A Specific Health Care Topic - Essay Example

?PICO Questions of the studies Living with a stoma is not a pleasant experience, but what are the effective therapies to uplift the sense of selfto those adult who have stoma? 2. It is not easy to accept experiencing with stoma, but what are the best counseling methods to speed up the coping process of women having stoma? 3. Having stoma is a stigmatic experience, but what are the best strategies to meet the individual expectations post-stomal reversal of those individual in order to minimize if not prevent distress? Abstract Ostomy surgery patients are plagued, not only with the altered lifestyle associated with the surgery; but also with the societal stigma attached to it. According to Bracken, “every patient who faces this type of surgery struggles with fears and anxieties that are universal...” (n.d. cited in International Ostomy Association, 2006). Pre-operative and post-operative health teachings are routine interventions that help the patient prepare for, and manage surgical outcomes; however, studies supporting the common areas of stomal patient concern are scarce. This meta-analysis was done to identify the subject matter that needed further emphasis during patient teaching; as well as to identify the different factors that contributed to the low self-esteem experienced by these patients. Although pre-operative and post-operative education in managing the stoma are being employed by health care institutions, the subject matter and the patient concerns addressed during patient teaching should be assessed in order to provide individualized health teaching that can address patient uncertainty in managing the stoma; allay anxiety in relation to social issues; and prepare the patient for the changes associated with the surgery. Background and Introduction A stoma is an artificial opening made on the side of the abdomen that is used as a permanent, or temporary outlet for feces or urine (Clinimed, n.d.). There are three different types: colostomy--for solid fecal outlet; ileostomy--for soft fecal outlet; and urostomy--as outlet for urine (Clinimed, n.d.). Indications for stoma surgery include: congenital conditions such as malformations in the anus and urethra, and diseases like inflammatory bowel disease, colorectal cancer, diverticulear disease, and ulcers. Ostomy surgery is performed by taking a portion of the large, or small intestine through the abdominal wall to provide an outlet for feces and urine (Encyclopedia of Surgery, n.d.). A collection bag is worn over the stoma and requires routine irrigation to prevent infection and other complications. This procedure is performed to aid healing by diverting fecal matter from an injured or diseased part of the large intestine, for temporary stomas, and to construct an alternative excretory pathway for fecal matter and urine, for permanent stomas. The estimated of the number of patients with a stoma vary across the globe. In the US, approximately 800,000 patients with a stoma were reported in 2000; with growth rate of 3% each year (Turnbull, 2008). Ontario, Quebec and British Columbia were reported to have the highest number of ostomy surgeries annually in 2009; with colostomy accounting for 55%; ileostomy 31%; and urostomy 14% (Registered Nurse’s Association of Ontario, 2009). According to Renzulli and Candinas (2007), stoma formation and delayed closure is associated with high morbidity; and complications including: stomal necrosis, stomal retraction, stomal stenosis, mucocutaneous separation and stomal prolapse. In a study conducted by Makela and Niskasaari (2006), which explored stoma care related problems experienced by stoma surgery patients in Northern Finland, it was found out that 35 patients of the 163 respondents developed stoma complications, particularly parastomal herninas (18 cases). Apart from the problem of having to live with the life-long risks associated with a stoma, self-esteem issues may also surface. According to Honkala and Bertero (2009), the most common concerns of patients before and after an ostomy surgery were “...fear of stool leakage, [escape of fecal] odor and pouch changing...” (p.19). the stigma associated with fecal matter, as well as the odor emitted from it, is the major contributors to the self-esteem issues. Of the 163 respondents in Makela and Niskasaari’s study, 78 patients (66%), 49 (72%) of which had a colostomy and 25 (56%) with an ileostomy, were reported to be well-adapted to their stoma; 41 respondents were reported to have difficulty adapting to their new situation; with 12 not being able to live with their altered body image; 10 had difficulties in their social life; while 9 had a hard time because of fecal leakage (2006). In a study conducted by MacDonald and Anderson (1984), 50% of the 420 patients with rectal cancer--265 of which have colostomies, experienced being labeled and ridiculed; with the highest incidence in younger patients and those with a colostomy. This review seeks to elucidate the common areas of concern of patients undergoing ostomy surgery, or those with a stoma to guide nurses in future pre-operative and post-operative health teaching. The literature accessed for this review was obtained from various database using the key terms: “ostomy”, “ostomy surgery”, “stigma”, “ostomy UK”, “statistics”, ” preoperative and postoperative education”, “colostomy”, “culture”, and “Maslow’s hierarchy of needs”. Review and discussion Manderson (2005) conducted a qualitative study exploring the experiences, and discomforts of 32 participants with a stoma, who responded to a research note placed in a national journal--Ostomy Australia. The participants were Australian, or English-speaking immigrants between the ages of 24 and 82 at the time of interview. Sixty one percent (21 participants) of which were females, and 34% (11 participants) were males (Manderson, 2005). At the time the research was conducted, 71% were married or in a serious relationship; 78% had children; and 50% were working at home or retired (Manderson, 2005). Data gathering was done by employing an unstructured interview, for 18 participants, and using a questionnaire with open-ended type questions, for 14 of the participants (Manderson, 2005). The information obtained from the interviews, as well as the questionnaires, were tape recorded and transcribed for thematic analysis; a review of related articles, published biographic accounts, and participation by the researcher in local meetings of stoma therapists was done to establish the validity and reliability of the data acquired (Manderson, 2005). The data led to the conclusion that living with a stoma, as well as the disease that led to the surgery, was demeaning to the “...sense of self as a valued adult and as a sexual being...”; it was also found out that incontinence was plaguing, not only the person with the stoma, but the partner as well (Manderson, 2005, p.412). According to the researcher, lover and spouses play a major role in providing the self-esteem needs of the patient with a stoma (Manderson, 2005). The increasing incidence of ostomy surgery patients in other countries limits the scope of the study since most of the participants recruited were of Australian descent. Culture plays a major role in the coping mechanisms used by people. According to Nardon (2006), the cultural perception about control over the environment, and the role orientation of an individual affects the way a person copes with the uncertainty of things. Education and support given, before and after ostomy surgery, was not taken into consideration by the researcher. Education can empower the patient by giving them the skills necessary to deal with the uncertainties that may come with a stoma. Knowing how to deal with these uncertainties gives the patient security, and allows them to progress from a state of fear and anger, to a state of control and acceptance over ones’ condition. According to Maslow’s hierarchy of needs, in order to achieve the highest level of the hierarchy--self-actualization, bottom needs such as: physiological, security, social, and esteem needs must be met first (Cherry, n.d.). When these are achieved, the person will then be able to focus on personal growth and expanding their potential, while becoming less concerned with other people’s opinions and societal stigmas (Cherry, n.d.). Honkala & Bertero (2009) conducted an interpretive phenomenological study that explored the lived experience of women with a stoma, and how their condition affected their way of life. Purposive sampling was done based on the following criteria: adult women older than 18, lived or was living with a stoma for 2 years or more, spoke and understood the Swedish language, and was a willing participant of the study. The study was able to recruit 17 women, between the ages 33 and 80 years old, who had had their stoma between 2 and 38 years (Honkala & Bertero, 2009). The data from the interviews allowed for the identification of two sufferings relieved by the surgery--protracted suffering, from frequent diarrhea, fecal incontinence and the like; and suffering from impending death (Honkala & Bertero, 2009). The researcher also identified 4 themes--”bodily restraints”, “I as a woman”, “adaptation to daily life”, that summarized the feelings and perceptions of women with a stoma (Honkala & Bertero, 2009, p.19). These themes served as the stepping stone that led them towards acceptance, which is embodied in the essence of “reconciliation to a changed life” (Honkala & Bertero, 2009, p.21). Women in the study were found out to be satisfied with their lives after the surgery, and have grown to accept, as well as live with, and around the limitations associated with having a stoma. The narrow age group among study participants may have affected the conclusion drawn by the researchers. Different age groups have different ways of perceiving struggles, of seeing themselves after the surgery, and of coping with the situation presented before them. According to Trouillet, et al. (2009), age inevitably affects the coping process. Although the main predictor of problem-focused and emotion-focused coping is not age, the experience that increases across a persons’ lifespan allow them to gain further insight to the events that can fuel self-efficiency, to acquire a social support system that can walk with them through changes like acquiring a stoma, and to learn how to better deal with stressors. The advantage of this study, however, is that it highlights the different levels of acceptance that a person with a stoma experiences through time. The wide discrepancy between the lengths of time that the respondents had their stoma enabled the researcher to show the different obstacles experienced by the women, as well as the turning points in their lives that allowed them to accept and adapt with their unique situation. Owen and Papageorgiou (2008) conducted an exploratory first level descriptive research designed to delineate the relationship between “...degree of stigma in chronic illness and ability to participate in the community...” using one-on-one semi-structured interviews employing open-ended question in data acquisition. Five participants, 2 males and 3 females between the ages 60-78 years old, were recruited via purposive sampling through their association with the colorectal and stoma care department at the Norfolk and Norwich University Hospital in Norwich (Owen & Papageorgiou, 2008). Interviews were audio taped, while researchers took notes to record the participant’s nonverbal language (Owen & Papageorgiou, 2008). The study found out that individual expectations post-stomal reversal were not met; causing distress, as well as a negative impact on the participants’ life (Owen & Papageorgiou, 2008). The narrow age range, and the lone age group--aged, where they belong, limits the generalizability of the research. In a study by Stevens (1993), “continuity in respect...meeting one’s expectations...and [a] sense of usefulness...” are the prerequisites for satisfaction in older adults aging 60 to 90. These prerequisites for satisfaction may not be the same for other age groups. Again, education pre- and post-stomal reversal was not taken into consideration by the researcher; as this can affect the patients’ perception of their condition after stomal reversal. Education before surgery can correct any misconceived outcomes by the patient; and prepare them for the associated risk and adverse effects of the surgery. According to Booth, et al. (2009), an educated patient is more satisfied, is more compliant with post-operative treatment programs, and is more active in providing and promoting self-care. Conclusion The different areas identified by the study from which to focus health teaching on are broad. Educating patients with a stoma should not only focus on stomal management, but should also include other aspects of the patient as person that may affect satisfaction and compliance with treatment and rehabilitative programs. Individualized patient teaching should be done with the underlying goal of shifting the patient from a state of uncertainty and fear, to one who is confident, empowered and capable of providing self-care. According to Sampaio, et al. (2008), “...the support-education system allows for the promotion health and [alters] the patients’ perception regarding the importance of self-care...” Empowering patients to take control of their health, not only promotes self-care, but also builds self-esteem. Self-esteem is built by treating oneself, the way one wants to treat by others (21). References Booth, K. et al., 2009. Patient education: medical assisting. 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Ostomy statistics: the $64,000 question. [Online]. Available at: http://www.o-wm.com/content/ostomy-statistics-the-64000-question [Accessed 11 May 2011]. Read More