Quality of Care after Ostomy Surgery: A Perspective Study of Patients

Author(s): 
Eva Persson, RNT, PhD, ETN; and Bodil Wilde Larsson, RNT, PhD

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.

Methods

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.

References: 

1. Alstad B, Bach K, Domonkos I, et al. Nordic standard for preoperative stoma care: Nordnäs. 1997. (In Swedish)
2. Olsen T, Alstad B, Thomsen L, Bach K, Berndtsson I, Palselius I. Postoperative standards. Stoma care. Skin care. Göteborg: Nordic stoma cooperation. (In Swedish) 2001.
3. Persson E, Hellström AL. Experiences of Swedish men and women 6 to 12 weeks after ostomy surgery. J WOCN. 2002;29(2):103–108.
4. Kelly MP, Henry T. A thirst for practical knowledge. Stoma patients’ opinions of the services they receive. Prof Nurs. 1992;7(6):350–351,354–356.
5. Cleary P, McNeal B. Patient satisfaction as an indicator of quality of care. Inquiry. 1988;25:25–36.
6. Ottosson B, Hallberg IR, Axelsson K, Loven L. Patients’ satisfaction with surgical care impaired by cuts in expenditure and after interventions to improve nursing care at a surgical clinic. Int J Qual Health Care. 1997;9(1):43–53.
7. Deeny P, McCrea H. Stoma care: the patient’s perspective. J Adv Nurs.1991;16:39–46.
8. Goodwin K. An insight into patient satisfaction. Evaluation of a stoma care service. Prof Nurs. 1992;8:153–156.
9. Vuory H. Patient satisfaction — does it matter? Qual Assur Health Care. 1991;3(3):183–189.
10. Donabedian A. Institutional and professional responsibilities in quality assurance. Qual Assur Health Care. 1989;1(1):3–11.
11. Reerink E. Defining quality of care: mission impossible? Qual Assur Health Care. 1990;2(3-4):197–202.
12. Wilde B, Starrin B, Larsson G, Larsson M. Quality of care from a patients perspective. Scand J Caring Sci. 1993;7:113–120.
13. Merkouris A, Ifantopoulos J, Lanara V, Lemonidou C. Patient satisfaction: a key concept for evaluating and improving nursing services. J Nurs Manag. 1999;7(1):19–28.
14. Eriksen LR. Patient satisfaction with nursing care: concept clarification. J Nurs Measure. 1995;3(1):59–76.
15. Wilde B, Larsson G, Larsson M, Starrin B. Quality of care. Development of a patient-centered questionnaire based on a grounded theory model. Scand J Caring Sci. 1994;8:39–48.
16. Larsson G, Wilde Larsson B, Munck I. Refinement of the questionnaire “Quality of Care from the Patient’s Perspective” using structural equation modelling. Scand J Caring Sci. 1998;12:111–118.
17. Persson E, Gustavsson B, Hellström A-L, Lappas G, Hultén L. Ostomy patients perception of quality of care. J Adv Nurs. 2005;49:1–8.
18. Wilde Larsson B, G. L, B S. Patients’ views on quality of care: a comparison of men and women. J Nurs Manage. 1999;7:133–139.
19. Petzall K, Berglund B, Lundberg C. How beds are used at a university hospital — a study of beds and bedside activities. Scand J Caring Sci. 1996;10:122–126.
20. Wilde B, Larsson G, Larsson M, Starrin B. Quality of care from the elderly person’s perspective: subjective importance and perceived reality. Agin Clin Exp Res. 1995;7:140–149.
21. Törnkvist L, Gardulf A, Strender L-E. Patients´ satisfaction with the care given by district nurses at home and at primary health care. Scand J Caring Sci. 2000;14:67–74.
22. Sainio C, Eriksson E, Lauri S. Patient participation in decision making about care. Cancer Nurs. 2001;24(3):172–179.
23. Jackson AL, Pokorny ME, Vincent P. Relative satisfaction with nursing care of patients with ostomies. J ET Nurs. 1993;20(6):233–238.
24. Jeffries E, Joels J, Butler J, Callum R, Little G, Johnson A. A service evaluation of stoma care nurses' practice. J Clin Nurs. 1995;4:235–242.
25. Erwin-Toth P, Spencer M. A survey of patient perception of quality of care. J ET Nurs. 1991;18:122–125.
26. Allison M, Stuchfield B. Helping to adjust: an holistic approach to stoma care. Nurs Stand. 1994;8:3–13.
27. Kammerer Quayle B. Making positive choices: body image and the new ostomy patients. Ostomy Wound Manage. 1994;40:16–21.
28. Model G. A new image to accept: psychological aspects of stoma care. Prof Nurs. 1990;5:100–104.
29. Borwell B. The psychosexual needs of a stoma patients. Prof Nurs. 1997;12:250–255.



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