Assignment Part 2: Psychosocial Nursing Interventions for a Young Patient

With Altered Body Image Related to Colostomy

Student: Toyin Fakus-Atundaolu
Student No: 8xx xxx xxx
Due Date: March 16, 2015
NURS 252: Complex Issue and Patient Safety
Professor:
Humber College (ITAL)

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Introduction
There is no doubt that a stoma can negatively affect a patients body image and thus create
distress psychologically and physically for both the patient and the family. An ostomy is an artificial
opening in the body for the purpose of waste elimination from an intestine due to a disorder such as
ulcerative colitis and colon cancer. In this assignment, I was presented with an eleven year old patient
with an ulcerative colitis, diagnosed since nine years old and with a temporary colostomy in placed since
ten years old; came to the clinic with his parents for follow up appointment. Patient complained of a mild
pain, and inability to have a bowel movement since three days earlier. Assessment of the stoma site shows
that it is reddened and swollen. Further investigation reveals noncompliance in his diet choices which is
likely resulting in constipation, a reddened stoma site and worried parents. Patient states I hate this hole
in my stomach; when do I get to have it removed? Altered body image is seen as a psychological
disturbance often associated post-stoma surgery, due to the alteration to physical appearance (Price,
1990; Williams, 2012).
Thus this paper will focus on why a disturbed body image related to colostomy is made a priority
in order to assist patient in overcoming his noncompliance by improving his self-esteem. Secondly, it will
discuss the nursing diagnosis of how the presence of a stoma could lead to a risk of low self-esteem based
on patients question and concern. This is important because temporary and permanent ostomies results
in changes in the users life such as in gastrointestinal function, as well as psychosocial factors including
self-esteem and body image (Backes et al., 2012). Finally, the paper will provide five prioritized and
sequential nursing interventions to help patient overcome the risk of disturbed body image related to
colostomy. There are various issues of quality of life for children with stomas, including body image and
peer reaction and so nurses are in a unique position to educate children and families on the proper care
of a stoma and to recognize potential complication (Gray et al., 2006).

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Risk of Disturbed Body Image Related to Colostomy

Various studies have shown that although, used as a lifesaver, the formation of stoma can have
an adverse effect on a persons quality of life as well as affect the lifestyle in a number of ways (Brown &
Randle, 2005). Thus, a sense of loss of self-esteem or body control as experienced by my patient is not
unusual. There is no control as body waste now passes out from the stoma into the collection device or
pouch, and there is no longer urge to pass stool, nor there any conscious control. Adaptation to these
changes will therefore require expert nursing care plan. According to Backes and his associates (2012),
the most frequent conditions that warrants the creation of a colostomy include trauma, genetic disorders,
inflammatory diseases, tumors and intestinal cancer. They affirm that support from both professional
healthcare, families, caregivers, and other community agencies could speed the recovery following such
surgery and enhance patients coping strategies to the new life which may be permanent or temporary as
in the case of my patient.
Risk for Low Self-Esteem
As mentioned on the previous page, the rationale behind prioritising the risk for low self-esteem
is based on the patients outburst question. Age 11 is regarded as preadolescent stage by most
developmental researchers and clinicians. This is when self-esteem and peer pressure is becoming a big
deal; and it is when they rely mostly on the outside world to validate them rather than their family. Thus,
I can understand my patients frustration over having a colostomy done. Studies have shown that
postoperative stage include the feelings of bodily violations, loss of loci control, and even depression
(young or old). He may not only feel anger towards himself but even towards his parents for having him.
Siddiqui et al (2010) conducted a study the indications and complications of colostomy in children. Their
findings show that bowel stomas play important part in the controlling of variety of congenital and
acquired gastrointestinal illnesses in young children. Furthermore, their findings also show that contrary
to adults, colostomy in children is a temporary procedure done for nonthreatening conditions; and in most

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cases it is usually performed as emergency procedure in paediatric group. Thus, if my patient can comply,
the colostomy will indeed be temporary; the five step nursing intervention is designed to help him boost
his image to make him heal quickly.
Nursing Interventions for My Patient
Nurses have very important role within holistic approach and empathetic interaction, for
determining and intervening to help patients overcome the problems they face with having a stoma. In
2007, an Ontario nurse Ramirez was disciplined for not providing enough stoma care education for a
relative that was going to provide home care for a patient with colostomy (CNO, 2007). Therefore as a
frontline care provider, it is important for nurses to provide care if possible research or collaborate with
other professionals to provide care and teachings for stoma patients and their families both
preoperatively and postoperatively. Clients may be referred to a stoma care center for family education
and preventions of complications.
According to the Crohns and Colitis (2014) booklet on Living Life with an Ostomy, it is normal
to feel negatively emotionally such as sadness, shame and anger. Therefore in the case of my young
patient, I will encourage him to verbalize his feelings regarding the ostomy. Rather than internalizing his
frustration, venting and expressing it may be the best therapy for him. Secondly, to maintain therapeutic
communication, I would want to explore his emotions further especially after the outburst. I may respond
to his statement The stoma seems to bother you a lot, would you like to further explore how it can work
for you seeing that it will only be there for some time. Depending on my patients response, together we
can get creative, visit some resources and community website.
The above organization for instance have a page where those living with Ostomy can interact
online as well as helpful videos on caring and living with the colostomy. They encourage patients to
participate in whatever physical activities they were involved with before the surgery. After all, the stoma
is hidden behind his clothing discreetly and he does not have to tell anyone he has one unless he chooses

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to. Furthermore, I can arrange with him to attend a support group where he would physical interactions
with those living with colostomy especially those around his age. Finally, I would refer patient and family
to a family social worker. I have research helpful online and community organization that could be of help.
Hopefully, the doctors office would had printed or ordered informative guide pamphlets to provide as
take home package. My expectation is for my patient to see the positive side of having the colostomy
rather than the negative image it presents.
Conclusion
Adjusting to living with a stoma, especially at a preadolescence stage, is a difficult process that
have both physical and psychological adverse effects on the patient. Therefore, nurses can collaborate
along with patient by working with specialist stoma-care nurses, social workers, and
community/professional organizations such as the Ostomy Canada Society, Crohns and Colitis and The
Canadian Association Enterostomal Therapy for both psychological support and practical solutions.
Addressing psychosocial concerns should become part of the care routinely given to stoma patients and
emphasis should be laid more on driving out negative thoughts and encouraging social interactions
(Simmons et al., 2007). I believe that the above nursing intervention will foster a positive self-esteem in
my patients and other patients that have to live permanently or temporarily with ostomas.

References

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(2007, October 15). Retrieved March 15, 2015, from http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2009/Lourdes Ramirez, IA04639, October 15, 2007.pdf
A Guide to Living with a Colostomy. (2007, September 1). Retrieved March 15, 2015, from https://www.caet.ca/caetenglish/documents/caet-guide-to-living-with-a-colostomy.pdf
Backes, M. T. S., Backes, D. S., & Erdmann, A. L. (2012). Feelings and expectations of permanent colostomy
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Ostomy Information. (2014, June 6). Retrieved March 15, 2015, from http://www.ostomycanada.ca/information/whatis-an-ostomy/ostomy-information/
Price B (1990) Body Image Nursing: Concepts and Care. Prentice Hall, London
Siddiqui, M. A., Solangi, R. A., & Soomro, B. A. (2010, December 31). Colostomy in Children: Indications and
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Simmons, K. L., Smith, J. A., Bobb, K.-A. and Liles, L. L.M. (2007), Adjustment to colostomy: stoma acceptance, stoma care
self-efficacy and interpersonal relationships. Journal of Advanced Nursing, 60: 627635. doi: 10.1111/j.13652648.2007.04446.x
Williams, J. (2012). Stoma care: intimacy and body image issues. Practice Nursing, 23(2), 91-93