Efeito do procedimento FOCUS-PDCA na melhoria da capacidade de autocuidado de pacientes submetidos a colostomia por câncer retal

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020012503729 copiar

Efeito do procedimento FOCUS-PDCA na melhoria da capacidade de autocuidado de pacientes submetidos a colostomia por câncer retal

About the SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Investigar o efeito do procedimento FOCUS-PDCA na habilidade de autocuidado de pacientes submetidos a colostomia por câncer retal.

Método:

Um ensaio clínico não randomizado com 160 pacientes com câncer retal submetidos a colostomia. O grupo controle recebeu intervenção de enfermagem de rotina, e o grupo observação recebeu o procedimento FOCUS-PDCA. A capacidade de autocuidado dos dois grupos foi investigada por 1 semana e 1 mês após a cirurgia, e foi feita uma análise comparativa entre os grupos.

Resultados:

Em uma semana após a cirurgia a capacidade de autocuidado de pacientes com câncer retal com colostomia aumentou de 39,09 pontos antes da implementação do procedimento FOCUS-PDCA para 60,15 pontos após a implementação; um aumento de 21,06%. Em um mês após a cirurgia, a capacidade de autocuidado aumentou de 61,50 pontos para 83,13 pontos após a implantação do procedimento FOCUS-PDCA; um aumento de 21,63%.

Conclusão:

A aplicação do procedimento FOCUS-PDCA melhorou a capacidade de autocuidado de pacientes com câncer retal submetidos a colostomia, melhorou sua saúde física e mental, reduziu as complicações da colostomia e melhorou sua qualidade de vida. Os resultados sugerem que vale a pena aplicar o FOCUS-PDCA de forma mais ampla.

DESCRITORES:
Gestão da Qualidade; Colostomia; Neoplasias Retais; Autocuidado; Aptidão; Enfermagem Oncológica

	Control group n=80	Observation group n=80	t/χ²/z	P
Age
Mean age (standard deviation)	62.6±8.27	64.2±8.34	-1.189^# # independent sample t-test was used for comparison between the two groups;	0.236
<55	14(17.5%)	13(16.25%)	-0.036^& & nonparametric test was used for comparison between the two groups;	0.971
56-65	28(35%)	30(37.5%)
66-75	32(40%)	30(37.5%)
>75	6(7.5%)	7(8.75%)
Sex			0.242^* * chi-square test was used for comparison between the two groups.	0.623
Male	52(65.0%)	49(61.25%)
Female	28(35.0%)	31(38.75%)
Complications
With complications	12(15.0%)	10(12.5%)	0.211^* * chi-square test was used for comparison between the two groups.	0.646
No complications	68(85.0%)	70(87.5%)
Education			-0.507^& & nonparametric test was used for comparison between the two groups;	0.612
None or Basic	16(20%)	12(15%)
Secondary or vocational	48(60%)	52(65%)
University	16(20%)	16(20%)
Marital status			2.535^* * chi-square test was used for comparison between the two groups.	0.469
Married	48(60%)	52(65%)
Separated-divorced	12(15%)	14(17.5%)
Widowed	15(18.75%)	8 (10%)
Single	5(6.25%)	6(7.5%)
Employment status			1.558^* * chi-square test was used for comparison between the two groups.	0.816
Occupational activity	13(16.25%)	15(18.75%)
Retired	30(37.5%)	33(41.25%)
Self-employed	14(17.5%)	10(12.5%)
Employee	18(22.5%)	15(18.75%)
Others	5(6.25%)	7(8.75%)

Dimension	Item
Self-care knowledge	The importance and function of colostomy Normal colostomy shape and color Colostomy chassis, accessory product functions The judgement and change timing of colostomy pocket leak The purchase way and storage method of colostomy pocket Related knowledge of diet and clothing after colostomy Related knowledge about sleep and motion after colostomy Bathing method after colostomy Related knowledge about sexual life after colostomy Identification and prevention of colostomy complication Time, frequency, place and method of postoperative follow-up
Self-care skills	Method for emptying feces in colostomy pocket Method of removing the colostomy chassis Method of measuring the size of a colostomy Clipping method of colostomy pocket Method of observe and clean the skin around the colostomy Method of pasting the colostomy chassis Method for dealing with various colostomy complications Proper use of colostomy attachment products
Self-care attitude	Read books on colostomy frequently Know self-stress relief and reasonable vent Know the benefits and barriers to healthy behavior Actively communicate with medical staff Visit the colostomy clinic regularly and see the doctor in time Be confident in your own healthy behaviors

Implementation time

Item

Before enterostomy

Talk about the importance of colostomy surgery Tell the way of colostomy surgery The importance of colostomy positioning Colostomy pocket wearing method and experience Psychological guidance and actively undergo surgery
Distribute and guide the colostomy care booklet

After enterostomy

Instruct patients how to select and store colostomy pocket,
Colostomy attachment products and announcements
Colostomy pocket replacement process: remove-check-clean-measure-tailor-paste
Instruct the tips for removing colostomy chassis, cutting and pasting colostomy pockets
Methods and observation points for preventing colostomy complications
Patient's diet,clothing,activities and social health guidance and announcements
Introduce the contents of sunshine lecture hall, colostomy clinic and colostomy association Set up the WeChat group and pay attention to Wechat official accounts
Psychological guidance to encourage patients to step into society
Correct sexual life guidance

	Number of patients	Self-care ability 1 week after operation (score)	Self-care ability at 1 month after operation (score)
Control group (̅X±s)	80	39.09+15.71	60.15+11.32
Observation
group	80	61.50+8.98	83.13+7.15
(̅X +s)
Increase (%)		21.06%	21.63%
t		38.651	49.895
P		<0.01	<0.01

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Chunyu LI, No. 977 Park Street, Yanji City, Jilin Province, China, chyli@ybu.edu.cn