Nurses' viewpoints on factors affecting ostomy care: A qualitative content analysis (2024)

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Nurs Open
v.10(8); 2023 Aug
PMC10333817

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Nurs Open. 2023 Aug; 10(8): 5261–5270.

Published online 2023 Apr 21. doi:10.1002/nop2.1764

PMCID: PMC10333817

PMID: 37084269

Ladan Naseh,¹ Mohsen Shahriari,² Aygineh Hayrabedian,³ and Mahin Moeini⁴

Author information Article notes Copyright and License information PMC Disclaimer

Associated Data

Data Availability Statement

Abstract

Aims

Ostomy plays an important role in management of medical conditions, especially postoperative status of colorectal and bladder cancers. Nurses who have the highest contact level with these patients, face many situations while providing care and need to acquire adequate knowledge and practice responding to patients' needs. The aim of this study was to explore the lived experiences of nurses in caring of abdominal ostomy patients.

Design

A qualitative content analysis study.

Methods

In this qualitative content analysis study, 17 participants were selected using purposeful sampling method and data were collected through in‐depth and semi‐structured interviews. Data analysis was done using conventional content analysis method.

Results

Analysis of the findings led to the emergence of 78 sub‐subcategories, 20 subcategories and seven main themes, including ‘Inefficient educational system’, ‘Nurse Characteristics’, ‘Workplace challenges’, ‘Nature of ostomy care’, ‘ Counseling and preparation of patients for surgery’, ‘Acquaintance with ostomy complications’, and ‘Proper planning of patient education’. Results showed that nurses in surgical wards provide non‐special ostomy care due to lack of sufficient knowledge and skills and absence of up‐to‐date and local clinical guidelines which is vital to provide evidence‐based scientific care and avoid unfounded and arbitrary care.

Keywords: Iran, nurse, ostomy, qualitative study

What does this article contribute to the wider global clinical community?

Use inter‐professional and inter‐professional settings to meet the different needs of patients and their families.
Improving the level of health literacy of patients in gaining more independence.
Paying attention to the role of support and training of nurses in patients' wards.
Promoting the scientific and practical competence of nurses in caring for patients with ostomy.

1. INTRODUCTION

Despite recent advances in treatment options, ostomy still has a special status in the management and treatment of many medical conditions (Adamou et al.,2018). A colostomy is needed to treat conditions such as bowel cancer, Crohn's disease, diverticulitis; anal, vaginal or cervical cancer; bowel incontinence; and/or Hirschsprung's disease (NHS,2017). There are more than 1 million people living with ostomy in the United States and more than 130,000 new cases are confirmed annually (Sun et al.,2018). According to the Iranian Ostomy Association (IOA), there are approximately 30,000 ostomy patients in Iran (Bagheri et al.,2017).

Living with colostomy causes negative impacts on the overall quality of life of the patients (Vonk‐Klaassen et al.,2016). Ostomy formation surgeries often introduce various ostomy‐related stressors, including body image disturbances and changes in the anatomy and function of the gastrointestinal tract, leading to maladaptation, psychological disturbance and impaired daily functioning (Verweij et al.,2017). Ostomates always experience problems associated with their self‐care and numerous complications. Depression and issues related to intimate relationships and sexual functions are common. Due to ostomy‐induced embarrassing events, they choose isolation and face hardships with professional, recreational and exercise activities (Sun et al.,2018). Therefore, nurses play a vital role in the process of caring the stoma patients to help them quickly adapt to the life after procedure (Heerschap & Duff,2021).

2. BACKGROUND

The literature shows a significant positive impact of improving ostomates' knowledge and self‐care abilities and competencies in taking care for their ostomies to reduce ostomy health‐related problems and complications (Ayaz‐Alkaya,2019). In such a situation, nurses who are the main providers of patient care (Yang et al.,2016), play a crucial role in a patient education to support and encourage him/her to enhance self‐care ability (Mohamed et al.,2017). Nursing support in pre‐, intra‐ and post‐operative periods is a vital component that yields positive outcomes in ostomy patients (Villa et al.,2018). Nurses are the first members of treatment team who have direct contact with ostomy patients and have to answer their questions and concerns (Farias et al.,2015). Stoma nurses are one of the main links between multidisciplinary teams, patients, families, hospitals and communities and they coordinate a multidisciplinary team, providing a team approach and bringing together the necessary experts in the community, to ensure that patients receive comprehensive, personalized, and timely care (Barwell,2012). All over the world, in order to improve the quality of life of colostomy patients, it is necessary to help educate their nursing staff in countries without the latest technology (Kadam & Shinde,2014). The lack of information, training by professional staff and other resources can cause nurses to feel helpless (Nieves et al.,2017). Lack of knowledge, limited time due to busyness of an acute ward, no availability of specialist nurses or abdication of responsibilities due to specialist nurses availability can all lead to obstacles in providing optimum ostomy care (Dunne,n.d.). Some nurses have stated that when they stumble upon an affected person who has had an ostomy, they are regularly negative on how to care for the stoma and how to assess quite several issues of the stoma and the surrounding skin. This lack of knowledge can make contributions to the nurse's stress and might also make the affected personal and household individuals to lose self‐assurance in the nurse (Wise,2019). Training and education would improve nurses' confidence and knowledge base but competence may decline if there is a lack of frequent exposure to stoma care. Ideally, ostomy care education should start at undergraduate level (Lee et al.,2008), which will give students more confidence, knowledge and experience as they transition from student to nurse (Zimnicki & Pieper,2018).A review of the literature shows that nurses' viewpoints on ostomy care are not well recognized. In order to provide better care to patients with ostomy, there is a need to understand the experience of nursing care of these patients, and based on that, appropriate scientific approaches should be used in managing patients.

3. THE STUDY

3.1. Aim(s)

The aim of this study was to explore the lived experiences of nurses in caring for patients with abdominal ostomy patients.

3.2. Objective

Explaining the experiences of nurses regarding intestinal ostomy wound care.
Determining the needs of nurses in caring in patients with intestinal ostomy wound.

4. METHODS/METHODOLOGY

4.1. Design

This was a qualitative study.

4.2. Theoretical framework

The data of this study was obtained through conventional content analysis (Lindgren et al.,2020).

4.3. Sampling and recruitment

The purposive sampling method was used with maximum variation in terms of age, sex, education level, employment status and work experience.

4.4. Sample size and power

The sampling process was continued until data saturation after 17th interview was reached. One of the participants after being coordinated and before the interview died.

4.5. Population and sample

The research population included nurses working in surgery wards and wound‐ostomy clinics of Isfahan, Iran, colorectal surgeons and ostomy patients.

4.6. Data abstraction

Data were collected through in‐depth semi‐structured face‐to‐face (Polit & Beck,2009) interviews with 17 participants and from the field notes from July 2018 to February 2020.

4.7. Inclusion and/or exclusion criteria

Inclusion criteria were having at least one‐year experience in the management of wound and ostomy; bachelor's degree or higher in nursing; and willingness to participate in the study.

4.8. Data sources/collection

Prior to study commencement, coordination has been done with all participants and before interviews they were informed of the study objectives by researchers. The researchers' interest in the topic was described. Interviewers were informed, fluent in communication skills and interviewing techniques. The interviews were planned based on the opinion of the participant at the clinic or at workplace. All interviews were conducted by the first and third authors lasting between 40 and 60 min.

The interviews started with a general question: ‘Please tell us about your experiences in caring for an ostomy patient’ and ‘What are the factors involved in caring for these patients’? and the interview was guided by asking probing questions according to the interviewee's responses. All interviews were audio recorded with the interviewee's permission by a smart cell phone. Recorded interviews were transcribed word for word; then, transcripts were perused and meaning units were identified. In order to confirm the participants' opinion regarding the accuracy of notes, transcriptions were returned and reviewed.

4.9. Data analysis

The data were analysed using conventional content analysis and the constant comparative method. At the end of each interview, the audio recording was transcribed with Microsoft Word 2016 following multiple reviews of the transcription, initial semantic units (codes) were identified. The extracted codes were then classified in terms of similarities and differences based on which the categories were defined. Categories were then reviewed, compared and grouped to extract main themes (Lindgren et al.,2020).

4.10. Ethical considerations

This study was approved by the Ethics Committee of Isfahan University of Medical Sciences, (ethical code: IR.MUI.REC.1396.2.143). Prior to the interviews, the study objectives and methods were explained to all the participants; in addition, they were assured of confidentiality and were asked to sign an informed consent form. The time and place of the interviews were also determined based on the participants' preference. The participants were also free to withdraw from the study anytime.

4.11. Rigour

In order to increase the credibility and acceptability criteria, attempts were made to allocate appropriate place and time for interviews, establish effective communication with participants, select key informants, carry out simultaneous data analysis, review themes extracted by all researchers and check a number of early codes with the help of participants to achieve a proper understanding in this regard. The credibility and dependability criteria were confirmed through extensive teamwork by the research team members combined with interaction and supervision of experts (Korstjens & Moser,2018). Two members of research team were expert in qualitative research.

5. FINDINGS

5.1. Participants

A total of 17 individuals participated in the study included of eight nurses, two surgeons working in different healthcare centres, five patients and two patient's spouse. Nurses held a bachelor's degree and had 3–25 years of experience in wound and ostomy management. Further participant characteristics are shown in Table1.

TABLE 1

Participant characteristics.

Number	Position	Age (years)	Gender	Location	Degree of education	Working experience (years)
1.	Nurse	50	Female	Isfahan	B. Sc. in Nursing	17
2.	Nurse	43	Female	Isfahan	B. Sc. in Nursing	8
3.	Nurse	33	Female	Isfahan	B. Sc. in Nursing	10
4.	Nurse	28	Male	Isfahan	B. Sc. in Operating Room	3
5.	Nurse	35	Female	Isfahan	B. Sc. in Nursing	5
6.	Nurse	41	Male	Isfahan	B. Sc. in Nursing	7
7.	Nurse	48	Male	Isfahan	B. Sc. in Nursing	25
8.	Nurse	37	Male	Isfahan	B. Sc. in Nursing	6
9.	Physician	52	Male	Isfahan	Colorectal Surgeon‐	10
10.	Physician	46	Male	Isfahan	Colorectal Surgeon‐	6
11.	Patient	58	Male	Isfahan	‐	‐
12.	Patient	27	Male	Isfahan	‐	‐
13.	Patient	60	Male	Isfahan	‐	‐
14.	Patient	40	Male	Isfahan	‐	‐
15.	Patient	62	Male	Isfahan	‐	‐
16.	Spouse	41	Female	Isfahan	‐	‐
17.	Spouse	56	Female	Isfahan	‐	‐

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After analysing the interviews, a total of 1289 initial codes, 78 sub‐subcategories, 20 subcategories and seven themes were obtained that reflect the viewpoints of participants regarding factors affecting ostomy care. The seven extracted themes were as follows: ‘Inefficient education system’, ‘Nurse Characteristics’, ‘Workplace Challenges’, ‘The nature of stoma care’, ‘Counselling and preparation of patients for’, ‘Acquaintance with complications of ostomy’ and ‘Proper planning of patient education’. All themes, subcategories and some quotes from participants are listed in Table2.

TABLE 2

Themes, subcategories and some quotes from participants.

Quotes from participants	Subcategories	Themes
‘Appropriate education is not provided in the university setting, they did not teach ostomy course to us, I had not seen any ostomy case during apprenticeships, etc. I did not know how to provide ostomy care before passing enterostomal therapy (ET) courses. (Nurse 2)’	Inadequate training of nurses at the university	Inefficient education system
‘The problem with classes held in the context of continuing education is that one or two companies that want to introduce their brand, immediately come and sponsor the program and advertise their products, as if they were teaching an illustrative catalog; our nurses just act as their catalog. (Nurse 6)’	Inadequacy of ostomy care training courses	Inefficient education system
‘To provide ostomy care and especially management of its complications, she definitely needs her own particular knowledge. Nurses should have knowledge of ostomy care; if they don't know, they should seek and acquire it. (Nurse 3)’	Having specialized knowledge and experience	Nurse characteristics
‘The nurse must know all the ostomy brands and to choose which is the best for the each patient. (Nurse 7)’ ‘Unfortunately, ostomy care is now mostly provided arbitrarily and has no specific scientific basis. You know, we do not have any indigenous guidelines in wards, but we do special practice and participate in various seminars to know about the results of the latest scientific research on ostomy care. (Nurse 1)’	Awareness of the components of careful care
‘I love patients, especially ostomates. I get very upset when I see some nurses are mainly looking for business. For example, they advise a particular brand to the patient, because they take benefit of commission of that. Every person has a mission in his/her life; I want to help the patients as much as I can. (Nurse 4)’	Individual attitudes and values
‘Our medical training system is wrong. Go and see our references; they have discussed about different ostomies, explained surgical techniques but haven’t talked a word about non‐surgical management of ostomy; so some of us even come into the discussion on the ostomy brand unwillingly. That's why I say surgical residents must take courses on the principles of wound management and ostomy. (Physician 2)’	Surgeons' ignorance of non‐surgical stoma issues	Workplace challenges
‘We have frequently discussed with the surgeons and justified that complications would be reduced significantly, if they consulted us preoperatively and determined the ostomy site and provided necessary training…, but still many surgeons do not believe it. They perform surgery on the patient and then discharge them. They don't care what the patient would do with this? (Nurse 8)’	Surgeons' disregard for the professionalism of stoma management
‘There are not enough ostomy‐specialized nurses who can meet these patients needs in hospital at any time of the day and night, for example, if there is a need for an emergency surgery in the night shift, they are absent and the surgeon cannot postpone surgery until the next morning when the nurse will come and do the stoma siting. (Physician 1)’	Lack of specialized nurses in hospitals
‐	Work pressure and lack of nurses in the wards
‘If a high‐quality bag is not used properly, it will leak leading to an unpleasant odor, skin wound, etc. This leakage is very annoying for the patients who are constantly complaining about it to us. (Nurse 5)’	Lack of or poor quality of stoma equipment in hospitals
‘Unfortunately nurses are not very interested in learning ostomy care. As they say, it's dirty, it has to deal with stools, when they have to change ostomy bags, but they don't do it in proper time (on time)and consequently the bag will be removed one to two hours later and starts leaking. (Nurse 3)’	Stoma discomfort for the nurse	The nature of stoma care
‘I'd rather not give care to an ostomy patient at all; wherever I have, I will think about them for several shifts, I feel pity for them. They're oppressed; the young people are just at the beginning of their married life and the old ones will be a burden on others from now on. What do they do with the bag, its odor and noise? bowel sounds? (Nurse 4)’	Nurses emotional damages	The nature of stoma care
‘When obtaining consent, I explain everything to the patients and their family clearly, I think when the surgeons talks with the patient frankly, it is much easier for the patient to accept it (ostomy) rather than they falsely saying that the patient will undergo the surgery and face no problem. (Nurse 7)’	The need for conscious patient satisfaction	Counselling and preparation of patients for surgery
‘Stoma siting is extremely important; a surgeon created a stoma near the abdominal midline; near surgical site sutures which are constantly infected with stoma secretions, become infected, now should we repair the middle wound or carry out ostomy? Everything is messed up. Moreover, the patient himself cannot properly take care of the stoma… his skin is constantly scarred; (s)he cannot even wear a belt.(Nurse 2)’	The importance of performing stoma siting	Counselling and preparation of patients for surgery
‘Depression is very common and they lose their self‐confidence due to lack of control over excretion, odor and bowel sounds. They are embarrassed and often intend to commit suicide, which means they prefer to die rather than live with ostomy. (Patient 4)’	Psychological crises	Acquaintance with ostomy complications
‘There are many physical complications such as allergy to ostomy supplies, skin leakages and burns, pressure wounds, fungal infections, prolapse, hernia, etc. (Nurse 2)’ ‘Thrush and fungal infections after chemotherapy and anorexia caused by ostomy, prevent proper nutrition. Sitting by the surgeon in the office several days before surgery, the patients and their family can more easily accept the ostomy surgery than when they sit by the surgeon in the hospital ward immediately before surgery (Patient 3)’	Physical consequences of ostomy
‘My spouse apparently accepted it. Anyway, he was a man with his own natural needs, but he had to take special considerations as compared to when I didn't have an ostomy. He never complained but I would be messed up. When I also asked for a divorce, I felt well…seems he was not against it. (Spouse 2)’	The effect of stoma on family‐marital life
‘He wouldn't go anywhere, he wouldn't even go out of home, and he would always say where would I empty this bag if I leave the house? If the bag is full, leaks, then it will smell bad. What do I do then? He was always worried. (Spouse 1)’	Stoma and community presence
‘When the patients learn how to take care of themselves and are not dependent on others, they can do their personal affairs even in private, accept their conditions better, and their morale improves much better. (Nurse 5)’	The importance of patient independence in self‐care	Proper planning of patient education
‘Their length of stay is short and they are discharged within a day or two after operation unless he/she suffers from a complication. Well, this patient is distressed and still doesn't know what has happened. (S/he) starts wondering when reaches home and says what I can do with this (stoma). That's why it's really critical to avoid abandoning the patient and a nurse must follow him/her up after discharge . (Nurse 6)'	The importance of not forsaking patients after discharge	Proper planning of patient education

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5.1.1. Inefficient education system

The majority of participants mentioned that the inefficiency of the education system in ostomy care and attributed it to inadequate nursing education at universities, nursing knowledge of ostomy care and ostomy care training courses. Participants also noted the inadequacy of in‐service or out‐service training for graduate nurses and believed that these courses were not effective due to reasons such as non‐academic training, lack of efficient administrators and beneficiary sponsors.

5.1.2. Nurse characteristics

From the participants' viewpoint, the nurse's specialized knowledge and experience, their knowledge of the components of meticulous nursing care as well as their individual attitudes and values all affect providing ostomy care. Participants believe that patient‐centred, ethical and evidence‐based care is among the components of meticulous nursing care that should be noticed by nurses.

5.1.3. Workplace challenges

Workplace challenges can affect the conditions of care delivery. This category included surgeons' unawareness of non‐surgical issues of a ostomy, disregard for interprofessional ostomy management, shortage of ostomy‐specialized nurses, high workload and limited time of nursing care and lack of ostomy equipment or low‐quality equipment if there is any . Another challenge was the surgeons' disregard for inter‐professional ostomy management. There is also the problem of ostomy‐specialized nurse's shortage.

Accessing high‐quality ostomy supplies is also an important factor in providing this care and in cases where the quantity and quality of supplies are not desirable, one cannot expect optimal ostomy care outcomes.

5.1.4. The nature of stoma care

Participants believe that the ostomy‐related issues affect the provision of care. This category included the unpleasant aspects of ostomy care for the nurse and the nurse's mental injury. On the other hand, ostomy care is one of the cares that impresses nurse's emotions, with most nurses being affected and experiencing ‐ injury when providing such care.

5.1.5. Counselling and preparation of patients for surgery

From the perspective of participants, preparation of patients for a surgery has a significant impact on his or her response to ostomy and cooperation with the treatment team. This category included the need for informed patient satisfaction, and the importance of stoma siting.

Another important factor in preoperative physiological preparation of patients is counselling with ostomy‐specialized nurses to do stoma siting. A well‐placed stoma has fewer complications and, therefore, the patient will be encouraged more to participate in the care process.

If the patient is not well justified before surgery and preoperative counselling is not performed, the patient may show reactions to ostomy, such as experiences shock, denies and rejects the ostomy, which is a major barrier to patient participation in the nursing care and education process.

5.1.6. Acquaintance with complications of ostomy

Participants believe that it is not enough to provide routine surgical care for ostomy management and the nurse needs to be aware of the various complications (psychological, physical, familial‐marital and social) of ostomy as well as know how to manage them. Psychological problems were very important for patients and families, specially depression.

Another major complication of ostomy is its impact on individuals' family life and marriage. Paying attention to this complication is especially critical in Iranian culture where family centre is very important and ostomy care is often done at home. Also, patients often choose social isolation due to ostomy and fear of noise, smell or odour.

5.1.7. Proper planning of patient education

Efficient patient training is another component of good care provision that includes the subgroup ‘the importance of patient autonomy in self‐care and avoiding patient abandonment after discharge’. The final goal of stoma nursing care is to enhance patient autonomy in self‐management.

Participants also emphasized the importance of patient's follow‐up after being discharged. A nurse stated.

6. DISCUSSION

The aim of this study was to explore nurses' viewpoints on factors affecting ostomy care. The results revealed that several factors are involved in ostomy care process. One of them is the quality of nursing education in the university. Education has a significant effect on nurses' knowledge and skills, and nurses with a bachelor's degree must be adequately prepared to meet expectations ahead (Farzi et al.,2018). Results showed that the academic education has not been effective in improving ostomy care, so that many nurses have little information about ostomy and basic ostomy care; consequently, they do not participate in ostomy care. Consistent with this finding, some studies reported that nurses lacked adequate knowledge of the provision of ostomy primary care (Bagheri et al.,2017). In addition, academic weakness to medical education policymaking and planning at the macro level or absence of appropriate training cases in apprenticeships and competent and trained clinical educators. They referred to the need to transform university education by incorporating this care in the list of compulsory courses of undergraduate nursing as well as provide specialized training of clinical educators. In line with these findings, Farzi et al. referred to clinical education as the heart of nursing education and emphasized that the employment of experienced clinical educators can influence the quality of nursing education (Farzi et al.,2018). Wound ostomy continence nurses (WOCNs) have an important role in the preoperative period, for example, it has been reported that patients whose ostomy sites are placed by a WOCN, suffer fewer postoperative complications than those whose ostomy sites are placed by other (McGrath,2017). In our study, in‐service nursing courses were also evaluated as insufficient and it is believed that the lack of efficient academic administrators for these courses and assignment of these programmes to ostomy supply companies have deviated these programmes from their main mission.

The findings also revealed the importance of having the knowledge and expertise to provide ostomy care. All acute care nurses should have the basic competence to provide postoperative care and educational support to new ostomy patients. This should include information on proper stoma assessment, the pouch system fitting, emptying and changing pouches, access to supplies and basic stoma‐related problem‐solving skills (Schreiber,2016). Gemille's study showed that nurses emphasized the importance of gaining experience in ostomy care and stated that reducing the opportunity for caring new ostomy patients in wards had a negative effect on their ability to retain their previous experiences (Yang et al.,2016). One of the main findings of Alenezi study was the existence of significant differences in nurses' confidence levels for providing ostomy care based on their knowledge, skills and barriers (Alenezi et al.,2022).

Results showed that meticulous nursing care requires patient‐centred approach, constant prioritization of patient needs and interests and provision of evidence‐based care. In addition, considering ethics and professional commitment and communication are important. Developing ethical values, enhances one's ability to reason and make ethical decisions in challenging situations and provides safe, legal and ethical care (Boozaripour et al.,2018). The ostomy patient has become a permanent consumer of ostomy appliances, and there is an intense competition between the ostomy appliances companies knowing that the cost of providing such equipment is also enormous. Therefore, the nurse must support the patient through their specialized knowledge and experience, and take into account the different conditions of the patient while prescribing appropriate equipment and help the patient not fall victim to such a market. Similarly, Duruk mentioned the abuse of patients by the agents of ostomy supply companies as well as their dependence on the products of a particular company as one of the important clinical consequences of the avoidance of ostomy care among nurses (Duruk & Uçar,2013).

Another important characteristic of the nurses was their attitudes and viewpoints that influence the level of participation in providing care and its quality. A nurse who is psychologically and emotionally severely affected due to the condition of the patient prefers to avoid ostomy care.

Workplace‐related factors were other categories in this study. Participants believed that surgeons generally do not have enough knowledge about non‐surgical ostomy issues, do not believe in management role of ostomy team and refuse to provide counselling to ostomy nurses. In such an environment, it is virtually impossible to provide ideal or optimal care. The shortage of specialized nurses in surgical wards was also considered as a major negative factor. Because nurses play a vital role in the process of caring the stoma patients to help them quickly adapt to the life after procedure (Heerschap & Duff,2021). Nurses are involved in both preoperative and postoperative process of providing education for stoma patients. In the preoperative phase, nurses act as an educator introduce the necessities and the change of appearance after operation as well as the lifestyle guidance (Burch,2017). Participants of this study recommended the presence of at least one ostomy‐specialized nurse in the surgical ward in each shift. Shortage of time for ward nurses and their overwhelming work load were other problems. Participants stated that ostomy care is a multifaceted, time‐consuming educational care process. They also expressed that when the specific features of this care are not taken into account and few ostomy patients are assigned to a stoma nurse as compared to other nurses, this nurse either entrusts the duty of ostomy bag replacement to another nursing assistant or performs routine surgical care. In Thorpe et al.'s study, ostomy‐specialized nurses stated that caring for ostomy patient is of low priority and is mainly limited to toilet care and as a result, such duty is frequently assigned to nursing assistants. They also mentioned that the impact of insufficient time allocation for stoma care as a barrier to empowering self‐care ability in patients (Thorpe et al.,2014) We also focused on the absence of ostomy appliances with adequate quantity or quality in the hospital wards as a significant barrier to providing appropriate care to these patients.

The nature of ostomy care was another category in this study. Participants believed that ostomy care is a disgusting task for most nurses due to having direct contact with stool and unpleasant odour, so they avoid such care. They also think that it is not their duty to take care of the ostomy patient. This finding is consistent with the results of the Duruk's study (Duruk & Uçar,2013). On the other hand, considering the changes and subsequent sufferings imposed by ostomy on the patient's life, the nurse is often filled with pity and sympathy for the patient and is hurt emotionally; consequently, they prefer to be less involved in this type of care.

From the perspective of the participants, when patients are better justified and prepared preoperatively, they will face and accept the ostomy more easer, which allows nurses to provide better care. The patient who is shocked after discovering his/her ostomy is mournful and does not accept it and cannot be cooperative with the nurse. Outcomes of surgical treatment depend on the patient's preoperative psychosocial preparedness (Ferreira et al.,2017), and several studies emphasize the effect of psychosocial adjustment to the ostomy if stoma nurses take care of patients (dos Reis,2016; Shrief & Mokhtar,2019). From the viewpoint of the participants, stoma siting was also necessary. Appropriate stoma sitting facilitates the use of the pouch, reduces spontaneous detachment, leakage and various skin complications, as well as enhances self‐care ability in the patient. One of the tasks of ostomy‐specialized nurses is to perform stoma siting to provide preoperative counselling (Pine et al.,2020).

From the participants' viewpoint, it is essential to know and manage ostomy complications. These comprise of a wide range of physical, psychological, familial‐marital and social issues Ran referred to the complications of ostomy as the most pressing self‐care needs in these patients after adapting to ostomy and using the ostomy pouch (Ran et al.,2016). The nurse should have sufficient knowledge about the cause of each of these complications and take appropriate preventive and treatment measures in addition to providing care and education to the patients and their family. But Bagheri in her study showed that nurses have insufficient knowledge of the prevention and control of ostomy complications (Bagheri et al.,2017).

Another important factor in ostomy care is the proper organization of the patient education process. According to the participants, ostomy care is not limited to the time of hospitalization, and the main part of specialized‐ostomy care begins after hospital discharge, because the ultimate goal is to help them acquire ostomy care and gain ability in self‐care activities. Ostomy patients have many self‐care needs and are much concerned about the acquisition of self‐care (Ran et al.,2016). Ostomy patients are hospitalized for a short time, and face various stoma‐related challenges, and experience many problems and concerns about living with ostomy after discharge, thus always need support, follow‐up and training provided by nurses (Zhang et al.,2013). Systematic follow‐up of the patient after hospital discharge by the specialist nurse, outpatiently or via telephone, especially in the first 2 years after surgery, has been shown to be a strategy to reduce complications (Carlsson et al.,2016). Also, it is very difficult to completely provide self‐care patient training in the hospital and it is not possible to make them independent because cancer patients (as the most likely cause of surgery) are often may not be enough time for psychological and emotional training pre‐operatively (Nieves et al.,2017).

6.1. Strength and limitations of the work

The subjective concerns and individual characteristics of the research participants can influence their response and participation in the interview. Also, like other qualitative studies, it was not possible to examine and show the relationship between some demographic characteristics of the research participants with the status of care provision and the challenges experienced.

6.2. Recommendations for further research

Development of a self‐care training programme based on explained needs for patients with ostomy.
Setting up a registration system for patients with ostomy.

7. CONCLUSION

In this study, several effective factors were identified in ostomy wound care. It can be helpful to use the results of this study to adopt effective measures at different educational and management levels to eliminate the challenges facing nurses in providing ostomy care, improving the quality of care and patients' quality of life.

This study also showed that nurses in surgical wards provide non‐special ostomy care, related to the lack of sufficient knowledge and skills. Lack of proper academic education, including insufficient attention to the theoretical education on wound and ostomy care and lack of opportunity to provide ostomy care, the lack of a competent clinical ostomy‐specialized educator, ineffective in‐service training courses and absence of up to date and local clinical guidelines were factors contributing to deficits in knowledge and practice of nurses.

Results showed that ostomy‐specialized cares are provided arbitrarily and emphasized that such cares are not performed in a standard manner in different wards of a hospital. Therefore, it is vital to compile ostomy wound care guideline or adapt global guidelines in order to provide evidence‐based scientific care and avoid unfounded and arbitrary care.

8. RELEVANCE TO CLINICAL PRACTICE

This qualitative study has showed that some factors effect on caring in patient with ostomy had provided by nurses. Nursing care requires patient‐centred approach, and holistic‐oriented approach with competency in knowledge and practice.

AUTHOR CONTRIBUTIONS

Moeini: Original idea, methodology, investigation and editing draft. Shahriari: Original idea, supervision, conceptualization, methodology, writing review and editing. Hayrabedian: Collecting data, writing review and editing. Naseh: Collecting data, writing review and editing.

FUNDING INFORMATION

None.

CONFLICT OF INTEREST STATEMENT

None of the authors of this study, individuals or devices have a conflict of interest in writing or publishing this article.

ACKNOWLEDGEMENTS

This article is part of a research project approved by the Nursing and Midwifery Care Research Center of Isfahan University of Medical Sciences. With the code hereby, the authors express their thanks to the respected Vice Chancellor for Research of the University for funding the project as well as all the dear participants for devoting their time to us.

Notes

Naseh, L., Shahriari, M., Hayrabedian, A., & Moeini, M. (2023). Nurses' viewpoints on factors affecting ostomy care: A qualitative content analysis. Nursing Open, 10, 5261–5270. 10.1002/nop2.1764 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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