[Factors which determine the psychological adjustment to permanent colostomies. An empirical study in Santiago, Chile]. / Factores que determinan la adaptación psicosocial a colostomías permanentes: un estudio empírico en Santiago, Chile.

BACKGROUND: The acceptance of a colostomy by a patient requires a great amount of psychological resources and social support. AIM: To identify factors that influence the postoperative adaptation to a colostomy. PATIENTS AND METHODS: Sixty patients subjected to a colostomy in 5 hospitals in Santiago were interviewed. The adaptation to the procedure was assessed using the Olsbrisch Ostomy Adjustment Scale. Three regression equations were elaborated to determine the main predictors associated to adaptation. Control variables such as sex, age and the lapse between the interview and the surgical procedure, were included in the model. RESULTS: The model used identified the simultaneous and combined effects of socioeconomic variables such as education and income on the adaptation to colostomy. A generalized detriment of the self image was detected. Patients valued the social support given by the family and friends. Multiple regression analysis determined that the main predictor of the patient's adaptation to colostomy was the level of self care developed. CONCLUSIONS: The better adaptation to a colostomy could be achieved by training the patient for an adequate self care and providing him with psychological and social support.

A multidimensional modeling of predictors influencing the adjustment to a colostomy.

PURPOSE: Factors contributing to the postoperative adjustment of patients who had undergone permanent colostomy surgery were studied. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: Sixty patients who underwent colostomy surgery at 5 hospitals in Santiago, Chile, between 1987 and 1995 were evaluated. Subjects were between the ages of 27 and 89 and underwent colostomy surgery from 4 months to 19 years before data collection. METHODS AND INSTRUMENTS: A demographic questionnaire and a semistructured interview were used to elicit information concerning psychosocial reactions to a colostomy and perceptions about the changes in lifestyle created by the ostomy. Medical records were reviewed for information about disease-related characteristics and an ostomy self-care scale measured coping skills. Adjustment to the colostomy procedure was measured by means of the Olbrisch ostomy adjustment scale. RESULTS: Patient adaptation to a colostomy is primarily affected by the following factors: (1) the level of ostomy self-care, (2) psychological support, and (3) social support from family and significant others. CONCLUSION: Successful adjustment to a permanent colostomy is most likely to occur if the patient receives adequate instruction in self-care and has the appropriate psychological support to integrate the new physical changes into a healthy body image. This includes continued acceptance from family and the patient's social network.

[Know well in order to do well]. / Saber bien para hacer bien.

Health care professionals should have comprehensive training, especially in the humanitarian aspects of care. This is essential to enable them to correctly resolve ethical conflicts that arise in professional practice. Starting from this premise, the article discusses some representative situations nurses encounter daily in their contacts with patients. An examination is made of the ethical aspects of the following: ordinary nursing activities; standards with regard to hospital visits by family members; administration of analgesics; schedules for feeding, drug administration, and the like; clinical research; professional secrecy; free professional practice; and death with dignity.