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Abstract(s)
A ostomia de eliminação (OdE) confronta a pessoa com mudanças nas suas dinâmicas quotidianas, em que projetos de vida poderão ter de ser reorientados, na procura da melhor adaptação física, emocional, familiar e social. O processo de transição nem sempre é fácil e favoravelmente ultrapassado, pelo que o cuidado de enfermagem em estomaterapia constitui um importante recurso para ajudar as pessoas a gerir os novos desafios, conseguir adaptar-se e experienciar melhor qualidade de vida (QdV). Constituíram-se como objetivos principais, criar um programa de intervenção de enfermagem em estomaterapia (PIEE), implementá-lo em pessoas com OdE e avaliar os seus efeitos na QdV e na adaptação à ostomia, através de quatro estudos. No primeiro estudo, identificaram-se áreas sensíveis à intervenção de enfermagem, que podem estar afetadas nas pessoas com OdE, e discrepâncias entre a necessidade de cuidados e a resposta dos enfermeiros dos Cuidados de Saúde Primários (CSP), influenciando a decisão de construir o PIEE, no estudo seguinte, estruturado em torno de seis focos relevantes da prática clínica em estomaterapia (Autocuidado, Autoconceito, Aceitação, Interação Social, Interação Sexual e Esperança). No terceiro estudo, criámos um instrumento que fosse sensível às intervenções de enfermagem na promoção da adaptação à OdE, que utilizámos no quarto estudo. A análise das suas propriedades métricas revelou critérios de validade e fiabilidade aceitáveis, podendo constituir uma ferramenta útil na prática e na investigação em enfermagem. No último estudo, implementámos e avaliámos os efeitos do PIEE na adaptação e QdV das pessoas com OdE. Para tal desenhámos um estudo quasi-experimental, com uma amostra de 105 pessoas com OdE, distribuídas por um grupo de intervenção (GI), sujeito ao PIEE, e um grupo de controlo (GC), constituídos em hospitais com e sem consulta de enfermagem de estomaterapia, respetivamente. A recolha de dados ocorreu um e seis meses após a alta hospitalar, usando como instrumentos, um questionário construído para o efeito, o Índice de Qualidade de Vida-Ostomia, traduzido e validado para a população portuguesa, e a Escala de Adaptação à Ostomia de Eliminação, criada no terceiro estudo. Os resultados indicaram que, no primeiro mês, a QdV e a adaptação à ostomia percebidas eram idênticas e satisfatórias em ambos os grupos. Ao sexto mês, a perceção de QdV e de adaptação à ostomia no GI era significativamente melhor do que no GC e do que nos dois grupos no primeiro mês. No GC não se constataram mudanças entre o primeiro e o segundo momento. Em síntese, intervenções sistemáticas do enfermeiro em estomaterapia, que se prolonguem no tempo, mostraram ter efeitos no processo de transição, pelo desenvolvimento da proficiência no autocuidado à ostomia, estimulação da autoconfiança e procura de recursos disponíveis, refletindo-se favoravelmente na perceção de QdV.
The elimination ostomy (EO) confronts each person with changes in their daily dynamics, where life projects may have to be reoriented, in search of better physical, emotional, family and social adjustment. The transition process is neither easy nor easily surpassed. Because of this, the enterostomal therapy nursing care is an important resource to help patients manage these new challenges, and be able to adapt and experience a better quality of life (QoL). Are constituted as main objectives, to create a enterostomal therapy nursing intervention program (ETNIP) and to implement it in people with EO, evaluating its effect on QoL and in adjustment to ostomy, using up to this, four studies. Through the first study, we identified sensitive areas to nursing intervention in enterostomal therapy, which can affect people with OE and we could detect discrepancies between the need of care and the response of nurses of the Community Health Care. This influenced the decision to develop a nursing intervention program in stoma care in the following study, structured around six relevant focuses of the enterostomal nursing practice (Self Care, Self-Conception, Acceptance, Social Interaction, Sexual Interaction and Hope). In the third study, we created an instrument that is sensitive to the interventions of nurses in promoting the adaptation to EO (used in the study fourth). The analysis of these metric properties revealed the acceptable criterion for both validity and reliability, allowing the tool to be useful in practice and nursing research. In the last study, we implemented and evaluated the effects of the ETNIP, on the adjustment and QoL for patients with EO. For this, we designed a quasi-experimental study with a sample of 105 participants with EO, distributed by an intervention group (IG), subject to the ETNIP, and a control group (CG) established in hospitals with and without enterostomal therapist consultation, respectively. Data collection occurred one and six months after hospital discharge, using as instruments, a questionnaire constructed for this purpose, the Ostomy Quality of Life Index, translated and validated for the portuguese population, and the Elimination Ostomy Adjustment Scale, created in the third study. Our results indicated that, in the first month, the QoL and the ostomy adjustment perceived were satisfactory and similar in both groups. However, in the sixth month the perception of QoL and the ostomy adaptation for the IG were significantly greater than in the CG, and the previous evaluations of two groups in the first month. The CG did not suffer any changes between the first and second evaluation. In conclusion, overtime systematic interventions of a nurse specialized in ostomy care has shown to have positive effects in the transition process. This is due to the development of proficiency in ostomy self-care, stimulation of self-confidence, and the search for other available resources, which in turn reflected favorably on the QoL perception.
The elimination ostomy (EO) confronts each person with changes in their daily dynamics, where life projects may have to be reoriented, in search of better physical, emotional, family and social adjustment. The transition process is neither easy nor easily surpassed. Because of this, the enterostomal therapy nursing care is an important resource to help patients manage these new challenges, and be able to adapt and experience a better quality of life (QoL). Are constituted as main objectives, to create a enterostomal therapy nursing intervention program (ETNIP) and to implement it in people with EO, evaluating its effect on QoL and in adjustment to ostomy, using up to this, four studies. Through the first study, we identified sensitive areas to nursing intervention in enterostomal therapy, which can affect people with OE and we could detect discrepancies between the need of care and the response of nurses of the Community Health Care. This influenced the decision to develop a nursing intervention program in stoma care in the following study, structured around six relevant focuses of the enterostomal nursing practice (Self Care, Self-Conception, Acceptance, Social Interaction, Sexual Interaction and Hope). In the third study, we created an instrument that is sensitive to the interventions of nurses in promoting the adaptation to EO (used in the study fourth). The analysis of these metric properties revealed the acceptable criterion for both validity and reliability, allowing the tool to be useful in practice and nursing research. In the last study, we implemented and evaluated the effects of the ETNIP, on the adjustment and QoL for patients with EO. For this, we designed a quasi-experimental study with a sample of 105 participants with EO, distributed by an intervention group (IG), subject to the ETNIP, and a control group (CG) established in hospitals with and without enterostomal therapist consultation, respectively. Data collection occurred one and six months after hospital discharge, using as instruments, a questionnaire constructed for this purpose, the Ostomy Quality of Life Index, translated and validated for the portuguese population, and the Elimination Ostomy Adjustment Scale, created in the third study. Our results indicated that, in the first month, the QoL and the ostomy adjustment perceived were satisfactory and similar in both groups. However, in the sixth month the perception of QoL and the ostomy adaptation for the IG were significantly greater than in the CG, and the previous evaluations of two groups in the first month. The CG did not suffer any changes between the first and second evaluation. In conclusion, overtime systematic interventions of a nurse specialized in ostomy care has shown to have positive effects in the transition process. This is due to the development of proficiency in ostomy self-care, stimulation of self-confidence, and the search for other available resources, which in turn reflected favorably on the QoL perception.
Description
Keywords
Ostomia de eliminação Programa de intervenção Enfermagem em estomaterapia Transição Qualidade de vida Adaptação Elimination ostomy Intervention program Enterstomal therapy nursing Transition Quality of life Stoma adjustment