Metcalf C
West Herts Community Health NHS Trust, Watford.
Br J Nurs. 1999;8(9):593-600. doi: 10.12968/bjon.1999.8.9.6621.
Teaching patients practical skills in stoma care is a complex process and although, arguably, at the very heart of stoma care nursing practice, has been largely ignored in the literature. Teaching principles are based upon social learning theory and educationalists provide guidelines on the most effective way to teach a practical skill. These guidelines have been utilized by nurses when teaching patients with newly formed stomas how to change a pouch. The process of adapting to a stoma and its daily management takes time. Psychologically, however, some patients will adapt more easily than others and researchers have attempted to identify factors which may account for this. Studies have demonstrated that patients who are satisfied with the amount of preoperative information they receive are less likely to develop psychological problems. Psychological adjustment may be affected if patients feel that they have developed insufficient pouch changing skills or have problems with leakage from their pouch or sore skin around their stoma. Studies have also demonstrated that cognitive factors, such as patients feeling in control of their illness and stoma, have been found to play a role in psychological adaptation. Clinical nurse specialists in stoma care are in an ideal position to target these cognitive factors using a variety of strategies including effective practical teaching to empower patients, thus facilitating psychological adaptation following stoma surgery.
向患者传授造口护理的实用技能是一个复杂的过程，尽管可以说这是造口护理实践的核心，但在文献中却 largely 被忽视了。教学原则基于社会学习理论，教育学家提供了关于教授实用技能最有效方法的指导方针。护士在教导新造口患者如何更换造口袋时采用了这些指导方针。适应造口及其日常管理的过程需要时间。然而，在心理上，一些患者比其他患者更容易适应，研究人员试图找出可能解释这一现象的因素。研究表明，对术前所获信息量感到满意的患者出现心理问题的可能性较小。如果患者觉得自己的造口袋更换技能不足，或者造口袋有渗漏问题，或者造口周围皮肤疼痛，心理调适可能会受到影响。研究还表明，认知因素，如患者感觉能够掌控自己的疾病和造口，在心理适应中发挥着作用。造口护理临床护士专家处于理想的位置，可以通过多种策略来针对这些认知因素，包括有效的实践教学来增强患者的能力，从而促进造口手术后的心理适应。
