Self-Concept, Body Image, Alteration

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.

Back to Care Plans