Knowledge of undergraduate nursing course teachers on the prevention and care of peristomal skin

Journal

of

Coloproctology

w w w . j c o l . o r g . b r

Original

article

Knowledge

of

undergraduate

nursing

course

teachers

on

the

prevention

and

care

of

peristomal

skin

Geraldo

Magela

Salomé

,

Luzicleide

Freire

dos

Santos

,

Helga

dos

Santos

Cabeceira

,

Ana

Maria

Marcheti

Panza

,

Maria

Angela

Boccara

de

Paula

a_{DepartmentofPlasticSurgery,UniversidadeFederaldeSãoPaulo(Unifesp),SãoPaulo,SP,Brazil}

b_{UniversidadedeTaubaté(UNITAU),Taubaté,SP,Brazil}

c_{UniversidadedoValedoSapucaí(UNIVÁS),PousoAlegre,MG,Brazil}

d_{SchoolofNursing,UniversidadedeSãoPaulo(USP),SãoPaulo,SP,Brazil}

e_{SchoolofPublicHealth,UniversidadedeSãoPaulo(USP),SãoPaulo,SP,Brazil}

f_{DepartmentofNursing,UniversidadedeTaubaté(UNITAU),Taubaté,SP,Brazil}

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received22February2014

Accepted15May2014

Availableonline19October2014

Keywords: Colostomy Ileostomy Education Nursingcare

a

b

s

t

r

a

c

t

Objective:Toevaluatetheknowledgeofundergraduatenursingcourseteacherson peris-tomalskincareinindividualswithintestinalstoma.

Methods:Thisisanexploratory,analyticalandcross-sectionalstudy,conductedwith under-graduatenursingcourseteachersfromtwoprivateuniversitiesinthecityofSãoPaulo, namedAandB.Thesampleconsistedof42teachers/nurses,being22fromUniversityA and20fromUniversityB,whosupervisedtheinternshipatHospitalVilaNova Cachoeir-inha.Withtheaimtocollectdata,astructuredquestionnaireconsistingof10questions (checklist)wasused;eachquestioninthechecklisthadcorrectandwronganswers.The teachershadtoindicatewith“x”thecorrectanswer.Thequestionnairewasdeliveredto teachers/nursesonapredeterminedday.DatacollectionwascarriedoutonAugust2006. Results:Themajorityofstudyparticipantsknowthatstomademarcationmustbeperformed preoperatively,andthatitisimportanttoeducatethepatientaboutsurgery,careforthe stomaandonthecollectingdevice,aswellastoperformasensitivitytestfortheequipment. Thehygieneshouldbeperformedwithmildsoapandwaterandwithapieceofclean,soft, dampcottonclothwithoutrubbing,andtheskinmustbekeptdry.Thehairremovalshould bedonewithcurvedtipscissors,cuttingclosetotheabdominalwall.

Conclusion:Theresultsshowedthat,althoughmostoftheparticipantshaveabasic knowl-edgeaboutstomizedpatientscare,updatingandimprovementareneeded.

©2014SociedadeBrasileiradeColoproctologia.PublishedbyElsevierEditoraLtda.All rightsreserved.

∗ _{Correspondingauthor.}

E-mail:salomereiki@yahoo.com.br(G.M.Salomé).

http://dx.doi.org/10.1016/j.jcol.2014.05.008

Conhecimentos

dos

docentes

do

curso

de

graduac¸ão

em

enfermagem

sobre

prevenc¸ão

e

cuidados

com

a

pele

periestoma

Palavras-chave: Colostomia Ileostomia Educac¸ão

Cuidadosdeenfermagem

r

e

s

u

m

o

Objetivo:Avaliaroconhecimentodedocentesdocursodegraduac¸ãoemenfermagemsobre oscuidadoscomdapeleperiestomalnosindivíduoscomestomasintestinais.

Métodos: Trata-se de um estudo exploratório, analítico e transversal realizado com

os docentes dos Cursos de Graduac¸ão em Enfermagem de duas Universidades

pri-vadas da cidade de São Paulo, denominadas A e B. A amostra foi constituída de 42

docentes/enfermeiros, sendo22daUniversidadeAe20da UniversidadeB,que supervi-sionavamestágionoHospitalVilaNovaCachoeirinha.Paraacoletadedados,foiutilizado questionárioestruturado,compostode10questões(checklist);cadaquestãodochecklist tinharespostascorretaseerradas.Osdocentestinhamdeassinalarcomxarespostacorreta. Oquestionáriofoientregueaosdocentes/enfermeirosemdiapré-determinado.Acoletade dadosfoirealizadaemagostode2006.

Resultado: Amaioriadosparticipantesdoestudosabequeademarcac¸ãodoestomadeve serrealizadanafasepré-operatóriaequeéimportanteorientaropacientequantoaoato operatório,aoscuidadoscomoestoma,equipamentoscoletoreserealizac¸ãodotestede sensibilidadeaosequipamentos.Ahigienedeveserfeitacomáguaesabãoneutroecom umpedac¸odetecidodealgodãolimpo,macioeúmido,semesfregar;apeledevesermantida seca.Aremoc¸ãodepêlosdeveserfeitacomtesouradepontacurva,cortandorenteàparede

doabdômen.

Conclusão: Osresultadosrevelaramqueapesardamaioriadosparticipantespossuir conhe-cimentosbásicossobreocuidadodapessoaestomizada,hánecessidadedeatualizac¸ão

eaprimoramento.

©2014SociedadeBrasileiradeColoproctologia.PublicadoporElsevierEditoraLtda. Todososdireitosreservados.

Introduction

Colon and rectum cancer is a disease that affects people

worldwide,beingregardedasthethirdmostcommoncauseof

deathbycancerintheworld,inbothgenders,andthesecond leadingcauseindevelopedcountries.1_{Thecensusofthe}

Insti-tutoNacionaldoCâncer(INCA)estimatedthat,in2010,28,110 casesofcolorectalcancerwerediagnosedinBrazil,with13,310 casesinmenand14,800casesinwomen.2,3

Technological and therapeutic advances in surgery and

early diagnosis of those patients undergoing an

ostomy-generating surgery contribute to the reduction of overall

postoperative complications, improving the quality of life,

bodyimageand self-esteem,resultinginincreasedsurvival

andfavoringthereturnofthesepeopletoleisureactivity,work andsociallife.3,4_{Itisalsoimportanttochoosethedevicewith}

aviewonpreventionandcareofperistomalskin

complica-tions,becauseitisnecessarytoeducateostomizedpatients withrespecttoself-careandforactionsthatcontributetothe preventionofperistomalskincomplications.

Itisuptothenursingstafftounderstandthereal

circum-stances ofthese people and their carers, so that theycan

receivecarebeyondthephysiologicalneedsandensure

emo-tionalsupport,guidance,respectandhelptowardanewway

oflife,withmoreautonomyofthestomizedindividualandits family.5,6_{Nursingprofessionalsworkingwithpeoplesuffering}

from chronicdiseases,especiallyostomized people,should

considertheseindividualsasthecenterofaprotective,

holis-ticand globalizedprocess and asactiveagents whichalso

take partintherehabilitativeprocess,eliminatingthe pas-siveimageofmerereceptaclesofcare,sothattheeducational activity materializesinareflectiveway,withinthecultural

universe of these clients, with whom these professionals

share thelearning.7,8 _{Therefore, itisuptotheprofessional}

todesignthecaretobeprovidedtothisindividualandthus

acquireknowledgeonthepreventionandcareofostomized

patients.

A large proportion of nurses/teachers working in the

stomatherapy area are concerned about the challenge of

teaching their students and staff with respect to

system-atic,individualizedcare, guidanceon stomaand skinlocal

care(hygieneandreplacementofcollectingdevice),

indica-tionofthecollectingdevicemostsuitedforeachsituationand aspectsrelatingtothepreventionofcomplications,aswellas thoseaspectsrelatedtothepsychosocialimpactcomingfrom theuseofastoma.

Evenwhennotspecializedinstomatherapy,thenursemust

understandhowthestomawasmanufacturedandthe

com-plicationsthatcanresultfromthissurgicalprocedure,aswell

as the characteristics ofthe effluent and the care for

pre-vention ofcomplications. In addition, the nurse can share

this knowledgewithstudents, clientsand other colleagues

who areworkingwithcompetenceinthisarea.9_Theactof

takingcareofastomizedpersondemandtechnicaland

andtreatmentofcomplications.Moreimportantly,thenurse mustunderstandthemultiplicityofaspectsrelatedtothenew conditionoflife,becausethereisevidenceofimpairmentin

multipledimensions,consideringthatthemeaningsandthe

symbolicaspectareexpressionsofasingularexperienceinthe

health-diseaseprocess,involvingseveralwaysofadjustment

tothenewlivingcondition.10

Giventhe plurality ofknowledge and constant changes

regardingstomacare, this ledto reflectionson the

impor-tanceofmasteringtheseskillsbythenurse(whetherornot

ateacher)andhowitsabsencecanjeopardizethequalityof

nursingcareandthequalityoftheseindividuals.

Thisstudyaimedtoassessthelevelofknowledgeof

under-graduatenursing teacherson the preventionofperistomal

skincomplicationsinintestinalstomausers.

Methods

This is a descriptive, exploratory, analytical and

cross-sectionalstudy,conductedwithundergraduatenursingcourse

teachersoftwoprivateuniversitiesinthecityofSãoPaulo,

namedAandB.

Thesampleconsistedof42teachers/nurses,being22from

University A and 20 from University B; these

profession-alssupervisedthenursinginternship atHospitalVilaNova

Cachoeirinha.Inclusion criteriawere:teachingatanursing

school for morethan a year, overseeing stages ofnursing

undergraduate students in their last year, providing care

forostomizedpatients, notbeingaspecialistin

stomather-apy or dermatology, and accepting to participate in the

study.

Astodatacollection,weusedastructuredquestionnaire

consistingof10 questions (checklist);each question inthe

checklisthadcorrectandwronganswers.Theteachershad

tocheckaboxwithxforthecorrectanswer.Thefirstpartof

thequestionnairewasrelatedtosocio-demographic

charac-teristicsofthepopulation,andthesecondpartfocusedonthe knowledgeanddifficultiesofteacherswithrespectto

knowl-edgeregardingtreatmentandpreventionofperistomalskin

complications.

Thequestionnairewasdeliveredtoteachers/nursesata

pre-determined day, ina private room, under the

supervi-sion of one of the authors of this study, considering the

need to preserve the reliability of data involving

informa-tion related tothe knowledge on preventionofperistomal

skincomplications.DatacollectionwascarriedoutonAugust 2006.

Thestudycompliedwiththeethicalguidelinesestablished

byResolution196/96ofthe NationalHealth Council/MSon

researchguidelinesandregulationsconcerninghuman

sub-jectsandwasapprovedbytheEthicsCommitteeinResearch

oftheUniversidadedeTaubaté(Protocol322/06).Authorization hasbeenappliedfordatacollectiontothecoordinatorsofthe twoparticipatinguniversities.

Thequestionsansweredbytheparticipatingteacherswere

conferred bythe authors, who used a template. The data

weremanuallytabulatedandpresentedintablescontaining

absolutenumbers andpercentages,involvingthose aspects

relevanttoachievingthegoalsproposedinthisstudy.

Results

Inthesamplestudied,itwasfoundthat16(73%)ofrecruited

teacherswerefemale,15(68%)wereagedbetween30and50

years,10(46%)were nursinggraduatesfor11–13years and

11 (50%)wereteaching forperiodsbetween6and10years.

Asforthetitlesanddegrees,only5(22.70%)oftherecruited teachershadaMaster’sdegree,andtheremaining17(77.30%) werespecialistsinsomefieldofNursing.

ItcanbeseeninTable1thatmostoftheparticipantsknow

theimportanceoftheequipmenttopreventperistomalskin

complications:15(68.2%)and14(70.0%)respectivelyforthe institutionsAandB.

Table2showsthatmostoftheteachersfromthetwo

partic-ipatinguniversitiesansweredthatstomademarcationshould

beperformedpreoperativelyandthatitisimportantto

edu-catethepatientontheoperativeprocedure,stomacareand

on the collectingdevice, and thata sensitivitytest forthe

equipmentshouldbeperformed.

InTable3,itcanbeseenthatthemajorityofteachersfrom

universitiesAandBalsoansweredthatatransparentdevice

shouldbeappliedintraoperatively,aswell asevaluating its adherenceandpreventingleakageorinfiltrationintothe sur-gicalwound;andinanticipationofthisevent,anewcollecting deviceshouldbeinstalled.

ThedatainTable4showthatalmostallrecruitedteachers

hadsaidthat,forthepreventionofperistomaldermatitis,the skinshouldbekeptfreeofmoistureand,uponremovalofthe collectingdevice,skinrubbingshouldbeavoided.

In Table 5, it can be seenthat the majority ofteachers

answeredthatoneshouldhygienizetheskinwithmildsoap

andwater,usingapieceofclean,soft,dampcottoncloth

with-out rubbing;theskinshouldbekeptdry;and hairremoval

shouldbedonewithcurvedtipscissors,cuttingclosetothe

abdominalwall.

Table6showsthatalmostallteachersrespondedthatthe

collectingdevicemustberemoved withgentlemovements,

andthemicroporousadhesiveremovalshouldstartatthe lat-eraltab;anditisconvenienttopresstheabdominalwallwith

theotherhand,whileremovingtheadhesivefromtheskin.

Discussion

In aneffort tokeepup withsocialchange, nursing

educa-torsareshowingincreasinginterestbyeducationalpractices, rethinkingthetrainingoffutureprofessionalsandprogressing

notonlyinthepreparationofanewnurseprofessionalbut,

aboveall,ofacriticalandreflectiveperson–acitizenreadyto create,proposeand,especially,construct.11

Theactofteachingrequiresacriticalreflectiononpractice

inadynamicanddialecticalmovementbetweenwhattodo

andwhattothink.Theeducatormustturntohimself/herself,

adopting a questioningattitude about his/her training and

becomingawarethatthisshouldbeanongoingand

Table1–Teachers’knowledgeattwoundergraduatenursingcourseswithrespecttouseofcollectingdevicestoprevent peristomalskincomplications.SãoPaulo,2006.

Knowledgeaboutequipmentuseinthepreventionofperistomalskincomplications UniversityA UniversityB

n % n %

Theuseofasuitableequipmentpostoperativelycontributesonlytothepreventionof allergicdermatitis.Anykindofcollectingbagcanbeused.

3 13.6 3 15.0

Abdominalcontour,preferenceonthetypeofcollectingdevice,typeofphysical activity,abilityconstraintsrelatedtomanualdexterity,visualacuityandlearning, andcollectingsystemadherence(sothatnoleakagenorinfiltrationintothesurgical woundoccurs)areimportantfactorsinselectingtheequipmenttoprevent complications.Allthesefactorscontributetothepreventionofcomplications.

15 68.2 14 70.0

Thecollectingdeviceisasafeguardforconditionsofsafety,protectionandeconomy. 4 18.2 3 15.0

Total 22 100.0 20 100.0

Table2–Teachers’knowledgeattwoundergraduatenursingcourseswithrespecttothenurse’sroleonpreoperative preparationoftheostomizedpatient.SãoPaulo,2006.

Knowledgeonthenurse’srolewithrespecttopatient’spreoperativepreparation UniversityA UniversityB

n % n %

Adequatelypreparethepatientforsurgery,performasensitivitytestanddecreasethe riskofsomecomplicationspreoperatively.

2 9.9 2 10.0

Complementexplanationsofthephysicianaboutthesurgery,answeranyquestionsof patientsusingclearandsimpleterms,andpreventcomplicationsthatmayimpair theirrecovery,renewingtheirconfidence.

1 4.5 2 10.0

Stomademarcation.Educatepatientswithrespecttothesurgery,previouspreparation ingeneral,thestoma,thecollectingdevice,publicassistanceprogramsand sensitivitytestingtoequipment.

19 85.6 16 80.0

Total 22 100.0 20 100.0

Table3–Teachers’knowledgeattwoundergraduatenursingcourseswithrespecttothenurse’sroleonintraoperative preparationoftheostomizedpatient.SãoPaulo,2006.

Knowledgeaboutthenurse’srolewithrespecttopatient’sintraoperativepreparation UniversityA UniversityB

n % n %

Applythetransparentcollectingdeviceandevaluateitsadherenceintraoperatively,at thetimeofitsinstallation,preventingleakageorsurgicalwoundinfiltration.In anticipationofthisevent,installanewcollectingdevice.

16 72.0 17 85.0

Detectelectrolyteandhemodynamicchangesandapplyatransparentdeviceinthe stoma.

3 13.6 2 10.0

Performstomasitedemarcation,talktothepatientandhis/herfamilyexplainingthe surgicalprocedure;applyatransparentequipmentinthestoma,whichallows constantobservationofthestoma.

3 13.6 1 5.0

Total 22 100.0 20 100.0

Table4–Teachers’knowledgeattwoundergraduatenursingcourseswithrespecttoperistomaldermatitisprevention. SãoPaulo,2006.

Knowledgeaboutperistomaldermatitishygiene UniversityA UniversityB

n % n %

Keeptheskinfreeofmoisture,makinguseofperistomalskin’sprotectivebarrier.Avoid skinrubbingwhileremovingwastematerialandequipment.

20 91.0 19 95.0

Keeptheskinmoist,makinguseofaskin’sprotectivebarrier. 1 4.5 1 5.0

Keeptheskinfreeofmoisture;skin’sprotectivebarrierisnotused. 1 4.5 – –

Table5–Teachers’knowledgeattwoundergraduatenursingcourseswithrespecttoperistomalskinhygiene.SãoPaulo, 2006.

Knowledgeaboutperistomalskinhygiene UniversityA UniversityB

n % n %

Hygienizewithmildsoapandwaterusingapieceofclean,soft,dampcottoncloth, withoutrubbing;theskinmustbekeptdry;hairremovalshouldbedonewithcurved tipscissors,cuttingclosetotheabdominalwall.

15 68.2 14 70.0

Hygienizewithmildsoapandwaterusingapieceofclean,soft,dampcottoncloth;hair removalshouldbedonewithscissors,cuttingclosetotheabdominalwall.

3 13.6 3 15.0

Hygienizewithmildsoapandwaterusingapieceofclean,soft,dampcottoncloth,with orwithoutrubbing;hairremovalshouldbedonewithcurvedorstraighttipscissors.

4 18.2 3 15.0

Total 22 100.0 20 100.0

Table6–Teachers’knowledgeattwoundergraduatenursingcourseswithrespecttocollectingdeviceremoval.São Paulo,2006.

Knowledgeaboutcollectingdeviceremoval UniversityA UniversityB

n % n %

Thisprocedureshouldbeperformedwithgentlemovements,andthemicroporous adhesiveremovalshouldstartatthelateraltab;itisconvenienttopressthe abdominalwallwiththeotherhand,whileremovingtheadhesivefromtheskin.

20 91.0 19 95.0

Itshouldbeperformedwithgentlemovements,andtheremovalshouldstartinany partoftheadhesive;itisconvenienttopresstheabdominalwallwiththeother hand,whileremovingtheadhesivefromtheskin.

1 4.5 1 5.0

Itshouldbeperformedwithgentlemovements,andthemicroporousadhesiveremoval shouldstartatthelateraltab;itisnotconvenienttopresstheabdominalwallwith theotherhand,whileremovingtheadhesivefromtheskin.

1 4.5 – –

Total 22 100.0 20 100.0

ofeverydaylifecanbeworkedoutandusedtoouradvantage, improvingthisconstructionprocess.12

Nursing teaching is a challenging process, and one

questionsthedegreeinwhichteachersandeducational insti-tutionspreparethestudentstocopewithpracticalsituations usingtheirownpotentialand,inparticular,tocopewiththose situationsthatinvolvetherelationshipwithothersin

Nurs-ingteaching,and howthistraining affectsthechoicesand

performanceoftheprofessionalinthisfieldofwork.13

Undergraduatenursing courseteachersprepare Nursing

students tocarryout their activities withskill and

techni-calandscientificcompetence,andwithawarenessaboutthe

importanceofcaringwithahumanizedtouch,guidingtheir

studentstowardrespectingtheneedthateveryprofessional

hastospecializeindifferentareas,withoutlosingsightofthe wholepicture.14

Inthefieldofstomatherapy,thenursingdisciplinehasbeen

generatingand validatingthe necessaryand useful

knowl-edgetoitsspecialtycarepractice,withtheaimtofulfillthe realneedsofpeopleinitsareasofcoverage:stomata,wounds

andincontinence. Regardingthe careofstomizedpatients,

itisknownthatthisisacomplexandmultifacetedpractice

and that, forits achievement,the professional must

mas-terspecificskills,notalwayswidelydiscussedatthetimeof

undergraduatenursingeducation.

Theseskillsinvolvepre-,intra-andpostoperativecarefor

theindividualtobetreatedwithanostomy,aiming,among

manythings,toencourageself-careandpreventionofstoma

andperistomalskincomplications.

MostoftheteachersfromuniversitiesAandBanswered

that,inpre-andintraoperativephases,atransparentdevice

should be applied, with evaluation of its adherence and

preventing leakage or surgical wound infiltration; and, in

anticipation ofits event,anewcollectingdeviceshouldbe

installed.

Themainmeasuresthatcanhelpinreducingperistomal

skin complicationsare: preoperativestoma demarcation,a

proper stoma application, a suited choice of the

equip-ment,patientandcaregivereducation,andmultidisciplinary

care.14–16

Inusers’guidanceandteachingonstomaandperistomal

skincarebythenurse,itisimportantthatthoseprocedures

relatedtoskincareandthechoiceandmaintenanceofthe

collectingdevicearedevelopedinsequential,logicalsteps,in orderthatthisinformationmaybetranslatedtothesituations ofeverydaylifeatpatient’shome.

The order of transference of guidelines for stoma and

peristomal skin care to the patient can influence his/her

well-beingineverydayroutine.Aninformationclearly trans-mittedcontributestoarousethepatient’sinterestinactively participatingintherehabilitationprocess.Theuser’s motiva-tionandinterestareessentialforhis/herparticipationinthe teaching-learningprocessand,consequently,inthe rehabili-tativeprocess.15,17–19

Preoperatively, stoma site demarcation should be

per-formed and, one can choose by placing a device with

Overall,thestudyparticipantsreportedthatstoma demar-cationcontributestothepreventionofstomaandperistomal skincomplications,andalsototherehabilitativeprocedure.

Choosingtheappropriatelocationintheabdominalwall

shouldbemadebypriordemarcationofthestomasite;this

siteshouldbelocatedinanarea ofskinwithout irregulari-ties,tofavortheattachmentofthecollectingequipment.The

demarcationshouldbeperformedwiththepatientin

differ-entpositionsandtakingintoconsiderationhis/herbodytype, abdomenconfiguration,motorskillsanddailyactivities.

Thedemarcationofthestomaisacriticalproceduretobe heldpreoperatively,standingoutasoneofthemostimportant aspectsoftherehabilitativeprocess.22–27

In the transoperative (or, more recently, perioperative)

phase,thenurseworkinginthesurgicalcenterinspire con-fidenceandminimizestheanxietyandfear,whenthepatient isfacedwithsurgery,stillduringthepreoperativevisit.

Fur-thermore,thepatient/inpatientunitnurse(whetherornota

stomatherapist)interactionisimportantfortheexchangeof

information,especiallywithrespecttothecollectingdevice designatedforpostoperativeuse.20,28

Duringthepostoperativenursingcare,thepatientshould

be encouraged to learn how to care for his/her stoma, in

order to preserve the independence and accepting a new

lifesituation.Hemodynamicconditionofthepatient,stoma

condition,effluentcontrol,and collectingdeviceadherence shouldalsobeevaluated.Postoperativenursingcareinvolves

paying attention to biological and psychosocial needs of

stomizedpatients;itcanbesaidthattherehabilitative pro-cessisdirectlyrelatedwiththesatisfactionoftheseneedsin anearly,individualizedandsystematicway.12,13,28

Almostallteachersrecruitedinthisstudyansweredthat, forperistomaldermatitisprevention,theskinshouldbekept

freefrommoistureand,uponthecollectingdeviceremoval,

skinrubbingshouldbeavoided;andhygienizationwithmild

soapandwatershouldbeperformedwithapieceofclean,soft,

dampcottonclothwithoutrubbing;theskinshouldbekept

dry;andhairremovalshouldbedonewithcurvedtipscissors, cuttingclosetotheabdominalwall.Allteachersansweredthat

theremovalofthecollectingdevicemustbeperformedwith

gentlemovements,withthe microporousadhesiveremoval

startingatthelateral tab;the wallofthe abdomenshould

bepressedwiththeotherhand,whileremovingtheadhesive

fromtheskin.

Dermatitisisafrequentcomplication,morecommon in

ileostomyandcolostomyproceduresandalsoinrightcolon

transversostomy.Althoughsomeauthorsdescribedermatitis

asalatecomplication,it canoccur atany time

postopera-tively.Dermatitiscanbeclassifiedaccordingtoseveralcolor-, relief-, thickness-and tissuerelated changes,being gener-allycategorized accordingtoits severityinmild, moderate

orsevere. Asforthe mostfrequentcauses,dermatitismay

be classified as: contact or irritant dermatitis and allergic dermatitis.13,29

Thenursingcareforstomizedpatientswithdermatitisare:

maintenanceofmoisture-free skin,useofaprotectiveskin

barrier,non-traumaticremovalofthedevice,avoidanceof

fric-tionandofcontinuouspressureontheskinbyusingavery

tightbelt,avoidanceofamaladaptativedevice,andself-care teaching.17,25

Thestomacareinclude:hygienizationofthestomaand

peristomalareawithmildsoapandwaterorsalinesolution,

properlydryingwithasoftcleancloth,periodicdrainingand

measurementoftheeffluent,manufactureofamoldofplate

hole(orcollectingequipmenthole)accordingtothemeasure

oftheresultofpreviouslymeasuredstoma,andselectionand

useanappropriatecollectingdeviceforeach typeofstoma

(takingintoaccountthepatientandeffluentcharacteristics), aswellaspatientandcaregiver’sabilities.19,22

Inorderfortheskintobecaredthroughoutthepatient’slife

cycle,itisimportanttounderstandthehumandevelopment

process,frominfancythroughold age,emphasizingmainly

theskindevelopmentandcharacteristics.26,27_{Itiscriticalto}

knowthecharacteristicsoftheskininbothstates,normaland abnormal,sothatanappropriatecareisperformed.

Thenursingpractice–aswellasthepracticeofthe

under-graduate nursing course teacher – in the pre-, intra- and

postoperative phases becomesessential forthe prevention

ofstomaandperistomalskincomplicationsand,asa

con-sequence,forthepatient’sgoodrecovery,beingalsovitalto his/herrehabilitationandsocialreintegration.30,31

Conclusion

Throughthisstudywecanconcludethat:

• Mostparticipantsknowtheequipmentimportancein

pre-venting peristomalskincomplications: 15(68.2%)and 14

(70.0%)respectivelyforinstitutionsAandB.

• TeachersfromuniversitiesAandBansweredthat,

intraop-eratively,itisnecessarytoapplyatransparentequipment andevaluateitsadherence,preventingleakageorsurgical woundinfiltration;andintheimminenceofthisevent,to installanewcollectingdevice.

• Teachersfromtheparticipatinguniversitiesansweredthat

stomademarcationmustbeperformedpreoperatively,and

thatitisimportanttoeducatethepatientaboutthesurgery, stomacareandcollectingdevice;andthatasusceptibility

testfortheequipmentshouldbeperformed.

• Participants know the importance of the equipment to

preventperistomalskincomplications: 15(68.2%)and 14

(70.0%),respectively,fortheinstitutionsAandB.

• Allteachersfromthetwouniversitiesansweredthatstoma

demarcationshouldbeperformedpreoperatively,andthat

itisimportanttoeducatethepatientontheactofsurgery, stomacare,collectingdevice,aswellasperforminga sen-sitivitytestfortheequipment.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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