Caracterização da atenção à saúde da pessoa com estomia de eliminação na rede de atenção à saúde: um estudo multimétodo

Abstract

Introduction: Elimination, urinary, and/or intestinal ostomies can chronically affect the physical, psychological, social, and environmental dimensions of individuals. Considering this, coordinating care within the health care network (HCN) during the rehabilitation process for individuals with an elimination ostomy should commence as soon as changes occur, incorporating all aspects of human development. Aim: To map and describe the health care provided to individuals with elimination ostomies in the HCN, particularly focusing on nursing actions, in a city within the interior of São Paulo state. Method: This was a mixed-method study, conducted in two stages, outlined below. Stage 1) Systematic Review, following the JBI method, with the guiding question: “How effective is the nursing care provided to individuals using elimination ostomies in the context of home rehabilitation?” Eight data sources were utilized, encompassing studies in Portuguese, English, and Spanish, from 2019 to 2024. Stage 2) Descriptive, retrospective, and documentary study. Adhering to ethical principles, the study was conducted using electronic and/or printed medical records of individuals with an elimination stoma from the Municipal Health Department and two hospitals in the municipality. Data collection from the respective medical records was executed using a characterization instrument developed by the researchers from September to December 2024. Descriptive and analytical statistical analyses of the variables were performed. Results: Stage 1) Out of 6,428 studies identified, 83 addressed the guiding question, of which 17 (100.00%) were selected for this review. Among the 17 studies, the final analysis revealed eight (47.00%) descriptive studies, five (29.41%) experimental studies, three (17.64%) quasi-experimental studies, and one (5.88%) cohort study. All studies were regarded as having good methodological quality; there was no blinding of samples, and the researchers did not conceal the intervention. The summary of the recommendations derived from the findings related to the following nursing actions: teleconsultations, provision of informative materials, use of technologies, family integration, addressing spiritual needs, home visits, support groups, continuity of care through phone calls, lectures, and health education. Stage 2) A total of 153 (100.00%) medical records of individuals with elimination stoma were identified in the study municipality, revealing a prevalence of six individuals with stomas for every 10,000 residents. From mapping the findings across the three collection sites, a predominant profile of white males with a mean age of 63.3 years ± 14.23, married, with permanent colostomies due to intestinal neoplasms, was identified. Regarding nursing actions, only 25.49% (n = 39) reported familiarity with four or more ostomy adjuvants; the ostomy protrusion was classified as “high profile,” “low profile,” and “protruding,” showing 32 different classifications in this data. Conclusion: Considering the recommendations from this systematic review and the actual characterization of individuals with ostomies, along with the mapping of the three services within the municipality, the scope of nursing actions to be undertaken in this municipality becomes apparent.