EFECTO DE LA CAPACITACIÓN ESTRUCTURADA EN SERVICIO SOBRE EL CONOCIMIENTO, PRÁCTICA Y AUTOCONFIANZA DE LOS ENFERMEROS RESPECTO AL CUIDADO DE PACIENTES CON COLOSTOMÍA

tce Texto & Contexto - Enfermagem Texto contexto - enferm. 0104-0707 1980-265X Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem RESUMEN Objetivo: Determinar el impacto de la capacitación estructurada en servicio sobre el conocimiento, práctica y autoconfianza de los enfermeros respecto al cuidado de pacientes con colostomía. Método: Utilizando un diseño cuasi-experimental de un solo grupo con pretest y postest, el estudio se realizó en el departamento de oncología de los Egypt Health Care Authority hospitals, Port Said governorate (Elmabra Hospital) y en el Instituto de Oncología en la ciudad de Damietta. Entre octubre de 2023 y enero de 2024, 50 enfermeros de los departamentos de oncología de las dos ciudades de Egipto participaron en el estudio para evaluar su conocimiento, práctica y autoconfianza antes y después de recibir capacitación en servicio sobre el cuidado de la colostomía. El análisis de datos se realizó utilizando estadísticas descriptivas, correlacionales e inferenciales. Resultados: La implementación de la capacitación estructurada en servicio mejoró significativamente los puntajes totales de conocimiento, práctica y niveles de autoconfianza de los enfermeros (p ≤ 0.05). Cabe destacar que después de la capacitación surgió una correlación positiva más fuerte entre el conocimiento y la práctica, el conocimiento y la autoconfianza, y la práctica y la autoconfianza de los enfermeros (r=0.757, r=0.738 y r=0.619, respectivamente). Sin embargo, estas correlaciones también fueron significativas antes del programa de capacitación. Conclusión: El estudio destaca la necesidad crítica de que los enfermeros se concentren en el campo especializado del cuidado de la colostomía mediante el establecimiento de un sistema de capacitación en servicio de rutina. Se requiere más investigación para validar los hallazgos de esta investigación. INTRODUCTION Colostomy, a surgical opening for the colon through the abdomen, is indicated for various reasons, including bowel malignancy, blockage, congenital abnormalities, fistula, trauma, stricture, ischemia, thrombosis, and inflammatory diseases1. Successful execution of colostomy care necessitates that nurses possess the requisite knowledge, attitude, and skills. Depending on the type of colostomy, patients may require a diverse array of nursing interventions2. Colostomy, frequently performed life-saving surgery, is employed to decompress an obstructed colon, or divert excrement. Despite the critical importance of colostomy care in enhancing the quality of life for patients, information on nurses’ knowledge, attitudes, and roles in this area is limited3, particularly in Egypt4. The management of colostomies and their complications falls under the purview of nursing, with an emphasis on providing physical, social, and emotional support5-6. The challenges faced by patients with ostomies can be mitigated, allowing them to regain a semblance of normalcy in their lives through the specialized care provided by trained nurses7. In recognition of the importance of addressing the unique needs of ostomy patients, an international declaration asserts their right to specialist pre- and post-surgical nursing care, whether within the confines of a hospital or in community settings. Colostomy nurses perform more intricate duties today than before, evolving from enteral therapists or bedside caregivers to experienced ostomy care practitioners and nurse scientists. Their pivotal role encompasses patient assistance, motivation, and meticulous attention to health education, fostering patient health literacy across diverse healthcare settings8. A comprehensive care program for a patient’s post-ostomy surgery is critical, covering essential practices such as bag preparation, draining, and replacement, as well as control measures like diet, fluid intake, identification of complications, medication considerations, and management of bloating and odor9. Self-confidence plays a pivotal role in identifying, escalating, and managing nursing errors, underscoring the need for nurses to possess knowledge and confidence in their abilities10. Adequate knowledge and confidence are crucial for nurses to provide optimal colostomy care and avoid complications following stoma surgery7,11. Recognizing the need for ongoing professional development and in-service training programs for nurses is recommended. These programs facilitate continuous training and peer group discussions, fostering an environment where professionals can enhance their skills and knowledge12. In conclusion, the multifaceted role of nurses in colostomy care underscores the necessity for continuous education, support, and self-confidence to ensure optimal outcomes for patients managing ostomies. Therefore, the current study aimed to assess the effect of structured in-service training on nurses’ knowledge, practice, and self-confidence regarding caring for patients with a colostomy. METHOD This study employed a one-group pretest-posttest quasi-experimental design guided by the STROBE tool. This design allows for the evaluation of changes within a single group over time, providing valuable insights into the impact of the intervention. The target population was all available nurses in the oncology department at Egypt Health Care Authority hospitals in Port Said governorate (Elmabra Hospital) and the oncology institute in Damietta City. The study was conducted between October 2023 and January 2024. These settings were selected to capture a diverse representation of the oncology nursing workforce in distinct healthcare facilities. The sample size was determined using the probability proportional to size (PPS) formula. Through this method, 50 nurses were selected utilizing convenience sampling, ensuring a balance between practicality and representation in the study. The inclusion criteria included registered nurses with a minimum of 1 year of experience in the oncology department. This criterion aimed to ensure that participants had a foundational level of expertise relevant to the study objectives. Nurses in administrative positions and those lacking direct patient contact were excluded from the study. The focus on frontline nursing staff with direct patient interactions aimed to maintain the relevance and applicability of the findings to those actively involved in patient care. As for the data collection, the tool of data collection encompassed four parts as follow: Part I: Demographic Characteristics: The first section of the structured interviewing questionnaire focused on gathering demographic information about the participating nurses, including age, marital status, and level of education. This foundational data provides context to the subsequent analysis of knowledge, practice, and confidence in colostomy care. Part II: Knowledge Assessment: A knowledge questionnaire, drawing inspiration from established works2,13-14, was used to evaluate nurses’ understanding of colostomy care. Comprising 19 multiple-choice questions, the questionnaire covered a spectrum of topics such as definition, causes, symptoms, preoperative preparations, postoperative exercise, application of tubes, immediate complications, warning signs, and dietary considerations. Responses were scored on a binary system (1 for correct, 0 for incorrect), with a maximum possible score of 19. The overall score was categorized as satisfactory (≥60%) or unsatisfactory (<60%). The reliability of the questionnaire was demonstrated through a Cronbach’s alpha coefficient of 0.854. Part III: Observational Practice Checklist: The Observational practice checklist for colostomy care consisted of 3 main categories, and all categories of the tool consisted of 48 items. The following items were covered in the best practices for stoma and peristomal skin care that the researcher observed and evaluated. These items included 17 items for emptying, cleaning, and reusing the bag, 14 for stoma irrigation, and 17 for applying a new pouch. In a scoring system, the items of care were observed and checked on a 2-point Likert scale (1= correct or done while 0 = incorrect or not done). The scores of the items were added up for each area, and the total score was divided by the number of items, yielding a mean and standard deviation (SD) score for the area, which was then converted into percent scores. If the percent score was 60% or higher, the observed practice was considered adequate; if it was less than 60%, it was deemed inadequate. Reliability was assessed by Cronbach’s alpha coefficient (0.82)4. Part IV: Nurse’s Self-Confidence: Nurse’s self-confidence scale consisted of a 13-item Likert scale measuring staff nurses’ self-confidence in caring for patients with ostomies15. Each response on the five-point Likert scale received a score between 1 (strongly disagree) and 5 (strongly agree). Self-confidence level items comprised questions relating to nursing staff self-confidence, practice, and supplies essential for ostomy care. There were seven items to measure knowledge-related self-confidence and six for skill-related self-confidence. Higher scores ≥60% indicated high self-confidence in care for colostomies, and lower scores <60% indicated low self-confidence in the procedure. The questionnaire has been tested for validity and reliability, and the tool’s reliability was assessed by Cronbach’s alpha coefficient (0.75)16. Before embarking on data collection, piloting of the adopted data collection tools was conducted on seven nurses working in units similar to the study setting to assess the clarity and feasibility of the tools. Nevertheless, the findings reflected clear and suitable tools for data collection, however, the results of the pilot study were not included in the final report of the current study. The participant nurses' knowledge, practice, and self-confidence in caring for colostomies were assessed initially before conducting the training program. The in-service training program was meticulously designed to consider the specific needs and understanding levels of colostomy nurses. The training material was presented in the form of a booklet, written in simple Arabic language, and accompanied by photo illustrations. The training comprised two parts: the theoretical part, delivered through lectures, group discussions, data show presentations, and posters, and the practical part, involving demonstrations, return demonstrations, and video illustrations. The theoretical component of the training spanned three sessions, each lasting approximately 45 minutes, with an additional 15 minutes allocated for feedback and questions. It covered crucial aspects of colostomy care, including the purpose and care of colostomy, daily life changes, elimination, diet regimen, traveling preparations, physical activities, follow-up visits, complications, and signs requiring immediate medical attention. The practical segment of the training was divided into two sessions, each lasting about 45 minutes. It was delivered through demonstration, return demonstration, and video illustration. The practical part encompassed hands-on activities such as measuring stoma size, emptying and changing the stoma pouch, stoma irrigation, and peristomal skin care. The training sessions were conducted in small groups of three to five nurses to ensure minimal disruption to their daily responsibilities. One month after the colostomy care training sessions, the structure and effectiveness of the in-service training were evaluated using the same questionnaire employed before the nurses’ exposure to the training. This assessment encompassed the nurses’ knowledge, self-confidence, and practice of colostomy care. This comprehensive evaluation allowed for a thorough examination of the impact of the training on participants. The study adhered to ethical standards, with each participating nurse being provided with a clear explanation of the study’s purpose and nature. Nurses were assured of their right to withdraw from the study at any point without repercussions on their care. Ethical approval for the study was obtained from the Research Ethics Committee (REC) at the Faculty of Nursing, Port Said University, under the reference NUR 1/10/2023-30. Informed consent was obtained from each nurse before participating, emphasizing transparency and respect for participants’ autonomy. The statistical analysis for this study was conducted using the Statistical Package for Social Sciences software program (SPSS) version 20.017. The data underwent a comprehensive analysis to derive meaningful insights into the impact of the in-service training program on nurses’ knowledge, self-confidence, and practice in colostomy care. Quantitative data were described using key statistical measures, including percentages and figures. The Shapiro-Wilk test was employed to confirm the normality of the data distribution. To provide a clear understanding of the data, the range (maximum value minus minimum value), mean, SD, and median of quantitative variables were calculated. These measures collectively presented a comprehensive overview of the central tendency and variability within the dataset. A significance level of 5% was adopted to assess the statistical significance of the results. This standard level allowed for a rigorous evaluation of the findings and determination of the reliability of the observed outcomes. The Marginal Homogeneity Test was applied to assess whether the marginal distributions of the two groups (pre- and post-training program) were equal. This test is valuable in determining if there were significant differences in the distributions before and after the intervention. For quantitative variables with a normally distributed distribution, a PairWise t-test was utilized to compare two periods (pre- and post-training). This test allowed for a detailed examination of statistically significant measurement differences between the two points. In cases where quantitative variables exhibited an anomalous distribution, the Wilcoxon signed ranks test was employed to compare two periods (pre- and post-training). This non-parametric test is particularly useful when the assumption of normality is not met. To assess the strength and direction of the monotonic relationship between groups before and after the training program, the Spearman correlation coefficient test (ρ or rho) was utilized. This test provides insights into the degree of association between variables without assuming a linear relationship. RESULTS A total of 50 nurses were included in this study, of whom 94% were in the age group 20 to less than 30, with a mean age of 25.64 ± 3.58, and the vast majority had nursing experience of 1 to 10 years (94%). About half of the participants (50.0 %) had technical nursing institutes education, and nearly half (48.0 %) of the nurses had previous years of training courses about colostomy for five to less than ten years (Table 1). Table 1- Description of the characteristics of participant nurses from the oncology department of Elmabra Hospital in Port Said and the oncology institute in Damietta City, Egypt, 2023 & 2024, (N=50). Variable No. (%) Age 20 - < 30 years 47(94.0) 30 - < 40 years 3(6.0) ≥ 40 years 0(0.0) Mean ± SD. 25.64 ± 3.58 Qualification Nursing Diploma 16(32.0) Nursing Technical Institute 25(50.0) Bachelor of Nursing 9(18.0) Previous years of training courses about colostomy Less than one year 0 (0) one - < 5 years 23(46.0) 5 - < 10 years 24(48.0) ≥ ten years 3(6 .0) Take advantage of the courses. No 45(90.0) Medium 5(10.0) Years of Experience 1-10 years 47(94.0) 11-20 years 3(6.0) Table 2 reveals a noticeable improvement in nurses’ knowledge post-implementation of the structured in-service training for knowledge about the colostomy bag, prevention of skin problems, diet, and overall knowledge score compared to pre-intervention with a statistically significant difference. The overall knowledge mean scores for the pre-training test and after-training program were 14.70±1.69 and 16.48±1.50, respectively. On the other side, there was a significant decrease in the mean score after the training in participants’ knowledge about the activities of patients with colostomies (p<0.001). Table 2 - Nurses' knowledge mean-score before and after in-service training at the oncology department of Elmabra Hospital in Port Said and the oncology institute in Damietta City, Egypt, 2023 & 2024, (N=50). Knowledge Mean scores (mean ± SD) Test of Sig. p§ Before training After training Knowledge about colostomy Min. - Max. 8.0 - 11.0 8.0 - 10.0 Z¶=1.277 0.202 Mean ± SD. 9.10 ± 0.95 9.22 ± 0.65 Knowledge about the colostomy bag Min. - Max. 0.0 - 2.0 1.0 - 2.0 Z=2.178* 0.029* Mean ± SD. 1.60 ± 0.67 1.84 ± 0.37 Knowledge about the prevention of skin problems Min. - Max. 0.0 - 3.0 1.0 - 4.0 Z=3.644* <0.001* Mean ± SD. 1.50 ± 0.81 2.28 ± 0.97 Knowledge about diet Min. - Max. 1.0 - 2.0 2.0 - 3.0 Z=6.208* <0.001* Mean ± SD. 1.80 ± 0.40 2.84 ± 0.37 knowledge about activities Min. - Max. 0.0 - 2.0 0.0 - 1.0 Z=3.135* 0.002* Mean ± SD. 0.70 ± 0.65 0.30 ± 0.46 Total knowledge of nurses Min. - Max. 12.0 - 18.0 14.0 - 19.0 Z=4.840* <0.001* Mean ± SD. 14.70 ± 1.69 16.48 ± 1.50 ¶: Wilcoxon signed-rank test (Z-test); §: p-value for comparing the Pre and Post; *: Statistically significant at p ≤ 0.05 Table 3 showed a noticeable improvement in nurses’ practice post-training compared to pre-intervention regarding emptying, cleaning, and reusing the bag, stoma irrigation, and applying a new pouch with statistical significance (P<0.001). Also, the overall practice mean scores for the pre-training test and after-training program were 39.60±6.66 and 45.94±1.15, respectively, with statistical significance. Table 3 - Nurses' practice mean-score before and after the in-service training program at the oncology department of Elmabra Hospital in Port Said and the oncology institute in Damietta City, Egypt, 2023 & 2024, (N=50). Practice Mean scores (mean ± SD) Test of Sig. p§ Before training After training Empty, clean, and reuse the bag. Min. - Max. 12.0 - 17.0 16.0 - 17.0 Z¶=4.105* <0.001* Mean ± SD. 15.20 ± 1.68 16.46 ± 0.50 Stoma irrigation Min. - Max. 3.0 - 14.0 12.0 - 14.0 Z=5.063* <0.001* Mean ± SD. 10.30 ± 3.26 13.04 ± 0.60 Applying a new pouch Min. - Max. 9.0 - 17.0 16.0 - 17.0 Z=4.256* <0.001* Mean ± SD. 14.10 ± 2.91 16.44 ± 0.50 Total practice of nurses Min. - Max. 30.0 - 48.0 44.0 - 47.0 Z=5.083* <0.001* Mean ± SD. 39.60 ± 6.66 45.94 ± 1.15 Median 40.50 46.0 Wilcoxon signed-rank test (Z-test); §: p-value for comparing the Pre and Post; *: Statistically significant at p≤0.05 Table 4 shows the mean scores and SD for the nurses’ self-confidence concerning knowledge and skill in different areas of ostomy and stoma care in pre- and post-educational programs. Regarding knowledge, the nurses demonstrated the highest self-confidence in ordering the correct supplies, with a mean rating of 5.14 (SD=1.07) after the in-service training compared to (2.58±0.50) before the training program. The nurse demonstrated self-confidence in terms of practice and improved self-confidence in all terms after the in-service training than before training, with a higher mean score in cutting the wafer to the appropriate size 5.06 (SD=1.22) and measuring the stoma 5.04 (SD=1.19) after the training program. Table 4 - Nurses' mean-score of self-confidence before and after the in-service training program at the oncology department of Elmabra Hospital in Port Said and the oncology institute in Damietta City, Egypt, 2023 & 2024, (N=50). Q Nurse Self-confidence Mean ± SD. Before training After training Knowledge statement: I feel confident 1 Knowing the difference between colostomy, ileostomy, and urostomy 2.00 ± 0.00 3.72 ± 0.99 2 Prevention of skin problems 2.56 ± 0.50 3.80 ± 1.01 3 Dealing with the odor 2.36 ± 0.48 3.78 ± 0.93 4 When to attach to a larger drainage bag if needed 1.84 ± 0.58 3.76 ± 1.02 5 Ordering the correct supplies 2.58 ± 0.50 5.14 ± 1.07 6 Dealing with peristomal skin problems 2.16 ± 0.65 4.46 ± 0.93 7 Knowledge of nutrition for patients with ostomies 2.34 ± 0.48 4.16 ± 1.13 Practice Statement: I feel confident 8 Emptying an ostomy appliance 2.42 ± 0.67 3.90 ± 0.95 9 Changing an ostomy appliance 1.88 ± 0.63 3.90 ± 0.99 10 Cutting the wafer to the appropriate size 2.36 ± 0.48 5.06 ± 1.22 11 Measuring the stoma 2.12 ± 0.63 5.04 ± 1.19 12 Applying the paste, if needed 2.22 ± 0.42 3.86 ± 0.90 13 How to attach to a larger drainage bag, if needed 2.42 ± 0.64 4.56 ± 0.91 The results also showed that the mean score of nurses’ self-confidence with knowledge and practice after training was significantly higher than the self-confidence mean score before training (Table 5). Table 5 - Total mean score of nurse’s self-confidence before and after training at the oncology department of Elmabra Hospital in Port Said and the oncology institute in Damietta City, Egypt, 2023 & 2024, (N=50). Nurse’s self-confidence Mean scores (mean ± SD) Test of Sig. p§ Before training After training Knowledge statement: I feel confident Min. - Max. 14.0 - 18.0 23.0 - 36.0 t‡=26.01* <0.001* Mean ± SD. 15.84 ± 1.39 28.84 ± 3.11 Skill statement: I feel confident Min. - Max. 10.0 - 16.0 17.0 - 32.0 t=23.433* <0.001* Mean ± SD. 13.42 ± 1.39 26.32 ± 3.42 Total nurse’s self-confidence Min. - Max. 25.0 - 32.0 40.0 - 68.0 t=28.039* <0.001* Mean ± SD. 29.26 ± 1.96 55.16 ± 5.99 ‡: Paired t-test; §: p-value for comparing between the Pre and Post; *: Statistically significant at p≤0.05 Table 6 illustrates the correlation between knowledge, practice, and nurses’ self-confidence before and after structured in-service training. The analysis reveals a noteworthy positive correlation between knowledge and practice, knowledge and self-confidence, and practice and self-confidence among the nurses, both before and after participating in the in-service training program. Remarkably, the positive correlation strengthened after the implementation of the training program, as evidenced by the higher Spearman’s correlation coefficient (rs) value observed in the post-training phase compared to the pre-training phase. Table 6 - Correlation between nurses' knowledge, practice, and self-confidence before and after training at the oncology department of Elmabra Hospital in Port Said and the oncology institute in Damietta City, Egypt, 2023 & 2024, (N=50). Correlation Before training After training Knowledge VS. Practice rs † 0.527* 0.757* p <0.001* <0.001* Knowledge VS. Nurse’s Self-confidence rs 0.465* 0.738* P 0.001* <0.001* Practice VS. nurse’s self-confidence rs 0.326* 0.619* p 0.021* <0.001* †: Spearman coeficiente; *: Statistically significant at p≤0.05 DISCUSSION The current study aimed to assess the impact of structured in-service training on nurses’ knowledge, practice, and self-confidence in caring for patients with colostomies. Examination of knowledge, practice, and self-confidence levels before and after the training indicated notable improvements, with a significantly higher mean score of advancement observed post-training. Colostomy-related issues substantially curtail social activities for patients, impacting their daily lives, diminishing their quality of life, and affecting family relationships18. Acute care nurses must possess foundational skills to support new ostomy patients with postoperative care and education. This includes expertise in accurate stoma assessment, fitting pouch systems, pouch maintenance, supply management, and fundamental problem-solving techniques for stomas19. Previous studies emphasize the significance of nurses gaining ostomy care experience, with limited opportunities negatively impacting their ability to retain experiences20-21. Globally, nursing care is guided by the nursing process, recognized as the cornerstone of modern practice and a crucial element in nursing education, serving as the foundation for all nursing actions in any environment or context22. There was a substantial increase in the mean knowledge score following the training, particularly in areas related to the colostomy bag, prevention of skin problems, and dietary considerations compared to the scores obtained before the training. The existing study found no significant difference in general background information and the anatomy and physiology associated with colostomy. Moreover, a considerable enhancement in the mean knowledge score post-training was observed regarding activities. This outcome aligns with the findings23, who investigated the impact of remote learning on ostomy knowledge. In their quasi-experimental pre-post study involving 41 nurses in a simulated learning environment program, significant improvement was noted in ostomy knowledge, with five nurses scoring above 80% on the pre-test and 32 scoring above 80% on the post-test23. In terms of practical application, the current study revealed a notable enhancement in nurses’ post-training practices compared to pre-intervention, specifically in activities such as emptying, cleaning, reusing the bag, stoma irrigation, and applying a new pouch. The overall practice mean scores for the pre-training test and after-training program were 39.60±6.66 and 45.94±1.15, respectively, with statistical significance. This finding is consistent with research24, who, in a quasi-experimental design study focused on enhancing nurses’ knowledge and practices for children with intestinal ostomies, observed improvement in the understanding of 28 out of 35 pediatric nurses after completing the program. The study revealed that 17 nurses had solid knowledge before the education sessions, while 28 nurses had a good understanding after completing the educational program24. Exposure to stoma care is pivotal, fostering the development of nurses’ self-confidence in providing stoma care. This sentiment echoes the results of a study25, underscored the positive impact of education on enhancing patients’ self-care abilities and care behaviors. The current study, in harmony with these findings, highlights the valuable role of education in improving nurses’ knowledge, confidence, and, ultimately, stoma care delivery. The study disclosed a notable increase in the self-confidence of most nurses when it came to ordering the correct supplies post-education, with a mean score of 5.14 (SD=1.07), compared to 2.58±0.50 in the pre-educational program. Following the in-service training, nurses exhibited improved self-confidence in their practical skills, surpassing their pre-training levels. Particularly noteworthy were the highest mean scores post-training in tasks such as cutting the wafer to the appropriate size (5.06±1.22) and measuring the stoma (5.04±1.19). This aligns with findings in research26, who observed enhanced confidence in nurse practitioners after an educational program focusing on advance directives. Similarly, authors 27 discovered that multidisciplinary teaching strategies could elevate nursing students’ learning practice, self-confidence, and satisfaction. In our study, post-training scores reflected a significant improvement in nurses’ self-confidence related to knowledge and skills, in line with study28 who highlighted the positive impact of well-organized educational programs on students’ cognitive growth and self-confidence when dealing with complicated issues. Contrarily, authors29 pointed out that lack of nurses’ confidence and expertise in providing ostomy care might result in inadequate attention to such patients in hospital settings. Our study reinforced the importance of training programs in addressing this issue. Furthermore, our study identified a stronger positive correlation post-training between nurses’ knowledge, practice, and self-confidence in stoma care than before the training. Although significant correlations existed both before and after the training program, our findings resonate with a systematic review30, emphasizing the effectiveness of active learning strategies over didactic teaching in enhancing retention of knowledge and improving clinical practice in sepsis training. In light of these results, providing nurses with opportunities for experiential learning, such as rotations at critical care facilities with simulation training, is imperative. This practical application of theoretical knowledge has proven instrumental in enhancing nurses’ competence and self-assurance. Our findings align with a study15 emphasized that ostomy training enhances the knowledge of various ostomy care aspects of nurses, thereby boosting self-confidence in delivering care. Furthermore, competent and confident nurses contribute to improved patient comfort and satisfaction. Cross, Roe15 surveyed staff nurses to investigate their perceptions of abilities and self-confidence in handling ostomy care, revealing that increased confidence and skill levels were associated with more years of expertise and direct ostomy treatment. This underscores the positive impact of hands-on experience on nurses’ proficiency in stoma care. Research31 demonstrated that nurses with improved levels of knowledge and expertise in stoma care not only enhance their ability to manage patients’ care effectively but also excel in communication and foster a positive sense of self. This emphasizes the broader benefits that stem from a heightened understanding and proficiency in the intricacies of ostomy care. While the current research has yielded promising results, it is important to acknowledge several inherent limitations that may temper the generalizability of our findings. One notable constraint lies in utilizing a non-probability sampling technique, which, by its nature, introduces a degree of selection bias. This means that the individuals included in our study may not fully represent the broader population, potentially impacting the external validity of our results. Furthermore, the restricted sample size employed in our research poses a significant limitation. A small sample size can compromise the study’s statistical power, limiting our ability to draw robust conclusions and generalize the findings to a broader context. CONCLUSION Our research delves into the impact of structured in-service training on nurses, explicitly focusing on bolstering their knowledge, refining their practice, and boosting self-confidence in caring for patients with colostomy. The significance of this study lies in its contribution to the broader goal of improving patient outcomes by elevating the competency of nurses in addressing the unique needs of individuals with colostomies. The structured in-service training serves as a pivotal intervention, aiming to equip nurses with the requisite skills and knowledge to navigate the complexities associated with colostomy care. By honing their expertise, we seek to enhance the quality of nursing care delivered to this medically complex patient population. The multifaceted nature of colostomy care demands a nuanced understanding, and our study endeavors to bridge potential gaps in knowledge and practice through targeted training. In conclusion, our study not only sheds light on the transformative impact of structured in-service training on nurses’ capabilities in colostomy care but also underscores the broader implications for patient safety, quality of care, and public health outcomes. As healthcare professionals become more adept at managing the unique challenges presented by colostomy patients, we move closer to a healthcare landscape that is not only competent but also compassionate and proactive in meeting the diverse needs of its patient population. As for the implications in practice, the study will inspire nurses to give patients’ colostomy an excellent treatment. The study will assist in lowering the cost of therapy and length of hospital stay for patients with colostomy. Patients with colostomy are more likely to experience psychological issues, malnutrition, noncompliance with treatment, stoma complications including stoma retraction, prolapsed, and hernia, as well as infections of the stoma and surrounding skin. Additionally, having a colostomy reduces quality of life; thus, this research will lay the groundwork for people with colostomy to live better for the rest of their lives. 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Effect of a stoma nursing care program on the adjustment of patients with an ostomy Aquichan Internet 2020 2024 Mar 13 20 1 e2014 Available from: https://doi.org/10.5294/aqui.2020.20.1.4 NOTES ORIGIN OF THE ARTICLE Article extracted from the - Effect of structured in-service training on nurses’ knowledge, practice, and self-confidence regarding patients’ colostomy care, presented to Oncology Department at Egypt Health Care Authority Hospitals in Port Said Governorate (Elmabra Hospital) and the Oncology Institute in Damietta City, in 2023/2024. FUNDING INFORMATION The authors received no financial assistance for this work’s research, writing, and publication. APPROVAL OF ETHICS COMMITTEE IN RESEARCH The study received approval from the Research Ethics Committee of the Faculty of Nursing at Port Said University, as indicated by the assigned Ethics Committee decision number (NUR 1/10/2023-30).