A úlcera de perna representa demanda crescente nos serviços de saúde. Por tratar-se de uma doença crônica, recorrente e de difícil manejo, a úlcera de perna é um problema que vem desafiando profissionais, pacientes e famílias. A necessidade de entender melhor a problemática existente no cuidado oferecido pelo enfermeiro ao paciente com úlcera e sua família, motivou a pergunta do estudo, a qual buscou responder como a família influencia e é influenciada pela úlcera de perna. O estudo teve como objetivo conhecer as percepções e crenças do paciente e de sua família em relação à úlcera de perna, bem como compreender como essas crenças influenciam o enfrentamento da família na experiência. O estudo de caso foi o método adotado, e as técnicas da história oral foram utilizadas para a coleta de dados. O estudo foi realizado com um casal idoso, o qual convive com a úlcera de perna da mulher, focando o impacto desse evento na história da família. As narrativas do casal permitiram a construção da memória coletiva organizada em três temas distintos os quais se inter-relacionam: Envelhecimento e doença, Jornada do tratamento, A ferida e o tempo. Os resultados permitiram compreender que a família influencia e é influenciada pela úlcera de perna e esta dinâmica determina um grande impacto na vida do casal que se encontra na fase tardia do ciclo de vida da família. O estudo identificou que as crenças do casal exercem grande influência sobre o impacto da doença em sua vida, além de determinar seu enfrentamento diante da situação. Este estudo, por considerar a família como categoria de análise, lança um novo olhar ao problema e acrescenta um conhecimento diferente no que se refere à relação entre a família e a ferida. Os resultados permitem uma reflexão acerca da importância do conhecimento profundo dos enfermeiros sobre as experiências dos pacientes e famílias que convivem com úlceras de perna. A valorização e o reconhecimento das forças da família no enfrentamento da doença e da mudança de comportamento do enfermeiro na prática clínica, a qual deve integrar um olhar além da ferida, considerando a interface entre a doença e o contexto familiar, são elementos capazes de estimular uma prática clínica centrada na família. / A leg ulcer is increasing demand on health services. Because it is chronic, recurrent and difficult to handle, leg ulcer is a problem that has defied professionals, patients and families. The need to better understand the problems existing in the care offered by nurses to patients with ulcer and their families led to the question of the study, which sought to answer how the family influences and is influenced by leg ulcer. The study aimed to understand the perceptions and beliefs of the patient and the family regarding leg ulcer as well as understand how these beliefs influence family coping experience. The case study method was adopted, and the techniques of oral history were used for data collection. The study was conducted with an elderly couple, who lives with woman\'s leg ulcer, focusing on the impact of this event in the family history. The narratives of the couple allowed the construction of collective memory organized into three distinct themes which are interrelated: Aging and illness, Journey of treatment, Wound and time. The results allowed to understand that family influences and is influenced by leg ulcers; family dynamics determines a great impact on the couples lives experiencing the late stage of the family life cycle. The study identified that the couples beliefs have great influence on the impact of the disease on their lives, and determine how they cope with the situation. This study, seeing the family as category of analysis, proposes a new perspective at the problem and adds new knowledge to the interaction between family and wound. The results allow a discussion about the importance of deep nursing knowledge about the experiences of patients and families living with leg ulcers. This new perspective requires a change in behavior of the nurse in clinical practice for a vision beyond the wound. The appreciation and recognition of the strengths of the family in coping with the illness and considering the interface between the disease and the family context are elements capable of stimulating a nursing family-centered practice.

Chronic diabetic foot ulcers, venous leg ulcers and pressure ulcers affect a large subset of the United State population yet they remain a challenge for physicians to treat. There are many different types of products on the market for the treatment of chronic wounds. Some use living cells but only two are FDA approved to heal chronic wounds. A new type of product recently garnered attention in the wound care market because it also contains living cells: hypothermically stored amniotic tissue products. Hypothermically stored amniotic tissue is unique because it maintains living cells and offers the benefits of containing signaling molecules and maintaining an intact extra cellular matrix. While there are other types of amniotic or placental tissue products in the wound care market, they are processed by dehydration or cryopreservation which limits their capacities for maintaining living cells. This thesis will explore the potential for hypothermically processed amniotic tissue products to treat chronic wounds.

Bakgrund: Kroniska bensår definieras som sår som sitter på underbenen och/eller fötterna och läker väldigt långsamt. I Sverige lider ca 50 000 personer av bensår och det är främst äldre som drabbas. Vanligaste orsaken till bensår är cirkulatoriska rubbningar som arteriell rubbning och venös insufficiens. Syfte: Syftet med denna uppsats var att beskriva patienters upplevelser av att leva med bensår. Metod: Sökning och sammanställning av tidigare forskning. Resultat: Patienterna upplevde bland annat svårigheter med att utöva fysisk aktivitet och ville ha mer stöd från sjukvårdspersonal. Patienterna upplevde att lukt och vätska från såren försvårade umgänge med andra och orsakade skamkänsla och oro. Smärta var ett stort problem och en ständig påminnelse om bensåren. Relationen till sjuksköterskan och upplevelsen av omvårdnaden kändes ibland otillräcklig och patienten önskade större förståelse. Diskussion: I mötet med en patient som lider av en kronisk sjukdom är det viktigt att sjuksköterskan förstår hur patienten hanterar sin diagnos. Mer information och stöd från sjuksköterskan kan göra skillnad i patienternas copingstrategier. Slutsats: Resultatet visar tydligt att patienter med venösa bensår upplever stort lidande och att det som patienterna upplever vara jobbigast med bensåren är smärtan och de förändringar som de måste genomgå på grund av sjukdomen. Effektivisering av vården kan minska risken för nedstämdhet, öka chanserna för bättre följsamhet samt öka livskvaliteten. / Background: Chronic leg ulcers are defined as ulcers located on the lower legs and/or the feet and heal very slowly. In Sweden approximately 50 000 people suffer from leg ulcers and it is mainly elderly people who suffers. Most common cause of ulcers is circulatory disorders like arterial and venous insufficiency disorder. Aim: The aim of this study was to describe patients’ experiences of living with a leg ulcer. Method: Search and compilation of previous research. Results: Patients experienced particular difficulties in physical activity and wanted more support from health professionals. Patients experienced that the smell and exudate from the wounds complicated relations with others and caused a feeling of shame and anxiety. Pain was a major problem and a constant reminder of the leg ulcers. The relationship with the nurses and their knowledge felt sometimes inadequate and the patient desired a greater understanding. Discussion: In the meeting with a patient suffering from a chronic illness, it is important that nurses understand how patients manage their diagnosis. More information and support from the nurse can make a difference in how patients cope with their illness. Conclusion: The results clearly show that patients with venous leg ulcers experience great suffering and that what patients perceive to be hardest with having leg ulcers is the pain and the changes they must undergo because of the disease. Efficiency care can reduce the risk of depression, increase the chances of better compliance and increase quality of life.

Syftet med föreliggande beskrivande litteraturstudie var att beskriva och sammanställa bidragande faktorer som påverkar patientens följsamhet till de egenvårdsråd som ges av sjuksköterskan gällande bensårsbehandlingen. Syftet var även att sammanställa vilken kvalitet inkluderade artiklar hade samt vilken relevans urvalet hade för inkluderade artiklars resultat. Artikelsökningen ägde rum i databaserna PubMed och Chinal, sökorden som användes var ”leg ulcer”, ”compliance” och ”nursing”. Resultatet baserades på tio artiklar där fyra artiklar hade hög kvalitet, fem artiklar hade medel kvalitet och en artikel hade låg kvalitet. Fyra kvantitativa artiklar samt en kvalitativ artikel använde bekvämlighetsurval, fem kvalitativa artiklarna använde strategiskt urval. Bidragande faktorer som påverkade patientens följsamhet till egenvårdsråd som gavs av sjuksköterskan gällande bensårsbehandlingen var smärta och obehag, patientens och sjuksköterskans bristande kunskaper, inkonsekventa råd, tillit till behandlingen och sjuksköterskan, förlust av identitet och självständighet samt övriga faktorer så som depression, demens och self-efficacy. Bidragande faktorer till bristande följsamhet gällande bensårsbehandling var komplexa. Det är därför viktigt att sjuksköterskan har förståelse för vilka faktorer som påverkar följsamheten för att kunna individanpassa råden och förhoppningsvis öka följsamheten. / The purpose of this descriptive literature review was to describe and summarize the contributing factors that influence patient's compliance to the self-care advice given by nurses regarding leg ulcer treatment. The aim was also to compile the quality of included articles and what relevance the sample had on the included articles results. The search for scientific articles were selected from the databases PubMed and Cinahl with the keyword ”leg ulcer”, ”compliance” and ”nursing”. The result was based on ten articles, of which four articles had high-quality, five articles had medium quality and one article had low quality. Four quantitative articles and one qualitative article ​​used a convenience sample, five qualitative articles used a purposive sample.LyssnaLäs fonetiskt The contributing factors that influenced patient's compliance to the self-care advice given by nurses regarding leg ulcer treatment proved to be pain and discomfort, the patient’s and the nurse’s lack of knowledge, inconsistent advice, trust in the treatment and the nurse, loss of identity and independence as well as other factors such as depression, dementia and self-efficacy. Factors contributing to poor compliance with leg ulcer treatment were complex. It is therefore important that the nurse has an understanding of the factors that influence compliance to personalize the advice and hopefully increase compliance.

Background: Chronic wounds are a significant health problem in various populations. Psychosocial stress is a lifestyle factor that has been shown to directly influence wound healing. Current findings support roles for assessment and reduction of psychosocial stress in the comprehensive management of chronic wounds, however, a gap remains between current research and current clinical practice. Purpose: To develop a novel method by which to educate nurses about the effects of psychosocial stress on wound healing while incorporating state-of-the-art technology that is sensitive to the needs of individuals with various learning styles. Objectives: To review current literature documenting the relationship between chronic psychosocial distress and delayed wound healing to identify essential content to include in educational modules for nurses. To develop three educational modules for nurses in inpatient and outpatient settings that address the relationship between chronic psychosocial distress and delayed wound healing, and the effects of stress-reduction interventions in formats that meet the needs of different learning styles. To conduct a focus group discussion with nurse-participants regarding educational module content and delivery methods in order to evaluate and improve these educational modules. Methods: A series of literature reviews were performed between June, 2010 and October, 2013, using articles identified through searches using the databases PubMed and CINAHL. Essential content regarding psychosocial stress and its impact on wound healing was identified, and was used in the development of educational modules, designed to meet the basic needs of individuals with different learning styles. A purposive sample of nurses was recruited through the use of flyers, reviewed the educational modules online, and met for a focus group to discuss their experiences with these modules. Outcomes: A novel method was developed by which to deliver educational material to nurses about psychosocial stress and delayed wound healing. Participants were motivated to learn, had self-awareness of their preferred learning styles, and responded positively to this method of education delivery; they were able to articulate the basic concepts presented in the modules. These findings may be generalizable to a larger audience and may inform the development of future education-delivery approaches in this area.

Bensår är en kronisk sjukdom och ger ofta underbensödem vilket gör att såren blir svårläkta. Den viktigaste behandlingsmetoden för att undvika ödem är kompressionsbandage. Många av de patienter som drabbas av bensår tycker att sårläkningsprocessen är svår att acceptera och de har därför problem med att fullfölja kompressionsbehandlingen. Syftet med studien var att undersöka vilka faktorer som hade betydelse för patientens följsamhet vid kompressionsbehandling av bensår. Arbetet har gjorts som en litteraturstudie av vetenskapliga artiklar. Resultatet visar att om distriktssköterskan ser patienten som en enskild individ, har helhetssyn och samarbetar med patienten samt är kunnig och erfaren, har patienterna lättare att tolerera behandling med kompressionsbandage. Kontinuitet i vården, det vill säga att ha en och samma distriktssköterska genom hela behandlingen, är även en viktig faktor för patienters följsamhet. Bättre dokumentation, generella riktlinjer för behandling och mer utbildning i sårvård behövs för att förbättra vården för bensårspatienter. / Leg ulcer is a chronic disease and the patient often gets lower leg oedema  which makes the ulcers difficult to heal. The most important treatment to avoid oedema is compression bandaging. Many patients with leg ulcer find the healing process hard to tolerate and have roblems to comply with compression therapy. The aim of the study was to examine which      factors that influences patients to comply with compression therapy. The study has been done as a literature review of scientific articles. The result shows that if the district nurse sees the patient as an individual, has a holistic approach and work with the patient and is knowlegeable and experienced, patients were more likely to accept treatment with compression bandages. Continuity in care, having the same nurse throughout the treatment, is also an important factor for patient compliance. Better documentation, general guidelines for treatment and more education in wound care is needed to improve care for leg ulcer patients.

Bakgrund; 3 % av världens befolkning lider av venösa bensår och de drabbade är främst äldre och kvinnor. Kompressionsbehandling och fysisk aktivitet är de två vanligaste egenvårdsåtgärderna och det ligger ett stort ansvar på sjuksköterskan att motivera patienten till en fungerande egenvård. Syfte; Syftet med denna litteraturstudie var att beskriva patienters svårigheter till följsamhet av egenvård och att belysa betydande aspekter i sjuksköterskans arbete för att kunna motivera patienter till följsamhet av egenvård vid venösa bensår samt att undersöka kvaliteten på urvalsmetoden forskarna till valda artiklar använt sig av. Metod; Denna litteraturstudie har en deskriptiv design och är baserad på tio vetenskapliga artiklar varav fyra är kvalitativa, tre är kvantitativa och tre är kvalitativa/kvantitativa och publicerade mellan 2004-2014. De vetenskapliga artiklarna inhämtades från databasen PubMed. Artiklarnas innehåll granskades utifrån likheter. Kvalitet, likheter och skillnader granskades i den metodologiska aspekten urvalsmetod. Resultat; Sju teman identifierades varav tre berörde patienters svårigheter till följsamhet av egenvård; kunskap och tro på sig själv och behandlingen, patienters svårigheter vid kompressionsbehandling som egenvårdsåtgärd, patienters svårigheter vid fysisk aktivitet som egenvårdsåtgärd och fyra behandlade aspekter i sjuksköterskans motiverande arbete; kunskap och information, patientens inställning, organisationsproblem och relationer. Gällande granskningen av artiklarnas urvalsmetod påvisades en varierande kvalitet. Konklusion; Kunskap och inställning hos både sjuksköterska och patient samt en god relation mellan dessa är av största vikt för få en fungerande egenvård och på så sätt minska prevalensen av venösa bensår. / Background; 3 % of the world’s population suffers from venous leg ulcers. Women and elderly are most affected. Compression therapy and physical activity is the most common self-care treatment for patients with venous leg ulcers and the nurse has a great responsibility to motivate patients to self-care. Aim; The aim of this study was to describe difficulties venous leg ulcer patients’ may experience performing self-care, to describe the nurses essential factors to motivate patients to adhere to self-care and to examine the quality of sampling methods in the studies included. Methods; A descriptive design was used and this study included four qualitative studies, three quantitative studies and three studies with both qualitative and quantitative design and was published between 2004-2014. The scientific articles were found in the database PubMed and the content of the articles was examined of their resemblance. Quality, similarities and differences were examined in the methodological aspect selection method. Results; Seven themes were identified and three of them described patients difficulties to adhere to self-care. Knowledge and belief in the treatment and themselves was found to be essential and the next two themes described patients’ difficulties to adhere to compression therapy and physical activity. The residual themes described the nurses’ essential factors to motivate patients to adhere to self-care, knowledge and information, the patients’ attitude towards self-care, organizational problems and the relationship between the nurse and patient. Regarding the review of the articles selection method, a varying quality was found. Conclusions; There are many factors influencing venous leg ulcer patients’ adherence to self-care. The nurses’ and the patients’ knowledge and attitude towards self-care activities is an important part of a functional self-care needed to reduce the prevalence of venous leg ulcers.

Bakgrund: I vårdandet av personer med svårläkta sår finns det en risk att fokus hamnar på såret i sig, istället för den enskilde individen. En avgörande faktor för framgångsrik sårläkning är att vårdaren intar ett helhetsperspektiv av personen. Tidigare forskning visar att livskvaliteten hos personer med bensår påverkas negativt av olika faktorer såsom smärta, nedsatt rörlighet och sömnstörningar. Sjuksköterskan bör bedöma och se till de faktorer som påverkar livskvaliteten hos varje enskild person, samt agera för att såret skall läka och lindra symtom. Syfte: Att belysa den personliga upplevelsen av att leva med svårläkta bensår ur ett livskvalitetsperspektiv. Metod: En litteraturstudie baserad på tolv studier med kvalitativ ansats. Därefter följer en deduktiv analys av materialet utifrån WHOQOL:s definition av livskvalitet enligt sex olika domäner. Artiklarna hittades via sökningar i databaserna Cinahl, MEDLINE, AMED och Academic Search Elite. Resultat: Livskvaliteten hos personer med bensår påverkades inom de fysiska och psykiska domänerna, liksom i domänerna grad av oberoende, sociala relationer och omgivning och miljö. Ingen påverkan inom domänen andlighet, religion och personlig tro har kunnat påvisas. Slutsats: Personer med bensår upplevde en negativ inverkan på sin livskvalitet. För att kunna upprätthålla och förbättra sin livskvalitet behövde personer med bensår hjälp och stöd i det dagliga livet. / Background: In the care of people with chronic wounds, there is a risk that the focus is placed on the wound itself, rather than on the individual. A crucial factor for successful wound healing is that the caregiver takes a holistic perspective of the person. Previous research shows that the quality of life in people with leg ulcers is adversely affected by various factors such as pain, impaired mobility and sleep disturbances. The nurse should assess and review the factors that affect the quality of life of every individual, and act to heal the wound and alleviate symptoms. Aim: To highlight the personal experience of living with chronic leg ulcers from a quality of life perspective. Method: A study based on twelve studies with a qualitative approach. This is followed by a deductive analysis of the material from WHOQOL's definition of quality of life under six different domains. Articles were found through searches of the databases Cinahl, MEDLINE, AMED and Academic Search Elite. Results: The quality of life in people with leg ulcers was affected in the physical domain, psychological domain, level of independence, social relationships and environment. No influence in the domain spirituality, religion and personal faith has been demonstrated. Conclusion: People with leg ulcers experienced a negative impact on their quality of life. In order to maintain and improve the quality of life for the individuals with leg ulcers, there is a major need for help and support in the daily life.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Bakgrund: Bensår är ett symtom som orsakas av olika bakomliggande sjukdomar varav nedsatt venös cirkulation är vanligast. Störst risk att drabbas har patienter över 65 år. Bensår är plågsamma för patienter och innebär stora kostnader för vården. Syfte: Att beskriva patienters upplevelser av att leva med bensår. Metod: Studien genomfördes som en litteraturöversikt där databaserna Cinahl, Pubmed och Psycinfo användes vilket resulterade i 16 vetenskapliga artiklar av både kvalitativ och kvantitativ design. Resultat: Patienters upplevelser av att leva med bensår resulterade i tre kategorier: att uppleva lidande, att känna sig begränsad samt att uppleva brister. Patienter upplevde stort lidande relaterat till att tvingas leva med smärta, sömnbrist samt negativa känslor. Begränsningar som patienter upplevde orsakades av fysisk begränsning, begränsning i val av kläder och skor samt social begränsning. Kunskaps- och informationsbrist hos patienter samt bristande kunskap om bensårsbehandling bland sjuksköterskor framkom i litteraturöversikten. Konklusion: Patienter upplevde omfattande lidande och begränsningar relaterat till att leva med bensår. Smärta var det mest dominerande symtomet som sällan var adekvat bedömd eller behandlad. Smärtproblematiken ledde i sin tur till försämring och förstärkning av andra symtom med djupgående påverkan på patienters välmående. Ökat stöd, information och smärtlindring skulle förbättra patienters välmående. / Background: Leg ulcer is a symptom caused by different underlying illnesses of which poor venous circulation is the most common one. People over 65 years of age are at the highest risk. Leg ulcer is a burden both for the patient and the healthcare system. Aim: To describe patients experiences of life with leg ulcers. Method: This study was conducted as a literature review, in which 16 articles was included using the databases Cinahl, Pubmed and Psycinfo. The articles were of qualitative and quantitative design. Result: Patient experiences of living with leg ulcers resulted in three categories: To experience suffering, to feel restricted and to experience lack of knowledge. The patients experienced a lot of suffering regarding pain, sleep deprivation and negative emotions. The patients also experienced limitations caused by immobility, limitations in the choice of clothes and shoes and social restrictions. The patients lack of knowledge, information and the nurses lack of knowledge about leg ulcer treatment was obvious in this study. Conclusion: Patient perceived a lot of suffering and limitations caused by life with leg ulcers. Pain was the most dominant symptom and was rarely assessed or treated properly. Pain caused deterioration and enhancement of other symptoms with profound effect on patient's wellbeing. Added support, information and pain control could improve patient wellbeing.