The aim of the study was to explore surgical nurses’ perceptions of patients’ needs post-stoma surgery. A descriptive and non-experimental, cross-sectional design was used in the study. Twelve female surgical nurses from two surgical wards were chosen by means of convenience sampling. Face-to-face semi-structured interviews comprising of both close-ended and open-questions were the main means for data collection.
The data was analyzed quantitatively by means of descriptive statics. Graphs and tables were used to illustrate the findings. Furthermore, content analysis was used to analyze the qualitative data. By investigating the nurses’ perceptions, proposed changes were suggested in order to provide better quality of care towards the post-operative stoma patients.
Results in the study indicate that the female surgical nurses’ perceptions of ostomates’ post-operative needs seems to be parallel to those of the stoma patients themselves. On the other hand, there were a small number of dissimilarities when perceptions were compared on whether the needs of ostomates’ were being attended to on the surgical ward. All of the participants stated that the physical, psychological and social needs were imperative for the post-operative stoma patient.
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Furthermore, results show that quite a few nurses expressed that they did not consider all aspects of ostomy care such as sexual health information-giving, teaching and counseling as being part of their nursing role on the ward, stating that this was the role of the Stoma Care Nurse. This suggests some degree of role ambiguity amongst the participants. In addition this may propose that nurses may not have the necessary knowledge, skills and confidence in assisting and dealing with the post-operative needs of stoma patients. However, several nurses suggested that certain aspects of ostomy care need improving upon, allowing for better quality of care thus attending to most, if not all, of the post-stoma patients’ needs.
The results are limiting to the small scale study, however they have highlighted several nursing implications. Recommendations for practice and education including post-graduate education and preparation for improving the nurses’ teaching skills and information-giving related to sexual health information and research were highlighted. In addition, specialized courses in stoma care and counseling programs for all surgical nurses was recommended, allowing nurses to have up-to-date knowledge on stoma care.
Furthermore, proposals for research including a research study using a larger-scale with an improved tool tested for reliability and validity, allowing for more generalizability of the results amongst the Maltese surgical nurses was emphasized at the end of this study.
Table of Contents
Dedication
i
Declaration
ii
Acknowledgements
iii
Abstract
iv
Table of Contents
vi
List of Figures
xi
List of Tables
xiii
CHAPTER 1 INTRODUCTION
1
1.1 Introduction
1
1.2 Local Situation
1
1.3 The purpose of the Study
2
1.4 Research Question
3
1.5 The Importance and Benefit of the Study
3
CHAPTER 2 LITERATURE REVIEW
2.1 Introduction
4
2.2 Ostomates’ post-operative Adjustment to Stoma Formation.
5
2.3 Ostomates’ perceptions of their post operative Physical Needs.
7
Stoma patients’ need for Self-Care
7
Patients’ post-operative Psychological Needs
9
2.4.1 Self Expression Needs
10
Stoma patients’ perceptions of Sexuality and Body Image post-stoma formation.
11
Ostomates’ Information Needs in the post-operative phase.
13
Stoma patients’ perceptions of Social
Support following stoma surgery.
16
2.7 Limitations
18
2.8 Conclusion
19
CHAPTER 3 METHODOLOGY
3.1 Aims and Objectives
20
3.2 Research Question
21
3.3 Operational Definitions
21
3.4 Research Design
22
3.5 Research Site
22
3.6 Target Population
23
3.6.1 Inclusion Criteria
23
3.6.2 Exclusion Criteria
24
3.7 Sampling Technique
24
3.8 Research Tool
25
3.9 Validity and Reliability
26
3.10 Pilot Work
27
3.11 Ethical Considerations
27
3.12 Data Collection and Analysis
29
3.13 Concluding Remarks
29
CHAPTER 4 FINDINGS AND DATA
ANALYSIS
4.1 Introduction
30
4.2 Demographic Data
31
4.3 Physical needs of post-operative stoma patients
35
4.4 Psychological needs related to stoma patient care
38
4.5 Post-operative Stoma Information
43
4.6 Education needs of the patient post-stoma formation
47
4.7 Nurses’ Role of different aspects of stoma care nursing
49
4.8 Enhancing Ostomy Care on the general surgical ward
58
4.9 Conclusion
60
CHAPTER 5 DISCUSSION
5.1 Introduction
61
5.2 Nurses’ perceptions of ostomates Physical and Educational needs in the Post operative phase
62
5.2.1 The nurses’ perceptions on the need to teach patient stoma care
63
5.2.2 Teaching the ostomates about an altered diet and required nutrients following stoma surgery
64
5.2.3 Nurses’ perceptions of the importance of teaching stoma patients about stoma complications
65
5.2.4 Nurses’ perceptions of ostomates alteration in clothing following stoma formation
66
5.3 Nurses’ perceptions of patients’ Psychological Needs post-stoma formation
67
5.3.1 Psychological Adjustment and Social Support
67
5.3.2 Reassurance
69
5.3.3 Sexuality and an Altered Body Image
70
5.4 Nurses’ perceptions of Ostomates’ Information needs
72
5.5 Nurses’ perceptions of ostomy care: The
Surgical Nurse and Specialist Nurses’ Role
74
5.6 Nurses’ Perceptions of Improving Ostomy Care on the Surgical Ward
78
5.7 Critique of the Study: Strengths and Limitations
79
5.7.1 Strengths
79
5.7.2 Limitations
80
5.8 Conclusion
81
CHAPTER 6 CONCLUSION &
RECOMMENDATIONS
6.1 Conclusion
82
6.2 Recommendations
83
6.2.2 Recommendations for Practice and Education
83
6.2.3 Recommendations for Research
85
REFERENCE LIST
86
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