A randomized prospective trial of an ostomy telehealth intervention for cancer survivors.

BACKGROUND: Cancer survivors with ostomies face complex challenges. This study compared the Ostomy Self-Management Telehealth program (OSMT) versus attention control usual care (UC). METHODS: Three academic centers randomized participants. OSMT group sessions were led by ostomy nurses and peer ostomates (three for ostomates-only, one for support persons, and one review session for both). Surveys at baseline, OSMT completion, and 6 months were primary outcome patient activation (PAM), self-efficacy (SE), City of Hope quality of life-Ostomy (COH-O), and Hospital Anxiety and Depression Scale (HADS). Surveys were scored per guidelines for those completing at least two surveys. Linear mixed effects models were used to select potential covariates for the final model and to test the impact of OSMT within each timeframe. RESULTS: A total of 90 OSMT and 101 UC fulfilled analysis criteria. Arms were well-matched but types of tumors were unevenly distributed (p = .023). The OSMT arm had a nonsignificant improvement in PAM (confidence interval [CI], -3.65 to 5.3]; 4.0 vs. 2.9) at 6 months. There were no significant differences in other surveys. There was a significant OSMT benefit for urinary tumors (four SE domains). Higher OSMT session attendance was associated with post-session improvements in five SE domains (p < .05), two COH-O domains (p < .05), and HADS anxiety (p = .01). At 6 months, there remained improvements in one SE domain (p < .05), one COH-O domain (p < .05), and HADS anxiety (p < .01). CONCLUSIONS: No clear benefit was seen for the OSMT intervention, although there may be an advantage based on type of tumor. Benefit with greater session attendance was also encouraging. PLAIN LANGUAGE SUMMARY: Cancer patients with ostomies have many challenges. We tested a telehealth curriculum compared to usual care. There are indications of benefit for the program for those that attend more sessions and those with urostomies.

Self-management goals of cancer survivors with an ostomy.

OBJECTIVES: Ostomies due to cancer surgery impose complex and enduring care challenges that necessitate cancer survivors" self-management. The objective of this analysis is to evaluate ostomates' self- management goals using a qualitative approach. METHODS: A multi-site randomized controlled trial testing the Ostomy Self-Management Training program (OSMT) was delivered via telehealth to a group of cancer survivors with an ostomy randomized to either the OSMT program with goal setting or usual care (UC), without goal setting. Goals were classified by type and frequency according to a modified City of Hope Health-Related Quality of Life framework (physical, psychological, social, spiritual, ostomy-specific, and healthcare quality domains), using a directed and systematic content analysis approach. RESULTS: The 524 self-management goals analyzed by domain frequencies physical (29.4%), ostomy specific (29.0%) and social well-being (25.0%) were predominant. Managing other health issues (7.6%), psychological issues (6.0%), and spiritual well-being issues (3.0%) were next. Common self-management themes were ostomy care independence (87.5%), handling cancer-related issues (62.5%), achieving acceptance (56.2%), resuming physical activity (43.0%), and maintaining fluid/diet balance (43.0%). DISCUSSION/CONCLUSION: Goal-setting offers insights into self-management concerns of cancer survivors with ostomies. Results demonstrate the broad aspects of self-management ostomates face. PRACTICE IMPLICATIONS: Self-management training with patient goal-setting may be used to help ostomates with cancer and their health care providers identify areas for needed education and support.

Estomaterapeutas no mundo do trabalho: facilidades e dificuldades para o exercício profissional / Estomaterapeutas en el mundo del trabajo: facilidades y dificultades para el ejercicio / Stomatherapists in the world of work: Practicalities and difficulties for the professional practice

RESUMO Objetivo analisar as facilidades e dificuldades percebidas por egressos de uma pós-graduação em Estomaterapia para atuação no mundo do trabalho. Métodos pesquisa qualitativa, desenvolvida com 22 egressos de um Curso de Pós-graduação em Enfermagem em Estomaterapia, de uma universidade pública da Região Sudeste do Brasil. A coleta de dados ocorreu por meio de entrevista semiestruturada, entre janeiro e abril de 2018. As entrevistas foram tratadas com base na análise temática de conteúdo. Resultados apreenderam-se como facilidades: reconhecimento do especialista, autonomia profissional, conhecimentos adquiridos por meio da especialização, disponibilidade de tecnologias de cuidados. Como fatores dificultadores, citaram-se: carência de recursos humanos e materiais, baixa remuneração do especialista, política institucional desfavorável, não valorização do estomaterapeuta. Conclusões e implicações para a prática as facilidades identificadas se relacionaram com o reconhecimento do especialista; a autonomia; a ascensão e o crescimento profissional; os conhecimentos adquiridos por meio da especialização; e a disponibilidade de tecnologias do cuidado para realização da prática profissional. As dificuldades analisadas no estudo estiveram vinculadas predominantemente à configuração do mundo do trabalho, cujos fundamentos se pautam no ideário neoliberal do Estado mínimo e no enxugamento da máquina pública.

RESUMEN Objetivo analizar las instalaciones y dificultades percibidas por los egresados de una Postgrado en Estomatoterapia para trabajar en el mundo laboral. Métodos investigación cualitativa, desarrollada con 22 graduados de un curso de Postgrado en Enfermería en Estomatoterapia, de una universidad pública en la Región Sudeste de Brasil. La recopilación de datos se realizó a través de entrevistas semiestructuradas, entre enero y abril de 2018. Las entrevistas se trataron en función del análisis de contenido temático. Resultados fue aprehendido como instalaciones: reconocimiento del especialista, autonomía profesional, conocimiento adquirido a través de la especialización, disponibilidad de tecnologías de atención. Como factores que obstaculizan, se citaron los siguientes: falta de recursos humanos y materiales, baja remuneración del especialista, política institucional desfavorable, falta de valoración del terapeuta del estoma. Conclusión e implicación para la práctica las dificultades analizadas en el estudio estuvieron principalmente relacionadas con la configuración del mundo del trabajo, cuyos fundamentos se basan en las ideas neoliberales del estado mínimo y la eliminación de la maquinaria pública.

ABSTRACT Objective to analyze the practicalities and difficulties perceived by graduates of a post-graduate program in Stomatherapy to perform in the world of work. Methods a qualitative research study, developed with 22 graduates from a Postgraduate course in Nursing in Stomatherapy, from a public university in the Southeast of Brazil. Data collection took place through semi-structured interviews, between January and April 2018. The interviews were treated based on the Thematic Content Analysis. Results the following were learned as practicalities: recognition of the specialist, professional autonomy, knowledge acquired through specialization, availability of care technologies. As hindering factors, the following were cited: lack of human and material resources, low remuneration of the specialist, unfavorable institutional policy, lack of appreciation for the stomatherapist. Conclusion and implication for the practice the difficulties analyzed in the study were predominantly linked to the configuration of the world of work, whose foundations are based on the neoliberal ideas of the minimum state and the wiping out of the public machinery.

Criança com estoma nos estudos de Pós-Graduação Stricto Sensu em Enfermagem: destacando aspectos epistemológicos / Child with stoma in Nursing post-graduation studies: epistemological aspects / Niño con estoma en estudios de Postgrado en Enfermería: destacando aspectos

Objetivo: analisar as dissertações e teses defendidas nos cursos de Pós-Graduação Stricto Sensu em Enfermagem, no Brasil, relativas ao tema criança com estoma, destacando seus aspectos epistemológicos. Método: estudo documental, descritivo, considerando o recorte temporal entre 2009 e 2019. Utilizou-se a Metodologia de Categorização Epistemológica para a Pesquisa na Enfermagem. Resultados: selecionaram-se doze estudos: dez dissertações de mestrado e duas teses de doutorado. Nota-se o predomínio de estudos na área/campo epistêmico assistencial, na linha de pesquisa: Processo de Cuidar em Saúde e Enfermagem. Identificou-se um maior interesse de estudos no contexto domiciliar e ambulatorial. Há predomínio da abordagem qualitativa e uso da entrevista para coleta de dados. Conclusão: os aspectos epistemológicos destacados possibilitam afirmar que as dissertações e teses relacionadas ao tema estão predominantemente orientadas para um pragmatismo epistemológico da assistência de enfermagem à criança com estoma e sua família, com objetos científicos delimitados para alcançar a compreensão desse fenômeno.

Objective: to examine postgraduate Nursing dissertations and theses defended in Brazil on the subject of children with stoma, highlighting their epistemological aspects. Method: this descriptive study considered studies published between 2009 and 2019 using the Epistemological Categorization methodology for research in Nursing. Results: twelve studies were selected: ten master's dissertations and two doctoral theses. The predominant epistemic area/field was "care", in the research line: "care process in health, and nursing". Studies were found to show greater interest in the home and outpatient context. The qualitative approach and data collection by interview predominated. Conclusion: from the epistemological aspects highlighted, it can be said that the dissertations and theses on the subject of children with stomata were predominantly oriented towards an epistemological pragmatism in nursing care for children with stoma and their families, with scientific objects delimited to achieve an understanding of this phenomenon.

Objetivo: analizar las disertaciones y tesis de posgrado en Enfermería defendidas en Brazil sobre el tema de niños con estoma, destacando sus aspectos epistemológicos. Método: este estudio descriptivo consideró estudios publicados entre 2009 y 2019 utilizando la metodología de Categorización Epistemológica para la investigación en Enfermería. Resultados: se seleccionaron doce estudios: diez tesis de maestría y dos tesis doctorales. El área / campo epistémico predominante fue el "cuidado", en la línea de investigación: "proceso de cuidado en salud y enfermería". Se encontró que los estudios muestran un mayor interés en el contexto domiciliario y ambulatorio. Predominó el enfoque cualitativo y la recolección de datos por entrevista. Conclusión: a partir de los aspectos epistemológicos destacados, se puede decir que las disertaciones y tesis sobre el tema de los niños con estoma estuvieron orientadas predominantemente hacia un pragmatismo epistemológico en la atención de enfermería al niño con estoma y sus familias, con objetos científicos delimitados para lograr un entendimiento. de este fenómeno.

Specializing Nurses as An Indirect Education Program for Stoma Patients.

Education programs are beneficial for patients with different chronic conditions. Prior studies have examined direct education, where information is transferred directly to patients. In contrast, in this program, information is transferred directly to nurses who become specialists and transfer education individually to patients. Hence, this paper evaluates the impact of having specialist nurses for stoma patients at hospitals, as those nurses provide healthcare to patients but also inform and educate patients about their condition and needs. The analysis uses an observational study with ostomized patients in Spain at hospitals with and without specialist nurses, and measures health service utilization and health-related quality of life (HRQL), besides performing a cost analysis and a cost-effectiveness analysis at both types of hospitals. The results show that patients with access to specialist nurses self-manage better, present lower adverse events and a better evolution of HRQL, and significantly demand more consultations with specialist nurses and less to A&E, primary care or specialists, resulting in important savings for the health system. Consequently, specializing or hiring nurses to provide indirect education to stoma patients is cost-effective and highly beneficial for patients. This type of indirect education strategy might be considered for specific conditions with low incidence or difficulties in identifying target patients or delivering information directly to them.

Effects of transtheoretical model-based intervention on the self-management of patients with an ostomy: A randomised controlled trial.

AIMS AND OBJECTIVES: To determine the effect of a transtheoretical model (TTM)-based intervention on patients with an ostomy and provide patient-centred, accessible assistance and dynamic education to improve patient self-management. BACKGROUND: Proper self-management may promote the rehabilitation of patients with an ostomy. TTM-based interventions have resulted in positive health behavioural changes. DESIGN: Randomised controlled trial performed according to the CONSORT guidelines. SUBJECT AND SETTING: The sample comprised 55 men and 37 women (24-77 years old, mean ± SD = 52.8 ± 11.13 years). The study settings included three tertiary hospitals in Changsha, Hunan, China. METHODS: The 92 patients, recruited from August 2012 to March 2013, were randomised into a control group and an intervention group. Randomisation was done by using a block randomisation list with a block size of 4. Self-management behaviours were assessed at the baseline, 2 days before discharge and after 1, 3 and 6 months of follow-up. The chi-squared test, independent sample t test and repeated measures analysis of variance were used to analyse the data. RESULTS: Patients in the intervention group were more likely to be at the action and maintenance stages compared with those in the control group. We also observed significant improvements in the self-management ability in the process of change, the decisional balance and self-efficacy in the intervention group compared with those in the control group after four intervention sessions and up to 6 months of follow-up. No serious intervention-related adverse events were observed. CONCLUSIONS: The TTM-based intervention had positive effects on self-management behaviours of patients with an ostomy. RELEVANCE TO CLINICAL PRACTICE: The TTM-based intervention had positive effects on self-management behaviours of patients with an ostomy and may provide a reference for health providers to develop behaviour promotion programmes to improve the self-management of patients with an ostomy.

Ensino da estomaterapia e suas repercussões para os egressos inseridos no mundo do trabalho / Stomatherapy education and its repercussions for the graduates inserted in the world of work

O objeto deste estudo versa sobre as dificuldades e as facilidades para os egressos do Curso de Estomaterapia da Faculdade de Enfermagem da Universidade do Estado do Rio de Janeiro (ENF/Uerj) atuarem como especialistas no mundo do trabalho. Apresentam-se, portanto, como objetivos: 1) elaborar um questionário para coleta de dados sociodemográfico e profissional voltado para enfermeiros especialistas; 2) validar um questionário para coleta de dados sociodemográfico e profissional voltado para enfermeiros especialistas; 3) caracterizar os aspectos sociodemográficos e profissionais dos egressos do Curso de Especialização em Enfermagem em Estomaterapia da Uerj, a partir do questionário elaborado e validado anteriormente; 4) analisar a percepção dos egressos da Pós-Graduação em Enfermagem em Estomaterapia da Uerj em relação à atuação como enfermeiro especialista no mundo do trabalho; 5) discutir o processo de formação em Estomaterapia do curso de especialização da Uerj, na percepção do egresso, em termos de limitação e potencialidade para atuação no mundo do trabalho. O apoio teórico foi embasado nas discussões sobre o mundo do trabalho em saúde e em enfermagem, o modelo neoliberal e suas respectivas repercussões para o trabalho de enfermagem, aspectos históricos da formação do enfermeiro, além da abordagem a respeito da contextualização histórica da pós-graduação Lato Sensu no Brasil e da especialização em Enfermagem em Estomaterapia, com as perspectivas de inserção no mundo do trabalho. Trata-se de um estudo de natureza qualitativa, do tipo descritivo-exploratório, com um apoio quantitativo. Nesse sentido, foi utilizado o Método de Triangulação dos Dados (questionário, a entrevista semiestruturada e a análise documental). Assim, foi construído e validado um questionário para traçar o perfil socioeconômico demográfico e profissional de especialistas no mundo do trabalho. O mesmo passou pela avaliação de sete juízas e pelo pré-teste com trinta especialistas de áreas diversas da enfermagem. Após as sugestões realizadas, o instrumento já validado foi adaptado para a coleta de informações com os egressos de estomaterapia da Uerj. Traçou-se um perfil das juízas, dos especialistas e dos 43 estomaterapeutas que responderam aos questionários. Também foram entrevistados 22 egressos do curso de especialização em estomaterapia da Uerj, por meio de uma entrevista semiestruturada, através da qual se analisaram os discursos, compondo-se três categorias: 1) O sentido de ser estomaterapeuta: especificidades envolvidas na especialidade, em que se discutiu a multiplicidade de sentidos que a especialidade revela para os egressos da Uerj; 2) Atuação no mundo do trabalho: limitações e capacidades percebidas pelos egressos, onde analisou-se a percepção dos egressos no que tange à atuação no atual mundo do trabalho em saúde, destacando-se as facilidades e as dificuldades encontradas por estes participantes e 3) Formação do especialista em Estomaterapia: potencialidades e fragilidades, onde abordaram-se os temas relacionados à formação do especialista em Estomaterapia (entre 2008 a 2013), destacando-se as potencialidades e as fragilidades encontradas durante o curso e que permearam o processo de ensino-aprendizagem dos pós-graduandos, à época. Acredita-se que esta pesquisa impulsione o surgimento de outras e possa contribuir para os campos da assistência, ensino, pesquisa e extensão, a partir de seu apoio teórico e metodológico e das discussões quantitativas e qualitativas que foram realizadas, com o fito de destacar a Estomaterapia enquanto especialidade da enfermagem.

The object of this study is about the difficulties and the facilities for the graduates of the Stomatherapy Course of the Faculty of Nursing at the State University of Rio de Janeiro (Uerj/ENF) to act as experts in the world of work. Thus, the following objectives are presented: 1) to elaborate a questionnaire for demographic and professional data collection aimed at specialist nurses; 2) to validate a questionnaire for professional and demographic data collection aimed at specialist nurses; 3) to characterize sociodemographic and professional aspects of the graduates of Uerj s Specialization Course in Nursing Stomatotherapy, from the elaborated and previously validated questionnaire; 4) to analyze the perception of graduates of Nursing Post-Graduation in Stomatherapy of Uerj in relation to the performance as specialist nurse in the world of work; 5) to discuss the training process in Stomatherapy of Uerj's specialization course, in the perception of the graduated student, in terms of limitations and potential for acting in the world of work. The theoretical support was based on discussions on the world of work in health and nursing, the neoliberal model and their implications for the work of nursing, historical aspects of the training of nurses, in addition to the approach regarding the historical context Lato Sensu post-graduate in Brazil and of specialization in nursing in Stomatherapy, with the prospects of insertion in the world of work. This is a qualitative study, descriptive-exploratory type, with a quantitative support. In this sense, the Data Triangulation Method was used (questionnaire, semi-structured interview and documentary analysis). Thus, a questionnaire was constructed and validated to draw the demographic, professional and socioeconomic profile of specialists in the world of work. The same went through the evaluation of seven judges and the pre-test with thirty experts from different areas of nursing. After the suggestions made, the already validated instrument was adapted for gathering information with the graduates of stomatherapy. A profile of the judges, the specialists and the 43 stomaterapists who answered the questionnaires was drawn. Were also interviewed 22 graduates of the specialization course in stomatherapy of Uerj, by means of a semi-structured interview, through which the discourses were analyzed, composing three categories: 1) The sense of being stomaterapist: specificities involved in the specialty in which they discussed the multiplicity of meanings which the specialty reveals to the graduates of Uerj; 2) Acting in the world of work: limitations and capacities perceived by graduates, where it was examined the graduates' perception regarding the performance in the current world of work in health, highlighting the advantages and the difficulties encountered by these participants and 3) Training of the specialist in Stomatherapy: potentialities and weaknesses, where topics related to the training of the Stomatherapy specialist (between 2008 and 2013) were addressed, highlighting the potentialities and weaknesses found during the course and that permeated the teaching of post-graduate students at the time. It is believed that this research promotes the emergence of others and can contribute to the fields of assistance, teaching, research and extension, based on their theoretical and methodological support and the quantitative and qualitative discussions that were carried out, in order to value Stomatherapy as a specialty of nursing.

Ensino da estomaterapia e suas repercussões para os egressos inseridos no mundo do trabalho / Stomatherapy education and its repercussions for the graduates inserted in the world of work

O objeto deste estudo versa sobre as dificuldades e as facilidades para os egressos do Curso de Estomaterapia da Faculdade de Enfermagem da Universidade do Estado do Rio de Janeiro (ENF/Uerj) atuarem como especialistas no mundo do trabalho. Apresentam-se, portanto, como objetivos: 1) elaborar um questionário para coleta de dados sociodemográfico e profissional voltado para enfermeiros especialistas; 2) validar um questionário para coleta de dados sociodemográfico e profissional voltado para enfermeiros especialistas; 3) caracterizar os aspectos sociodemográficos e profissionais dos egressos do Curso de Especialização em Enfermagem em Estomaterapia da Uerj, a partir do questionário elaborado e validado anteriormente; 4) analisar a percepção dos egressos da Pós-Graduação em Enfermagem em Estomaterapia da Uerj em relação à atuação como enfermeiro especialista no mundo do trabalho; 5) discutir o processo de formação em Estomaterapia do curso de especialização da Uerj, na percepção do egresso, em termos de limitação e potencialidade para atuação no mundo do trabalho. O apoio teórico foi embasado nas discussões sobre o mundo do trabalho em saúde e em enfermagem, o modelo neoliberal e suas respectivas repercussões para o trabalho de enfermagem, aspectos históricos da formação do enfermeiro, além da abordagem a respeito da contextualização histórica da pós-graduação Lato Sensu no Brasil e da especialização em Enfermagem em Estomaterapia, com as perspectivas de inserção no mundo do trabalho. Trata-se de um estudo de natureza qualitativa, do tipo descritivo-exploratório, com um apoio quantitativo. Nesse sentido, foi utilizado o Método de Triangulação dos Dados (questionário, a entrevista semiestruturada e a análise documental). Assim, foi construído e validado um questionário para traçar o perfil socioeconômico demográfico e profissional de especialistas no mundo do trabalho. O mesmo passou pela avaliação de sete juízas e pelo pré-teste com trinta especialistas de áreas diversas da enfermagem. Após as sugestões realizadas, o instrumento já validado foi adaptado para a coleta de informações com os egressos de estomaterapia da Uerj. Traçou-se um perfil das juízas, dos especialistas e dos 43 estomaterapeutas que responderam aos questionários. Também foram entrevistados 22 egressos do curso de especialização em estomaterapia da Uerj, por meio de uma entrevista semiestruturada, através da qual se analisaram os discursos, compondo-se três categorias: 1) O sentido de ser estomaterapeuta: especificidades envolvidas na especialidade, em que se discutiu a multiplicidade de sentidos que a especialidade revela para os egressos da Uerj; 2) Atuação no mundo do trabalho: limitações e capacidades percebidas pelos egressos, onde analisou-se a percepção dos egressos no que tange à atuação no atual mundo do trabalho em saúde, destacando-se as facilidades e as dificuldades encontradas por estes participantes e 3) Formação do especialista em Estomaterapia: potencialidades e fragilidades, onde abordaram-se os temas relacionados à formação do especialista em Estomaterapia (entre 2008 a 2013), destacando-se as potencialidades e as fragilidades encontradas durante o curso e que permearam o processo de ensino-aprendizagem dos pós-graduandos, à época. Acredita-se que esta pesquisa impulsione o surgimento de outras e possa contribuir para os campos da assistência, ensino, pesquisa e extensão, a partir de seu apoio teórico e metodológico e das discussões quantitativas e qualitativas que foram realizadas, com o fito de destacar a Estomaterapia enquanto especialidade da enfermagem.

The object of this study is about the difficulties and the facilities for the graduates of the Stomatherapy Course of the Faculty of Nursing at the State University of Rio de Janeiro (Uerj/ENF) to act as experts in the world of work. Thus, the following objectives are presented: 1) to elaborate a questionnaire for demographic and professional data collection aimed at specialist nurses; 2) to validate a questionnaire for professional and demographic data collection aimed at specialist nurses; 3) to characterize sociodemographic and professional aspects of the graduates of Uerj's Specialization Course in Nursing Stomatotherapy, from the elaborated and previously validated questionnaire; 4) to analyze the perception of graduates of Nursing Post-Graduation in Stomatherapy of Uerj in relation to the performance as specialist nurse in the world of work; 5) to discuss the training process in Stomatherapy of Uerj's specialization course, in the perception of the graduated student, in terms of limitations and potential for acting in the world of work. The theoretical support was based on discussions on the world of work in health and nursing, the neoliberal model and their implications for the work of nursing, historical aspects of the training of nurses, in addition to the approach regarding the historical context Lato Sensu post-graduate in Brazil and of specialization in nursing in Stomatherapy, with the prospects of insertion in the world of work. This is a qualitative study, descriptive-exploratory type, with a quantitative support. In this sense, the Data Triangulation Method was used (questionnaire, semi-structured interview and documentary analysis). Thus, a questionnaire was constructed and validated to draw the demographic, professional and socioeconomic profile of specialists in the world of work. The same went through the evaluation of seven judges and the pre-test with thirty experts from different areas of nursing. After the suggestions made, the already validated instrument was adapted for gathering information with the graduates of stomatherapy. A profile of the judges, the specialists and the 43 stomaterapists who answered the questionnaires was drawn. Were also interviewed 22 graduates of the specialization course in stomatherapy of Uerj, by means of a semi-structured interview, through which the discourses were analyzed, composing three categories: 1) The sense of being stomaterapist: specificities involved in the specialty in which they discussed the multiplicity of meanings which the specialty reveals to the graduates of Uerj; 2) Acting in the world of work: limitations and capacities perceived by graduates, where it was examined the graduates' perception regarding the performance in the current world of work in health, highlighting the advantages and the difficulties encountered by these participants and 3) Training of the specialist in Stomatherapy: potentialities and weaknesses, where topics related to the training of the Stomatherapy specialist (between 2008 and 2013) were addressed, highlighting the potentialities and weaknesses found during the course and that permeated the teaching of post-graduate students at the time. It is believed that this research promotes the emergence of others and can contribute to the fields of assistance, teaching, research and extension, based on their theoretical and methodological support and the quantitative and qualitative discussions that were carried out, in order to value Stomatherapy as a specialty of nursing.

Conteúdo de estomaterapia e estratégias de ensino no currículo de graduação em enfermagem / Stomatherapy content and teaching strategies in the undergraduate nursing curriculum / Contenido de estomaterapia y estrategias de enseñanza en el componente curricular del pregrado en enfermería

Objetivos: identificar os conteúdos teórico-práticos relacionados à estomaterapia, no Curso de Graduação em Enfermagem, analisando seus conteúdos programáticos, estratégias e ementas; e discutir a abordagem dos conteúdos e das estratégias de ensino adotadas pelos docentes para o aprendizado de tais conteúdos. Método: estudo qualitativo, documental, cujo cenário foi a Faculdade de Enfermagem da Universidade do Estado do Rio de Janeiro. A pesquisa documental utilizou especificamente as ementas e os cronogramas do 1º ao 9° períodos da graduação. A coleta de dados ocorreu em novembro de 2016, sendo submetidos à análise de conteúdo modalidade temática. Resultados: evidenciou-se que os conteúdos abordados na graduação se referem às temáticas de feridas e estomias em sua predominância, e não se identificou conteúdo de incontinências. Conclusão:considera-se que há necessidade de inserir conteúdo relativo à incontinência anal e urinária haja vista a relevância epidemiológica e o sofrimento psicofísico da pessoa com tal problemática.

Objectives: to identify the theoretical and practical stomatherapy-related subjects in the undergraduate nursing program, analyzing their program content, strategies and outlines; and to discuss the approach to the content and the teaching strategies adopted by teachers for such content. Method: qualitative, documentary study, conducted at the nursing department of Rio de Janeiro State University. The documentary research used specifically the outlines and timetables from the 1st to 9th undergraduate terms. Data were collected in November 2016, and subjected to thematic content analysis. Results: the content addressed in the undergraduate course was found to refer predominantly to the themes of wounds and stomas, and no incontinence-related content was identified. Conclusion: there was considered to be a need to introduce content on anal and urinary incontinence, given the epidemiological relevance and psychophysical suffering of people with such problems.

Objetivos: identificar los contenidos teóricos y prácticos relativos a estomaterapia, en el curso de pregrado en enfermería, analizando sus contenidos programáticos, estrategias y registros; y discutir el enfoque de los contenidos y de las estrategias de enseñanza adoptadas por los profesores para el aprendizaje de dicho contenido. Método: estudio cualitativo, documental, cuyo escenario fue la Facultad de Enfermería de la Universidad del Estado de Río de Janeiro. La investigación documental utilizó específicamente los registros y los cronogramas del 1º al 9º períodos de pregrado. La recolección de datos se produjo en noviembre de 2016, siendo sometidos al análisis de contenido temático. Resultados: se evidenció que los contenidos abordados en el pregrado se refieren a temáticas de heridas y estomas en general y no se identificó contenido sobre incontinencias. Conclusión: se considera que existe una necesidad de insertar contenido relacionado a incontinencia anal y urinaria, dada la importancia epidemiológica y el sufrimiento psicofísico de la persona con dicho problema.

Ostomy Care at Home.

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Evaluation of Web-Based Ostomy Patient Support Resources.

PURPOSE: To evaluate currently available, no-cost, Web-based patient support resources designed for those who have recently undergone ostomy surgery. DESIGN: Descriptive, correlational study using telephone survey. SAMPLE AND SETTING: The sample comprised 202 adults who had ostomy surgery within the previous 24 months in 1 of 5 hospitals within a large healthcare organization in the Midwestern United States. Two of the hospitals were academic teaching hospitals, and 3 were community hospitals. METHODS: The study was divided into 2 phases: (1) gap analysis of 4 Web sites (labeled A-D) based on specific criteria; and (2) telephone survey of individuals with an ostomy. In phase 1, a comprehensive checklist based on best practice standards was developed to conduct the gap analysis. In phase 2, data were collected from 202 participants by trained interviewers via 1-time structured telephone interviews that required approximately 30 minutes to complete. Descriptive analyses were performed, along with correlational analysis of relationships among Web site usage, acceptability and satisfaction, demographic characteristics, and medical history. RESULTS: Gap analysis revealed that Web site D, managed by a patient advocacy group, received the highest total content score of 155/176 (88%) and the highest usability score of 31.7/35 (91%). Two hundred two participants completed the telephone interview, with 96 (48%) reporting that they used the Internet as a source of information. Sixty participants (30%) reported that friends or family member had searched the Internet for ostomy information on their behalf, and 148 (75%) indicated they were confident they could get information about ostomies on the Internet. Of the 90 participants (45%) who reported using the Internet to locate ostomy information, 73 (82%) found the information on the Web easy to understand, 28 (31%) reported being frustrated during their search for information, 24 (27%) indicated it took a lot of effort to get the information they needed, and 39 (43%) were concerned about the quality of the information. CONCLUSION: Web-based patient support resources may be a cost-effective approach to providing essential ostomy information, self-management training, and support. Additional research is needed to examine the efficacy of Web-based patient support interventions to improve ostomy self-management knowledge, skills, and outcomes for patients.

Vivência do professor no cotidiano da criança com estomia: abordagem da Fenomenologia Social / Experience of teachers in the daily life of a child with stoma: a Social Phenomenology approach

Este estudo procurou compreender a vivência de professores no processo de inclusão de crianças com estomia, tendo como referencial a Fenomenologia Sociológica. Foram realizadas entrevistas, com cinco professores, no período entre dezembro de 2015 e janeiro de 2016. A coleta de dados foi efetuada por narração do professor, posterior transcrição e análise dos dados. Emergiram quatro categorias temáticas: sentimentos vividos pelos professores; fatores que interferem nos cuidados; estratégias eficazes para o cuidado; estratégias para melhoria dos cuidados. Os professores, valorizaram a integração da criança com estomia na escola; consideram que esta ocorre com a modificação da formação pedagógica; e apontaram a necessidade da presença do enfermeiro nas escolas. Os resultados mostram a importância do desenvolvimento de ações e estratégias de apoio aos professores e aos alunos com estomia no contexto de uma escola inclusiva, considerando que o enfermeiro escolar é determinante para a promoção em saúde destas crianças.

This study has sought to understand the experience of teachers in the process of inclusion of children with stoma, being Sociological Phenomenology the reference. Interviews were conducted with five teachers between December 2015 and January 2016. Data collection was carried out from the narration of teachers, with later transcription and data analysis. Four thematic categories emerged: feelings experienced by teachers, factors that interfere with care, effective strategies for care, and strategies to improve care. The teachers valued the integration of the child with stoma in the school; they consider that this happens with the modification of the pedagogical formation, and they also pointed out the need for the presence of nurses in schools. The results show the importance of the development of actions and strategies to support teachers and students with stoma in the context of an inclusive school, considering that the school nurse is a determining factor for the health promotion of these children.

Applying the Chronic Care Model to Support Ostomy Self-Management: Implications for Oncology Nursing Practice.

BACKGROUND: Living with an ostomy requires daily site and equipment care, lifestyle changes, emotional management, and social role adjustments. The Chronic Care Ostomy Self-Management Training Program (CCOSMTP) offers an ostomy self-management curriculum, emphasizing problem solving, self-efficacy, cognitive reframing, and goal setting. OBJECTIVES: The qualitative method of content analysis was employed to categorize self-reported goals of ostomates identified during a nurse-led feasibility trial testing the CCOSMTP. METHODS: Thirty-eight ostomates identified goals at three CCOSMTP sessions. The goals were classified according to the City of Hope Health-Related Qualify of Life Model, a validated multidimensional framework, describing physical, psychological, social, and spiritual ostomy-related effects. Nurse experts coded the goals independently and then collaborated to reach 100% consensus on the goals' classification. FINDINGS: A total of 118 goals were identified by 38 participants. Eighty-seven goals were physical, related to the care of the skin, placement of the pouch or bag, and management of leaks; 26 were social goals, which addressed engagement in social or recreational roles and daily activities; and 5 were psychological goals, which were related to confidence and controlling negative thinking. Although the goals of survivors of cancer with an ostomy are variable, physical goals are most common in self-management training.

A chronic care ostomy self-management program for cancer survivors.

BACKGROUND: Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial and error to improve self-management. METHODS: This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at 6-month follow-up (Patient Activation Measure, self-efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with ostomy care survey, and the City of Hope Quality of Life Ostomy). Changes from pre-intervention to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations. RESULTS: Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4-4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including patient activation (p = 0.0004), self-efficacy (p = 0.006), total HRQOL (p = 0.01), physical well-being (p = 0.005), and social well-being (p = 0.002). Survivor anxiety was significantly reduced by follow-up (p = 0.047). CONCLUSIONS: This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors.

Ostomate-for-a-Day: A Novel Pedagogy for Teaching Ostomy Care to Baccalaureate Nursing Students.

BACKGROUND: The literature describing successful pedagogies for teaching ostomy care to baccalaureate nursing students is limited. This qualitative study investigated the potential benefits of participating in an immersive simulation that allowed baccalaureate nursing students to explore the physical and psychosocial impact of ostomy surgery. METHOD: Junior-level nursing students attended a 2-hour interactive session during which they learned about preoperative stoma site marking and practiced the maneuvers on a peer. Students then wore an ostomy appliance for the next 24 hours, completed tasks simulating ostomy self-care, and submitted a three- to four-page reflection on the experience. These data were coded using the iterative process of constant comparison described by Glaser. RESULTS: Six major themes were identified: Accommodation for Activities of Daily Living, Coping with Annoyances, Body Image and Feelings, Disclosure, Insights for Teaching, and Empathy. CONCLUSION: Each participant affirmed the value of the experience. Suggestions for future research studies are discussed.

Discharge planning for a patient with a new ostomy: best practice for clinicians.

A comprehensive discharge plan for a patient with a new stoma is needed to ensure the individual receives the necessary ostomy education prior to discharge. The plan should include teaching basic skills and providing information about how to manage the ostomy (ie, emptying and changing the pouch, how to order supplies, available manufacturers, dietary/fluid guidelines, potential complications, medications, and managing gas and odor), assisting with transitions in care, and providing information about resources for support and assistance. The purpose of this best practice guideline is to provide clinicians with a brief overview of the essential elements that should be included in the discharge plan to facilitate patient education and the transition of care from hospital to home.

Processo educativo desenvolvido por enfermeiros voltado para inclusão laboral de pessoas com estomia / Educative process developed by nurses for ostomized patients work inclusion

Estudo cujo objeto tratou do processo educativo desenvolvido por enfermeiros que atuam na reabilitação de pessoas com estomia, com vistas à inclusão laboral. Os objetivos foram: a) descrever a percepção dos enfermeiros sobre as ações educativas realizadas com as pessoas com estomia; b) identificar as ações educativas realizadas, objetivandoa inclusão laboral; c) analisar a sistematização adotada para o processo educativo; d) discutir as facilidades e dificuldades para o processo educativo; e) elaborar protocolo, enfatizando a inclusão laboral. O apoio teórico abordou a estomaterapia e os cuidados às pessoas com estomia; a inclusão social e no trabalho; a formação em enfermagem e o processo educativo como ferramenta para o cuidado. O referencial teórico-metodológico baseou-se no materialismo histórico-dialético. Pesquisa qualitativa e exploratória, de caráter interpretativo e crítico, apoiada na perspectiva dialética, realizada com 6 enfermeiros de um Programa de atenção às pessoas com estomia, e 40 pessoas com estomiaque participaram das consultas. O método de análise foi o histórico-dialético, do qual emergiu cinco categorias: a) percepções e idealizações dos enfermeiros sobre o processo educativo; b) contradição entre a perspectiva holística do cuidado e a prática do enfermeiro; c) complexidade do processo de educar: paradoxos entre a organização laboral, o processo de formação e o cotidiano do enfermeiro; d) o conhecimento dos enfermeiros e a possibilidade de formulação de sugestões; e e) sistematização da assistência de enfermagem e o processo educativo das pessoas com estomia. Os resultados revelaram que o processo educativo realizado pelos enfermeiros possui como foco orientações direcionadas à recuperação física dos clientes. Os aspectos psicossociais e de inclusão laboral quase não são abordados, e quando os são, ocorrem de forma incipiente. Alguns fatores contribuem para esta orientação direcionada à dimensão fisiológica: formação do enfermeiro com influência do modelo biomédico e construção histórica dos centros de reabilitação pautada na assistência biologicista. Em contrapartida, esses enfermeiros possuíam experiência em estomaterapia e no atendimento à clientela, conhecendo suas necessidades e atendendo usuários com diversas características facilitadoraspara inclusão laboral. A abordagem em relação à inclusão no trabalho ocorreu somente aos clientes que indagavam sobre esta questão e com os mais jovens, representando importante lacuna no processo educativo. As estratégias educativas mais utilizadas estavam relacionadas à demonstração prática dos procedimentos a serem realizados com a estomia, e centradas no diálogo, que representa a base da pedagogia problematizadora, essencial para o processo educativo. As sugestões para facilitar as orientações direcionadas à inclusão laboral foram: a capacitação dos enfermeiros na graduação e pós-graduação; elaboração de pesquisas e estudos que divulguem esta temática; criação de grupos de apoio aos clientes; e fornecimento de folders explicativos. Concluiu-se que as pessoas com estomia raramente são abordadas em relação à inclusão laboral, e que o processo educativo está centrado em um modelo biomédico, não privilegiando suas dimensões psicossociais. Há de se rever e reestruturar este processo educativo, no sentido de englobar orientações holísticas à clientela, favorecendo sua reabilitação e inclusão no trabalho, contribuindo para melhoria da qualidade de vida.

Study which object dealt with educative process developed by nurses working with ostomized people under rehabilitation aiming at work inclusion. The objectives were: a) to describe the nurses´ perception concerning educative actions carried out with ostomized patients, b) to identify such educative actions for work inclusion. c) to analyze the systematization chosen for the educative process, d) to discuss facilities as well as difficulties for the process e) to elaborate the guidelines protocol emphasizing work inclusion. Theoretical support approached Stomotherapy and the stomized`s care; social and work inclusion; nursing education and the educative process as a tool for excellence care. Theoretical background was based on historical dialectical materialist theory. Qualitative and exploratory, critical-interpretative research supported by dialetic perspective carried out with 6 nurses from the stomized people care program at a rehabilitation center and with 40 stomized patients who underwent consultations. The analysis methodology consisted of dialetic- hermeneutic from which five categories arisen: a) perceptions and idealization from the nurses concerning the educative process, b) contradiction between holistic care and the nurses´practices, c) complexity of the educational process itself: work organization, nursing education and the everyday nurse´s practice paradox, d) Nurses´ knowledge and the possibility of formulating suggestions and, e) the systematization of nursing assistance and the educative process for the stomized. Results have revealed that the educative process performed by nurses focuses on guidelines concerning the stomized´s physical recovery. Psychosocial aspects as well as work inclusion are almost not approached. If they do so it is not effectively. Some aspects can contribute to such a physiologic- restricted orientation: nurse´s background has the influence of the biomedical model and the historical construction of rehabilitation centers lies on biologicist assistance. On the other hand those nurses are experienced in assisting the stomized as much as for Stomotherapy. They know their needs and they assist users with diverse characteristics and it could turn work inclusion easier. The approach regarding work inclusion can only take place in stomized who inquired such things and with young clients who represent a sharp gap on educative process developed by nurses. The most used educational strategies were related to a practical demonstration of procedures to be performed with the stoma and which relied on the dialogism as the basis for the pedagogy of problematization, essential to assure the educative process. Some were the suggestions to facilitate the work inclusion guidelines: training nurses at undergraduation as well as at graduation, creation of researches and studies to publish such theme; creation of supportive groups to the stomized; and, explanatory folders supplying. It was concluded that rarely are the stomized people argued concerning work inclusion and the educational process was also observed to be focused on a biomedical model which does not privilege psychosocial dimensions. It is necessary to reconsider and rearrange the educative process to embody holistic guidelines to the clients, so as to favour their social and work inclusion for the improvement in their life quality.