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Psychosocial Issues
A. Patient’s Concerns about Surgery
The reaction to intestinal or urinary diversion
surgery varies from one individual to the other. To
some, it will be a problem, to other, a challenge;
where one person considers its life-saving, another
finds it a devastating experience. Each person will
adapt or adjust in their own
way and in their own time.
Body Image/Self-Esteem Concerns
Permanent and significant changes in the body’s
appearance and functional ability may change the way
the person internalizes their body image and
self-concept.
Fear of loss is normal and facing any loss is
difficult. What are patients giving up by having
this operation? Is there any gain? How changed will
they be? Such thoughts may lead to weeping or
depression, or they may be denied.
It is important to understand the impact of the
ostomy surgery on the
patient’s change in self-image and how they perceive
themselves. It may be accepted as the lesser of two
evils, or they may refuse to acknowledge its
existence, or may hold onto the belief that it is a
temporary situation.
Within the rehabilitation process there are times
that patients should have the opportunity to express
or deny their feelings, about their surgery, the
changes in their body or their self-image.
Self-Care Concerns
Patients have to be reassured that they will be
taught self-care and that they will be able to
master the management process. Basic anatomy and
physiology should be explained to new patients, so
they can better understand the extent of their
surgery. Management options should be offered.
Patients should begin to assist the
ostomy nurse with caring
for the ostomy as soon
as possible. Becoming involved in this process will
begin to build confidence and help the patient to
regain control of his situation.
Relationship Concerns
Patients may fear that their social role may be
changed and that others may not accept them as in
the past. One of the first concerns seems to be how
to tell others about your surgery, who to tell and
when.
• Patients should be prepared to explain their
surgery with a few brief statements such as, “An
ostomy is a surgical
procedure for the diversion of bowel (or bladder).”
• They should understand that they do not have to
tell everyone about the surgery. Be selective about
who and how much to tell. It may be only to friends
who will be supportive throughout the rehabilitation
process.
Returning to the work place may present a concern
about restroom facilities, interaction with
co-workers, and feelings of being “watched.”
• Maybe a few of their co-workers may need to know
in the event of an emergency.
• Employability and insurability are issues for some
individuals. If these issues develop, seek help from
healthcare professionals and/or talk with others who
have found solutions to any of these issues.
Sexuality issues are common concerns for the new
ostomate. Linked closely
to our feelings of sexuality is how we think about
ourselves and our body image.
• Any sexuality concerns that you have should be
discussed between the patient and his partner. It is
likely that the partner will have anxieties due to a
lack of information. An intimate relationship is one
in which it matters how well two people can
communicate about the most personal of human
functions, that is, bodily elimination and sex.
• Ostomy surgery may present more concerns for
single individuals. When to tell depends upon the
relationships. Brief casual dates may not need to
know. If the relationship grows and leads to
intimacy, the partner needs to be told about the
ostomy prior to a sexual
experience.
B. Phases of Psychological Adaptation
Almost every patient goes through four phases of
recovery following an accident or illness that
results in loss of function of an important part of
the body. The patient, along with the family, goes
through these phases, varying only in the time
required for each phase. People may experience the
various phases of adaptation in a different order
and at varying rates. Some people may skip certain
phases entirely and some may move up and down at
different times.
These phases are shock, denial, acknowledgment and
resolution.
1. Shock or Panic
Usually occurs immediately after surgery. The
patient is unable to process information and may be
tearful, anxious and forgetful. This phase may last
from days to weeks.
2. Defense/Retreat/Denial
This phase may last for weeks or months and delays
the adaptation process. During this phase, the
individual denies or minimizes the significance of
the event and defends himself against the
implications of the crisis. You may note the
avoiding of reality and “wishful” thinking.
3. Acknowledgment
As the patient moves to the next step of
acknowledgment, he begins to face the reality of the
situation. As you give up the existing old
structure, you may enter into a period, at least
temporarily, of depression, of apathy, of agitation,
of bitterness, and of high anxiety.
4. Adaptation/Resolution
During this phase, the acute grief begins to
subside. The patient copes with their situation in a
constructive manner and begins to establish new
structures. They develop a new sense of worth. This
phase may take one to two years.
With the aid of an ostomy
nurse and the ostomy
visitor, you learn about living with a stoma.
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