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Implementing a Self-Efficacy-Based Nursing Bundle to Enhance Social Support in Patients with Enterostomies: A
Xiaoli Xing1, Xiangxia Rong1, Mei Xue2
1Department of Nursing, The First Hospital of Anhui University of Science and Technology (Huainan First People's Hospital), Huainan City, Anhui Province, People's Republic of China.
Background:
Patients with enterostomies face major challenges related to inadequate social support and lack of continuity in traditional nursing care. Current care models often fail to address the psychological and social needs of these patients, leading to poor outcomes and reduced quality of life.
Objective:
To evaluate the effectiveness and safety of a self-efficacy-based nursing bundle in improving social support and self-care ability, reducing stoma-related complications and alleviating pain/discomfort among patients with enterostomies.
Design/Methods:
This was a single-centre, quasi-experimental before-after quality improvement (QI) study comparing the baseline period (Q1-Q2 2023, n = 45) with the intervention period (Q3-Q4 2023, n = 45). The intervention was developed and implemented using the Focus-Organise-Clarify-Understand-Select Plan-Do-Study-Act (FOCUS-PDSA) QI methodology. The primary outcome measure of study was social support, and the secondary outcome measures were self-care ability, reduction of stoma-related complications, and reduction of pain/discomfort. And the primary outcome was the change in Social Support Rating Scale (SSRS) score from baseline to 3 months. Multivariate linear regression adjusted for confounders with Benjamini-Hochberg correction for multiple comparisons (pre-specified in the analysis plan). This study was approved by the Ethics Committee of the First Hospital of AUST (no: 2023-KY-B114-001).
Results:
After adjustment, the total SSRS score increased by 10.7 points (95% CI: 8.4-12.9, Cohen's d = 1.24). Significant improvements were observed in subjective support (β = 4.2, 95% CI: 3.1-5.3), objective support (β = 3.8, 95% CI: 2.9-4.7) and support utilisation (β = 2.7, 95% CI: 1.8-3.6). Secondary outcomes also favoured the intervention, including improved self-care ability (Exercise of Self-Care Agency score increase, adjusted difference = 10.4, 95% CI: 7.2-13.6), reduced peristomal pain (visual analogue scale adjusted difference = -1.6, 95% CI: -2.3 to -0.9) and fewer stoma-related complications (28.9% vs 11.1%, RR = 0.38, 95% CI: 0.15-0.98). No serious adverse events were reported.
Conclusion:
This QI project demonstrates a replicable, low-cost intervention that considerably improves social support and clinical outcomes for patients with enterostomies. The FOCUS-PDSA framework supported successful implementation, and the intervention warrants dissemination to primary care settings.
