Efficacy of a Social Interaction Intervention in Early Postoperative Period to Improve Coping in Persons With an Ostomy: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to analyze the efficacy of a social interaction intervention delivered during the early postoperative time period on the coping process in persons with a new ostomy. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The sample comprised 52 persons who underwent surgical management of colorectal including a fecal ostomy; 27 were randomly allocated to the intervention group and 25 to the control group. One participant allocated to the control group died before data collection; thus, findings are based on data from 51 participants. The study setting is the Regional University Hospital of Malaga, located on the southern coast of Spain. METHODS: Ostomy visitors (persons living with an ostomy) were taught to listen to the experiences and the concerns of the participant and to serve as an example of an individual who has successfully learned to live with a fecal ostomy. The intervention was a visit with a person with a new ostomy during the early postoperative period. Control group participants were offered standard care that did not include the visit from a person with an ostomy. Outcome measures were taken from the Nursing Outcomes Classification taxonomy. The main outcome measure was coping; secondary outcome measures were health beliefs and acceptance of health status. Bivariate analyses were performed to evaluate differences between groups in terms of the primary and secondary outcomes. A multivariate linear regression analysis was performed to identify predictor variables of the primary outcome, and effect size calculations were used to differentiate statistical significance versus clinical relevance. RESULTS: There were no differences in demographic or pertinent characteristics of participants in the 2 groups. Participants who received the intervention achieved a higher mean coping process scores: 3.90 vs 3.19, P = .002 and Cohen d = 0.97. In addition, intervention group participants achieved a higher mean efficacy for the secondary outcomes: 3.78 versus 2.97 (P = .0004) and Cohen d = 1.11 for health beliefs, and 3.68 versus 2.83 (P = .0001) and Cohen d = 1.24 for acceptance of health status. Linear regression analysis indicated that the social interaction intervention (ß= .799; P = .000) and undergoing urgent versus routine ostomy surgery (ß=-.610; P = .005) were related to coping. CONCLUSIONS: Findings indicate that a visit with a trained person living with an ostomy facilitated coping and improved health beliefs and acceptance of health status.

La información, elemento clave para reconstruir la autoestima. Relato de una persona recientemente ostomizada / Information, a key element to re-establish self-esteem. The case of a recently ostomized person

En las ostomías digestivas se avoca el intestino a la pared abdominal con fines excretores. Esto supone un gran cambio que afecta a la persona en todas sus dimensiones (física, psíquica y social) y exige un esfuerzo de adaptación. Este relato biográfico expone la experiencia de una persona intervenida de cáncer colorrectal a la que se le ha realizado una ileostomía. Los datos se recogieron durante el postoperatorio mediante una entrevista en profundidad semiestructurada; fue grabada íntegramente para su posterior trascripción y análisis cualitativo. El impacto emocional que desencadena la situación y la desinformación son las categorías temáticas centrales alrededor de las cuales se articula el discurso del informante. La narrativa de sus vivencias pone de manifiesto la necesidad de ofrecer unos cuidados personalizados en los que se tengan en cuenta las necesidades emocionales con el fin de facilitar el proceso de afrontamiento/adaptación

Gastrointestinal ostomies involve creating a stoma in the abdominal wall for excretory proposes. This procedure results in important changes that affect the patient in many ways, physical, psychological and social, requiring an effort to overcome. This report describes the experience of a person who had an ileostomy due to colorectal cancer. During the postoperative period the patient underwent a semistructured in-depth interview, fully recorded digitally for later transcription and qualitative analysis. The emotional impact triggered by the situation and misinformation were the main subject categories discussed by the patient. The narrative of this patient's experience highlights the need to provide personalized care considering the emotional needs of the patient in order to ease the process of coping and adapting

La adaptación al entorno sociofamiliar del paciente ostomizado. Estudio cualitativo de un caso / The ostomyzed patient's adaptation to social and family environment

Objetivo: Conocer el afrontamiento y adaptación de una persona colostomizada a lo largo de dos años. Metodología: Estudio cualitativo de un caso. Se ilustra el caso de un paciente colostomizado a causa de un cáncer de recto. Los datos se recogieron mediante entrevistas semiestructuradas al paciente y al familiar en dos tiempos distintos, durante la hospitalización y a los dos años. Las cuatro entrevistas se grabaron, trascribieron y analizaron según el método de Taylor-Bogdan. Resultados: Durante la hospitalización priman las estrategias de afrontamiento dirigidas a aliviar las emociones negativas delegando los cuidados del estoma en su familiar. A los dos años se observa una preocupación mayor por las cuestiones prácticas logrando finalmente ser autónomo. Se descubren los aspectos que han contribuido a esa adaptación y los cambios provocados por la ostomía en su vida. Conclusiones: Se evidencia la necesidad de un cuidado individualizado que considere al ostomizado en su dimensión biopsicosocial (AU)

Objective: Knowing how a person deals with and adapts to a colostomy along a two years period. Methods: Qualitative case study. The case shows a colostomyzed patient due to a rectal cancer. Data collected through semistructured interviews to the patient and a relative at two different moments: during hospitalization and two years later. The four interviews were recorded, transcribed and analyzed according to Taylor-Bogdan Method. Results: Confrontation strategies aimed at alleviate negative emotions by delegating the cares of the stoma to relatives are key during hospitalization. Two years later, there is a higher concern for practical questions and the patient can finally reach autonomy. The report shows the aspects leading to adaptation and the changes the ostomy brings about in the patient's life. Conclusions: Ostomyzed people require individualized care based on their biopsycosocial dimension (AU)