Características sociodemográficas e clínicas que afetam a qualidade de vida em pacientes estomizados intestinais
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Data
2016-03-02
Autores
Crepalde, Patrícia Aparecida Francelino [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O estomizado é o indivíduo submetido à cirurgia de desvio do trânsito intestinal, que consiste na abertura da parede abdominal de um segmento, desviando os efluentes para o meio externo. Objetivo: Avaliar a qualidade de vida dos estomizados assistidos em serviço especializado e estudar a associação destes desfechos com as características sociodemográficas e clínicas. Método: Trata-se de um estudo transversal analítico. Este estudo foi realizado no Núcleo de Assistência ao Ostomizado, do Hospital das Clínicas de Botucatu, no período de outubro de 2014 a agosto de 2015, e aprovado pelo Comitê de Ética e Pesquisa da Faculdade de Medicina de Botucatu-Unesp, por meio do protocolo nº 291.707/2013. A amostra foi composta de 60 pacientes. Para a coleta de dados utilizou-se dois instrumentos, sendo o primeiro um formulário, compreendido pelas etapas: caracterização sociodemográficas e clínicas, aspectos fisiológicos, psicossociais, nutricionais e legais; e para a avaliação da QV, utilizou-se o instrumento WHOQOL-bref, composto por 2 questões gerais de QV e 24 facetas, que se referem a quatro domínios: físico, psicológico, relações sociais e meio ambiente. Resultados: Do total de 60 pacientes estomizados predominou o sexo feminino (51,7%), idade acima de 61 anos (60%), da cor branca (93,3%), residentes em Botucatu (53,3%), vivem com companheiro (55%), têm renda familiar entre 1 a 3 salários mínimos (78,3%), são aposentados (63,3%) e o ensino fundamental, com (61,7%). Referente ao tempo de estomizado (71,7%), está em média há 6 anos. O motivo que levou a confecção do estoma foi câncer (61,7%) e o agravo crônico que prevaleceu entre os indivíduos estomizados foi a hipertensão arterial sistêmica (31,7%). Quanto à derivação, evidenciaram-se as colostomias descendentes, com (53,3%). O seguimento médico regular é evidente em (90%) dos indivíduos. No que diz respeito ao dispositivo coletor, (80%) utiliza de uma peça drenável, variando de 25 a 102 milímetros de diâmetro; com relação à troca do dispositivo, (33,3%) troca a cada três dias e relata ter “muita” dificuldade no autocuidado com o estoma (65%) e com a bolsa coletora (61,7%). Quanto à presença da insônia, (35%) referiu insônia após a estomia. A atividade sexual foi mantida pela minoria, (31,5%), após a presença do estoma. Referente aos aspectos emocionais de dependência (50%) evidenciou ser fato, após o estoma. A respeito da ajuda recebida após estomia, (100%) relata ter a família como suporte. Quanto às orientações recebidas no pós-operatório, (96,7%) dos indivíduos relataram ter recebido orientação. Do total de 60 pacientes estomizados, (80%) relatou que os dispositivos são suficientes no mês e apenas (20%) dos indivíduos estomizados conhecem os seus direitos legais. O domínio psicológico apresentou a média mais elevada, 70,8, evidenciando que mesmo a autoimagem podendo estar prejudicada pela confecção de um estoma, esse domínio teve uma avaliação melhor, comparada com outros domínios da QV. Considerando p>0,10, as seguintes associações, foram realizadas: ter diabetes mellitus, fazer seguimento médico regularmente, sentir dependência após estomia, ter atividade sexual após estomia, visitar os amigos após estomia, índice de massa corporal ser mais elevado e conhecer os direitos legais. As variáveis que associaram negativamente na QV no domínio físico foram “diabetes mellitus” (p=0,021) e “sente dependência após a estomia” (p=0,016). Nos domínios físico e psicológico, a variável “faz seguimento médico regularmente” (p=0,007 e p=0,062) melhorou a QV, respectivamente. A variável “visitar os amigos após estomia” (p=0,000 e p=0,007) associou positivamente nos domínios psicológico e social. Ainda no domínio psicológico, a variável “ter atividade sexual após estomia” (p=0,035) contribui para uma melhor QV. A variável “conhecer os direitos” (p=0,001), no domínio ambiental, associou positivamente na QV do indivíduo estomizado. Como produto deste estudo foi construído uma cartilha com a descrição de conceitos sobre o estoma e suas causas, o fluxo de atendimento nos diferentes níveis de atenção à saúde, e as diretrizes legais que subsidiam a assistência do indivíduo estomizado. Conclusão: Portanto, pode-se concluir que os indivíduos estomizados deste estudo, avaliaram a QV de maneira positiva e que com a aquisição de novos conhecimentos dos direitos legais, poderá haver uma melhora da QV.
Introduction: An ostomized individual is the one who underwent an intestinal transit bypass surgery, which consists of opening the abdominal wall of a segment to diverting the effluent to the outside. Objective: To evaluate the quality of life of ostomized patients assisted in specialized service and study the association of those outcomes with the sociodemographic and clinical characteristics. Method: This is an analytical cross-sectional study. This study was conducted at the Ostomized Patients Assistance Center of Botucatu Clinical Hospital, from October 2014 to August 2015, and approved by the Research Ethics Committee of Botucatu - Unesp Medical School, through protocol No. 291,707 / 2013. The sample consisted of 60 patients. To collect the data we used two instruments: first, a form consisting of sociodemographic and clinical characterization, physiological, psychosocial, nutritional and legal aspects. To evaluating their quality of life, we used the WHOQOL -BREF instrument , consisting of two general questions of quality of life and 24 facets, which relate to four realms: physical, psychological, social relationships and environmental. Results: Of the 60 ostomized prevalences were: females (51.7%) , above the age of 61 years (60%), white (93.3%), living in Botucatu (53.3%), living with partner (55%), family income between 1-3 minimum wages (78.3%), retired (63.3%) and elementary schooling (61.7%). Referring to a colostomy time, (71.7%) had been ostomized for 6 years on average. The reason that led to the stoma was cancer (61.7%) and the chronic aggravation that prevailed among the ostomized individuals was hypertension (31.7%). As for the derivation, the descending colostomies stood out (53.3%). Regular medical follow-up is evident in (90%) of the individuals. With respect to pickup device 80 uses a draining % workpiece, ranging from 25 to 102 mm diameter; regarding the device exchange, (33.3%) changed every three days and reports having "a lot of of" difficulty in self-care of the stoma and 65% with the collection bag (61.7%). For the presence of insomnia, (35%) reported insomnia after ostomy. Sexual activity was maintained by the minority (31.5%) after the presence of stoma. Referring to the emotional aspects of dependence, (50%) showed to be real. Regarding the aid received after ostomy, (100%) reported having help in the family. The Guidelines received in the postoperative period, (96.7%) reported having received guidance. Of the total 60 ostomized patients, (80%) reported that the devices are sufficient in the month and only (20%) knew their legal rights. The psychological domain had the highest average (70.8%), showing that even the self-image can be impaired by making a stoma, this area had a better evaluation, compared with other areas of quality of life. Associations were made, but only a few were associated ( p> 0.10) , as having diabetes mellitus, regular medical follow-up, dependency feeling after ostomy, sexual activity after ostomy , visit friends after ostomy, body mass index being higher and knowledge of legal rights. The variables that negatively associated quality of life in the physical domain were "diabetes mellitus" (p = 0.021) and "feels dependence after stoma" (p = 0.016). The physical and psychological domains, the variable" makes regular medical follow-up" (p = 0.007 and p = 0.062) improved quality of life, respectively. The variable visiting friends after stoma" (p = 0.000, p = 0.007) positively associated in the psychological and social domains. Even in the psychological domain, the variable "sexual activity after stoma" (p = 0.035) contributes to a better quality of life. The variable "know your rights" (p = 0.001), in the environmental field, associated positively on the quality of life of ostomized patients individual. As a product of this study a booklet was made, with descriptions of concepts about the stoma and its causes, the flow of care at different levels of health care, and legal guidelines that support the care of ostomized individuals. Conclusion: Therefore, we can conclude that the ostomized individuals in this study evaluated their quality of life in a positive way and that, with the acquisition of new knowledge of their legal rights, there can be a better quality of life.
Introduction: An ostomized individual is the one who underwent an intestinal transit bypass surgery, which consists of opening the abdominal wall of a segment to diverting the effluent to the outside. Objective: To evaluate the quality of life of ostomized patients assisted in specialized service and study the association of those outcomes with the sociodemographic and clinical characteristics. Method: This is an analytical cross-sectional study. This study was conducted at the Ostomized Patients Assistance Center of Botucatu Clinical Hospital, from October 2014 to August 2015, and approved by the Research Ethics Committee of Botucatu - Unesp Medical School, through protocol No. 291,707 / 2013. The sample consisted of 60 patients. To collect the data we used two instruments: first, a form consisting of sociodemographic and clinical characterization, physiological, psychosocial, nutritional and legal aspects. To evaluating their quality of life, we used the WHOQOL -BREF instrument , consisting of two general questions of quality of life and 24 facets, which relate to four realms: physical, psychological, social relationships and environmental. Results: Of the 60 ostomized prevalences were: females (51.7%) , above the age of 61 years (60%), white (93.3%), living in Botucatu (53.3%), living with partner (55%), family income between 1-3 minimum wages (78.3%), retired (63.3%) and elementary schooling (61.7%). Referring to a colostomy time, (71.7%) had been ostomized for 6 years on average. The reason that led to the stoma was cancer (61.7%) and the chronic aggravation that prevailed among the ostomized individuals was hypertension (31.7%). As for the derivation, the descending colostomies stood out (53.3%). Regular medical follow-up is evident in (90%) of the individuals. With respect to pickup device 80 uses a draining % workpiece, ranging from 25 to 102 mm diameter; regarding the device exchange, (33.3%) changed every three days and reports having "a lot of of" difficulty in self-care of the stoma and 65% with the collection bag (61.7%). For the presence of insomnia, (35%) reported insomnia after ostomy. Sexual activity was maintained by the minority (31.5%) after the presence of stoma. Referring to the emotional aspects of dependence, (50%) showed to be real. Regarding the aid received after ostomy, (100%) reported having help in the family. The Guidelines received in the postoperative period, (96.7%) reported having received guidance. Of the total 60 ostomized patients, (80%) reported that the devices are sufficient in the month and only (20%) knew their legal rights. The psychological domain had the highest average (70.8%), showing that even the self-image can be impaired by making a stoma, this area had a better evaluation, compared with other areas of quality of life. Associations were made, but only a few were associated ( p> 0.10) , as having diabetes mellitus, regular medical follow-up, dependency feeling after ostomy, sexual activity after ostomy , visit friends after ostomy, body mass index being higher and knowledge of legal rights. The variables that negatively associated quality of life in the physical domain were "diabetes mellitus" (p = 0.021) and "feels dependence after stoma" (p = 0.016). The physical and psychological domains, the variable" makes regular medical follow-up" (p = 0.007 and p = 0.062) improved quality of life, respectively. The variable visiting friends after stoma" (p = 0.000, p = 0.007) positively associated in the psychological and social domains. Even in the psychological domain, the variable "sexual activity after stoma" (p = 0.035) contributes to a better quality of life. The variable "know your rights" (p = 0.001), in the environmental field, associated positively on the quality of life of ostomized patients individual. As a product of this study a booklet was made, with descriptions of concepts about the stoma and its causes, the flow of care at different levels of health care, and legal guidelines that support the care of ostomized individuals. Conclusion: Therefore, we can conclude that the ostomized individuals in this study evaluated their quality of life in a positive way and that, with the acquisition of new knowledge of their legal rights, there can be a better quality of life.
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Palavras-chave
Assistência de enfermagem, Estomia, Qualidade de Vida, Nursing Care, Ostomy, Quality of Life