Orientações do enfermeiro estomaterapeuta para os cuidados à estomia intestinal da criança no domicílio: a ótica dos familiares cuidadores

Abstract

Technological advances in health care, discovered in recent decades, have ensured the survival of many children who previously could not survive, which eventually led to the so-called children with special health care needs, among them children with intestinal stomas. These children require specific technological care by using ostomy products, which involves family caregivers in order to guide them how to take care of their children. Therefore, this study aimed: to know the orientations given by enterostomal therapy nurse and received by the family caregivers regarding their child’s intestinal stoma care; to understand the contribution of these orientations in the stoma’s care process by the family caregivers; and to analyze the difficulties experienced by the family members regarding the guidance given by the enterostomal therapy nurse about the care of their child's intestinal stoma. Methodology: Qualitative research, descriptive and exploratory. The scenario was the home of the child with intestinal stoma and the participants were 09 family caregivers. Data were collected from June to November 2019. As a data collection instrument, it was used a semi-structured interview, which was audio-recorded and transcribed, analyzed from Bardin's content analysis, and interpreted according to health education in the Freire’s perspective. As results, three analytical categories emerged: 1st: Guidance about the child’s intestinal stoma care, from which emerged the subcategories: a) Peristomal and ostomy skin care, and b) Care in the use of the pouching system; 2nd: The difficulties experienced by family caregivers about their child's intestinal ostomy care, including the following subcategories: a) Fear of the unknown; b) The absence or divergences in the orientations received by family caregivers in the hospital environment, and c) The search for guidance on the internet; and 3rd: The importance of the guidance received by family caregivers provided by the enterostomal therapy nurse. Conclusion: It was evidenced in this study that most of the family members were oriented about the peristomal skin care by washing with water and mild soap, maintaining the skin dry and removing adhesive residues. Concerning the care with the pouching systems, they were instructed about how handling and closing the pouch itself, as well as the ways of cutting the adhesive base of the pouching system. However, at certain times, some of these guidelines were absent or were divergent by both the enterostomal therapy nurse and the intrahospital healthcare team, which caused fear, despair and concern on the family caregivers. Thus, it is relevant that each care orientation must to be performed by the nursing professional and specially by the enterostomal therapy nurse throughout the hospitalization period through dialogue, empathy and effective communication, which certainly can contribute to the reduction of physical and psychological harm of both child and family.