title: The Urostomy Education Scale: a reliable and valid tool to evaluate urostomy self-care skills among cystectomy patients.
abstract: OBJECTIVE
  : The purpose of this study was to validate a quantitative scale for nurses to evaluate self-care skills among patients undergoing cystectomy with creation of a urostomy.
  
  
  METHODS
  Twelve patients undergoing cystectomy with formation of a urostomy participated in the research. The study took place at Aarhus University Hospital, Denmark-a bladder cancer center performing approximately 100 cystectomies annually.
  
  
  METHODS
  The Urostomy Education Scale was developed in 2010 based on review of stoma care literature. Areas recognized as standard procedure in urostomy care were identified and categorized into 7 self-care skills necessary for changing the pouching system. The 7 skills were reaction to the stoma, removing the pouching system, measuring the stoma diameter, adjusting the size of the urostomy diameter in a new stoma appliance, skin care, fitting a new stoma appliance, and emptying procedure. Each skill is rated on a 4-point scale according to the patient's need of assistance from the nurse. Higher scores indicate a higher level of patient self-care skills related to changing a urostomy pouching system.
  
  
  METHODS
  Content, criterion, and construct validity were evaluated by a panel of experts using the Delphi method in 2010. To test interrater reliability and criterion validity, 4 nurses attended 12 patient training sessions at different postoperative days. Each patient was taught how to change a urostomy appliance using a standardized approach. One experienced enterostomal therapy nurse acted as the instructor and 3 other nurses observed and scored the patient's self-care skills. The 3 nurses' scores were analyzed using Bland Altman Plots with Limits of Agreements.To test construct validity, patients were categorized into 3 groups. The mean score in each group was used to analyze differences between groups using one way analysis of variance.
  
  
  RESULTS
  Analysis revealed that the Urostomy Education Scale distinguished urostomy self-care skills practice by beginners versus experienced patients (P= .01). Comparison of scores among the 3 nurses revealed no statistically significant differences. In addition, the Urostomy Education Scale demonstrated satisfactory reliability with Limits of Agreements ranging from -3 to 3; 86% of scores differed by 2 points or less.
  
  
  CONCLUSIONS
  To our knowledge, the Urostomy Education Scale is the first validated tool for nurses to document the patient's level of urostomy self-care skills.
authors.affiliation: Susanne Ammitzbøll Kristensen, RN, MHSc, Department of Urology, Aarhus University Hospital, Aarhus, Denmark. Sussie Laustsen, PhD, Centre of Research in Rehabilitation, Institute of Clinical Medicine and Section of Nursing Science, Aarhus University, Aarhus, Denmark. Berit Kiesbye, RN, WOC nurse, Department of Urology, Aarhus University Hospital, Aarhus, Denmark. Bente Thoft Jensen, MPH, PhD student, Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Susanne Ammitzbøll
authors.initials: SA
authors.lastname: Kristensen
authors.forename: Sussie
authors.initials: S
authors.lastname: Laustsen
authors.forename: Berit
authors.initials: B
authors.lastname: Kiesbye
authors.forename: Bente Thoft
authors.initials: BT
authors.lastname: Jensen
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000451:nursing; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care / Q000592:standards*