Dr. Urmila Chaudhari*
Assistant Professor, Department of Nursing, Tilak Maharashtra Vidyapeeth,
Pune, Maharashtra, India
urmilasalgar1959@gmail.com
Abstract:
Introduction: The aim of the study is to assess
the knowledge and practice skills of home-based colostomy caregivers of
children with a colostomy. The objective of the study was to assess the
effectiveness of video teaching module on colostomy care among home-based colostomy
caregivers.
Method:
A quasi-experimental study design and 30 samples were
adopted. The samples selected by the purposive sampling technique those were
fulfilled the sample criteria. Demographic and structured knowledge
questionnaires were used for the data collection.
Result:
Descriptive and inferential statistics were used for data
analysis by using SPSS software version 16.0. Out of 30 samples, demographic
variables, 23 (76.6%) of the participants are of age between 21 and 30 years,
21 (70%) were housewives, 23 (76.6%) were mothers, 16 (53.4%) completed higher
secondary, and 23 (76.6%) have monthly family income of INR 5001–10000. The
majority of the children with a colostomy were toddler 22 (73.3%), gender ratio
was equal, 27 (90%) are of Hindu religion, and 29 (96.7%) undergone colostomy.
Knowledge score was divided based on percentage. Good knowledge scores in pre-
and posttest are 0 and 29 (96.5%); moderate knowledge in pre- and posttest, 9
(30.5%) and 1 (3.3%); and poor knowledge in pre- vs posttest, 21(70%) and 0,
respectively. Inferential statistics evaluated colostomy care video
intervention. Knowledge was assessed by paired t test, −
19.607 (p < 0.05); similarly, practice skill assessed by
Wilcoxon signed-rank was (z) − 4.716 (p < 0.01).
Conclusion:
Colostomy care video was a powerful tool to enhance primary
caregivers’ confidence, colostomy care skills, and attitude.
Keywords: Colostomy
care, Knowledge, Practice, Primary caregivers, Video teaching module
INTRODUCTION
The
colostomy is a surgical procedure in which colon was brought through the
abdominal wall to ease the diversion of stool from the damaged part of the
colon. It may be performed in any part of the colon and normally prepared in
the sigmoid colon [1]. Colostomy was first introduced by
a French surgeon for the treatment of left colon neoplastic obstruction [2]. In 1920, Dr. Bryan Brooke developed
guidelines on standard construction on colostomy care [3]. This procedure may be considered
a life-saving procedure and designed for a short time or the rest of a patient’s
life. In children, colostomy is performed for various problems like birth
defects, trauma, and infectious disease of the gastrointestinal tract [4]
The
colostomy is an invasive procedure, and it may cause discomfort in various
levels like pain at surgical incision, stoma complications, diet, and fluid
imbalance. In addition to parent’s emotion and psychological perspectives, this
is a devastating circumstance for healthcare workers [5]. Colostomies for children in
developing and undeveloped countries have significant social and financial
effects on low-income families [6].
Developed
nations like the USA reported that approximately 100000 population experienced
colostomy or ileostomy. More than 50,000 patients undergo colostomy in India,
and most of them are referred from peripheral centers [7]. Present incidence rates show that
India needs to set up additional colostomy care and manages centers throughout
the nation. A colostomy required for 4–8 months or until further definite
surgery in children. However, the majority of children received colostomy by
parents or primary caregivers in their home setting. Hence, caregivers required
special knowledge and skills to performed colostomy care. Caregivers or parents
have focused on child’s diet, stomal care, and early identification and
management of colostomy complications [8].
Sound colostomy has reduced the mortality and morbidity rates. Therefore, in
1970, an Indian healthcare worker was trained in the USA; later, he turned to
colostomy care trainer for nurses, doctors, and surgeons in India and other
parts of Asia.
This study
aimed to assess the knowledge and practice skills of home-based colostomy
caregivers. Parents or caregivers had poor concept of colostomy, especially
those who are not admitting and taking responsibility on their child’s disease.
Therefore, the investigator developed colostomy care video which may strengthen
the primary caregiver’s confidence and practice skills.
Objective
The first
objective of the study was
1. To assess the level of knowledge and
practice of home-based colostomy care among primary caregivers of children with
colostomy.
2. The second objective of the study
was to determine the effectiveness of video-assisted teaching module on
knowledge and practice of home-based colostomy care among primary caregivers of
children with colostomy.
METHODS
Study Design and Participants
An
evaluative study of quasi-experimental one-group pre- and postdesign was
adopted with a total of 30 samples recruited between January 2018 and July 2018
in the Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute
of Medical Science, (SGPGIMS), Lucknow, Uttar Pradesh, India. The samples are
selected by purposive sampling technique, and the sample size was determined by
sample size calculation formula using the previous study with 80% power and 5%
error. The target population of the study was primary caregivers who were giving
colostomy care in their home setting.
Inclusion Criteria
Inclusion
criteria for study samples were (i) primary caregivers of children with
colostomy, (ii) primary caregivers of children with colostomy age between 0 and
12 years, (iii) primary caregivers who were not aware of colostomy care, and
(iv) children with a colostomy for more than 2 weeks.
Exclusion Criteria
Exclusion
criteria for study participants are (i) children who were admitted for
colostomy closure, (ii) primary caregivers who were not able to speak or
understand Hindi or English language, (iii) critical ill children, and (iv)
caregivers not able to communicate.
Ethical Consideration
Instrument
Socio
demographic characteristics (primary caregivers: age, gender, religion,
education status, and, occupation; children with colostomy: age, gender, type
of stoma, and duration of stoma). Likewise, the second instrument was
standardized self-developed knowledge questionnaires on home-based colostomy
care. The knowledge questionnaire divided into four domains like general
information on the human digestive tract, colostomy care, diet, and
complications. The third instrument was the colostomy care checklist comprised
of 22 items. The tool and video were validated by experts from various fields;
later, the reliability was checked by interrater, and split method reliability
of knowledge was 0.78 and practice was 0.77, respectively.
Colostomy Care Video
Colostomy
care video was developed and validated by colostomy nurses and pediatric
surgeons from SGPGIMS. The investigator selected a child with colostomy and
explained the purpose of videography to the parent. The researcher strictly
adhered to the child’s privacy and does not reveal a child’s identity;
videographer blurred the child’s face and only focused on the colostomy site.
The colostomy video comprised of anatomy and physiology of the human digestive
system, colostomy care, diet management, and prevention of colostomy-related
complications.
Data Collection
The
investigator explained the study purpose to all participants in their regional
language (Hindi). The demographic and knowledge questionnaires were given and
asked them to complete than observed practice skills in the procedure room
department of pediatric surgery, SGPGIMS Lucknow, India. Participants have
taken approximately 20–30 min to complete the first instrument; similarly, 20
min was taken for the second instrument (practice checklist). After the
pretest, the researcher has displayed the self-developed video on colostomy
care in the seminar hall, department of pediatric surgery,SGPGIMS, Lucknow, UP,
India.
Data Analysis
Obtained
data were organized, coded, tabulated, and analyzed using SPSS version 16 (IBM
SPSS Inc, Chicago, IL, USA). A descriptive statistic used to describe the study
sample characteristics includes frequency and percentage. Similarly, the mean
and standard deviation was used for knowledge and practice
scores. Inferential statistics was used to assesse the effectiveness of
colostomy care video among primary caregivers of children with
colostomy,stuay findings summarised in Table 6 and 7.
Table
6.: Paired t test values computed between the pretest and
posttest knowledge scores on colostomy care. N = 30
|
Total
scores |
Mean |
SD |
Mean
difference |
Paired t test
value (t) |
P value |
|
Pretest |
14.20 |
4.046 |
|||
|
Posttest |
28.37 |
1.474 |
14.167 |
−
19.607 |
< 0.01 |
*p <
0.05
Table
7.: Wilcoxon’s Sign rank values computed between the pre-test and post-test
scores practice of home-based colostomy care. N = 30
|
Total scores |
Median |
Interquartile range |
Wilcoxon sign ranked value (z) |
p value |
|
Pretest |
12 |
10–13 |
||
|
Posttest |
18 |
16–20 |
− 4.716 |
< 0.01 |
*p <
0.05
RESULT
The data
were collected (Tables 1 and 2) from 30 primary home-based
colostomy caregivers of children with a colostomy. The finding of the study
shows that 23 (76.6%) of the participant’s age between 21 and 30 years, 21 (70%)
were housewife, 23 (76.6%) were mothers, 16 (53.4%) completed higher secondary,
and in 23 (76.6%) families, their income per month was INR 5001–10000. The
majority of the children with colostomy were toddler 22 (73.3%), equal gender
ratio, 27 (90%) were Hindu religion, and 29 (96.7%) undergone colostomy.
Table
1.
|
Participant characteristics |
Frequency (f) |
Percentages (%) |
|
Age in year |
||
|
21–30 |
23 |
76.7 |
|
31–40 |
5 |
16.7 |
|
> 40 |
2 |
6.6 |
|
Gender |
||
|
Male |
6 |
20 |
|
Female |
24 |
80 |
|
Caregiver relation to child |
||
|
Father |
6 |
20 |
|
Mother |
23 |
76.7 |
|
Guardian |
1 |
3.3 |
|
Caregivers education |
||
|
Higher primary and secondary |
16 |
53.4 |
|
Intermediate |
4 |
13.3 |
|
Graduation |
6 |
20 |
|
Postgraduation and above |
4 |
13 |
|
Employment status |
||
|
Employed |
5 |
16.7 |
|
Self-employed |
4 |
13.3 |
|
Housewife |
21 |
70 |
|
Type of family |
||
|
Joint family |
15 |
50 |
|
Nuclear family |
15 |
50 |
|
Family income |
||
|
< Rs 5000 |
2 |
6.7 |
|
Rs 5001–10000 |
23 |
76.7 |
|
< Rs 10001 |
5 |
16.6 |
|
Previous knowledge |
||
|
Yes |
1 |
3.3 |
|
No |
29 |
96.7 |
|
If yes, the source of knowledge |
||
|
Internet |
01 |
100 |
Frequency (f)
and percentage (%) distribution of the caregivers based on sample
characteristics. N = 30
Table
2. Frequency (f) and percentage (%) distribution of children with a
colostomy. N = 30
|
Participate characteristics |
Frequency (f) |
Percentages (%) |
|
Age of child in year |
||
|
0–3 |
22 |
73.3 |
|
4–6 |
08 |
26.7 |
|
Gender |
||
|
Male |
15 |
50 |
|
Female |
15 |
50 |
|
Religion |
||
|
Hindu |
27 |
90 |
|
Muslim |
3 |
10 |
|
Type of stoma |
||
|
Colostomy |
29 |
96.7 |
|
Ileostomy |
`1 |
3.3 |
|
Duration of stoma |
||
|
0–6 months |
30 |
100 |
The
knowledge score was divided based on the obtained score. Those who scored more
than 75% were considered good knowledge, 50–75% moderate knowledge, and poor
knowledge when they obtain score less than 50%, i.e., good knowledge score in
pre- and posttest 0 and 29 (96.5%), moderate knowledge in pre- and post,
9(30.5%) and 1 (3.3%), and poor knowledge pre- vs post 21 (70%) and 0,
respectively (Table 3).
Table
3. Frequency (f) and percentage (%) distribution of participants based on the
pretest and posttest knowledge sore. N = 30
|
Knowledge scores on colostomy care |
Pretest |
Posttest |
||
|
f |
% |
f |
% |
|
|
Good knowledge > 76% (26–34) |
0 |
0 |
29 |
96.7 |
|
Moderate knowledge 50–75% (18–25) |
9 |
30 |
1 |
3.3 |
|
Poor knowledge < 50% (0–17) |
21 |
70 |
0 |
0 |
With regard
to Table 4, knowledge of primary caregivers in
different domains of mean, standard deviation, i.e., anatomy and physiology
pre- and posttest 3.40 ± 1.522 and 5.47 ± 1.008 and mean percentage pre- and
posttest were 48.5% and 78.1%. Peristomal care pre- and posttest was 7.03 ±
2.251 and 14.00 ± 1.365, and the mean percentage was 41.3% and 82.3%. Diet
management was 1.73 ± 1.143 and 4.40 ± 0.770, and the mean percentages were
34.6% and 88%. Colostomy-related infection pre- and posttest was 2.03 ± 1.450
and 4.47 ± 0.629, and mean percentage was 40.6% and 89.4%, respectively. The
overall mean and SD pre- and posttest were 14.19 ± 6.366 & 28.34 ± 3.772,
respectively.
Table
4. Area wise mean and SD, mean percentage of pretest and posttest knowledge
scores. N = 30
|
Area of knowledge |
Maximum possible score |
Mean ±SD |
Mean percentage |
||
|
Pretest |
Posttest |
Pretest (%) |
Posttest (%) |
||
|
Anatomy and physiology |
7 |
3.40 ± 1.522 |
5.47 ± 1.008 |
48.5 |
78.1 |
|
Peristomal care |
17 |
7.03 ± 2.251 |
14.00 ± 1.365 |
41.3 |
82.3 |
|
Diet management |
5 |
1.73 ± 1.143 |
4.40 ± 0.770 |
34.6 |
88 |
|
Prevention of infection |
5 |
2.03 ± 1.450 |
4.47 ± 0.629 |
40.6 |
89.4 |
|
Overall |
14.19 ± 6.366 |
28.34 ± 3.772 |
|||
The data in
Table 5 show that there was a positive
correlation in colostomy practice. The following items were found the highest
difference of mean and standard deviation before and after colostomy care video
intervention: gathered all the articles in pre- and posttest 14 (46.6%) and 27
(90%), used warm water while cleaning the peristomal skin pre- and posttest
score 11 (36.6%) and 22 (73.3%), majority of caregivers had not used the gloves
after wash contaminated hands pre- and posttest 16 (53.3%) and 28 (93.3%), and
performed hand hygiene followed by colostomy care procedure enhanced the pre-
and posttest 14 (46.6) and 25 (83.3%), respectively. Similarly, Table 6 summarized that there was a
positive statistical significant difference in the pre- and posttest of the
knowledge scores of participants on home-based colostomy care as the pretest
mean and standard deviation was14.20 ± 4.046 and 28.37 ± 1.474; similarly, mean
difference pre- and posttest was 4.167 and paired t test,
− 19.607 (p < 0.05).
Table
5. Frequency (f) and percentages (%) of the practice of home-based
primary colostomy caregivers. N = 30
|
Home-based primary colostomy
caregivers’ practice |
Pretest |
Posttest |
||||||
|
Yes |
No |
Yes |
No |
|||||
|
(f) |
(%) |
(f) |
(%) |
(f) |
(%) |
(f) |
(%) |
|
|
Gathered articles |
14 |
46.6 |
16 |
53.4 |
27 |
90 |
3 |
10 |
|
Ensure assistant for help |
17 |
56.6 |
13 |
43.4 |
24 |
80 |
6 |
20 |
|
Ensure privacy |
16 |
53.3 |
14 |
46.7 |
25 |
83.3 |
5 |
17.7 |
|
Provide comfortable position |
14 |
46.6 |
16 |
53.4 |
23 |
76.6 |
7 |
23.4 |
|
Perform hand hygiene |
18 |
60 |
12 |
40 |
26 |
86.6 |
4 |
13.4 |
|
Empty the colostomy pouch |
18 |
60 |
12 |
43.3 |
23 |
76.6 |
7 |
23.4 |
|
Ensure the colostomy pouch leakage |
16 |
53.3 |
14 |
46.7 |
23 |
76.6 |
7 |
23.4 |
|
Carefully remove the pouch |
17 |
56.6 |
13 |
43.4 |
21 |
70 |
9 |
30 |
|
Notified the peristomal skin
condition |
16 |
53.3 |
14 |
46.7 |
21 |
70 |
9 |
30 |
|
Use warmed water for clean the
stoma |
11 |
36.6 |
19 |
63.4. |
22 |
73.3 |
8 |
26.7 |
|
Measured the stoma size by a stoma
measure guard and select stoma pouch |
19 |
63.4 |
11 |
36.6 |
22 |
73.3 |
8 |
26.7 |
|
Apply the quaze piece over the
stoma to prevent the further contamination |
18 |
60 |
12 |
40 |
26 |
86.6 |
4 |
13.4 |
|
Removed contaminated gloves and
performed hand hygiene |
17 |
56.6 |
13 |
43.4 |
27 |
90 |
3 |
10 |
|
Wear the gloves |
16 |
53.3 |
14 |
46.7 |
28 |
93.3 |
2 |
6.7 |
|
Apply the stoma care product, i.e,
powder, paste |
20 |
66.6 |
10 |
33.4 |
24 |
80 |
6 |
20 |
|
Fixed the stoma pouch over stoma |
16 |
53.3 |
14 |
46.7 |
26 |
86.6 |
4 |
13.4 |
|
Clamp the new pouch on bottom |
16 |
53.3 |
14 |
46.7 |
23 |
76.6 |
7 |
23.4 |
|
Performa hand hygiene |
14 |
46.6 |
16 |
43.4 |
25 |
83.3 |
5 |
16.7 |
|
Ensure the comfort position |
13 |
43.3 |
17 |
56.7 |
22 |
73.3 |
8 |
26.7 |
|
Observed the stool for nature and
consistency |
16 |
53.3 |
14 |
46.7 |
26 |
86.6 |
4 |
13.4 |
|
Perform after procedure and
disposal of waste |
16 |
53.3 |
14 |
46.7 |
26 |
86.6 |
4 |
13.4 |
|
Document date and time |
16 |
53.3 |
14 |
46.7 |
26 |
86.6 |
4 |
13.4 |
The data
presented in Table 7 shows positive significant
practice skills. Median and interquartile range in pre- and posttest 12 vs 18
and 10–13 vs 16–20, respectively. Wilcoxon signed-rank was (z) −
4.716 (p < 0.01). Therefore, the video increased the caregiver
skills, and the stated research hypothesis was accepted.
DISCUSSION
The present
study described the effectiveness of self-developed colostomy care video on
knowledge and practice among home-based colostomy caregivers of children with a
colostomy. A colostomy is a simple procedure performed in an emergency
condition and often reported in low and middle-income countries. Usually,
children required long time colostomy care while primary caregivers or parents
have a major role in their home setting, and they required specific knowledge
and skills. Caregivers must have adhered to new responsibility for the
betterment of child’s prospective life. Sound health education to caregivers
and families brought down child mortality rates.
Supporting
study summarized mean and standard deviation in pre- and postvideo intervention
0.9 ± 2.5 and 15.89 ± 4.02 and 16.4 ± 1.67 and 5.6 ± 2.0, respectively. Hence,
colostomy care video was significantly increased primary caregivers’ knowledge
and practice skills [9]. Another previous study reported
that the effectiveness of an instructional package was more efficient in
colostomy care among caregivers. Findings of the study reviewed that pre- and
posttest mean scores was 47.00 and 65.33, respectively. After video teaching
module the primery caregivers' knowledge was increased on colostomy care; paired
t test − 5.98, at p < 0.001 [10, 11]. A similar study conducted by
Angélica [12], the audio-visual technology,
increased the caregiver’s confidence and skills on colostomy care. Home visits
and regular health education reduced the peristomal skin infection and improved
the quality of life [13]. The peristomal complication is a
major reason for child mortality therefore primary caregivers carefully assess
the child and refereed for specific treatment.
The previous
research study result revealed that the instructional package on colostomy care
practice was more effective [9]. Even though our study result
on practice skills was significant with the colostomy care video. Similar
supporting studies' findings revealed that Audio-Visual aids were
more effective among primary caregivers of colostomy children. However,
children are susceptible to peristomal infections therefore, early identification
and appropriate intervention may reduce the complications.
Balance,
variety of diet, and plenty of fluid may reduce the colostomy blockage [14]. Sound colostomy construction and
caregivers’ skills may improve a child’s health [15]. Therefore, caregivers give
attention to risk factors, early management, and stomal function [16]. Early assessments have improved
the quality of life and early colostomy closure [17].
CONCLUSION
The use of
educational materials in the form of audio-video can improve the confidence of
primary caregivers towards the colostomy care. The authors concluded that
colostomy care video was an impact on primary caregivers' knowledge and
practice skills. A colostomy is a common procedure in children however
most parents not ready to accept their child's conditions. This video evidence
gained more confidence of parents about home-based colostomy care.
COMPLIANCE WITH ETHICAL STANDARDS
Conflict
of Interest
The authors
declare that they have no conflict of interest
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