Self-Concept, Body Image, Alteration

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Altered self-concept and change in body image experienced post-operatively can be related to ostomy surgery and the resultant loss of bowel control, and changed body appearance.

The nurse can help the patient post-operatively by:

  • Initiating primary nursing to establish a therapeutic relationship.

  • Encouraging patient to express feelings and concerns.

  • Acknowledging and accepting feelings of anger, grief, dependency, relief, etc.

  • Discussing with patient and family the affect of the surgery.

  • Observing patient's and family’s non-verbal and verbal behaviours.

  • Providing support by listening to concerns and answering questions.

  • Assisting patient to identify positive behaviours that will aid recovery.

  • Identifying what the patient expects with regards to the stoma appearance, incision, drains.

  • Dispelling misconceptions.

  • Identifying patient's and family’s understanding of the effect of stoma on clothing, bathing, activities, work, diet, relationships, sexuality.

  • Arranging for an ostomy visitor (if appropriate).

  • Providing literature to reinforce information.

  • Determining patient’s main source(s) of support and usual coping mechanisms. Arranging for involvement of family in care — as desired by the patient and family.

  • Discussing with family ways to provide support.

  • Assessing and addressing the needs and concerns of the family.

  • Encouraging patient and family to communicate feelings to one another in a direct manner.

  • Assisting patient to make decisions about self-care.

  • Gradually involve the patient in self-care activities.

  • Praising achievements; offering continued support.

  • Discussing resumption of usual activities at home.

  • Consulting with others re additional counselling — Enterostomal Therapy nurses, Social Workers, Clinical Nurse Specialists.

  • Arranging for ongoing support at home.

  • Discussing how to increase personal comfort and acceptance of ostomy — hygiene and odour control, pouch selection, lingerie.

  • Discussing how to prepare for intimacy. Include partner in ostomy teaching.


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