# Situation: A 60-year-old man had an abdominoperineal resection with a permanent descending colostomy for rectal cancer 7 days ago. The stoma is pink and moist, and the colostomy is functioning. His wife will help him at home. The nurse begins discharge teaching. When the nurse brings the pouching supplies, he turns his face away and says, "I can't look at that thing." Which action should the nurse take FIRST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629753  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 60-year-old man had an abdominoperineal resection with a permanent descending colostomy for rectal cancer 7 days ago. The stoma is pink and moist, and the colostomy is functioning. His wife will help him at home. The nurse begins discharge teaching.

When the nurse brings the pouching supplies, he turns his face away and says, "I can't look at that thing." Which action should the nurse take FIRST?

## 보기

1. Show him a video of a pouch change done by another client
2. Acknowledge his feelings and ask him to hold the new pouch **✔ 정답**
3. Postpone all stoma teaching until he asks to learn about it
4. Teach his wife the full pouch change so she can do it for him

**정답: 2**

## 해설

His reaction shows that the affective part of learning—accepting the stoma—must come first. The nurse acknowledges his feelings and invites a small, safe step of participation, which builds readiness and self-efficacy without forcing him. Handing care to his wife or waiting passively delays his own learning, which he needs before discharge.

## 심화 해설

Why the correct answer is option 2

The patient’s statement, “I can’t look at that thing,” is not primarily a request for technical information. It reflects the affective domain of learning—the emotional and attitudinal component that must be addressed before psychomotor skill training can succeed. After abdominoperineal resection, the stoma represents a visible alteration in body image, and avoidance is a common early coping response [1][4].

Acknowledging the patient’s feelings validates his distress without dismissing it, while asking him to simply hold the pouch is a small, non-threatening behavioral step that builds readiness. This approach respects his autonomy and begins to move him from avoidance toward participation at his own pace. It is consistent with the principle that psychosocial adjustment is a prerequisite for effective self-care education [1].

Watch out! Option 1 jumps too quickly to a full demonstration before the patient has expressed any willingness to engage. Showing a video may increase anxiety if the affective barrier is not addressed first.

Watch out! Option 3 delays teaching entirely. Discharge is approaching, and passive waiting can prolong dependence and increase anxiety. The patient needs structured, incremental exposure rather than avoidance.

Watch out! Option 4 shifts the learning burden to the wife. While caregiver involvement is valuable, the patient’s own self-efficacy is the priority. If the nurse teaches only the wife, the patient may feel further alienated from his own care and body [2].

Psychosocial context from the evidence

Literature on ostomy patients consistently identifies body image disturbance, depression, anxiety, and social isolation as major postoperative concerns [1][4]. Avoidance of looking at or touching the stoma is a behavioral manifestation of these emotional responses. Patients who receive structured educational interventions with nursing follow-up show reduced anxiety and depression compared with standard care [3]. This supports the idea that education must be delivered in a way that first addresses emotional readiness.

How the nurse builds readiness

| Nursing action | Purpose | Why it works |
| --- | --- | --- |
| Acknowledge feelings (“It’s hard to look at it right now”) | Validate the emotional response | Reduces shame and builds trust [1] |
| Ask him to hold the pouch (not apply it) | Introduce a small, safe step | Increases self-efficacy without overwhelming him |
| Offer to describe the stoma while he holds the pouch | Pair verbal information with tactile exposure | Bridges affective and cognitive learning |
| Invite his wife to observe, not take over | Include caregiver support | Prepares her to assist without replacing the patient [2] |

Why this matters for discharge

At 7 days postoperatively, the stoma is pink and moist, and the colostomy is functioning—physiologically stable. The remaining barrier is psychological. If the patient cannot look at or touch the stoma, he cannot learn to empty, clean, or change the pouch independently, which places him at risk for peristomal skin complications and readmission. Structured education combined with nursing follow-up has been shown to reduce peristomal complications [3].

Key point! The first step in stoma teaching is not demonstrating technique—it is assessing and responding to the patient’s emotional readiness. Acknowledgment plus a small participatory step is the correct initial intervention.References (research sources)

- [1]Overview of psychosocial problems in individuals with stoma: A review of literature.Research articleAyaz-Alkaya S (2019) · DOI: 10.1111/iwj.13018

- [2]"Translational" Patient Education in Adult Cancer Patients with Entero-Urostomy and Their Caregivers: A Qualitative Focus Group Study.Research articlePanattoni N, Campoli A, Spano A, De Stefano C, De Rossi D, Sorrenti F, Paterniani A, De Leo A, Petrone F, Iacorossi L, Di Simone E. (2026) · DOI: 10.3390/healthcare14162501

- [3]A comprehensive educational intervention to reduce depression, anxiety and complications in Greek patients with ostomy.Research articleTzani ME, Govina O, Katsoulas T, Kavga A, Drakopoulou M, Tsatsou I, Kalemikerakis I. (2026) · DOI: 10.15386/mpr-2941

- [4]Living with a stoma: a review of the literature.Research articleBrown H, Randle J (2005) · DOI: 10.1111/j.1365-2702.2004.00945.x

## 임상 시나리오

Stoma Teaching ReadinessAddress feelings before skills
A patient who says "I can't look at that thing" is showing an affective barrier, not asking for technical steps. Acknowledge the feeling, then invite one small, safe action such as holding the pouch to build self-efficacy.

After abdominoperineal resection, a new stoma is a visible change in body image. Avoidance is a common early coping response, so psychosocial adjustment must come before psychomotor skill training.

CautionDo not postpone all teaching until the patient asks, and do not shift full care to the wife. Discharge is near, and the patient needs structured, incremental exposure rather than avoidance or caregiver dependence.

## 핵심 개념

- **Affective domain** — The emotional and attitudinal component of learning that must be addressed before psychomotor skill training can succeed.
- **Abdominoperineal resection** — Surgical removal of the rectum and anus with creation of a permanent colostomy, often for rectal cancer.
- **Self-efficacy** — A person's belief in their ability to perform a behavior, which is built through small, successful steps.
- **Body image disturbance** — Emotional distress from a visible change in body appearance or function, such as a new stoma.
- **Colostomy** — A surgically created opening in the colon brought to the abdominal surface for elimination of stool.

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