Autocuidado com a estomia intestinal e equipamento coletores: perspectiva das pessoas estomizadas intestinais, familiares e equipe multidisciplinar do programa de ostomizados

Abstract

This is a study of mixed design, typified as explanatory sequential, where, in the first quantitative, descriptive and cross-sectional stage, the objective was to analyze the sociodemographic, clinical and self-care characteristics of ostomized individuals enrolled in a Program for Ostomized People in the countryside of the state of São Paulo; and, in the second exploratory qualitative stage, it aimed to analyze and to construct the meaning of the self-care experience with intestinal ostomy, from the perspective of patients, relatives, and the multidisciplinary team of the Program for Ostomized People (Opinion nº 896.782/2014 CEP/EERP-USP). In the quantitative stage, we applied two instruments, one for the sociodemographic characterization of the ostomized subjects and their relatives, and another to measure the self-care capacity of the ostomized subjects and their relatives, through inclusion and exclusion criteria. The descriptive statistical analysis of the data indicated that, of the total of 120 surveyed ostomized subjects, there was a predominance of 57.5% male; 64.9% aged up to 73 years; 68.4% with up to five years of schooling and 71.0% married; 76.0% had colostomy, of which 62.6% due colorectal neoplasm; with complications present in 54.2% of ostomized patients, mainly the parastomal hernia in 39.1%; and 68.5% used the one-piece drainage bag. As for the general self-care capacity, 95.9% of ostomized subjects showed full capacity; however, 56.8% showed full capacity for the specific self-care with intestinal ostomy and collecting equipment. Moreover, 32 relatives took part in this stage, with a predominance of 75% female; 56.2% aged over 60 years; 46.9% with schooling between 5 and 10 years; with 71.9% married/stable relationship; 68.8% without work activity and 50.0% with family income between 3 and 4 minimum wages. These results allowed us to measure the context of the study and to refine the criteria for selecting the possible participants for the qualitative stage. This was developed by means of in-depth interviews with the focal group technique, distinctly for the ostomized participants, relatives, and the professionals of the Program for Ostomized People, besides field diary, non-participant and participant observation to obtain the data, using Thematic Analysis and the Social Model of Disability for interpreting them. The experience of the ostomized patients was categorized with the theme "The experience of the need for self-are after the process of intestinal ostomization", with two thematic cores "Interdisciplinary care required for the ostomized people"; and "Self-care for rehabilitating the ostomized person", which highlighted the need for specialized hospital care and the continuity of interdisciplinary professional support for outpatient follow-up. The data about the relatives were discussed through the theme: "Challenges of the relative in living with the ostomized person", with the thematic units "The overload of responsibility for caring for and the prejudice arising from intestinal ostom...

Equipamentos coletores/adjuvantes de estomizados intestinais e a assistência especializada: a acessibilidade para o alcance da reabilitação

“…Em relação à cor de pele, a maioria (60,8%) dos participantes afirmou ser de cor branca, semelhantemente a de outros estudos (PITTMAN et al, 2008;MITCHELL et al, 2007). SASAKI et al, 2017;SASAKI, 2018).…”

“…No programa especializado de estomizados, o enfermeiro é responsável pela consulta de Enfermagem, com levantamento de dados clínicos e de tratamentos realizados, exame físico e avaliação da estomia intestinal, presença de complicações, seleção e indicação de EC/adjuvantes, além do gerenciamento da previsão e provisão de materiais e EC/adjuvantes (LENZA, 2011;LENZA et al, 2013;SASAKI, 2018).…”

“…O desafio é a superação da deficiência restrita à esfera privada e familiar para uma questão pública para a garantia dos direitos de cidadania da pessoa com estomia intestinal por meio de proteção social ou por instrumentos legais. (SANTOS, 2008;GIRONDI, SANTOS, 2011;LENZA et al, 2015;SASAKI et al, 2017;SASAKI, 2018;MORAES, 2019). (REED, 2012;HOCH et al, 2013;CLAESSENS et al, 2015;SASAKI, 2018 (BRASIL, 2009;MORAES et al, 2016;SASAKI, 2018).…”

“…O autocuidado é uma intervenção fundamental para a reabilitação desta clientela, contudo, a abordagem tem sido pontual, com uma perspectiva procedimental (SASAKI et al, 2017;SASAKI, 2018).…”

“…Para tanto, no ensino pré-operatório ao paciente e família deve-se contemplar informações sobre a cirurgia e suas consequências, além dos procedimentos perioperatórios, que devem ser vinculados ao ensino do autocuidado no pós-operatório para a alta hospitalar, com contrarreferência ao programa de estomizados (SASAKI et al, 2017). (REED, 2012;HOCH et al, 2013;MARTINS;TAVERNELLI;SANSOM, 2013;RATLIFF, 2014;CLAESSENS et al, 2015;NEIL et al, 2016;SASAKI, 2018). Isto ocorre quando este processo é considerado e vivido na esfera individual e privada, o que vincula ao cuidado procedimental da troca de EC/adjuvantes e à tentativa de resolução de problemas, na medida em que ocorrem (MORAES et al, 2016;MORAES, 2019).…”