INTRODUCTION:

Health is a state of optimal functioning or wellbeing. As defined by the World Health Organization, one’s health includes physical, social and mental components and is not merely the absence of disease or infirmity. Health is often a subjective state - a person may be treated, but still have some psychological problems related to his body (Carol, 2005). The world health organization lists that the leading cause of illness or death is due to injuries, cancer, cardiovascular diseases, maternal and nutritional conditions, infectious and parasitic diseases and HIV/AIDS (WHO, 2004).Cancer is the leading cause of death globally. WHO estimates that 7.6 million people died of cancer in 2004 and 84 million people will die in the next 10 years if action is not taken (Rambo, 1984). Colon and rectal cancers stand third among the other types of cancers leading to death. There are about 10, 80,000 people around the world and 78,000 people in South East Asia living with colon and rectal cancers. Bladder cancer accounts for 5 percentages of all new cases of cancer among men and 3 percentages of all new cases of cancer among women. Yet it is the fourth most prevalent cancer in men and sixth most prevalent in women (WHO, 2008). Despites advancements in medical and surgical interventions for cancer, stoma surgery is still one of the major treatment for many patients with colorectal and bladder cancer and radical surgical resection being considered the only chance for the permanent cure. Because stoma surgery is a radical procedure the patient not only needs to cope with a major operation but also faces the loss of important bodily function, distortion of body image and change in person’s care .The major issue for stoma patients and their significant others is the management of stoma, physical dexterity, self concept, and self efficacy (kit man, 2007).

Many clinical studies found patients with ostomies to be a group of people facing multiple adjustment demands. One of these demands is coping with a significant change in body image and self efficacy. Studies reveal that the primary needs revolved around personal or social acceptance of altered body image (Walsh,1995).

Practice is advancing and the future holds a time of dynamic change and challenge in stoma care nursing. Today’s nurse can look forward to an opportunity to broaden their ability to advocate for the needs of patient with stomas by preparing a teaching module so that the overall health of stoma patients is not compromised. .

OBJECTIVES OF THE STUDY:

1. To assess the perceived of body image of stoma patients before and after the structured teaching programme.

2. To assess the self efficacy of stoma patients before and after the structured teaching programme.

3. To assess the knowledge of stoma patients before and after the structured teaching programme.

4. To evaluate the effectiveness of structured teaching programme on knowledge of stoma care, self efficacy and perceived body image among stoma patients.

5. To find out the association between knowledge of stoma care, self efficacy, perceived body image and selected demographic and clinical variables of stoma patients.

MATERIALS AND METHODS:

Pre experimental design was used to assess the Perceived body image and self efficacy, knowledge and the effectiveness of structured teaching programme on stoma care self efficacy, body image and knowledge of patients with stoma. The study was conducted in Christian medical college, Vellore, a multidisciplinary specialty, tertiary medical care centre with 2334 beds located in Tamil Nadu with all medical facilities to cater to needs of the patients. A sample size of 50 men and women with stoma who visited stoma surgery OPD, urology OPD, stoma clinic and selected surgical wards and those who filled in the inclusion criteria during the study period were selected through the total enumeration sampling technique .The tool consisted of demographic, clinical data and also the modified body image scale (Licavoli, 1998) was used to assess the body image of patients with stoma. This consists of 17 statements and is a four point likert scale. The general self efficacy scale (Mathias Jerusalem and Ralf Schwarzer’s, 1981) was used to assess the self efficacy of patients with stoma. The knowledge questionnaire consists of ten items each consisting of three options and one correct answer. Demographic and the clinical data were collected from the patients. Body image scale and the self efficacy scale were given to the patients for self evaluation. Structured teaching programme on stoma care self efficacy and body image was given to the patients, and as a post test assessment the body image scale and the self efficacy scale was given again to the patient for self evaluation again after 5 days of teaching.

RESULTS:

Figure1. Distribution of subjects according to the type of stoma (N=50)

Figure 1 displays that 48% of the subjects with stoma had colostomy. 32% of them had ileostomy and 20% of them had ileal conduit.

Table 1 shows that the pretest mean as 38.82 and post test mean as 48.58 thereby there is a mean increase in the score of perceived body image by 9.76, . It shows that the increase in the level of body image was highly significant (P < 0.001).

Table 2 shows that the pretest mean as 22.40 and post test mean as 29.52 thereby there is a significant increase in the score of self efficacy by 7.12. This shows that the increase in the level of self efficacy was highly significant (P <0.001).

Figure2. Distribution of subjects with stoma according to their knowledge score in pretest (N=50)

Table 1: Effectiveness of structured teaching programme on perceived body image of subjects with stoma (N=50)

PRETEST		POST TEST		PAIRED DIFFERENCE		T VALUE	P- VALUE
Mean	SD	Mean	SD	Mean	SD	T VALUE	P- VALUE
38.82	7.08	48.58	7.99	9.76	6.26	11.01	< 0.001**

Table 2 :Effectiveness of structured teaching programme on self efficacy in subjects with stoma (N=50)

PRETEST

POST TEST

PAIRED DIFFERENCE

T VALUE

P- VALUE

Mean

22.40

5.99

29.52

6.39

7.12

5.41

9.30

0.001**

**P<0.001.

Figure 2 reveals that 14% of the subjects with stoma had poor knowledge of stoma care.44% had average knowledge, and 38% of them had good knowledge. Only 2% of them had very good knowledge in the pretest. Post test reveals that 40% of the subjects had very good knowledge on stoma care. 58% had good knowledge and 2% had average knowledge and none exhibited poor knowledge the post test.

Association between the clinical variables and demographic variables was checked using chi square, there was no significant association between the perceived body image and socio demographic variables of patients with stoma namely age, sex, education, occupation, income, marital status, religion, language, area.

DISCUSSION:

The study findings revealed that there was statistically significant difference in pre and post body image, self efficacy and knowledge scores in regard to the structured teaching programme on stoma care and therefore the null hypothesis is accepted.

This suggests that patients with stoma have negative body image, poor self efficacy and average knowledge which needs to be addressed by health care professionals so that they are lead to good quality life.

BIBLIOGRAPHY:

· Bandura.A. (2006) Self efficacy mechanism in psychological activation and health promoting behavior. Pp-229-270. New York raven.

· Carol.J.B.(2008) Grant awarded to study self efficacy.

· Kitman.H.(2007). Self efficacy and QOL among patients in hongkong. Cancer nursing. 30(3).

· Rambo. (1984). Stoma care. Journal of wound management. 12(3).

· WHO. (2004). The global burden of disease .30.

Received on 03.10.2013 Modified on 22.11.2013

Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 155-157