1. Enhancing Recovery After Colorectal Surgery Theory Guiding Practice Lorraine Babcock UCF

2.  The cognitive adult patient s/p colorectal surgery (with a new stoma) present multifaceted challenges for nursing  Enhanced recovery programs designed to reduce recovery time are now in use  High stress & anxiety hinder retention of patient education, often delaying discharge  The nurse must develop a plan of care with emphasis on coping strategies & education  Surgeons & patients rely on nursing for positive outcomes Background

3.  Adult stoma patients with normal intellect experience ineffective health maintenance related to impaired knowledge regarding integration of stoma care into their lifestyle  The essence of this problem is motivation & changing behavior Statement of the Problem

4.  Inflammatory bowel disease (IBD) includes Crohn’s & ulcerative colitis  IBD causes pain, altered elimination, fatigue, & malnutrition  IBD affects as many as 1.4 million people in the US  Over 100,000 hospitalizations per year are due to IBD  IBD has an overall healthcare cost of over $1.7 billion annually  Patients usually require healthcare throughout their lifetime  There is no medical cure, only symptom management & surgical intervention (when medicine fails)  Focus on education & coping is beneficial for patient recovery Significance of the Problem

5.  Nursing has an opportunity to help improve patient outcomes by applying a middle range theory to ready the patient for discharge  The Theory of Self-Efficacy will address the core problems of motivation & changing behaviors  The goal is to use the critical elements to design successful plans of care for the stoma patient  Shared decision making  Teamwork  Communication  The patient, family, providers, & nursing should be involved Specific Aims

6.  Definition of self-efficacy: the individual’s own recognition of his or her ability to take action  Theory of Self-Efficacy is based on the social cognitive theory  Two vital concepts of the theory  Self-efficacy expectations  Outcome expectations  The environment & interactions with others are also influential  The individual must believe they are capable of causing a certain outcome Theory of Self-Efficacy

7.  To apply the theory, the nurse should focus on each of the theory’s informational sources  Enactive attainment  Ex: set goal for patient to return demonstrate self-care of stoma by postoperative day 2  Vicarious experience  Ex: visualize others performing the desired behavior  Verbal persuasion  Ex: nursing & providers give verbal encouragement & support the patient’s efforts  Physiological feedback during a behavior  Ex: maintain pain at an acceptable level through use of relaxation techniques & non-opioid medications Application of Theory to Practice

8.  Adult stoma patients with normal intellect often have difficulty incorporating self-care into their lifestyle after discharge  Stress & anxiety may hinder knowledge retention  Problems with ineffective coping, motivation, & changing behavior are common  Enhanced recovery discharge objectives are often hard to meet without focused nursing interventions  Through application of the Theory of Self-Efficacy, the nurse can effect positive outcomes, where the patient is motivated & able to change behaviors Summary and Conclusions

9.  Aasa, A., Hovbäck, M., & Berterö, C. M. (2013, June). The importance of preoperative information for patient participation in colorectal surgery care. Journal of Clinical Nursing, 22(11-12), 1604-1612.  Ackley, B. J., & Ladwig, G. B. (2006). Nursing Diagnosis Handbook (8th ed.). St. Louis, Missouri: Mosby Elsevier.  Allison, M., Lindsay, J., Gould, D., & Kelly, D. (2013, November). Surgery in young adults with Inflammatory Bowel Disease: A narrative account. International Journal of Nursing Studies, 50(11), 1566-1575.  Babcock, L. (2013, October 25). NGR5800: Paper 2 Analysis of a Nursing Problem.  Borkowski, S. (1998). Pediatric stomas, tubes, and appliances. The Pediatric Clinics of North America, 45(6), 1419-1435.  CDC. (2012). Inflammatory Bowel Disease. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/ibd/  Danielson, A. K., Soerensen, E. K., Burcharth, K., & Rosenberg, J. (2013, January). Impact of a temporary stoma on patients’ everyday lives: feelings of. Journal of Clinical Nursing, 22(9-10), 1343-1352.  Krouse, R. S., Grant, M., Rawl, S. M., Mohler, M. J., Baldwin, C. M., Coons, S. J., et al. (2009, March). Coping and acceptance: The greatest challenge for veterans with intestinal stomas. Journal of Psychosomatic Research, 66(3), 227-233.  Mayo Clinic. (1998-2013). Inflammatory bowel disease. Retrieved from Mayo Foundation for Medical Education and Research: http://www.mayoclinic.com/health/inflammatory-bowel-disease/DS01195/DSECTION=symptoms  McEwen, M., & Wills, E. M. (2011). Theoretical Basis for Nursing (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.  Peter, D., & Robinson, P. (2011, October). Teach-back technique must be taught. Patient Education Management, 18(10), 112-113.  Readding, L. A. (2005, September). Hospital to home: smoothing the journey for the new ostomist. British Journal of Nursing, 14(16), S17-S20.  Singh, S., Butow, P., Charles, M., & Tattersall, M. H. (2010, September). Shared decision making in oncology: assessing oncologist behaviour in consultations in which adjuvent therapy is considered after primary surgical treatment. Health Expectations.  Smith, M. J., & Liehr, P. R. (2014). Middle Range Theory for Nursing (3rd ed.). New York: Springer Publishing Company.  Trunnell, E. P. (1996, January). Mindfulness and people with stomas. Journal of Wound, Ostomy and Continence Nursing, 23(1), 38-45.  Wong, E. M.-L., Chan, S. W.-C., & Chair, S.-Y. (2010, May). Effectiveness of an educational intervention on levels of pain, anxiety, and self-efficacy for patients with musculoskeletal trauma. Journal of Advanced Nursing. References