Journal Information
Vol. 36. Issue 3.
Pages 162-172 (July - September 2016)
Share
Share
Download PDF
More article options
Visits
...
Vol. 36. Issue 3.
Pages 162-172 (July - September 2016)
Original Article
DOI: 10.1016/j.jcol.2016.04.009
Open Access
Association of sociodemographic and clinical factors with spirituality and hope for cure of ostomized people
Associação dos fatores sociodemográficos e clínicos com a espiritualidade e esperança de cura dos ostomizados
Visits
...
Carmelita Naiara de Oliveira Moreira, Camila Barbosa Marques, Marcial Alexandre Pereira da Silva, Fernanda Augusta Marques Pinheiro, Geraldo Magela Salomé
Corresponding author
geraldoreiki@hotmail.com

Corresponding author.
Universidade do Vale do Sapucaí (UNIVÁS), Pouso Alegre, MG, Brazil
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (5)
Table 1. Results obtained for mean scores of the Scale for Health Locus of Control, Herth Hope Scale, and Self-rating Scale for Spirituality, and the means of the Scale of Dimensions for Health Locus of Control in individuals with intestinal stoma seen at the Polo of Ostomized Patients of the city of Pouso Alegre.
Table 2. Means for total scores of the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control, for the health locus of control related to socio-demographic data of patients with intestinal stoma seen at the Polo of Ostomized Patients of the city of Pouso Alegre.
Table 3. Means of the dimensions of the Scale for Health Locus of Control, related to socio-demographic data of patients with intestinal stoma seen at the Polo of Ostomized Patients in the city of Pouso Alegre.
Table 4. Means for the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control, related to ostomy data of patients with intestinal stoma seen at the Polo of Ostomized Patients in the city of Pouso Alegre.
Table 5. Mean of dimensions of the Scale for Locus of Health Control related to ostomy data of patients with intestinal stoma seen at the Polo of Ostomized Patients of the city of Pouso Alegre.
Show moreShow less
Abstract
Objective

To evaluate the sociodemographic and clinical factors related to patients with intestinal stoma and correlate them to the health locus of control, spirituality and hope for a cure.

Method

This study was conducted at the Polo of Ostomized Patients of the city of Pouso Alegre, Minas Gerais. Participants were 52 patients with intestinal stoma. The scale for Health Locus of Control, the Herth Hope Scale, and the Self-rating Scale for Spirituality were used for data collection.

Results

The patients were aged up to 50 years, with the following means: Herth Hope Scale: 17.53; Self-rating Scale for Spirituality: 19.33. With regard to marital status, single people had a mean of 21.00 for the Herth Hope Scale. Retired ostomized patients had a mean of 20.53 for the Herth Hope Scale, of 10.38 for the Self-rating Scale for Spirituality, and of Scale for Health Locus of Control, of 18.79. The patients whose cause of making the stoma was neoplasia attained a mean of 19.43 for the Self-rating Scale for Spirituality. Regarding the character of the stoma, the mean for the Herth Hope Scale was 18.40. In the ostomized individuals who lived with the stoma for less than four years the means for the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control were 17.39, 20.35, and 23.09, respectively. Patients who did not participate of an association or support had means for the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control of 19.08, 17.25, and 20.63 respectively.

Conclusion

Ostomized patients believe they can control their health and that those involved in their care and rehabilitation can contribute to their improvement.

Keywords:
Intestinal stoma
Internal-external control
Spirituality
Religion
Hope
Resumo
Objetivo

Avaliar os fatores sociodemográficos e clínicos relativos aos pacientes com estoma intestinal e correlacioná-los ao locus de controle da saúde, espiritualidade e esperança de cura.

Métodos

Este estudo foi realizado no Polo dos Ostomizados da cidade de Pouso Alegre, Minas Gerais. Fizeram parte do estudo 52 pacientes com estoma intestinal. Foram utilizados para coleta de dados a Escala para Locus de Controle da Saúde; Escala de Esperança de Herth, e Self-rating Scale for Spirituality.

Resultados

Os pacientes na faixa etária até 50 anos tiveram as seguintes médias: Herth Hope Scale: 17,53; Self-rating Scale for Spirituality: 19,33. No que concerne ao estado civil, as pessoas solteiras tiveram a média de 21,00 para a Escala de Esperança de Herth. Os ostomizados aposentados atingiram as seguintes médias para as escalas: Escala de Esperança de Herth: 20,53; Self-rating Scale for Spirituality: 10,38 e Escala para Locus de Controle da Saúde: 18,79. Os pacientes cuja causa da confecção do estoma foi neoplasia tiveram a média de 19,43 para a Self-rating Scale for Spirituality. Com relação ao caráter do estoma, a média da Escala de Esperança de Herth foi 18,40. Nos ostomizados que conviviam com o estoma havia menos de 4 anos as médias das Escalas de Esperança de Herth, Self-rating Scale for Spirituality, e Escala para Locus de Controle da Saúde foram de 17,39, 20,35, e 23,09, respectivamente.

Conclusão

os pacientes ostomizados acreditam que podem controlar sua saúde e que as pessoas envolvidas no cuidado e na sua reabilitação podem contribuir para sua melhora.

Palavras-chave:
Estoma intestinal
Controle interno-externo
Espiritualidade
Religiosidade
Esperança
Full Text
Introduction

When the patient is subjected to an ostomy and goes through a surgical procedure, the physician performs the externalization of a hollow organ such as the bowel or bladder, through a hole in the abdomen, called stoma.1–3 This procedure is carried out in order to maintain the elimination function, provoking various changes, among which we can highlight the removal of gases, odors and feces through the stoma that is located on the abdomen. Thus, there is a change in body image, sexuality and in the way of dressing, affecting interpersonal relationships and impacting negatively on the physical, psychological, social and sexual health of the individual who must live with this life condition.2–5

These changes that occur in the daily life of ostomized people, and even the psychosocial, emotional and biological changes, may lead these individuals to a loss of control of elimination and to the need to use of collector equipment for feces and/or urine, which causes a change in the individual's body image. Thus, a constant fear arises, of not being able to resume the activities of daily living prior to the stoma, with consequent social isolation, a negative financial commitment, and psychological distress. Given this situation, the patient often loses his/her faith and hope to get a better health, becoming doubtful as to whether he/she will be able to perform self-care, especially in terms of stoma cleaning and bag exchanging.1,6–11

Often the patient ends up having a change in his/her religiousness, losing faith and any hope of cure or improvement, for fear of not being able to do self-care, including cleaning the peristomal skin and exchanging and cleaning the bag. This fact has, as a consequence, changes in quality of life, self-esteem, spirituality, self-image, sexuality, family and social life and leisure activities.

Spirituality can be defined as a belief system that includes intangible elements that convey vitality and meaning to life events. Such a belief can mobilize extremely positive energies and initiatives, with an unlimited potential to improve the person's quality of life. Religious people are physically healthier, have more healthful lifestyles and require less health care. There is an association between spirituality and health, which is probably valid and possibly causal. It is fully recognized that the health of individuals is determined by the interaction of physical, mental, social and spiritual factors.12,13

Hope is a state associated with a positive outlook for the future, a way to cope with the situation that one is experiencing,14,15 in which the individual has faith and the hope of his/her cure or improvement. Hope induces the individual to act and gives strength to solve problems and confrontations, such as loss, tragedy, loneliness and suffering.16

Health locus of control is a set of beliefs that individuals lay at the source of control of usual behaviors or events that occur to themselves or to the environment in which they are inserted, indicating the existence of a control of internal-external reinforcement, with regard to the degree to which the individual believes that the reinforcements are contingent on his/her conduct.17,18

The construct “health locus of control” is designed as a multidimensional variable. External beliefs can be divided into random expectations (the reinforcement would be determined by luck, by fate) and expectations that the reinforcements would be dependent on the action of powerful others (such as family, teachers or doctors). The subjects who believe that powerful others control their lives can act differently, in comparison with those who believe that the events of their lives emerge chaotically and unpredictably.19,20

The evaluation of the health locus of control and spirituality and hope of cure can become an essential instrument in guiding health actions for ostomized people, considering that this provides subsidies for a better understanding of the psychosocial and emotional factors involved with the difficulties of living with the stoma and in the achievement of self-care.

In a context of complexity and problems with which the ostomized individual must deal, the study of aspects of health control, by the individual, about his/her spirituality level and hope of cure will provide relevant information which may influence the self-care by the ostomized individual, helping in his/her acceptance of being an ostomized patient and in living with the stoma. Thus, this study aims to evaluate socio-demographic and clinical factors linked to patients with an intestinal stoma, correlating these factors to the health locus of health control, spirituality, and hope of a cure.

Methods

This is a descriptive, cross-sectional analytical study.

This study was conducted at the Polo of Ostomized People in the city of Pouso Alegre, Minas Gerais. 52 patients with intestinal stoma were included.

The inclusion criteria were age ≥18 years and being an intestinal stoma carrier, and exclusion criteria were patients with dementia syndromes and other conditions that could prevent them from understanding and answering to the questionnaires.

Data were collected after approval by the Ethics Committee on Research of the Faculdade de Ciências da Saúde “Dr. Jose Antonio Garcia Coutinho” and after the Free and Informed Consent Form was signed by the patient or his/her caregiver (opinion number: 620462). Data were collected by the researchers themselves. The inclusion of the patient in the study followed the order of arrival at the outpatient clinic. The sample was selected in a non-probabilistic, by convenience, way.

For data collection, three questionnaires were applied: first, a questionnaire on demographic and stoma-related data; then the Scale for Health Locus of Control; the third questionnaire was the Herth Hope Scale and, finally, the Self-rating Scale for Spirituality. Each interview lasted approximately 25min.

The Scale for Health Locus of Control has been translated and validated for the Portuguese language. The instrument validation, after application in four samples, was verified as to the reliability (internal consistency) through Cronbach's alpha, and the values found for the subscales were: Internality for health, 0.62–0.71; Externality-chance for health, 0.51–0.78; and Externality- powerful others, 0.62–0.67. This scale consists of three subscales, each containing six items regarding the following dimensions: Internality for health (items 1, 6, 8, 12, 13 and 17), wherein the scores reflect the degree to which the subject believes that he/she himself controls his/her state of health; externality-powerful others for health (items 3, 5, 7, 10, 14 and 18), wherein the scores reflect the degree to which the subject believes that other persons or entities (doctors, nurses, friends, family, God, etc.) can control his/her health; and Externality-chance for health (items 2, 4, 9, 11, 15 and 16), in which the scores indicate the degree to which a person believes that his/her health is controlled at random, without his/her interference or the interference from other people The scores for each dimension range from 1 to 5; for the alternatives “I totally agree,” “I partially agree,” “I am undecided,” “I partially disagree,” and “I strongly disagree,” the following values are respectively added: 5, 4, 3, 2, and 1. The score obtained for the dimensions will be the sum of the items of the subscale at issue. The total value of items belonging to each of the three subscales represents the total scores with respect to the dimension of the health locus in question. The total amount obtained from each subscale may vary between 6 and 30 and indicates that the higher the value, the stronger the belief in this dimension. The scale is presented in its entirety, in which the items of the subscales are interleaved.14,21

The Escala da Esperança de Herth (EEH), that is, the Portuguese version of the Herth Hope Scale, is a tool which consists of 12 items with a total score of 12–48 points, with responses produced in a Likert-like scale, with scores from 1 to 4 points for each one of these items. The higher the score, the greater the hope. The items 3 and 6 have an inverted score.20,22

The Self-rating Scale for Spirituality is a self-report instrument consisting of six items that assess aspects of the individual's spirituality. Respondents must mark one of five options ranging from 1 – “I strongly agree,” 2 – “I agree,” 3 – “I partially agree,” 4 – “I disagree,” and 5 – “I strongly disagree;” and the answers should be produced according to the individual's perception at the time of answering the questions. For its use, one must sum up the points, whose total range from 6 to 30. To do this, one must previously recodify each item of this instrument (for example, a score=5 becomes 1, 2 becomes 4, and so on). The recoded responses are summed to produce the total score, and this, in turn, represents the level of spiritual guidance. To make a comparison of scores between groups, one should work with the averages obtained in each group, applying an appropriate statistical test to check for differences between them. The summing of items allows the reading of scores, that is, the higher the score, the higher the levels of spiritual guidance. The items in this scale refer to a divine intervention in the patient's daily life and the practice of religious rituals, like praying. This scale, which evaluates the levels of spirituality, was validated in Brazil. The scale reliability test involving the two scales had a Cronbach's alpha coefficient of 0.86, a value which was considered acceptable, which validates its use in the Brazilian context.23,24

In the assessment of the results, data were entered and analyzed using the statistical program SPSS v. 8.0. For data analysis, the following statistical tests were used: for the distribution of absolute (n) and relative (%) frequencies, Pearson's chi-squared test was used, which determined whether the distribution was different from 5%, that is, p<0.05. The comparison between two groups was performed using the Mann–Whitney test; and when there were more than two groups, the Kruskal–Wallis test was used. For the correlation of continuous with semi-continuous variables, the Spearman's correlation test was used.

Results

Regarding socio-demographic data, for the 52 ostomy patients seen at the Polo of Ostomized Patients of the city of Pouso Alegre, we found that 33 (63.50%) were female, mean age 67 years; 35 (67.40%) were married; 34 (65.40%) were retired and 40 (76.90%) of the patients were participants attending to support groups or associations. As to data related to the stoma, 40 (76.90%) were a result of neoplasia, 44 (84.60%) of them were of the colostomy type, 40 (76.90%) were permanent stomas having a diameter between 20 and 40mm, and 39 (75%) were two-piece devices. Thirty-one patients (51.70%) lived with the stoma for up to 4 years.

Table 1 lists the means of the total score of the scales used in this study: for the Scale for Health Locus of Control, 19.53; for the Herth Hope Scale, 38.27; and for the Self-rating Scale for Spirituality, 23.67, with difference statistically significant. Regarding the dimensions of the Scale for Health Locus of Control, changes in mean total score were noted for the dimensions Externality-chance for health, 11.48; and Externality-powerful others, 19.48. Differences statistically significant were noted between dimensions. These findings imply that the individuals who participated in the study do not believe that professionals or other people involved in the care can control their health; on the other hand, they believe that they themselves control their health. But they believe that the improvement of health or their cure can depend on divine intervention.

Table 1.

Results obtained for mean scores of the Scale for Health Locus of Control, Herth Hope Scale, and Self-rating Scale for Spirituality, and the means of the Scale of Dimensions for Health Locus of Control in individuals with intestinal stoma seen at the Polo of Ostomized Patients of the city of Pouso Alegre.

Instrument  p-Value  Mean  Median  Standard deviation  Minimum  Maximum 
Total score of the Scale for Health Locus of Control  0.00719.53  19.0  2.114  20.53  19.0 
Total score of the Herth Hope Scale  38.27  38.0  3.515  32  47 
Total score of the Self-rating Scale for Spirituality  23.67  24.5  5.279  11  30 
Total score of the dimensions of the Scale for Health Locus of Control  p-Value  Mean  Median  Standard deviation  Minimum  Maximum 
Dimensions of the Scale for Health Locus of Control
1-Internality for health  0.02722.48  22.5  2.646  16  28 
2-Externality-powerful others  11.48  14.0  2.222  12  29 
3-Externality-chance for health  19.48  20.0  4.881  10  30 

Pearson's Chi-squared test, Mann–Whitney test and Kruskal–Wallis test. Statistical significance p0.05.

Table 2 lists the mean of the total scores of the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control. With regard to socio-demographic data, the variables that showed changes were: patients aged up to 50 years, with the following means: Herth Hope Scale: 17:53, and Self-rating Scale for Spirituality: 19:33. Regarding marital status, single people had a mean of 21.00 for the Herth Hope Scale. Retired ostomized patients presented the following means: Herth Hope Scale: 20.53; Self-rating Scale for Spirituality: 10:38, and Scale for Health Locus of Control: 18.79. These findings mean that ostomized patients who were single, retired, and aged up to 50 years do not believe in divine intervention to obtain improvement or cure. The statistical differences were mixed. However, retired ostomized patients also do not believe that the professionals involved in the care of their health can contribute to their improvement.

Table 2.

Means for total scores of the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control, for the health locus of control related to socio-demographic data of patients with intestinal stoma seen at the Polo of Ostomized Patients of the city of Pouso Alegre.

Instrument  Age group
  ≤50 years51–69 years>70 years
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Herth Hope Scale  17.53  18.0  3.980  39.00  39.0  3.671  38.06  38.0  2.883  0.040a 
Self-rating Scale for Spirituality  19.33  20.0  7.355  24.20  25.0  4.312  25.12  25.0  3.426  0.010a 
Scale for Health Locus of Control  30.60  30.0  8.798  63.05  64.5  6.581  63.29  64.0  8.809  0.581 
Instrument  Gender
  MaleFemale
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Herth Hope Scale  21.84  22.0  2.588  22.85  23.0  2.647  0.808 
Self-rating Scale for Spirituality  22.79  22.0  3.809  19.15  18.0  4.280  0.027 
Total locus of the Scale for Health Locus of Control  21.11  21.0  4.841  18.55  20.0  4.724  0.021a 
Instrument  Marital status
  SingleMarriedWidow(er)
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Herth Hope Scale  21.00  28.0  8.725  23.77  25.0  7.999  61.78  64.0  7.480  0.017a 
Self-rating Scale for Spirituality  18.00  19.5  4.106  38.29  39.0  3.569  38.44  38.0  3.127  0.050a 
Total locus of the Scale for Health Locus of Control  20.25  22.0  6.964  63.11  63.0  5.042  26.33  25.0  2.739  0.967 
Instrument  Scholarship
  Fundamental education unfinishedFundamental education completed
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Herth Hope Scale  24.04  24.0  7.183  23.25  25.0  8.854  0.533 
Self-rating Scale for Spirituality  37.86  38.0  3.274  38.75  39.5  3.791  0.366 
Total locus of the Scale for Health Locus of Control  63.04  63.5  4.333  61.71  62.0  6.278  0.598 
Instrument  Occupation
  RetireeUnemployedWorking
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Herth Hope Scale  20.53  21.0  2.286  22.33  22.5  1.633  22.42  24.0  3.942  0.039a 
Self-rating Scale for Spirituality  10.38  12.0  4.192  21.33  23.0  4.457  20.33  19.5  5.416  0.023a 
Total locus of the Scale for Health Locus of Control  18.79  19.5  4.904  19.83  20.5  6.555  21.25  20.0  3.720  0.024a 
Instrument  Family income
  ≤3 minimum wages>3 minimum wages
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Herth Hope Scale  38.33  38.0  3.694  38.08  39.0  3.040  0.805 
Self-rating Scale for Spirituality  23.77  24.0  5.239  23.38  26.0  5.606  0.830 
Total locus of the Scale for Health Locus of Control  61.03  61.0  7.607  66.62  66.0  7.719  0.027a 

Pearson's Chi-squared test, Mann–Whitney test and Kruskal–Wallis test.

a

Statistical significance p0.05.

Table 3 lists the means of the dimensions of the Scale for Health Locus of Control related to sociodemographic variables. The dimensions that exhibited changes were: for ostomized patients aged up to 50 years: Externality-powerful others, mean 18.73, and Externality-chance for health: 10.40. Also for the dimension Externality-chance for health, alterations were found in the means for the following variables: single (unmarried) patients: 15.12; widowers, 19.80; retirees, 8.79; 19.83. Changes in the mean occurred only in the dimension Externality-chance for health.

Table 3.

Means of the dimensions of the Scale for Health Locus of Control, related to socio-demographic data of patients with intestinal stoma seen at the Polo of Ostomized Patients in the city of Pouso Alegre.

Dimensions  Age group
  ≤50 years51–69 years>70 years
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  22.53  23.0  3.114  22.65  23.0  2.815  22.24  22.0  2.078  0.893 
POLC – Externality-powerful others  18.73  19.0  5.092  20.50  19.0  3.777  21.41  22.0  4.823  0.041a 
CHLC – Externality-chance for health  10.40  08.0  2.867  19.90  20.0  4.128  19.65  21.0  5.678  0.778 
Dimensions  Gender
  MaleFemale
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC–Internality for health  21.84  22.0  2.588  22.85  23.0  2.647  0.189 
POLC–Externality-powerful others  22.79  22.0  3.809  18.55  20.0  4.724  0.003a 
CHLC–Externality-chance for health  21.11  21.0  4.841  11.15  09.0  2.280  0.050a 
Dimensions  Marital status
  SingleMarriedWidow(er)
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC–Internality for health  23.13  23.5  1.885  22.54  22.0  2.894  21.67  21.0  2.179  0.519 
POLC–Externality-powerful others  20.00  19.0  5.155  20.77  20.0  4.492  19.78  19.0  3.962  0.798 
CHLC–Externality-chance for health  15.12  14.5  4.970  19.80  20.0  4.928  20.33  22.0  4.500  0.17a 
Dimensions  Scholarship
  Fundamental education unfinishedFundamental education completed
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC–Internality for health  22.36  22.0  2.376  22.63  23.0  2.975  0.720 
POLC–Externality-powerful others  20.61  19.0  3.775  20.33  20.5  5.198  0.827 
CHLC–Externality-chance for health  20.07  21.0  5.099  14.79  18.0  4.625  0.013a 
Dimensions  Occupation
  RetireeUnemployedWorking
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-value 
IHLC–Internality for health  22.53  22.0  2.286  22.33  22.5  1.633  22.42  24.0  3.942  0.982 
POLC–Externality-powerful others  20.38  19.0  4.192  21.33  23.0  4.457  20.33  19.5  5.416  0.886 
CHLC–Externality-chance for health  8.79  9.5  1.904  19.83  20.5  6.555  21.25  20.0  3.720  0.327 
Dimensions  Family income
  ≤3 minimum wages>3 minimum wages
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC–Internality for health  22.18  22.0  2.713  23.38  23.0  2.293  0.157 
POLC–Externality-powerful others  19.64  19.0  3.983  23.00  22.0  4.950  0.017a 
CHLC–Externality-chance for health  19.23  20.0  4.826  13.23  11.0  3.166  0.040a 

Pearson's Chi-squared test, Mann–Whitney test and Kruskal–Wallis test.

a

Statistical significance p0.05.

These findings imply that individuals aged up to 50 years believe that their improvement or cure depends on other people (family members, caregivers, health professionals) and on themselves. But single, widowed, unemployed, or retired ostomized patients do not believe that their improvement or cure depends on external assistance, or that there may be interference from others (family members, caregivers, health professionals).

Table 4 lists the means of the total score of the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control in relation to intestinal stoma data. Variables that showed changes were: patients for whom the cause of making the stoma was neoplasia, with a mean of 19.43 in the Self-rating Scale for Spirituality. Regarding the character of the stoma, the mean of the Herth Hope Scale was 18.40. For ostomized patients living with the stoma for less than 4 years, the mean of the Herth Hope Scale was 17.39; Self-rating Scale for Spirituality, 20.35; and Scale for Health Locus of Control, 23.09. For those patients who did not participate in a support association or group, the means were: for the Herth Hope Scale, 19.08; for the Self-rating Scale for Spirituality, 17.25; and for the Scale for Health Locus of Control, 20.63.

Table 4.

Means for the Herth Hope Scale, Self-rating Scale for Spirituality, and Scale for Health Locus of Control, related to ostomy data of patients with intestinal stoma seen at the Polo of Ostomized Patients in the city of Pouso Alegre.

Instrument  Cause of making the stoma
  NeoplasiaOther
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Scale for Health Locus of Control  62.33  63.0  7.816  62.75  63.0  8.709  0.873 
Herth Hope Scale  38.55  39.0  3.441  37.33  37.0  3.750  0.298 
Self-rating Scale for Spirituality  19.43  20.5  4.540  21.17  23.0  6.873  0.006a 
  Stoma type
  ColostomyIleostomy
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Scale for Locus of Health Control  62.84  64.0  7.971  60.13  60.0  7.900  0.379 
Herth Hope Scale  38.52  38.5  3.084  36.88  35.5  5.384  0.423 
Self-rating Scale for Spirituality  24.23  25.0  4.974  20.63  20.0  6.209  0.076 
  Stoma character
  DefinitiveTemporary
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Scale for Health Locus of Control  62.85  64.0  8.285  61.00  62.0  6.809  0.932 
Herth Hope Scale  18.40  318.0  3.828  37.83  38.5  2.250  0.021a 
Self-rating Scale for Spirituality  20.45  22.0  4.260  21.08  21.0  7.440  0.033a 
InstrumentStoma diameter
0–20mm20–40mm40–80mm
Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Scale for Health Locus of Control  64.08  62.0  9.634  63.26  64.0  7.025  59.15  59.0  7.766  0.224 
Herth Hope Scale  37.17  37.0  2.623  39.37  40.0  3.564  37.00  36.0  3.606  0.049a 
Self-rating Scale for Spirituality  21.42  23.0  6.788  24.78  25.0  4.627  23.46  23.0  4.684  0.047a 
InstrumentDevice type
One-piece deviceTwo-piece device
Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Scale for Health Locus of Control  60.85  63.0  5.713  62.95  64.0  8.559  0.709 
Herth Hope Scale  36.92  38.0  2.629  38.72  39.0  3.685  0.112 
Self-rating Scale for Spirituality  24.15  26.0  5.786  23.51  24.0  5.170  0.401 
  Stoma time (years) (groups)
  >4 years4–7 years8–11 years12–21 years
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Scale for Health Locus of Control  23.09  25.0  8.224  62.46  64.0  6.173  64.13  64.0  10.316  64.50  64.5  0.011a   
Herth Hope Scale  17.39  18.0  3.513  38.54  38.0  2.989  38.75  39.5  2.550  39.88  39.5  0.017a   
Self-rating Scale for Spirituality  20.35  21.0  6.087  27.00  28.0  3.291  25.50  26.0  3.162  23.13  23.0  0.032a   
Instrument  Participation in support association or group
  YesNo
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
Scale for Health Locus of Control  20.63  19.545  8.002  61.75  19.0  8.058  0.041a 
Herth Hope Scale  38.03  38.0  3.214  19.08  08.5  4.441  0.030a 
Self-rating Scale for Spirituality  30.60  30.0  08.798  17.25  O9.0  2.751  0.011a 

Pearson's Chi-squared test, Mann–Whitney test and Kruskal–Wallis test.

a

Statistical significance p0.05.

Differences statistically significant were observed in these variables. Ostomized patients whose cause of making the stoma was neoplasia (in the variable “character of the stoma”), those who lived with the injury for less than 4 years and that did not attend to an association or support group, do not believe that their improvement or cure depends on the help of others, or that there may be interference from others (family members, caregivers, health professionals), and also do not believe in the intervention of God and have no hope that they will improve or obtain a cure. Table 5 shows the mean of the dimensions of the Scale for Health Locus of Control relevant to the variables pertaining to the intestinal stoma, and one can see that only the dimension Externality-chance for health presented changes. The ostomized patients whose cause of the making of the ostomy was neoplasia had a mean of 9.78; people with an ileostomy had a mean of 11.38, and for those with a temporary stoma, the mean was 7.33. Patients living with the stoma from 4 to 7 years had a mean of 8.65. For those ostomized patients who did not attend to a support association or group, the mean was 19.37. There were statistical differences between the variables. These findings mean that ostomized subjects do not believe that their improvement or cure depends on external assistance, or that there may be interference from others (family members, caregivers, health professionals).

Table 5.

Mean of dimensions of the Scale for Locus of Health Control related to ostomy data of patients with intestinal stoma seen at the Polo of Ostomized Patients of the city of Pouso Alegre.

Instrument  Stoma cause
  NeoplasiaOther
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  22.17  22.0  2.827  23.50  24.0  1.624  0.049a 
POLC – Externality-powerful others  20.38  19.5  4.418  20.83  21.5  4.707  0.757 
CHLC – Externality-chance for health  09.78  20.0  4.764  21.88  19.899  5.351  0.433 
Instrument  Stoma type
  ColostomyIleostomy
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  22.50  22.5  2.732  22.38  22.5  2.264  0.904 
POLC – Externality-powerful others  20.84  20.0  4.398  18.50  17.5  4.440  0.173 
CHLC – Externality-chance for health  19.50  20.0  4.934  11.38  13.120  3.897  0.048a 
Instrument  Stoma character
  DefinitiveTemporary
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  22.55  22.5  2.689  22.25  22.5  2.598  0.734 
POLC – Externality-powerful others  20.17  19.5  4.361  21.50  20.5  4.758  0.370 
CHLC – Externality-chance for health  20.13  20.0  4.936  07.33  06.5  4.185  0.052a 
Instrument  Stoma diameter
  0–20mm20–40mm40–80mm
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  22.83  23.0  2.691  21.96  22.0  2.738  23.23  23.0  2.351  0.324 
POLC – Externality-powerful others  20.67  19.5  5.630  20.26  20.0  4.053  20.77  19.0  4.362  0.934 
CHLC – Externality-chance for health  20.58  19.5  5.265  21.07  21.0  3.668  15.15  14.0  4.413  0.006a 
Instrument  Device type
  One-piece deviceTwo-piece device
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  23.00  23.0  2.614  22.31  22.0  2.667  0.419 
POLC – Externality-powerful others  20.15  19.0  4.375  20.59  20.0  4.517  0.763 
CHLC – Externality-chance for health  17.77  15.0  5.464  20.05  20.0  4.605  0.146 
  Stoma time
  <4 years4–7 years8–11 years12–21 years
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  22.13  22.0  2.616  23.00  24.0  3.240  21.75  22.0  2.053  23.38  24.0  2.200  0.500 
POLC – Externality-powerful others  20.35  19.0  5.219  19.23  19.0  3.632  22.12  21.0  4.291  21.25  21.5  3.240  0.509 
CHLC – Externality-chance for health  08.65  09.0  3.628  20.23  20.0  4.285  20.25  21.0  6.861  19.88  20.5  4.853  0.013a 
  Participation in support association or group
  YesNo
  Mean  Median  Standard deviation  Mean  Median  Standard deviation  p-Value 
IHLC – Internality for health  22.68  23.0  2.759  21.83  21.0  2.209  0.338 
POLC – Externality-powerful others  20.60  20.0  4.528  20.08  18.5  4.316  0.728 
CHLC – Externality-chance for health  22.48  22.5  2.646  19.37  20.0  5.097   

Pearson's Chi-squared test, Mann–Whitney test and Kruskal–Wallis test.

a

Statistical significance p0.05.

Discussion

Regarding the socio-demographic characterization, there was a predominance of female ostomized patients, with a mean age of 67 years, married, retired and who did not participate in support groups or associations, which is in line with other studies involving patients with an intestinal stoma.1,4–6,9–11

With respect to data related to the stoma, in the majority of patients, the cause of making the stoma was neoplasia, their stoma was of colostomy type, with a permanent stoma measuring between 20 and 40mm of diameter and using a two-piece device. Most individuals lived with the stoma for up to 4 years. These findings corroborate the results of several studies.1,4,5,11

In this study, the patients evaluated had mean scores of the Scale for Health Locus of Control. For the dimensions Externality-chance for health and Externality-powerful others, the scores were low. With respect to the mean of the Herth Hope Scale and Self-rating Scale for Spirituality, the scores were normal.

By comparing sociodemographic and stoma data with the use of the instruments Scale for Health Locus of Control, Herth Hope Scale, and Self-rating Scale for Spirituality, one can see that there were changes and statistical significance in the following variables: age group, female gender, singles subjects and retirees, and the cause of making the stoma was neoplasia, with the use of a permanent stoma, living with an ostomy for up to four years, and not participating in support association or group. These findings imply that the individuals who participated in this study do not believe that professionals or people involved in the care can control their health status, and also do not believe in divine intervention; on the other hand, they believe that they themselves control their health.

The health locus of control is a model that questions whether the belief of the individual, i.e., his/her motivation (internal and external) determines the action to be taken. Those who believe that the results, at least in part, are dependent on the actions taken, are considered internally oriented; those who follow an external orientation generally do not believe or do not strongly believe in the external relation of the outcome and of the individual action.25 The beliefs influence people with a stoma in the perception and expression of hope in the their improvement or cure, courage to perform self-care, courage to react and to fight against prejudice and stigma that their will face in their day-to-day lives, and how to deal with such a situation in the conviviality with a stomized human being.26–28

Spirituality and religion are related to each other, but although these concepts are often used interchangeably, they do not share the same characteristics. Spirituality is something broader and more personal, and is related to a set of inner values, inner wholeness, harmony, and connection with others; it stimulates an interest in others and in ourselves and looks for a unity with life, nature, and the universe. Spirituality is what gives meaning to life, regardless of one's religion, and thus, generates the capacity to endure debilitating feelings of guilt, anger, and anxiety; furthermore, spiritualist aspects can mobilize positive energies and improve the quality of life.29,30 When it comes to ostomized people, spirituality can be contemplated as one of the coping resources in performing self-care and rehabilitation.

In one study, its authors report that one of the ways of coping with the disease and with death is directly linked to the intensity of faith and religious beliefs – that is, ways of expressing spirituality. The authors concluded that one of the ways of coping with adverse and favorable situations is found in the feeling of faith in God. Faith in God is a deep-seated feeling in our culture and is as necessary as the other ways of coping31; the discourse shows that the spiritual dimension occupies a prominent place in ostomized people's lives and also shows that it is essential to be aware of the spirituality of the users to plan a nursing care and the guidance of self-care.

In a study where the authors evaluated the role of nurses in the rehabilitation process of ostomized patients, it was concluded that the process of rehabilitation of these people, when designed in a holistic and systematic manner, through the application of the Nursing Process, becomes a tool that promotes the return to activities of daily living, including work, as it is at this point that the guidelines related to self-care with the stoma and peristomal skin will be implemented, showing to the user that he/she can live without severe tensions with his/her stoma. It is noteworthy that only after the adjustment of the stomized individual to his/her new condition of life is that he/she will acquire confidence and security to return to work and social activities.32

In another study, its authors concluded that the nursing instructions to the individual who was ostomized should be systematized and holistic, permeating all biopsychosocial aspects involved in the recovery of this type of client. The teaching of self-care, understood as the first step in the rehabilitation process, should also govern the guidelines aimed at the recovery of self-esteem of the patients, reinforcing the importance of social inclusion in their lives. Thus, with the help of the nursing staff and family, ostomized people may seek a better quality of life, even in the presence of a stoma, when these individuals will realize that they can return to the multiple activities of daily living, pursuing their life plans.33

Spirituality contributes to the well-being of ostomized people, favoring their resilience in the success of self-care and rehabilitation. Certain religious and spiritual behaviors and beliefs are directly related to overall happiness and physical health, considering that they discourage an engagement in unhealthy behaviors. Through this study, we conclude that ostomized patients believe that can control their health and that those people involved in their care and rehabilitation can contribute to their improvement. They consider that the cure or improvement is under the divine influence through religious practices or beliefs.

Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
M.S. Mota, G.C. Gomes, V.M. Petuco, R.M. Heck, E.J. Barros, V.L. Gomes.
Facilitators of the transition process for the self-care of the person with stoma: subsidies for Nursing.
Rev Esc Enferm USP, (2015), pp. 82-88
[2]
S.G. Ang, H.C. Chen, R.J. Siah, H.G. Ele, P. Klainin-Yobas.
Stressors relating to patient psychological health following stoma surgery: an integrated literature review.
Rev Oncol Fórum Enferm, (2013), pp. 587-594
[3]
A. Altschuler, M. Ramirez, M. Grant, C. Wendel, M.C. Hornbrook, L. Herrinton, et al.
The influence of husbands ‘or male partners’ support on women's psychosocial adjustment to having an ostomy resulting from colorectal cancer.
J Wound Ostomy Continence Nurs, (2009), pp. 299-305
[4]
G.M. Salomé, S.A. Almeida.
Association of sociodemographic and clinical factors with the self-image and self-esteem of individuals with intestinal stoma.
J Coloproctol, (2014), pp. 159-166
[5]
G.M. Salomé, S.A. Almeida, M.M. Silveira.
Quality of life and self-esteem of patients with intestinal stoma.
J Coloproctol, (2014), pp. 231-239
[6]
R.A. Monge, M.C.Q. Avelar.
Assistência de enfermagem aos pacientes com estomia intestinal: percepção dos enfermeiros.
Online Braz J Nurs, (2009), pp. 45-52
[7]
V.C. Mauricio, N.V.D.O. Souza, M.T.L. Lisboa.
Determinantes biopsicossociais do processo de inclusão laboral da pessoa estomizada.
Rev Bras Enferm, (2014), pp. 415-421
[8]
G.M. Salomé, M.R.F. Carvalho, M.R. Massahud, B. Mendes.
Profile of ostomy patients residing in Pouso Alegre city.
J Coloproctol, (2015), pp. 106-112
[9]
G.M. Salomé, L.F. Santos, H.S. Cabeceira, A.M.M. Panza, M.A.B. Paula.
Knowledge of undergraduate nursing course teachers on the prevention and care of peristomal skin.
J Coloproctol, (2014), pp. 224-230
[10]
V.F. Costa, S.G. Alves, C. Eufrásio, G.M. Salome, L.M. Ferreira.
Body image and subjective well-being in ostomists in Brazil.
Gastrointest Nurs, (2014), pp. 37-47
[11]
M. Mota, G.C. Gomes.
Changes in the process of living of ostomized patients after surgery.
J Nurs UFPE, (2013), pp. 7074-7081
[12]
G.M. Salomé, S.A. Almeida, B. Mendes, M.R.F. Carvalho, M.R.M. Junior.
Assessment of subjective well-being and quality of life in patients with intestinal stoma.
J Coloproctol, (2015), pp. 168-174
[13]
G.M. Salomé, A.S. Almeida, L.M. Ferreira.
Association of sociodemographic factors with hope for cure, religiosity, and spirituality in patients with venous ulcers.
Adv Skin Wound Care, (2015), pp. 76-82
[14]
K. Herth.
The relationship between level of hope and level of coping response and other variables in patients with cancer.
Oncol Nurs Forum, (1989), pp. 67-72
[15]
A. Jakobsson, Segesten k, L. Nordholm, S. Oresland.
Establishing a swedish instrument measuring hope.
Scand J Caring SCI, (1993), pp. 135-139
[16]
K. Herth.
Abbreviated instrument to measure hope: development and psychometric evaluation.
J Adv Nurs, (1992), pp. 1251-1259
[17]
S.A. Haslam, S. Reicher.
Stressing the group: social identity and the unfolding dynamics of responses to stress.
J Appl Psychol, (2006), pp. 1037-1052
[18]
J.B. Rotter.
Internal versus external control of reinforcement: a case history of variable.
Am Psychol Assoc, (1990), pp. 489-493
[19]
H. Levenson.
Activism and powerful others: distinctions within the concept of internal-external control.
J Pers Assess, (1974), pp. 377-383
[20]
A.C. Sartore, S.A.A. Grossi.
Herth hope index: instrument adapted and validated to portuguese.
Rev Esc Enferm Usp, (2008), pp. 227-232
[21]
J.E. Rodríguez-Rosero, M.G.C. Ferriani, C.M.F. Dela.
Escala de locus de controle da saúde – MHLC: estudos de validação.
Rev Latino-Am Enfermagem, (2002), pp. 179-184
[22]
A.C.S. Balsanelli, S.A.A. Grossi, K. Herth.
Assessment of hope in patients with chronic illness and their family or caregivers.
Rev Acta Paul Enferm, (2011), pp. 354-358
[23]
M. Galanter, H. Dermatis, G. Bunt, C. Williams, S. Trujillo.
Assessment of spirituality and its relevance to addiction treatment.
J Subst Abuse Treat, (2007), pp. 257-264
[24]
M.A.S. Gonçalves, S.C. Pillon.
Adaptação transcultural e avaliação da consistência interna da versão em português da Spirituality Rating Scale.
Rev Psiquiatr Clín, (2009), pp. 10-15
[25]
C.M.F. Dela.
Escala multidimensional de locus de controle de Levenson.
Arq Bras Psicol, (1987), pp. 79-97
[26]
J.C.B. Santana, Â.B. de Souza, B.S. Dutra.
Percepções de um grupo de enfermeiras sobre o processo do cuidar de pacientes de ostomia definitiva.
J Nurs UFPE, (2011), pp. 1710-1715
[27]
M.L. Martins, V.C. Perugini, R.D.M. Silva.
Processo de viver com estomia: facilidades e limites.
Rev Estima, (2006), pp. 15-20
[28]
A.F.M. Cascais, J.G. Martini, P.J.S. Almeida.
O impacto da ostomia no processo de viver humano.
Rev Texto Contexto Enferm, (2007), pp. 163-167
[29]
M. Aaad, D. Masiero, L.R. Battistella.
Espiritualidade baseada em evidências.
Rev Acta Fisiátr, (2001), pp. 107-112
[30]
G.P. Kurita, C.A.M. Pimenta.
Adesão ao tratamento da dor crônica e o locus de controle da saúde.
Rev Esc Enferm USP, (2004), pp. 254-261
[31]
G.M. Salomé, V.R. Pereira, L.M. Ferreira.
Spirituality and subjective wellbeing of patients with lower-limb ulceration.
J Wound Care, (2013), pp. 230-236
[32]
V.C. Mauricio, N.V.D. Oliveira, M.T.L. Lisboa.
The nurse and her participation in the process of rehabilitation of the person with a stoma.
Rev Esc Anna Nery, (2013), pp. 416-422
[33]
S.N. Mendonça, C.C. Lameira, N.V.D.O. Souza, C.C.P. Costa, V.C. Maurício, P.A. Silva.
guidelines for nursing and implications for the quality of life of stomized people.
Rev Enferm UFPE, (2015), pp. 296-304
Copyright © 2016. Sociedade Brasileira de Coloproctologia
Idiomas
Journal of Coloproctology

Subscribe to our newsletter

Article options
Tools