NUZHAT SULTANA Online Phd Nursing Student Texila American University EFFECT OF COLOSTOMY CARE IN-SERVICE EDUCATION ON THE LEVEL OF COMPETENCE AMONG NURSES WORKING IN SURGICAL UNITS NUZHAT SULTANA Online Phd Nursing Student Texila American University

Summary Introduction: Colostomy care is significant nursing intervention to ensure patient centered care. The assessment of nurses knowledge of colostomy care has not been conducted before at the study hospital. Purpose: This study was conducted to evaluate the nurses knowledge of colostomy care, and the effect of colostomy care in-service education on the level of competence among nurses working in surgical units. Method: Participatory Action Research (PAR) approach was selected using pre and post- test to assess the nurses knowledge managing patients with colostomy

Cont.. Result: The study results indicates that the nurses working in the surgical units of the study hospital lack the required knowledge related to colostomy care. However, before and after the training session significant difference in knowledge, skills and attitude was noted. Conclusion: The study findings suggest that there is an intense need to deal with this area and develop the mechanism for regular in-service education sessions on colostomy care for nurses working in surgical units. Moreover, future researches are warranted in this important aspect of nursing care.

Background A number of patients undergo colostomy procedure every year to treat and reduce patients’ pain and discomfort. On the other hand, this procedure causes stress and agony for patients, as a result of skin irritation 76%, pouch leakage 62%, unpleasant odor 59%, avoidence of enjoyable activities 54%, and depression/anxiety 53%, cited in (Dabirian, Yaghmaei, Rassouli, & Tafreshi, 2011). Key professional role of nurses working with colostomy patients is to provide high standard care based on patient's need (Bhzeh, Teleb, Mahmoud, & Soliman, 2013).

Cont… Colostomy is a surgical procedure that takes out one end of large intestine and colon is sidetracked through an incision in the abdominal wall to form a stoma. A stoma is the opening in the skin where a small bag for collecting feces is attached. People with temporary or long-term colostomies have pouches attached to their sides where feaces collect and easily disposed off (Bhzeh, et al., 2013), (Burch, 2011). A recent study conducted in Pakistan reported the lack of trained nurses in colostomy care (Zakri, Shah, Khaliq, & Asghar, 2010). Managing colostomy patient is a complex situation, it is important that time to time nurses knowledge must be up-dated to help the patient to deal with altered health condition (Ardigo & Amante, 2013).

Purpose of the study To evaluate the nurses knowledge regarding colostomy care, and the effect of colostomy care in-service education on the level of competence among nurses working in surgical units.

Methodology Design: Participatory Action Research (PAR) approach was selected using pre and post- test to assess the nurses knowledge managing patients with colostomy with IRB approval. Sample: The purposive sample of (n=39) Nurses was selected from male and female surgical units at Shifa International Hospital Islamabad, Pakistan a private tertiary hospital.

Cont… Data Collection Data was collected in last week of June 2016, Using self-developed tool based on current literature review in the form of pre-test and post-test. Tool consisted of two parts: Part1: Demographics characteristics: (age, Gender, academic qualification and job experience). Part 2: Assessment of nurses' knowledge related to colostomy care included five subjective type questions (Each question was allocated 5 marks. Validity of tools was done by two expert nurses. A pilot study was carried out on 10% of sample to test the feasibility of the study)

Pre & Post test Questions Define colostomy. Name the types of colostomy. List at least 5 teaching needs of colostomy patient. List the food that should be recommended to colostomy patient that makes the stool soft. Name Supplies used for Colostomy Care and also listing 3 competencies required for Colostomy Care.

Results & Discussion

Demographic Male (n=26) Female (n=13) 21-40 (n=33) 41-60 (n=6) Registered Nurse (n=28) Assistant Head Nurse & Above (n=11) BScN (n=8) General Nursing 3 Years Diploma (n=31) *13 One year Specialization Fresh (10) 1-10 Years (n=23) 11-40 Years (n=6) Gender

Overall Pre-test & Post-test Score (N=39) F % 6 15.4 2* 5.1 3 2 20 7.7 4 7 17.9 21 10.3 5 22 23 8 9 24 10 12.8 12 1 2.6 25 18 46.2 13 Mean 6.08 22.38 Std. Deviation 3.74 5.54 P-value (T-test) 0.000 (Sig. 2-tailed) Overall Pre-test and Post-test Score The Overall Pre-test mean score was 6.08; Standard deviation 3.74; Minimum score 0 (n=6) and Maximum score 13 (n=2) Majority of the participants (n=33) scored between 3 to 13. In overall Post-test mean score was 22.38; Standard deviation 5.54; Minimum score 0 (n=2) those who did not attempt the post-test, while majority of the participants (n=19) scored between 20 to 24 and (n=18) scored 25 the highest. Test of Significance Null Hypostasis: Stated that mean score of pre-test = mean score of post-test. Alternative Hypostasis: Stated that mean score of pre-test ≠ mean score of post-test. The mean score of pre-test was 6.08 and the mean score of post-test was 22.38, so there was enough evidence to reject H0. P-value for all the pre-test and post-test responses were calculated using T-test. In all of the components a significant difference was observed as all 2-sided significance value for the complete set of questions came out to be highly significant < 0.005. * = Those who did not attempt the post-test

Conclusion Overall this study shows that nurses working in surgical wards in study hospital lack the required knowledge and competence related to colostomy care. Therefore, nurse managers need to develop effective mechanism of regular in-service education for nurses working in surgical units. Though the sample size was small and study findings cannot be generalized even then study has the implication on nursing practice, education and research.

Recommendations Study findings suggest that nurse managers must assess the nurses knowledge regarding colostomy care on regular basis Develop the effective mechanism for continue education to up- date nurses with required knowledge and skills to manage colostomy patients in surgical units to ensure patient centered care. Replication of the study on larger scale in multiple sitting should be conducted for the purpose of generalization.

References Ardigo, F. S., & Amante, L. N. (2013). Knowledge of the Professional about Nursing Care of People With ostomies and their Families. Text Context Nursing, 22(4), 1064-1071. doi: https://dx.doi.org/10.1590/S0104-07072013000400024 Bhzeh, N. M., Teleb, S. M., Mahmoud, M. A., & Soliman, A. M. (2013). Colostomy: Developing Nursing Care Standards for Patient with Colostomy. The Medical Journal of Cairo University, 81(2), 57-64. Burch, J. (2011). Resuming a normal life: holistic care of the person with an ostomy. British Journal of Community Nursing, 16(8), 366-373. doi: 10.12968/bjcn.2011.16.8.366

Cont.. Dabirian, A., Yaghmaei, F., Rassouli, M., & Tafreshi, M. Z. (2011). Quality of life in ostomy patients: a qualitative study. Patient preference and adherence, 5, 1-5. doi: 10.2147/ppa.s14508 Zakri, R. H., Shah, S. A., Khaliq, T., & Asghar, T. (2010). Impact of Ostomy Surgery on Hospitalized Patients at a Tertiary Care Hospital in Pakistan. Ann. Pak. Inst. Med. Sci, 6(1), 36-39.