Participant enrollment and procedure. At the end of the fall 2016 semester, faculty told students across the 3 years of the prelicensure undergraduate baccalaureate educational program about the project during a clinical post-conference session for the students in fundamentals and medical-surgical nursing courses and after the lecture for the critical care course. Students were invited to participate in the assessment project and were told the purpose of the project, details of the survey, and that responses were anonymous. Students were informed the goal of the project was to improve the curriculum about the care of the person with an ostomy. They were free to respond or not respond to items on the survey. Because participation or nonparticipation was both voluntary and anonymous, students were assured their course grade would not be affected. Each student responded to the survey 1 time. All students in the selected courses were asked to participate; there were no exclusion criteria. The survey was paper/pencil and took approximately 30 minutes to complete.
Design. This project was developed as a curricular assessment project, used a survey methodology, and was conducted by 2 faculty. Because this was not a human subjects research study, it was determined that Institutional Review Board approval was not required. The authors assessed a component of an internal educational program in terms of student knowledge, skill, and confidence in the care of a person with an ostomy. The faculty used the students’ responses to this project to examine course content and learning experiences to enhance stoma care teaching.
Participants. Students in this project were enrolled in either a traditional or a second career/accelerated baccalaureate program. The content and experiences in both programs are the same; the second career program progresses at a faster pace. Potential clinical experiences with patients who have an ostomy occur across the curriculum in this baccalaureate prelicensure nursing program.
Students in their first year of nursing take a fundamentals of nursing course. During this course, they receive a 1-hour basic lecture about the anatomy and functioning of fecal and urinary ostomies, pouch emptying and changing, diet, fluids, self-care, sexuality, and mental health. Because this is the first nursing course, ostomy complications and peristomal skin changes are not discussed. The lecture content follows the nursing fundamentals textbook,14 which has sections about meeting the needs of patients with bowel or urinary diversion. The textbook incorporates text and pictures about the person with an ostomy and the care required. During laboratory practice (3 hours), students handle ostomy pouching systems and measure and apply a pouch to a mannequin. Pouch selection is limited to either a 1- or 2-piece drainable appliance. Use of accessory products such as paste or barrier rings is not included. During the clinical experience, which takes place on a variety of medical-surgical units in a number of acute care hospitals (6.5 hours per week), students may be assigned patients who have an ostomy. However, patient assignments are dependent on the patient population at the assigned unit as well as faculty preference in the selection of patients.
Students in the second year of the program take 2 separate yet related medical-surgical nursing courses. Course content includes two 1- to 2-hour sessions during class time that focus on care of the patient with urinary and intestinal disorders. This includes discussion of the management of patients with urinary and fecal diversions but only in relation to specific disease processes. For example, colostomies are discussed as an outcome of treatment for colon cancer. Clinical experiences occur in an acute care setting for 6.5 hours per day, 1 day per week, on a variety of medical-surgical units. As with students in the first year of the program, hands-on experience with a patient with an ostomy is inconsistent. The course includes a simulation laboratory experience on the care of a patient who has both an ileostomy and heart failure. This simulation requires the student to change an ostomy pouching system as well as integrate the concepts of fluid and electrolyte balance; however, the focus of the simulation is on the cardiac condition, not ostomy management. As in the first year of the nursing program, ostomy complications and skin changes are not discussed and the focus is on the immediate physical care of the patient as opposed to psychosocial or discharge needs.
Students in the third year of the prelicensure program take a course focused on critical care. The critical care course contains lecture content about the critically ill patient but does not include content specific to the care of a patient with an ostomy or a clinical component. Students in this year also take 2 additional courses (leadership and immersion); these courses include clinical experiences but course content does not focus on the person with an ostomy.
Across all years, the clinical sites for courses vary in the types of patients that students encounter. For example, 1 clinical site might have primarily postoperative patients while another clinical site’s patient population may have a cardiac focus. Students’ assignments are based on a combination of course objectives, faculty preference, and available patients. Therefore, despite course objectives, there may not be a patient with a urinary or fecal diversion on the assigned unit or the faculty may not choose the patient with an ostomy for any number of reasons.
Survey instruments. The study authors used questions based on established questionnaires and developed new survey instruments for this assessment. The first part included basic demographic questions (gender, age) and asked participants to state which nursing course they currently were enrolled in.
Zimnicki-Pieper Knowledge Test. The Zimnicki-Pieper Ostomy Knowledge Test (Z-POKT) was developed based on a review of the literature and professional experience to measure ostomy knowledge. The Z-POKT consists of 50 true-false-do not know items. This type of test format is quick for students to answer and easy to score. If study participants did not know an answer, they were asked to not guess but to check do not know. Questions with a do not know response or items left blank were considered wrong when tabulating scores. The total Z-POKT score was obtained by tabulating the number of correct answers.
Before the Z-POKT was used for the study, 12 WOC nurses were asked to evaluate the appropriateness of the questions for ostomy knowledge for prelicensure students enrolled in a baccalaureate nursing program. These nurses did not give suggestions for items to be revised, added, or removed from the test. All gave a global response that the test was appropriate. The Z-POKT’s Cronbach’s alpha was 0.75 on this initial use.
The Ostomy Skills section lists 5 skills: measure stoma, cut pouching system, change pouching system, empty pouching system, and apply paste or barrier ring. Students distinguished between the described tasks they performed in the learning and/or simulation laboratory and those tasks they performed in clinical practice with patients by placing a check mark in the box by the item. The checked items were tabulated for a total number of skills performed in each setting.
In the Confidence with Ostomy Care section, students were asked to rate their confidence using an adaptation of 1 section of the City of Hope Staff Survey on Ostomy Care15 that included knowledge of different types of pouching systems, determining fit and size of a pouching system, applying an ostomy pouch, emptying an ostomy pouching system, teaching ostomy care for self-care at home, and advising the patient about community resources. They completed the thought, I feel confident in my… or I feel confident that I can…. Each was scored 1 (strongly disagree) to 5 (strongly agree). Total confidence scores could range from 6 (low) to 30 (high).
Statistical analysis. Responses to the survey were entered into an Excel file. The file was converted for analysis by the IBM Statistical Package for the Social Sciences (SPSS Statistics, (Armonk, NY). Responses were primarily examined using descriptive and correlational statistics; when appropriate, inferential statistics also were used for comparisons. The project intention was not to compare ostomy knowledge, skills, and confidence by year in the program. However, because information about this topic is so limited, some outcomes were compared by program year using analysis of variance.