O autocuidado de pessoas com estomias intestinais: uma abordagem à luz da teoria de Orem

Abstract

Initial Considerations: intestinal ostomies are created when there is a change in intestinal function, to enable the elimination of feces and gases. People with a stoma are subjected to numerous challenges and must adapt to a new reality. Self-care is essential in the nurse's assessment of assistance. Objectives: to understand self-care among people with intestinal ostomies in light of Dorothea Orem's theory; assess the knowledge of people with ostomies about the definition of self-care; evaluate the autonomy and self-esteem of the person with a stoma in relation to self-care performance. Method: descriptive, exploratory, qualitative study, in which, to produce data, a semi-structured interview guide was applied to people with intestinal stoma registered in the Ostomy Program of a reference Health Center. The inclusion criteria were being 18 years old or over, being registered in the Program and having an intestinal stoma for at least 3 months. The exclusion criteria were people with a medical diagnosis of hearing loss and aphonia, as this could make it impossible to respond during the interview. The analysis was carried out using the Thematic Analysis proposed by Braun and Clarke, which included six phases and allowed reflections and associations between research findings, scientific literature and Orem's theoretical approach. The study complied with the ethical precepts of resolution 466/2012, of the National Health Council, and was approved by the Research Ethics Committee of the Universidade Estadual do Piauí, with No 6.217.037. Results: 18 people with intestinal ostomies participated in the research, the majority of whom were men (62%), aged between 31 and 50 years (47%), single (22%), with permanent colostomy (33%) and who were affected with colorectal neoplasia (33%). It was observed that the majority of interviewees are capable of developing self-care skills, showing feelings of autonomy, freedom and independence. However, those who do not perform this self-care reported difficulty with the dexterity and other necessary skills to perform it. The majority of participants reported improvement in these actions following guidance from the nursing professional. Self-care includes the availability of collection equipment and adjuvants, self-esteem and self-image, family support and psychosocial support. Carrying out self-care involves personal empowerment and provides quality of life. The nurse was assigned a primary role in assisting people with a stoma. Final Considerations: the information collected allowed us to understand that the Support-Education System, proposed by Orem, is the one that best fits the reality of people with intestinal ostomies. Participants related the definition of self-care to hygiene or the search for health services. It is necessary to include biopsychosocial aspects, such as access to equipment and products necessary for the ostomy. The nurse must recognize difficulties and provide guidance regarding the main needs and actions. The scope to the public is highlighted as a limitation, which could be assumed to carry out self-care, since going to the service to receive the equipment would already indicate autonomy. It is expected that there will be a contribution to quality care practice for people with an intestinal stoma. Furthermore, it is expected that the study will strengthen the theme, through the role of nurses in assisting people with ostomies. Keywords: Osomy. Self-care. Nursing Theory. Nursing. Enterostomal Therapy.