [Figure 2]. With regard to taking care of stoma outdoors, 47.8% were fairly confident, 39.1% of ostomates were moderately confident and 8.7% were slightly confident. Almost all of them (95.7%) were fairly confident in following nurses' instruction. Many patients found it difficult to take care of stoma when they were ill. Majority of them (65.2%) were under moderately confident level. In wearing the clothes they like, only 47.8% were fairly confident, whereas 52% of them were either moderately or only slightly confident. Many (56.5%) were not fully confident in carrying out light duties in the house and 60.9% were fairly confident in preventing skin problems. These findings are supported by the study by Pandey et al., which reported that 33% of patients are not confident in taking care of the stoma in the right way outdoors and 18% and 15% of patients are not confident in taking care of stoma when they were ill and to carry out light duties in and around the house, respectively.
|Figure 2: Distribution of subjects related to self-efficacy on aspects of stoma self-management.|
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| Discussion|| |
Subjects recruited for the study were from the clinical unit, which specialises in stoma care and who were attended by stoma care nurses every day. In spite of such close attention many of them reported fair confidence and none high confidence. Stoma self-care efficacy has been positively related to stoma adjustment., Lack of high confidence may be due to incomplete adjustment to having stoma in most of them. The current study findings also highlight that patients lack confidence in certain aspects of stoma care self-efficacy such as taking care of stoma outdoors, during illness, wearing clothes they like and preventing skin problems. Body image concerns and acceptance in the society may be issues that hinder them to have high confidence in certain aspects. Further exploration on factors that are related to self-efficacy is needed. Nurses need to be aware of these special situations which demand appropriate interventions to enhance the stoma-QOL. As sample size and data collection period were limited, a similar study with a large sample and extended period of data collection could be undertaken for generalisation.
| Conclusion|| |
Living with stoma is not easy. For ostamates, the adjustment to having a stoma is a convoluted process. Adjustment and acceptance of the stoma lead to higher self-efficacy and better QOL. Nurses who take care of patients with ostomy either in the hospital or in the community need to be sensitive to their needs related to acceptance and adaptation to ostomy and provide care based on each individual. This study has provided some insight into which areas need more attention so that the specialised nurses could focus their efforts on the specific area of need.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]