Nursing diagnosis: disturbed Body Image related to Biophysical—presence of stoma, loss of control of bowel elimination, Psychosocial—altered body structure, Disease process—cancer, colitis, and associated treatment regimen
Possibly evidenced by
Verbalization of change in body image, fear of rejection or reaction of others, and negative feelings about body
Actual change in structure and/or function—ostomy
Not touching or looking at stoma, refusal to participate in care
Desired Outcomes/Evaluation Criteria—Client Will
Verbalize acceptance of self in situation, incorporating change into self-concept without negating self-esteem.
Demonstrate beginning acceptance by viewing and touching stoma and participating in self-care.
Verbalize feelings about stoma and illness; begin to deal constructively with situation.
Nursing intervention with rationale:
1. Ascertain whether support and counseling were initiated when the possibility and/or necessity of ostomy was first discussed.
Rationale: Provides information about client’s/SO’s level of knowledge and anxiety about individual situation.
2. Encourage client/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression, and grief over loss. Discuss daily “ups and downs” that can occur.
Rationale: Helps client realize that feelings are not unusual and that feeling guilty about them is not necessary or helpful. Client needs to recognize feelings before they can be dealt with effectively.
3. Review reason for surgery and future expectations.
Rationale: Client may find it easier to deal with an ostomy done to correct long-term disease than for traumatic injury, even if ostomy is only temporary. Also, client who will be undergoing a second procedure to convert ostomy to a continent or anal reservoir, may possibly encounter less severe self-image problems because body function eventually will be "more normal."
4. Note behaviors of withdrawal, increased dependency, manipulation, or noninvolvement in care.
Rationale: Suggestive of problems in adjustment that may require further evaluation and more extensive therapy.
5. Provide opportunities for client/SO to view and touch stoma, using the moment to point out positive signs of healing, normal appearance, and so forth. Remind client that it will take time to adjust, both physically and emotionally.
Rationale: Although integration of stoma into body image can take months or even years, looking at the stoma and hearing comments made in a normal, matter-of-fact manner can help client with this acceptance. Touching stoma reassures client/SO that it is not fragile and that slight movements of stoma actually reflect normal peristalsis.
6. Provide opportunity for client to deal with ostomy through participation in self-care.
Rationale: Independence in self-care helps improve self-confidence and acceptance of situation.
7. Plan care activities with client.
Rationale: Promotes sense of control and gives message that client can handle situation, enhancing self-concept.
8. Maintain positive approach during care activities, avoiding expressions of disdain or revulsion. Do not take angry expressions of client/SO personally.
Rationale: Assists client/SO to accept body changes and feel good about self. Anger is most often directed at the situation and lack of control or powerlessness individual has over what has happened—not with the individual caregiver.
9. Ascertain client’s desire to visit with a person with an ostomy. Make arrangements for visit, if desired.
Rationale: A person who is living with an ostomy can be a good support system and role model. Shared experiences helps reinforce teaching and facilitates acceptance of change as client realizes “life does go on” and can be relatively normal.