Stoma self-care guide

Abdominal stomas are a common surgical procedure in clinical practice. Stomas are categorized as temporary or permanent based on the length of recovery time. Temporary stomas are typically reversible after a short period of time and have minimal impact on the patient's long-term quality of life. Permanent stomas are commonly used after rectal cancer surgery. Because the tumor is located close to the anus, radical surgery cannot preserve the anus. Therefore, a stoma is created in the abdominal wall after surgery. This stoma is permanent and cannot be re-introduced. This creates significant inconvenience for the patient and can also lead to low self-esteem. Quality of life refers to a person's subjective experience of daily life, encompassing psychological, physical, and social functioning. However, with improving living standards, patients are no longer solely focused on prolonging survival; they also demand a more dignified existence. While permanent stomas can extend lifespan, they can also significantly impact their quality of life. Therefore, improving the quality of life for patients with permanent stomas has become a hot topic in modern medicine.

Analysis of factors affecting quality of life in patients with permanent stoma

Stoma duration, postoperative complications, negative emotions, self-care ability, self-efficacy, and psychosocial adaptability are important factors affecting quality of life. Self-care ability, self-efficacy, and psychosocial adaptability are protective factors for patients' postoperative quality of life, while stoma duration, postoperative complications, and negative emotions are high-risk factors affecting patients' quality of life. Studies have shown that patients with stomas for less than one year have a lower quality of life, which may be due to the shorter stoma-wearing time and poor stoma management skills. Negative emotions mainly refer to the low self-esteem, pessimism, loss, and even thoughts of self-abandonment that patients may experience after surgery. The main reason for this is that although ostomy surgery saves patients' lives, changes in normal physiological structure lead to changes in patients' bowel movements, making it difficult for patients to accept their own image for a while. Lack of professional care after stoma surgery can easily lead to a series of complications such as stoma stenosis, surrounding abscesses, prolapse, and bleeding. Patients with severe stoma stenosis will need to undergo another surgery, which will lead to a serious decline in their quality of life. Studies have shown that the higher a patient's self-care ability and self-efficacy, the better their postoperative stoma management and the lower the incidence of postoperative complications. A higher level of social adaptability can help patients feel more at ease with their illness and increase their confidence in treatment. Therefore, self-care ability, self-efficacy, and social-psychological adaptability are protective factors for quality of life. Effective measures should be taken after surgery to maximize the patient's self-care ability, self-efficacy, and social-psychological adaptability, thereby improving their overall quality of life.

Nursing interventions

Preoperative psychological nursing intervention

Patients undergoing permanent ostomy surgery not only have to endure the pain of surgery but also face the reality of altered anatomy. Coupled with the altered bowel movements and the financial burden of expensive long-term ostomy products, patients are prone to negative emotions such as fear, depression, and pessimism, and may even consider giving up treatment. Therefore, caregivers should actively communicate with patients and their families, using educational materials, videos, and face-to-face interactions to educate them about the ostomy procedure and the safety of their daily lives, work, and sexual function. Preoperative visits with patients who have experienced and recovered from permanent ostomy surgery can also be conducted to share their experiences and boost their confidence. Furthermore, to alleviate patients' anxiety and fear, social and family support can be leveraged to encourage them to actively pursue treatment, such as through the presence and comfort of family and friends.

Nursing intervention to prevent complications

Stoma prolapse, stenosis, and peristomal dermatitis are common postoperative complications, making prevention of these complications crucial for improving patients' quality of life. Currently, there are no effective interventions for stoma prolapse, requiring further surgical intervention. Stoma stenosis is prevented by dilation of the anus, typically beginning one week after surgery. The specific method is to insert the index finger 2–3 cm into the stoma and hold it there for 3 minutes. This is done daily, and after one week of training, this is increased to every other day. After discharge, patients and their families are advised to dilate the anus once every 1–2 weeks. The specific duration of dilation should be determined by the doctor. However, care should be taken to ensure gentle dilation to avoid damaging the bowel or stoma. Some patients develop inflammatory lesions in the skin around the stoma after stoma treatment due to allergies to stoma products or untreated intestinal secretions. To prevent peristomal dermatitis, choosing the right stoma product is paramount, followed by ensuring that the patient and their family members always keep the skin around the stoma clean.

Strengthen patient self-care guidance

Improving self-care ability is not only beneficial for patients to timely control the condition of their own stoma, but also beneficial for taking care of their own daily life and reducing the burden on their families. Generally, in the early stage of stoma opening, because patients have little knowledge of stoma care, and intestinal dysfunction causes a large amount of fecal water and intestinal fluid to leak out, patients are often at a loss and basically need to rely on medical staff for care. Therefore, nursing staff should demonstrate and teach patients and their families relevant stoma care knowledge, and urge patients to practice continuously during hospitalization, so as to improve patients' self-care ability and prepare for better self-care after discharge. During the patient's practice, the stoma nurse and therapist will evaluate the patient's self-care ability, correct any deficiencies in a timely manner, and give praise and commendation for good performance.

In summary, common factors affecting the quality of life of patients with permanent stomas after surgery include negative emotions, stoma complications, stoma duration, and personal self-care ability. Therefore, it is important to prioritize patients' emotional

responses and implement effective preoperative psychological care measures to reduce their stress response. Postoperatively, we can help reduce the incidence of complications by preventing complications, enhancing their self-care abilities, and providing ongoing care outside the hospital. Through personal efforts, we can also reduce the burden on their families, thereby improving their overall quality of life.