My Scope of Practice: Pioneering Wound, Ostomy, and Continence Care Nursing in Brazil

One’s life has value so long as one attributes value to the life of others by means of love, friendship, indignation and compassion. – Simone de Beauvoir, French author

Health care, especially a niche such as wound, ostomy, and continence care, demands practitioners be open to change, able to easily adapt, and willing to break new ground. As one of the founding members of the Brazilian Association of Enterostomal Therapy — ostomy, wound, and continence care (SOBEST), Vera Lúcia Conceição de Gouveia Santos, BSN, MSN, PhD, CWOCN (TiSOBEST) has exemplified these traits throughout her career in Brazil. 

Dr. Santos graduated with her Baccalaureate in Nursing in 1977, received her Master’s in Nursing in 1989, and earned her Doctorate in Nursing in 1996 from the School of Nursing of the University of São Paulo, Brazil (EEUSP). Dr. Santos, along with several colleagues and nursing students, founded a scientific study group called the Enterostomal Therapy Nursing Group, an affiliate of the São Paulo chapter of the Brazilian Nursing Association. “Although this group lasted only 2 years, during which time we promoted short meetings and clinical case discussions, it can be considered the basis for SOBEST, which was founded in 1992,” says Dr. Santos.

In 2008, she completed her postdoctorate degree at the Hospital del Mar Medical Research Institute, Barcelona, Spain in quality of life, an academic and teaching specialty she incorporated into WOC nursing at EEUSP. She would go on to register the first group related to research in the National Council of Scientific and Technological Development (CNPq).

In 1989, Dr. Santos also obtained Enterostomal Therapy Nursing Education Program (ETN) Certification at Complutense University of Madrid, Spain. After obtaining her ETN certification, Dr. Santos and a colorectal surgeon developed the first Enterostomal Therapy Nursing Education Program (ETNEP) in Brazil at the EEUSP in 1990. “This was only the second program in Latin American countries,” Dr. Santos says. “The other program was in Colombia and was established at roughly the same time as ours. At that time, there were only 4 ET nurses in Brazil. The first program was offered to 10 nurses and all were approved as the first ET nurses educated in Brazil. Because our program was based on United States’ programs, we included additional topics, albeit basic, on wound and continence care in addition to stoma care. This was and still is the paradigm for the development of the ETN/WOCN specialty in Brazil. Currently, 18 ETNEPs, all recognized by SOBEST and also by the World Council of Enterostomal Therapists, provide education in all Brazilian regions. More than 1,000 ET nurses have been educated in Brazil since 1990.”

After earning her doctorate degree, Dr. Santos decided to focus on research and education. She maintained her involvement with ETNEPs in the EEUSP, teaching at the Master’s and Doctorate levels. She and her colleague, Isabel Cesaretti, BSN, MSN, PhD, CWOCN (TiSOBEST) published the first Brazilian book about ostomy care in 2000: Assistencia em Estomaterapia; Cuidado do Ostomizado (Enterostomal Therapy Assistance: Care of Persons with Ostomies), now in its second edition, one of the most important textbooks on ostomy care in Brazil.

In addition to helping found SOBEST, Dr. Santos has served in many capacities, including the Scientific Committee. She was the first president, holding office for 7 years. Last year she was nominated as the Director of SOBEST International Relationships. The multidisciplinary founding team (colorectal surgeon, psychologist, social worker, dietitian, and Dr. Santos) of the Hospital das Clínicas Ostomy Outpatient Center, considered one of the first and best specialized centers in the country, developed the first state public health protocol to regulate the care of people with ostomies in São Paulo state. This guideline was put into practice in 1987 and used as a basic protocol for the future development of a national law regarding stoma care, a project in which Dr. Santos participated from 2001 to 2007. Currently, this national law is included in a major National Policy for Handicapped Persons. “The WOC nurse has become an important resource in Brazil,” Dr. Santos says.

Through her triumphs over the economic and political barriers to specialized health care in Brazil, Dr. Santos not only helped create the ETN/WOCN community in her country, but she also continues to help grow this community by educating all levels of nurses. For this effort, she has received national and international recognition. “When I took care of my first ostomy patient in my undergraduate course in nursing, I saw the value of being a specialist,” she says. “I always thought I had an important mission as a nurse — that is, to make a difference. Developing the first ETN/WOCN program in Brazil was my way of achieving that mission.” This compassionate pioneer in the wound, ostomy, and continence field of nursing has certainly made a valuable difference in this scope of practice.

This article was not subject to the Ostomy Wound Management peer-review process.