The mediating role of resilience in the relationship between personality and adjustment to disease in patients with a drainage enterostomy.

An understanding of what variables are involved in a better adjustment to chronic disease makes it possible to implement more suitable community healthcare interventions. It also allows the design of educational programmes aimed at increasing the independence of these patients, thereby enabling them to achieve a better health status. Both the personality and the resilience of the patient have been shown to play an important role in the process of adjusting to the new living conditions that result from having a chronic disease. Yet, to date, little research has been conducted in this area. This study uses structural equation modelling to explore the relationships among the personality factors, resilience and the variables of adjustment to disease (i.e. quality of life and level of self-care). The sample consists of 125 patients with a drainage enterostomy. Results show that the relationship model with the best fit is the one that considers resilience as a mediating variable in the relation between personality and disease adjustment variables. The implications of the findings and the limitations of the study are also discussed.

Development and Validation of an Instrument Measuring Self-Care in Persons With a Fecal Ostomy.

PURPOSE: The purpose of this study was to describe development of the Specific Self-Care for Ostomized Patients Questionnaire (CAESPO) instrument and evaluate its construct validity, internal reliability, and test-retest reliability (temporal stability). DESIGN: Prospective evaluation of psychometric properties of the instrument. SUBJECTS AND SETTING: The study sample comprised 125 persons (n = 89, 71.2% men) with a temporary (n = 42, 33.6%) and permanent (n = 83, 66.4%) colostomy (n = 102, 81.6%) and ileostomy (n = 23, 18.4%). Their mean age was 66.72 years; all had undergone ostomy surgery at least 3 months prior to study participation. Participants were drawn from 4 acute care facilities in the province of Castellon, Spain. INSTRUMENT: The CAESPO Questionnaire is completed by a nurse or health care provider. It comprises 3 sections: the first queries sociodemographic data, the second queries pertinent clinical data, and the third contains 58 scored items with 4 ordinal responses. Possible cumulative scores ranged from 58 to 232 points; scores are reported based on a derived percentage score that varies from 0 to 100, where a score of 0 indicates lower self-care and 100 indicates a high level of self-care. METHODS: Data were collected at baseline and retesting was completed 6 months later. Internal consistency of the CAESPO was evaluated using the Cronbach α coefficient; temporal stability (test-retest reliability) was evaluated using the test-retest procedure; confirmatory factor analysis based on conceptually hypothesized factor structure was performed to evaluate construct validity. RESULTS: Initial assessment of the construct validity of the CAESPO using confirmatory factory analysis revealed a poor fit, resulting in removal of multiple items from each of the subscales owing to low-factor loading values. The final model comprised 58 scored items; it was found to have a good fit based on standard indices (χ= 43.132, P < .001; root mean square error of approximation = 0.155 [0.107-0.204]; Bentler-Bonett normed fit index = 0.957; comparative fit index = 0.967; incremental fit index = 0.968), indicating adequate construct validity. The internal consistency of the CAESPO total score was acceptable at α = 0.889. Test-retest reliability (temporal stability) was deemed excellent (α = 0.987). CONCLUSIONS: Psychometric tests indicate that the CAESPO is a valid and reliable instrument for measuring self-care in persons living with a fecal ostomy.