Quality of Care after Ostomy Surgery: A Perspective Study of Patients
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A stoma operation involves a major life change for the patient. Physical damage, disfigurement, loss of a bodily function, and a change in personal hygiene are cause for concern and make heavy demands on the provision of quality of care.1-3 In order to facilitate patient adaptation to new life with a stoma, detailed oral and written pre- and postoperative information that explains how to live with a stoma must be provided — eg, how to manage leisure activities, diet, the stoma appliance, and sexual activity.1-3
In many cases, seeing an ostomy appliance before the operation helps alleviate patient fears.4 Most importantly, clear communication and information and the ability to participate and be actively involved in the treatment are prerequisites for patient satisfaction with care.5,6 One study7 used open-ended interviews to evaluate how well nursing care met the needs of patients undergoing ostomy surgery. Patients perceived that physical, but not psychological, needs had been met. Another study8 showed that enterostomal therapists (ET) often believed they delivered the best possible ostomy care within the given time and financial constraints. This was evaluated by studying patient’s perceptions of quality of care. A subsequent study found that satisfied patients seemed more willing to follow professional advice and instructions.9
Quality of care is a multidimensional concept with various meanings. The definitions in the literature seem to focus on two major domains: 1) desirable characteristics of care, criteria, standards, and policy issues; and 2) evaluations of the outcome of care.10,11 Patients’ views on what is important in connection with the care they receive may be seen as one aspect of quality of care; patient satisfaction is increasingly used as an indicator of this quality.9,12,13 Patient satisfaction has been defined as the patients’ subjective evaluation of their cognitive and emotional reaction as a result of the interaction between their expectations regarding ideal nursing care and their perceptions of the actual nursing care.14
The purpose of this prospective, descriptive study was to examine ostomy patients’ perceptions of quality of care in terms of their evaluation of actual care conditions, as well as the subjective importance they ascribe to those conditions.
Subjects and procedure. The survey was carried out over 3 months in 1997 at nine small and middle-sized Swedish hospitals. Patients were eligible to participate if they had undergone surgery for the creation of a colostomy, ileostomy, or urostomy during the present hospitalization, were 16 years of age or older, communicative, able to understand Swedish, and willing to participate.
The ET nurse responsible for care provided oral and written information about the study to eligible patients after their surgery and obtained oral informed consent from them. The patients received the questionnaire and answered it anonymously in the hospital the day before discharge. The questionnaire was returned in a postage-paid envelope to a nurse at one of the hospitals.
The study was conducted according to the Ethical Guidelines of the Nordic Nurses Sciences Association.
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