Kaohsiung J Med Sci February Vol No H - PDF document

Kaohsiung J Med Sci February 2004 € Vol 20 € No 2H.C. Tseng, H.H. Wang, Y.Y. Hsu, and W.C. Weng70 ELATEDUTPATIENTS Received: July 18, 2003 © 2004 Elsevier. All rights reserved.According to statistics posted by the Taiwan Department ofHealth, carcinoma of the rectum was the third major causeHealth care professionals could provide more assistanceIllness can be a source of stress because of the demandson the individual. When the demand is perceived as Stress in patients with colostomies71Kaohsiung J Med Sci February 2004 € Vol 20 € No 2Outpatients with permanent colostomies experienceproblems in all aspects of quality of life [4], such as fecalincontinence and increased frequency in defecation [11],Colostomy patients who obtain support from familymembers and spouses tend to have better rehabilitation.Trainor [19] and Zhao [20] did not find age to be apredictive factor of acceptance of a colostomy, but HellmanGutman and Reiss demonstrated that young femalecolostomy patients tend to experience disappointment,Thomas et al studied colostomy patients 3 months to 1year after colostomy creation [23]. They assessed psychologicfemale colostomy patients had medium to heavy psychiatricSubjects who have regular colostomy irrigation spendless time dealing with feces and appliances than those whoAge, type of preoperative illness, quality of the operation,social support, individual factors, and length of time afterPATIENTS AND METHODSSubjectsConvenience sampling was used in this study. Subjects stress on a five-point Likert scale: 0, never had experi-ence; 1, had experience but never felt bothered by the factor;2, sometimes felt stress and the factor influenced activitiesof daily living; 3, had been bothered by the stress; and 4, al-ways sensed the stress and had great distress in activitiesof daily living. A higher score indicates higher levels ofstress.The Stress of Colostomy Patients Scale was determinedto have satisfactory content validity upon examination byexperts. Construct validity was established by principalfactor analysis. The total variance was 40.1%. Four factorswere categorized, including stress from changes in physicalstatus (22.8%), stress from changes in interaction with familymembers (6.5%), stress from changes in self-concept (5.8%),and stress from care of the colostomy (5.0%). Split halfreliability was 0.94. Cronbachs ! for reliability was 0.91 forthe whole scale and 0.85, 0.80, 0.80, and 0.78 for the foursubscales, respectively [5]. Split half reliability in the pre-sent study was 0.91. Cronbachs ! in the present study was0.90 for the whole scale and 0.85, 0.78, 0.80, and 0.80 for eachsubscale.Statistical analysisData were analyzed using SPSS version 10 (SPSS Inc,Chicago, IL, USA) for Windows. Descriptive statistics, one-way ANOVA, and stepwise multiple regression analysiswere applied. Levenes test was used to examine normalityand heterogeneity. Because there was no significantdifference (p � 0.05) between each item, ANOVA wasemployed.RESULTS � 656 4 1 � 12 4 the diseaseŽ; and, I suffer from insomniaŽ. Patients were MeanSD502.311.13512.651.07412.351.12402.051.07542.551.26352.791.25342.391.23371.821.11721.991.07221.360.97281.481.03221.530.99302.151.01241.590.8315. I worry that the colostomy puts me at higher risk of a hernia due to exercise and physical activity.262.091.10391.861.17181.230.76371.410.98391.591.28351.971.02562.221.25462.441.25571.650.76471.810.721.760.89621.981.01521.581.09431.881.02301.991.07171.330.71321.720.82 Kaohsiung J Med Sci February 2004 € Vol 20 € No 2H.C. Tseng, H.H. Wang, Y.Y. Hsu, and W.C. Weng74concept, and care of the colostomy, were analyzed using anindependent t test or one-way ANOVA. Caregivers had asignificant effect (t = 10.89, p )analyzing the stress levels due to each factor, two variablest = 7.27, p )(t13.73, p )()DISCUSSIONThe most important stressor reported by patients wasmonths after the operation. The percentage of patients whoThe illiteracy rate in this study was higher than that ina previous study (24.6% vs 31.5%) [5]. Therefore, written gui-However, colostomy care may be a burden for patientsand family members. Health care professionals and family Changes inChanges in interaction withChanges inColostomyphysical statusfamily self-conceptcare6.2152.54Employment post-operation*1.91Caregivers of colostomy patients* Stress in patients with colostomies75Kaohsiung J Med Sci February 2004 € Vol 20 € No 2(13.7%) provided the most help and support to subjects.Caring, love, and support from family and health care pro-Zhaos study revealed that colostomy patients withother diseases show a significant difference from thoseCONCLUSIONThe results of this study indicate that other diseases andan increased burden on the children and spouses of older co-Nurses should provide client-centered education in skillsof colostomy care for patients and their families. In Taiwan,In addition to colostomy care, 42.5% of subjects receivedother treatments, such as chemotherapy or radiotherapy.When providing health education, health care profes-sionals should encourage colostomy patients to care for theirOur subjects were recruited entirely from one medicalcenter in southern Taiwan, and the results may not be appli-ACKNOWLEDGMENTSWe are grateful to the 73 subjects who participated in this 2.Lewis SM, Collier IC, Heitkemper MM. Medical-SurgicalNursing … Assessment and Management of Clinical Problems.St. Louis: Mosby, 1996;1073…257.3.Thompson J. A practical ostomy guide. Part one. 4.Camilleri-Brennan J, Steele RJ. Quality of life after treatment6.Roberts BL, Fitzpatrick JJ. Margin in life among hospitalized14.Thomas C, Turner P, Madden F. Coping and the outcome of20.Zhao JY. 22.Chang HD, Ku NP. A preliminary study on the psychosocial25.Wang HH. The impact of caregiving role on women: nursing26.Black PK.