The Path Of Stoma Pressure On Self-management In Permanent Colostomy Patients

ObjectiveThe study was to investigate the level of stoma pressure,quality of social relationship,resilience and self-management,as well as analyze their correlation and the pathway between stoma pressure and self-management in permanent colostomy patients.This study provides a reference for developing effective improving the self-management level of patients with colostomy.MethodsThrough the use of convenient sampling method,a total of 275 patients with permanent colostomy who were reviewed at the wound ostomy clinic of two tertiary hospitals in Qingdao from November 2017 to August 2018.All participant were surveyed using demographic characteristics questionnaire,Stress of Colostomy Patient Scale,Social Relationship Quality Scale,Conner-Davidson Resilience Scale and Self-Management scale.All data were analyzed by SPSS 19.0 and AMOS 21.0.The demographic data,stoma stress,social relationship quality and self-management were described using mean±standard deviation,frequency and percentage;t-test,one way analysis of variance was used to analyze the influencing factor of stoma pressure,self-management,respectively.Pearson correlation analysis was used to analyze the correlation among stoma pressure,and self-management.Multiple linear regression analysis was performed on self-management.Path analysis was employed to test the mediating roles of quality of social relations,resilience in relationship between stoma pressure and self-management.Results1.For these patients,the total scores of stoma pressure was 77.40±11.35,at a moderate level.Each dimension is divided into high-to-low changes in self-concept,changes in physical condition,changes in interaction with family members,and colostomy care.The influencing factors of stoma pressure were age,education level,family average monthly income,past medical history,postoperative time,self-careability,communication with medical staff.2.The total scores of self-management score was 84.93±11.64,at a moderate level.Each dimension is divided into high-to-low symptom management,psychological management,daily life management,ostomy nursing management,information management.The influencing factors of self-management were age,family average monthly income,past medical history,postoperative time,communication with medical staff.3.The total scores of social relationship quality was 49.28±6.10.Each dimension is divided into high-low to family commitment,family intimacy,friend relationship.4.The total scores of resilience was 56.00±4.18.Each dimension is divided into high-low,self-improvement,optimism,and tenacity.5.The correlation among stoma pressure,quality of social relationship,resilience and self-management were as follows:stoma pressure scores were negatively correlated with social relationship quality(r=-0.466,P < 0.01);stoma pressure scores were negatively correlated with resilience(r=-0.506,P<0.01);stoma pressure were negatively correlated with self-management(r=-0.652,P<0.01);there were a significant positively correlation between social relationship quality scores and resilience scores(r=0.463,P<0.01);social relationship quality scores was positively correlated with self-management(r=0.570,P<0.01);resilience scores were positively correlated with self-management(r=0.595,P <0.01).6.Multiple linear regression analysis showed that postoperative time,stoma stress,social relationship quality,and resilience were predictors of self-management,accounting for 55.8% of total self-administration variability(F=44.282,P<0.001).7.The pathways between stoma pressure and self-management in permanent colostomy patients were as follow: stoma pressure may predict self-management directly forward positive way,the standardized estimate is-0.304,and the confidence interval of95% is [-2.883,-0.494 ] and accounted for 44.4% of the total effect;social relationship quality had partial mediating effect between stoma pressure and self-management,the standardized estimate is-0.161,and the confidence interval of 95% is [-0.649,-0.147]and accounted for 23.5% of the total effect;resilience had partial mediating effect between stoma pressure and self-management,the standardized estimate is-0.155,the confidence interval of 95% is [-0.230,-0.083],and accounted for 22.7% of the total effect.stomapressure affected self-management through the chain intermediary effect of social relationship quality and resilience.the standardized estimate is-0.064,and the confidence interval of 95% is [-0.082,-0.027] and accounted for 9.4% of the total effect.ConclusionPatients with permanent colostomy have higher stoma pressure and poor self-management ability.Ostomy stress was a negative predictor of self-management.Social relationship quality and psychological resilience were positive predictors of self-management.The ostomy stress of patients with permanent colostomy could directly affect self-management,social relationship quality and resilience as intermediary variables could regulate the effect of stoma pressure on self-management.social relationship quality and resilience decreased the negative effect of stoma pressure on self-management.social relationship quality and resilience may protect patients from self-management.