Quality of Life

Quality of life (QoL) emerges as an important concept and outcome in health and healthcare practice and a perceived QoL is an important dimension of the health of both the population in general and the individual member of that population. The measurement of a patient's QoL after stoma surgery is an important focus in the evaluation of nursing practice. The role that nurses play in assessing and maintaining health will be one of the influences on the QoL of patients who have had stoma surgery.

There is much debate about what makes up QoL and health researchers and sociologists are divided between those who support a broad concept (Gill and Feinstein, 1994) and those who take a more pragmatic view (Guyatt and Cook, 1994). Even with debate and controversy among researchers there is a general acceptance that there are four domains to be examined when measuring a patient's QoL. These are the patient's:

• physical functional status

• symptoms and side effects

• social functioning

• psychological state.

When QoL is measured, instruments are used to provide information. These can be specific or generic. Generic instruments show a summary of health status, functional status and general QoL. Specific instruments will measure problems to do with a specific disease state, patient group and areas of functioning. The strength of specific indices is that they focus on areas that are most important to the patient.

Surgical interventions, whether elective or emergency, in diseases such as diverticulitis that will raise a stoma, result in psychological and physical trauma, which will impact on the lives of the patients involved, either temporarily or permanently. After major surgery, sometimes with little warning, patients suddenly find themselves having to adjust not only to the fact that they may have had life-saving surgery, but also to the management of an appliance that enables everyday functioning and excretion, and gradually have to learn to accept their lives with an adjusted expectation of normality.

Quality of life for a patient after stoma surgery for diverticular disease is what the healthcare professional is striving for. Nurses are continually striving to improve their quality of care and need information about the outcome of the care that they provide in order to redirect their efforts to areas where the outcome is not ideal. QoL assessment can provide such information and give a qualitative measure of the patient's subjective well-being and functional limitations. The data produced from such studies of stoma patients can be considered and used as an indicator of that patient's rehabilitation.

In selecting valid instruments for a QoL study it is important that the clinical questions are relative to care. The instrument should be:

• population specific

• suitable for both cross-sectional and longitudinal studies

• suitable for measuring appropriate health dimensions

• suitable for scoring and interpretation by care giver

• suitable for self-completion by all patients to whom it is administered

• validated against a 'gold standard'.

Patients who have had emergency surgery for diverticular disease and find that they have a stoma after surgery, often a colostomy, are devastated. Quite often, because the patient is being prepared for surgery as an emergency it may not be explained to, or fully understood by, the patient what the outcome of the surgery may be. Often patients will have no idea what a stoma means or even more specifically what a colostomy is. It is particularly important that this group of patients who undergo emergency surgery are identified and their QoL problems resolved.

There are many QoL indices that are available, but it is important that the correct index be used and often it is the functional limitations after stoma surgery that need to be measured. A suitable index is the one devised by Padilla and Grant (1985), which was developed to measure the QoL as an outcome variable in cancer patients. In looking at a QoL study for stoma patients other domains should be considered such as:

• psychological well-being

• physical well-being

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