O autocuidado em pacientes com estomia intestinal à luz de Dorothea Orem: da reflexão ao itinerário terapêutico / Self-care in patients with intestinal ostomy under Dorothea Orem's light: from reflection to therapeutic itinerary

A pessoa estomizada é toda aquela que é subemtida a uma intervenção cirúrgica com exteriorização do sistema digestório, respiratório e urinário, criando uma abertura artificial exteriorizada denominado estoma. A confecção de uma estomia resulta em mudanças na rotina da pessoa, que serão evidenciadas em todos os níveis da sua vida, onde pode-se citar as necessidade de realização do autocuidado para manutenção da qualidade de vida e rotina de atividade diárias deste paciente. No que tange ao autocuidado, Orem refere que todos os seres humanos têm potencial para desenvolver suas habilidades intelectuais e práticas, além da motivação essencial para o autocuidado. Refere ainda que o autocuidado tem como propósito o desempenho ou prática de atividades que os indivíduos realizam em seu benefício para manter a vida, a saúde e seu bem estar. O modelo propõe que todos os pacientes sejam encorajados a cuidar de si próprios e tenham participação ativa no processo de cuidados. Diante da problemática apresentada pode-se destacar como objeto de estudo o autocuidado do paciente estomizado a luz de Dorothea Orem. Esta pesquisa teve como objetivo: Discutir o autocuidado realizado pelo paciente estomizado à luz de Dorothea Orem. Em relação ao Método, tratou-se de um estudo exploratório descritivo, tendo como fonte de informação a pesquisa de campo e abordagem qualitativa sobre o autocuidado realizado pelo paciente estomizado em um município da Metropolitana II e foi realizada no Núcleo de Atenção à Saúde da Pessoa Estomizada no Hospital Orêncio de Freitas no município de Niterói, estado Rio de Janeiro. Os participantes foram os pacientes atendidos por demanda livre e agendados, que se enquadraram nos critérios de inclusão e aceitem, de livre e espontânea vontade, participar desta pesquisa. A coleta de dados foi realizada através de entrevista com roteiro semiestruturado, com gravação em áudio para melhor tratamento e transcrição dos dados posteriormente e, por sua vez, analisou-se os dados na ótica de Dorothea Orem. Como resultados deste estudo, frente às características dos 32 participantes, vislumbrou-se prevalência das estomias intestinais no sexo masculino, em sua grande maioria advinda do diagnóstico de câncer de reto, tendo evidencia significativa a baixa escolaridade dos sujeitos e, por sua vez, baixa remuneração familiar que pode ser visto com um grande ofensor para execução do autocuidado. Entretanto, os participantes da pesquisa evidenciaram que passam a viver melhor quando compreendem e aceitam o estoma e esse processo pode ser facilitado pelo enfermeiro, por meio da Consulta de Enfermagem, sobretudo quando adota na sua prática assistencial a teoria de autocuidado de Dorothea Orem, a qual preconiza três atividades: contato inicial com o paciente que demanda o cuidado que se traduz em um sistema que contempla as exigências terapêuticas e os meios de auxílio; continuidade desse contato para o desenvolvimento de ações de enfermagem, sendo inclusos os familiares ou responsáveis pelo cuidado para a atuação nos momentos atuais e futuros; e o estágio de preparação do paciente para conduzir ações de cuidado de maneira independente. Nessa fase, tanto o paciente quanto os familiares já estão treinados em relação aos cuidados básicos para realização da higiene e troca dos dispositivos intestinais, entre outros cuidados necessários. Por conseguinte, evidencia-se a importância da utilização do referencial teórico de Orem para a abordagem desta clientela, com a finalidade de ajudá-la a resolver seus déficits de autocuidado, fornecendo-lhes informações úteis, apoio emocional e psicológico. Portanto, é por meio do sistema de apoio-educação, que compõe a teoria dos sistemas de enfermagem, que este processo pode tonar-se eficaz

The stomized person is all that is subordinated to a surgical intervention with exteriorization of the digestive, respiratory and urinary system, creating an artificial exteriorized opening called stoma. The making of an omen results in changes in the person's routine, which will be evidenced at all levels of his life, where he can mention the need for self-care to maintain the quality of life and daily routine of this patient. In regard to self-care, Orem says that all human beings have the potential to develop their intellectual and practical skills, as well as the essential motivation for self-care. It also states that self-care is intended for the performance or practice of activities that individuals perform for their benefit to maintain life, health and well being. The model proposes that all patients be encouraged to take care of themselves and have an active participation in the care process. In view of the problematic presented, it is possible to emphasize as object of study the self-care of the patient estomizado the light of Dorothea Orem. This research had as objective: To discuss the self-care performed by the patient estomizado in the light of Dorothea Orem. Regarding the method, this was a descriptive exploratory study, having as information source the field research and qualitative approach on self-care performed by the stomized patient in a city of the Metropolitan II and will be held at the Center for Health Care of the Person Estomized at the Orêncio de Freitas Hospital in the city of Niterói, state of Rio de Janeiro. The participants were patients who were attended to by free demand and scheduled, who met the inclusion criteria and accepted, of their own free will, to participate in this research. The data collection was performed through an interview with semi-structured script, with audio recording for better treatment and transcription of the data later, and, in turn, the data were analyzed in the optics of Dorothea Orem. As a result of this study, the prevalence of intestinal stomies in the male sex was mainly due to the diagnosis of rectal cancer, in view of the characteristics of the 32 participating subjects, with a significant evidence of the subjects' low level of education and, in turn, low family compensation that can be seen with a large offender for self-care enforcement. However, the research subjects showed that they live better when they understand and accept the stoma, and this process can be facilitated by the nurse through the Nursing Consultation, especially when she adopts Dorothea Orem's theory of self-care in her care practice. which advocates three activities: initial contact with the patient who demands the care that translates into a system that contemplates the therapeutic requirements and means of assistance; continuity of this contact for the development of nursing actions, including family members or caregivers to act in current and future moments; and the stage of preparation of the patient to conduct care actions independently. In this phase, both the patient and family members are already trained in basic care for the hygiene and exchange of intestinal devices, among other necessary care. Therefore, it is important to use Orem's theoretical framework to approach this clientele in order to help them solve their self-care deficits by providing them with useful information, emotional and psychological support. Therefore, it is through the support-education system, which makes up the theory of nursing systems, that this process can be effective

La persona estomizada es toda aquella que está subordinada a una intervención quirúrgica con exteriorización del sistema digestivo, respiratorio y urinario, creando una abertura artificial exteriorizada denominada estoma. La confección de una estomia resulta en cambios en la rutina de la persona, que serán evidenciadas en todos los niveles de su vida, donde se pueden citar las necesidades de realización del autocuidado para mantener la calidad de vida y rutina de actividad diarias de este paciente. En lo que se refiere al autocuidado, Orem señala que todos los seres humanos tienen potencial para desarrollar sus habilidades intelectuales y prácticas, además de la motivación esencial para el autocuidado. El autocuidado tiene como propósito el desempeño o práctica de actividades que los individuos realizan en su beneficio para mantener la vida, la salud y su bienestar. El modelo propone que todos los pacientes sean alentados a cuidar de sí mismos y tengan participación activa en el proceso de cuidados. Ante la problemática presentada se puede destacar como objeto de estudio el autocuidado del paciente estomizado a la luz de Dorothea Orem. Esta investigación tuvo como objetivo: Discutir el autocuidado realizado por el paciente estomizado a la luz de Dorothea Orem. En cuanto al Método, se trató de un estudio exploratorio descriptivo, teniendo como fuente de información la investigación de campo y abordaje cualitativo sobre el autocuidado realizado por el paciente estomizado en un municipio de la Metropolitana II y se realizará en el Núcleo de Atención a la Salud de la Persona Estomizada en el Hospital Oréncio de Freitas en el municipio de Niterói, estado de Río de Janeiro. Los participantes fueron los pacientes atendidos por demanda libre y programados, que se encuadrar en los criterios de inclusión y aceptar, de libre y espontánea voluntad, participar de esta investigación. a recolección de datos fue realizada a través de una entrevista con un itinerario semiestructurado, con grabación en audio para mejor tratamiento y transcripción de los datos posteriormente y, a su vez, se analizaron los datos en la óptica de Dorothea Orem. Como resultado de este estudio, frente a las características de los 32 sujetos participantes, se vislumbró prevalencia de las estomias intestinales en el sexo masculino, en su gran mayoría proveniente del diagnóstico de cáncer de recto, teniendo evidencia significativa la baja escolaridad de los sujetos y, a su vez, baja remuneración familiar que puede ser visto con un gran ofensor para la ejecución del autocuidado. Sin embargo, los sujetos de la investigación evidenciaron que pasan a vivir mejor cuando comprenden y aceptan el estoma y ese proceso puede ser facilitado por el enfermero, por medio de la Consulta de Enfermería, sobre todo cuando adopta en su práctica asistencial la teoría de autocuidado de Dorothea Orem, que preconiza tres actividades: contacto inicial con el paciente que demanda el cuidado que se traduce en un sistema que contempla las exigencias terapéuticas y los medios de auxilio; la continuidad de ese contacto para el desarrollo de acciones de enfermería, siendo incluidos los familiares o responsables por el cuidado para la actuación en los momentos actuales y futuros; y la etapa de preparación del paciente para conducir acciones de cuidado de manera independiente. En esta fase, tanto el paciente como los familiares ya están entrenados en relación a los cuidados básicos para la realización de la higiene y el cambio de los dispositivos intestinales, entre otros cuidados necesarios. Por lo tanto, se evidencia la importancia de la utilización del referencial teórico de Orem para el abordaje de esta clientela, con la finalidad de ayudarla a resolver sus déficits de autocuidado, proporcionándoles informaciones útiles, apoyo emocional y psicológico. Por lo tanto, es a través del sistema de apoyo-educación, que compone la teoría de los sistemas de enfermería, que este proceso puede tonificarse eficaz

Application of Orem’ self-care theory in patients with a tendency of ovarian hyperstimulation syndrome / 第二军医大学学报

Objective To investigate the performance of Orem’ sef-care theory application in the patients with a tendency of ovarian hyperstimulation syndrome (OHSS). Methods A total of 307 patients with a tendency of progressing OHSS, who were treated in Reproductive Medicine Center of Changhai Hospital of Second Military Medical University from Oct 2015 to Oct 2016, randomly received routine nursing management in combination with Orem’ sel--care theory (Orem’ sel--care theory group, n=165) or routine nursing management (routine group, n=142). The incidence and severity of OHSS of the patients in the two groups were compared and analyzed. Results Sixty-eight of 307 OHSS tendency patients finally developed OHSS, with 38 in the routine group (16 mild OHSS, 18 moderate and four severe), and 30 in the Orem’ sef-care theory group (20 mild, nine moderate and one severe). There was no significant difference in OHSS incidence between the two groups (P>0. 05); while the reduction of OHSS severity in the Orem’ sef-care theory group was more obvious than that in the routine group, and the difference was statistically significant (P<0. 05). Conclusion Orem’ sef-care theory nursing management has an advantage in reducing the severity of OHSS over routine nursing and is worthy of clinical use.

Impact of dressing techniques under Orem self-care theory on ability of daily living of stroke patients with hemiplegia / 现代临床护理

Objective To explore the effect of dressing techniques under Orem self-care theory on the ability of daily living of stroke patients with hemiplegia. Methods About 96 stroke patients with hemiplegia were randomly divided into an experimental group and a control group, 48 cases in each group. The patients in the experimental group received training on dressing techniques under Orem self-care theory, while those in the control group received routine training on dressing techniques.The daily life ability of both groups was comfared. Result After one month, the Barthel scores in the experimental group were higher than those of the control group (P<0.05). Conclusion Dressing techniques under Orem self-care theory can improve the ability of daily living of stroke patients with hemiplegia.

Application of Orem self-care mode on hip function recovery of elderly patients with artificial hip replacement / 现代临床护理

Objective To explore the application of Orem self-care mode on hip function recovery of elderly patients with artificial hip replacement . Methods Fifty elderly patients with hip arthroplasty from 2014 January to December were set as control group and received routine nursing methods from 2015 January to December 50 elderly patients with hip arthroplasty , were set as observation group and received Orem self-care mode . The hip function of the two groups was evaluated by Harris scale. Result The hip joint function of observation group was higher than that of control group and the difference was statistically significant (P<0.05). Conclusion Orem self-care mode applied in nursing of elderly patients with hip arthroplasty can improve the recovery of elderly patients with hip function.

Influence of Orem self-care theory on postpartum quality of life and role change of parturients with natural labor / 中国实用护理杂志

Objective To study the influence of Orem self-care theory on postpartum quality of life and role change of parturients with natural labor. Methods 100 parturients with natural labor in our hospital from May 2010 to July 2011 were selected as research object,and they were randomly divided into the control group and the observation group with 50 cases in each group,the control group was taken care with routine nursing methods,the observation group was given with nursing according to Orem self-care theory.Then the SCL-90 score,situation of role change and satisfaction degree of two groups before nursing and on the second and fifth days after nursing were analyzed and compared. Results The SCL-90 score of the observation group after the nursing on second and fifth days was all lower than those of the control group,the better rate of role change was higher than that of the control group,patients'satisfaction degree was higher than that of the control group. Conclusions The Orem self-care theory plays an important role in improving the quality of life and role change of parturients with natural labor after delivery,and it can significantly improve satisfaction degree of parturients.

Application of Orem self-care theory in nursing of patients receiving chemotherapy after cervical cancer surgery / 中国实用护理杂志

ObjectiveTo study the application effect of Orem self-care theory in nursing of postoperative chemotherapy patients after cervical cancer surgery. Methods60 patients receiving chemotherapy after cervical cancer surgery were randomly divided into the self-care group and the control group with 30 cases in each group,the control group received routine nursing,on this basis the self-care group was given nursing intervention according to different requirement of patients by using three nursing model of Orem self-care theory-supportive education,part compensation,complete compensation system.The nursing effect was compared between two groups. ResultsCompared with the control group,the rate of gastrointestinal adverse reaction was lower,the anxiety and depression symptom alleviated,satisfaction degree of patients and their relatives with nursing improved,self-care ability of patients was enhanced in the self-care group,all had significant differences. ConclusionsApplication of self-care theory in nursing care of patients during chemotherapy after cervical cancer can greatly mobilize the enthusiasm of patients and their families and reduce the incidence of gastrointestinal side effects.Meanwhile,it can make close nurse-patient relationship,improve the satisfaction degree of patients and their families,improve self-care capacity,improve the quality of care,reduce the psychological symptoms of patients,so it has significant social and economic benefits.

Application of self-care of body posture in patients after modified radical mastectomy / 中国实用护理杂志

Objective To explore the nursing effects of self-care body posture in patients after modified radical mastectomy. Methods The clinical data of 102 patients with modified radical mastectomy were randomly divided into the study group and the control group, all patients met the following standard:clear consciousness, effective communication, no paralysis of limbs, no fracture. In the study group, according to Orem"self-care theory" concept, patients carried out self-care body posture with mainly focus on self-emancipated and the body center of gravity position, in the control group patients were given traditional posture care with mainly emancipated assistance. The first time getting out-of-bed, the occurrence of various complications, the comfort level of emancipation and posture, as well as nursing satisfaction on the first day after surgery were observed and compared between the two groups. Results The two groups showed significant difference in the first time out-of-bed, anxiety, the comfort level of emancipation and posture, as well as nursing satisfaction. There was no significant difference between the two groups in dizziness, limb swelling, flap effusion, flap necrosis. No pressure ulcer occurred. Conclusions Making use of self-care body posture in patients after modified radical mastectomy can improve the satisfaction and comfort of the patients, and improve the patients' recovery, without increasing the complication, which is worth promoting.

Application of Orem self-care theory to the patients after renal transplantation / 中国康复理论与实践

@# ObjectiveTo observe the effect of Orem self-care theory on the patients after renal transplantation.Methods102 patients after renal transplantation into were randomly divided into the observation group(52 cases),which received Orem self-care,and comparison group(50 cases),which received general care.Self-care ability,rate of infection and mental status of the 2 groups patients were observed and recorded.ResultsFor patients of the observation group,self-care ability of was obviously better(P<0.01),the rate of infection was lower(P<0.05),and mental status was improved(P<0.01) compared with patients of the observation group.ConclusionThe application of Orem self-care on patients after renal transplantation can promote self-care ability and decrease post-operation complications.