Factors affecting the quality of life among ostomy patients in Saudi Arabia

Background: Advances in surgical techniques have improved the management of many diseases. Stoma creation is a common therapeutic, surgical technique used around the world. Complications following ostomy surgery can diminish the quality of life (QOL) for individuals who live with an ostomy in terms of physical, psychosocial, social and spiritual limitations. Aim: This study aims to explore the quality of life among ostomy patients and to identify nurses’ ostomy care confidence level in knowledge and skills in the Kingdom of Saudi Arabia. Method: This study used a mixed-method research design. The study was undertaken at five hospitals within the capital city of the Kingdom of Saudi Arabia. It was based on the Quality of Life Ostomy Model and Quality of Life as an Outcome Variable Model. A modified City of Hope-Quality of Life-Ostomy Questionnaire was used to obtain data from patient participants. A survey was used to collect nurse participants’ data. A convenience sample from five specialist hospitals was invited to participate in this study. Twelve patients with an ostomy also participated in semi-structured interviews for the qualitative research component. Results: There were 421 participants with colostomy, ileostomy or urostomy. The results indicated that 239 of the sample were male and 182 were female; the most common diagnosis was cancer (56%) as compared to non-cancer patients (44%), 51% of participants had temporary ostomies while 48% were permanent. The quantitative results of ostomy patients indicated multiple health-related quality of life challenges were reported by Saudi patients with intestinal stomas. The overall QOL mean score was moderate for ostomy patients in Saudi Arabia. The highest domain mean score was the social well-being and the lowest for physical well-being. Also, the results revealed that stoma type, gender and healthcare institution greatly differed on QOL score. Ostomy surgery interferes with religious practice in Muslim people, particularly during Hajj worship and fasting for Ramadan. The themes identified from qualitative data analysis include the following: reshaping of religious practices, apprehension and adaptation to living with a stoma, which participants discussed related to ostomy issues they experienced following ostomy surgery. The results of the quantitative data analysis for nursing staff indicated that 95.1% of participants worked in adult care, the majority in surgical areas (82.2%). There were significant relationships between the confidence level of knowledge/skills for ostomy care and years of nurse’s experience and ostomy care training received in nursing school; however, no relationship with the nurse’s level of education. Conclusion: The study findings reported a greater understanding of the challenges patients with stoma experience in Saudi Arabia. The process of adaptation and the change in their lifestyle also affects patients’ quality of life. The healthcare providers can use the study results to create a supportive intervention strategy that is needed to maximise QOL for people with a stoma. The findings demonstrated that the type of a stoma (temporary/permanent), gender and hospital where patients received care reported a different profile of influences on the overall aspects of QOL. Additional studies are needed to understand the specific barriers among each group, which may assist in developing intervention strategies to improve the stoma patients’ QOL. In addition, while most nurses were confident in their ability to care for ostomy patients, they were concerned about causing stoma problems. This suggests that improving the quality of ostomy care nurses provide may result in fewer negative outcomes for ostomy patients. This study identifies issues associated with stoma creation among Saudi people and can help in planning and providing the required nursing care, which may support the reduction of predictable problems. Recommendations for future studies related to nursing professional practice are indicated. Research problem: There is a lack of data on the quality of life among Muslim ostomy patients in the literature, and in particular, studies in Saudi Arabia. Therefore, conducting a study about QOL in ostomy patients could help for future research as well as help to improve QOL among those patients and may improve the providing nursing care in the area of ostomy care. Moreover, this study could increase the attention of care facilities in the area of stoma for both patients and nurses. Recommendations for future studies related to quality of life in different regions of Saudi Arabia and nursing professional practice are indicated. Implication for practice: This study identifies issues associated with stoma creation among Saudi people and can help in planning and providing the required nursing care which may support in the reduction of predictable problems. The findings of this study also provide health care professional the manifestations that influence the quality of life among people with ostomy which can help in approaches to offer support for ostomy patients and family to increase their quality of life. With regard to nursing care for ostomy patients, there is a need for nurses to improve their ostomy management knowledge and skills for clinical practice.