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ORIGINAL ARTICLE
Year : 2016  |  Volume : 21  |  Issue : 2  |  Page : 54-56
 

Video teaching program on management of colostomy: Evaluation of its impact on caregivers


Department of Pediatric Surgery, College of Nursing, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Date of Web Publication18-Feb-2016

Correspondence Address:
Heena Dabas
All India Institute of Medical Sciences (AIIMS), New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.176933

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   Abstract 

Context: Care of a child having colostomy has not been institutionalized for a long time for economic and administrative reasons. After stoma formation, stoma care has to be provided to the child by caregivers at home. Hence, caregivers need to be provided with ongoing education and support, commencing from preoperative teaching to discharge from the hospital and home care. Aims: The aims of this study were to develop video-based learning resource material and to evaluate its effectiveness in terms of knowledge and skill attainment by caregivers. Settings and Design: The study design was time series, one group pretest and post test. This was conducted among 30 caregivers attending pediatric surgery outpatients and indoor departments of a tertiary level care center. Materials and Methods: A video teaching program (VTP) related to pediatric colostomy was developed and used to teach the caregivers about colostomy care. Pretested and validated knowledge questionnaire, observational checklist, and stoma assessment scale (SAS) were used to assess the knowledge and skills of caregivers before and after the administration of VTP immediately (post test 1) after and 2 weeks (post test 2) after the intervention. Statistical Analysis Used: Repeated measures analysis of variance (ANOVA), Bonferroni correction, Mann-Whitney U test, and Kruskal-Wallis test were used. Results: There were significant increases in knowledge (from 10.9 ± 2.5 to 16.4 ± 1.67 and 15.9 ± 4.02, P = 0.001, maximum score 20) and skill scores as assessed by the observation checklist (from 5.6 ± 2.0 to 9.8 ± 1.6 and 8.6 ± 2.1, P = 0.001, maximum score 12) immediately after and 2 weeks after the VTP. However, a decline in skills was observed at 2 weeks when compared with immediate scores, as measured by the observation checklist. There was no significant increase in the skill scores of caregivers as measured by SAS at 2 weeks compared to the immediate scores. Conclusion: The VTP was effective in bringing about an increase in the knowledge and skill of caregivers of children having colostomy. Therefore, video can be utilized for the counselling of caregivers of children with colostomy.


Keywords: Discharge counseling, temporary colostomy, video teaching program (VTP)


How to cite this article:
Dabas H, Sharma KK, Joshi P, Agarwala S. Video teaching program on management of colostomy: Evaluation of its impact on caregivers. J Indian Assoc Pediatr Surg 2016;21:54-6

How to cite this URL:
Dabas H, Sharma KK, Joshi P, Agarwala S. Video teaching program on management of colostomy: Evaluation of its impact on caregivers. J Indian Assoc Pediatr Surg [serial online] 2016 [cited 2019 Jul 22];21:54-6. Available from: http://www.jiaps.com/text.asp?2016/21/2/54/176933



   Introduction Top


The care of a child with colostomy is a complex, challenging, and lengthy process, despite its temporary status in most children. [1] After stoma formation, stoma care has to be provided to the child by caregivers at home. Hence, caregivers need to be provided with ongoing education and support commencing from preoperative teaching to discharge from the hospital and home care. Most of the currently available teaching aids describe colostomy care for adults and very few teaching aids are available that direct themselves to the needs of children and their caregivers. Therefore, the need was felt to develop a video teaching program (VTP) on colostomy care for pediatric patients and evaluate its effectiveness.


   Materials and methods Top


Thirty caregivers attending the pediatric surgery outpatient and indoor departments of a tertiary level institution were conveniently selected, i.e., those who were available. All caregivers of children who had colostomy for more than 2 days, were aged 0-12 years, were hemodynamically stable, were willing to participate, and could understand Hindi or English were included in the study. Caregivers of those children who were admitted for colostomy closure were excluded from the study. The study procedure and protocol were reviewed and approved by the Ethics Committee of the hospital. A VTP of 9 min duration addressing the basic anatomy of the intestines, indications for colostomy, signs of healthy stoma, stoma cleaning and dressing, complications related to colostomy, and other important concerns was developed and used to teach the caregivers about colostomy care. Pretested and validated knowledge questionnaire, [2] observational checklist, and stoma assessment scale (SAS) were used to assess the knowledge and skills of caregivers before and after the administration of VTP immediately (post test 1) and 2 weeks (post test 2) after the intervention. A pretested, validated, knowledge questionnaire having 20 items (α = 0.93) was used to assess the knowledge of caregivers regarding colostomy care in children before and after the intervention. A score of 1 was given for every correct answer, and 0 for an incorrect answer, the maximum possible score being 20. The skills of caregivers related to colostomy care and the outcome of colostomy care were assessed before and after intervention using pretested and validated observational checklist (α = 0.91) and SAS (α = 0.83). The checklist comprised 12 items; every correct step of performance was rewarded with a score of 1 and every incorrect step was given a score of 0, with the maximum possible score being 12. Two items were related to precolostomy care, 8 items were related to the procedure, and 2 items were related to postcolostomy care. The SAS had 5 items related to the outcome of care: condition of the surrounding skin, pus discharge, ulcers on the stoma, bleeding from the stoma, and passage of stool from the rectum.

After obtaining written informed consent from the caregivers, the demographic data of caregivers were collected and baseline knowledge and skill scores related to colostomy care were assessed. In total, 30 teaching sessions were conducted (22 in outpatient, 8 in ward). The sessions were conducted using discussion and projection of the 9-min VTP on pediatric colostomy care. The entire session lasted for 30 min. Doubts of the caregivers related to colostomy care in children were resolved. The knowledge and skills of the caregivers related to colostomy care were assessed again immediately after the teaching session and 2 weeks later.


   Results Top


The majority of the caregivers were mothers (80%), female (93.3%), married (90%), homemakers (67.7%), and having monthly family income of up to Rs. 10,000 (76.7%), with the median age of 27.4 years (19-60). Most of the caregivers (30%) had studied up to 8th standard, while 26.7% were illiterate. The majority of caregivers neither had previous knowledge of colostomy care (93.3%) nor had previous experience of colostomy care (100%).

The median age and duration of colostomy of the children at the time of study was 3 months (0.1-96 months) and 5.75 months (0.2-120 months) respectively. Exactly half of the children who had undergone temporary colostomy had anorectal malformations (ARM) (50%), closely followed by Hirschsprung's disease (HD) (43%), and the remaining 7% had history of sexual assault [Figure 1].
Figure 1: Diagnosis of children with colostomy (n = 30)

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Most of the caregivers did not follow handwashing, cleaning the stoma in circular fashion from the outer to the inner side, or placing coconut oil-soaked cloth on the stoma before the study was conducted.


   Discussion Top


The mean pretest knowledge (10.9 ± 2.5) and skill (5.6 ± 2.0) scores (as measured by observation checklist) of the caregivers were higher than 50% of the maximum possible scores [Table 1]. The higher knowledge and skill scores of the caregivers in the present study can be attributed to their access to tertiary level care for seeking treatment for their children with colostomy and the information they received from that facility. The VTP resulted in significant improvement in the knowledge scores of the caregivers (16.4 ± 1.67 and 15.9 ± 4.02, P = 0.001). The findings of this study are in concordance with the findings of Kalia et al. [1]
Table 1: Effectiveness of video-assisted teaching program (VTP) on knowledge and skills of caregivers of children having
colostomy (N = 30)


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The use of audiovisual educational aids [3],[4] in teaching caregivers of children with colostomy has been shown to cause improvement in their knowledge and skills. In our study, increase in knowledge scores immediately after VTP and 2 weeks following that was 27.5% and 25%, respectively. The findings of the present study are similar to the findings of Greenberg et al., [2] who reported 22% increase in mean knowledge scores of the caregivers in assessing and recognizing their child's pain immediately after viewing the video on pain management.

In the present study, there was significant improvement in skill scores of the caregivers (9.8 ± 1.6 and 8.6 ± 2.1, P = 0.001, 71% of the maximum possible score 12) immediately and at 2 weeks following VTP. This was in concordance with the findings of Tearl et al., [4] who evaluated the effectiveness of a respiratory therapist-driven family education program for parents of children and found that there was statistically significant improvement as compared to pretraining scores. There appeared to be higher net gain improvement post test as compared to the present study, which could be due to the longer duration of intervention (6-8 weeks) as compared to the present study. However, similar observations were not noted in skill scores measured by SAS scale (4.7 ± 0.67 and 4.6 ± 0.56, P = 0.40).

There was significant decrease in skill scores from immediately after the VTP to 2 weeks later: 9.8 to 8.6 (1.2%) (P = 0.017); when assessed by direct observation, the reason for the decline can be related to the retention of knowledge and skills after varying time periods, as documented in other studies. [5],[6]

Acknowledgment

I would like to thank the Almighty, my parents, my brother Aditya Dabas, and my friends Teenu Xavier and Ashish Chaudhary for their constant support and motivation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kalia R, Walia I, Rao KL. Developing of educational aids for the parents of children having colostomy. J Indian Assoc Pediatr Surg 2004;9:15-9.  Back to cited text no. 1
  Medknow Journal  
2.
Registered Nurses′ Association of Ontario. Ostomy Care and Management. Clinical Best Practice Guidlines. Toronto, ON: Registered Nurses′ Association of Ontario (RNAO); 2009.  Back to cited text no. 2
    
3.
Greenberg RS, Billet C, Zahurak M, Yaster M. Videotape increases parental knowledge about pediatric pain management. Anesth Analg 1998;89:899-903.  Back to cited text no. 3
    
4.
Tearl DK, Hetzog JH. Home discharge of technology-dependent children: Evaluation of a respiratory-therapist driven family education program. Respir Care 2007;52:171-6.  Back to cited text no. 4
    
5.
Suchitra JB, Lakshmi Devi N. Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Indian J Med Microbiol 2007;25:181-7.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Madden C. Undergraduate nursing students′ acquisition and retention of CPR knowledge and skills. Nurse Edu Today 2006;26:218-27.  Back to cited text no. 6
    


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