The Development of A Nursing Care Model for Patients with New Colostomy in Lamphun Province

Abstract

This developmental study aimed to develop a nursing care model for patients with new colostomy in Lamphun Province and to evaluate its effects on the incidence of peristomal skin excoriation, hospital re-admission rates due to colostomy-related complications, return rates for repeated colostomy care education, and patients’ knowledge and correct practices in colostomy care. The research was conducted in three phases. In the developmental phase, key issues were identified through literature review and similar-context studies, and a draft model was created. This model was appraised by experts using the AGREE II instrument, achieving a quality score of 70.67%. In the pilot phase, the model was implemented with 56 colostomy patients—both newly operated and those referred from other hospitals—using a sample size determined by Cochran’s formula. Data were collected between 4 July 2022 and 26 June 2023. In the evaluation phase, the outcomes were analyzed using descriptive statistics, paired t-tests, and independent t-tests.

The finalized nursing model comprised six components: (1) establishment of an ostomy clinic; (2) a structured service system encompassing pre-operative nursing, and post-operative nursing, discharge planning, and continuous follow-up; (3) development of clinical guidelines and provisioning of specialized equipment for colostomy care; (4) implementation of an information system for patient data management; (5) health education and discharge planning delivered by a stoma nurse ; and (6) a referral network to facilitate patients’ reintegration into the implementation of the model in community led to significant improvements. The mean of peristomal excoriation rates fell from 0.14 to 0.04 (p < .05), the readmission rates for colostomy complications dropped from 0.44 to 0.00 (p < .05), and repeat education return rates decreased from 0.89 to 0.00 (p < .05). Additionally, patients’ knowledge and correct practices regarding ostomy equipment use, diet, appliance management, physical activity, and recognition of abnormal symptoms increased significantly (p < .01). These findings demonstrate that the developed nursing model effectively enhances clinical outcomes and supports a continuous, structured care approach for new ostomates.

It is suggested that this study is highly specific in nature, with its primary users being specialized nurses in colostomy care. Therefore, it is recommended that guidelines should be developed to facilitate the use of the nursing model by general professional nurses. This can be achieved by establishing consultation channels where general nurses can receive guidance on the application of the colostomy care model from specialized nurses. Incorporating information technology to support communication can further enhance the convenience and efficiency of nursing practice.