Abstract
Patients who undergo stoma surgery experience difficulties in adapting physically and psychologically. The priority is to support them in learning self‐care for successful rehabilitation and psychosocial adaption to a new life. In order to do this, it is important to provide ostomates with repetitive reinforcement education on self‐care in a continuous and individual manner, not just to increase knowledge or perform related skills. This study aims to evaluate the effects of ostomy management reinforcement education (OMRE) in ostomates and to identify the optimal frequency of reinforcement education using an equivalent control group post‐test design. Participants were 60 ostomates admitted to a university hospital after ostomy formation surgery, and they were randomly assigned to a control and two experimental groups of this study. The OMRE was given to the control group (n = 20), experimental group 1 (n = 20), and experimental group 2 (n = 20) once, twice, and three times, respectively. Participants' self‐care knowledge, self‐efficacy, and ability of stoma appliance change were evaluated before and after the OMRE. Major results of this study were as follows: the self‐care knowledge score of post‐test was higher than the pretest in the control, experimental 1, and experimental two groups (P < 0.001). The self‐efficacy score of post‐test was higher than the pretest in the control, experimental 1, and experimental 2 groups (P < 0.001). The self‐care knowledge score according to the frequency of OMRE did not differ among the control, experimental 1, and experimental 2 groups (F = 1.921, P = 0.156). The self‐efficacy score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 8.616, P = 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post‐hoc analysis: a < b, c). The ability of stoma appliance change score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 49.546, P < 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post‐hoc analysis: a < b, c). Results of this study suggested that the OMRE was effective for promoting hospitalised ostomates' self‐care knowledge, self‐efficacy, and ability of stoma appliance change, and two sessions of the OMRE was the most effective. Findings of this study may be useful in planning education programmes designed to improve self‐care ability for hospitalised ostomates.
Keywords: ability of stoma appliance change, ostomy management reinforcement education, self‐care knowledge, self‐efficacy
1. INTRODUCTION
Patients who undergo stoma surgery experience difficulties in adapting to cancer as well as physical and mental difficulties, and these pose a serious threat to their quality of life.1 As patients have to excrete intestinal contents through a stoma, they face problems such as leakage, ballooning of bags, poor placement of the stomal appliance, and skin rashes that in turn cause physical problems such as a decrease in personal hygiene and other physical changes.2 When proper physical management is not carried out, participants experience loss of self‐esteem and shame, avoid contact with others, and suffer self‐rejection and despair.3 For ostomates to adapt to post‐surgery changes in stoma care and daily life, the priority is to support them in learning self‐care for ostomy management.4 This entails a need for integrated and planned self‐care education as a means of supporting ostomates in overcoming the aforementioned physical, psychological, and social difficulties.5 These days, in Korea, hospitalised ostomates leave the hospital without receiving proper education on self‐care as there is less opportunity to provide them with education on ostomy because of decreases in length of hospital stay and increase in laparoscopic surgery. Patients eventually rely on medical personnel or family members rather than themselves for ostomy management when leaving the hospital,6 and this makes it difficult for patients to deal with many physical problems caused by improper self‐care on their own and lowers their self‐confidence, thereby having a negative impact on the successful rehabilitation and psychosocial adaption to a new life.7, 8 In general, ostomates receive two sessions of demonstration training on replacement of ostomy aids from nurses during their hospital stay and are largely informed of the precautions for daily life and diet, as well as additional explanations and instructions for inquiries;6 however, there has yet to be any study of the effectiveness of such short‐term standardised educational programmes on developing an adequate level of self‐care in ostomates. Ramsdell and Annis proposed a repetitive educational programme as an effective method for enhancing the effectiveness of education for haemodialysis patients and stressed that a repetitive educational programme was effective in enhancing the awareness of patients by nurses, supporting patients in better adapting to the condition, and developing awareness of the need for self‐care and treatment.9 Moreover, “reinforcement” can be most effective in inducing change in behaviour through repetitive learning, and Thorndike10 and Skinner11 stated that reinforcement allows us not only to induce desirable behaviour but also to control undesirable behaviour. In recent studies, an educational programme that involved reinforcement education by providing vicarious experience through two sessions of demonstration training, two sessions of model‐based training, self‐ostomy management training, and a feedback system with compliments and corrections12 was demonstrated to have greater effects in increasing self‐efficacy in ostomates than an educational programme involving vicarious experience through one session of demonstration training5 or an educational programme involving one session of demonstration training and model‐based training.13 Previous studies thus suggest that it is highly important to provide ostomates with repetitive reinforcement education on self‐care in a continuous and individual manner, but they have not provided evidence for the optimal frequency of reinforcement education on self‐care.
Against this background, this study aims to evaluate the effects of ostomy management reinforcement education (OMRE) on self‐care knowledge, self‐efficacy and ability to change stoma appliance in ostomates and to identify the optimal frequency of reinforcement education, thereby developing a nursing intervention to promote self‐care of ostomy and encouraging ostomates to engage in adequate self‐care during their hospital stay. The specific objectives of the study are as follows:
Identify the effects of OMRE on the self‐care knowledge level of ostomates.
Identify the effects of OMRE on the self‐efficacy of ostomates.
Identify the effects of OMRE on the ability of ostomates to change stoma appliance.
Identify the effects of the frequency of OMRE on self‐care knowledge, self‐efficacy, and ability to change stoma appliance of ostomates.
2. MATERIALS AND METHODS
2.1. Ethical consideration
The experimental protocol for this study was approved by the Ethics Committee at Korea University Hospital, Korea.
2.2. Study design
This study used an equivalent control group pretest–post‐test design to identify the effects of OMRE on the self‐care of ostomates and the optimal frequency of reinforcement education. The sample size of the control group and the two experimental groups was 20 participants each, for a total of 60 participants, after reference to a table by Cohen14 for a power of 0.70, effect size of 0.40, and α of 0.05. All participants were randomly assigned to one group.
2.3. Data collection period and study participants
The data collection period of this study was from October 2009 to October 2010, and the 60 study participants were hospitalised ostomates who had undergone stoma surgery at a university‐affiliated hospital (K) with 800 sickbeds, located in Seoul, Korea.
2.4. Study tools
-
1
Measurement tool for self‐care knowledge level
The measurement tool for self‐care knowledge level consists of a total of 30 items: 15 items on caution in daily life (5 items on odour and gas control, 2 items on skin care near the ostomy, 2 items on diarrhoea and constipation, 1 item on bath, 2 items on exercise, 1 item on travel, and 2 items on marriage life); 6 items on post‐surgery physical management; 2 items on the definition and status of ostomy; 5 items on aid selection and change (replacement) methods; 1 item on emotional and psychological management; and 1 item on the structure and function of the digestive organs. The score is calculated by giving 1 point for a right answer and 0 points for a wrong answer or an unanswered item, and the total score ranges from 0 to 30 points. The higher the total score, the higher the respondent's self‐care knowledge level.
-
2
Measurement tool for self‐efficacy
The measurement tool for self‐efficacy consists of a total of 17 items: 3 items on skin care; 2 items on stoma appliance change (replacement); 6 items on diet; 1 item on clothing; 1 item on exercise; 1 item on participation in a self‐help group meeting; 1 item on emergency measures; 1 item on sleeping; and 1 item on stress management. The responses range from “not confident at all” (10 points) to “very confident” (100 points). The higher the total score (170 to 1700 points), the higher the self‐efficacy level.
-
3
Measurement tool for ability to change stoma appliance
This tool observes and records participants on a 4‐point scale. The higher the total score, the higher the ability to change stoma appliance. The total score ranges from 10 to 40 points.
2.5. Ostomy management reinforcement education
This programme offers ostomates the opportunity to change an ostomy pouch on their own for correction in sequence and method, with a feedback system at the end to give correction and compliments (eg, “You are doing great”). Each session of training was 30 minutes long. In addition, further explanations and instruction were given on self‐care knowledge, including the replacement period for stoma appliances, daily life precautions (eg, putting on clothes, diet, exercise, bath, sleeping, sex life, work, and social activities), and ostomy‐related complications. Participants were then asked questions on self‐care knowledge, and their wrong answers were corrected with explanations.
2.6. Study procedure
As a preliminary investigation, a survey was conducted on the general characteristics of the control group and experimental groups 1 and 2, self‐care knowledge, and self‐efficacy. The ability to change stoma appliance had no preliminary investigation, and only a post‐test investigation was conducted as it was impossible to observe ostomates' ability to change stoma appliance, as Day 3 after surgery, which was the starting date of the preliminary investigation, was earlier than when participants received education on self‐care.
On Day 3 after surgery, the participants of the study received basic education on ostomy management (30 minutes) from the research team of this study, and the OMRE (30 min), which is the experimental treatment of the study, was conducted on Day 5 after surgery. On Day 7 after surgery, experimental groups 1 and 2 received one additional OMRE. On Day 9 after surgery, experimental group 2 received a second additional OMRE. The control group received a total of one OMRE session, experimental group 1 a total of two OMRE sessions, and experimental group 2 a total of three OMRE sessions.
A post‐test investigation was conducted on Day 7 after surgery for the control group, on Day 9 after surgery for experimental group 1, and on Day 11 after surgery for experimental group 2. The surveys on self‐care knowledge level and self‐efficacy were conducted, and ostomates' ability regarding stoma appliance change was observed prior to the investigation.
2.7. Statistical analysis
Data were collected and analysed using SPSS (Version 12.0) statistical software (SPSS Inc., Chicago, IL, United States). The errors and percentages of the general characteristics of all participants were analysed for descriptive statistics. Chi‐square tests and ANOVAs were used for the analysis of the homogeneity test of the general characteristics, self‐care knowledge, and self‐efficacy of the control group and experimental groups 1 and 2. A pretest and post‐test comparison of self‐care knowledge and self‐efficacy of the control group and experimental groups 1 and 2 was conducted using paired t tests. The differences in average post‐test scores of self‐care knowledge, self‐efficacy, and ability of stoma appliance change of the control group and experimental groups 1 and 2 were analysed using anova, followed by a Scheffe's post‐hoc analysis. The reliability of the measurement tools was obtained using Cronbach's α.
3. RESULTS
3.1. General characteristics of participants and homogeneity test
The test of general characteristics and homogeneity of the control group and experimental groups 1 and 2 showed no significant difference on any items except for hospital stay (Table 1). The reason for the significant difference in hospital stay is because experimental group 2 was required to stay at least 11 days in hospital to receive three sessions of reinforcement education, and any participant who did not meet this requirement was withdrawn from the study.
Table 1.
General characteristics of participants and the homogeneity test
| General characteristics | Cont. (n = 20) | Exp. 1 (n = 20) | Exp. 2 (n = 20) | x 2 | P |
|---|---|---|---|---|---|
| Gender | |||||
| Male | 15 (75%) | 17 (85%) | 15 (75%) | 0.786 | 0.675 |
| Female | 5 (25%) | 3 (15%) | 5 (25%) | ||
| Age (years) | |||||
| 30‐39 | 0 (0%) | 2 (10%) | 1 (5%) | 17.438 | 0.065 |
| 40‐49 | 3 (15%) | 3 (15%) | 1 (5%) | ||
| 50‐59 | 3 (15%) | 7 (35%) | 12 (60%) | ||
| 60‐69 | 9 (45%) | 4 (20%) | 6 (30%) | ||
| 70‐79 | 5 (25%) | 3 (15%) | 0 (0%) | ||
| 80‐89 | 0 (0%) | 1 (5%) | 0 (0%) | ||
| M(SD) | 61 (9.19) | 58 (13.96) | 56 (8.69) | ||
| Marital status | |||||
| Unmarried | 0 (0%) | 3 (15%) | 1 (5%) | 6.829 | 0.555 |
| Married | 16 (80%) | 15 (75%) | 15 (75%) | ||
| Other | 4 (20%) | 2 (10%) | 4 (20%) | ||
| Education | |||||
| Elementary school graduation | 5 (25%) | 2 (10%) | 1 (5%) | 5.188 | 0.520 |
| Middle school graduation | 2 (10%) | 4 (20%) | 3 (15%) | ||
| High school graduation | 9 (45%) | 10 (50%) | 9 (45%) | ||
| College graduation and above | 4 (20%) | 4 (20%) | 7 (35%) | ||
| Monthly income | |||||
| <1 million won | 9 (45%) | 10 (50%) | 8 (40%) | 10.200 | 0.423 |
| ≥1 million won, <4 million won | 9 (45%) | 8 (40%) | 8 (40%) | ||
| ≥4 million won | 2 (10%) | 2 (10%) | 4 (20%) | ||
| Main caregiver | |||||
| Parents | 0 (0%) | 2 (10%) | 1 (5%) | 9.265 | 0.320 |
| Spouse | 9 (45%) | 13 (65%) | 12 (60%) | ||
| Sibling | 1 (5%) | 1 (5%) | 2 (10%) | ||
| Children | 10 (50%) | 4 (20%) | 4 (20%) | ||
| Others | 0 (0%) | 0 (0%) | 1 (5%) | ||
| Hospital stay | |||||
| ≤7 days | 5 (25%) | 1 (5%) | 0 (0%) | 19.600 | 0.001 |
| 8‐10 days | 7 (35%) | 7 (35%) | 0 (0%) | ||
| ≥11 days | 8 (40%) | 12 (60%) | 20 (100%) | ||
| Stoma type 1 | |||||
| Colostomy | 2 (10%) | 2 (10%) | 5 (25%) | 2.353 | 0.308 |
| Ileostomy | 18 (90%) | 18 (90%) | 15 (75%) | ||
| Stoma type 2 | |||||
| Permanent | 2 (10%) | 0 (0%) | 3 (15%) | 3.055 | 0.217 |
| Temporary | 18 (90%) | 20 (100%) | 17 (85%) | ||
| Conservative treatment | |||||
| None | 15 (75%) | 9 (45%) | 10 (50%) | 7.051 | 0.133 |
| Chemo Tx | 5 (25%) | 10 (50%) | 7 (35%) | ||
| Chemo Tx + radiation Tx | 0 (0%) | 1 (5%) | 3 (15%) | ||
Abbreviations: Cont., control group; Exp., experimental group.
3.2. Pre‐homogeneity test of self‐care knowledge and self‐efficacy
Homogeneity was found among the three groups with no statistically significant difference (P = 0.192) in self‐care knowledge. The three groups were found to be homogeneous, with no statistically significant difference (P = 0.636) in self‐efficacy (Table 2).
Table 2.
Pre‐homogeneity test of self‐care knowledge and self‐efficacy
| Cont. (n = 20) | Exp.1 (n = 20) | Exp.2 (n = 20) | F | P | |
|---|---|---|---|---|---|
| M (SD) | M (SD) | M (SD) | |||
| Self‐care knowledge | 1.9 (1.68) | 1.2 (1.44) | 2.1 (1.53) | 1.701 | 0.192 |
| Self‐efficacy | 676.5 (130.64) | 690.8 (164.12) | 720.5 (149.30) | 0.456 | 0.636 |
Abbreviations: Cont., control group; Exp., experimental group.
3.3. The effects of the OMRE on self‐care knowledge
The effects of the OMRE on self‐care knowledge were tested, and the results showed a statistically significant difference (P < 0.001). According to the results, the self‐care knowledge level of ostomates was higher after receiving the OMRE than before (Table 3).
Table 3.
The effects of the OMRE on self‐care knowledge
| Prior knowledge | Post‐knowledge | Post‐prior knowledge | t | P | |
|---|---|---|---|---|---|
| M(SD) | M(SD) | M(SD) | |||
| Control group (n = 20) | 1.90 (1.68) | 19.45 (4.68) | 17.55 (4.99) | 15.731 | <0.001 |
| Experimental group 1 (n = 20) | 1.20 (1.44) | 21.85 (3.82) | 20.65 (3.91) | 23.616 | <0.001 |
| Experimental group 2 (n = 20) | 2.05 (1.54) | 20.20 (3.25) | 18.15 (3.76) | 21.590 | <0.001 |
Abbreviation: OMRE, ostomy management reinforcement education.
3.4. The effects of the OMRE on self‐efficacy
The effects of the OMRE on self‐efficacy were tested, and the results showed a statistically significant difference (P < 0.001). According to the result, the self‐efficacy of ostomates was higher after receiving the OMRE than before (Table 4).
Table 4.
The effects of the OMRE on self‐efficacy
| Prior self‐efficacy | Post‐self‐efficacy | Post‐prior self‐efficacy | t | P | |
|---|---|---|---|---|---|
| M (SD) | M (SD) | M (SD) | |||
| Control group (n = 20) | 676.50 (130.64) | 1108.50 (209.84) | 432.00 (215.86) | 8.950 | <0.001 |
| Experimental group 1 (n = 20) | 690.80 (164.12) | 1375.00 (222.72) | 684.20 (243.43) | 12.570 | <0.001 |
| Experimental group 2 (n = 20) | 720.50 (149.30) | 134.00 (228.93) | 619.50 (150.38) | 18.423 | <0.001 |
Abbreviation: OMRE, ostomy management reinforcement education.
3.5. The effects of the frequency of the OMRE on self‐care knowledge
The effects of the frequency of the OMRE on self‐care knowledge was tested, and the results showed no statistically significant difference (F = 1.921, P = 0.156) (Table 5).
Table 5.
The effects of the frequency of the OMRE on self‐care knowledge, self‐efficacy, and ability to change stoma appliance
| M | SD | F | P | Scheffe | |
|---|---|---|---|---|---|
| Self‐care knowledge | |||||
| Control group (n = 20) | 19.45 | 4.68 | 1.921 | 0.156 | |
| Experimental group 1 (n = 20) | 21.85 | 3.81 | |||
| Experimental group 2 (n = 20) | 20.20 | 3.25 | |||
| Self‐efficacy | |||||
| Control group a (n = 20) | 1108.50 | 209.84 | 8.616 | 0.001 | a < b, c |
| Experimental group 1b (n = 20) | 1375.00 | 222.72 | |||
| Experimental group 2c (n = 20) | 1340.00 | 228.93 | |||
| Ability of stoma appliance exchange | |||||
| Control group a (n = 20) | 22.10 | 1.94 | 49.543 | <0.001 | a < b, c |
| Experimental group 1b (n = 20) | 27.50 | 2.21 | |||
| Experimental group 2c (n = 20) | 27.55 | 1.79 | |||
Abbreviation: OMRE, ostomy management reinforcement education.
3.6. The effects of the frequency of the OMRE on self‐efficacy
The effects of the frequency of the OMRE on self‐efficacy was tested, and the results showed significantly higher scores for experimental groups 1 and 2 than the control group (F = 8.616, P = 0.001), while there was no statistically significant difference in the scores of experimental groups 1 and 2 (Scheffe's test result: a < b, c) (Table 5).
3.7. The effects of the frequency of the OMRE on ability to change stoma appliance
The effects of the frequency of the OMRE on the ability to change stoma appliance was tested, and the results showed significantly higher scores for experimental groups 1 and 2 than the control group (F = 49.543, P < 0.001), while there was no statistically significant difference in the scores of experimental groups 1 and 2 (Scheffe's test result: a < b, c) (Table 5).
4. DISCUSSION
The OMRE was found to be effective in improving participants' self‐care knowledge, self‐efficacy, and ability of stoma appliance change. In terms of the optimal frequency of the OMRE, one session of education was shown to be effective enough to improve self‐care knowledge, and two sessions sufficed to improve self‐efficacy and ability to change stoma appliance. Based on these results, it is assumed that the OMRE does not have further effects in improving ostomates' self‐care knowledge as each session provides the same content. On the other hand, the result also suggests that one session of education is enough to provide ostomates with a sufficient level of self‐care knowledge, and this should be taken into account when applying educational programmes for improving self‐care knowledge of ostomates in clinical studies.
In contrast, the effects on self‐efficacy and ability to change stoma appliance varied according to the frequency of the OMRE. That is, experimental groups 1 and 2, which received two or three sessions of the OMRE, showed higher scores in self‐efficacy and ability to change stoma appliance than the control group, and it may be assumed that participants' self‐efficacy was improved through success experience, one of the self‐efficacy resources suggested by Bandura,14 repetition of success experience in particular. In addition, participants were able to repeatedly learn and practice the educational content through the second and third sessions to build on their learning from the first session, which allowed them to observe and remember their own behaviour for comparison and correction while receiving repeated corrective feedback in the process. This is assumed to have contributed to higher scores for their self‐efficacy and ability to change stoma appliance. The study result is in line with the findings of previous studies; consider, for example, the study by Kang,13 which provided one session of demonstration training and participatory practical training using models, and the study by Ahn,12 which provided two sessions of demonstration training and two sessions of practical training (one session of model‐based training and one session of ostomy practice). This repeated experience showed that there was an increase of 14% in self‐efficacy after ostomates received the OMRE. In addition, it is assumed that this study was more effective in improving self‐efficacy by providing the OMRE, which allowed ostomates to practice the pouch change numerous times, compared with the study by Kim and Park,5 which provided only vicarious experience through demonstration training, or the study by Lee,15 which provided only demonstration training using research and videos. However, it was notable that participants' self‐efficacy score and ability of stoma appliance change score significantly increased when the frequency of the OMRE was increased from one to two sessions, whereas their scores remained at a similar level or decreased instead when the frequency was increased from two to three sessions. This may be assumed to be because frequent educational and training sessions may have rendered participants less independent, reduced their confidence, or deterred them from further improving their self‐efficacy and ability to change stoma appliances change as they gained enough confidence or satisfaction from repetitive learning without facing any difficulty or problem. Based on this study result, it would appear that two sessions of the OMRE would be sufficient to improve self‐efficacy and ability of stoma appliance change of ostomates, and more sessions would be unnecessary.
In the study by Kim and Park,5 which provided only one session of demonstration training, there was a difference of 9% in self‐care engagement level between the control group, which received no educational programme, and the experimental group, which did. In the study by Choi,16 which provided two sessions of demonstration training, there was a difference of 7% between the control and experimental groups. In comparison with these two studies, this study provided two or three sessions of the OMRE and showed an increase of 14% in participants' self‐care engagement with respect to their ability of stoma appliance change. This result is considered to be related to the characteristics of the OMRE applied in this study, in which basic education was provided prior to the OMRE, and participants received basic education on Day 3 after surgery. During this time, instructors directly demonstrated and explained the process of changing the pouch to participants. The reason why no direct practical training was provided at this point was because participants found it difficult to do the task by themselves as they were still recovering from the pain or psychological shock of surgery. Then, all three groups, the control group and experimental groups 1 and 2, directly engaged in the pouch change on Day 5 after surgery and received one session of OMRE, where compliments and corrective feedback were provided. On Days 7 and 9 after surgery, the experimental groups received one or two additional sessions, in which they repeatedly practiced the process and received compliments and corrective feedback. This is a highly distinctive feature from previous studies, which only provided demonstration training, and thus, it may be considered that providing OMRE for a total of two or three sessions of direct practical training was effective in improving participants' self‐efficacy and ability of stoma appliance change.
In this study, the control group and experimental groups 1 and 2 had different lengths of hospital stay, and this should be taken into account when interpreting the result of this study. Considering that the severity of a disease is proportional to the length of a patient's hospital stay,17 the varied lengths of hospital stays of the control and experimental groups in this study may have affected the result, and future studies should ensure that the control and experimental groups have the same period of hospital stay of 11 days or more.
While ostomates may use ostomy for their entire lifetime or only temporarily, it is important for them to be able to self‐care as it is rare for ostomates to stay at the hospital throughout the recovery process. Inability of self‐care may cause several physical problems and lower patients' confidence, which in turn affects rehabilitation. This study provided OMRE and obtained the result of improving ostomates' self‐efficacy and ability of stoma appliance change. In addition, there have been many previous studies that developed and provided a number of educational programmes, but none has proposed an optimal frequency of self‐care education. In this context, this study is significant in that it explored an intervention method to identify the optimal frequency of education to provide ostomates with an adequate level of self‐care within a short period of hospital stay. This study is also significant in the following aspects: the work efficiency of nurses can be improved by reducing unnecessary educational sessions as two sessions of the OMRE are sufficient to develop an adequate level of self‐efficacy and ability of stoma appliance change for ostomates, and cost‐effectiveness can be improved by reducing treatment costs that might have occurred from providing unnecessary educational sessions.
Thus, this study suggests that the OMRE is effective in improving self‐care knowledge, self‐efficacy, and ability of stoma appliance change of ostomates and confirms that two sessions of OMRE are the most efficient in improving ostomates' self‐care capabilities. This study's results should provide important guidelines for developing and implementing educational programmes on ostomy management and self‐care for ostomates.
5. LIMITATIONS
This study was conducted in a university‐affiliated hospital (K) in Seoul, Korea. As the total number of study participants is not high, the study results should not be generalised, and there need to be repeated studies with a higher number of participants.
In this study, the educational programme was provided during participants' hospital stay, and a post‐test investigation was conducted. There needs to be a follow‐up investigation of the long‐term effects of the programme to confirm if the result is maintained after participants leave the hospital.
The educational programme used in this study should be complemented with additional content to improve participants' self‐care knowledge, and the effects thereof should be tested.
As the difference in the lengths of the hospital stays of the three groups in the study may have affected the study results, the effects of the OMRE need to be tested in patients with the same length of hospital stay of 11 days or more.
Seo H‐W. Effects of the frequency of ostomy management reinforcement education on self‐care knowledge, self‐efficacy, and ability of stoma appliance change among Korean hospitalised ostomates. Int Wound J. 2019;16(Suppl. 1):21–28. 10.1111/iwj.13047
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