Complications in intestinal ostomies with eliminatory function and nursing management: scoping review protocol
Creators: name: da Silva, Rodrigo
name: Antunes, Lucas
name: de Kassio Nunes, Geovane
name: da Silva, Rafael
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Nursing Administration
subject: Perioperative, Operating Room and Surgical Nursing
subject: Gastroenterology
subject: Medicine and Health Sciences
subject: Medical Specialties
subject: Other Nursing
subject: Nursing
subject: FOS: Health sciences

description: Introduction Ostomies are defined as surgically created openings or canals that make a path between the inner of an organ and the outer environment. They are intended to minimize problems that temporarily or permanently disable a segment of the body, seeking to maintain the function of the organ affected by pathologies or trauma. 1,2 Ostomies can be permanent or temporary and, depending on the affected organ, receive different names and specific care. In the present study, the research interest is around eliminatory ostomies with eliminatory function, which are ileostomies and colostomies (ascending, transverse, descending and sigmoid), which are categorized as intestinal ostomies. 3 The national literature regarding the epidemiological data of individuals with ostomies, in general, is still incipient and needs further investigation, however, it is estimated that about one million and 400 thousand surgeries for making ostomies are performed per year in Brazil. According to the Ostomy Associations of America, approximately 100,000 to 130,000 new surgical procedures for making an ostomy are performed in the United States of America (USA), with colostomy being the most made.4,5,6 This data, in particular, is in line with the results of a study carried out in Brazil on the profiles of ostomies in relation to location, which demonstrated a greater predominance of intestinal ostomies, particularly colostomy and ileostomy.7 In this context, it is considered that the increase in the number of neoplasms and gastrointestinal diseases evidenced in the morbidity profile of the population increases the number of people who need intestinal stomas as a therapeutic strategy and, therefore, in view of the risks, there is an increase the susceptibility to complications, namely: hernias, retractions, necrosis, infections, fistulas, more common in colostomy.8 Complications are divided into complications in the ostomy or skin peristomia. In addition, they are also divided in relation to the period of appearance, which can be immediate (within the first 24 hours after the ostomy is made), early (up to 1 week after the ostomy is made) or late (after 1 week, extending up to months after hospital discharge)9,10 Complications related to intestinal stomas are described in the literature in several studies, being frequent in the lives of patients who have newly made stomas. 1,2,11 The rate of complications related to ostomy in the USA is from 21 to 70%.6 In Brazil, an investigation on the perceptions of the quality of care of patients with ostomy, that 71% of patients with ileostomies and 43% of patients with colostomy had complications. 12 Data show rates from 70% to 80% for the development of some complication in patients with ostomies. It is estimated that a person in this condition has the experience of at least one complication up to the second year after confection. 13,14 Complications, in general, are caused by several factors, including the difficulty in self-care in relation to the stoma, the presence of more than one stoma, the high-output stoma. There are also factors related to the approach to surgery, such as emergency surgery, containment sutures, laparoscopic approach, which are more prone to complications. The characteristics of size, shape and height of the stoma influence differently on skin adhesion, which can generate contact with effluents and increase the risk of complications. 13 In addition, in the case of late complications, the presence of comorbidities, especially obesity and high intramuscular pressure, which can result in prolapses and parastomy hernia. 15 In view of this panorama of ostomies and their complications, it is considered that the qualification of nurses and the use of instruments that can help in the early identification of risk factors and in the proper management of complications are essential in improving their professional performance, with potential impact on patient fitness and well-being. 16 After hospital discharge, the specialist nurse is responsible for inspecting the ostomy and the peristomy region to assess aspects of the ostomy in relation to color, shape, size, humidity, presence of exudate or other substances, pain and skin lesions. Thus, the late postoperative period, established one week after surgery, is considered an essential time to monitor the patient and their needs and to minimize and prevent complications.17 When critically reflecting on the care provided by nurses in managing the care of patients with ostomies, in particular with a focus on the management of complications, it is pointed out that nurses, regardless of their specialist status, should provide assistance to this patient in different care settings, in the hospital or out-of-hospital context. Thus, nursing care in the presence of complications should prevent the worsening of the condition of the ostomy, the skin peristomia and its functionality. On the other hand, inadequate management can lead to consequences that worsen the patient's quality of life, bring psychosocial impacts, the need for surgical interventions and the use of complementary materials. 10 Therefore, the absence of follow-up by a qualified professional in the postoperative period can lead the patient to develop peristomia complications and their consequences.13 Therefore, there is a responsibility of health professionals in actions against complications, in view of the reduction of their occurrence and rapid reversal in their validity, aspects that should be enhanced by the presence of professionals prepared for this demand in the services, especially the experts.18 In view of the shortage of specialized professionals in health services, it is assumed that the construction of an assessment instrument, as a health care technology, can help nurses' decision-making in the field of care for patients with functional intestinal ostomy. eliminatory with late complications, guiding nursing care during the management of such complications. In this context, it is assumed that the construction of an assessment instrument will help nurses' decision-making in the field of care for patients with intestinal ostomy with an eliminatory function with complications, helping to guide nursing care during the management of such complications based on scientific evidence. This type of technology has the potential to contribute to knowledge in the area for general practitioners and to directly impact the nursing care provided to clients with this specific need at various levels of health care. Therefore, it is necessary to know the scope of knowledge present in the literature about late complications and the nursing approaches to them, in order to identify and report the scientific evidence that can support the proposition of a health care technology on this topic. Therefore, the objective is: To map the existing knowledge about complications and actions related to nursing therapy in patient care with complications related to intestinal ostomies with eliminatory function. Review questions What are the late complications in eliminatory intestinal ostomies? What is the nursing care for people with late complications in intestinal ostomies with eliminatory function? Population Patients with intestinal ostomies with eliminatory function. Concept Nursing care in the face of late complications of intestinal ostomies with eliminatory function. Context Any context. Type of study We will use primary papers found in predefined databases according to specific eligibility criteria. Furthermore, this scope review will include data found in the grey literature, such as protocols, guidelines, and manuals. Our focus lies in articles that approaches late complications in intestinal ostomies and nursing management to these complications will be considered. For our search in the databases, we will adopt theme-pertinent descriptors and keywords in three languages: Portuguese, English, and Spanish. As for the grey literature, we will search through databanks of theses, and websites of reference entities in the Enterostomal Therapy fields. Languages will also be limited to Portuguese, English, and Spanish, and there will be no time restriction in terms of data production. Yet, whenever there are updates on guidelines/manuals, we will use only the most recent version. Methods This review follows the Joanna Briggs Institute’s (JBI) methodology for scope reviewing, and adopts the 2020 JBI Manual for Evidence Synthesis. 19 Search strategy Firstly, we have searched through databases in order to identify descriptors or keywords for the development of this study (Appendix I). Later on, we will search for scientific papers in these databases: Literature of Latin America and the Caribbean (LILACS), National Library of Medicine (Medline via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Spanish Bibliographic Index of the Health Sciences (IBECS), SciVerse Scopus (SCOPUS), Embase, and Web of Science. After crossing the descriptors and the keywords in each of the selected bases, we will apply initial filters of “complete text”, “paper”, and language. Appendix II features an example of the strategy that we will use for this scope review. We will search for grey literature evidence in the CAPES Theses and Dissertations Catalogue, in documents available at websites of official institutions, in guidelines and manuals of both national, and international institutions. We will also search in reference entities in the stomatherapy fields in order to find materials on complications and actions related to intestinal ostomies (Appendix III). Study selection We will import every selected paper into the Mendeley Reference Manager, and remove all duplicates. Firstly, we will submit the papers to an exploratory reading of their title and/or abstract by a reviewer, in order to decide whether they fit in the study’s theme and, thus, should be selected. Texts that adhere to the theme of the investigation will be fully read by two reviewers separately, and will be thoroughly analyzed according to the eligibility criteria. Afterwards, we will compare the reviewers’ selections, and, if there is any divergence, we will resolve them by means of consensual discussion, or of a third senior reviewer. Lastly, the studies that have been fully read and excluded for not meeting the inclusion criteria will be counted, and we will systematize the reasons for exclusion in an appendix of the final report. This report will also describe the search process, and the paper selection through the PRISMA Flowchart. Data extraction Data will be extracted by a tool of data collection developed for this review, and two reviewers will participate in this process with the support of the software Microsoft Excel®. Collected data will provide us with information about the studies on drug labelling in Intensive Care, Emergency, and Anesthetic Units. We will control the year of publication, the authorship, the country of publication, the title of the paper, the language, the type of study, the number and the profile of the participants, type of complication, management/care for the complication, results (if applicable). We might contact authors of specific papers if additional information be necessary. Furthermore, we may modify the tool of data collection throughout the investigation, if the analyzed papers highlight the need for additional information (Appendix IV). Data mapping We will present the extracted data in tableaux (Appendix V), and thus characterize, assemble, synthetize, and describe the findings of this review. Hence, after mapping the results, we will correlate them to the goals of this investigation. The information identified will be relevant for understanding which complications occur in the late postoperative period and what actions the nurse can take to manage the complication. Funding There is no funding for this investigation. References 1. MIRANDA SM, Luz MHBA, Sonobe HM, Andrade EMLR, Moura ECC. Caracterização Sociodemográfica e Clínica de Pessoas com Estomia em Teresina. Rev Estima, v. 14, n. 1, 2016. Disponível em: https://www.revistaestima.com.br/estima/article/view/117 2. AZEVEDO C, Faleiro JC, Ferreira MA, Oliveira SP, Mata RF da, Carvalho, EC de. 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