Avaliação do perfil e da qualidade de vida de pessoas idosas com estomias de eliminação / Assessment of profile and quality of life of elderly people with elimination ostomies / Avaluación del perfil y calidad de vida de las personas mayores con estomas de eliminación

Objetivo:Avaliar o perfil epidemiológico e a qualidade de vida das pessoas idosas com estomias de eliminação de uma microrregião de saúde de Minas Gerais. Métodos: Trata-se de um estudo transversal realizado em um serviço público de atenção à saúde. Para descrição do perfil foram avaliados todos os prontuários de pessoas idosas com estomias. Em seguida, foi avaliada a qualidade de vida por meio do questionário City of Hope-Quality of Life-Ostomy Questionnaire. Resultados: Verificou-se uma população majoritariamente feminina (55,2%) com idade média de 67 anos (± 8,8). As estomias eram em 64% definitivas, tendo o câncer colorretal o principal diagnóstico (71%) e em 41,4% apresentavam dependência parcial para o autocuidado. Com relação à avaliação da qualidade de vida, os domínios bem-estar espiritual, físico e social apresentaram melhores indicadores de avaliação (8,1; 8,1; e 8,2 respectivamente). Evidenciou-se que o tipo de estomia e o tempo de permanência se associam negativamente com a qualidade de vida das pessoas com estomias. Conclusão: A qualidade de vida de idosos com estomia de eliminação mostrou-se bem avaliada, principalmente nos domínios bem-estar físico, social e espiritual.

Objective:The aim of this study was to assess the epidemiological profile and quality of life of elderly people with elimination ostomy in a health region in Minas Gerais. Methods: This is a cross-sectional study carried out in a public health care service. To describe the profile, all medical records of elderly people with ostomy were evaluated. Then, quality of life was assessed using the City of Hope-Quality of Life-Ostomy Questionnaire. Results:There was a mostly female population (55.2%) with a mean age of 67 years (± 8.8). In 64%, the ostomies were definitive, with colorectal cancer being the main diagnosis (71%) and in 41.4% they were partially dependent on self-care. Regarding the assessment of quality of life, the domains of spiritual, physical and social well-being had better assessment indicators (8.1; 8.1; and 8.2 respectively). It was evident that the type of ostomy and the length of stay are negatively associated with the quality of life of people with ostomies. Conclusion: The quality of life of elderly people with an elimination ostomy was well evaluated, especially in the domains of physical, social and spiritual well-being.

Objetivo:El objetivo de este estudio fue evaluación del perfil epidemiológico y la calidad de vida de los ancianos con ostomía en una región sanitaria de Minas Gerais. Métodos: Se trata de un estudio transversal realizado en un servicio público de salud. Para describir el perfil se evaluaron todas las historias clínicas de ancianos con ostomía. Luego, la calidad de vida se evaluó mediante el Cuestionario City of Hope-Quality of Life-Ostomy. Resultados: Se encontró una población mayoritariamente femenina (55,2%) con una edad media de 67 años (± 8,8). En el 64% las ostomías fueron definitivas, siendo el cáncer colorrectal el diagnóstico principal (71%) y en el 41,4% fueron parcialmente dependientes del autocuidado. En cuanto a la evaluación de la calidad de vida, los dominios de bienestar espiritual, físico y social presentó mejores indicadores de evaluación (8.1; 8.1; y 8.2 respectivamente). Se evidenció que el tipo de ostomía y la duración de la estancia se asocian negativamente con la calidad de vida de las personas con ostomías. Conclusión: La calidad de vida de los ancianos con ostomía de eliminación fue bien evaluada, especialmente en los dominios de bienestar físico, social y espiritual.

Caracterização Sociodemográfica e Clínica de Crianças com Estomia: Um Estudo Epidemiológico / Sociodemographic and Clinical Characterization of Children With Stoma: an Epidemiological Study / Caracterización Sociodemográfica y Clínica de Niños con Ostomía: Un Estudio Epidemiológico

Objetivo:Caracterizar o perfil clínico epidemiológico de crianças com estomia atendidas no ambulatório de um hospital público de ensino de referência na área infantil no Brasil. Método: Estudo descritivo, documental, retrospectivo e de natureza quantitativa, realizado por meio da extração de dados sociodemográficos e clínicos de prontuários eletrônicos de crianças com estomia, acompanhadas de 2014 a 2018. Os dados passaram por estatística descritiva e, na análise, foram organizados em uma planilha no programa Microsoft Excel versão 2010, distribuídas em três tabelas, seus valores representados em frequência absoluta e relativa. Resultados: Das 85 crianças com estomia, houve predominância do sexo masculino, idade entre 1 a 4 anos. Anomalia anorretal foi considerada o principal diagnóstico. Constatou-se elevado número de colostomias confeccionadas. Dermatite de contato foi a complicação periestomal mais frequente. Verificou-se a dificuldade na rotina de comparecimento das famílias ao ambulatório e constatou-se a mãe como cuidadora principal. Conclusão: O estudo concluiu relevantes aspectos relacionados ao planejamento do cuidado pautado na demanda de cada criança e na educação em saúde para a prevenção de complicações, ações indispensáveis na oferta do cuidado de enfermagem seguro e de qualidade, como também favorecer operacionalização das políticas públicas relacionadas à saúde da criança com estomias.

Objective:To characterize the epidemiological clinical profile of children with ostomies treated in the outpatient clinic of a reference public teaching hospital for children in Brazil. Method: Descriptive, documentary, retrospective and quantitative study, carried out by extracting sociodemographic and clinical data from electronic medical records of children with ostomies, monitored from 2014 to 2018. The data underwent descriptive statistics, and in the analysis, the data were organized in a spreadsheet in Microsoft Excel version 2010, distributed in three tables, their values represented in absolute and relative frequency. Results: Of the 85 children with ostomy, there was a predominance of males, aged between 1 and 4 years. Anorectal anomaly was considered the main diagnosis. There was a high number of colostomies made. Contact dermatitis was the most frequent peristomal complication. There were difficulties in the routine of families attending the outpatient clinic, and the mother as the main caregiver. Conclusion: The study found relevant aspects related to care planning based on the demand of each child and health education for the prevention of complications, essential actions in the provision of safe and quality nursing care, as well as favoring the operationalization of public policies related to the health of children with ostomies.

Objetivo:Caracterizar o perfil clínico epidemiológico de crianças com estomia atendidas no ambulatório de um hospital público de ensino de referência na área infantil no Brasil. Método: Estudo descritivo, documental, retrospectivo e de natureza quantitativa, realizado por meio da extração de dados sociodemográficos e clínicos de prontuários eletrônicos de crianças com estomia, acompanhadas de 2014 a 2018. Os dados passaram por estatística descritiva e, na análise, foram organizados em uma planilha no programa Microsoft Excel versão 2010, distribuídas em três tabelas, seus valores representados em frequência absoluta e relativa. Resultados: Das 85 crianças com estomia, houve predominância do sexo masculino, idade entre 1 a 4 anos. Anomalia anorretal foi considerada o principal diagnóstico. Constatou-se elevado número de colostomias confeccionadas. Dermatite de contato foi a complicação periestomal mais frequente. Verificou-se a dificuldade na rotina de comparecimento das famílias ao ambulatório e constatou-se a mãe como cuidadora principal. Conclusão: O estudo concluiu relevantes aspectos relacionados ao planejamento do cuidado pautado na demanda de cada criança e na educação em saúde para a prevenção de complicações, ações indispensáveis na oferta do cuidado de enfermagem seguro e de qualidade, como também favorecer operacionalização das políticas públicas relacionadas à saúde da criança com estomias.

Practice Implications from the WCET® International Ostomy Guideline 2020.

GENERAL PURPOSE: To introduce the 15 recommendations of the International Ostomy Guideline (IOG) 2020, covering the four key arenas of education, holistic aspects, and pre- and postoperative care; and to summarize key concepts for clinicians to customize for translation into their practice. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Analyze supporting evidence for the education recommendations in the IOG 2020.2. Identify a benefit of the International Charter of Ostomate Rights.3. Distinguish concepts related to pre- and postoperative ostomy-related care.4. Select a potential barrier to IOG 2020 guideline implementation.

The second edition of the WCET ® International Ostomy Guideline (IOG) was launched in December 2020 as an update to the original guideline published in 2014. The purpose of this article is to introduce the 15 recommendations covering four key arenas (education, holistic aspects, and pre- and postoperative care) and summarize key concepts for clinicians to customize for translation into their practice. The article also includes information about the impact of the novel coronavirus 2019 on ostomy care.

Therapeutic Patient Education: A Multifaceted Approach to Ostomy Care.

This contribution presents a literature review of therapeutic patient education and a summary of an oral presentation given by two wound care specialists at a recent European Congress. It relates these to models of care in nursing science and other research that contributes to this approach at the core of healthcare practice.

Cancer survivors' challenges with ostomy appliances and self-management: a qualitative analysis.

PURPOSE: An ostomy poses significant health-related quality of life (HRQOL) issues for cancer survivors. Survivors must learn to manage pouching appliances and adjust to the psychosocial consequences of living with an ostomy. We explored, through qualitative analysis, the challenges with self-management and ostomy appliances reported by cancer survivors. METHODS: Pooled data from two studies with a question on the greatest challenge of living with an ostomy and intervention session notes were analyzed using content analysis approach. The themes were reviewed and agreed upon by the research team, and counts were tallied for each theme based on the number of times they were mentioned by participants. RESULTS: Of the 928 greatest challenge responses and session notes, a total of 106 mentions (11%) were focused on ostomy appliances, associated repercussions, and time taken for ostomy care. Eight themes emerged: bleeding, pain, leakage, skin problems/irritation/rash, wafer-related issues, materials getting under the wafer, time to care for ostomy, and solutions to clean the stoma. Challenges described included poor wafer adherence, allergic reactions to adhesives, and pain around the stoma site. These challenges resulted in anxiety related to leakage, odor, and/or skin irritation, which negatively impacted on participation in social activities and self-confidence with ostomy care. CONCLUSIONS: Cancer survivors living with an ostomy experience multiple obstacles with ostomy appliances and caring for their ostomy. Continued innovation in ostomy appliance design and technology is needed to help cancer survivors with successfully managing ostomy care.

Equilibrio emocional, capacidad de autocuidado e integridad cutánea en la persona ostomizada / Emotional balance, self-care ability and skin integrity in ostomized persons

Objetivo: explorar la relación entre equilibrio emocional, autocuidado e integridad cutánea en personas ostomizadas mediante criterios de resultado NOC. Método: estudio observacional prospectivo. Se incluyeron pacientes ostomizados en seguimiento en "Consulta de Ostomía" a los siete días del alta, a los dos, seis y 12 meses. Se estudiaron variables sociodemográficas, clínicas y de resultado, basadas en ocho indicadores relacionados con los NOC (1101) Integridad tisular: piel y membranas mucosas, (1615) Autocuidado de la ostomía y (1204) Equilibrio emocional. Se realizó análisis descriptivo, usando frecuencias, medias y desviaciones estándar (DE). Se estudiaron las correlaciones entre los indicadores derivados de los NOC. Resultados: se incluyeron 55 pacientes. El 65,45% (n= 36) era hombre, con una edad media (DE) de 67,45 (13,4) años, siendo el 58,2% mayores de 65 años. Se restableció la continuidad intestinal en el 50,90% (n= 28) de los participantes. La integridad de la piel la consiguió el 10,90% (n= 6) (visita 1), llegando al 100% (n= 20) (visita 4). Logró un autocuidado adecuado el 18,18% (n= 10) (visita 1), llegando al 100% (n= 20) (visita 4). No consiguió equilibrio emocional ningún paciente en la visita 1, obteniéndolo el 34% (n= 17) (visita 2), el 59,5% (n= 21) (visita 3) y el 70% (n= 14) (visita 4). Las correlaciones entre variables se presentan de forma directa y positiva, con niveles de asociación moderado-bueno. Todas son estadísticamente significativas. Conclusiones: el porcentaje de pacientes con problemas en la piel periestomal mejora a lo largo del seguimiento. El autocuidado aumenta gradualmente así como el equilibrio emocional. Hay relación directa y positiva entre integridad cutánea y autocuidado, calidad del sueño, apetito, mantenimiento del arreglo e higiene personal y manifestación de un estado de ánimo sereno

Objective: to explore the relationship between emotional balance, self-care and skin integrity in ostomized persons through the NOC Outcomes Criteria. Method: a prospective observational study, including ostomized patients under follow-up in the Ostomy Unit at seven days after discharge, and at two, six and 12 months. Sociodemographical, clinical and outcome variables were studied, based on eight indicators associated with the NOC (1101) Tissue Integrity: Skin & Mucous Membranes, (1615) Ostomy Self-Care and (1204) Emotional Balance. A descriptive analysis was conducted, using frequencies, means and standard deviations (SD). Correlations between NOC-derived indicators were studied. Results: the study included 55 patients; 65.45% (n= 36) were male, with 67.45 (13.4) years as mean age (SD), and 58.2% were >65-year-old. Intestinal continuity was restored in 50.90% (n= 28) of the participants; 10.90% (n= 6) achieved skin integrity (visit 1), reaching 100% (n= 20) (visit 4). An adequate self-care was achieved by 18.18% (n= 10) (visit 1), reaching 100% (n= 20) (visit 4). No patient achieved emotional balance at Visit 1; 34% (n= 17) had achieved it at Visit 2, 59.5% (n= 21) at Visit 3, and 70% (n= 14) at Visit 4. Correlations between variables were presented in a direct and positive manner, with Moderate-Good association levels; all of them were statistically significant. Conclusions: the proportion of patients with problems in peristomal skin improved throughout follow-up. Self-care was gradually increased, as well as emotional balance. There was a direct and positive relationship between skin integrity and self-care, quality of sleep, appetite, maintaining personal hygiene and care, and reporting a serene mood

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.

The effect of an interactive follow-up program on ostomy adjustment of inpatients after their discharge from surgical wards of the hospitals affiliated to Isfahan University of Medical Sciences.

PURPOSE: Ostomy patients suffer from many physical and mental problems, which can be solved to a large extent with the help of education and follow-up programs. These follow-ups can be done in person or on the telephone by the nurses, or even, by sending a text message that is an easier way for the patients to adapt to their condition. This study aimed to investigate the effect of an interactive follow-up program on the adjustment of ostomy inpatients after being discharged. METHODS: This study is a clinical trial, conducted on 64 ostomy patients who were discharged from the surgical wards of the hospital affiliated to Isfahan University of Medical Sciences. Subjects in the experimental group participated in a 6-week follow-up program via text message. The information about the patients were collected by Olbrisch Ostomy Adjustment Scale. RESULTS: The obtained results have suggested that 34.4% of the patients in the experimental group and 28.1% of the patients in the control group were female. Before the intervention, comparing the mean score of ostomy adjustment and its dimensions in the two groups showed no significant difference (P > 0.05). However, a significant difference was observed between the two groups immediately after the intervention (P < 0.05) and 1 month after the intervention, except for dimension of negative acceptance (P > 0.05). CONCLUSIONS: The findings of this study suggested that using SMS can be considered as a proper tool or method for following up the ostomy patients.

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.

Relative Tranquility in Ostomy Patients' Social Life: A Qualitative Content Analysis.

BACKGROUND: Ostomy significantly alters one's elimination pattern and can affect the individual in physiological, psychosocial and spiritual aspects. Over time, the ostomy patient's experience changes and they develop coping strategies to handle the new reality. The aims of this study sought Iranian ostomy patients' main problem, how they deal and the outcome of their efforts to manage that problem in their daily lives. METHOD: A qualitative content analysis was conducted involving twenty-seven ostomy patients that were chosen by purposeful sampling and referred to the Iranian Ostomy Association from October 2015 to June 2016. RESULTS: The mean age of the participants was 55 years, 15 were males, the major cause of ostomy was colorectal cancer and the colostomy was the most common type of ostomy, and nineteen of them between one and twenty years lived with an ostomy. Most of them were married, had bachelor degree and received adjuvant therapy, and few were employed. Guarantee indecisive to maintain a stable life with an ostomy and the possibility of ostomy disclosure unpredictability show relative tranquility in patients' social life. CONCLUSION: Because of the ostomy nature, there is not the possibility of full control over life with an ostomy and this issue is causing concerns in their family and social life.

Reinserción laboral de personas con una ostomía en la Comunidad Autónoma de Galicia / Reintegration into the work force of persons with ostomy in the Autonomous Community of Galicia

OBJETIVO: conocer y analizar la realidad del paciente ostomizado desde el punto de vista de su posible reinserción laboral en la Comunidad Autónoma de Galicia. MÉTODO: estudio descriptivo, transversal y multicéntrico sobre los pacientes ostomizados desde la perspectiva de su reincorporación o no a la actividad laboral. El periodo de la investigación fue de octubre de 2014 a septiembre de 2015. Se realizó una única visita, en la que se recogieron una serie de datos basales con respecto a la ostomía, los antecedentes, la calidad de vida y cuestiones acerca de la situación laboral del paciente. Se emplearon el Cuestionario de Calidad de Vida (Stoma-QoL) y el Instrumento para la valoración de la piel periestomal (DET Score). RESULTADOS: se reclutaron un total de 138 pacientes entre los seis centros participantes en la Comunidad Autónoma de Galicia. La edad media de los participantes fue de 52,97 años y la mediana de 54,50 años. En el 71% de los casos incluidos se trataba de una ostomía definitiva frente a un 29% en el que esta tenía intención temporal. La neoplasia resultó ser el motivo más frecuente, con un porcentaje mayor al 68% de los casos, seguido por patologías inflamatorias con más del 15%. Un 80,26% de los pacientes ostomizados declaró su intención de reincorporarse a la vida laboral, sin embargo, solamente un 21,80% se reincorporó a su anterior puesto de trabajo. De los pacientes ya reincorporados a la vida laboral un 18,18% manifiesta haberse visto obligado a hacerlo por exigencias externas a su voluntad. Un 16,03% de la muestra declaró que la condición de la piel ha sido una barrera importante en su reincorporación laboral. CONCLUSIONES: aunque para el paciente ostomizado existen numerosas barreras para poder trabajar de nuevo, el estudio demuestra que los pacientes ostomizados que vuelven a su actividad laboral previa a la cirugía tienen una mayor calidad de vida, por lo que se evidencia la necesidad del apoyo de personal experto en el cuidado de las personas con ostomías, así como de un equipo multidisciplinar, no solo para el cuidado desde la perspectiva de la salud física, sino para intentar abarcar y dar apoyo sociolaboral

OBJECTIVE: to understand and analyze the reality of patients with ostomy from the point of view of their potential reintegration into the work force in the Autonomous Community of Galicia. METHOD: a descriptive, transversal and multicenter study on patients with ostomy from the perspective of their reintegration to the work activity. The period of research was from October, 2014 to September, 2015. A single visit was conducted, where a series of basal data were collected regarding the ostomy, background, quality of life, and questions about the working status of the patient. The Questionnaire on Quality of Life (StomaQoL) and the Tool for Peristomal Skin Assessment (DET Score) were used. RESULTS: in total, 138 patients were recruited from the six participating centres in the Autonomous Community of Galicia. The mean age of participants was 52.97 years, with a median 54.50 years. In 71% of cases included, the ostomy was permanent, vs. 29% of cases where it was intended as temporary. Neoplasia appeared as the most frequent reason, with a >68% percentage of cases, followed by inflammatory conditions in >15% of cases. An 80.26% of ostomates declared their intention to reincorporate to working life; however, only 21.80% could return to their previous job position. From those patients already reintegrated to working life, 18.18% stated that they had been forced to do it by demands outside their own will, while 16.03% of the sample declared that the status of their skin had been a major barrier to their reincorporation to work. CONCLUSIONS: even though there are numerous barriers for ostomates to work again, this study showed that those patients with ostomy who returned to the work activity they held previously to surgery had a better quality of life; this makes evident the need for support by staff with expertise on care for ostomates, as well as for a multidisciplinary team, not only for care from a physical health perspective, but in order to try to include and provide social and occupational support

Executive Summary: Enhanced Recovery After Surgery: Best Practice Guideline for Care of Patients With a Fecal Diversion.

Enhanced Recovery After Surgery (ERAS) is a multimodal program developed to decrease postoperative complications, improve patient safety and satisfaction, and promote early discharge. In the province of Ontario, Canada, a standardized approach to the care of adult patients undergoing elective colorectal surgery (including benign and malignant diseases) was adopted by 15 hospitals in March 2013. All colorectal surgery patients with or without an ostomy were included in the ERAS program targeting a length of stay of 3 days for colon surgery and 4 days for rectal surgery. To ensure the individual needs of patients requiring an ostomy in an ERAS program were being met, a Provincial ERAS Enterostomal Therapy Nurse Network was established. Our goal was to develop and implement an evidence-based, ostomy-specific best practice guideline addressing the preoperative, postoperative, and discharge phases of care. The guideline was developed over a 3-year period. It is based on existing literature, guidelines, and expert opinion. This article serves as an executive summary for this clinical resource; the full guideline is available as Supplemental Digital Content 1 (available at: http://links.lww.com/JWOCN/A36) to this executive summary.

The view of nurses about educational practices targeted at people with a stoma / La visión de los enfermeros sobre las prácticas educativas dirigidas estomizadas personas / A visão dos enfermeiros sobre as práticas educativas direcionadas as pessoas estomizadas

Objective: To analyze the point of view of nurses in respect to educational activities aimed at social inclusion of people with ostomies. Method: A qualitative and exploratory, interpretive and critical study based on a dialectical perspective was carried out with six nurses in a municipal rehabilitation center in Rio de Janeiro. The triangulation method was used with individual interviews, participant observation and analysis of documents. Data was analyzed using a historical and dialectical approach. Results: The preparation of people with a stoma in relation to achieving autonomy and independence through teaching self-care was considered important by the nurses; this aspect was highlighted as the most important of all actions performed in the educational process. Conclusions: The nurses had a humanized practice with the educational strategies used by these professionals aiming at making the educational process more dynamic, focused on practical nursing and directed toward real customer needs.

Objetivo: Analizar los puntos de vista de las enfermeras en las actividades educativas con personas con ostomía, dirigidos a la inclusión social. Método: Cualitativa y exploratoria, interpretativo y crítico, basado en la perspectiva dialéctica, que se celebró en un Centro de Rehabilitación Municipal, en Río de Janeiro, con seis enfermeras. Se utilizó el método de triangulación a través de entrevistas individuales, observación participante y análisis de documentos. Analizar la información desde el enfoque histórico y dialéctico. Resultados: Las enfermeras consideran importante la preparación de las personas con estoma para el logro de la autonomía y la independencia a través de la educación de autocuidado, y pusieron de relieve este aspecto como la más importante de todas las acciones realizadas en el proceso educativo. Conclusiones: Las enfermeras tuvieron una práctica humanizada y estrategias educativas utilizadas por estos profesionales destinadas a convertirse en el proceso educativo más dinámico, destinadas a la práctica y dirigidos a las necesidades reales de los clientes.

Objetivo: Analisar o ponto de vista dos enfermeiros sobre as ações educativas realizadas com as pessoas com estomia, visando à inclusão social. Método: Pesquisa qualitativa e exploratória, interpretativa e crítica, apoiada na perspectiva dialética, realizada em um Centro Municipal de Reabilitação, do Rio de Janeiro, com seis enfermeiros. Utilizou-se a triangulação do método por meio da entrevista individual, da observação participante e da análise documental. Analisaram-se as informações a partir da abordagem histórico-dialética. Resultados: Os enfermeiros consideraram importante o preparo das pessoas com estomia para o alcance da autonomia e independência através do ensino do autocuidado, e destacaram esse aspecto como o mais relevante entre todas as ações realizadas no processo educativo. Conclusões: Os enfermeiros apresentavam uma prática humanizada e as estratégias educativas realizadas por estes profissionais objetivavam tornar o processo educativo mais dinâmico, voltado para a prática e direcionado às reais necessidades da clientela.

A Cross-sectional Study to Determine Whether Adjustment to an Ostomy Can Predict Health-related and/or Overall Quality of Life.

Ostomy-specific adjustment may or may not predict health-related quality of life (HRQoL) and/or overall quality of life (QoL). A cross-sectional study was conducted among patients recruited from the customer registers of 8 surgical suppliers and pharmacies across Norway between November 2010 and March 2011 to determine which of the 34 items of the Ostomy Adjustment Scale (OAS) are the strongest predictors for HRQoL and overall QoL and to determine the HRQoL and overall QoL of individuals with an ostomy compared to a control group representing the general population. Persons who were >18 years old; had a permanent colostomy, ileostomy, or urostomy for >3 months; and could read and write Norwegian were invited to participate. The participants received information about the study in a letter from the researcher and returned their demographic information (addressing gender, age, marital status, education, diagnosis, time since surgery, and ostomy type) and study questionnaires using prepaid envelopes. The 158 participants (mean age 64 years [range 29-91], 89 [56%] men and 69 [44%] women) completed and returned by mail a sociodemographic questionnaire, the 34-item OAS (questions scored on a scale of 1 to 6, totally disagree to totally agree, score range 34 to 204), the Short Form-36 (SF-36, including 2 main components [physical and mental issues] divided into 8 subscales, scored from 0 to 100), and the 16-item Quality of Life Scale (QOLS) instrument (each response scored 1 to 7, from very dissatisfied to very satisfied; total score ranging from 16 to 112). Statistical analysis, including ordinary least square regression analyses, assessed whether the OAS independently predicted the sum scores of the SF-36 (physical component summary [PCS] and mental component summary [MCS]) and the QOLS score after adjusting for age, gender, marital status, education, diagnosis, time since surgery, and ostomy type. The OAS significantly predicted the SF-36 (PCS and MCS) and QOLS scores (P <0.001). Five (5) OAS items ("living a fulfilling life," "being free to travel where I want despite my ostomy," "realizing that this ostomy will be there forever," "worries about being left alone," and "embarrassing accidents in sexual activities") strongly predicted the composite score of the SF-36 (PCS and MCS) and QOLS measurements. The SF-36 scores in physical role functioning, general health, vitality, and MCS were lower in ostomy patients than controls (P < 0.05), whereas no difference was found for QOLS. Overall, ostomy-specific adjustment may be an important predictor of HRQoL and overall QoL, with the OAS factors described above having greater influence. More research such as prospective cohort studies are needed regarding patient adjustment to an ostomy.

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.

The effects of using a moldable skin barrier on peristomal skin condition in persons with an ostomy: results of a prospective, observational, multinational study.

Peristomal skin problems are the most commonly experienced physical complication following ostomy surgery and often are caused by leakage or a poorly fitting skin barrier. A prospective, multicenter, observational evaluation of persons with a colostomy, ileostomy, or urostomy was conducted to assess the incidence of peristomal lesions and level of patient satisfaction with moldable skin barriers. Peristomal skin was assessed using the Studio Alterazoni Cutanee Stomale (SACS™) scale, and patients were asked to rate barrier application and usage variables. During a period of 12 months, and using convenience sampling, 561 patients from 90 centers in 3 countries were enrolled: 28 in Germany, 48 in Poland, and 14 in the United States. Participants included 277 new stoma patients (average time since surgery 0.3 months; average age 64.7 ± 12.86 years) who had a colostomy (174), ileostomy (72), or urostomy (10); and 284 patients with an existing stoma (average time since surgery 18.2 months; average age 66 ± 12.62 years) who had a colostomy (174), ileostomy (88), or urostomy (22) who experienced skin complications using a traditional skin barrier (ie, a solid or flexible barrier with precut opening or one requiring cutting an opening to accommodate the stoma). All patients were assessed at baseline and after 1 and 2 months. In the patients with a new stoma, 225 (90.4%) had intact skin at baseline, 239 (95.6%) had intact skin after 2 months, and 98% rated overall satisfaction with the barrier as good or excellent. In the patients with an existing stoma, intact skin was observed in 103 patients (39.5%) at baseline and 225 (86.2%) after 2 months, with 96.5% of patients rating overall satisfaction with the barrier as good or excellent. In this group, the proportion of patients who used accessory products (eg, belt, deodorants, powder) was 73% at baseline and 64.2% at the 2-month follow-up. The moldable skin barriers evaluated were effective in preventing and healing peristomal skin complications and were rated as good or excellent by the vast majority of patients. Comparative studies are warranted to evaluate the efficacy and cost-effectiveness of this moldable skin barrier.