“A STUDY TO EVALUATE THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON COLOSTOMY CARE OF

ADULT AMONG III YEAR B.Sc NURSING STUDENTS IN SELECTED

PRIVATE COLLEGES AT BANGALORE’’

M.Sc Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

By

MS. SWATI S. AWATHARE

M.Sc NURSING 1ST YEAR

2010-2012

Under the Guidance of

HOD, Department of Medical Surgical Nursing

Nightingale College of Nursing

Guruvanna Devara Mutt

Near Binnyston garden

Magadi Road

Bangalore –23

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,KARNATAKA

CURRICULUM DEVELOPMENT CELL

CONFORMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Registration number :

Name of the candidate : Ms.Swati S. AwathareAddress : Guruvanna Devara Mutt, Near Binnyston Garden, Magadi Road, Bangalore-23 Name of the institution : Nightingale College of NursingCourse of study and subject : M.Sc. Nursing in Medical Surgical Nursing.

Date of admission to course :

Title of the topic : A study to evaluate the effectiveness of structured teaching programme on colostomy care of adult among III year B.Sc nursing students in selected private colleges at Bangalore.

Brief resume of the intended work : Attached

Signature of the student :

Guide Name S :

Remarks of the guide :

Signature of the guide :

Co-guide name :

Signature of co-guide :

HOD name :

Signature of HOD :

Principal Name : Mrs.Jayakadambari

Principal Mobile No : 09886367287

Principal E-mail ID : nightingale_principal@rediffmail.com

Remarks of the Principal :

Principal Signature :

2

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1

NAME OF THE CANDIDATE

AND ADDRESS

MS.SWATI S. AWATHARE

I YEAR M.Sc. NURSING,

NIGHTINGALE COLLEGE OF NURING

GURUVANNA DEVARA MUTT, NEAR

BINNYSTON GARDEN,

MAGADI ROAD,BANGALORE-23

2 NAME OF THE INSTITUTION NIGHTINGALE COLLEGE OF NURING,

GURUVANNA DEVARA MUTT, NEAR

BINNYSTON GARDEN, MAGADI

ROAD,BANGALORE-23

3 COURSE OF STUDY AND

SUBJECT

M.SC NURSING IN MEDICAL SURGICAL

NURSING

4 DATE OF ADMISSION TO THE

COURSE

15.09.2010

5 TITLE OF THE TOPIC:

“A STUDY TO EVALUATE THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON COLOSTOMY CARE OF

ADULT AMONG III YEAR B.Sc NURSING STUDENTS IN SELECTED

PRIVATE COLLEGES AT BANGALORE’’

3

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

A variety of gastrointestinal/genitourinary etiologies may necessitate the

creation of a fecal or urinary diversion. Teaching the patient how to carte of a new also

my can be a challenging experience for the nurse. The patient with an stormy needs

Encouragement, support and counseling to learn how to integrate self stormy care into

daily activities.

A variety of gastrointestinal/genitourinary may necessitate the creation of

a fecal or urinary diversion. These may include biventricular disease, inflammatory

bowel disease, colorectal (meer, intestinal abstraction, gastrointestinal trauma and

gynecological cancers (Beitz 2004).

Indication for creating a urinary stoma are bladder cancer Neurogenic

bladder, interstitial cystitis & Refractory redication cystitis. The Etiology of the disease

will determine if the ostomy is going to be temporary or permanent (Toma selli &

McGinis,2004).

Among different types of surgically created ostomies, a colostomy is an

opening constructed in the colon (large intestine) to allow for the Elimination of stool. A

colostomy may be located in the ascending, transverse or sigmoid colon. The point of

surgical resection will determine the consistency of the stool output. An ileostomy is

surgically constructed from ileum (Small intestine) it is created high in the

gastrointestinal tract, therefore, stool output is of relatively high amount and of liquid

consistency (Vasilevsky & Gardon 2004).

* Patient Education :

When a patient is scheduled for ostomy surgery he or she may

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experience many feelings such as variety fear, loss of body image and depression

especially if a diagnosis of cancer is the cause for surgery, preoperactive teaching can

help relieve some of these feeling and contribute to the patient’s positive Recovery

(O’shea 2001).

One essential component of the patient’s preoperative teaching is a

consultation with a wound ostomy and continence nurse (WOCN) preoperative

counseling provides the apportunity to assess the patient’s knowledge of the disease,

educational level, support system, Employment, involvement in physical activities such

as sports or hobbies and financial concern regarding purchase of ostomy supplies in

addition, assessment of any physical.

1) Majority 70% of ostomates had colostomy.

2) Majority 76% of the ostomates had 0-10 years of duration of ostomy.

3) 84% of ostomates had a change in their clothing style because of ostomy.

4) Majority 66% of the ostomates had a change in their dies because of ostomy.

38% of Ostomates has problem while traveling due to Ostomy.

6.1 NEED FOR STUDY

M.Joyce Black 2005 study that in prepaparaton for discharge,client need support and

knowledgeable advice as they to know the nearest location for purchase of ostomy

supplies immeadiately after dissmissel,home deliveries of supplies may be necessary.

The enterostomal therapy nurse can help the client learn to manage and accept the

ostomy and to achieve a smooth transition from the health care facility to the home

Some cities have established ostoy rehabilitation clinics to help clients and most

largeclinic to help clients and most large communities have an ostomy association that

maintains contacts with American cancer society.These supportive group are helpful

5

because client can share their ostomy concern with other who have the similar problem.

A home health care referral can add to the client peace of mind,identify a problems that

might not otherwise be know and ensure necessary follow up care.

Before disharge advice clientthat it may take several weeks for them to regain their

strength after major bowel surgery further when segment have been removed from the

bowel,bowel habbit may alter until body adjust to the situation.A nurse may need to

teach the client because wound may not be healed totally by the time the client is

discharged.

1)Majority 70% of ostomates had colostomy.

2)Majority 76% of the ostomates had 0-10 years of duration of ostomy.

3)84% of ostomates had a change in their clothing style because of ostomy.

4)Majority 66% of the ostomates had a change in their dies because of ostomy

38% of Ostomates has problem while traveling due to Ostomy(oshea 2001).

5) 48% of the Ostomates were practicing irrigation to regulate their bowl.

6) 40% Ostomates were using two piece pouches.

7) All 100% of Ostomates felt comfortable with their Ostomy care. (TNA

JOURNAL-2010)

From the above background we need to study and to evaluate the effectiveness of

structured teaching programme on colostomy care of adult among III year B.Sc nursing

students in selected private colleges at Bangalore

6

6.2 REVIEW OF LITERATURE

A review of literature is an essential aspect of scientific research .It is a

systematic identification, location, and scrutiny summary of written material that

contains information relevant to the problem under study. It helps to identify the similar

studies for the investigator. It enables the researcher to focus on related studies around

the world at different set up. The major goal of review of literature is to develop a

strong knowledge base to carry out research a non research scholarly activity1.

Ostomy complications: Annually, nearly 120,000 people undergo ostomy surgery

in the US and an estimated 800,000 individuals in the JS live with an ostomy. Despite

major advances in ostomy care and designated ostomy specialist such as WOCNs, as

much as two thirds of individuals who undergo ostomy surgery will experience one or

more stoma complications. These complications can significantly interfere with

activities of daily living, lead to psychosocial distress, and reduce quality of life.

The actual incidence of peristomal and stomal complications is difficult

to ascertain because rates reported in the literature very widely from 6% to 66.8%.

Differences in definitions, consensus of terms, populations, study design, and tiing of

measurements make comparisons of rates across studies problematic. A review of the

literature revealed numerous studies describing different complication rates, select,

relevant studies are presented to illustrate the wide range of rates reported in the

literature.

In a large prospective audit of 3,970 ostomy patients, Cottamet al

documented 1,329 (34%) complications (including peristomal skin-related problems),

within 3 weeks of surgery.

Herlufsen et al investigated the frequency, severity, and diversity of peristomal skin

disorders among individuals with a permanent stoma in a community population and

7

found that skin disorders were higher for ileostomy (57%) and urostomy patients (48%)

than for colostomy partiens (35%). Only 38% of study participants with diagnosed

peristomal skin complications agreed they had a problem and more than 80% of

participants did not seek professional help for these problems.

Ratliff et al evaluated 220 new ostomy paritents at a 2 months follow-up

visit and identified a 16% peristomal complications rate. Ratliff and Donovan studied

161 ostomy paritents seen in a 1 year period and reported complication rate of 6% with

complications highest in paritents with an ideal conduit (15%) and ilcostomy (9%).

In a descriptive study, Richbourg et al, using a survey questionnaire mailed to

individuals who had undergone ostomy surgey at their facility, identified 34 people

(76%) who had peristomal skin irritation. Participants ratedperistomal skin irritation as

one of their top five difficulties after hospital discharge. Wood et al followed partients

with an ileal conduit for up to 63.4 months after surgery and reported an ovrall stoma

complications rate of 34.4% in addition, re-operation was required in 24.7% of the total

patient population due to parastomal hernia and stoma retraction.

Sulvadulena conducted a systematic review and identified 21 studies published

between 1990 and 2007 that measure the incidence of stomal and peristomal

complications. Due to differences in study design, operational definitions, and timing of

measurements, Salvadalena concluded it is not possible to pool date and measure the

incidence of stomal and peristomal complications, Variability in study designs and

absence of operational definitions were indentified as major problems is necessary to

investigate challenges encountered by ostomates postporatively.

Stomal/peristomal assessment instruments: Bosio et al conductedf a

prospective, observational study between 2003 and 2006 across eight ostomy centers in

Italy. Patients were divided into two groups according to onset of complications (less of

greater than 1 year). Peristomal skin was assessed at 0,4,12 and 24 weeks. Peristomal

skin complications were identified in 339 of 656 ostomy patient (52%, 272 men and 67

women.) From the data obtained in this study, a classification scheme based on

8

recurrent clinical manifestations (lesions) and topographical location was created and

the SACS Instrument was developed by seven enterostomal nurses and four surgeons

from eight facilities in Italy. The five most common sessions (L) observed in the Bosio

study and included in the instrument are hyperemic lesion (Peristomal skin reddening

without loss of substance), erosive lesion with loss of substance not extending beyond

the dermis, ulcerative lesion extending beyond the dermis, ulcerative fibrin us/necrotic

lesion, and proliferate lesions (granulomas, oxalate depiosits, neoplasm). Skin lesion

severity is assessed on a scale of 1 to X – eg. LI for less severe and LX for more severe

skin complications. Five topographical (T) location quadrants are used to documents

peristomal lesion location.

The criteria used in the instrument are universally familiar in that I is

similar to wound depthdescription and T to thaty of the grid used to help locate lesions

in breast cancer patients (See

Figure 1) The instrument reduces the subjective assessment of peristomal skin lesions

and promotes a universal language for communicating peristomal skin disorder.

However, the SACS instrument only addresses one component of ostomy clinical

decision-making and a broader instrument, such as an algorithm, is needed to address all

aspects of the management of stomal and peristomal complications.

In another effort to provide clinicians with a classification system for

peristomal skin complications the Ostomy Skin Tool was developed by a group of 12

ostomy care nurses from around the world in collaboration with an ostomy products

manufacturer. The Ostomy Skin Tool is comprised of two sections. Part One is used to

calculate a score that describe the peristomal skin condition and incorporates both the

area affected and severity of the problem. Part two is a diagnostic guide that provides

classification of peristomal skin complications according to clinical assessment and

standardized descriptions. Content validity of the tool, the Coloplast dialogue study, is

in progress.

In an effort to establish valid, reliable definitions for stomal and

9

peristomal complications, Colwell and Beitz surveyed 686 WOCNs to clicit their

evaluation on the proposed definitions. On a scale of 1 to 4, the mean score for all

definitions and interventions was 3.64 (SD=0.30) and the overall survey’s Content

Validity Index (CVI) was 91, demonstrating a high consensus.

The definitions proposed by Colwell and Beitz, along with use of the

SACS instrument, may offer clinicians a common language and objective way to

diagnose and classify peristomal skin complications. Universal adoption of both also

will allow clinicias to accurately measure the prevalence and incidence of peristomal

and stomal complication; both the definitions and the SACS Instrument have been

content validaterd but must be tested with real patients for kfull validity and reliability.

Ultimaterly, this may help WOCN expand the integration of evidence into practice and

lead to improvements in the quality of care for the individuals living with an ostomy.

Algorithms and content validation. Algorithms are graphic care maps

that allow users to visualize major cognitive components and processes of a clinical

problem; they enable the clinician to complete a stepwise evaluation of a specifica issue.

From a metacognitive perspective, algorithms help organize thinking, make

relationships more meaningful, and highlight crucial decision points.

Most algorithms and decision maps in healthcare are not research-based

and lack a data-driven evidence base to support their efficacy. Typoically they only

have face or preliminary content validity, the lowest level of evidence (See Table 1).

Establishing content validity helps ensure the components and information included

adequately reflect the domain of content critical for inclusion (eg. Ostomy care); this

rigorous two-stage process is based on development and judgment quantification. Poor

scrutiny and incompletion of either stage compromises validity.

The development stage consists of domain (topical area) idenfification,

item generation, and instrument construction. Because of the nature of ostomy care

algorithm objectives, validity depends on the adequacy with which the characteristics of

a variety of ostomies are sampled and represented. This development process is based

10

on use of content experts (ie. Clinical experts).

Selected wound care algorithm have been content validated. The

Solutions Algorithms, developed bt Conva Tec Inc. (Skillman.NI) were content

validated in 1999 and more recently were construct validated – ie, tested for use in the

selection of correct wound care using photographs of actual wounds. To the authors’

knowledge, no evidence based, validated algorithmic approaches to ostomy care are

currently available.

More people than ever before are surviving cancer. The 5-year survival rate for

colorectal cancer increased from 51% in the mid-1970s to 65% in 2004 (American

Cancer Society, 2008). This is changing the view of cancer as an acute incurable disease

to one of a manageable chronic disease. Patients who have had surgery with an ostomy

require short and long term follow up to adjust and manage complications. Educational

needs idenfified by patients with an ostomy include stoma care skills, counseling, diet,

obtaining supplies, and management of complications (McMullen et al, 2008; Readding,

2005).

Increasingly, there is a need for comprehensive rehabilitative colorectal

cancer program to address ongoing management of symptoms and complications across

the disease continuum. Establishing a comprehensive program to meet the educational

and service needs of the paritent with colorectal cancer is essential to providing quality

effective care. Moreover, there is a shift taking place in how involved patients want to

be in making decisions and obtaining helath-released information and care. Younger

patients are more Internet-savvy and more active in their health care choices, whereas

older patients tend to rely on the physician or care provider for information and decision

support (Al-Bharani & Plusa, 2004). Patients value the presence of the multidisciplinary

care team to provide information and manage care, beginning early in the diagnosis and

continuing across the disease trajectory (Board, 2007). Thus timely assessment of

patient learning needs and style is critical to successful education of the patient land

11

family.

Patient education as an expected standard of care for oncology nurses

(Boyle, Bruce, Iwamoto, & Summers, 2004). Surgical oncology staff nurses play an

important role in initial assessment and the provision of instrumental and educational

support to the patient with colerestal cancer, both preoperatively and postoperatively,

transitioning the patient to community-based care. Consequently, the knowledge base

and skill level of each nurse affects the care and education of the patient. Nurses need to

have core knowledge and skills in the management of colorectal cancer care,

specifically ostomy care, as well as an understanding of how the care provided is linked

to other care providers along the illness continuum. Basic competency for all acture care

nurses providing care and educational support for the new postoperative ostomy patient

should include the following stoma assessment, pouch fitting, pouch emptying, acces to

resources and supplies, and basic problem-solving skills (Boarini, Mc-Nichjol, Carmel,

Golberg, & Pruitt, 2004). A few studies have show the importance of nursing

knowledge and confidence as it relates tonew ostomy patient satisfaction (Jackson et

al.,199; Moore et al., 1998). Findings show a possible link between how nurses perceive

their competence, their level of ongoing in-service education, and ostomy patient

satisfaction. Nurses who perceive themselves to have high competence and a favourable

perception of the ostomy patient were found to have had significantly more education

(Moore et al., 1998). Ostomy patients who were cared for by a nurse who was highly

confident were more satisfied with their care (Jackson et al., 1993). Thus, nurses’

perception of their level of knowledge and skill affects how the ostomy patient

perceives the care experience. In another study examining the use of an educational

intervention to improve nursing knowledge in caring for the patient with colorectal

cancer, researchers showed significant improvement in disease-related knowledge from

pre-to-positintervention (knowledge et al., 2008). Additionally, nurses attending this

self-directed education intervention program showed positive attitudes toward patients

with colorectal cancer 4 months postintervention and maintained knowledge gained

during the program (Knowles et al., 2008).

12

One of the challenges associated with maintaining staff nurse

competency is the infrequency with which the average staff nurse ineracts with the new

or long term colorectal cancer survivor with an ostomy and therefore less opoportunity

to keep staff nurses’ skills current. In addition, there is a shortage of specialty wound

ostomy continence nurses nationally, leaving care of the new or long-term ostomy

patient to the acute care, clinical, and home health staff nurse. Increased staff nurse

expertise and confidence will facilitate optiomal ostomy patient skill mastery and

complem,ent the work of would ostomy continence nurses and other health care team

members in providing care to the new ostomy patient.

STATEMENT OF PROBLEM

“A study to evaluate the effectiveness of structured teaching programme on colostomy

care of adult among III year B.Sc nursing students in selected private colleges at

Bangalore

6.3 OBJECTIVES OF THE STUDY

To assess the level of knowledge on colostomy care of adult among III year B.Sc

nursing students .

To develop the structured teaching program on colostomy care of adult among

BSc nursing students..

To evaluate the effectiveness of structured teaching programme on colostomy

care of adult among III year B.Sc nursing students..

To find out the association between the post test knowledge on colostomy care

of adult among with their selected demographic variables.

HYPOTHESIS

13

H1:The mean post test knowledge score on colostomy care of adult

among III year B.Sc nursing students will be greater than the mean

pretest knowledge score.

H2:There will be a significant association between the levels of

knowledge on colostomy care of adult with their selected demographic

variables.

OPERATIONAL DEFINITIONS

EFFECTIVENESS:

It refers to the difference between pre test and post test level of knowledg colostomy

care of adult among III year B.Sc. nursing students after giving a structured teaching

programme on colostomy care of adult.

COLOSTOMY CARE

A colostomy is a surgically created opening in the abdominal wall through which

digested food passes. It may be temporary or permanent. The opening is called a stoma

from the Greek word meaning mouth. Stool passes through the stoma into a pouch

attached to the stoma on the outside of the abdomen. The pouch, stoma, and skin

surrounding the stoma require care and maintenance by the patient or caregiver.

STRUCTURED TEACHING PROGRAMME

Structured Teaching Programme is a tool that helps people to understands and

manage daily life the Structured Teaching Programmeis a process of arranging

material in a services of several steps designed to lead a learner through

Structured Teaching from known to unknown of new and more complex

knowledge and principles

ASSUMPTIONS

14

The students may have inadequate knowledge regarding colostomy care of

adult .

The students will be gaining adequate knowledge regarding colostomy care of

adult after giving a structured teaching programme.

The knowledge colostomy care of adult will help the student to provide

preoperative and postoperative care while they handle the patients who

undergone colostomy operation.

DELIMITATIONS

The study is limited to only III year B.Sc. nursing students.

The study is limited to assess only the knowledge on colostomy care of adult .

The study is limited for 4 weeks.

PROJECTED OUTCOME

The study will improve the level of knowledge on colostomy care of adult among III

year B.Sc nursing students. At the same time, the study will prove the effectiveness of

structured teaching programme On colostomy care of adult .

MATERIALS AND METHODS

SOURCE OF DATA

Data will be collected from III year B.Sc nursing students from selected private colleges

at Bangalore.

RESEARCH DESIGN

The research design adopted for this study is one group pretest and post test research

design and quasi experimental study.

RESEARCH APPROACH

15

7. The research approach is evaluative approach.

SETTING

The study will be conducted in selected private colleges at Bangalore .

POPULATION

All the III year B.Sc. nursing students of selected private colleges at Bangalore.

METHOD OF DATA COLLECTION

SAMPLING PROCEDURE

The sampling techniques adopted for this study is purposive.SAMPLING SIZE

The sample size is 60. Non-probability sampling technique.

INCLUSION CRITERIA

The criteria for sample selection are students of III year B.Sc. nursing who;

Have the willingness to participate in study.

Know English well.

EXCLUSION CRITERIA

Students who are studying in I, II, year and III B.Sc.nursing selected private colleges at

Bangalore.

16

INSTRUMENT INTENDED TO BE USED

SELECTION OF TOOL

PART 1: This consist of demographic variables such as age, sex, religion, cast,

nationality, socioeconomic status, education and income of their parents, attended

conferences and workshops related to colostomy care.

PART 2: A structured questionnaire will be used to assess the knowledge of students on

colostomy care.

PART 3: A structured teaching programme which may last for 30-40 minutes duration

involving lecture and discussion of definition,indication, purpose, contraindication,

procedure, preoperative and postoperative nursing care complications and health

education of colostomy care of adult using appropriate A.V aids which will be prepared

ahead by the researcher and validated by the experts.

SCORING PROCEDURE

For knowledge assessment

For answers; If answer yes 1

If answer No 0

SCORING INTERPRETATION

LEVEL OF KNOWLEDGE RANGE

Adequate Knowledge >68%

Average Knowledge 34-67%

Inadequate Knowledge <33%

17

DATA COLLECTION METHOD

Prior permission will be obtained from the college Principal before

conducting the study. The study will be based on one group pre- test and post- test

design. Questionnaire will be distributed to the students for collecting the data.5

samples will be taken per day for the study. The study will be completed within 4

weeks.

PILOT STUDY

10 samples will be selected and study will be conducted to find the feasibility.

DATA ANALYSIS PLAN

The plan for data analysis was as follows;

The data obtained will be analyzed in view of the objectives of the study using

Structured Teaching Programme.

The plan for data analysis was as follows;

Frequencies and percentage of distribution will be used to analyze the

demographic data.

Mean, median, mode, standard deviation is used for assessing the knowledge

scores.

Chi-square list to find out the association between knowledge on management of

extra pyramidal symptoms with selected demographic variables. The significant

finding will be expressed in the tables, figures and graphs.

18

HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

YES, Ethical clearance will be obtained from the research committee of Nightingale

College of nursing, consent will be taken from concerned authority and permission will

be taken from the study subjects before the collection of data.

LIST OF REFERENCES

1)Clark,J & Grover,P: Colostomy Guide. Available at: http://www.uoaa.org/ostomy_info/pubs/uoa_colostomy_en.pdf., Accessed October 4, 2006.

2)Black,P: Practical stoma care. Nurs Stand, 2000; 14(41):47-53.

3)Burch,J: The pre- and postoperative nursing care for patients with a stoma. Br J Nurs, 2005; 14(6):310-318.

4)Colwell,JC, Goldberg,M, & Carmel,J: The state of the standard diversion. J Wound Ostomy Continence Nurs, 2001; 28(1):6-17.

19

8.

5)Doughty,D: Principles of ostomy management in the oncology patient. J Support Oncol, 2005; 3(1):59-69.

6)Burch,J & Sica,J: Urostomy products: an update of recent developments. Br J Community Nurs, 2004; 9(11):482-486.

7)Smeltzer SC, Bare BG (eds): : Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 10th ed. . Lippincott Williams and Wilkins, Philadelphia, PA; , 2003.

8. Tumbuli GB, Erwin-Toth P. Ostomy carte: foundation for teaching and practice.

Ostomy Wound Manage. 1999.45(1A Suppl) 235.

9.Christian M, Martinsorn M.Getting paid for all your hard work: the basics of

reimbursement for healthcare products and services, Regulatory Affairs Focus,

2002, July 5-10.

9.Sulivan S.Watkins J.Sweet S.Ramsay S Health technology assessment in helath-

care decisions in the United States, Value in Health, 2009: 12(2):S39-S44.

10.WOCN Scoeity. 2008 WOC Nursing Salary and Productivity Survey. Mt.

Laurel.NJ: WOCN:2008. Available at www.wocn.org.Accessed September

1,2010.

11.Tumbuli GB. Who is really providing ostomy cre today? Ostomy Wound

Manage. 2002. 48(9): 16-18.

12.Black P.Peristomal skin care: an overview of available products. Br.J.Nurs,

2007; 16(17):1048-1056.

13.WOO KY, Sibald RG, Ayello EA, Coutts PM, Grade DE, Peristomal skin

complications and management. Adv Skin Wound Care. 2009/22 522-532.

14.Colwell JC, Principle of stoma management, in Colwell J, Goldberg M, Camel

J (eds), Fecal & Urinary Diversions, Management Principles. St. Louis, MO:

20

Mosby; 2004:259.

15.Tumbuli GB. The ostomy assessment inventor; a data-gathering process to

enhace appropriate system selection. Ostomy Wound Manage, 1998; 44(2) 28-37.

16.St.Cyr.D.An evaluation of the Canadian Custody Assessment Guide. Ostomy

Wound Manager. 2002, 48(8):26-32.

17.WOCN Society, stoma Complications: Best Practice for Clinicians. Mt. Laurel,

NJ:WOCN;2005.

18.Bosio G,Pisani F,Lucibello L, et al. A proposal for classifying peristomal skin

disorders: results of multicenter observational study. Ostomy Wound Manage,

2007;53(9):38-43.

19.Pittman J, Rawl SM, Schmidt CM,. Grant M, Ko CY, Wendel C,Krouse RS,

Demographic and cilinical factors srelated to ostomy complications and quality of

life in veterans with an ostomy.JWOCN, 2008:35(5);493-503.

20.Colwell JC Shoma and peristomal complications, in Cowell J, Goldber M,

Camel J (eds), Fecal U Urinary Diversions. Management Principles. St.Louis,

MO:Mosby, 2004;34(1)57-69.

21.Colwell J.Beitz, J.Survey of wou8nd ostomy and continence(WOC) nurse

ciricians on stomal and peristomal compliations a content validation study J

WOCN, 2007,34(1);57-69.

22.Salvadalena G, Incidence of complications of the stoma and perstomal skin

among individuals with colostomy, ileostomy and urostomy a systematic review J

WO?CN 2008,35(5), 596-607.

23.EnglishF, Claessens I. How peristomal skin disorder impact on ostomy care,

WCET J.2008:28(2 suppl)3-7.

21

24.Nugent KP, DanielsP, Stewart B, Patankar R, Johnson CD. Quality of life in

stoma patients. Dis Colon Rectum, 1999, 42(12)1569-1574.

25.Cottarn J.Richards K, Hasted A, Blackman A Results of a nationwide

prospective audit stoma complication within 3 weeks of surgery. Colerectal Dis,

2007;9(9):834-838.

26.Herlufsen P, Olsen AG, Carlsen B, at. al. Ostomy Skin Study. A study of

peristomal skin disorders in patients with permanent stomas. Br J.Nurs.

2006,15(16):854-862.

27.Ratilla CR, Scarano KA, Donovan AM, Descriptive study of perstomal

complications. JWOCN.2007;34(1);70-79.

28.Ratillil CR, Donovan AM, frequency of peristomal complications. Ostomy

Would Manage.2004, 47(8):26-29.

29.Richbourgh L, Thorpe JM, Flapp CG, Difficulties experienced by the ostomate

after hoispital discharge, JWOCN. 2007;34(1):70-79.

30.'Wood DN, Allen SE Hussian M, Greenwell TJ, Shah PJ, Stomal complication

of ileal conduits are significantly higher when formed in women with intractable

urinary incontinence. JUrol.2004,172(6Pt.1):2300-2303.

31.Claessens I, Cobos Serrano JL. English E.Martins L, Tavernelli K, Peristomal

skin disorders and the ostomy skin tool, WCET J.2008;28(2):26-27.

32.Martins L, Tavlemelli K, Cobos Serrano JL, Introducing a peristomal skin

assessment tool: the Ostomy Skin Tool WCET J.2008;28(2 Suppl):S8-S13.

33.Hadom DC, McCommick K,Dikno A, An annolated algorithmic approach to

clinical guideline development, JAMA 1992, 267(24):3311-3314.

34.Beitz.J.Concept maps: navigating the learning process. Nurse

22

Edu.1998;23(5);35-41.

35.Beitz J.van Rijswijk L. A cross-sectional study to validate wound care

algorithms: a content validation study. J WOCN. 1999;24:241-249.

36.Beitz J, van Rijswijk L. A cross –sectional study to validate would care

algorithms for use by registered nurses. Ostomy Wound Manage. 2010.;58(4):46-

59.

37.Grant JS, Davis LL, Selection and use of content experts for instrument

development, Res.Nurs. Health.1997; 20(3);269-274.

38.Lyon MR, Determination and qualification of content validity. Nurs

Res.1986;35(6):382-385.

39.Polit DF, Back CT. The Content Validity Index: are you sure you know what’s

being reported? Critique and recommendations. Res.Nurs Health. 2006:29(5):489-

497.

40.Waltz CW, Bausell RB, Nursing Research: Design, Statistics, and Computer

Analysis, Philadelphia; PA:F.A Davis, 1981.

41.Berk RA, Importance of expert Judgment in content-related validity evidence.

West J.Nurs Res.1990:12(5), 659-671.

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 GUIDE

23

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF THE PRINCIPAL

12.2 SIGNATURE

24