REVIEW PROTOCOL

Instruments for nursing appointments with patients with elimination ostomies: a scope review protocol

Daniely Maillard Monteiro1, Euzeli da Silva Brandão1, Patrícia Britto Ribeiro de Jesus1

1Universidade Federal Fluminense, Niterói, RJ, Brazil

ABSTRACT

Objective: to map the instruments validated in Brazil to guide nursing appointments with adult patients in the pre- and postoperative period of elimination ostomies. Method: Scope review protocol according to the methodology of the Joanna Briggs Institute. The PCC (Population, Concept, and Context) mnemonic will be used. The search in the databases will be performed with the descriptors indexed in the Medical Subject Headings: Nursing, Ostomy, Colostomy, Ileostomy, Patients, Practice Guidelines, Preoperative Care, Postoperative Care, Validation, studies and the free term: Urostomy. Studies with different methodological designs, dissertations, theses, and guidelines of expert societies will be included, without temporal or language limitations. The identified studies will be exported to the EndNote Clarivate Analytics Software to remove duplicates and then to the Rayyan Software to be screened by two independent reviewers. After fully reading the studies, the results will be analyzed and discussed.

Descriptors: Nursing; Ostomy; Validation Study.

INTRODUCTION

Defined as a means of communication of an organ with the external environment, urinary and intestinal ostomies are classified as elimination ostomies, as they promote the excretion of urine, feces, and gas through the abdominal wall(1).

In Brazil, health units are responsible for the comprehensive and interdisciplinary care of ostomized patients, which begins with the decision on the need for an ostomy. It is a surgical procedure in a hospital environment, and the continuity of care is carried out in reference centers, which welcome the patient and guarantee their right to education, rehabilitation, and to collection and adjuvant equipment(2).

The diversion of urinary or intestinal transit for elimination through the abdominal wall is a factor that commonly generates issues of acceptance regarding the new body condition, aversion to personal image, damage to interpersonal life, staying in seclusion at home, feelings of anxiety, depression, insecurity, and low self-esteem(3). In addition to these social and emotional disorders, complications in the stoma and peristomal area are pointed out as factors that require intervention by healthcare providers and, consequently, a greater number of appointments in health institutions(4).

Thus, to meet the specific demands of this population, based on their clinical, nutritional, emotional, and social needs, a multidisciplinary team is necessary(2). In this context, appointments with nurses are an important technological tool for comprehensive care of the individual, since it is guided by scientific methods that allow the approach of health/disease issues from the diagnosis, through intervention, to the evaluation of the response induced by the care provided(5).

Considering the organization of professional work regarding method, personnel, and instruments, the Federal Nursing Council (COFEN) determined, through the COFEN Resolution 358/2009(6) (Revoked by COFEN Resolution 736 of January 17, 2024)(7), that the Nursing Process should be implemented in all public and private institutions where professional nursing care occurs. In this sense, Leite and Aguiar(8) mention the use of the nursing process to qualify the nursing care provided to the ostomized individual and meet the demands of the basic human needs affected.

Developing and validating an instrument for nursing appointments with ostomized patients, guided by scientific methodology, is of significant relevance to a structured appointment in comprehensive and humanized care, bringing benefits to the user, as well as professional satisfaction when checking the results obtained from the use of the instrument (9).

Thus, it is understood that nursing appointments guided by specific instruments for this population favor the clinical evaluation and understanding of the emotional and social influences imposed by the new condition and susceptibilities that this group of people is exposed to.

In an attempt to recognize research on the topic, in September 2022, the following international review databases were investigated: International Prospective Register of Systematic Reviews (PROSPERO), Open Science Framework (OSF) and the FIGSHARE repository, evidencing the lack of research records with a similar objective to this review. It is important to mention that, in 2023, a systematic review protocol aimed at people with elimination ostomies was identified, but its methodological purpose was to analyze research results that investigated the psychometric properties of quality-of-life instruments(10).

Thus, the following purpose was established: to map the instruments validated in Brazil to guide the nursing appointment with adult patients in the pre- and postoperative period of elimination ostomies.

METHOD

Scope review protocol, which consists of a study design aimed at guiding the identification and mapping of the main scientific evidence on a given area/topic(11). The protocol, prepared before the review, seeks to ensure that the review methods are transparent and reproducible when published. Following this research plan helps to avoid biases in the conduct of the review(12).

It is believed that this research design was chosen because it offers a "scope" that will serve as a consistent discussion about the instruments available in the literature to guide nursing appointments with patients in the pre- and postoperative period of elimination ostomies. This scope review protocol was registered in the OSF, at https://osf.io/7gxzn/?view_only=7ea1edd389c1402a9ca4d86364cec401.

It was developed considering the five stages recommended by the Joanna Briggs Institute (JBI) methodology: 1) Establishment of the research question; 2) Identification of relevant studies; 3) Selection and inclusion of studies; 4) Data mapping, extraction, and organization; 5) Grouping and interpretation of results. To ensure the integrity of the study and methodological rigor, for writing and review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist will be used(11).

Establishing the research question

To establish the research question and the identification of the key elements to conduct the review, the following mnemonic will be used: PCC (Population, Concept, and Context). Thus, the research question was elaborated: “what are the instruments validated in Brazil to guide nursing appointments with adult patients in the pre- and postoperative period of elimination ostomies?”, as shown in Figure 1.

Figure 1 - Mnemonic used to establish the research question and identify the key elements for the review. Niterói, RJ, Brazil, 2022

Identification of relevant studies

Research strategy/Selection of the source of evidence

The preliminary survey of descriptors and keywords was carried out with the librarian of the Aurora de Afonso Costa School of Nursing - Fluminense Federal University. Thus, for the search and identification of relevant studies, the following descriptors indexed in the DeCS/MeSH (Descriptors in health sciences/Medical Subject Headings) will be used: "Nursing", "Ostomy", "Colostomy", "Ileostomy", "Patients", "Practice guidelines", "Preoperative Care", "Postoperative Care", "Validation studies" and the free term: "Urostomy", using combinations of terms according to the bases accessed. The Boolean operators AND and OR will be applied in a restrictive and additive manner, respectively, as shown in Figure 2.

Figure 2 - Search strategy. Niterói, RJ, Brazil, 2022

The Virtual Health Library (VHL), Online Medical Literature Search and Analysis System (MEDLINE), Spanish Bibliographic Index in Health Sciences (IBECS), Latin American and Caribbean Health Sciences Literature (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHAL), ACADEMIC SEARCH PREMIER, Scopus SciVerse (Scopus), US National Library of Medicine National Institutes of Health (PubMed) will be used to search for and identify the studies. The search for publications will be carried out on the Journal Portal of the Coordination for the Improvement of Higher Education Personnel (CAPES), through remote access to the content of the Federated Academic Community (CAFe). To contemplate the gray literature, the Brazilian Digital Library of Theses and Dissertations (BDTD) and the Capes Thesis Catalog will be accessed.

Selection and inclusion of studies

Inclusion criteria

Full-text studies will be included, with different methodological designs, with their main topic being the instruments validated in Brazil to guide the nursing appointment of adult patients in the pre- and postoperative period of elimination ostomies. Dissertations, theses, and guidelines of expert societies, without time frame, published in any language will also be considered. Literature considered relevant to the review, not fully available, will be requested in particular from the authors.

Exclusion criteria

Studies that are under the process of validation and those that only mention the exclusive evaluation of the stoma and not the ostomized person, in addition to duplicates, will be excluded.

Data mapping, extraction, and organization

Thus, the methodological process of selecting and including studies will consist of identifying publications in data sources and selecting relevant texts following the inclusion criteria, according to the PCC acronym and the pre-established research question. Two independent reviewers will conduct the screening process simultaneously and blindly using different electronic devices. After searching the texts in the databases, the studies will be exported to the EndNote Clarivate Analytics Software, through which they will be grouped and removed when in duplicates. Then, the remaining records will be exported to the Rayyan Software, the two reviewers will independently screen the material found (reading the title and abstract), with the double-blind option activated. The results found will be analyzed and discussed between both reviewers, after fully reading the studies. If there are disagreements, a third reviewer will be asked to analyze the study. To identify other relevant studies, a reverse search will be performed in the references of the selected articles. To compile the selected data, a data extraction instrument will be prepared in an Excel spreadsheet with the following information: journal, study title, author(s), year and state in which the study was carried out, method, number of participants, and content/characteristics of the instrument validated in Brazil to guide the nursing appointment with adult patients in the pre- and postoperative period of elimination ostomies. During data analysis, the instrument may be changed according to necessity. In case such a change occurs, it will be informed in the Scope Review.

Grouping and interpretation of results

The results will be shown by answering the research question. Result synthesis and data will be shown in tables, in addition to the narrative discussion. As it is public domain data, the review study does not require approval by the ethics committee.

ACKNOWLEDGMENTS

We would like to thank the employees of the Nursing School Library (BENF) of the Federal Fluminense University (UFF) for the help in defining the descriptors and the search criteria on the databases.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

1. Matsubara MGS, Villela DL, Hashimoto SY, Reis HCS, Sconato RA, Denardi UA, et al. Feridas e Estomias em Oncologia: uma abordagem interdisciplinar. São Paulo: Lemar; 2011.

2. Ministério da Saúde (BR). Portaria nº 400, de 16 de novembro de 2009. Estabelece Diretrizes Nacionais para a Atenção à Saúde das Pessoas Ostomizadas no âmbito do Sistema Único de Saúde – SUS [Internet]. Brasília: Ministério da Saúde; 2009 [cited 2022 Jul 15]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2009/prt0400_16_11_2009.html

3. Silva AL, Vieira ABD, Moraes RHG, Mazoni SR, Kamada I. Subjectivities and challenges of people living with an intestinal ostomy. Braz J Enterostomal Ther - Rev Estima. 2021;19:e1721. https://doi.org/ 10.30886/ estima. v19.1034_PT

4. Pinto IES, Queirós SMM, Queirós CDR, Silva CRR, Santos CSVB, Brito MAC. Risk factors associated with the development of elimination stoma and perístoma skin complications. Rev Enf Referência. 2017;4(15):155-66. https://doi.org/10.12707/RIV17071

5. Crivelaro PMS, Posso MBS, Gomes PC, Papini SJ. Nursing consultation: a comprehensive care tool in primary healthcare. Brazil J Develop. 2020;6(7):49310-21. https://doi.org/10.34117/bjdv6n7-542

6. Conselho Federal de Enfermagem (BR). Resolução Cofen 358, 15 de outubro de 2009. Dispõe sobre a Sistematização da Assistência de Enfermagem e a implementação do Processo de Enfermagem em ambientes, públicos ou privados, em que ocorre o cuidado profissional de Enfermagem, e dá outras providências [Internet]. Brasília: COFEN; 2009 [cited 2022 Sept 26]. Available from: http://www.cofen.gov.br/resoluo-cofen-3582009_4384.html

7. Conselho Federal de Enfermagem (BR). Resolução Cofen 736, 17 de janeiro de 2024. dispõe sobre a implementação do processo de enfermagem em todo contexto socioambiental onde ocorre o cuidado de enfermagem [Internet]. Brasília: COFEN; 2024 [cited 2024 Feb 20]. Available from: https://www.cofen.gov.br/resolucao-cofen-no-736-de-17-de-janeiro-de-2024/

8. Leite MS, Aguiar LC. Diagnósticos de enfermagem em pacientes submetidos à colostomia. Enf Foco. 2017;8(2). https://doi.org/10.21675/2357-707X.2017.v8.n2.1227

9. Paczek RS, Oliveira TK, Passberg LZ, Tanaka AKSR, Lana LD. Instrument for implementing the nursing process during ostomate consultation: an experience report. Cienc Cuid Saude [Internet]. 2022 [cited 2022 Oct 20];21:e59744. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1384512

10. Fernandes FBDA, Machado RS, Lopes AM, Arrais KLBM, Silva GRFS. Instruments to assess quality of life in ostomized adults: a systematic review protocol. Online Braz J Nurs. 2023;22 Suppl 1:e20236640. https://doi.org/10.17665/1676-4285.20236640

11. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis [Internet]. Adelaide: JBI; 2020 [cited 2022 Jul 10]. Available from:  https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-12

12. Moraes EB. Review Protocols. Online Braz J Nurs. 2022;21 Suppl 1:e20226585. https://doi.org/10.17665/1676-4285.20226585

Submission: 28-Apr-2023

Approved: 11-Mar-2024