Student Author Award Submission— Self-Esteem Disturbance in Patients with Urinary Diversions: Assessing the Void

  • Wed, 9/3/08 - 10:25am
  • 0 Comments
  • 8518 reads
Author(s): 
Mona Salloum, RN, BSN

Patients, whether continent or incontinent, with urinary diversions may experience self-esteem problems. Living a life with “abnormal” urinary function, life-long catheterization, stoma care, incontinence, and urine leakage issues can lead to feelings of shame and decreased self-worth. Patients who receive a neobladder, for example, have to adapt to permanent body function alterations.1 Much of the literature on related topics addresses body image and quality-of-life concerns in patients who have had a cystectomy and a urinary diversion; self-esteem, specifically, has not received the same attention. Although self-esteem is related to body image, sexuality, and quality-of-life issues, self-esteem disturbance is a specific nursing diagnosis2 and, therefore, should be treated independently as the focus of research. The purpose of this paper is to discuss self-esteem changes in patients who undergo urinary diversions and to present a nursing plan of care for these patients.

The Concept of Self-Esteem

Self-esteem is one’s personal judgment regarding his or her own self worth.3 It is a sociopsychological construct of an individual’s perception of self4 formed all throughout childhood, adolescence, and adulthood. Self-esteem develops from within the self and through others. The development of self-esteem comes, in part, from the love and acceptance of others and is directly related to self-ideal, a carefully constructed image of the type of person one would like to be depending on aspirations, goals, and values.3 Self-concept is the way in which an individual sees him or herself.

The closer one’s self-concept is to one’s self-ideal, the higher one’s self-esteem (see Figure 1). High self-esteem also is attributed to the acceptance of self, despite mistakes, defeats, and failure.3 When people do not attain goals and feel unloved by others, they will feel inferior and have lower self-esteem. People also tend to see themselves as others believe them to be. 4

Body image, sexuality, and other personality traits can be affected by altered health status, such as a urinary diversion, and can result in a change in self-esteem. McMullin and Cairney4 state, “The relative salience of body image to identity formation acts as a mechanism through which self-esteem is made manifest in individuals.” People who accept their bodies are more likely to have a higher self-esteem.3 The origins of self-esteem can be traced back to childhood and are related to acceptance, warmth, involvement, consistency, praise, and respect.3 Early ideas and behaviors of continence and bladder/bowel function are also developed during childhood and can affect self-esteem.

References: 

1. Beitz JM, Zuzelo PR. The lived experience of having a neobladder. West J Nurs Res. 2003;25(3):294–316.
2. North American Nursing Diagnosis Association. Nursing Diagnoses: Definitions and Classification. Philadelphia, Pa.: NANDA;1997–1998.
3. Stuart GW, Laraia MT. Principles and Practice of Psychiatric Nursing, 7th ed. St. Louis, Mo.: Mosby Inc;2001.
4. McMullin JA, Cairney J. Self-esteem and the intersection of age, class and gender. J Aging Stud. 2004;18:75–90.
5. Zickler CF, Richardson V. Achieving continence in children with neurogenic bowel and bladder. J Pediatr Health Care. 2004;18(6):276–283.
6. Puckett MB, Black JK. Development from Prebirth through Age Eight, 4th ed. Upper Saddle River, NJ: Pearson Education Inc;2005.
7. Uro Today. Translating urology research into clinical practice. Bladder cancer cases, prevalence and mortality. Available at: http://www.urotoday.com. Accessed February 20, 2005.
8. Colwell JC, Goldberg MT, Carmel JE. Fecal and Urinary Diversions: Management Principles. St. Louis, Mo.: Mosby Inc;2004.
9. Turner WH, Bitton A, Studer UE. Reconstruction of the urinary tract after radical cystectomy: the case for continent urinary diversion [Editorial]. Urology. 1997;49(5):663–667.
10. City of Hope. Types of urinary diversions. Available at: http://www.cityofhope.org/Urology/urinaryTypes.asp. Accessed February 18, 2005.
11. Beitz JM. Continent diversions: the new gold standards of ileoanal reservoir and neobladder. Ostomy Wound Manage. 2004;50(9):26–27.
12. Bladder Cancer Webcafe. Neobladder Information. Available at: http://blcwebcafe.org/neobladders.asp. Accessed February 25, 2005.
13. Tefelli MV, Gheiler EL, Tiguert R, et al. Urinary diversion-related outcome in patients with pelvic recurrence after radical cystectomy for bladder cancer. Urology. 1999;53(5):999–1004.
14. Perimenis P, Koliopanou E. Postoperative management and rehabilitation of patients receiving an ileal orthotopic bladder substitution. Urol Nurs. 2004;24(5):383–386.
15. McHugh JP. Body image and ostomy surgery. Ostomy Q. 1998;35:30–32.
16. Golis AM. Sexual issues for the person with an ostomy. J WOCN. 1996;23(1):33–37.
17. Benezra V, Lambrou NC, Salom EM, Penalver MA. Conversion of an incontinent urinary conduit to a continent urinary reservoir (Miami Pouch). Gynecol Oncol. 2004;94(3):814–817.
18. Moreno JG, Chancellor MB, Karasick S, King S, Abdill CK, Rivas DA. Improved quality of life and sexuality with continent urinary diversions in quadriplegic women with umbilical stoma. Arch Phys Med Rehabil. 1995;76(8):758–762.
19. Grossfeld GD, Stein JP, Bennett CJ, et al. Lower urinary tract reconstruction in the female using the Koch ileal reservoir with bilateral ureteroileal urethrostomy: update of continence results and fluorourodynamic findings. Urology. 1996;48(3):383–388.
20. Tolch, M. Four steps to teaching ostomy care. Health Module. 1997;27:32hn9-32hn10.
21. Gulanick M, Klopp A, Galanes S, Gradishar D, Puzas MK. Nursing Care Plans: Nursing Diagnosis and Interventions, 4th ed. St. Louis, Mo.: Mosby Inc, 1998.
22. Dalgic G. Altered body image in the person with a stoma. J World Counc Enterostomal Ther. 2000;20:39–41.
23. White C. Psychological management of stoma-related concerns. Nurs Stand. 1998;12(36):35–38.
24. Potter KL. Surgical oncology of the pelvis: ostomy planning and management. J Surg Oncol. 2000;73(4):237–242.

image description image description 




  


  
Post new comment


  



 
 



  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
  • Use  to create page breaks.
More information about formatting options




Image CAPTCHA

 
 
 
Enter the characters shown in the image.