Psychosocial adjustment among patients with ostomy: a survey in stoma clinics, Nepal

Abstract

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. Perceived lack of family support (b=−0.367, P<0.001), total dependence on others to care for ostomy (b=−0.357, P<0.001), and unemployment (b=−0.144, P=0.032) significantly predicted lower psychosocial adjustment scores. However, increased time since ostomy surgery (b=0.361, P<0.001) significantly predicted higher psychosocial adjustment scores. Conclusion:Ostomy often affects all aspects of a patient's life; however, emotional, sexual, and social lives are the most affected areas. Importantly, the focus of treatment for ostomates should expand beyond the physical boundaries and should consider psychosocial concerns as well.

Effects of social support and self‐efficacy on the psychosocial adjustment of Korean ostomy patients

“…Moreover, a recent study reported that stoma management education provided by nurses immediately after surgery is too short for patients to fully understand the contents even though it was still considered helpful . Multiple studies have also emphasised that programmes for the continued management of stomas provided by medical staff are required even after discharge, which is consistent with the current findings and recommendations …”

“…When the factors that influence the adjustment group were tested after adjusting for time, medical staff support was found to increase the patients' psychosocial adjustment, while the level of adjustment decreased with increases in the family's support. Although many studies found that family support positively influences the adjustment and quality of life of ostomy patients, this study found that the patients' high level of support from their families decreased their psychosocial adjustment when time was statistically adjusted.…”

“…36 Multiple studies have also emphasised that programmes for the continued management of stomas provided by medical staff are required even after discharge, which is consistent with the current findings and recommendations. 12,17,19 As rapidly evolving new medical technologies now provide more information, medical staff is required to provide support and sufficient education on new medical technologies and ostomy goods. However, in Korea, overcrowding at general hospitals has led to problems such as medical staff shortages and reduced treatment times.…”

“…Indeed, belief in one's self-efficacy was found to increase when patients could independently perform self-care, including stoma management. 19 Moreover, self-efficacy over stomas was found to be a major predictor that relieves the burden of stomas and promotes psychosocial adjustment in colostomy patients. 14,18,20 Various South Korean studies have investigated the psychosocial adjustment of ostomy patients.…”

“…Such self‐efficacy over stomas is an important factor that influences the self‐care behaviours of colostomy patients. Indeed, belief in one's self‐efficacy was found to increase when patients could independently perform self‐care, including stoma management . Moreover, self‐efficacy over stomas was found to be a major predictor that relieves the burden of stomas and promotes psychosocial adjustment in colostomy patients …”