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Demographic, Clinical, and Quality of Life Variables Related to Embarrassment in Veterans Living With an Intestinal Stoma

Mitchell, Kimberly A.; Rawl, Susan M.; Schmidt, C. Max; Grant, Marcia; Ko, Clifford Y.; Baldwin, Carol M.; Wendel, Christopher; Krouse, Robert S.

Section Editor(s): Hocevar, Barbara J. BSN, RN, CWOCN, ET

Journal of Wound, Ostomy and Continence Nursing: September-October 2007 - Volume 34 - Issue 5 - p 524–532
doi: 10.1097/01.WON.0000290732.15947.9e
ostomy Care

Objective The study aims were to identify demographic, clinical, and quality of life variables related to embarrassment for people living with ostomies and to determine the experiences and/or feelings of veterans who were embarrassed by their ostomy.

Design This was a cross-sectional, correlational study.

Setting and Subjects A convenience sample of veterans (n = 239) living with ostomies from 3 VA medical centers was studied. The veterans were primarily Caucasian (84%), male (92%), and older (M = 69).

Instruments The modified City of Hope Quality of Life-Ostomy questionnaire was used. Additionally, an open-ended question related to living with an ostomy was asked.

Methods The questionnaire packets were mailed to participants and self-administered.

Results Approximately half of the participants (48%) rated their embarrassment as low, but 26% reported high embarrassment. Participants with high embarrassment were compared to those with low embarrassment on demographic, clinical, and quality of life variables. High embarrassment was associated with poorer total quality of life (P < .001) and poorer quality of life on the physical (P < .001), psychological (P < .001), social (P < .001), and spiritual (P < .001) subscales. Younger (P < .001) and unpartnered veterans (P < .001) were more likely to be highly embarrassed. Veterans with high embarrassment had higher anxiety (P < .001) and depression (P < .001), more difficulty with intimacy (P < .001), and felt more isolated (P < .001). Spiritual domain variables like hopefulness were associated with low embarrassment (P < .001). Sources of embarrassment included leakage, odor, and noise.

Conclusions Embarrassment may negatively impact a person's quality of life; therefore, the variables associated with high embarrassment should be recognized and addressed.

Kimberly A. Mitchell, MS, RN, Doctoral student, School of Nursing, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana; Assistant Professor, Saint Francis Medical Center College of Nursing, Peoria, Illinois.

Susan M. Rawl, PhD, RN, Associate Professor, School of Nursing, Indiana University Purdue University at Indianapolis, Center for Nursing Research, Indianapolis, Indiana.

C. Max Schmidt, MD, PhD, Staff General Surgeon, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Assistant Professor, Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Cancer Research Institute, Indianapolis, Indiana.

Marcia Grant, RN, DNSc, FAAN, Director, Department of Nursing Research and Education, City of Hope National Medical Center and Beckman Research, Duarte, California.

Clifford Y. Ko, MD, Staff Colorectal Surgeon, VA Greater Los Angeles Healthcare System, Los Angeles, California; Assistant Professor, UCLA, Los Angeles, California.

Carol M. Baldwin, PhD, RN, AHN-BC, Associate Professor, Southwest Borderlands, Arizona State University, College of Nursing, Phoenix, Arizona.

Christopher Wendel, MS, Biostatistician, Research Service Line, Southern Arizona VA Health Care System, Tucson, Arizona.

Robert S. Krouse, MD, Staff General and Oncologic Surgeon, Southern Arizona VA Health Care System, Surgical Care Line, Tucson, Arizona; Associate Professor, University of Arizona, Tucson, Arizona.

Corresponding author: Kimberly A. Mitchell, 511 N.E. Greenleaf, Peoria, IL 61603 (

Copyright © 2007 by the Wound, Ostomy and Continence Nurses Society