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Nursing and Health Sciences (2014), 16, 483489

Research Article

Taking good care of myself: A qualitative study on

self-care behavior among Chinese persons with a
permanent colostomy
Hui Tao, PhD, RN,1,2 Praneed Songwathana, PhD, RN,1 Sang-arun Isaramalai, PhD, RN1 and
Qingxi Wang, Enterostomal Therapist, RN3
1
Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand, 2School of Nursing, Kunming Medical University,
and 3Colorectal Cancer Department, Third Affiliated Hospital of Kunming Medical University, Kunming, China

Abstract In Chinese culture, as a possible consequence of Confucianism, caring for the sick is considered a moral
obligation of family members, while self-care is only the basis of fulfilling filial piety.This qualitative study aims
to explore the self-care behavior among persons with a permanent colostomy in a Chinese cultural context of
emphasizing the role of family caregiving. Data from in-depth interviews with seven Chinese adults at a
university hospital in southwest China were analyzed using content analysis. Informants self-care behavior
was characterized by taking good care of myself, which underlined individuals efforts to manage colostomy-
related impacts involving: (i) taking care of my colostomy with a proper degree of independence; (ii) taking
care of my life by dealing with limitations; (iii) taking care of my mood in a positive way. Findings revealed that
informants self-care behavior was linked to their Confucian beliefs in family obligations, and also influenced
by a happy-go-lucky outlook of life, a likely product of Taoism. The information is useful for nurses to design
a culturally appropriate care plan to improve self-care behavior and proper family caregiving.

Key words behavior, Chinese culture, colostomy, qualitative, self-care, stoma.

INTRODUCTION (McVey et al., 2001; Smith et al., 2007; Li & Zou, 2008;
Williams, 2008; Honkala & Berter, 2009; Andersson et al.,
The formation of permanent colostomy is usually for treating
2010; Boyles, 2010).
colorectal cancer. According to statistics from the Interna-
Previous studies revealed that self-care plays a pivotal role
tional Agency for Research on Cancer (IARC) of the World
in stoma care and management. Regarded as a conviction
Health Organization in 2012, in the Peoples Republic of
that individuals can successfully manage their stomas, efficacy
China it was estimated that there were 253 000 new cases of
of stoma self-care displayed a positive correlation with both
colorectal cancer, 139 000 deaths, and 583 000 survivors
psychosocial adaptation (Bekkers et al., 1996; Simmons et al.,
within five years of diagnosis (IARC, 2012). The estimated
2007) and quality of life (Wu et al., 2007; Cheng & Xu, 2009).
number of colostomy patients was around 1 000 000 in main-
Moreover, ability in stoma self-care was positively correlated
land China, and new cases annually were approximately
with psychosocial adaptation (Hu et al., 2010; Xu et al., 2010;
100 000 (Wan, 2007).
Cheng et al., 2013).
People with a permanent colostomy encounter physical
The experience of colostomy patients has been explored in
changes concerning body image, defecation patterns, and
different countries during the past two decades (Tao et al.,
sexual function. These individuals have to live with various
2014). However, little is known about how people care for
restrictions involving diet, dressing, physical exercise, recrea-
themselves in a Chinese cultural context which emphasizing
tion, social activity, travel, working, and intimate behavior.
more about family caregiving than self-care. Findings may
Consequently, they may experience psychosocial problems,
improve understanding of how cultural factors influence self-
for example anxiety, depression, disgust, embarrassment,
care behavior, and inform nursing professionals how to facili-
unacceptance, loss of personal control, low value, self-
tate both self-care and family caregiving in the Chinese
inferiority, insecurity about life, social stigma, and isolation
cultural context.

Background: Chinese cultural context

Correspondence address: Hui Tao, Faculty of Nursing, Prince of Songkla University,
Hat Yai 90112, Thailand. Email: taohui216@hotmail.com Unlike the Western viewpoint which regards self-care as
Received 18 February 2014; revision received 10 July 2014; accepted 6 August 2014 the individuals responsibility for their own growth and

2014 Wiley Publishing Asia Pty Ltd. doi: 10.1111/nhs.12166

484
development (Richard & Shea, 2011), Chinese people
emphasize providing care to the sick as a moral obligation of
family members grounded in Confucian family ethics, viola-
tion of which will induce a sense of moral failure (Wong &
Pang, 2000). Despite self-care being considered the basis
of fulfilling filial piety (Lin, 2009), the predominance of
family caregiving may bring out a unique manifestation of
self-care behavior among Chinese persons with a permanent
colostomy.
Moreover, in mainland China, there are several issues in
the field of stoma nursing care. Some are similar to other
countries, for example insufficient discharge preparedness to
perform stoma care at home among patients and their car-
egivers due to shortened hospital stays (Richbourg et al.,
2007), and lack of continuity of nursing care for colorectal
cancer patients after discharge (Beaver et al., 2010). The
others involve paucity of attention to post-discharge needs of
stoma patients (Zhang et al., 2013), lack of routine stoma
home visits in the community, and a limited number of
enterostomal therapist (ET) nurses (Xu, 2009).
Aim
This study aimed to describe and interpret self-care behavior
among people with a permanent colostomy in a Chinese
cultural context.
METHODS
Design
This study was a part of the reconnaissance phase of an action
research study, the findings of which have contributed to the
analysis of overall situations of people living with colosto-
mies. A qualitative approach was employed using in-depth
interviews as the main method. Open-ended questions were
initially used, and subsequent probing questions were gener-
ated from dialogue with informants to gain more deep and
detailed information (DiCicco-Bloom & Crabtree, 2006).
Participants
This study was conducted at a surgical unit of a university
hospital, Kunming, China. Purposive sampling was used to
select key informants using the inclusion criteria: (i) Chinese
adults who know their diagnosis; (ii) had a permanent colos-
tomy for less than one year; (iii) able to communicate with
the interviewer in mandarin or local languages; (iv) no
history of psychiatric disorders. An ET nurse working in this
unit was responsible for recommending informants from
those returning to hospital for postoperative medical
check-up or chemotherapy. Finally, this study recruited seven
key informants with diverse demographics. Four family car-
egivers (two spouses, one sister, and one daughter) were
included as secondary informants who were present when
key informants were interviewed.
Ethical considerations
Permission for informants involvement was obtained from
the Institutional Review Board, Faculty of Nursing, Prince of
2014 Wiley Publishing Asia Pty Ltd.
H. Tao et al.
Songkla University, and the Medical Ethical Committee of
the hospital where this study was conducted. A complete
explanation and a written description about research objec-
tives, methods, potential risks and benefits were given to each
informant. These informants were allowed to ask questions,
decline/accept participation in this study, and withdraw at any
time. Written or oral informed consent was gained from each
informant before data collection.
Data collection
Data were collected by the first author from January to
March 2013 until data saturation through in-depth face-to-
face interview, participant observation, and taking field notes.
All interviews were tape-recorded and transcribed verbatim.
These interviews lasted 3080 min and were conducted in a
ward or a meeting room according to informants preference
and convenience. Each interview was started with one open
question Could you please tell me about your experience
after having a colostomy? Then, the interviewer encouraged
informants to recall their experience at preoperation,
postoperation, and postdischarge, especially their direct self-
care behavior (doing by oneself) and indirect self-care
behavior (receiving care from others). Predetermined ques-
tions were used, for example How do you look after your-
self? What support do you get from your family caregivers,
nurses, and others? How do you feel about living with a
colostomy? Subsequently, more probing questions were
used, for example Could you tell me why you rejected the
fecal diversion before surgery, and why you finally accepted
it?
Data analysis
Data were analyzed using inductive content analysis summa-
rized by Elo and Kyngas (2008). The analysis process
included selecting analysis units, making sense of data as a
whole, open coding, coding sheets, grouping, categorization,
and abstraction.
Trustworthiness
Trustworthiness was achieved by the criteria: credibility,
dependability, confirmability, and transferability (Lincoln &
Guba, 1985). Prolonged engagement was performed by the
first author. Data and method triangulations were taken into
consideration. The second author and the fourth author
conducted peer-debriefing to gain consensus on analysis
accuracy. Results of this study were verified by four key
informants: as an example, one informant said, I cannot
express my ideas well due to my poor educational back-
ground, but you have expressed what I want to say. In this
manner, member checking was performed. The research
process was audited by the second author and all relevant
documents were kept, for example demographic forms,
informed consent forms, field notes, audio-digital records,
verbatim transcripts, and coding sheets. Selection of diverse
informants and provision of adequate quotations of inform-
ants statements were used to avoid researchers bias in data
Self-care of Chinese colostomy patients 485

analysis. Thick description about informants, context, and

chemotherapy
Postoperative
research process provided the readers an opportunity to

Yes
Yes
Yes
Yes
Yes

Yes
Yes
transfer the findings into similar contexts.

RESULTS

colostomy (months)
Period of having a
Demographics of key informants

6.5

3.5
Key informants (four male and three female) aged 3968

11
3
5

3
years (M = 54), living with a permanent colostomy for 211
months (M = 5). All of them were married Han people, diag-
nosed with rectal cancer, and receiving postoperative chemo-
therapy. The majority (57%) were male, 57% were peasants,

Laparoscopic radical
and 57% underwent a Miles surgical operation. Regarding

Surgical procedure
educational background, 29% were illiterate, 43% graduated
from primary school, 14% had a middle school education,

rectectomy
and 14% possessed a high school diploma (Table 1).

Hartmann

Hartmann
Miles
Miles

Miles
Miles
Themes
Self-care behavior of Chinese persons with a permanent

Rectal cancer
Rectal cancer
Rectal cancer
Rectal cancer
Rectal cancer

Rectal cancer
Rectal cancer
Diagnosis
colostomy was characterized by taking good care of myself,
which emphasized individuals efforts to manage colostomy-
related impacts including: taking care of my colostomy with a
proper degree of independence, taking care of my life by
dealing with limitations, and taking care of my mood in a
positive way. Level of education

Primary school

Primary school

Primary school

Middle school
High school

Illiteracy

Illiteracy
Taking care of my colostomy with a proper degree
of independence
All informants intended to take care of their colostomies
with a proper degree of independence. The proper degree
Occupation

allowed these informants to feel themselves capable and not

Peasant
Peasant
Peasant

Peasant
Retired

Retired
Worker

There are 56 ethnicities in China, and Han people are the largest group.
being a burden to family. Independence was shown in
behavior of using stoma appliances and handling peristomal
skin problems.
Marital status

Using stoma appliances. A one-piece stoma appliance was

Married
Married
Married
Married
Married

Married
Married

commonly used by informants owing to its negligible cost and

softness. Through learning from nurses, families, and fellow
patients, these informants dealt with stoma appliances with
different degrees of independence.
Ethnicity

Three informants reported often emptying and cleaning

Han
Demographics of key informants

Han
Han
Han
Han

Han
Han

pouches, and cutting and attaching skin barriers without any

assistance. They believed that taking care of their own colos-
tomies was a reasonable and unescapable responsibility.Also,
Age (years)

they were pleased that their families occasionally changed

stoma appliances for them expressing concern and love. As
68
47
39
57
52

53
62

one informant stated:

It is not good to let others empty and change stoma
appliances for you, because the excrement is dirty. It
Gender

Female
Female

Female

would be better to care of the colostomy by yourself,

Male
Male

Male

Male

because the excrement is yours and you would not feel it

dirty . . . I usually handle stoma appliances by myself
Table 1.

Code

except when my wife is at home. She is glad to change

P1
P2
P3
P4
P5

P6
P7

stoma appliances for me to express her guan-xin (,

2014 Wiley Publishing Asia Pty Ltd.

486
concern) and bu-xian-qi (, lack of disgust). (47-
year-old male)
Three other informants said they were responsible for only
emptying and cleaning pouches. They thought that skin bar-
riers attached by their families could be kept longer. As one
informant explained:
I can attach skin barriers by myself, but they will soon
leak. Conversely, the skin barrier can be used for a
longer time if my family attaches the skin barrier for me.
(39-year-old female)
Exceptionally, one older informant completely relied on her
family. While being interviewed, she was receiving chemo-
therapy and suffering from nausea, vomiting, and fatigue. Her
daughter cared for her in a ward. She expressed her sense of
incapability as follows:
(Sign) I have no energy. I cannot change stoma appli-
ances by myself. My daughter or husband do this for me
. . . Dealing with the pouch is very troublesome. When
my feces come out, if my children are not there, my
husband has to deal with it for me. He grew tired of this.
(62-year-old female)
Handling peristomal skin problems. At the early postopera-
tive stage, most informants suffered peristomal skin problems
often feeling itchy. With the assistance of families and the
guidance of the ET nurse, these informants handled skin
problems through learning the correct application of stoma
appliances and accessories. As one informant stated:
After the surgery was just done, I felt my peristomal skin
itchy every day. I had to scratch it. Ouch, it was too itchy.
Once I could not bear it, my husband would change a
new stoma appliance for me to make me better . . . Later,
I followed suggestions from the ET nurse: not cutting
skin barriers so big; avoiding food which easily causes
diarrhea; using skin protection powder. After two
months post-operation, I did not feel itchy again. (39-
year-old female)
Taking care of my life by dealing with limitations
Having a colostomy led to various limitations in informants
daily, social, and sexual lives. These individuals made efforts
to deal with limitations to reduce the negative impacts of
colostomy-related surgery on themselves and their families.
Overcoming limitations in daily life. Limitations in daily life
were relevant to housework, diet, sleep, dressing, and physical
exercise. Informants endeavored to overcome these limita-
tions by means of doing light housework and not lifting heavy
things to prevent peristomal hernia; choosing light and
digestible food to improve regular defecation; averting spicy,
deep-fried, pickled, or grilled food to prevent cancer recur-
rence; choosing less gas-producing food to evade embarrass-
ment of flatus; releasing gas from the pouch before sleep to
prevent it breaking; wearing larger clothes without a belt to
2014 Wiley Publishing Asia Pty Ltd.
H. Tao et al.
avoid pressure on the colostomy; avoiding physical exercise
which may damage the colostomy.
Reconciling with limitations in social life. Informants per-
ceived their colostomies as a surprising thing or making
them different from common people. Hence, they tried to
conceal their colostomies from others to look normal in
public, and avoid themselves and their families being further
isolated and laughed at. Two informants stated:
Some people asked, Are you defecating? I answered
no and pulled up my clothes to expose part of my
abdomen to them. I asked them, You take a look at my
abdomen. Where are the feces? (His wife was standing
beside him and explained: He would not like others to
know that he has a stoma. When other people asked
whether he is defecating, he always replies no). (52-year-
old male)
Some friends would like to see my colostomy. I do not
show it to them. It does not sound good if they spread it
around that I have a colostomy. (47-year-old male)
Due to the intention of keeping the colostomy secret from
the public, the informants often worried about odor and
noise relevant to leaking and flatus.This restricted their social
activities. Two informants mentioned:
There is little time for me to socialize with my friends
after having a colostomy . . . my main worry is the stoma
appliances leaking. (47-year-old male)
At present, I seldom go to public places . . . I have no
way. I cannot control this thing (flatus). It makes a loud
noise and I just let it go. After all, it has been different
from my previous situation in that I could control it
(flatus) for a while in public places. (53-year-old male)
Nevertheless, these informants endeavored to reconcile
with limitations in their social lives using various strategies:
emptying pouch at home before going outside; frequently
checking stoma appliances to detect any leaking or being full
of gas/feces; preparing spare stoma appliances when a long
way from home.
Compromising with limitations in sexual life. Although
colostomy-related surgery and treatment may influence indi-
viduals sexual life, especially in younger people, a few
informants mentioned relevant issues. Embarrassment of
talking about sexual topics to others is a barrier for these
informants to seek support from healthcare professionals.
Likewise, many healthcare professionals feel awkward pro-
viding information on sexual issues. One informant reflected:
[The surgery has] some impacts on my fu-qi-sheng-huo
(, sexual life) . . . I feel shy to ask the surgeon
when my husband and I may tong-fang (, have sex).
Also, the surgeon has not proactively informed us about
this issue. (39-year-old female)
Therefore, some informants and their spouses delayed
their first trial of having sex after surgery. Through
emphasizing responsibilities of keeping marital loyalty and
Self-care of Chinese colostomy patients
family integrity, they compromised with such limitations in
sexual life, e.g. unattractive body image with a colostomy,
female dyspareunia, or male impotence. One informant
stated:
My husband said that he has become a guang-han-zi
(, a male who is single) for one year since I got
sick. However, he did not mind this (no sexual inter-
course with each other) based on our many-year mar-
riage with two children. (39-year-old female)
Taking care of my mood in a positive way
Having a colostomy and receiving cancer treatment nega-
tively influenced the mood state of informants. Nevertheless,
these informants strived to take care of their own moods in a
positive way thanks to a Chinese belief that positive moods
can improve bodily health. They usually adopted the follow-
ing strategies.
Accepting the possibility of colostomy formation
preoperatively. Informants perceptions on colostomy were
frequently associated with abnormality, inconvenience, diffi-
culty of care, social isolation, and limited work choice. Thus,
before surgery, all informants wanted surgeons to preserve
their original anuses, if possible. However, a common consen-
sus, regarding saving life as the most important thing,
allowed these informants to accept the possibility of colos-
tomy formation through following surgeons suggestions and
abiding by their destinies. As two informants articulated
preoperatively:
Considering having a colostomy is different from ordi-
nary people, I did not want gai-dao (, fecal diver-
sion). But, in order to bao-ming (, save life), I had to
listen to surgeons and ting-tian-you-ming (,
abide by my destiny). (68-year-old male)
I had no more ideas except paying attention to bao-ming
. . . I have got this disease [cancer]. I can only ting-tian-
you-ming. (53-year-old male)
Appraising the current life positively. Despite many limita-
tions in living with a colostomy, most informants appraised
their current lives in a positive way to facilitate their bodily
recovery from surgery. Evidence can be seen in these inform-
ants expressions, for example having to face the reality of
colostomy formation, being realistic, thinking only about the
present (living in the moment), letting it be, getting used to
living with a colostomy, adapting to living with a colostomy,
living well, living without worry/discomfort.
Appreciating emotional support from families. Families are
an imperative source for informants to obtain emotional
support (mostly encouragement and consolation). The
informants appreciated their families and intended to pay
them back. They endeavored to take good care of themselves
to regain the power to repay their families. Two informants
stated:
487
My husband did me a big favor. Also, my parents-in-law
helped me a lot. In short, all of my family encouraged me
. . . My mother-in-law said to me, We accept the fate.
Only if you are alive, can you enjoy your life . . . If you
cannot do farming labor, you may look after children at
home. Like this, your children will still feel happy. (39-
year-old female)
I cannot help her by earning a living during chemo-
therapy. After I feel better, I will repay to her . . . Now, I
can deal with stoma appliances by myself. Later, I will
find a job to make money to support my family as best as
I can. (47-year-old male)
Being happy-go-lucky. The attitude of being happy-go-lucky
was repeatedly mentioned by informants, which benefited
them to alleviate mental distress. Similarly, the Chinese belief
in keeping body-and-mind in harmony supported the inform-
ants to abandon negative moods. Some informants adjusted
their moods through feeding livestock and poultry, planting
vegetables and flowers, watching television, and attending
recreational activities. Three informants explained:
It is my thinking that I can only be sui-yu-er-an
(, happy-go-lucky) because thinking more is
useless . . . I just do what surgeons tell me. (57-year-old
female)
Other patients said to me, Relax, dont always think
about it, dont care about it. Only if your mood is happy,
can you be better.. . . Now I feel better after chemo-
therapy. I did always want to cry when I went back home.
(39-year-old female)
I feed rabbits and pigeons at home. One objective is to
supplement household income; the other is to regulate
my mood. (His wife explained: Feeding pigeons is wan-
xin-qing (, to have fun). As long as he can be in a
good mood, I will feel satisfied). (53-year-old male)
DISCUSSION
Taking good care of myself is a feature of the self-care
behavior of Chinese persons with a permanent colostomy.
Good care emphasizes more about individuals efforts to
manage colostomy-related impacts than good outcomes.
Similarly, a Japanese perception of self-care also stresses
ones active involvement in dealing with ones health issues
(Yamashita, 1998: 372). This feature was derived from the
interview data and is supported by traditional Chinese
philosophical thoughts. One is Confucianism, and the other is
Taoism.
According to Confucianism, only when a person takes
good care of himself/herself, can he/she take better care of
his/her family members. Thus, it becomes possible that he/she
fulfills filial piety to parents (jin-xiao, ), and assumes
obligations to other family members. As Confucius stated,
The body and hair and skin are received from the parents,
and may not be injured: this is the beginning of filial piety
(Lin, 2009: 186). Therefore, it is understandable that a moti-
vation of Chinese people to perform self-care behavior is to
2014 Wiley Publishing Asia Pty Ltd.
488
fulfill their moral obligations to other family members, on the
basis of maintaining their own health. Meanwhile, when they
accept caregiving from family members, the family members
also accomplish their moral obligations. Both self-care and
family caregiving are imperative for the individuals to adapt
to their colostomies and maintain harmony among family
members.
When individuals were unable to take care of themselves
owing to bodily discomfort or mental distress, they also
adopted the Taoist view of being happy-go-lucky to safeguard
self-esteem and accept family caregiving. Both being happy-
go-lucky and abiding by destiny signify rebellion against the
responsibilities of Confucianism and compliance with the law
of nature (dao, ) in Taoism. As Lin (2009) maintained, The
naturalism of Taoism is the balm that smoothes the wounded
Chinese soul (p. 120). Furthermore, Chinese people take the
belief of the connection of body and mind from Taoism, that
is, bodily and mental health are interactional, and pursue
harmony between the two. Because negative moods may
slow down bodily recovery while positive moods may speed it
up, keeping positive moods becomes a universal strategy to
cope with stressful situations.
A positive mood is also valuable for individuals to deal
with colostomy-related negative impacts. Popek et al. (2010)
found that patients who were optimistic and positive to
accept their colostomies embraced a high quality of life. Opti-
mistic attitudes can assist people to adapt successfully to
illness (Carver, 2005). Also, resilience is a significant factor
for stoma patients to thrive (Grant et al., 2011). Apart from
optimism and resilience, other positive moods could be
helpful for individuals recovery, such as happiness, gratitude,
peacefulness, relief and satisfaction, which need further
exploration.
Healthcare professionals play a key role in meeting indi-
viduals informational needs on colostomy care. Because of
trust in the authority of healthcare professionals, all inform-
ants in this study had learnt about colostomy and its care
mostly from their surgeons and nurses. The timely, adequate
and precise provision of information is vital for the individu-
als to decide whether to accept the fecal diversion, learn and
master usage of stoma appliances, and handle colostomy-
related problems. It has been suggested that teaching stoma
self-care should take place as early as possible in order to
facilitate recovery and early discharge due to shortened hos-
pital stays (Thorpe et al., 2014). Meanwhile, the individuals
need a gradual process to reduce dependence on healthcare
professionals and increase personal autonomy and independ-
ence. Healthcare professionals should recognize individual
diversity, cultural differences, believe in their potential,
encourage them to perform self-care behavior, and accept
proper family caregiving.
This study was conducted in southwestern China and
employed a small sample. Its results may not be generaliz-
able to other parts of China or other countries. However,
generalization is not the goal of qualitative research. The
understanding of self-care behavior among Chinese people
living with colostomies is helpful for healthcare profession-
als to provide appropriate assistance. The experience of
people living with colostomies in other family contexts, for
2014 Wiley Publishing Asia Pty Ltd.
H. Tao et al.
example those who live alone without any family caregiving,
still needs to be explored. All informants were of Han back-
ground and self-care behavior among the 55 other
ethnicities may be different from Han people due to various
family cultures, customs, lifestyles, and beliefs in self-care
and family caregiving. Lastly, with changes of Chinese family
structure, the function of family caregiving is declining and,
stoma self-care issues for those living at home will have to
be addressed.
CONCLUSIONS
It is a private and family affair to cope with illness and adver-
sity in Chinese culture. According to Confucianism, individu-
als have the responsibility of taking good care of themselves
due to the requirement of filial piety; family members have a
moral obligation to care for their sick relatives. Therefore,
Chinese people living with colostomies make efforts to take
good care of their stomas, lives, and moods, in order to fulfill
filial piety and obligations to other family members. Also,
they accept certain support from family members, so as to
improve their own health and allow family members to
accomplish their moral obligations of caregiving. It is empha-
sized that self-care and receiving care from family members
are two significant factors to improve adaptation to their
colostomies. Knowledge from this study is valuable for nurses
to deliver culturally appropriate care to facilitate individuals
self-care and family caregiving.
ACKNOWLEDGMENTS
This study is one part of a PhD dissertation of the first author,
funded by the Faculty of Nursing and Graduate School,
Prince of Songkla University, Thailand. The authors thank all
the informants for their collaboration. Encouragement and
support from the colleagues of the first author in the School
of Nursing of Kunming Medical University are appreciated.
CONTRIBUTIONS
Study Design: HT, PS, SI.
Data Collection: HT.
Data Analysis: HT, PS, QW.
Manuscript Preparation: HT, PS.
Manuscript Revision: HT, PS, SI, QW.
REFERENCES
Andersson G, Engstrom A, Soderberg S. A chance to live: womens
experiences of living with a colostomy after rectal cancer surgery.
Int. J. Nurs. Pract. 2010; 16: 603608.
Beaver K, Latif S, Williamson S et al. An exploratory study of the
follow-up care needs of patients treated for colorectal cancer.
J. Clin. Nurs. 2010; 19: 32913300.
Bekkers MJ, van Knippenberg FC, van den Borne HW, van
Berge-Henegouwen GP. Prospective evaluation of psychosocial
adaptation to stoma surgery: the role of self-efficacy. Psychosom.
Med. 1996; 58: 183191.
Self-care of Chinese colostomy patients
Boyles A. Patient outcomes and quality of life following stoma-
forming surgery. Gastrointest. Nurs. 2010; 8: 3035.
Carver CS. Enhancing adaptation during treatment and the role of
individual differences. Cancer 2005; 104: 26022607.
Cheng F, Meng AF, Yang LF, Zhang YN. The correlation between
ostomy knowledge and self-care ability with psychosocial adjust-
ment in chinese patients with a permanent colostomy: a descriptive
study. Ostomy Wound Manage. 2013; 59: 3538.
Cheng F, Xu Q. Study on correlation between quality of life and
self-efficacy in patients with permanent colostomy. J. Nurs. 2009;
16: 912 (in Chinese).
DiCicco-Bloom B, Crabtree BF. The qualitative research interview.
Med. Educ. 2006; 40: 314321.
Elo S, Kyngas H. The qualitative content analysis process. J. Adv.
Nurs. 2008; 62: 107115.
Grant M, McMullen CK, Altschuler A et al. Gender differences in
quality of life among long-term colorectal cancer survivors with
ostomies. Oncol. Nurs. Forum 2011; 38: 587596.
Honkala S, Berter C. Living with an ostomy: womens long term
experiences. Nord. J. Nurs. Res. Clin. Stud 2009; 2: 1922.
Hu AL, Zhang MF, Hang MF et al. The status and related factors of
adjustment in colostomy patients. Chin. J. Nurs. 2010; 45: 109111
(in Chinese).
International Agency for Research on Cancer (IARC). Colorectal
Cancer: Estimated Incidence, Mortality and Prevalence Worldwide
in 2012. 2012. [Cited 28 Apr 2014.] Available from URL: http://
globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.
Li P, Zou HW. A qualitative study of the psychological experience of
patients with rectal cancer undergoing permanent colostomy.
Nurs. J. Chin. Peoples Lib. Army 2008; 25: 58 (in Chinese).
Lin YT. My Country and My People. Beijing: Foreign Language
Teaching and Research Press, 2009.
Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage,
1985.
McVey J, Madill A, Fielding D. The relevance of lowered personal
control for patients who have stoma surgery to treat cancer. Br. J.
Clin. Psychol. 2001; 40: 337337.
489
Popek S, Grant M, Gemmill R et al. Overcoming challenges: life with
an ostomy. Am. J. Surg. 2010; 200: 640645.
Richard AA, Shea K. Delineation of self-care and associated con-
cepts. J. Nurs. Scholarsh. 2011; 43: 255264.
Richbourg L, Thorpe JM, Rapp CG. Difficulties experienced by the
ostomate after hospital discharge. J. Wound Ostomy Continence
Nurs. 2007; 34: 7079.
Simmons KL, Smith JA, Bobb KA, Liles LL. Adjustment to colos-
tomy: stoma acceptance, stoma care self-efficacy and interpersonal
relationships. J. Adv. Nurs. 2007; 60: 627635.
Smith DM, Loewenstein G, Rozin P, Sherriff RL, Ubel PA. Sensitiv-
ity to disgust, stigma, and adjustment to life with a colostomy. J.
Res. Pers. 2007; 41: 787803.
Tao H, Songwathana P, Isaramalai SA, Zhang Y. Personal awareness
and behavioural choices on having a stoma: a qualitative
metasynthesis. J. Clin. Nurs. 2014; 23: 11861200.
Thorpe G, McArthur M, Richardson B. Healthcare experiences of
patients following faecal output stoma-forming surgery: a qualita-
tive exploration. Int. J. Nurs. Stud. 2014; 51: 379389.
Wan DS. Current status and prospect of enterostomal therapists
training in China. Chin. Cancer 2007; 16: 2325 (in Chinese).
Williams J. Flatus, odour and the ostomist: coping strategies and
interventions. Br. J. Nurs. 2008; 17: S10.
Wong TK, Pang SM. Holism and caring: nursing in the Chinese
health care culture. Holist. Nurs. Pract. 2000; 15: 1221.
Wu HK, Chau JP, Twinn S. Self-efficacy and quality of life among
stoma patients in Hong Kong. Cancer Nurs. 2007; 30: 186193.
Xu HL. Development on the research of stoma care and enterostomal
therapists. Shanghai Nurs. 2009; 9: 9395 (in Chinese).
Xu Q, Cheng F, Dai XD, Yang NL. Study on psychosocial adjustment
and its correlated factors in patients with permanent colostomy.
Chin. J. Nurs. 2010; 45: 883885 (in Chinese).
Yamashita M. The exercise of self-care agency scale. West. J. Nurs.
Res. 1998; 20: 370381.
Zhang JE, Wong FK, You LM et al. Effects of enterostomal nurse
telephone follow-up on postoperative adjustment of discharged
colostomy patients. Cancer Nurs. 2013; 36: 419428.
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