title: Struggles, strengths, and strategies: an ethnographic study exploring the experiences of adolescents living with an ostomy.
abstract: BACKGROUND
  Adolescents with IBD requiring ostomy surgery experience perioperative needs that may exceed those of patients experiencing other major abdominal surgery 1. This procedure requires ongoing and vigilant daily care and management. Gastrointestinal symptoms and complications impose psychological and social stresses on young patients 2, and the procedure results in body image changes and daily regimens of self-care. This study aimed to explore adolescents' experiences and quality of life following ostomy surgery.
  
  
  METHODS
  Ethnographic interviews and a subsequent focus group were conducted with 20 adolescents with an ostomy or j-pouch being treated at the Hospital for Sick Children in Toronto, Canada. Interviews were transcribed verbatim and subjected to theme generation.
  
  
  RESULTS
  Findings suggest that adolescents are profoundly affected by their ostomy. Adolescents convey strength as well as adjustment struggles. Identified impacts include body intrusion and body image changes, decreased independence, secrecy about the ostomy, adjustment over time, challenges for the family, and strategies for constructively moving forward.
  
  
  CONCLUSIONS
  Implications address the importance of ensuring meaningful opportunities to understand and reframe the stresses of illness. An ongoing clinical challenge involves the promotion of a healthy self-esteem and psychosocial adjustment for these adolescents and their families. Finding effective ways to minimize stress and embarrassment and reframe personal shame, constitute important clinical priorities. Opportunities for peer support and family dialogue may assist in clarifying worries and easing the burden carried by these young persons. Flexible and adequately funded resources are advocated in fostering quality of life.
authors.affiliation: Faculty of Social Work, Central and Northern Region, University of Calgary, Edmonton, Alberta, Canada. nicholas@ucalgary.ca
authors.forename: David B
authors.initials: DB
authors.lastname: Nicholas
authors.forename: Sylvia R
authors.initials: SR
authors.lastname: Swan
authors.forename: Ted J
authors.initials: TJ
authors.lastname: Gerstle
authors.forename: Theresa
authors.initials: T
authors.lastname: Allan
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Griffiths
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000884:Anthropology, Cultural; D039021:Colonic Pouches; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009864:Ontario; D010030:Ostomy / Q000523:psychology*; D011788:Quality of Life; D055815:Young Adult