الفهرس 
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Abstract
Colostomy is one of the lifesaving procedures performed worldwide. It refers to a surgically created opening in the abdomen in which a part of the colon is brought outside the abdominal wall to create a stoma through which feces passes out of the body into an external pouching system. It can be done either for emergency or elective surgical conditions for the management of many conditions including; colorectal cancer, intestinal obstruction, colorectal trauma, acute diverticulitis, and inflammatory bowel diseases,either for decompression of an obstructed colon or diversion of feces. It can be temporary or permanent.
Assessment of knowledge and self-efficacy among patients with a colostomy is a very important role of the nurse. The nurses assess patients’ knowledge regarding normal stoma characteristics, colostomy care, nutritional pattern, Potential complications, and management of colostomy problems, lifestyle modifications, and follow-up. Stoma care self-efficacy which refers topatients’ beliefs that they can successfully manage their stoma to minimize adverse outcomes should be also assessed.
The nurse plays a vital role in providing continuity of teaching and cares for the colostomy patients based on their needs, improving self-efficacy, and promoting patients outcomes.
This study aimed to:
Assess knowledge and self-efficacy among patients with a colostomy.
Research questions:
a) What is the knowledge level among patients with a colostomy?
b) What is the level of patients’ self-efficacy for colostomy care?
Materials and method:
Research design:
A descriptive research design was utilized to meet the aim of the present study.
Setting:
This study was conducted at Alexandria Main University Hospital in the following settings: Colorectal Surgical Outpatient, Gastrointestinal Surgical Outpatient, and Oncology Surgical Outpatient Clinics.Furthermore, data were collected also from Colorectal Surgical, Gastrointestinal Surgical, and Oncology Surgical Units.
Subjects:
Based on the Epi Info program, a convenient sample of 60 adult patients with colostomy from both sexes admitted to the above-mentioned settings that selected according to the following criteria:
• Conscious adult patients from age 20 to 60 years old.
• Able to communicate verbally.
• Agreeing to participate in the study.
• With a temporary or permanent colostomy
• Patients who attended for follow up after one month or more from hospital discharge after surgery
Tools of the study:
To fulfill the aim of the study, two tools were used for data collection.
Tool I: Knowledge of Patients with Colostomy Structured Interview Schedule.
This tool was developed by the researcher after reviewing related literature to assess the colostomy patients’ knowledge. It was divided into two parts:
Part I: Patients’ Socio-demographic and Clinical Data:
This part included data related to:
Part I-a: Socio-demographic data: It included the following data such as age, gender, marital status, area of residence, level of education, occupation, and monthly income.
Part I-b: Clinical Data: It was designed to obtain information related to the patient’s present history such as diagnosis, type of colostomy, stoma site, duration of living with a colostomy, type of current medications. In addition to patients’ history such as previous training on stoma care, receiving pre-operative teaching, previous hospitalization, and associated diseases.
Part II: knowledge of Patients with Colostomy:
This part addressed the knowledge of patients with a colostomy. It was composed of six main items. It was used to assess the patient’s knowledge concerning the following items which include; knowledge regarding normal stoma characteristics, colostomy care, nutritional pattern, control, and management of colostomy problems, and/or complications, lifestyle modifications, and follow-up.
Tool (II): Stoma Care Self-Efficacy Scale:
It is 3 points Likert Scale that was adapted by the researcher from (Bekkers et al., 1996). It consisted of 13 items on self-efficacy of managing a stoma. It was designed to assess a general sense of perceived self-efficacy to assess coping with day-to-day difficulties of managing a stoma.
Method:
It was conducted in the following steps:
- Ethical Research Committee approval and administrative authorities permissionwere obtained after an explanation of the study aim.
- After a thorough review of relevant literature, Tools I was developed, and tool II was adapted by the researcher.
- Content validity of these tools I and II was done by 5 experts in the medical surgical nursing field. This was to assess their objectivity, clarity, completeness, and the necessary modifications were done.
- Tools reliability was tested using Cronbach’s Alpha test.
- A pilot study was conducted on 10% of the total studied subjects (excluded from the sample), and modifications were done.
- Using the tool I and II each patient in the following settings: Colorectal Surgical Outpatient, Gastrointestinal Surgical Outpatient, and Oncology Surgical Outpatient Clinics,Colorectal Surgical, Gastrointestinal Surgical and Oncology Surgical Units at Alexandria Main University Hospital was interviewed individually once for 30-45 minutes after explaining the study aim.
- Data collection was conducted over 6 months (from June - November 2020).
Statistical analysis of the data:
After completion of data collection, statistical tests were carried out using SPSS, version 25 for both data presentation and statistical analysis of the result. The number and percentage were used for describing and summarizing qualitative data. Mean and the standard deviation were used to present the quantitative data.
The main results of the study were as the following:
• Almost two thirds (65%) of the studied patients had good knowledge level about normal stoma characteristics.
• More than half (61.7%) of the studied patients had poor knowledge level concerning colostomy care and life-style modifications.
• The majority (81.7%) of the studied patients had poor knowledge level regarding the nutritional pattern and colostomy problems and/or complications management.
• More than half (58.3%) of the studied patients had poor knowledge level about follow-up.
• The majority (81.7%) of the studied patients had poor knowledge level, while 13.3% of them had fair knowledge level and only 5 % of them had good knowledge level for total knowledge level.
• More than two-thirds (68.3%) of the studied patients had low self-efficacy, while less than one-third (30.7%) of them had high self-efficacy.
• There was a statistically significant relationship between patients’ Overall knowledge and age, gender, educational level, previous training on stoma care.
• There was a statistically significant relationship between patients’ Overall self-efficacy and age, educational level.
• There was a statistically significant strong positive correlation between patients’ overall knowledge mean percent score and overall self-efficacy mean percent score.
The main recommendations based on the findings of the present study were as follow:
Recommendations for Patients:
o Develop and implement educational programs for patients with colostomy in order to improve their knowledge and self-efficacy regarding colostomy care, involving family and caregivers who participate in colostomy patient’s care.
o Prepare colored illustrated, Arabic language booklet that should be available and distributed to each patient with a colostomy.
o Prepare simplified illustrated and comprehensive videos to be presented to patients with colostomy to improve their knowledge and self-efficacy.
Recommendations for Nurses:
o Prepare training programs for nurses about the learning needs of colostomy patients to be well prepared to provide support, instructions, and training for colostomy patients.
o Conduct periodic scientific meetings among physicians and nurses to discuss patient’s problems and establish a comprehensive plan to meet colostomy patients’ needs.
Recommendations for Further studies:
o Replication of the same study on a larger sample of colostomy patients at different geographical areas for evidence of the results and generalization.