Although stomas increase patient survival rates, the physical, psychological, and social problems patients experience can decrease their quality of life.6,20,31,32 Specifically, a patient’s adjustment to a stoma and his/her spirituality are reported to be factors that can directly or indirectly affect quality of life.6,17,33 The mean quality-of-life score in the present study is in line with previous research from individuals in the US and China.6,20 Although the adjustment to a stoma score of participants in the present study is similar to previous studies conducted in China7 and Turkey,8 it is higher than the scores of individuals with stomas living in China6 and Nepal.24 The mean spiritual well-being score in the present study agreed with results of studies conducted in Taiwan (patients with a colostomy and colorectal cancer) and Australia (patients with cancer)4,14; however, it was lower than scores of individuals with lung and colorectal cancer.16 As Clay et al16 noted, the results may have been different because adjustment to a stoma and spirituality were influenced by cultural and regional factors.
Spirituality is an important component in coping with cancer, in individual adaption to life after treatment, and in assessing quality of life in situations that lead to serious changes such as undergoing stoma creation.16 The present study revealed a moderate, positive, significant relationship between spiritual well-being and quality of life and showed that as spiritual well-being increased, quality of life increased as well. Within this context, the data obtained in this study are in line with data in the literature.13,17,22 Because nurses are important members of the health care team and play an important role in increasing the quality of life of individuals with stomas,3 developing spiritual well-being via nursing practices can play a significant role in improving the quality of life of these patients.
Although a sense of comfort and confidence stemming from religious and spiritual beliefs can be important factors for emotional, physical, and social well-being, a sense of peace and perception of life have been found to be more important for quality of life.13,17,22 A moderate positive relationship was reported between the subscales of the existential dimension of spiritual well-being (the meaning and peace subscales) and quality of life in the present study. However, no relationship was noted between the religious dimension (the faith subscale) and quality of life. Other researchers have reported that spiritual well-being had a stronger impact than religious belief on individuals with serious diseases (including those with cancer), and feelings of meaning and peace had a stronger relationship than religious belief with quality of life.4,13,17,22 The existential dimension is not a stable factor because it has been shown in an exploratory study34 and in a randomized controlled trial35 to have the capacity for improvement through structural interventions such as psychological therapy programs or the use of meaning-making coping strategies in individuals with stomas. The data obtained in this study are important in this respect. On the other hand, some studies18,19 assert that the religious dimension is an important component of quality of life and that a higher religious dimension is associated with a better quality of life; however, the high scores of the religious dimension obtained in those studies could have resulted from the fact that the participants were apparently at the end of their lives, they believed their life-threatening disease would not change, and they attributed this situation to the will of a higher power. A cross-sectional, descriptive study in Turkey by Akgül and Karadag12 to determine the impact of colostomy and ileostomy on Muslim patients’ (N = 150) acts of worship found mandatory Islamic practices were performed less by individuals with stomas after their ostomy surgeries. The systematic review by Iqbal et al11 asserted that Muslims with ostomies had lower quality of life and that psychological factors, social isolation, lack of information about complications, and sexual dysfunction, as well as a decrease in religious practices, were factors in this finding.
This study also identified a moderate positive relationship between spiritual well-being and adjustment to the stoma and that the greater the spiritual well-being, the better the adjustment. These results parallel the findings of a study conducted among patients with colorectal cancer and colostomy.14 Although the meaning and peace subscales of spiritual well-being had a moderate positive relationship with adjustment to a stoma, no relationship was found with the faith subscale in the present study. The descriptive, cross-sectional study conducted by Li et al14 among Taiwanese patients with colorectal cancer and a colostomy (N = 45) found spirituality is related to psychosocial adjustment in patients with colorectal cancer stomas, but the religious dimension did not affect psychosocial adjustment. However, a cross-sectional qualitative study36 conducted among colorectal cancer patients in New Zealand (N = 20) and Iran (N = 20) found the religious dimension can be related to psychosocial adjustment. Spirituality can be affected by cultural factors, explaining the difference in results. It can be argued, based on the current results and the literature, that spirituality facilitates adjustment to a stoma by increasing the meaning of life through deeper understanding and aim or desire to live, thus becoming influential in the healing of the disease.
According to a descriptive study,4 increasing spiritual well-being and psychosocial adjustment also affects patient quality of life. The present study found a high positive and statistically important relationship between the mean adjustment to a stoma and quality-of-life scores and that quality of life increased along with adjustment. These results are supported in the literature.6,32 In this context, adjustment to a stoma and quality of life are related concepts, and adjustment to a stoma can increase quality of life.6
In the present study, no relationship was noted among stoma duration, quality of life, adjustment to the stoma, and spiritual well-being; these findings are supported by the research.7,14,17 Having a stoma can lead to anxiety, making some patients’ adaptation to their new lives more difficult and prolongs their adjustment period. Getting used to living with a stoma takes time, and it is also necessary for the person to adjust their interest, attitude, and feelings toward living with a stoma.7
Hierarchical regression analysis revealed that adjustment to a stoma and spirituality have an effect on quality of life in individuals with stomas and that these variables are important predictors of quality of life. These results are compatible with the literature4,6,14,17,22 that shows age, gender, and obstacles preventing care are factors affecting quality of life, adjustment to a stoma, and spiritual well-being.6-8,20,25,31 However, the present study revealed these factors have no influence on these outcomes. In addition, it is clearly stated in the literature that a stoma, regardless of the type or the reason for the ostomy, leads to great changes in the functions and life of an individual.3,13,21,31 The fact that demographic characteristics and stoma information did not affect quality of life could be attributed to the anxiety and stress, decrease in self-efficacy and psychosocial adjustment, deterioration in personal relations, lack of social support, and spirituality experienced by individuals with a stoma.5,23,25,37 In addition, these results could have been affected by the fact that the study was cross-sectional and that the sample was heterogeneous.
Nurses play an important role in evaluating individuals’ spiritual needs, establishing therapeutic communication, helping patients fulfill religious obligations, and providing emotional and spiritual care.20,38 Using the results obtained from this study in the nursing profession will be important in terms of increasing adjustment to a stoma and quality of life of the patient. However, spirituality, which is an integral part of holistic care in the medical setting, is a factor that is mostly overlooked. Therefore, strategies and programs that integrate spiritual well-being and adjustment into nursing care are needed.39