Construction of a Perioperative Care Protocol for Individuals with Intestinal Ostomies

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Abstract

Objective: To develop a nursing protocol to guide perioperative care for individuals with intestinal ostomies. Method: A methodological study conducted between March and June 2022, using a quantitative approach. The study was divided into three stages: 1) an exploratory phase to determine the characteristics of the target population using a questionnaire; 2) the definition of perioperative recommendations based on Enhanced Recovery After Surgery® (ERAS); and 3) the creation of the protocol. Data analysis involved simple descriptive statistics. Results: Ten (10) patients responded preoperatively, while only six (6) responded postoperatively. Preoperative education was provided by nurses in 50% of cases. Findings showed an absence of ostomy site marking in 90% of cases, insufficient self-care in 60%, and postoperative complications in 60%, including edema, mucocutaneous separation, contact dermatitis, peristomal hernia, edge maceration, and granuloma. The proposed protocol consists of a care flowchart with four lines of follow-up within the institution and a consolidated framework with four key axes of perioperative nursing actions. Each axis includes sub-axes that detail specific guidelines to be implemented. Conclusion: The situational analysis of the target population and perioperative complications demonstrated the feasibility of developing a perioperative care protocol focused on the immediate preoperative, intraoperative, and postoperative phases.

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References

Rivet EB. Ostomy management: a model of interdisciplinary care. Surg Clin North Am. 2019;99(5):885-98. https://doi.org/10.1016/j.suc.2019.06.007

Hsu MY, Lin JP, Hsu HH, Lai HL, Wu YL. Preoperative stoma site marking decreases stoma and peristomal complications: a meta-analysis. J Wound Ostomy Continence Nurs. 2020 May/Jun;47(3):249-56. https://doi.org/10.1097/won.0000000000000634

Thum M, Paula MAB, Morita ABSP, Balista AL, Franck EM, Lucas PCC. Complicações tardias em pacientes com estomias intestinais submetidos à demarcação pré-operatória. ESTIMA, Braz J Enterostomal Ther. 2018;16:e4218. https://doi.org/10.30886/estima.v16.660_PT

Tomasi AVR, Santos SMA, Honório GJS, Girondi JBR. Convivendo com estomia intestinal e a incontinência urinária. Texto Contexto Enferm. 2022;31:e20210115. https://doi.org/10.1590/1980-265X-TCE-2021-0398pt

Teles AAS, Pantoni LA, Neves WFS, Aguiar JC, Russo TMS, Paraizo-Horvath CMS, Correa Júnior AJS, Sonobe HM. Perioperative nursing care for patients with colorectal cancer: sociodemographic, clinical and therapeutic characterization. Res Soc Dev. 2021;10(7):e30310716599. https://doi.org/10.33448/rsd-v10i7.16599

Qin F, Zhen L, Ye X, Wei H, Zhu M, Chen J, Shi L. Stigma and its influence on patients with temporary ostomy: a cross-sectional survey. J Wound Ostomy Continence Nurs. 2020 May/Jun;47(3):244-8. https://doi.org/10.1097/won.0000000000000645

Freitas JPC, Borges EL, Bodevan EC. Caracterização da clientela e avaliação de serviço de atenção à saúde da pessoa com estomia de eliminação. ESTIMA, Braz J Enterostomal Ther. 2018;16:e0918. https://doi.org/10.30886/estima.v16.402_PT

Nunes MLG, Santos VLCG. Instrumentos de avaliação das complicações na pele periestomia: revisão integrativa. Aquichan. 2018;18(4):477-91. https://doi.org/10.5294/aqui.2018.18.4.9

Almeida AO, Dantas SRPE, Paula MAB, Silva JLG, Franck EM, Oliveira-Kumakura ARS. Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists. Rev Bras Enferm. 2021 Mar;74(1):e20200360. https://doi.org/10.1590/0034-7167-2020-0360

Figueiredo TWB, Mercês NNA, Lacerda MR, Hermann AP. Developing a nursing healthcare protocol: a case report. Rev Bra Enferm. 2018;71(suppl 6):2837-42. https://doi.org/10.1590/0034-7167-2017-0846

Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saúde Pública. 2010;44(3):559-65. https://doi.org/10.1590/S0034-89102010000300021

Vieira FS. Complicações de estoma intestinal e pele periestoma de pacientes em seguimento ambulatorial [dissertação mestrado]. Ribeirão Preto: Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto; 2014. https://doi.org/10.11606/D.22.2014.tde-06022015-174658

Carrilho MPG, Pontífice-Sousa P, Marques RMD. ERAS® program – nursing care for patients undergoing colorectal surgery. Acta Paul Enferm 2021;34:eAPE002105. https://doi.org/10.37689/acta-ape/2021AR02105

Mendes DIA, Ferrito CRAC, Gonçalves MIR. Nursing Interventions in the Enhanced Recovery After Surgery®: scoping review. Rev Bras Enferm. 2018;71(Suppl 6):2824-32. https://doi.org/10.1590/0034-7167-2018-0436

Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) society recommendations: 2018. World J Surg. 2019 Mar;43(3):659-95. https://doi.org/10.1007/s00268-018-4844-y

Queiroz ST, Costa VVL, Cunha RR, Araujo MS, Silva AF, Barros KS, Dias LNM, Barreto JTT, Amaral MPC. Consumo alimentar de macronutrientes e estado nutricional de pessoas com estomia. ESTIMA, Braz J Enterostomal Ther. 2022;20:e1722. https://doi.org/10.30886/estima.v20.1224_PT

Freitas Nascimento MV, Vera SO, Silva MCR, Morais FF, Andrade EMLR, Bastos SNMAN. Perfil sociodemográfico e clínico de pacientes em pós-operatório de confecção de estomas intestinais de eliminação. Cienc Enferm. 2018;24:15. https://doi.org/10.4067/s0717-95532018000100215

Brasil. Ministério da Saúde. Instituto Nacional de Câncer. Estimativa 2020: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2019 [citado 2022 Dec. 08]. Disponível em: https://www.inca.gov.br/publicacoes/livros/estimativa-2020-incidencia-de-cancer-no brasil

Ripollés‐Melchor J, Varela MLF, Camargo SC, Fernández PJ, del Barrio ÁC, Martínez‐Hurtado E, Casans-Francésc R, Abad-Gurumeta A, Ramírez-Rodríguez JM, Calvo‐Vecino JM. 2018. Aceleração da recuperação após protocolo cirúrgico versus cuidados perioperatórios convencionais em cirurgia colorretal. Um estudo de coorte em centro único. Rev Bras Anestesiol. 2018;68(4):358-68. https://doi.org/10.1016/j.bjan.2018.01.003

Camargo FC, Iwamoto HH, Galvão CM, Pereira GA, Andrade RB, Masso GC. Competences and barriers for the evidence-based practice in nursing: an integrative review. Rev Bras Enferm. 2018 Jul-Aug;71(4):2030-8. https://doi.org/10.1590/0034-7167-2016-0617

Gonçalves NS, Gomes IV, Florêncio FC, Souza IBF, Serrano SQ. Atividade lúdica no processo educacional ao paciente estomizado. Enferm Bras. 2021;20(3):384-98. https://doi.org/10.33233/eb.v20i3.4813

Heidari-Beni F, Esmaeilian S, Yousefi F, Zarei MR, Farahani MA. Comparison of face-to-face education and multimedia software education on adjustment of patients with intestinal ostomy: a randomized controlled trial. J Wound Ostomy Continence Nurs. 2022 Mar-Apr;49(2):152-7. https://doi.org/10.1097/WON.0000000000000854

Wang SY, Chang TH, Han CY. Effectiveness of a multimedia patient education intervention on improving self-care knowledge and skills in patients with colorectal cancer after enterostomy surgery: a pilot study. Adv Skin Wound Care. 2021 Feb;34(2):1-6. https://doi.org/10.1097/01.ASW.0000725192.98920.c4

Pontes JPJ, Mendes FF, Vasconcelos MM, Batista NR. Avaliação e manejo perioperatório de pacientes com diabetes melito. Um desafio para o anestesiologista. Rev Bras Anestesiol. 2018;68(1):75-86. https://doi.org/10.1016/j.bjane.2017.04.017

Diniz IV, Costa IKF, Nascimento JA, Silva IP, Mendonça AEO, Soares MJGO. Factors associated to quality of life in people with intestinal stomas. Rev Esc Enferm USP. 2021 Aug;55:e20200377. https://doi.org/10.1590/1980-220X-REEUSP-2020-0377

Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Portaria no 400, de 16 de novembro de 2009 [Internet]. [citado 2022 Dec. 08]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2009/prt0400_16_11_2009.html

Published

2024-10-31

How to Cite

1.
Dias AL de L, Neves WF dos S, Conceição de Lima F, Sagica T dos P, Correa Júnior AJS, Mendes CP, et al. Construction of a Perioperative Care Protocol for Individuals with Intestinal Ostomies. ESTIMA [Internet]. 2024 Oct. 31 [cited 2024 Dec. 13];22. Available from: https://www.revistaestima.com.br/estima/article/view/1535

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