The aim of the study was to explore surgical nurses’ perceptions of patients’ needs post-stoma surgery. A descriptive and non-experimental, cross-sectional design was used in the study. Twelve female surgical nurses from two surgical wards were chosen by means of convenience sampling. Face-to-face semi-structured interviews comprising of both close-ended and open-questions were the main means for data collection.

The data was analyzed quantitatively by means of descriptive statics. Graphs and tables were used to illustrate the findings. Furthermore, content analysis was used to analyze the qualitative data. By investigating the nurses’ perceptions, proposed changes were suggested in order to provide better quality of care towards the post-operative stoma patients.

Results in the study indicate that the female surgical nurses’ perceptions of ostomates’ post-operative needs seems to be parallel to those of the stoma patients themselves. On the other hand, there were a small number of dissimilarities when perceptions were compared on whether the needs of ostomates’ were being attended to on the surgical ward. All of the participants stated that the physical, psychological and social needs were imperative for the post-operative stoma patient.

Furthermore, results show that quite a few nurses expressed that they did not consider all aspects of ostomy care such as sexual health information-giving, teaching and counseling as being part of their nursing role on the ward, stating that this was the role of the Stoma Care Nurse. This suggests some degree of role ambiguity amongst the participants. In addition this may propose that nurses may not have the necessary knowledge, skills and confidence in assisting and dealing with the post-operative needs of stoma patients. However, several nurses suggested that certain aspects of ostomy care need improving upon, allowing for better quality of care thus attending to most, if not all, of the post-stoma patients’ needs.

The results are limiting to the small scale study, however they have highlighted several nursing implications. Recommendations for practice and education including post-graduate education and preparation for improving the nurses’ teaching skills and information-giving related to sexual health information and research were highlighted. In addition, specialized courses in stoma care and counseling programs for all surgical nurses was recommended, allowing nurses to have up-to-date knowledge on stoma care.

Furthermore, proposals for research including a research study using a larger-scale with an improved tool tested for reliability and validity, allowing for more generalizability of the results amongst the Maltese surgical nurses was emphasized at the end of this study.

Table of Contents

Dedication

i

Declaration

ii

Acknowledgements

iii

Abstract

iv

Table of Contents

vi

List of Figures

xi

List of Tables

xiii

CHAPTER 1 INTRODUCTION

1

1.1 Introduction

1

1.2 Local Situation

1

1.3 The purpose of the Study

2

1.4 Research Question

3

1.5 The Importance and Benefit of the Study

3

CHAPTER 2 LITERATURE REVIEW

2.1 Introduction

4

2.2 Ostomates’ post-operative Adjustment to Stoma Formation.

5

2.3 Ostomates’ perceptions of their post operative Physical Needs.

7

Stoma patients’ need for Self-Care

7

Patients’ post-operative Psychological Needs

9

2.4.1 Self Expression Needs

10

Stoma patients’ perceptions of Sexuality and Body Image post-stoma formation.

11

Ostomates’ Information Needs in the post-operative phase.

13

Stoma patients’ perceptions of Social

Support following stoma surgery.

16

2.7 Limitations

18

2.8 Conclusion

19

CHAPTER 3 METHODOLOGY

3.1 Aims and Objectives

20

3.2 Research Question

21

3.3 Operational Definitions

21

3.4 Research Design

22

3.5 Research Site

22

3.6 Target Population

23

3.6.1 Inclusion Criteria

23

3.6.2 Exclusion Criteria

24

3.7 Sampling Technique

24

3.8 Research Tool

25

3.9 Validity and Reliability

26

3.10 Pilot Work

27

3.11 Ethical Considerations

27

3.12 Data Collection and Analysis

29

3.13 Concluding Remarks

29

CHAPTER 4 FINDINGS AND DATA

ANALYSIS

4.1 Introduction

30

4.2 Demographic Data

31

4.3 Physical needs of post-operative stoma patients

35

4.4 Psychological needs related to stoma patient care

38

4.5 Post-operative Stoma Information

43

4.6 Education needs of the patient post-stoma formation

47

4.7 Nurses’ Role of different aspects of stoma care nursing

49

4.8 Enhancing Ostomy Care on the general surgical ward

58

4.9 Conclusion

60

CHAPTER 5 DISCUSSION

5.1 Introduction

61

5.2 Nurses’ perceptions of ostomates Physical and Educational needs in the Post operative phase

62

5.2.1 The nurses’ perceptions on the need to teach patient stoma care

63

5.2.2 Teaching the ostomates about an altered diet and required nutrients following stoma surgery

64

5.2.3 Nurses’ perceptions of the importance of teaching stoma patients about stoma complications

65

5.2.4 Nurses’ perceptions of ostomates alteration in clothing following stoma formation

66

5.3 Nurses’ perceptions of patients’ Psychological Needs post-stoma formation

67

5.3.1 Psychological Adjustment and Social Support

67

5.3.2 Reassurance

69

5.3.3 Sexuality and an Altered Body Image

70

5.4 Nurses’ perceptions of Ostomates’ Information needs

72

5.5 Nurses’ perceptions of ostomy care: The

Surgical Nurse and Specialist Nurses’ Role

74

5.6 Nurses’ Perceptions of Improving Ostomy Care on the Surgical Ward

78

5.7 Critique of the Study: Strengths and Limitations

79

5.7.1 Strengths

79

5.7.2 Limitations

80

5.8 Conclusion

81

CHAPTER 6 CONCLUSION &

RECOMMENDATIONS

6.1 Conclusion

82

6.2 Recommendations

83

6.2.2 Recommendations for Practice and Education

83

6.2.3 Recommendations for Research

85

REFERENCE LIST

86