Enhanced Nursing Care for Improving the Self-Efficacy & Health-Related Quality of Life in Patients with a Urostomy

Figures & data

Table 1 General Characteristics of Studies and Participants

First Author and Year	Study Design	Sample Size (Exp/Con)	Country	Setting	Age (Exp/Con; Years)	Male (%)	Married (%)	Bladder Cancer (%)	Ileal Conduit (%)
Pazar, B. et al (2015)^Citation17	Cross-sectional descriptive	24	Turkey	Hasan Kalyoncu University, Gaziantep, Turkey	63.45 ± 6.33		22 (91.6)	23 (95.8)
Furukawa, C. et al (2013)^Citation18	Cross sectional questionnaire by interview	60	Japan	Municipal hospital, Osaka, Japan	72.1 ± 9.04*	43 (71.7)		54 (90)	47 (78.3)
Gomez, A. et al (2014)^Citation19	Cross sectional questionnaire by phone interview	54	Spain	Hospital Clinic, Barcelona, Spain	69.75 ± 9.51*			54 (100)	54 (100)
Masiero, M. et al (2021)^Citation20	Observational study of patients and caregivers	382	Italy	European Institute of Oncology, RCCS, Milan, Italy	67.29 ± 9.23	319 (82.9)		382 (100)
Wulff-Burchfield, E. M. et al (2021)^Citation22	Qualitative, descriptive	29	United States of America	University of Kansas Medical Center, Kansas City, KS, USA	70.75 ± 10.68*	22 (76)	24 (82.8)	29 (100)	29 (100)
Ali, N. S. and H. Z. Khalil (1989)^Citation23	Randomized controlled trial (RCT) with Pretest-posttest design	30	Egypt					30 (100)
Zganjar, A. et al (2021)^Citation24	Longitudinal Quality Improvement feasibility study	51	United States of America	University of Kansas Medical Center, Kansas City, KS, USA	72.2 ± 8.65	38 (75)		51 (100)	51 (100)
Jensen, B. T. et al (2017)^Citation26	Randomized controlled trial (RCT)	107 (50/57)	Denmark	Aarhus University Hospital, Denmark	68.5 ± 9.8/ 70.6 ± 9.2	79 (76)	63 (58.9)	107 (100)	92 (85.9)
Merandy, K. et al (2017)^Citation27	Randomized controlled trial (RCT)- two-arm pilot study	8 (4/4)	United States of America	New York Presbyterian Hospital/ Weill Cornell Medical College in New York. USA	73.6 ± 14.08*	8 (100)		8 (100)	5 (62)
Hao, H. et al (2022)^Citation28	Randomized controlled trial (RCT)	80 (40/40)	China	Affiliated Hospital of Nantong University, Nantong, P.R. China	64.8 ± 12.58 /63.25 ± 17.16		66 (82.5)	19 (23.7)
Zhou, H. et al (2019)^Citation29	Randomized controlled trial (RCT)	46 (23/23)	China	Shanghai Pudong Hospital, affiliated with Fudan University Pudong Medical Center, Shanghai, China	65.04 ± 11.61/66.13 ± 11.01	43 (93)	36 (78.2)	46 (100)	46 (100)

Note: *Estimated mean and standard deviation from median and range or interquartile range.

Abbreviations: Exp, experimental group; Con, control group.

Table 2 Outcome Assessment and Main Findings

Study	Assessment Method	Time Points of Assessment	Outcome Measure	Instrument	Main Findings
Pazar, B. et al (2015)^Citation17	Physical intervein and mail response	At least 4 months after urostomy.	Impact of urostomy on daily life activities, Health-related quality of life (HRQOL)	A research-based self-prepared questionnaire (37 questions) European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3 (EORTC QLQ-C30)	Body image, sexual problems were the main identified factors Lower HRQOL compared to population-based norms Age, employment, and living status had significant impact on HRQOL
Furukawa, C. et al (2013)^Citation18	Physical Interview	At least one month after discharge and 3.4 years (median time) since surgery	Health-related quality of life Impact of patient factors on HRQOL	Medical Outcomes Research Short Form 36, version 2 (SF36v2)	Surgery timing (role physical, vitality, and role emotion domains), employment (role physical domain), support at home (mental health domain), and belonging to peer support groups (body pain domain) had significant impact on certain domain of SF36v2.
Gomez, A. et al (2014)^Citation19	Telephonic interview	6 months after urostomy	Health-related quality of life	Stoma–Quality of Life questionnaire (20 Qs)	High quality of life percentage
Masiero, M. et al (2021)^Citation20		1 month before surgery, 2 weeks and 6 months after surgery	Psycho-emotional wellbeing Global Health Status (GHS) HRQOL	Emotion thermometer (ET) EORTC QLQ-C30	Improved GHS/QoL and psycho-emotional wellbeing at 6 months
Wulff-Burchfield, E. M. et al (2021)^Citation22	Physical interviews	3 to 18 months	Educational and psychological impacts Identification of themes	Self-prepared questionnaire	Anxiety was reduced and confidence was boosted Three themes were identified, 1) motivation was provided by lack of knowledge, fear, and concern; 2) Attitudes included acceptance and dependence; 3) Education
Ali, N. S. and H. Z. Khalil (1989)^Citation23	Telephonic interview	Before discharge and 3^rd postoperative day	State anxiety	A-state form of the State Trait Anxiety Inventory	Significantly lower state anxiety on the third day postoperatively and before discharge Main anxieties were related to being cancer patients and the impact of surgery on their bodies and on their social and marital life.
Zganjar, A. et al (2021)^Citation24	Physical interviews	At enrollment/discharge, 2-week (OAS), 6-week and 12-week	Health-related quality of life Ostomy-specific adjustments during the study	SF36v2 The Ostomy Adjustment Scale (OAS)	Improvement at 6-week in HRQOL that persisted a 12-week OAS level at discharge was maintained at 6- and 12-week assessment
Jensen, B. T. et al (2017)^Citation26	Physical interviews	At day 35, 120 and 365 postoperatively	Self-efficacy	Urostomy Education Scale	Improved self-efficacy observed in the intervention group.
Merandy, K. et al (2017)^Citation27	Physical interviews		Self-efficacy Feasibility and self-care skills	Six-item Self-Efficacy to Manage Chronic Disease (SES6G) scale Exploratory self-efficacy (ESE) question Urostomy Education Scale (UES) (for incontinent UD) An exploratory continent UD scale (ECUDS) (for continent UD)	No difference in self-efficacy was noticed between the cohorts Feasibility was noticed
Hao, H. et al (2022)^Citation28	Telephonic interaction	Three months after discharge	Social stigma Quality of life	Social Impact Scale (SIS) Quality of life scale for cancer patients (QLQ-C30)	Social stigma was significantly lowered and quality of life was enhanced in the intervention group
Zhou, H. et al (2019)^Citation29	Physical and telephonic interaction	At discharge and 6 months post-surgery	Self-efficacy Health-related quality of life	Stoma Self-Efficacy Scale (SSES) and the City of Hope Quality of Life-Ostomy (COHQOL-O)	Improvements in the intervention group were noticed in terms of self-efficacy and HRQOL.

Table 3 Intervention Details

Study	Point of Intervention	Intervention Provider	Duration of Intervention	Frequency	Program Format
Wulff-Burchfield, E. M. et al (2021)^Citation22	Prior to surgery	A urology nurse practitioner, an ostomy nurse, and a project coordinator	2-hour Stoma Boot Camp	Once preoperatively	Lecture, audiovisual presentations, hands-on activities with pouching supplies, use of an anatomical model to illustrate the surgical procedure, use of a soft stoma doll for take home use with younger family members. The presence of a patient advocate – a previous SBC attendee who served as a model of post-ostomy life, answered participant questions, and demonstrated what a stoma looked like on a real person. A stoma product manufacturer’s representative was also present to answer questions. Take home materials included an illustrated booklet of the content, sample pouching supplies from a manufacturer’s representative, the stoma doll, and a DVD of stoma-related information.
Ali, N. S. and H. Z. Khalil (1989)^Citation23	1–2 days prior to surgery			Once preoperatively	Ostomy education A visit by a peer with an ostomy Time to express concerns and anxiety about the procedure
Zganjar, A. et al (2021)^Citation24	Within 2 weeks of the surgery date	Advanced practice providers, residents, ostomy nurses, research staff, floor nurses, and a patient advocate.	3-hour Stoma Boot Camp	Once preoperatively	A short audio-visual presentation by residents and advanced practice providers that reviewed the definition of an ostomy, the operation itself, recovery and expectations for their post-operative care. Ostomy nurses then demonstrated basic urostomy care − pouching, sizing, emptying − with hands-on supply kits that patients/care-givers could practice with and take home. Additionally, the ostomy nurses reviewed trouble-shooting tips for common ostomy problems (irritated skin, barrier not sticking, bleeding, stoma prolapse/retraction), and expectations for normal daily living (showering, exercise, sleeping, clothing, swimming, sexual intimacy). Supplemental information consisted of additional online written and video resources regarding their ostomy care, postoperative expectations, and follow-up information. During their hospitalization the stoma boot-camp patients were given the standard postoperative education − typically three education sessions with 1–2 pouch changes prior to discharge.
Jensen, B. T. et al (2017)^Citation26		Two Urological Enteral Stoma Therapy Nurses (ET)		Once preoperatively	The two ET’s introduced and instructed the intervention group to basic stoma care and change of appliance using a training kit with an artificial stoma. The patient was informed about the urostomy and life with a urostomy related to the individual patient’s life and life style. Every patient had a follow up prior to surgery where the ET observed self-care skills regarding stoma care and change of appliance.
Merandy, K. et al (2017)^Citation27	Delivered on postoperative day 4, 5, or 6	Clinician, wound ostomy and continence nurse (WOCN)	One-hour	Once postoperatively	A simplified medical illustration of participant-specific UD A step-by-step UD self-care instructional video, and a pictorial Microsoft PowerPoint^®.
Hao, H. et al (2022)^Citation28	Over 3 months	3 attending physicians, 5 nurses, and 2 recovered patients		Continued interaction	Nurses provided routine nursing and health education before and after surgery for the urinary system cancer and after discharge from the hospital The physicians were responsible for surgical planning and follow-up of the pre-inpatients Using the message function on the WeChat public account, the responsible nurses promptly completed the postoperative pipeline maintenance and stoma nursing care to provide professional help and promote patients with active treatment in the intervention group. Patients helped each other and tided over difficulties Empathy counseling and psychological adjustment Family support
Zhou, H. et al (2019)^Citation29	Over 6 months	1 WOC/enterostomal therapy nurse and 3 RNs with specialized training in ostomy care		Continued interaction	Routine care included ostomy-related education preoperatively and at discharge delivered to both cohorts. The multicomponent intervention included a health record for every individual that focused on the patient’s self-management, recovery from ostomy surgery, ostomy care skills, diet, psychosocial assessment, stomal or peristomal complications, and pouching problems. Participants attended lectures given by the ostomy care team monthly, which included a pouching demonstration, emphasize on the importance of their participation in the patient’s physical care and the need of ongoing emotional support, and at least one family member attended the lecture in person. A physical assessment and care were performed by the ostomy care team. A telephone call monthly from a member of the ostomy care team wherein the patient and family members were encouraged to discuss challenges with pouching, any stomal or peristomal complications, diet, lifestyle, physical activity, and psychosocial status. Patients and families were also encouraged to attend an ostomy support group held quarterly.

Figure 1 PubMed search outcome with key term “Urostomy” from 1973 to 2022.

Figure 2 Research strategy and study selection.

Figure 3 Primary disease of the participants.

Figure 4 Type of urinary diversion constructed for participants.

Figure 5 Triangle of Perioperative care for patients with urostomy. Three major ingredients include ostomy-related education, psychological counseling and patient’s factors. Point of intervention starts from preoperative to postoperative in the form continued care to enhance the self-efficacy and quality of life in these patients.

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