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Qualidade de vida e complicações dos portadores de ostomia de eliminação
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Abstract(s)
Introdução: A problemática da ostomia provoca na pessoa, uma situação de elevado stress, que pode decorrer do diagnóstico, bem como da intervenção cirúrgica, podendo provocar alterações na sua qualidade de vida. A qualidade de vida da pessoa portadora de uma ostomia de eliminação irá depender da sua aprendizagem ao nível do autocontrole comportamental, da autonomia pessoal e da aprendizagem social (1). A intervenção cirúrgica da qual resulta a construção de uma ostomia de eliminação, leva a pessoa ostomizada a recorrer a comportamentos adaptativos e estratégias de resolução de problemas. A resposta à problemática causada pela construção de um estoma, é influenciada pelas características pessoais de cada um, bem como as variações externas, a qualidade do suporte familiar, económico e assistencial recebido durante as fases do tratamento cirúrgico que originou a ostomia (2). O objetivos deste estudo foram: caracterizar a pessoa ostomizada; identificar as complicações mais comuns no pósoperatório; conhecer a percepção da pessoa ostomizada sobre a adaptação à sua nova condição de vida; identificar o impacto provocado pela ostomia de eliminação intestinal nos estilos de vida da pessoa; e, avaliar a sua qualidade de vida. Material e Métodos: Estudo exploratório de caráter transversal, num paradigma quantitativo, com uma amostra de conveniência constituída por todos os portadores de ostomia de eliminação intestinal, provisória ou definitiva, de ambos os sexos que aceitaram participar no estudo, com tempo máximo de cirurgia 3 meses, em oito instituições nacionais. O estudo pela realização de uma entrevista pela enfermeira responsável pela consulta de estomaterapia e respetivo preenchimento de um questionário. A colheita de dados realizou-se no período entre 1 de Junho de 2014 a 31 de Março de 2014. O estudo foi autorizado pelas respetivas comissões de ética de cada instituição. Resultados: Foram obtidos 224 Questionários completas, 68% do sexo masculino e 32% do sexo feminino, com idade média de 65,33 anos (dp=14,01) e mais de 70% tem como formação académica o 1 ciclo. Foi ainda possível caracterizar que 60,3% dos portadores com ostomia refere ter prestador de cuidados; 20% vivem sozinhos; e 22% referem dependência económica de terceiros. Quanto à sua situação de saúde 25% dos pacientes consideraram o seu estado de saúde como mau, e quando em comparação com 5 anos atrás 80% pensam que é pior (p <0,001). Ao nível da situação económica de acordo com a classificação de Graffar em que 39% pertenciam às classes III e IV baixo nível económico ou pobre. A funcionalidade da família, foi avaliada pelo teste de Apgar, que demonstrou que a (17%) pertence a uma família com moderada a alta disfuncionalidade. Relativamente à tipologia do estoma 75% são colostomizados e 25% ileostomizados, destes 61% são temporários, 62,9% são proeminentes como característica anatómica, e a causa mais prevalente da confecção do estoma (69,5%) são as neoplasias. As complicações mais comuns no estoma identificadas no mês anterior ao estudo: retração (3,2%), edema (3,2%), deiscência da sutura (2,7%) e prolapso (2,7%). Quanto as complicações mais comuns na pele peri-estoma, o eritema cutâneo (30%) foi a complicação mais prevalente. Sobre o impacto da estilos de vida ostomia: 42% dos portadores de ostomia têm uma percepção negativa da sua qualidade de vida, 7,5% destes utentes ainda rejeita o seu estoma e 36,6% resigna-se com a sua situação, pese embora 63,8% referem ter ficado deprimidos depois da confecção da ostomia. Quanto às principais alterações nas atividades de vida diárias 74% deixaram de trabalhar, 17,4% tem dificuldades em vestir-se e/ou adaptar o seu vestuário; 62,9% dos ostomizados alterou/adaptou a sua dieta à sua nova condição; 51% referem redução da atividade sexual e 42% dos homens relataram problemas com ereção. Conclusões: A autonomia, independência e a qualidade de vida, constituem temas de crescente relevância, na prestação de cuidados, mas relacionadas com a pessoa portadora de ostomia são ainda escassas. Estes resultados ajudam a compreender complicações estoma e facilitar a adaptação a esta transição. Identificar precocemente complicações no estoma e pele peri-lesional , bem como a sua prevenção, permite reduzir custos e redução da qualidade de vida. Tendo em conta as necessidades identificadas neste estudo é passível de se implementar programas educacionais para portador de ostomia e prestador de cuidados.
Introduction: An ostomy generates in the patient a high stress situation, which may result from the diagnosis as well as surgical intervention and may cause changes in their quality of life. The quality life of a person with an ostomy depends of the personal capacity of learning in relation to teh personal self-control behavior, autonomy and social learning (1). The surgical intervention that results in a construction of an ostomy, leads the ostomate to use adaptive behaviors and problem-solving strategies. The answer to the problems caused by the construction of a stoma, is influenced by the personal characteristics, as well as external changes, the quality of family, economic and care support received during the stages of surgical treatment that originated the ostomy (2). Objectives of this study were to characterize the person with an elimination ostomy disposal; identify the most common complications in the postoperative period; know the perception of the ostomy patient on adapting to their new condition of life; identify the impact caused by intestinal elimination ostomy in the person's lifestyles; and assess their quality of life. Methods: An exploratory, quantitative and cross-sectional study, with a convenience sample of all patients with intestinal elimination ostomy, temporary or permanent, of both sexes who agreed to participate in the study, with maximum time of surgery 3 months in eight national institutions. Data collection was conducted through an interview by the nurse responsible for stomatherapy consultation and appropriate completion of a questionnaire. The collection of data took place in the period from 1 June 2014 to 31 March 2014. The study was approved by the respective ethics committees of each institution. Results: 224 completed questionnaires, 68% male and 32% female were obtained with a mean age of 65.33 years (SD = 14.01) and over 70% have basic education. It was also identified that 60.3% of patients with an ostomy report to have caregiver; 20% of them live alone; and 22% said economic dependence on third parties. As for his health situation 25% of patients considered their health as bad, and when compared to five years ago 80% think it is worse (p <0.001). Regarding the economic situation according to Graffar classification, 39% were in classes III and IV classified as low or poor economic level. The family functionality was evaluated by Apgar test, which showed that the (17%) belongs to a family with moderate to high dysfunction. Regarding the stoma type: 75% colostomys and 25% ileostomys; 61% of the ostomys are temporary; 62.9% are prominent as anatomical feature, and the most prevalent cause of making the stoma (69.5%) were câncer. The most common complications in the stoma identified in the previous month study: decrease (3.2%), edema (3.2%), suture dehiscence (2.7%) and prolapse (2.7%). The most common complications peristoma skin, rash (30%) was the most prevalent complication. About Ostomy impact on lifestyles: 42% of patients with ostomy have a negative perception of their quality of life, 7.5% of users still rejects their stoma and 36.6% resigns with their situation, despite 63.8% reported having been depressed after the making of the ostomy. The major changes in daily life activities: 74% stopped working, 17.4% have difficulty dressing and / or adapt their clothing; 62.9% changed / adapted their diet to their new condition; 51% report reduced sexual activity and 42% of men reported problems with erection. Conclusions: autonomy, independence and quality of life are increasingly important issues in providing care, but related to the bearer of ostomy people are still scarce. These results help to understand stoma complications and facilitate adaptation to this transition. early identification of complications in the stoma and peri-lesional skin as well as its prevention, reduces costs and reduced quality of life. Taking into account the needs identified in this study is likely to implement educational programs for ostomy carrier and carer.
Introduction: An ostomy generates in the patient a high stress situation, which may result from the diagnosis as well as surgical intervention and may cause changes in their quality of life. The quality life of a person with an ostomy depends of the personal capacity of learning in relation to teh personal self-control behavior, autonomy and social learning (1). The surgical intervention that results in a construction of an ostomy, leads the ostomate to use adaptive behaviors and problem-solving strategies. The answer to the problems caused by the construction of a stoma, is influenced by the personal characteristics, as well as external changes, the quality of family, economic and care support received during the stages of surgical treatment that originated the ostomy (2). Objectives of this study were to characterize the person with an elimination ostomy disposal; identify the most common complications in the postoperative period; know the perception of the ostomy patient on adapting to their new condition of life; identify the impact caused by intestinal elimination ostomy in the person's lifestyles; and assess their quality of life. Methods: An exploratory, quantitative and cross-sectional study, with a convenience sample of all patients with intestinal elimination ostomy, temporary or permanent, of both sexes who agreed to participate in the study, with maximum time of surgery 3 months in eight national institutions. Data collection was conducted through an interview by the nurse responsible for stomatherapy consultation and appropriate completion of a questionnaire. The collection of data took place in the period from 1 June 2014 to 31 March 2014. The study was approved by the respective ethics committees of each institution. Results: 224 completed questionnaires, 68% male and 32% female were obtained with a mean age of 65.33 years (SD = 14.01) and over 70% have basic education. It was also identified that 60.3% of patients with an ostomy report to have caregiver; 20% of them live alone; and 22% said economic dependence on third parties. As for his health situation 25% of patients considered their health as bad, and when compared to five years ago 80% think it is worse (p <0.001). Regarding the economic situation according to Graffar classification, 39% were in classes III and IV classified as low or poor economic level. The family functionality was evaluated by Apgar test, which showed that the (17%) belongs to a family with moderate to high dysfunction. Regarding the stoma type: 75% colostomys and 25% ileostomys; 61% of the ostomys are temporary; 62.9% are prominent as anatomical feature, and the most prevalent cause of making the stoma (69.5%) were câncer. The most common complications in the stoma identified in the previous month study: decrease (3.2%), edema (3.2%), suture dehiscence (2.7%) and prolapse (2.7%). The most common complications peristoma skin, rash (30%) was the most prevalent complication. About Ostomy impact on lifestyles: 42% of patients with ostomy have a negative perception of their quality of life, 7.5% of users still rejects their stoma and 36.6% resigns with their situation, despite 63.8% reported having been depressed after the making of the ostomy. The major changes in daily life activities: 74% stopped working, 17.4% have difficulty dressing and / or adapt their clothing; 62.9% changed / adapted their diet to their new condition; 51% report reduced sexual activity and 42% of men reported problems with erection. Conclusions: autonomy, independence and quality of life are increasingly important issues in providing care, but related to the bearer of ostomy people are still scarce. These results help to understand stoma complications and facilitate adaptation to this transition. early identification of complications in the stoma and peri-lesional skin as well as its prevention, reduces costs and reduced quality of life. Taking into account the needs identified in this study is likely to implement educational programs for ostomy carrier and carer.
Description
Keywords
Autocuidado Autonomia Autonomy Enfermagem Estomaterapia Nursing Qualidade de vida Quality of life Selfcare Stomatherapy
Pedagogical Context
Citation
Alves, P., Miranda, L., Teixeira, C., & Silva, N. I. et al. (2016). Qualidade de vida e complicações dos portadores de ostomia de eliminação. In M. M. Vieira, J. Neves-Amado, B. Araújo, & S. Deodato (Eds.), 10th international seminar on nursing research proceedings (pp. 116-117). Article 407 Universidade Católica Portuguesa.
Publisher
Universidade Católica Portuguesa
CC License
Without CC licence