Psychosocial adjustment among patients with ostomy: a survey in stoma clinics, Nepal

Abstract

Sital Gautam,1 Surya Koirala,2 Anju Poudel,1 Dipak Paudel,3 1Department of Nursing, Nepal Medical College, 2Department of Nursing, Institute of Medicine, Tribhuvan University, Nursing Campus Maharajgunj, 3Department of Medicine, People’s Medical College, Kathmandu, Nepal Background: Ostomy changes the overall lifestyle of a person, and ostomates have been identified as a chronic illness population frequently experiencing adjustment problems. Purpose: The aim of this study was to determine the psychosocial adjustment and its predictors among patients with ostomy in Nepal. Patients and methods: A descriptive cross-sectional study was conducted in two stoma clinics of Nepal. Patients who had a colostomy, ileostomy, or urostomy, visited the selected stoma clinics during the data collection period, and who had ostomy for at least 6 months before data collection were included in the study. A total of 130 patients were included in this study. Data on sociodemographic and clinical variables were collected. Psychosocial adjustment score was measured using Ostomy Adjustment Inventory-23. Results: A total of 130 patients (80 males and 50 females) were included in the study. The mean age of the patients was 51 years, ranging from 23 to 78 years. The study findings revealed that mean ±SD adjustment score was 41.49±13.57, indicating moderate impairment in the psychosocial adjustment among ostomates, and the mean ±SD scores of acceptance, anxious preoccupation, social engagement, and anger were 22.01±6.99, 8.75±3.89, 5.38±3.41, 5.35±1.62, respectively. Four variables contributed significantly to the final model, explaining 46.8% of variance in the psychosocial adjustment score (R2 =0.468, F(4, 125) =27.53, P<0.001). Perceived lack of family support (β=−0.367, P<0.001), total dependence on others to care for ostomy (ß=−0.357, P<0.001), and unemployment (ß=−0.144, P=0.032) significantly predicted lower psychosocial adjustment scores. However, increased time since ostomy surgery (ß=0.361, P<0.001) significantly predicted higher psychosocial adjustment scores. Conclusion: Ostomy often affects all aspects of a patient’s life; however, emotional, sexual, and social lives are the most affected areas. Importantly, the focus of treatment for ostomates should expand beyond the physical boundaries and should consider psychosocial concerns as well. Keywords: ostomy, stoma surgery, ostomates, psychosocial adjustment, quality of life