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espanolObjetivo: Identificar puntos de consenso de tomadores de decisiones, profesionales, y usuarios, frente a aspectos fundamentales que debe contener un Modelo de Gestion de Casos en el contexto colombiano, para atender personas en situacion de pluripatologia y sus cuidadores familiares. Metodo: Estudio descriptivo, Metodo consenso entre expertos, muestreo por conveniencia. Se realizo tecnica Delphi de tiempo real en dos rondas. El analisis incluyo promedios aritmeticos para determinar las propuestas mas importantes y gobernables. Resultados: Participaron 25 expertos en la primera ronda y 23 en la segunda. Se obtuvo mayor consenso en: Mayor disponibilidad de recursos economicos para garantizar infraestructura y recursos humanos suficientes; cualificacion de recurso humano; potenciar la figura de la enfermera gestora de casos; implementacion de rutas de atencion integrales; sistemas de informacion que faciliten el transito y conexion de los usuarios; planes de alta y vinculacion de actores sociales para fomentar la autogestion. Conclusion: La adaptacion del Modelo de GC en el sistema de aseguramiento colombiano, permitio identificar factores sustanciales para implementarlo en los niveles macro, meso y micro del sistema de salud, reconocido por los actores como altamente fragmentado. portuguesObjetivo: identificar os pontos em comum de tomadores de decisoes, profissionais e usuarios,perante aspectos fundamentais a considerar-se no Modelo de Gestao de Casos (MGC) no contexto colombiano, para atender as pessoas em situacao de multiplas patologias e os seus cuidadores familiares. Materiais e metodos: estudo descritivo. Metodo de consenso entre expertose amostragem por conveniencia. Realizou0-se a tecnica Delphi de tempo real em duas chances. A analise incluiu medias aritmeticas para determinar as propostas mais importantes e governaveis. Resultados: participaram 25 expertos na primeira virada e 23 na segunda.Obteve-se maior consenso em: maior disponibilidade de recursos financeiros para garantir a infraestrutura e recursos humanos suficientes; qualificacao do recurso humano; potenciar a figura da enfermeira gestora de casos; implementacao de rotas de atendimento integrais; sistemas de informacao que facilitem a transicao e conexao entre os usuarios; planos de alta vinculacao de atores sociais para o fomento da autogestao. Conclusao: a adaptacao do MGC no sistema de saude colombiano, permitiu identificar fatores substanciais para implementa-lo nos niveis macro, intermediarios e micro do sistema de saude, reconhecido pelos atorescomo altamente fragmentado. EnglishAbstractAim: To identify points of consensus of decision makers, professionals and users, regarding the fundamental aspects that a Case Management Model must contain in the Colombian context, for the care of patients with pluripathology and their family caregivers. Method: Descriptive study, consensus method between experts was used, the sampling was for convenience. A real-time Delphi technique was performed in two rounds. The analysis was carried out with arithmetic averages to determine the most important and governable proposals.Results: In the study 25 experts participated in the first round and 23 in the second. The elements of greater consensus were: Greater availability of economic resources to guarantee sufficient infrastructure and human resources; human resource qualification; enhance the figure of the nurse case manager; implementation of comprehensive care routes; information systems that facilitate the transit and connection of users; hospital discharge plans and linkage of social actors to promote self-management.Conclusion: The adaptation of the CM Model in the Colombian healthcare system allowed the identification of factors that are substantial for its implementation at macro, meso and micro levels of the health system, which it was recognized by the actors as highly fragmented.

espanolIntroduccion: Los pacientes con Enfermedad Renal Cronica en condicion de pluripatologia presentan deterioro funcional progresivo, vulnerabilidad clinica, polifarmacia, disminucion de calidad de vida, impacto psicosocial y alto costo para la persona y familia. Enfermeria debe conocer las caracteristicas clinicas y sociodemograficas para identificar las necesidades. Objetivo: Establecer a traves de una valoracion multidimensional las condiciones sociodemograficas y clinicas de pacientes pluripatologicos con enfermedad renal cronica y sus cuidadores familiares. Material y Metodo: Estudio descriptivo de corte transversal, participaron 97 personas con enfermead renal cronica en situacion de pluripatologia y sus cuidadores familiares, afiliados a dos aseguradoras de Bogota, Colombia. Se realizo valoracion multidimensional al paciente y cuidador con instrumentos validados. Analisis descriptivo, se utilizo STATA version 13. Resultados: El 52,6% fueron mujeres mayores de 80 anos, 48% estaban casados, todos cursaron primaria completa. Adicional a enfermedad renal, el 43,3%. presenta tres enfermedades asociadas. El 36,08% reporto independencia total en Actividades Basicas de la Vida Diaria. El 38% presenta riesgo social medio y problematico, y mayor alteracion de calidad de vida. Los principales cuidadores son hijos, seguidos de conyuges. Conclusion: La mayoria de pacientes con ERC en condicion de pluripatologia presentan tres enfermedades cronicas asociadas, EPOC, cardiopatias y enfermedades mentales. Los resultados reflejan complejidad clinica y psicosocial asociada especialmente a niveles de dependencia funcional y riesgo social. Las dimensiones de calidad de vida mas afectadas son funcion fisica y rol fisico. Los cuidadores familiares principalmente son los hijos, la sobrecarga intensa es baja y la adopcion del rol cuidador es adecuada. EnglishIntroduction: Comorbid patients with Chronic Kidney Disease present progressive functional deterioration, clinical vulnerability, polypharmacy, diminished quality of life, psychosocial impact and high cost for the person and their family. Nursing must know the clinical and sociodemographic characteristics to identify patient’s needs. Objective: To establish through a multidimensional assessment the sociodemographic and clinical conditions of multiple pathological patients with chronic kidney disease and their family caregivers. Material and Method: Descriptive cross-sectional study, involving 97 people with chronic kidney disease in a situation of multiple pathologies and their family caregivers, attending in two centers in Bogota, Colombia. A multidimensional assessment was performed on the patient and caregiver with validated instruments. For the descriptive analysis, STATA version 13 was used. Results: 52.6% were women over 80 years old, 48% were married, all of them completed primary school. In addition to kidney disease, 43.3%. has three associated diseases. 36.08% reported total independence in Basic Activities of Daily Living. 38% present a medium and problematic social risk, and a severe alteration in the quality of life. The main caregivers were children, followed by spouses.Conclusion: Many comorbid patients with chronic kidney disease present three associated chronic diseases, COPD, heart disease and mental illnesses. The results reflect clinical and psychosocial complexity associated especially with levels of functional dependence and social risk. The most affected quality of life dimensions are physical function and physical role. Family caregivers are mainly children, with a low burden is low and the adoption of the caregiver role is adequate.

Introducción: la estadía en la unidad de cuidados intensivos genera cambios en la dinámica familiar causados por las alteraciones en las actividades diarias que obligan a utilizar estrategias que los mitiguen. Objetivo: describir las estrategias de afrontamiento de los familiares de pacientes críticos. Materiales y métodos: revisión integradora de literatura en las bases de datos PUBMED, LILACS, EPISTEMONIKOS, CUIDEN, SCIELO, CINAHL y CLINICALKEY, obteniendo 13 artículos: 7 estudios cuantitativos observacionales, 4 cualitativos fenomenológicos y 2 revisiones sistemáticas. Resultados: se determinó que las estrategias más utilizadas por los familiares de pacientes críticos son respuesta emocional, apoyo social, valores y creencias y crisis familiar. La más recurrente en los estudios revisados es la respuesta emocional debido a la implicación afectiva que tiene en los familiares la hospitalización de su ser querido. Conclusión: la respuesta emocional usada por los familiares como estrategia evidencia la necesidad de que las enfermeras garanticen espacios de acercamiento y expresión de sentimientos. Los servicios de salud deben priorizar el trato humanizado y una comunicación acorde con las necesidades de los familiares.

espanolIntroduccion: La hipertension arterial y la diabetes mellitus son dos de las principales causas de morbimortalidad, siendo las precursoras de la enfermedad renal cronica, catalogandose como un problema de salud publica que afecta a uno de cada diez adultos en el mundo. La falta de cumplimiento al tratamiento es la mayor causa de fracaso en los programas de promocion y prevencion, con esta revision sistematica se busca aportar a los profesionales de enfermeria evidencia cientifica a traves del uso de las tecnologias de la informacion y la comunicacion que permitan mejorar la adherencia terapeutica. Objetivo: Identificar la efectividad de las tecnologias de la informacion y la comunicacion en la adherencia terapeutica en personas con Hipertension Arterial y Diabetes Mellitus. Material y Metodo. Se realizo una revision sistematica de literatura en las bases de datos CUIDEN, CINAHL, COCHRANE, LILACS, PUBMED y OVID NURSING. Despues de aplicar filtros de seleccion y listas de verificacion de calidad metodologica se obtuvieron 18 articulos para analisis, 12 ensayos clinicos aleatorizados, 3 estudios cuasi-experimentales y 3 revisiones sistematicas. Se clasifico el nivel de evidencia de los estudios segun el instituto Joanna Briggs. Resultados. Se establecieron 3 categorias: Intervenciones unicomponente, intervenciones multicomponente y rol de enfermeria en el uso de TICs para favorecer la adherencia. Conclusiones. Dentro del cuidado de la salud actualmente hay hallazgos iniciales que apoyan la efectividad del uso de las tecnologias de la informacion y la comunicacion convirtiendola en una herramienta que favorece la adherencia al tratamiento en pacientes con hipertension arterial y diabetes mellitus. EnglishIntroduction: Arterial hypertension and diabetes mellitus are two of the main causes of morbidity and mortality, being the precursors of chronic kidney disease Revisiones https://doi.org/10.37551/S2254-28842020003 Efectividad de las tecnologias de la informacion y comunicacion en la adherencia terapeutica de pacientes con Hipertension Arterial y Diabetes Mellitus Diana Patricia Gonzalez-Ruiz, Daniela Alejandra Getial-Mora, Maria Alejandra Higidio-Miranda, Sandra Milena Hernandez-Zambrano Facultad de Enfermeria. Fundacion Universitaria de Ciencias de la Salud. Colombia Como citar este articulo: Gonzalez-Ruiz DP, Getial-Mora DA, Higidio-Miranda MA, Hernandez-Zambrano SM. Efectividad de las tecnologias de la informacion y comunicacion en la adherencia terapeutica de pacientes con Hipertension Arterial y Diabetes Mellitus. Enferm Nefrol. 2020 Ene-Mar;23(1):22-32 Correspondencia: Diana Patricia Gonzalez Ruiz E-mail: dpgonzalez@fucsalud.edu.co 23 23 Enferm Nefrol. 2020 Ene-Mar;23(1):22-32 Gonzalez-Ruiz DP et al. https://doi.org/10.37551/S2254-28842020003 Revisiones and classified as a public health problem that affects one in ten adults in the world. Lack of compliance with treatment is the major cause of failure in promotion programs and prevention. This systematic review seeks to provide scientific evidence to nursing professionals using information and communication technologies that improve therapeutic adherence. Objective: Identify the effectiveness of information and communication technologies in therapeutic adherence in people with Arterial Hypertension and Diabetes Mellitus. Material y Method: A systematic literature review was carried out in the CUIDEN, CINAHL, COCHRANE, LILACS, PUBMED and OVID NURSING databases. After applying the selection criteria and methodological quality checklists, 18 articles were obtained for analysis: 12 randomized clinical trials, 3 quasi-experimental studies and 3 systematic reviews. The level of evidence of the studies was classified according to the Joanna Briggs Institute. Results: Three categories were established: single interventions, multicomponent interventions and nursing role in the use of ICTs to favour adherence. Conclusions: Currently, within health care, there are initial findings that support the effectiveness of the use of information and communication technologies, being a tool that favours therapeutic adherence in patients with arterial hypertension and diabetes mellitus.

Introducción: La hemodiálisis (HD) puede mejorar la supervivencia en los pacientes con Enfermedad Renal Crónica (ERC), pero trae consigo complicaciones y efectos físicos negativos, cambios emocionales y de autoimagen que disminuyen la calidad de vida y determinan la necesidad de cuidados paliativos desde el inicio del tratamiento. Objetivo: Comprender las necesidades paliativas percibidas por el profesional de enfermería, pacientes sometidos a hemodiálisis y sus cuidadores principales informales atendidos en una Unidad Renal de la cuidad de Bogotá-Colombia. Material y Método: Estudio descriptivo, fenomenológica. Se recolectaron los datos a través de la entrevista a profundidad individual semiestructurada. Se entrevista-ron 16 personas (6 pacientes, 5 cuidadores principales y 5 enfermeras). El tamaño de la muestra se determinó por saturación de datos. El análisis se llevó a cabo mediante el método propuesto por Colaizzi.Resultados: Emergieron 10 categorías: Percepciones sobre la enfermedad, Red de apoyo e interacción famiiar, Limitaciones laborales, económicas y sociales, Red de apoyo asistencial, Necesidades de afrontamiento de la persona y cuidador, Intervenciones del equipo de sa-lud, Factores motivacionales para cuidar, Cambios en los estilos de vida, Generación de redes apoyo y Proyecto de vida. Conclusión: La imposibilidad de continuar con el trabajo, los estudios y el proyecto de vida es la necesidad de mayor impacto negativo en cuanto a la calidad de vida de los pacientes y cuidadores familiares. Sentimientos de tristeza, soledad y baja autoestima están presentes en la mayoría de los pacientes y cuidadores que requieren de la intervención oportuna del equipo interdisciplinario. Introduction: Hemodialysis (HD) can improve survi-val in patients with Chronic Kidney Disease (CKD), but it causes complications and negative physical effects, emotional changes and self-image that diminish the quality of life and determine the need for palliative care from the beginning of treatment.Objective: To understand the palliative needs perceived by the nursing professional, patients on hemodialysis and by their main informal caregivers treated in a Renal Unit of the city of Bogotá - Colombia.Material and Method: Descriptive, phenomenological study. The data was collected through semi-structured in-depth interviews. Sixteen people were interviewed (6 patients, 5 main caregivers and 5 nurses). The sam-ple size was determined by data saturation. The analysis was carried out using the method proposed by Colaizzi.Results: 10 categories emerged: Perceptions about the disease; Support network and family interaction; Labor, economic and social limitations; Support ne-twork; Needs of coping with the person and caregiver; Interventions of the health team; Motivational factors to care; Changes in lifestyles; Generation of support ne-tworks and Life project.Conclusion: The impossibility of continuing with wor-king life, studies and life project is the need of greater negative impact in terms of the quality of life of patients and family caregivers. Feelings of sadness, loneliness and low self-esteem are present in most patients and caregivers who require timely intervention by the inter-disciplinary team.

The main aim of this article is to explore the experiences and life situations of people living with intestinal stomas. Previous studies indicated the need to investigate the concerns of ostomy patients and how these concerns can affect their quality of life and their approaches to the comprehensive conceptualization of the bodily changes. A qualitative systematic review and metasynthesis design was carried out by using the main scientific databases. Original articles from 2002 to 2015 were selected based on their qualitative methodology. Methodological quality was evaluated using the Critical Appraisal Skills Program. The findings were synthesized using the metasynthesis procedure of Sandelowski. The final number of articles included was 95 and 1,982 participants. Regarding the metasummary, the data generated 191 thematic statements that were organized into eight categories. The findings support an explanatory model of the experience of people with ostomy based on three aspects: Acceptance, Adaptation, and Autonomy.

El objetivo fue identificar experiencias de implementación de educación interpares para favorecer el autocuidado del paciente oncológico. Se realizó una revisión integradora de la literatura en las bases de datos Cumulative Index to Nursing and Allied Health Literature (CINAHL), Epistemonikos, Cochrane, PubMed y los motores de búsqueda Biblioteca Virtual en Salud (BVS) y Google académico. Se utilizaron cinco ecuaciones con términos identificados en los descriptores Ciencias de la Salud (DeCS) y Medical Subject Heading (MeSH), se buscaron artículos en el idioma español, inglés y portugués, publicados entre 2012 y 2017. De los resultados, se seleccionaron siete artículos que cumplieron con los criterios de elegibilidad. Se evidenció que el desarrollo de programas de educación interpares tiene un impacto positivo al permitir formar pacientes expertos en el manejo del cáncer, representando beneficios para ellos, sus familias y las instituciones de salud. Se concluyó que la implementación de estos programas es un método efectivo para concienciar a los pacientes sobre su enfermedad y la importancia que en estos tienen el autocuidado para tener una mejor calidad de vida; además, el hecho de que la educación sea brindada por los mismos pacientes, facilita la comprensión de la enfermedad al hablar a través de la propia experiencia. The objective had to identify the implementation of peer health education experiences to favor the self-care oncological patient. The method had a integrative review study made in the databases CINAHL, Epistemonikos, Cochrane, PubMed and the search Virtual Health Library (VHL) and Google academic. Five equations were used with terms identified in the descriptors Health Sciences (DeCS) and Medical Subject Heading (MeSH). Articles were searched in the Spanish, English and Portuguese languages, published between 2012 and 2017. In the results seven articles were selected that met the eligibility criteria. Was evident that the development of peer health education programs has a positive impact when training expert patients whit cancer, representing benefits for them, their families and health institutions. It was concluded that the implementation of these programs is an effective method to raise awareness of patients about their disease and the importance of self-care to have a better quality of life, in addition to the fact that education is provided by the same patients facilitates the understanding of illness when speaking through one's experience.

Aims/objectives: To analyse the relevance in clinical practice of factors reviewed in previous studies that define the experience of people with a stoma (ostomates), through the opinions of stoma care nurses. Method: Categories and thematic statements were reviewed by stoma care nurses using a modified Delphi method. They assessed the clinical relevance of the previously identified issues by measuring the intensity of the described situations within their practice. Results: Social impact was the most significant issue. Other relevant aspects were ‘description of disease’, ‘interaction with mutual help groups’, ‘health education’ and ‘consultation with professionals to improve self-care’, among others. In view of these results, an explanatory model was proposed whose central category was the ‘necessity of educating ostomates’, assuming that, if it is mediated by stoma care nurses in combination with others (such as mutual help groups), it will have a positive impact on the promotion of self-care, and it would reduce the negative impact of the stoma. Conclusions: The social dimension was the most outstanding area in the care of ostomates. Patients were afraid of social relationships, triggering situations of isolation and limiting their exposure to unfamiliar environments. If precautions related to stoma care are maintained, it will allow them to live a life without these limitations.

Los pacientes que ingresan a las Unidades de Cuidados Intensivos (UCI) no siempre evolucionan hacia la recuperación, lo que implica que el personal de la UCI tenga una visión holística para favorecer una “buena muerte” centrada en el acompañamiento familiar y la mitigación del sufrimiento. Objetivo: comprender el sentido otorgado por los profesionales de la salud de la UCI respecto a los cuidados del paciente al final de la vida y el apoyo a sus familiares. Metodología: estudio cualitativo descriptivo en dos UCI de Bogotá. La información se obtuvo con la técnica de grupos focales y se analizó siguiendo la propuesta de Taylor y Bogdan, adaptada por Amezcua y Hueso. Resultados: emergieron cuatro categorías: sentidos y significados del equipo interdisciplinario respecto a la muerte, comunicación al final de vida en la UCI, percepciones sobre muerte digna en la UCI y dilemas éticos respecto al manejo terapéutico al final de vida. Conclusiones: Para la atención del paciente crítico al final de la vida se debe garantizar comodidad, ausencia de dolor, acompañamiento familiar, bienestar espiritual, respeto por la voluntad del paciente y una buena comunicación que facilite la inclusión de los familiares en la toma de decisiones. Para mitigar la sobrecarga y el sufrimiento del personal de salud generado por la muerte y la toma de decisiones al final de vida, se sugiere formación y diseño de protocolos multidisciplinarios.

The aim of this article is to explore patients' experiences of having a stoma, in particular those relating to: emotion and social issues; changes in quality of life; feelings of fear, shame or frustration because of the altered lifestyle; and changes in roles and relationships and in their social environment. This article is part of a research project that employs a three-step method, including a metasynthesis method for international qualitative research, the development of clinical pathways for nursing diagnoses, interventions and outcomes, and the implementation and evaluation of these clinical pathways. This article describes the first phase of the research. The results show that, internationally, there are many similarities in the ways in which individuals with a stoma cope with having a stoma.

Aim To determine the effectiveness of a case management model for approaching multi-pathological people in a health promoting entity of the contributory healthcare scheme in Bogota, Colombia between 2018 - . Design Mixed methods research. Method The study contemplates two components: a quantitative component using a quasi-experimental analytical design before and after longitudinal intervention to determine the effectiveness of the case management model and a qualitative descriptive design to understand the experience of the participants about the model. The Administrative Department of Science, Technology and Innovation of Colombia (Colciencias) funded this project by means of call 777-November 2017, under the financing agreement No. 848-December 2017. Discussion Addressing problems deriving from the structure of the Colombian healthcare system is crucial for implementing case management models. Furthermore, the effectiveness of such models may be affected by power relations and market failures, but the proved potential of a model may represent a generalized benefit for the Colombian health system. Impact In Colombia, considering complications and management of chronic non-communicable diseases as isolated cases is considered as the highest cost events in healthcare provision, since an average of 12.8 million pesos is invested in each patient. This has led to rethink the management in these patients by means of a comprehensive model that guarantees the effectiveness of healthcare delivery, in the framework of a healthcare system heavily affected by payment capacity, where the market has a strong predominance, such as the case of Colombia. Trial registration number RPCEC00000293.

Aim: to describe ostomy patient’s perception about health care received, as well as their needs and suggestions for healthcare system improvement. Method: qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. Results: perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. Conclusion: findings contribute to address the main patients’ needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process) and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma.

Objective: to describe the coping of stoma patients with the news about the ostomy, as well as to analyze the meaning and the experience of their new bodily reality. Method: qualitative phenomenological study undertaken through semistructured interviews with 21 stoma patients. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stomal therapy nurses. The software Atlas.ti was used. Results: two main categories emerge: "Coping with the news about receiving a stoma" and "Meaning and experience of the new bodily reality". The informants' answer varies, showing situations that range from the natural acceptance of the process to resignation and rejection. The previous experiences of other family members, the possible reconstruction of the stoma or the type of illness act as conditioning factors. Conclusions: the coping with the news about the stoma is conditioned by the type of illness, although the normalization of the process is the trend observed in most informants. Nursing plays a fundamental role in the implementation of cognitive-behavioral interventions and other resources to promote the patients' autonomy in everything related to care for the stoma. RESUMO Objetivo: descrever o enfrentamento de pessoas ostomizadas diante da notícia da realização do estoma, assim como analisar o significado e a vivência diante de sua nova realizada corporal. Método: estudo qualitativo fenomenológico mediante entrevistas semiestruturadas com 21 personas ostomizadas. Foi desenvolvido através da comparação constante de dados, incorporação progressiva de sujeitos e triangulação entre investigadores e enfermeiras especialistas em estomaterapia. Foi utilizado o software Atlas.ti. Resultados: emergiram duas categorias centrais: "Enfrentamento diante da notícia de que serão ostomizados" e "Significado e vivência da nova realidade corporal". A resposta dos informantes é variável, revelando situações que vão desde a aceitação natural do seu processo até a resignação e a rejeição. As experiências prévias de outros familiares, a possibilidade de reconstrução do estoma ou o tipo de doença são fatores condicionantes. Conclusões: o enfrentamento diante da notícia do estoma está condicionado pelo tipo de doença. Apesar disso, observa-se que a maioria dos informantes tende a normalizar o processo. A enfermagem tem papel fundamental na implementação de intervenções cognitivas-comportamentais e outros recursos destinados à promoção da autonomia dos pacientes em tudo relacionado ao cuidado do estoma. RESUMEN Objetivo: describir el afrontamiento de personas ostomizadas ante la noticia de la realización de la ostomía, así como analizar el significado y la vivencia ante su nueva realidad corporal. Método: estudio cualitativo fenomenológico mediante entrevistas semiestructuradas a 21 personas ostomizadas. Se realizó análisis mediante comparación constante de datos, incorporación progresiva de sujetos y triangulación entre investigadores y enfermeras expertas en estomaterapia. Se empleó el programa Atlas.ti. Resultados: emergen dos categorías centrales: "Afrontamiento ante la noticia de que van a ser ostomizados" y "Significado y vivencia de la nueva realidad corporal". La respuesta de los informantes es variable, percibiéndose situaciones que van desde la aceptación natural de su proceso hasta la resignación y el rechazo. Las experiencias previas de otros familiares, la posibilidad de reconstrucción del estoma o el tipo de enfermedad, son factores condicionantes. Conclusiones: el afrontamiento ante la noticia del estoma está condicionado por el tipo de enfermedad, aunque la normalización del proceso es la tendencia observada en la mayoría de los informantes. Enfermería tiene un papel fundamental en la puesta en marcha de intervenciones cognitivos-conductuales y otros recursos destinados a la promoción de la autonomía de los pacientes en todo lo relacionado con el cuidado del estoma.