Pouresmail Zohre, Nabavi Fatemeh Heshmati, Abdollahi Abbas, Shakeri Mohammad Taghi, Saki Azadeh
Mashhad University of the Sciences, Mashhad, Iran.
Wound Manag Prev. 2019 Jun;65(6):30-39.
The appearance of a stoma and the potential for contact with stool may negatively affect postoperative teaching effectiveness, especially for patients with cultural and religious backgrounds that consider stool untouchable. Instruction that involves the use of a physical stoma simulator for practice may help address this problem.
The aim of this pilot study was to determine the effects of simulation in ostomy self-care training on self-efficacy and adjustment.
A randomized clinical trial was conducted among patients at 2 public medical center surgical units in eastern Iran from April 2015 to December 2015 using consecutive sampling. Patients who spoke Persian, were 18 to 65 years of age, had a temporary or permanent intestinal stoma, and did not have comorbidities that might interfere with self-care teaching were invited to participate and randomly allocated to the simulation (SG) or the control group (CG). Both groups were provided 4 training sessions; the first and fourth session was the same for each group, but in sessions 2 and 3, the SG group used a wearable stoma simulator, whereas the CG group used the demonstration-return method. Demographic and stoma variables were collected, and the Stoma Self-Efficacy Scale (SSES) and Ostomy Adjustment Inventory-23 (OAI-23) were administered at baseline (following surgery), after 4 instructional sessions, and 45 days following the last education session. Descriptive statistics and chi-squared, Fisher's exact, Mann-Whitney , repeated measure, and least significant difference tests were used to analyze the data.
Of the 53 patients enrolled, 46 (23 in each group) completed the study. Mean age for SG and CG patients was 45.91 ± 10.40 and 53.78 ± 9.15, respectively ( = .009). The majority of patients were female (SG: 11 [47.8%]; CG: 14 [60.9%]), married (SG: 20 [87.0%]; CG: 19 [82.6%]), and had a diagnosis of cancer (SG: 20 [87.0%]; CG: 21 [91.3%]). The mean SSES score for stoma self-efficacy was 103.82 ± 15.81 in the SG and 89.91 ± 13.41 in the CG after the fourth session. Results indicated an improvement in self-efficacy in both groups from baseline to final follow-up visit ( <.0001). SSES in the SG was significantly different from baseline to final follow-up visit during the study (F = 3.183, = .008). Mean OAI-23 scores were 51.04 ± 13.37 in the SG and 50.82 ± 13.84 in the CG at baseline and after the intervention (fourth session) were 60.56 ± 16.41 in the SG and 53.95 ± 13.22 in the CG group. The repeated measure test results indicated significant increases in adjustment scores from baseline to final follow-up visit in both groups ( = .000).
The results of this pilot study suggest that using simulation to teach ostomy self-care improves self-efficacy after 3 and 9 weeks. Further randomized controlled trials that expand the sample size and demographic should be conducted.
造口的外观以及与粪便接触的可能性可能会对术后教学效果产生负面影响，尤其是对于那些文化和宗教背景认为粪便不可触碰的患者。涉及使用物理造口模拟器进行练习的指导可能有助于解决这个问题。
本试点研究的目的是确定造口自我护理模拟训练对自我效能感和适应能力的影响。
2015年4月至2015年12月，在伊朗东部的2个公立医疗中心外科病房，采用连续抽样法对患者进行随机临床试验。邀请讲波斯语、年龄在18至65岁之间、有临时或永久性肠道造口且没有可能干扰自我护理教学的合并症的患者参与，并随机分配到模拟组（SG）或对照组（CG）。两组均接受4次培训课程；每组的第一次和第四次课程相同，但在第2次和第3次课程中，SG组使用可穿戴造口模拟器，而CG组使用示范-回示法。收集人口统计学和造口变量，并在基线（手术后）、4次教学课程后以及最后一次教育课程后45天，使用造口自我效能量表（SSES）和造口适应量表-23（OAI-23）进行评估。使用描述性统计、卡方检验、费舍尔精确检验、曼-惠特尼检验、重复测量检验和最小显著差异检验来分析数据。
在纳入的53例患者中，46例（每组23例）完成了研究。SG组和CG组患者的平均年龄分别为45.91±10.40岁和53.78±9.15岁（P = 0.009）。大多数患者为女性（SG组：11例[47.8%]；CG组：14例[60.9%]），已婚（SG组：20例[87.0%]；CG组：19例[82.6%]），诊断为癌症（SG组：20例[87.0%]；CG组：21例[91.3%]）。第四次课程后，SG组造口自我效能感的平均SSES评分为103.82±15.81，CG组为89.91±13.41。结果表明，两组从基线到最终随访的自我效能感均有所提高（P < 0.0001）。在研究期间，SG组的SSES从基线到最终随访有显著差异（F = 3.183，P = 0.008）。基线时，SG组的平均OAI-23评分为51.04±13.37，CG组为50.82±13.84；干预后（第四次课程），SG组为60.56±16.41，CG组为53.95±13.22。重复测量检验结果表明，两组从基线到最终随访的适应评分均显著增加（P = 0.000）。
本试点研究结果表明，使用模拟教学造口自我护理可在3周和9周后提高自我效能感。应进行进一步扩大样本量和人口统计学范围的随机对照试验。
