Loss and grief reactions as responses to surgery

Psychological issues affecting patients living with a stoma

Stoma surgery is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate postoperative and recovery period, but for the rest of the patient's life. There are changes in bodily function, altered body image, physicality and personal care needs. These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient's needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue throughout the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the past three decades there has been increasing recognition that quality of life (QoL), which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to health professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. This article examines stoma patients' perceptions of their outcomes from recent research. It discusses how more can be done by health professionals to support stoma patients through their initial transition to life with a stoma and for the rest of their life.

Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives

BACKGROUND

Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes.

METHODS

We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive.

RESULTS

Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support.

CONCLUSION

Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment.

Body image and acute burn injuries: a literature review

This article reviews the literature on adaptation to altered body image. An understanding of the factors affecting this may enable practitioners to help patients cope with the changes in body image caused by disfiguring burn injuries.

[Conceptual framework for ostomy care in the hospitalized adult patient]

The author points out a brief revision of the legal, ethical and scientific bases of the ostomy care process and describes some important topics about caring the ostomist in the different operatory phases.

A service evaluation of stoma care nurses' practice

Stoma care nurses aim to meet the physical, psychological, social and spiritual needs of patients. Development of stoma care nursing services has varied, as it has been the responsibility of each nurse, resulting in differences in the mode of delivery. This qualitative and quantitative study involved stoma care nurses from six areas in Essex, to assess patient perception of the service they received. Overall, the satisfaction level was high despite differences in delivery of care especially timing and frequency of visits at home.

The concept of grief: a foundation for nursing research and practice

In spite of the significance of grief as a human response, research to expand knowledge of this phenomenon has been impeded by the existence of a conceptual problem. In this study, a comprehensive and systematic review of both current and classic literature concerning grief was conducted within the disciplines of nursing and medicine. Findings contributed to the definition of grief as a pervasive, highly individualized, dynamic process that often is discussed normatively within professional disciplines. This definition provides not only a synthesis of knowledge concerning grief but a reconceptualization that can promote efforts to clarify this important concept for nursing.

Extended body image in the ventilated patient

This paper explores the experience of altered body image in unexpected critical illness, with particular interest in the extended body image of ventilated patients. It examines from the patients perspective, the impact that ventilation within the intensive care environment, can have on an individuals body image. The concept is developed to explore nursing strategies aimed to support and promote a positive body image in ventilated patients.

Managing radical surgery: notes from the patient's viewpoint

Based on a diary which was kept while preparing for and undergoing pan-proctocolectomy, the paper describes the process of coming to terms with an ileostomy. A number of stages in the process are identified: anticipation, reorientation, trauma, maintenance of selfimage and accommodation. The social-psychological strategies for coping with the process are elaborated.