Orientador: Magda Cristina Queiroz Dell'Acqua / 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%). Refe... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: 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... (Complete abstract click electronic access below) / Mestre

Diversas vezes, como artifício de cura de algumas doenças do aparelho intestinal ou do trato urinário, um procedimento cirúrgico nomeado por estomia é uma técnica médica utilizada para manter o paciente em vida. Este procedimento acarreta em uma série de questões físicas e psicológicas para o estomizado, cuja falta de informação e de produtos modernos disponíveis no mercado podem agravar a situação. Através destas constatações, surgiu a intenção de criar produtos de moda, no segmento moda praia, para mulheres que passaram pela cirurgia em questão. Mas o intuito de desenvolvimento de tais produtos fez surgir, ainda, a constatação de outro problema: a carência de um método específico da moda que levasse em consideração as necessidades reais do usuário em questão. Enquanto as metodologias de design de produto têm focado no usuário, os métodos de projeto de moda costumam ignorar a pesquisa e as necessidades humanas, identificando o desenvolvimento com o estilo de quem o projeta. A possibilidade da constatação de necessidades reais do usuário, em projetos de moda, pode ser um caminho promissor se forem considerados os princípios do design. Sendo assim, o presente estudo teve como objetivo geral: desenvolver um método adaptado, embasado em métodos já consagrados do design e da moda, destinado para a criação de produtos de moda que possam atender às necessidades reais do usuário. Neste caso, para a criação de produtos no segmento moda praia que contemplem os anseios de mulheres com estoma. A criação e a aplicação da referida adaptação propiciou o desenvolvimento facilitado dos produtos pretendidos. Pretende-se que o método gerado seja válido para projetos de moda que, assim como este, possuam uma problemática bem definida e uma verificação de necessidade do usuário, assim como acontece nos projetos de design. / In the curing process of many diseases of the intestinal or urinary system, several times a surgical procedure known as ostomy is the only way to keep the patient alive. This procedure includes a series of physical and psychological issues, whose the lack of information and modern products available on the market can aggravate the situation. Through these findings, the intention was to create fashion products, in the beachwear segment, for women with stoma. But the development of these products led to the discovery of another problem: the lack of a specific fashion method that takes into account the real needs of the user. While product design methodologies have focused on the user, fashion design methods have ignored research and human needs. So, the development is identified in the style of the designer. The possibility of verifying the user's real needs in fashion projects can be a promising way if the designer considers the principles of design. Therefore, the present study aimed to develop an adapted method, based on methods of design and fashion, aimed at the creation of fashion products that can meet the real needs of the user - in this case, for the creation of products in the beachwear segment that contemplate the desires of women with stoma. The creation and implementation of this adaptation has facilitated the further development of products. It was intended that the method created be valid for fashion projects that, like this one, have a well-defined problem and a user need, as well as in the design projects.

Background: Surgeries history stretches far back in time. Stoma operations started being successfully in the 19th century. In the 1950s, a standard treatment for stoma operations was developed which still is being used today. The reason for getting a stoma may be due to various things such as illness or trauma. Getting a stoma can lead to a changed body perception and can affect the individual's experience of health and suffering. It´s up to the nurse to be able to approach these patients and their experiences in the best professional way. Aim: The aim of the study was to describe patients experiences of living with a stoma. Method: This study has been conducted as a qualitative litterature review. An analysis of eleven qualitative articles was carried out. Results: Three themes explaining the patient's experience of living with a stoma where identified as: the patient's path to acceptance, the patient's obstacles to the way of acceptance and the continued life with a stoma. Eight sub-themes: teaching and information, social support, an inner process, complications and leakage, uncertainty and concern, changed body perception, daily constraints, adaptation to a new life situation, where discovered. Conclusion: The experience of living with a stoma varies from person to person. There are factors that can affect the patient's life with a stoma. There are both positive and negative experiences that create an overall picture.

Background: When patients suffer from sicknesses such as rectal cancer, Chrons disease and ulcerative colitis, then ostomies can be a course of treatment. Earlier research show that nurses lack knowledge to be able to care for patients with ostomies while expected to have an important role in the patients’ well-being.  Problem: Lack of knowledge from the general nurse about ostomy care impacts patients since their lives are affected by living with a stoma.  Aim: To describe patient´s experiences of living with a stoma. Method: A literature review based on ten qualitative scientific articles with descriptive synthesis. Results: Experiences shown in the results were divided into three themes: “Emotionell influence”, “Changes in everyday life” and “Acceptance of living with a stoma”.  Out of these themes came six subthemes: “To feel worry”, “To feel frustration”, “To feel shame”, “To live with a changed body”, “To be limited physically in one´s life”, “To lose control”.  Conclusion: Life with a stoma brings daily changes and influences the patients emotional state in relation to their body and their new situation. These experiences can in their turn evolve and patients can come to accept the stoma over time. Patients experiences a lack of information concerning ostomy care and support in living with a stoma. The results show that patients due to their ostomy experience suffering related to illness, to care, and to life.

Background: Abdominal ostomy is an artificial opening in the abdomen that is done through a surgical procedure. This is due to cancer diagnosis and / or inflammatory diseases of the intestine. Intimacy and sexuality are important aspects of the quality of life of an individual that can be affected by different factors. It is the nurse's responsibility to promote health, and the nurse's role to convey knowledge of sexual health to patients. Aim: The purpose was to describe the experiences of sexual health in people with abdominal ostomy. Method: Literature review with a qualitative approach. Results: The results show that people with abdominal ostomy experienced a change in sexualhealth caused by various aspects. The results also show a need for increased healthcare guidance about sexual health, and support from relatives is an important component. Conclusion: Taboos about sexuality were discussed and need to be put in relation to where in the world one is. Sexual health is individual and looks different globally, because there are different societal and cultural norms and values. Strategies for healthcare professionals were discussed in order to be able to address sexual health and to support people with abdominal ostomy in the best possible way

Bakgrund: Ordet stomi innebär en öppning eller mun som placeras på huden och är sammankopplat till ett eller två organ. En stomi kan användas när ett organ av olika anledningar behöver avlastas. Under de senaste tio åren har antalet individer med stomi ökat i Sverige. Att leva med stomi kan orsaka belastning på det fysiska samt psykiska välmåendet. Sjuksköterskan har ett ansvar att stödja patienten och vägleda patienten genom den nya livsförändringen.  Syfte: Syftet var att belysa patientens upplevelse av att leva med stomi. Metod: Författarna använde sig av en litteraturöversikt där tio originalartiklar av både kvalitativ och kvantitativ design användes. Studiernas resultat granskades och kategoriserades, därefter tematiserades de utifrån olika rubriker.  Resultat: Patienterna upplevde att rädslan för läckage och odör samt exponering av stomipåsen resulterade i isolering från vardagliga aktiviteter och sociala sammanhang. Patienterna upplevde även att den bristfälliga informationen från sjuksköterskan satte prägel på deras livskvalité och orsakade en känsla av osäkerhet. Resultatet beskrivs under tre huvudteman. Dessa huvudteman är: Upplevelse av förändrad kroppsuppfattning med subteman: Anpassning och acceptans och förändrade förutsättningar med stomi. Andra och tredje huvudtemat är: Information och kunskapsbrist samt hinder för samliv Diskussion: Resultatet diskuterades utifrån Katie Erikssons teori om sjukdomslidande kring patienternas upplevelse vid en stomioperation. Detta resulterade i ett hälsohinder hos patienterna som speglas i frånvaro av hälsa. Lidandet grundades i stor del av bristen på information från sjuksköterskan, vilket ledde till dålig förberedelse preoperativt samt dålig anpassning postoperativt. / Background: The word ostomy means an opening or mouth that is placed on the skin and is connected to one or two organs. A stoma can be used when an organ for various reasons needs to be relieved. Over the past ten years, the number of stoma individuals has increased in Sweden. Living with an ostomy can cause stress on physical as well as mental well-being. The nurse has a responsibility to support the patient and guide the patient through the new life change. Aim: The aim of the study was to illuminate the patient's experience of living with an ostomy Method: The authors used a literature review according to where ten original articles of both qualitative and quantitative design were used. The results of the studies were reviewed and divided into different categories which were then thematized based on different headings. Results: The patients felt that the fear of leaks and odors and exposure of the ostomy bag resulted in isolation from everyday activities and social contexts. Patients also felt that the infrequent information provided by the nurse had an impact on their quality of life and caused a feeling of uncertainty. The results are described under three main themes. These main themes are: Experience of changing body perception, with subthemes: Adaptation and acceptance and the new life. The second and third main themes are: Information and lack of knowledge and barriers to cohabitation. Discussion: The results were discussed on the basis of Katie Eriksson's theory of disease sufferings regarding patients' experience in an ostomy operation. This result in a health barrier in patients reflected in the absence of health. The suffering was mostly due to the lack of information from the nurse, which led to poor preparation preoperatively as well as poor adjustment postoperatively.

For a person stoma means change both in the health as well as psychosocial area. It is necessary to perceive the person as a bio-psycho-socially-spiritual being requiring satisfaction of all his/her needs. Shortage of satisfaction of psychosocial needs can have very serious impacts on the overall health condition of the client. Stoma nurses and stoma clubs significantly contribute to satisfaction of needs. Stoma nurses deal not only with a preoperative, postoperative care for stoma suffering people, their education but they also help them to solve problems, which occurred in connection with stoma, answer their questions and are their consultants and support. Stoma nurses are a great benefit for stoma suffering people and their families. Stoma clubs are voluntary associations where people suffering stoma meet. Their task is to defend the interests and rights of stoma suffering people, organise meetings, special seminars, cultural events and stays. Versatile activity of the clubs is involved in client?s stoma adaptation, improvement of his/her life and making satisfaction of psychosocial needs easier. The target of the Diploma Thesis was to find out the most frequent psychosocial problems of stoma patients and whether stoma stresses more ileostoma patients than colostomy ones. Targets of the thesis were met. There were defined five hypotheses for the targets. First hypothesis dealt with the question, whether stoma patients suffer lack of satisfaction of psychosocial needs. Second hypothesis analysed, whether stoma disturbed partner life of the stoma patient. Third hypothesis analysed, whether stoma nurses bring benefit to a stoma patient and the fourth one, whether stoma clubs are beneficial for a stoma patient. These hypotheses were proved. The fifth hypothesis analysed, whether stoma stresses more ileostoma than colostomy patients. This hypothesis was not proved. To collect data I used the form of quantitative research using non-standardised questionnaire for people suffering ileostoma and colostomy. This Diploma Thesis shall point out the necessity of satisfaction of psychosocial needs of stoma patients in practice.

Background: Rectal cancer 5-year survival has increased from 58% of those diagnosed in 1987-1989 to 68% of those diagnosed in 2003-2009. Rectal cancer patients commonly receive one of two surgical treatments: permanent ostomy (a resection of tumor following by a stoma) or anastomosis (a resection followed by a reconnection with or without a prior temporary ostomy). The multifaceted consequences of both types of surgery potentially can affect both long-term psychological well-being and financial concerns of patients and their families. The overall goal of this dissertation is to increase the understanding of the impact of depression on the quality of life of rectal cancer survivors. Methods: The research data were based on a quality of life survey conducted in 2010-2011 among long-term survivors (≥ 5 years post-diagnosis) of rectal cancer. Participants were identified through the Kaiser Permanente (KP) health systems in Northern California and Southwest Washington/Oregon. Data included both the 2010/2011 survey data and KP electronic medical records (EMRs). Results: 1) The 24.7% prevalence of self-reported current depression among long-term rectal survivors was observed with a higher prevalence of 31% among those with permanent ostomies. Although average perceived financial burden level was low in this population of insured cancer survivors, 20% still reported moderate-to-high burden. Perceived financial burden was especially high among those who recalled having depression immediately after surgery and reported depression at the time of survey.2) All self-reported measures showed low sensitivity varying from 26% to 56% and high specificity from 77% to 82.7% against either diagnostic scheme from EMRs. Using either diagnostic scheme, the MCS-12 measure, a Mental Composite Summary (MCS) score from the 12-item Short-Form Health Survey with a cut-off point of≤45.6 for a self-reported depression, performed better as compared to the other two self-reported measures. 3) Approximately one in six rectal cancer survivors experienced depression after their surgery of sufficient severity to result in a depression diagnosis. Among survivors with recurrent depression diagnoses, those with a permanent ostomy reported significantly lower psychological well-being than those with an anastomosis. Conclusions: Depression burden is elevated after receiving surgery and remains a problem long after cancer diagnosis and treatment. Types of rectal cancer surgery received and gender of survivors may complicate the extent of depression burden. Among long-term rectal cancer survivors, having depression is associated with higher perceived financial burden. Chronic or recurrent course of depression may exist in this group of rectal cancer survivors and has significant impact on long-term psychological well-being. Self-reported measures for depression, such as MCS-12 measure with a cutoff point≤45.6, have the potential to be utilized for epidemiological studies when common screening instruments, electronic medical records, or administrative databases are not available. Implications: These findings underline the significance of depression assessments after surgery for this population of rectal cancer survivors and the importance of symptoms monitoring throughout the cancer survivorship continuum. Depressive symptoms should be monitored and managed as early as after cancer diagnosis and surgery to optimize survivors' long-term emotional well-being. In addition, depression screening and treatment as well as discussion of financial issues may have important roles in long-term survivorship care planning, particularly for those with permanent ostomies.

Bakgrund: Omkring 25000 individer i Sverige lever idag med en stomi. Stomin kan ha en påverkan på den sexuella hälsan då den kan orsaka problem vid sexuella aktiviteter. Den kan också hota vuxenrollen på grund av förlusten av att inte kunna konrollera tarmen. Sjuksköterskans uppgift är att ge vägledning, utbildning och information om sjukdomsförloppet och den sexuella hälsan. Att prata om sexualitet inom sjukvården kan dock vara problematiskt då det är ett känsligt ämne för både patient och sjuksköterska. Syfte: Att beskriva individers upplevelser av sexualitet i samband med stomi. Metod: Litteraturöversikten baserades på tio vårdvetenskapliga artiklar som hämtats från databaserna CINAHL Complete, PubMed, Medline, Academic Search Complete och DOAJ. Resultat: I resultatet framkom fem stycken teman. Rädsla och oro vid sex som visar på att många var rädda för att stomin skulle lukta, läcka eller låta vid sexuella aktiviteter. Upplevelser av smärta vid sex som visar att många upplevde smärtor vid samlag på grund av de nervskadebildningar som stomoperationen medförde i underlivet. Partners betydelse för sexualiteten som visar att partnern utgjorde en stor del för återupptagandet av sex. Känslor kring sexualitet som visar att många kände sig osexiga och ville dölja stomipåsen. Stöd från sjukvården som visar på att många sakande information från sjukvården om hur stomin skulle påverka deras sexuella liv. Diskussion: Resultatet diskuterades utifrån begreppet hälsa och med hjälp av andra vetenskapliga artiklar. Områden som berördes i resultatdiskussionen var känslor och informationens betydelse. / Background: Around 25000 individuals are living with an ostomy in Sweden today. An ostomy can affect sexual health and cause difficulties during sexual activities. The status as an adult may also be threatened by the loss of bowel control. The nurse's role is to guide, give instruction and educate about the course of the disease and sexual health. To talk about sexuality can be problematic in healthcare because of the sensitive nature of the subject for both the patient and nurse. Aim: The aim of this study is to describe the individual’s experiences of sexuality in connection with an ostomy.  Method: This literature overview was based on ten scientific articles retrieved from the databases CINAHL Complete, PubMed, Medline, Academic Search Complete. Results: The results are presented in five themes. Fear and anxiety during sex indicates that many were afraid that an ostomy would make noises, leak or smell during sexual activities. Experience of pain during sex indicates that many experienced pain during intercourse because of the nerve damage caused by the creation of an ostomy which caused pain in both male and female sexual reproductive organs. The Partners significance to sexuality indicates that partners constituted a large part of the resumption of sex. Feelings about sexuality indicate that many felt sexually unattractive with a pouch on the stomach and wanted to hide it. Support from the healthcare workers- many were not informed by healthcare workers about how an ostomy would affect their sexual life.   Discussions: The results were discussed from the concept of health and with the support other scientific articles. The areas of greatest influence were the Emotional aspect and The significance of educating of the patient.

Bakgrund: Stomi innebär att genom kirurgiskt ingrepp anlägga en öppning genom bukväggen för att avleda tarminnehåll. Många stomiopererade kan ha svårigheter att hantera den nya situationen. Syfte: Att beskriva upplevelser kring hur det är att leva med tarmstomi. Metod: Litteraturstudie med tio vetenskapliga artiklar av kvalitativ eller kvantitativ design. Resultat: Att leva med tarmstomi medförde en förändrad livssituation, som för många var svår att hantera. Den nya situationen orsakade fysiska och psykiska problem. Rädsla för lukt, läckage och gaser hade en negativ inverkan på vardagen och det sociala livet. Diskussion: Sjuksköterskan kan oavsett arbetsplats möta människor med tarmstomi. Då många stomiopererade upplever det svårt att hantera sin nya livssituation är det av stor vikt att belysa dessa människors upplevelser. För att kunna utföra god omvårdnad är det viktigt att sjuksköterskan är medveten om de problem som kan uppstå. För att minska upplevelsen av problem relaterade till stomin samt underlätta anpassningen till den nya livssituationen med tarmstomi bör mer information och stöd ges både pre- och postoperativt. / Background: Having an ostomy means that through surgical construction through the abdominal wall, having an opening to divert the bowel contents. Many who had surgery to a stoma find it difficult to manage the new situation. Aim: To describe experiences of living with an ostomy. Method: This study was designed as a literature review contending ten scientific articles with qualitative or quantitative approach. Result: Living with an ostomy result in an altered situation of life, of many hard to handle. The new situations in life lead to physical and psychological problems. Concerns about odor, leakage and emissions had a negative impact on everyday life and social life. Discussion: The nurse can regardless of where she works meet people with an ostomy. Many people find it difficult to handle found problems, therefore it is important to illuminate these people´s experiences of living with an ostomy, in order of giving good care. It is important that the nurse is conscious of the problems that may arise. To reduce the perception of problems related to the stoma and facilitate adaption to the new situation with an ostomy, more support and information should be given, pre and post- surgery.