Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 1 Isabelle Pereira da Silva https://orcid.org /0000-0002-9865-2618 Universidade Federal do Rio Grande do Norte, Brazil. isabelle.silva.015@ufrn.edu.br Iraktânia Vitorino Diniz https://orcid.org /0000-0002-0309-6007 Universidade Federal da Paraíba, Brazil. contato@iraktania.page Julliana Fernandes de Sena https://orcid.org /0000-0002-8968-1521 Universidade Federal do Rio Grande do Norte, Brazil. julliana.sena.012@ufrn.br Silvia Kalyma Paiva Lucena https://orcid.org /0000-0002-1191-927X Universidade Federal do Rio Grande do Norte, Brazil. silvia.lucena@ufrn.br Lorena Brito do O’ https://orcid.org /0000-0002-8419-3457 Universidade Federal do Rio Grande do Norte, Brazil. lorena.o.702@ufrn.edu.br Rodrigo Assis Neves Dantas https://orcid.org /0000-0002-9309-2092 Universidade Federal do Rio Grande do Norte, Brazil. rodrigo.neves@ufrn.br Isabelle Katherinne Fernandes Costa https://orcid.org /0000-0002-1476-8702 Universidade Federal do Rio Grande do Norte, Brazil. isabelle.fernandes@ufrn.br Artículo Self-Care Requisites for People with Intestinal Ostomies: A Scoping Review* Received: 17/10/2022 Sent to peers: 20/01/2023 Approved by peers: 16/03/2023 Accepted: 23/03/2023 * This article derives from the master’s thesis “Construction of mobile application prototype to assist in the self-care of people with an intestinal ostomy” of the Graduate Program in Nursing of Universidade Federal do Rio Grande do Norte, Brazil. Available at: https://repositorio.ufrn.br/jspui/handle/123456789/32394. This research was funded by the National Council for Scientific and Technological Development, public notice CNPq/ MS/SCTIE/Decit 27/2019. DOI: 10.5294/aqui.2023.23.2.5 Para citar este artículo / To reference this article / Para citar este artigo Silva IP, Diniz IV, Sena JF, Lucena SKP, Do O’ LB, Dantas RAN et al. Self-care requisites for people with intestinal ostomies: A scoping review. Aquichán. 2023;23(2):e2325. DOI: https://doi.org/10.5294/aqui.2023.23.2.5 https://orcid.org/0000-0002-9865-2618 mailto:isabelle.silva.015@ufrn.edu.br https://orcid.org/0000-0002-0309-6007 mailto:contato@iraktania.page https://orcid.org/0000-0002-8968-1521 mailto:julliana.sena.012@ufrn.br https://orcid.org/0000-0002-1191-927X mailto:silvia.lucena@ufrn.br https://orcid.org/0000-0002-8419-3457 mailto:lorena.o.702@ufrn.edu.br https://orcid.org/0000-0002-9309-2092 mailto:rodrigo.neves@ufrn.br https://orcid.org/0000-0002-1476-8702 mailto:isabelle.fernandes@ufrn.br https://repositorio.ufrn.br/jspui/handle/123456789/32394 https://doi.org/10.5294/aqui.2023.23.2.5 https://doi.org/10.5294/aqui.2023.23.2.5 https://crossmark.crossref.org/dialog/?doi=10.5294/aqui.2023.23.2.5&domain=pdf&date_stamp=2023-05-19 Theme: Promotion of health, well-being, and quality of life Contribution to the discipline: Self-care is an indispensable factor to all human beings and an object of health care. People with os- tomies present new demands of self-care that require support to achieve the necessary skills and knowledge. In this sense, this study contributes to expanding the knowledge about the necessary requi- sites for the person with an ostomy, found in literature, which sup- port the planning and assistance of health professionals, especially nursing, to this population in the process of health education. More- over, the review can provide the basis for new intervention studies in the area, improving the assistance to this population. Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 3 Abstract Self-care is one of the main factors altered in the life of a person with an ostomy. Self-care requisites with nursing support are necessary. Objectives: To map the self-care requisites for people with intestinal ostomies in their adaptive process, guided by Orem’s theory. Materials and methodology: A scoping review was conducted between May and June 2022, in which studies published from 2000 to 2022 were select- ed, based on Orem’s self-care deficit nursing theory. The sources of evidence used were Medical Literature Analysis and Retrieval System Online, Cinahl, Scopus, Latin American and Caribbean Health Sciences Literature, Nursing database, Índice Bibliográfico Español en Ciencias de la Salud, Web of Science, Scientific Electronic Library Online, Brazil- ian Digital Library of Theses and Dissertations, Open Access Scientific Repositories of Portugal, Theses Canada, DART-Europe E-Theses Por- tal, and National ETD Portal. Studies presenting at least one requisite of self-care for people with intestinal ostomies, whether or not they addressed Orem’s theory, and that were published in full were includ- ed. We followed the recommendations of the Joanna Briggs Institute and the PRISMA International Guide, registered in the Open Science Framework (10.17605/OSF.IO/XRH5K). The following descriptors and search strategies were used: (ostomy OR colostomy OR ileostomy OR stoma) AND (self-care OR self-management) AND (adaptation OR adjust- ment). Results: The final sample was composed of 87 studies. In univer- sal requisites, studies in the category “nutritional aspects” predominat- ed, of which the most frequent was “eat regularly and follow a balanced diet” (23; 26.4%); in developmental requisites, the prevalent category was “stoma and peristomal skin care” and requisite “assess peristomal skin integrity” (27; 31.0%); in the health deviation requisites, the pre- dominant category was “choice of collection equipment and adjuvant products” and the requisite “use hydrocolloid powder to absorb mois- ture in cases of dermatitis” (13; 14.9%). Conclusions: The study contrib- utes to guiding the assistance to the person with an ostomy, improving the self-care learning process. However, new intervention studies are still needed. Keywords (Source: DeCS) Ostomy; self-care; nursing; health education; nursing models. 4 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 Requisitos de autocuidado a personas con ostomías intestinales: revisión de alcance* Resumen El autocuidado es uno de los principales factores en la vida de la per- sona con ostomía. Requisitos de autocuidado con el soporte de la en- fermería son necesarios. Objetivos: mapear los requisitos de auto- cuidado a personas con ostomía intestinal en su proceso adaptativo, norteado por la teoría de Orem. Materiales y método: revisión de alcance llevada a cabo entre mayo y junio de 2022, en la que se se- leccionaron estudios publicados de 2000 a 2022, desde el marco de la teoría de enfermería del déficit del autocuidado de Orem. Se em- plearon como fuentes de evidencia Medical Literature Analysis and Retrieval System Online, Cinahl, Scopus, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Base de datos en Enfermería, Índice Bibliográfico Español en Ciencias de la Salud, Web of Science, Scientific Electronic Library Online, Biblioteca Digital Brasileira de Te- ses e Dissertações, Repositório Científico de Acesso Aberto de Por- tugal, Theses Canada, DART-Europe E-Theses Portal y National ETD Portal. Se incluyeron estudios que presentaran al menos un requisito de autocuidado a personas con ostomías intestinales, que abordaran o no la teoría de Orem y publicados en la íntegra. Se siguieron las recomendaciones de Joanna Briggs Institute y Prisma International Guide, con registro en la Open Science Framework (10.17605/OSF.IO/ XRH5K). Se emplearon los siguientes descriptores y estrategias de búsqueda: (ostomy OR colostomy OR ileostomy OR stoma) AND (self care OR self-management) AND (adaptation OR adjustment). Resulta- dos: la muestra final fue de 87 estudios. En los requisitos universales, predominaron estudios en la categoría “aspectos nutricionales”, de los cuales el más frecuente fue “comer regularmente y seguir una di- eta balanceada” (23; 26,4 %); en los requisitos de desarrollo, la cate- goría prevalente fue “cuidados con la ostomía y la piel periestomal” y el requisito, “evaluar la integridad de la piel periestomal” (27; 31,0 %); en los requisitos de desviación de la salud, la categoría predominante fue “selección del equipo recolector y los productos adyuvantes”, y el requisito, “usar polvo hidrocoloide para absorber la humidad en casos de dermatitis” (13; 14,9  %). Conclusiones: el estudio aporta a la orientación de la atención a la persona con ostomía, lo que puede mejorar el proceso de aprendizaje del autocuidado. Sin embargo, nuevos estudios de intervención aún son necesarios. Palabras clave (Fuente: DeCS) Ostomía; autocuidado; enfermería; educación en salud; modelos de enfermería. * El artículo se deriva de la tesis de maestría “Construción de protótipo de aplicación móbil para auxiliar en el autocuidado a personas con ostomías intestinales” en el marco del Programa de Postgrado en Enfermería de la Universidade Federal do Rio Grande do Norte, Brasil. Disponible en: https://repositorio.ufrn.br/jspui/handle/123456789/32394. La investigación fue auspiciada por el Conselho Nacional de Desenvolvimento Científico e Tecnológico, edital CNPq/MS/SCTIE/Decit 27/2019. https://repositorio.ufrn.br/jspui/handle/123456789/32394 Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 5 Requisitos de autocuidado para pessoas com estomias intestinais: revisão de escopo* Resumo O autocuidado é um dos principais fatores alterados na vida da pessoa com estomia. Requisitos de autocuidado com o apoio da enfermagem são necessários. Objetivos: mapear os requisitos de autocuidado para pessoas com estomia intestinal em seu proces- so adaptativo, norteado pela teoria de Orem. Materiais e método: revisão de escopo realizada entre maio e junho de 2022, na qual foram selecionados estudos publicados de 2000 a 2022, com base no referencial da teoria de enfermagem do déficit do autocuidado de Orem. Utilizaram-se como fontes de evidência Medical Literature Analysis and Retrieval System Online, Cinahl, Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de dados em Enfermagem, Índice Bibliográfico Español en Ciencias de la Sa- lud, Web of Science, Scientific Electronic Library Online, Biblioteca Digital Brasileira de Teses e Dissertações, Repositório Científico de Acesso Aberto de Portugal, Theses Canada, DART-Europe E-Theses Portal e National ETD Portal. Incluíram-se estudos que apresentas- sem pelo menos um requisito de autocuidado para pessoas com es- tomias intestinais, que abordassem ou não a teoria de Orem e pub- licados na íntegra. Seguiram-se as recomendações da Joanna Briggs Institute e do Prisma International Guide, com registro na Open Sci- ence Framework (10.17605/OSF.IO/XRH5K). Usaram-se os seguintes descritores e estratégias de busca: (ostomy OR colostomy OR ileos- tomy OR stoma) AND (self care OR self-management) AND (adapta- tion OR adjustment). Resultados: a amostra final foi composta de 87 estudos. Nos requisitos universais, predominaram estudos na cate- goria “aspectos nutricionais”, dos quais o mais frequente foi “comer regularmente e seguir uma dieta equilibrada” (23; 26,4 %); nos requi- sitos de desenvolvimento, a categoria prevalente foi “cuidados com a estomia e a pele periestomal” e o requisito, “avaliar a integridade da pele periestomal” (27; 31,0 %); nos requisitos de desvio de saúde, a categoria predominante foi “escolha do equipamento coletor e dos produtos adjuvantes”, e o requisito, “usar pó hidrocoloide para ab- sorver a umidade em casos de dermatite” (13; 14,9  %). Conclusões: o estudo contribui para nortear a assistência à pessoa com estomia, melhorando o processo de aprendizado do autocuidado. Contudo, novos estudos de intervenção ainda são necessários. Palavras-chave (Fonte DeCS) Estomia; autocuidado; enfermagem; educação em saúde; modelos de enfermagem. * Este artigo é derivado da dissertação de mestrado “Construção de protótipo de apli- cativo móvel para auxiliar no autocuidado de pessoas com estomias intestinais” do Pro- grama de Pós-Graduação em Enfermagem da Universidade Federal do Rio Grande do Norte, Brasil. Disponível em: https://repositorio.ufrn.br/jspui/handle/123456789/32394 https://repositorio.ufrn.br/jspui/handle/123456789/32394 6 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 Introduction Intestinal ostomies consist of surgical openings to exteriorize a seg- ment of the intestine to supply the needs of fecal elimination (1). The process of living with an ostomy has repercussions on biopsychoso- cial aspects and promotes changes and adaptations in people’s daily habits, self-care, and self-image (2). Self-care is one of the main factors altered in the life of a person with an ostomy, due to the new demands of body care that perme- ate aspects such as body hygiene, stoma and peristomal skin, nu- trition, sexuality, social relations, and psychological factors. Insuffi- cient self-care can lead to complications associated with the stoma and hinder the adaptive process (3). Dorothea Orem defines self-care as actions that people perform to maintain the functioning and well-being of the body, preserving or- ganic development, health, and life. When there is an imbalance be- tween the demands and the ability to perform these actions, there is a self-care deficit, a situation in which the nurse plays an import- ant role in supporting the patient who has difficulties in self-care (4). People with ostomies experience deficits, especially during the ini- tial period after surgery, related to the new skills required in the care of the ostomy and the collection equipment, as well as the psy- chological and social repercussions (5). These aspects derive from problems of acceptance and aversion to touch or care for the stoma, and from difficulties with the required skills and in the process of learning about self-care (3, 6). Such factors need to be developed and directed by the nurse in the process of health education, in which the person with an ostomy, along with caregivers and family members, has a central and active role. For this, Orem establishes essential actions for the provision of self-care, called “requisites”, which can be universal when they con- cern the maintenance of life, developmental when related to body changes or new events, and of health deviation when associated with pathologies or injuries (4). It is fundamental that people with ostomies develop these req- uisites in their learning process of self-care with the support of nursing, especially because the nurse has an important role in the performance of healthcare services for people with ostomies with- in the Unified Health System (SUS, by its acronym in Portuguese), participating in the comprehensive assistance to the population, as well as in the duties of organizing services (7). In this sense, this study is justified by the need to expand the knowl- edge of nurses about the requisites of self-care, aiming to improve the assistance provided, in addition to giving information that can support the development of technologies and educational methods for the self-care of this population. Therefore, the objective of the Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 7 study is to map the self-care requisites for people with intestinal ostomies in their adaptive process, guided by Orem’s theory. Materials and Methodology The study consists of a scoping review conducted from May to June 2022, based on the theoretical framework of Orem’s self- care deficit nursing theory (4), in which studies published from 2000 to 2022 were selected. We followed the protocol of the Joanna Briggs Institute (JBI) Reviewers’ Manual: delimitation of the research question, surveys of studies in the literature, se- lection based on eligibility criteria, data analysis, synthesis, and presentation (8). For the structured presentation of results, the recommendations of the Preferred Reporting Items for System- atic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR [9]) were followed. A search for protocols similar to this review was performed in April 2022 in the JBI Clinical Online Network of Evidence for Care and Therapeutics (COnNECT+), Database of Abstracts of Re- views of Effects (DARE), The Cochrane Library, and International Prospective Register of Ongoing Systematic Reviews (PROSPE- RO) data sources. It was found that there are no protocols similar to the purpose of this study. After that, a search protocol was created with the following items: objective, guiding question (mnemonic “Population, Con- cept, Context — PCC”), inclusion and exclusion criteria, search strategy, data to be extracted from the studies, and form of presentation of results. The study protocol was registered on the Open Science Framework (OSF) platform under the DOI: 10.17605/OSF.IO/XRH5K. The guiding question was elaborated from the mnemonic “PCC”, in which “P” indicates people with intestinal ostomies; “C”, self- care requisites; “C”, adaptive process. In this way, the aim is to question what self-care requisites are necessary for people with ostomies in their adaptive process. The descriptors were selected in the indexed vocabulary of the Medical Subject Headings (MeSH) and Descriptors in Health Sci- ences (DeCS); in addition, the keywords were searched in the studies available in the National Library of Medicine (PubMed) and the Cumulative Index to Nursing & Allied Health Literature (Cinahl), according to the recommendations of the JBI. Based on this, the following search strategy was elaborated: (ostomy OR colostomy OR ileostomy OR stoma) AND (self-care OR self-man- agement) AND (adaptation OR adjustment). The following data sources were used: Medical Literature Analy- sis and Retrieval System Online (Medline), Cinahl, Scopus, Latin American and Caribbean Health Sciences Literature (Lilacs, by 8 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 its acronym in Portuguese), Nursing Database (BDEnf, by its acro- nym in Portuguese), Índice Bibliográfico Español en Ciencias de la Sa- lud (IBECS), Web of Science, and Scientific Electronic Library Online (SciELO). Regarding the gray literature sources, studies were sought in the Brazilian Digital Library of Theses and Dissertations (BDTD, by its acronym in Portuguese), the Open Access Scientific Repository of Portugal (RCAAP, by its acronym in Portuguese), Theses Canada, the DART-Europe E-Theses Portal, and the National ETD Portal. Due to the specifications of the data sources, the search strategy was adapted to each of them, but we tried to keep it as similar as possible to the original strategy. Table 1 presents the strategies used for each source. Table 1. Search Strategies Conducted in Each Data Source. Natal, Rio Grande do Norte, Brazil, 2022 Search Strategies Source TI ostomy OR TI colostomy OR TI ileostomy OR TI stoma AND TI self care OR TI self- management AND TI adaptation OR TI adjustment Medline TI ostomy OR TI colostomy OR TI ileostomy OR TI stoma AND TI self care OR TI self- management AND TI adaptation OR TI adjustment Cinahl (TITLE-ABS-KEY (ostomy) OR TITLE-ABS-KEY (colostomy) OR TITLE-ABS-KEY (ileostomy) OR TITLE-ABS-KEY (stoma) AND TITLE-ABS-KEY (self AND care) OR TITLE-ABS-KEY (self AND management) AND TITLE-ABS-KEY (adaptation) OR TITLE-ABS-KEY (adjustment)) Scopus (tw:(ostomy)) OR (tw:(colostomy)) OR (tw:(ileostomy)) OR (tw:(stoma)) AND (tw:(self-care)) OR (tw:(self-management)) AND (tw:(adaptation)) OR (tw:(adjustment)) Lilacs (tw:(ostomy)) OR (tw:(colostomy)) OR (tw:(ileostomy)) OR (tw:(stoma)) AND (tw:(self-care)) OR (tw:(self-management)) AND (tw:(adaptation)) OR (tw:(adjustment)) BDEnf (tw:(ostomy)) OR (tw:(colostomy)) OR (tw:(ileostomy)) OR (tw:(stoma)) AND (tw:(self-care)) OR (tw:(self-management)) AND (tw:(adaptation)) OR (tw:(adjustment)) IBECS (tw:(ostomy)) OR (tw:(colostomy)) OR (tw:(ileostomy)) OR (tw:(stoma)) AND (tw:(self-care)) OR (tw:(self-management)) AND (tw:(adaptation)) OR (tw:(adjustment)) SciELO (all fields: ostomy AND all fields: self-care) BDTD Ostomy OR (colostomy OR ileostomy OR stoma) AND self-care OR (self-management) AND adaptation OR (adjustment) RCAAP Ostomy OR colostomy OR ileostomy OR stoma AND self-care OR self-management AND adaptation OR adjustment Theses Canada Ostomy OR colostomy OR ileostomy OR stoma AND self-care OR self-management AND adaptation OR adjustment DART-Europe E-Theses Portal Ostomy OR (colostomy OR ileostomy OR stoma) AND self-care OR (self-management) AND adaptation OR (adjustment) National ETD Portal Source: Elaborated by the authors. Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 9 The eligibility criteria included studies that presented at least one requisite of self-care (actions aimed at the provision of self- care [4]) for people with intestinal ostomies, whether or not they addressed Orem’s theory, and that were published in full online in the Journals Portal of the Coordination for the Improvement of Higher Education Personnel (Capes, by its acronym in Portu- guese). Access to the portal was through the Federated Academ- ic Community (CAFe, by its acronym in Portuguese), a resource funded by the university where the study was conducted. Dupli- cates, editorials, experience reports, opinion articles, and theo- retical essays were excluded. The studies were initially selected based on the titles and ab- stracts, and after the initial sorting, they were read in full for the sample selection. The search was conducted by two research- ers independently, and at the end, the selected texts were com- pared and read in their entirety. In case of disagreement, a third researcher delimited the study to be included. No software was used in the process of selection and analysis of the studies. The self-care requisites were grouped as proposed by Orem (5): universal when they addressed basic activities of daily living for the functioning of the body, developmental when related to spe- cialized actions of the universal requisites for changes in body development or new conditions or events, and health deviation for situations of diseases or injuries that require diagnostic, ther- apeutic or rehabilitative care actions. Moreover, the requisites were subdivided into thematic categories based on the Brazilian Consensus on Stomal Therapy (10). The selected studies were identified by the letter “E”, from E1- E83 (6, 11-96). The data extracted from the studies of the final sample (identification data, type of study, and recommenda- tions for self-care) were tabulated in a Microsoft Excel spread- sheet, analyzed according to descriptive statistics, and present- ed in table format. Results A total of 35,363 studies were identified in the databases and gray literature, of which 87 were selected to compose the sam- ple, as detailed in the diagram of Figure 1. Of this total, 78 are articles, with eight dissertations and one thesis. Regarding the characterization of the studies in the sample, it was found that most were from the Cinahl database (52; 59.8%) and the British Journal of Nursing (18; 20.7%), published in the United Kingdom (40; 46.0%) and carried out in the United King- dom (44; 50.6%). The publications occurred between 2000 and 2022, mostly in the years 2019 (9; 10.3%), 2013 (8; 9.2%), and 2014 (7; 8.0%), and were found to be predominantly literature reviews 10 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 Studies identi�ed in databases n = 35,363 Studies identi�ed in gray literature n = 270 Total number of studies n = 35,633 Total number of studies after application of �lters n = 17,935 Filters: Full text and abstract available Excluded due to duplicity Excluded for not meeting inclusion criteria n = 116 Excluded for not answering the research question n = 51 Pre-selected by title and abstract n = 286 Total number of studies after exclusion due to duplicity n = 254 Studies included in the sample n = 87 Total number of studies after application of eligibility criteria n = 138 ID EN TI FI C A TI O N SO R TI N G EL IG IB IL IT Y IN C LU SI O N (50; 57.5%). Regarding self-care requisites, 78 requisites were iden- tified, of which 19 were classified as universal, 41 as developmental, and 18 as health deviation. Concerning the universal requisites, described in Table 2, most stud- ies were identified in the category “nutritional aspects”, of which the most frequent was “eating regularly and following a balanced diet”. In addition, within this category, the least frequent were “observe the effects of dietary changes on stool” (5; 5.7% [29, 36, 73, 78, 92]), “avoid consuming large amounts of fluid during or immediately be- fore or after meals” (4; 4.6% [14, 22, 32, 34]), “avoid talking while eat- ing” (3; 3.4% [56, 75, 78]), “avoid foods that may cause obstruction” (3; 3.4% [16, 21, 73]), “avoid foods that cause diarrhea” (3; 3.4% [14, 15, 52]), and “control foods that cause odor” (2; 2.3% [18, 78]). Figure 1. Diagram of Study Selection from Data Sources. Natal, Rio Grande do Norte, Brazil, 2022 Source: Elaborated by the authors. Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 11 Table 2. Absolute and Relative Frequency of the Universal Requisites Identified in the Studies. Natal, Rio Grande do Norte, Brazil, 2022 Universal requisites Studies n (%) Nutritional aspects Eat regularly and follow a balanced diet E2, E6, E12, E13, E15, E16, E17, E18, E19, E20, E23, E27, E29, E33, E40, E46, E48, E49, E67, E69, E71, E75, E84. 23 (26.4) Maintain a good fluid intake E2, E4, E8, E9, E17, E19, E20, E24, E27, E33, E40, E46, E48, E49, E51, E56, E67, E69. 18 (20.7) Avoid gas-producing foods E2, E12, E13, E15, E17, E51, E56, E63, E67, E69, E71, E80, E81, E82. 14 (16.1) Masticate food thoroughly E2, E12, E17, E19, E27, E33, E37, E40, E46, E48, E56, E67, E69, E71. 14 (16.1) Taste foods gradually E12, E17, E20, E23, E24, E27, E33, E40, E56, E69, E71. 11 (12.6) Intestinal control Watch for signs of change in the stool E5, E7, E37, E45, E53, E63, E86. 7 (8.0) Physical activities Perform moderate physical exercises to prevent constipation E19, E20, E39, E51. 4 (4.6) Take walks to help stimulate bowel function and muscle tone E39, E40, E62. 3 (3.4) Professional clinical advice should be sought before beginning any kind of exercise E39, E40. 2 (2.3) Sexuality Express concerns and doubts about sexual aspects and body image E66, E73, E75, E84. 4 (4.6) Explore other comfortable positions for sexual activities E66, E73, E83. 3 (3.4) Accept to adapt to changes and self-image after the ostomy E85, E87. 2 (2.3) Discuss aspects that can improve self-image with health-care professionals E36. 1 (1.1) Source: Elaborated by the authors. As for the developmental requisites, described in Table 3, the predominance of the category “stoma and peristomal skin care” and the requisite “assess peristomal skin integrity” were ob- served. In this category, the least frequent requisites were “keep the peristomal skin clean and dry” (4; 4.6% [43, 46, 67, 74]), “cut the peristomal skin hairs” (3; 3.4% [45, 79, 83]), “measure the length and width of irregular stomas” (2; 2.3% [45, 63]), and “ex- pose the skin around the stoma to the sun” and “protect the sto- ma with moist gauze” (1; 1.1% [83]). 12 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 Table 3. Absolute and Relative Frequency of the Developmental Requisites Identified in the Studies. Natal, Rio Grande do Norte, Brazil, 2022 Developmental Requisites Studies n (%) Stoma and Peristomal Skin Care Assess peristomal skin integrity E20, E26, E23, E25, E29, E32, E33, E35, E37, E38, E40, E43, E46, E47, E50, E52, E53, E54, E55, E56, E58, E67, E68, E69, E72, E76, E86. 27 (31.0) Clean the peristomal skin with tap water and dry thoroughly E1, E9, E15, E17, E19, E21, E22, E25, E26, E29, E38, E40, E41, E56, E57, E58, E67, E69, E72, E76, E81, E82. 22 (25.3) Check the normal appearance of the stoma E3, E4, E7, E9, E15, E17, E20, E24, E27, E29, E40, E41, E43, E46, E50, E52, E67, E72, E76, E77. 20 (23.0) Assess the viability of the ostomy and its characteristics E7, E8, E25, E29, E35, E38, E50, E52, E55, E68, E72, E76. 12 (13.8) Avoid the use of moisturizers on the peristomal skin E29, E41, E56, E58, E68, E69, E76. 7 (8.0) Choice of Collection Equipment and Supplies The opening of the base plate should be cut in the diameter of the stoma E1, E3, E7, E8, E13, E14, E17, E20, E24, E29, E38, E40, E41, E50, E58, E61, E68, E72, E76, E77. 20 (23.0) Use products that act as a barrier to protect the peristomal skin E3, E8, E17, E19, E21, E24, E26, E32, E38, E44, E46, E47, E50, E57, E58, E65, E68, E69, E72. 19 (21.8) Remove the collection bag carefully E1, E3, E15, E17, E21, E22, E25, E38, E57, E58, E67, E69, E72, E76, E77. 15 (17.2) Measure the stoma to define the size of the collection bag cutout E15, E17, E23, E24, E25, E29, E38, E40, E56, E61, E67, E76, E77. 13 (14.9) Empty the bag when it is 1/3 or even 1/2 full E1, E3, E7, E9, E17, E29, E33, E40, E56, E69, E72, E76. 12 (13.8) Choice of Collection Equipment and Supplies Choose the collection equipment according to the needs, individual characteristics, and type of stoma E10, E11, E12, E22, E23, E37, E41, E52, E68, E69, E72, E76, E85. 13 (14.9) Use products for stomas to fill skin folds and level the skin E3, E8, E19, E32, E38, E40, E41, E44, E50, E60, E72. 11 (12.6) Use bags with activated charcoal filters for the neutralization of odor E12, E17, E51, E56, E67, E69, E71, E74, E77, E78. 10 (12.0) Use a transparent collection bag when it is necessary to visualize the stoma E4, E7, E12, E41, E72, E77. 6 (6.9) Use deodorant sprays in the bag to control odors E27, E44, E51, E56, E69, E71. 6 (6.9) Nutritional Aspects Decrease fiber intake for people with ileostomies E2, E12, E24, E27, E31, E33, E43, E49. 8 (9.2) Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 13 Developmental Requisites Studies n (%) Maintain adequate fiber food and fluid intake for people with colostomies E24, E46, E48, E51, E63, E69. 6 (6.9) Recognize symptoms of dehydration in people with ileostomies E2, E30, E59, E67. 4 (4.6) Sexuality Use alternative strategies such as underwear and belts to encourage intimacy E6, E37, E62, E66, E73, E75, E83. 7 (8.0) Empty or replace the collection bag before intercourse E6, E64, E66, E73, E75. 5 (5.7) Avoid foods that can cause gas or strong odors before intercourse E66, E75. 2 (2.3) Clinical Assistance Express concerns or anxieties in conversations with health-care professionals E36, E37, E40, E64, E70, E73, E75, 6 (6.9) Seek help from professionals to evaluate the possibility of using continence systems E6, E64, E75, 3 (3.4) Social Aspects Participate in groups with other people with ostomies E23, E74, E86, E87. 4 (4.6) Physical Activities Empty the collection bag before physical activities E67, E76. 2 (2.3) Source: Elaborated by the authors. In the category “care of the collection equipment and supplies”, it was observed that “assess peristomal skin integrity” was the most common requisite. The least frequent requisites were “carefully remove adhesive parts of the collection equipment” (10; 12.0% [25, 28, 40, 41, 43, 46, 50, 71, 75, 77]), “check for signs of leakage in the collection equipment” (9; 10.3% [20, 25, 27, 33, 43, 47, 60, 74, 79]), “adjust the opening of the collection equipment in the first weeks after surgery” (7; 8.0% [29, 45, 47, 51, 74, 79, 92]), “carefully place the collection equipment around the stoma” (6; 6.9 % [16, 24, 25, 73, 83, 84]), “take extra supplies and collection equipment when away from home” (6; 6.9% [6, 15, 75, 83, 86, 87]), “fix the collection equipment correctly from bottom to top on the peristomal skin” (6; 6.9% [11, 27, 33, 41, 83, 84]), “identify and perform the change of the collection equipment when the plate is saturated” (5; 5.7% [18, 44, 67, 75, 83]), “when changing the col- lection equipment, keep it pressed for a few seconds” (4; 4.6% [26, 41, 83, 84]), “apply the barrier cream in circular movements with the fingertip” (3; 3.4% [28, 51, 62]), and “monitor the adapta- tion to the collection equipment” (2; 2.3% [93, 95]). The category “choice of the collection equipment and supplies” had the most common requisite for choosing the collection equipment according to the needs, individual characteristics, 14 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 and type of stoma. And the requisite “patients along with the nurse select the appropriate collection equipment” was the least frequent (3; 3.4% [25, 54, 83]). Table 4 presents the health deviation requisites, which had “choice of collection equipment and supplies” as the most frequent catego- ry, and the requisite “use hydrocolloid powder to absorb moisture in cases of dermatitis”. In this category, the least frequent requisites were “change the collection equipment in case of allergic dermati- tis” (8; 9.2% [17, 21, 25, 46, 58, 58, 67, 71, 77]), “use barrier products and rings in the presence of granulomas” (6; 6.9% [25, 43, 58, 69, 71, 88]), and “use Aloe vera may help in the management of peristomal complications” (1; 1.1% [30]). Table 4. Absolute and Relative Frequency of Health Deviation Requisites Identified in the Studies. Natal, Rio Grande do Norte, Brazil, 2022 Health Deviation Requisites Studies n (%) Choice of Collection Equipment and Supplies Use hydrocolloid powder to absorb moisture in cases of dermatitis E8, E13, E19, E24, E26, E32, E41, E50, E57, E60, E65, E68, E69. 13 (14.9) Managing contact dermatitis treatment using ostomy skin barriers E7, E20, E26, E37, E38, E40, E42, E50, E54, E61, E65, E69. 12 (13.8) Use a bag with convex barrier rings in cases of retraction E7, E8, E16, E23, E34, E37, E53, E63, E65, E69, E72. 10 (12.0) Manage the parastomal hernia with the use of a support belt, one-piece systems, and skin protection products E1, E5, E7, E20, E23, E46, E53, E63, E65, E69. 10 (12.0) Identify and manage the underlying cause of stomal complications E23, E32, E38, E46, E53, E57, E61, E68, E69, E84, E85. 11 (12.6) Stoma and Peristomal Skin Care Monitor the extent of necrosis, assessing the stoma and peristomal skin E4, E23, E37, E40, E65, E69. 6 (6.9) Observe signs of ischemia when the stoma presents stenosis E4, E7, E20, E53, E63. 5 (5.7) Observe signs of stoma obstruction in case of complications E5, E86. 2 (2.3) Prevent stomal and peristomal complications E85, E86. 2 (2.3) Demonstrate strategies for the resolution of stomal and peristomal complications E86. 1 (1.1) Clinical Assistance Seek nursing professional help in case of stomal and peristomal complications E46, E52, E56, E67, E68, E72, E76, E86, E87. 9 (10.3) Seek professional help when effluents are above normal volume E30, E56, E67, E86. 4 (4.6) Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 15 Health Deviation Requisites Studies n (%) Nutritional Aspects Use oral rehydration in case of large losses of fecal content E59, E67. 2 (2.3) Physical Activities Discontinue exercise in case of health problems E39. 1 (1.1) Sexuality Seek professional help to evaluate physiological problems related to sexual activities E6, E62, E64, E66, E73. 5 (5.7) Source: Elaborated by the authors. Discussion It was observed that the studies mapped mainly requisites on as- pects of care with the stoma and the peristomal skin, nutritional aspects, and the choice of collection equipment and supplies. Moreover, most of the requisites were developmental, related to the changes that people with ostomies face both in body aspects and in activities of daily living. Such findings indicate the need for professionals to emphasize these aspects in the process of health education. The universal requisites presented the nutritional aspects as the most frequent category, with requisites that addressed proper nutrition, fluid intake, and bowel control, including the obser- vation of changes in the stool. Orem establishes the provision of sufficient food for the needs of body integrity, as well as the care related to elimination needs as essential for self-care. This principle should be considered by nursing, which should support this process so that the individual can manage food choices and control excrement (4). Given this need, it becomes essential to monitor the changes in eating habits that people with intestinal ostomies experience since nutrition influences bowel function and elimination, which can generate undesirable effects, such as the increase of flatus, associated with the stoma type (97, 98), resulting in poorer qual- ity of life, since the loss of consumption of certain foods may de- prive the pleasurable sensations associated with eating (99, 100). In this sense, it is necessary that, in this population’s assistance, the orientations about nutritional aspects are included, as well as the available strategies that can help the person in their au- tonomy, such as the practice of irrigation, if the individual meets the conditions required to perform it (98). Furthermore, the joint work of nursing with the multi-professional team is highlighted, through the services of attention to the health of the person with an ostomy, which has, in the scope of SUS, multi-professional 16 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 assistance that includes nutritionists to meet the needs of nutrition- al and dietary assessment (7). Regarding the developmental requisites, the predominant category was “stoma and peristomal skin care”, with emphasis and more fre- quency on the requisite “assessment of peristomal skin integrity”, fol- lowed by the categories “care and choice of the collection equipment and supplies”, which presented requisites on the correct use and handling of this equipment and the choice of products for self-care. These results are related to the changes experienced and the new self-care needs, which require specific actions for the proper func- tioning of the ostomy and the protection against complications, in which the support of the nursing team is of fundamental importance. For this reason, the assessment of the peristomal skin integrity is one of the essential care after having an ostomy, to prevent complications associated with the use of the collection system and the contact of stool with the skin (25). The latest recommendations encourage nurs- es to enable the patient to assess their stoma and peristomal skin, so that they can actively participate in the care and identify changes for preventive care, with the support of health professionals (10). Among the factors that can interfere with the integrity of the peri- stomal skin, the inadequate handling of collection equipment, efflu- ent leakage, and the self-care deficit related to hygiene are highlight- ed (3). These difficulties occur mainly during the initial period after surgery, which generates feelings of anxiety and insecurity. There- fore, adequate instruction about this care provides greater safety and satisfaction to this population, especially when performed by nurses with specialized knowledge in stomal therapy (101). Regarding the requisites related to the collection equipment, we emphasize the importance of the choice of the collection equip- ment being made in a participative way between nurses and the population with an ostomy. In the context of the SUS, the collection equipment and supplies are made available in the care services for people with ostomies free of charge, and when selected appropri- ately and periodically reassessed, they provide confidence and sat- isfaction to the person with an ostomy (102), besides contributing to the resolution of complications (7). The selection of the collection equipment follows the nurse’s prescrip- tion, which must be based on the individuality of each person, consid- ering the aspects of the patient’s preference, type of ostomy, adapta- tion, peristomal skin, and characteristics of the person’s abdomen (10). As for the health deviation requisites, the main category referred to the choice of the collection equipment and supplies, in which the main requisite dealt with the use of hydrocolloid powder to absorb moisture in cases of dermatitis. This category, as well as that of sto- ma and peristomal skin care, indicated mainly the handling of stomal and peristomal complications, present in several studies. Se lf -C ar e Re qu is it es f or P eo pl e w it h In te st in al O st om ie s: A S co pi ng R ev ie w 17 Complications, besides negatively impacting the adaptation of people with ostomies, cause costly expenses for health services. Thus, the population can benefit from more emphasis on preven- tive education rather than only receiving curative treatment (103). Several products are available to assist in the prevention and treatment of stomal and peristomal complications, such as barrier films, adhesive removers, pastes, and powders with actives that protect or assist in the healing of lesions. It is necessary to assess not only the lesion but also the person with an ostomy as a whole, given the impact that this complication can cause in their lives, to then designate a specific conduct for each situation (104). Regarding the categories of physical activities, sexuality, and so- cial aspects present in the requisites, this review highlights the scarcity of research on these topics. This can be explained be- cause, in self-care, the emphasis is notoriously on practical skills related to ostomy care, along with the peristomal skin and the collection equipment. However, the repercussions of an ostomy transcend the phys- iological changes and alter how the person sees him or herself and how he or she relates to other people as a result (105). Ac- cording to Orem, health deviation requisites also encompass the need to accept self-image modifications arising from treatments, health conditions, or illness (4). Thus, a multidimensional nursing approach that focuses, in addition to physical changes, on emo- tional, sexual, and social aspects is imperative to assist in the self-care of this population. It is also noteworthy that self-care involves not only the practical care with the ostomy and the collection equipment, but also the psychological, physical, and environmental needs (4). Thus, sen- sitivity and knowledge of nursing are crucial to identifying the main needs of this population, in an individualized and holistic way, to provide the demands of self-care. Some strategies and educational technologies are being pro- duced and have shown positive effects on health education, which can support nursing care to the person with an ostomy for the provision of self-care (106). Considering the requisites identified in this study, it is expected to assist in the planning of interventions for the self-care of this population, as well as in new studies for the advancement of knowledge in the area. As a limitation, this review presents the mapping of the requisites identified in different types of studies without assessing the de- gree of evidence and indication for clinical practice. More studies are needed to understand these requisites based on the expe- riences of people with ostomies and evidence-based research, using Orem’s theory to support nursing care for this population. 18 A Q U IC H A N | eI SS N 2 02 7- 53 74 | A Ñ O 23 - V O L. 2 3 N º 2 - CH ÍA , C O LO M BI A - A BR IL -J U N IO 2 02 3 | e 23 25 Conclusions This study presented the main self-care requisites mapped in the literature and guided by Orem’s theory. The universal requisites mainly addressed nutritional aspects; for the developmental requi- sites, the stoma and peristomal skin care predominated; as for the main health deviation requisites, they dealt with the choice of the collection equipment and supplies in case of complications. 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