Study design and sample. In this descriptive and cross-sectional study, data were collected from patients who underwent tracheostomy in November and December 2019. The study was performed between November 2019 and January 2020. The study population consisted of 80 patients who underwent tracheostomy due to laryngeal carcinoma in a university hospital’s otorhinolaryngology service and were invited to participate in this descriptive and cross-sectional study prior to discharge. Patients who were not willing to participate in the study (12 patients), patients with psychiatric problems (2 patients), patients who died (3 patients), and patients whose tracheostomy was closed within 1 month after discharge (3 patients) were excluded from the study. Sixty (60) patients who agreed to participate in the study voluntarily, who had no sensory or hearing loss, who were 18 years of age or older, who were literate, who were discharged with a tracheostomy, and who continued home care for at least 1 month (maximum 3 months) after discharge were included in the study. Telephone numbers and addresses were supplied voluntarily by patients who had inclusion criteria, and interviews were conducted at patients’ homes within 1 to 3 months after discharge. Data for patients who met the criteria for participation were collected and are presented in the Results section.
Ethical approval. Before the start of the study, institutional permission was obtained from the hospital where the research was conducted, and ethics committee approval was obtained from the Regional Public Hospital’s Ethics Committee for Non-Interventional Clinical Research. In addition, the purpose of the study, the methods of the study, and the expected benefits and risks were explained to the patients, and their written consents were obtained through the Informed Voluntary Consent Form.
Data collection methods. Data were collected by the researcher using paper-and-pencil questionnaires via face-to-face interviews with patients. Interviews were conducted during the home care of patients, and each interview took approximately 15 to 20 minutes. Interviews were conducted once, and all took place between 1:00 PM and 3:00 PM. In addition, patients were given the telephone number of the researcher to contact as needed regarding care practices and problems encountered.
Data collection tools
Sociodemographic Characteristics Form. This form was developed by the researchers according to the literatüre.5,9,10,13,15 Expert opinions were obtained from one instructor in the Surgical Diseases Nursing Department, one instructor in the Fundamentals of Nursing Department, one instructor in the Department of Public Health Nursing, one instructor in the Psychiatric Nursing Department, and one physician in the Otorhinolaryngology Department regarding the items developed, and changes were made in line with their recommendations. The form contained 12 items encompassing patient-specific information about the date of tracheostomy, date of discharge with tracheostomy, regular outpatient care, age, sex, body mass index (BMI; calculated by measuring the height and weight by the same researcher and using the same measurement tools at each patient interview), education level, health insurance, income level, amount of money allocated to care, smoking status, and presence/absence of chronic disease.
Body Cathexis Scale. The Body Cathexis Scale (BCS), developed by Secord and Jourard in 1953,22 assessed one’s satisfaction with 40 separate body parts or functions. The Turkish adaptation of the Body Cathexis Scale was carried out by Hovardaoğlu in 1992.23 The Turkish version of the questionnaire is a 5-point Likert type scale consisting of 40 items. The most positive expression is worth 1 point, and the most negative expression is worth 5 points (1 = I like it very much, 2 = I like it, 3 = I am indecisive, 4 = I do not like it, and 5 = I do not like it at all). Accordingly, the lowest and highest scores of the scale are 40 and 200, respectively. Higher scores reflect a lower satisfaction with one’s body parts or functions, whereas lower scores reflect higher satisfaction. The overall reliability coefficient of the Body Cathexis Scale was found to be 0.91 in a Turkish validity and reliability study carried out by Hovardaoğlu,23 and it was highly reliable with a reliability coefficient of 0.94.
Satisfaction With Life Scale. The 7-point Likert-type Satisfaction With Life Scale was used in this study. This scale was developed by Diener et al in 198524 and adapted to Turkish by Köker in 1991.25 It consists of 5 items with the following scoring sytem: 1 = strongly disagree, 2 = disagree, 3 = slightly disagree, 4 = neutral, 5 = slightly agree, 6 = agree, and 7 = strongly agree. The total score ranges between 5 and 35. Life satisfaction decreases as the total score decreases. The overall reliability coefficient of the Satisfaction With Life Scale was found to be 0.85 in a Turkish validity and reliability study carried out by Köker,25 and it was highly reliable with a reliability coefficient of 0.94.
Attitude Scale toward Seeking Psychological Help. The short form of the Attitude Scale toward Seeking Professional Psychological Help (ATSPPH-SF), developed by Fischer and Turner in 1970,26 was adapted into Turkish by Türküm in 1997.27 This 5-point Likert type scale, in which individuals’ attitudes toward seeking professional help are measured, consists of 18 items (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree). Scores range from 18 to 90, and a higher score indicates a more positive attitude toward seeking psychological help. The overall reliability coefficient of the Attitude Scale toward Seeking Psychological Help was 0.88 in a Turkish validity and reliability study carried out by Türküm,27 and the reliability coefficient of the scale was 0.81.
Data analysis. Data were gathered from the interviews and entered into SPSS v18.0 (IBM SPSS Statistics, Chicago, IL). BMI was grouped as follows: underweight (below 18.50 kg/m2), healthy (18.50–24.99 kg/m2), pre-obese (25.00–29.99 kg/m2), and obese (above 30.00 kg/m2). The minimum wage in Turkey is 373 USD, and the poverty threshold in Turkey is 185 USD; because of those factors, monthly income and monthly budget for tracheostomy care were grouped into 3 outcomes; 0–185 USD, 186–373 USD, and > 373 USD. According to the inclusion criteria, patients had been receiving home care for 1 to 3 months; therefore, time since discharge with tracheostomy was grouped into 2 outcomes (< 2 months and ≥ 2 months) and time since tracheostomy surgery was grouped into 2 outcomes (< 45 days and ≥ 45 days). Descriptive statistics, independent samples t-test, analysis of variance (ANOVA), and Pearson correlation analysis were used to analyze the data; P < .05 was accepted as the level of significance.