Bakgrund: Personer med bensår kan man stöta på inom hela hälso- och sjukvårdssystemet och venösa bensår är en av de vanligaste. De kan vara kroniska och svårläkta, också orsaka smärta för personen. Risken att utveckla venösa bensår ökar även med åldern. Det fattas vetenskapligt underlag och riktlinjer för behandling av venösa bensår men kompressionsbehandling är en vanlig och avgörande faktor som kombineras med att man innan rengör såret genom debridering. Kirurgi och fysisk aktivitet är andra faktorer som kan förbättra läkning. Det krävs kunskap och erfarenhet hos sjuksköterskan i valet och utförandet av behandling.Vården av venösa bensår kan vara besvärande för personen och skapa lidande. Syfte: Att beskriva personers upplevelser av vård vid venösa bensår. Metod: En icke-systematisk litteraturöversikt med 15 inkluderade kvalitativa- och kvantitativa artiklar har gjorts. Artiklar som är publicerade mellan 2011-2021 har inhämtats från CINAHL och PubMed. Samtliga artiklar har genomgått en kvalitetsgranskning innan en integrerad dataanalys gjordes. Resultat: Av de insamlade artiklar framkom det att personers förväntningar av vården intemotsvarade verkligheten. De upplevde den mer tidskrävande och begränsande för sitt sociala och privata liv. Personer hade genomgått många misslyckade behandlingar och kände därför en desperation för att hitta en behandling som botade deras venösa bensår. Personer upplevde att de fått förståelse och kunskap om sitt tillstånd och som var en bramotivation för att följa sin behandlingsplan, dock upplevde personer brister i sjuksköterskans bemötande som försvårade följsamheten. Slutsats: I denna litteraturöversikt framkom det att sjuksköterskor generellt behöver mer kunskap och förståelse för hur de venösa bensåren påverkar personernas livssituation. Ökade kunskaper om själva tillståndet och de olika behandlingsalternativ som finns kunde minska lidandet hos de personer som behandlas och hade en tät vårdkontakt. Detta skulle även öka personcentreringen gällande vård hos personer med venösa bensår och därmed ge förutsättningarna för en bättre vård. / Background Persons with leg ulcers can be encountered throughout the health care system and venous leg ulcers are one of the most common, they can be chronic and difficult to heal and even cause pain. The risk of developing venous leg ulcers also increases with age. There is a lack of scientific basis and guidelines for the treatment of venous leg ulcers, but compression therapy is a common and decisive factor that is combined with a cleansing of the wound with debridement. Surgery and physical activity are other factors that can improve healing. Knowledge and experience of healthcare professionals is required in the selection and performance of treatment. The care of venous leg ulcers can be perceived as difficult and cause suffering. Aim To describe persons’ with venous leg ulcers experiences of care. Method A non-systematic literature review with 15 included qualitative and quantitative articles has been made. Articles published between 2011-2021 have been obtained from CINAHL and PubMed. All articles have undergone a quality review before an integrated data analysis was performed. Results From the collected articles, it showed that person’s expectations of care did not match the reality. They found it more time consuming and limiting for their social and private lives. People had undergone many failed treatments and therefore felt a desperation to find a treatment that cured their venous leg ulcer. People felt that they gained understanding and knowledge about their condition, which was a good motivation to follow their treatment plan. However, people experienced lack in the nurse's treatment that made compliance more difficult. Conclusions In this literature review it is evident that nurses need more knowledge and an understanding about how venous leg ulcers impacts a person’s life. An increased knowledge about the condition and the different treatment options that are available could decrease the suffering the persons are experiencing receiving treatment. This could also increase the person centred care aspects of care when it comes to venous leg ulcers, thus making it possible for a better care.

Bakgrund: Svårläkta bensår är symtom på underliggande sjukdom och drabbar cirka två procent av befolkningen. Det är ett plågsamt tillstånd som kräver kontinuerlig omvårdnad under långa perioder.  Syfte: Syftet var att belysa vuxna personers erfarenheter av att leva med svårläkta bensår. Metod: En litteraturstudie genomfördes utifrån tio kvalitativa empiriska studier och analyserades med Fribergs femstegsmodell. Studierna återfanns i CINAHL, PubMed, Scopus och Google scholar. Resultat: Utifrån analysen formades fyra huvudkategorier och tio underkategorier. ’Förlorad makt över kroppen’: ’Outhärdlig smärta’ och ’Outhärdlig lukt’. ’Förlorad kontroll över livet’: ’En begränsad vardag’, ’Svårt att upprätthålla relationer’ och ’Måsta härda ut’. ’Betydelsen av delaktighet’: ’Svårt att känna tillit’, ’Att känna sig nonchalerad’ och ’Att känna samhörighet’. ’Ständig ovisshet’: ’Att inte veta varför’ och ’Rädsla för framtiden’. Bensåren orsakade ett stort lidande i livets fysiska, psykiska och sociala aspekter.  Konklusion: För att lindra lidandet behöver sjuksköterskor ökad kunskap samt förståelse för att kunna ge en god omvårdnad. Vården måste prioritera denna patientgrupp och omorganisera för en bättre struktur vid diagnostisering, behandling och uppföljning. Det behövs fler interventionsstudier om svårläkta bensår. / Background: Hard-to-heal leg ulcers are symptoms of underlying disease and affects about two percent of the population. It is an agonizing condition that requires continuous care for long periods.  Aim: The aim was to shed light on adults' experiences of living with hard-to-heal leg ulcers.  Methods: A literature study was conducted based on ten qualitative studies and analyzed with Friberg's five-step model. The studies were found in CINAHL, PubMed, Scopus and Google scholar.  Results: Based on the analysis, four main categories and ten subcategories were formed. ’Lost power over the body’: ’Unbearable pain’ and ’Unbearable odour’. ’Lost control over life’: ’A limited everyday life’, ’Difficult to maintain relationships’ and ’Must endure’. ’The importance of participation’: ’Difficult to feel trust’, ’To feel neglected’ and ’To feel affinity’. ’Constant uncertainty’: ’Not knowing why’ and ’Fear of the future’. The leg ulcers caused great suffering in the physical, psychological and social aspects of life. Conclusion: To ease the suffering, nurses need to increase their understanding and knowledge to provide a good care. The healthcare organization must prioritize this patient group and reorganize for a better structure in diagnosis, treatment and follow-up. More intervention studies are needed about hard-to-heal leg ulcers.

Behandling och omvårdnad vid svårläkta bensår är komplext då en bidragande orsak till uppkomst är arteriell och/eller venös insufficiens, där initial diagnos är grundläggande. Adekvat behandling kräver kännedom om bakomliggande faktorer, förbandsmaterial samt omläggningsprinciper. Svårläkta bensår förekommer främst hos personer över 65 års ålder. I takt med att medelåldern ökar, ökar även prevalensen av dessa sår vilket ställer krav på sjukvården, inte minst på sjuksköterskan för att tillgodose patientens behov samt främja hälso- och sjukvårdens budget.Studien innefattar åtta semistrukturerade intervjuer utförda på fem äldreboenden. Materialet analyserades med kvalitativ innehållsanalys. Det konstaterades att sjuksköterskan besitter ett stort ansvar gällande sårbehandling i den kliniska verksamheten. Sjuksköterskorna uttryckte bristande kännedom likväl erfarenhet inom det berörda området och upplevde ett behov av kompetensutveckling i avseende till sårbehandling. Erfarenhet av bensår samt kollegors rekommendationer ansågs ligga till grund för hur sårvården bedrevs på besökta verksamheter. Att inneha ett helhetsperspektiv betonades av betydelse för resultatet av vård och behandling. Omhändertagandet av svårläkta bensår beskrevs som komplext, kunskapskrävande och kostsamt. Mer utbildning behövs för att optimera sårvården. / Treatment and nursing of slow healing leg ulcers is complex as a contributing factor to the occurence is arterial and/or venous insufficiency, where the diagnosis is fundamental. Adequate treatment requires knowledge of the underlying factors, dressings and rescheduling principles. Slow-healing leg ulcers occurs mainly in people over age 65. As the average age increases, so does the prevalence of these wounds, which places demands on health care, not least the nurse to meet the patient's needs and promote the health care budget.In this study eight semi-structured interviews was conducted in five elderly homes. The material was analyzed using qualitative content analysis. It was found that nurses possess a big responsibility concerning wound treatment in the clinical practice. The nurses expressed lack of knowledge as well experience in the relevant field and felt a need for professional development in relation to wound care. Experience of leg ulcers and colleagues' recommendations were considered to be the basis for the wound care conducted in visited units. An holistic approach was emphasized relevant to the outcome of care and treatment. The disposal of slow healing leg ulcers were described as complex, knowledge-intensive and costly. More education is needed to optimize wound care.

Syftet med denna litteraturstudie var att lyfta fram hur vardagen upplevs, och vad som påverkar den, av patienter med svårläkande venöst bensår. Elva vetenskapliga artiklar granskades och kvalitetsbedömdes enligt givna kriterier. Därefter inleddes den strukturella analysen där tre huvudteman framträdde. Carnevalis balansmodell användes som teoretisk referensram. De tre teman som återfanns var: relationen mellan patient och profession; fysiska, psykiska och sociala konsekvenser av att leva med svårläkande venöst bensår, samt föreställningar och kunskap. Det första temat berörde vikten av god kommunikation mellan patient och profession. Det andra temat behandlade patientens egna känslor och upplevelser relaterade till bensåret. Det tredje temat hanterade kunskap och föreställningar bland såväl patient som sjuksköterska och läkare. Sjuksköterskan har makt och kunskap att påverka alla de faktorer som präglar patientens tillvaro. Genom god kommunikation, kontinuitet och ett hänsynstagande till patientens upplevelser förknippade med bensåret, i synnerhet smärta, kan dennes balans i vardagen återskapas. / The aim of this literature review was to highlight the daily life experiences, and what affects them, when living with a venous leg ulcer. Eleven research articles were examined and measured by quality according to a given set of criteria. Thereafter the structural analysis was commenced whereby three major themes emerged. Carnevali’s theory of daily life balance was used as a theoretical framework. The three themes that crystallised were: the relation between patient and profession; physical, psychological and social consequences of living with a slow healing venous leg ulcer, and knowledge and perceptions related to the ulcer. The first theme regarded the importance of good communication between the patient and the profession. The second theme considered the patient’s own experiences and feelings in relation to the leg ulcer. The third theme handled the knowledge and perceptions that influenced the patient’s lived experience. The registered nurse has the power and the knowledge to influence the ingredients that shape the patient’s life trajectory. Through good communication, continuity and consideration towards the patient’s feelings related to the leg ulcer, especially regarding pain, the daily life balance could be regained.

Bakgrund: Bensår är ett globalt hälsoproblem och befolkningen blir allt äldre. Därmed ökar kroniska sjukdomar och risken att utveckla bensår. De flesta bensåren behandlas inom primärvården där distriktsköterskans roll är central. Det krävs att distriktssköterskan har en helhetsyn i vårdandet och därmed ett personcentrerat arbetsätt. Personcenterad vård är en av distriksköterkans kärnkompetenser varför erfarenheter av personcentrerad vård i mötet med personer med bensår utforskas. Syfte: Att beskriva distriktssköterskors erfarenhet av personcentrerad vård i mötet med personer som har bensår. Metod: Kvalitativ intervjustudie. Nio distriktsköterskor intervjuades genom individuella semistrukturerade intervjuer. Texten bearbetades med kvalitativ innehållsanalys med induktiv ansats. Resultat: Resultatet visade att personcentrerad vård ansågs vara ett naturligt arbetssätt för distriktssköterskorna och innefattade helhetsyn, delaktighet och kontinuitet. Resultatet belyste distriktsköterskans roll att anpassa sitt förhållningsätt, vikten av teamarbete samt att distriksktssköterskorna besitter djupare kunskap i det personcentrerade vårdandet av personer med bensår. Det framkom varierande förutsättningar för personcenterad vård i organsiationer, arbetsplatsen och patientmöten. Slutsats: Distriktssköterskorna har en central roll i den personcentrerade vården genom fördjupade kunskaper. Därför är det viktigt att det finns goda förutsättningar för personcentrerad vård för personer med bensår eftersom det kan öka livskvalitén och minska tiden för sårläkning. Det kan även bidra till större arbetstillfredsställelse för distriktsköterskor och kostnadseffektivitet. / Background: Leg ulcers are a global health problem and the population is getting older. This increases chronic diseases and the risk of developing leg ulcers. Most leg ulcers are treated in primary care where the district nurse's role is central. It is required that the district nurse has a holistic view of care and thus a person-centered way of working. Person-centered care is one of the district nurse's core competencies, which is why experiences of person-centered care when dealing with people with leg ulcers are explored. Aim: To describe district nurses' experience of person-centred care in the meeting with people having leg ulcer. Method: Qualitative interview study. Nine district nurses were interviewed through individual semi-structured interviews. The text was processed with qualitative content analysis using an inductive approach. Results: The result showed that person-centred care was considered a natural way of working for the district nurses and included a holistic view, participation and continuity. The result highlighted the role of the district nurse in adapting their approach, the importance of teamwork and that the district nurses have deeper knowledge in the person-centred care of people with leg ulcers. Various conditions emerged for person-centred care in organisations, the workplace and patient meetings. Conclusions: The district nurses have a central role in person-centred care through in-depth knowledge. Therefore, it is important that there are good conditions for person-centered care for people with leg ulcers because it can increase the quality of life and reduce the time for wound healing. It can also contribute to greater job satisfaction for district nurses and cost efficiency.

The thesis explores chronic leg ulceration experienced by young people who inject drugs (PWID). The applied health research study, in two phases, used a sequential explanatory mixed methods design. Phase 1 involved a survey of 200 people who injected drugs to investigate the prevalence of skin problems and leg ulceration, together with the identification of risk factors for ulceration. Phase 2 involved a series of fifteen qualitative semi-structured interviews that explored the results relating to risk factors with a sample of PWID who had experienced leg ulceration, and investigated participants’ perceptions of appropriate harm reduction methods. Main findings There were three research questions in this study: 1) What is the extent of skin problems and chronic leg ulceration in young people who inject drugs? The study identified a high prevalence of leg ulceration as 15%. 60% of the sample had experienced a skin problem. Each reported skin complication is clearly defined. 2) What causes chronic leg ulceration in young people who inject drugs? Leg ulceration experienced by PWID in this study was directly linked to deep vein thrombosis (DVT), as well as injecting in the groin and the leg. DVT was strongly associated with groin and leg injecting. The acceptance amongst injectors of the groin and leg as a site of choice has occurred with a lack of awareness of the long-term consequences of damage to the limb. 3) What are appropriate harm reduction measures in young people who inject drugs? Harm reduction methods related to the development of leg ulceration have been absent across schools and drug services. Training for healthcare workers which enables them to identify risk factors should be developed, and harm reduction information related to leg ulceration should be included in drug education within schools, and instigated within drugs services. This applied health research has led to a number of practice-focused recommendations surrounding clinical care including early detection of venous insufficiency and accessible services to prevent, assess, and treat venous disease in PWID. The original contribution to knowledge is three-fold: 1. Leg ulcers have been found to be highly prevalent in young people who inject drugs. 2. Ulceration is predominantly caused by venous thrombosis due to injecting in the legs or groin. 3. Harm reduction related to the development of venous disease has lacked impact and effect.

Objetivo: Determinar a influência do resultado imediato da angioplastia infrainguinal no sucesso clínico em 24 meses. Métodos: Foi realizado um estudo observacional prospectivo, que avaliou 40 angioplastias percutâneas infrainguinais, realizadas no período de abril de 2007 a fevereiro de 2011. Foram incluídos somente os casos com sucesso técnico e angiográfico intraoperatório. Todos os pacientes eram portadores de isquemia crítica de membro inferior decorrente unicamente de obstrução arterial crônica infrainguinal. Ultrassom com Doppler colorido (UDC) foi realizado um dia antes da cirurgia e no pós-operatório imediato. Foram registradas as velocidades de pico sistólico (VPS) nas artérias tibial anterior, tibial posterior e fibular na topografia do tornozelo. O gradiente de VPS pré e pós-operatório (GVPS) foi analisado e comparado prospectivamente quanto à melhora clínica em 2 anos, conforme os padrões recomendados pela SVS/ISCS. Foram utilizados os valores da artéria com a melhor variação perioperatória e da média das 3 artérias. Sucesso clínico foi definido como ausência de dor de repouso ou cicatrização de lesão. Resultados: Fizeram parte do estudo 19 mulheres e 20 homens, com média de idade de 68,5 ± 8,1 anos. Após 2 anos de seguimento, 26/40 lesões tiveram sucesso clínico sem novas intervenções cirúrgicas. Tempo de cicatrização variou de 4 a 111 semanas (mediana = 21,5 semanas). Lesões TASC II A/B tiveram sucesso clínico maior que TASC II C/D em 1 ano de seguimento (p<0,05), mas não em 2 anos (p=0,11). Entre os 14 casos de insucesso clínico, 6 foram submetidos a nova angioplastia e 4 a enxerto arterial. Três pacientes com angioplastia pérvia não tiveram cicatrização de lesão. Um paciente teve recorrência da úlcera no retorno de 24 meses. A perviedade primária foi de 62,5% ± 7,7% em 2 anos; e o salvamento de membro, de 92,5% ± 4,2% no mesmo período. Houve aumento de VPS, no leito distal, identificado pelo UDC. A variação de VPS foi de 44,4 cm/s, na melhor artéria, e de 21,9 cm/s, na média das artérias, para os casos de sucesso clínico. Para os casos de insucesso clínico, a variação foi de 45,3 cm/s, na melhor artéria, e de 24,7 na média das artérias. A comparação por UDC pré-operatória e pós-operatória imediata, através de VPS, não mostrou diferença estatística entre o grupos em 2 anos de seguimento. Conclusão: o aumento de fluxo pela avaliação por UDC, no pós-operatório imediato, não está relacionado com a resolução dos sintomas em 24 meses / Purpose: to evaluate the impact of the initial result of Percutaneous angioplasty (PA), objectively assessed with duplex-ultrasound, in the two-years clinical outcome. Methods: Between February 2007 and April 2011 thirty-nine patients with femoropopliteal atherosclerotic disease successfully treated by PA were included (40 limbs). One patient had both limbs treated in different occasions, and was considered as 2 cases for analysis. All patients had critical ischemia with rest pain and ischemic ulcers due to infrainguinal obstructions alone. The patients were submitted to duplex-ultrasound examination on the day before and on the first or second day after the procedure. Peak systolic velocities (PSV) was recorded in the anterior tibial, posterior tibial and fibular arteries at the level of distal third of the leg. All patients were followed for 2 years. Comparison between good and bad groups were based on VPS, including the perioperative gradient (GPSV) of the artery with highest variation and the mean of the VPS in the 3 arteries. After 2-years good result were defined as good when the patient had no pain and complete healing of a previous ulcer or minor amputations. It was considered as bad result when a second intervention was required or when unhealed lesions were present at the end of the 2-year period. Results: Mean age was 68,5 ± 8,1 years-old. In 26 cases the long-term result was good. Healing time ranged from 4 to 111 weeks (median 21.5). Bad long-term results were observed in 14 cases. Three lesions had persisted unhealed despite patent angioplasty. One case has ulcer recurrence at 24 months appointment. In 10 cases a second procedure was carried out (redo angioplasty in 6 and bypass in 4). TASCII A/B registered better clinical success then TASCII C/D (p<0,05) at 1-year follow-up but not at 2-years (p=0,11). Two-year limb salvage was 92,5% ± 4,2%. Primary patency was 62,5% ± 7,7% in 2-years. GVPS was 44,4 cm/s (highest artery) and 21,9 cm/s (mean PSV) in success group. GVPS was 45,3 cm/s (highest artery), and 24,7cm/s (mean VPS). The quality of the initial result, as measured by GPSV, was not associated with a good or bad long-term success (p>0,05). Conclusion: once the procedure was successfully performed, the degree of increase in flow is not related to the long-term durability and ulcer healing

This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-05-05T11:59:34Z No. of bitstreams: 1 arquivototal.pdf: 5234063 bytes, checksum: fe7ba1c1c886c41ee14f65f53af04756 (MD5) / Made available in DSpace on 2016-05-05T11:59:34Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 5234063 bytes, checksum: fe7ba1c1c886c41ee14f65f53af04756 (MD5) Previous issue date: 2015-10-14 / Introduction: Nurses from Primary Health Care (PHC) have faced difficulties to provide people with venous ulcer (VU) with care, due to poor knowledge on the theme. This research has emerged as an educational proposal for these professionals, based on the Theory of Meaningful Learning. Objective: Evaluate the effects of an educational intervention guided by the Theory of Meaningful Learning, as a strategy to change the theoretical and practical knowledge of nurses from PHC on care for a person with venous ulcer. Method: Quasi-experimental research, with a before-after design and a quanti-qualitative approach, carried out with 78 nurses who work in the Family Health centers (FHCs) in João Pessoa, Paraíba, Brazil. The inclusion criteria were: having within the area covered by the FHC a user with VU; having schedule availability to attend the course. The exclusion criteria were: missing the first or last day and having more than one absence during the educational intervention. The operational steps of the research were: (1) Preparation of the data collection instruments; (2) Validity and reliability of data collection instruments; (3) Diagnostic assessment; (4) Educational intervention; (5) Quantitative assessment; (6) Qualitative assessment. The educational intervention took place between April and June 2014, with a workload of 35 hours. Participants answered a self-assessment instrument and a questionnaire with items related to a person with VU, before and after the intervention. After six months, ten nurses were interviewed to constitute the qualitative analysis. In the analysis of quantitative data, we used the version 21.0 of the statistical package SPSS, with descriptive and inferential analyses and structural equations in the software AMOS Grafics, version 21.0. In the qualitative analysis, we used Bardin’s content analysis technique. The research was approved by the Research Ethics Committee, of the Health Sciences Center, under the Protocol 0708/13. Results: Most of the participants are women (95%), aged between 26 and 69 years, having an average education length of 18.6 years and an average of 12.7 years working with PHC. The self-assessment instrument proved to be reliable and it identified that the two-factor model is what best explains nursing care for a person with VU, understood through theory and practice. In self-assessment, there was an advance in scores between before and after that, on the assessment scale, came from average values close to no knowledge to mean scores closer to excellent, in almost all items. Besides, more than half of the participants hit the questions on VU assessment, prevention, and treatment, after the intervention, and there was a significant increase in the number of correct answers in relation to those stating “I do not know.” In qualitative analysis, the following categories emerged: Category I - Evaluating the training course; Category II - Barriers for applying the knowledge acquired; and Category III - Easy ways for applying content in daily work. Conclusion: The educational intervention for nurses from PHC, in the light of the Theory of Meaningful Learning, generated knowledge change regarding care for a person with VU. However, there is a need to keep the opportunity of Continued Health Education open for these professionals. / Introdução: Enfermeiros da Atenção Primária à Saúde (APS) têm encontrado dificuldades para assistir pessoas com úlcera venosa (UV), devido ao pouco conhecimento sobre a temática. Esta pesquisa emergiu como uma proposta educacional para esses profissionais, baseada na Teoria da Aprendizagem Significativa. Objetivo: Avaliar os efeitos da intervenção educativa pautada na Teoria da Aprendizagem Significativa, como estratégia para mudar o conhecimento teórico e prático de enfermeiros da APS no cuidado com a pessoa com úlcera venosa. Método: Pesquisa quase-experimental, do tipo antes-depois, com abordagem quanti-qualitativa, realizada com 78 enfermeiros que atuam nas unidades de Saúde da Família (USF) de João Pessoa/PB. Os critérios de inclusão foram: ter na área de abrangência da USF usuário com UV; ter a disponibilidade de horário para comparecer ao curso. Os critérios de exclusão foram: falta no primeiro ou no último dia e mais de uma falta durante a intervenção educativa. As etapas operacionais da pesquisa foram: (1) Elaboração dos instrumentos de coleta de dados; (2) Validade e fidedignidade dos instrumentos de coleta de dados; (3) Avaliação diagnóstica; (4) Intervenção educativa; (5) Avaliação quantitativa; (6) Avaliação qualitativa. A intervenção educativa ocorreu entre abril e junho de 2014, com carga horária de 35 horas. Os participantes responderam um instrumento autoavaliativo e um questionário com itens referentes à pessoa com UV, antes e depois da intervenção. Depois de seis meses, dez enfermeiros foram entrevistados para compor a análise qualitativa. Na análise dos dados quantitativos, utilizou-se a versão 21.0 do pacote estatístico SPSS, com análise descritiva e inferencial e equações estruturais no programa AMOS Grafics, versão 21.0. Na análise qualitativa, utilizou-se a técnica de análise do conteúdo de Bardin. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, do Centro de Ciências da Saúde, sob o Protocolo nº 0708/13. Resultados: A maioria dos participantes é mulher (95%), com idades entre 26 e 69 anos, com tempo médio de formação de 18,6 anos e média de 12,7 anos de serviço na APS. O instrumento de autoavaliação se revelou confiável e identificou que o modelo bifatorial é o que mais bem explica a assistência de enfermagem à pessoa com UV, compreendida a partir da teoria e da prática. Na autoavaliação, houve um avanço nos escores entre o antes e o depois que, na escala de avaliação, saía de médias próximas a nenhum conhecimento para escores médios mais próximos de excelente, em quase todos os itens. Além disso, mais da metade dos participantes acertaram as questões sobre avaliação, prevenção e tratamento de UV, depois da intervenção, e houve expressivo aumento do número de acertos em relação às respostas “não sei”. Na análise qualitativa, emergiram as seguintes categorias: Categoria I - Avaliando o curso de capacitação; Categoria II - Barreiras para aplicação do conhecimento adquirido; Categoria III - Facilidades para a aplicação do conteúdo no cotidiano profissional. Conclusão: A intervenção educativa para enfermeiros da APS, à luz da Teoria da Aprendizagem Significativa, gerou mudança de conhecimento em relação ao cuidado com a pessoa com UV. Contudo, faz-se necessário manter a oportunidade de Educação Permanente em Saúde para esses profissionais.

Made available in DSpace on 2015-05-08T14:47:22Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 5598900 bytes, checksum: c32ff6c73e89e1ebe6c75057b97f640c (MD5) Previous issue date: 2011-03-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: The vascular ulcer is the most meaningful complication regarding venous or arterial insufficiency, which has recurrent character and affects different age groups with prevalence above 65 years old. It is chronic wound which results in financial burden and affects the life quality of its carriers. The research development, for the fulfillment of new products which aid the treatment of this kind of wound as well as others, aims to provide benefits for society that needs to have access to advanced technology and with low cost. Objectives: To compare the solution use, while in test, at 0,9% sodium chloride and essential oil of Cymbopogon citratus Stapf leaves with saline at 0,9% in the cleaning process of vasculogenic ulcers; to investigate whether the solution, being tested, is coadjuvant in the healing process of such lesions; to evaluate the odor reduction of the vasculogenic ulcers during the use of the solution being tested; and to identify complication signs in the healing process of vasculogenic ulcers during the use of the solution, being tested, and saline. Methodology: It is a clinical, prospective, randomized, double-blind trial developed in the dressing sector of the outpatient clinic of the Lauro Wanderley University Hospital (HULW). The research encompassed vasculogenic ulcer carriers, with the sample of eighteen lesions (n=18) distributed in two groups, the experimental group (n = 11), which used the solution in test, and the control one (n = 07), which used saline at 0,9%. For data collection, several instruments were used, such as: an instrument with sociodemographic data and health conditions, including anamnesis and other files for lesions evaluations, once a week, such as Pressure Ulcer Scale for Healing (PUSH), TELER indicator and self-evaluation for odor, numerical scale for pain and complication register (bleeding, increase of necrosis area, increase of infection signs) and file for the dressing accomplishment of each group. The research was approved under the CEP/HULW no. 054/10 protocol. The data collection phase occurred in the period from June 8th, 2010 to August 2nd, 2010. In the data analysis, the SPSS statistical package (Statistical Package for Social Sciences) version 17.0, with inferential statistic techniques was used. The significance level used concerning the decisions of the statistical tests was 5%. Results and Data Analysis: The results point out that there was no meaningful difference between the groups for none of the variables: wound size, exudate, kind of tissue, pain and odor (p > 0,05) in each evaluation. However, it could be perceived meaningful difference in regard to the following variables: lesion size, kind of tissue, pain and odor when the paired comparison tests were used in evaluations of the same group, with results favorable to solution in test. Final Comments: the solution in test aids the reepithelialization process; it did not present any effect on the reduction of lesion exudate; it provides comfort for the patient and the professional who carries out the dressing, neutralizing unpleasant odors originated from the wound bed; it is safe to be used in human beings once it does not cause either irritation or infection signs; it can easily remove dirt of the wound bed; and it helps cleaning the perilesional area. It is suggested that further research should be fulfilled with a greater number of participants. / Introdução: A úlcera vascular se apresenta como a complicação mais significativa da insuficiência venosa ou arterial, que tem caráter recidivante, acomete diferentes faixas etárias, com prevalência acima de 65 anos. É ferida crônica que traz ônus financeiro e afeta a qualidade de vida de seus portadores. O desenvolvimento de pesquisas, para a criação de novos produtos que auxiliem o tratamento desse tipo de ferida e de outras, visa trazer benefício à sociedade, que precisa ter acesso à tecnologia avançada e com menor custo. Objetivos: Comparar o uso da solução em teste à base de cloreto de sódio a 0,9% e do óleo essencial das folhas de Cymbopogon citratus Stapf com a solução salina a 0,9% no processo de limpeza de úlceras vasculogênicas; investigar se a solução em teste é coadjuvante no processo de cicatrização dessas lesões; avaliar a redução do odor de úlceras vasculogênicas durante o uso da solução em teste; e, identificar sinais de complicações no processo de cicatrização de úlceras vasculogênicas durante o uso da solução em teste e da solução salina. Metodologia: Trata-se de um ensaio clínico, prospectivo, randomizado, duplo-cego desenvolvida no setor de curativos do Ambulatório do Hospital Universitário Lauro Wanderley (HULW). A população do estudo foi constituída por clientes portadores de úlceras vasculogênicas, sendo a amostra de dezoito lesões (n=18) distribuída em dois grupos, experimental (n = 11), que usou a solução em teste, e o grupo controle (n = 07), que usou a solução salina a 0,9%. Para coleta de dados, utilizou-se um instrumento com dados sociodemográficos e condições de saúde, incluindo anamnese e outras fichas para avaliação das lesões, uma vez por semana, incluindo a Pressure Ulcer Scale for Healing (PUSH), indicador TELER e autoavaliação para o odor, escala numérica para dor e registro de complicações (sangramento, aumento da área de necrose, aumento de sinais de infecção) e ficha guia para realização do curativo de cada grupo. A pesquisa foi aprovada sob protocolo CEP/HULW nº 054/10. A fase de coleta de dados ocorreu no período de 08 de junho de 2010 a 02 de agosto de 2010. Na análise dos dados, utilizou-se pacote estatístico SPSS (Statistical Package for Social Sciences) versão 17.0, com técnicas de estatística inferencial. O nível de significância utilizado nas decisões dos testes estatísticos foi de 5%. Resultados e Análise dos Dados: Os resultados apontam que não se comprovou diferença significativa entre os grupos para nenhuma das variáveis: tamanho da ferida, exsudato, tipo de tecido, dor e odor (p > 0,05) em cada avaliação. Porém, percebeu-se diferença significativa nas variáveis: tamanho da lesão, tipo de tecido, dor e odor quando se utilizou os testes de comparação pareada nas avaliações dentro do mesmo grupo, com resultados favoráveis à solução em teste. Considerações Finais: a solução em teste auxilia no processo de reepitelização; não apresentou ação sobre a redução do exsudato das lesões; traz conforto ao cliente e ao profissional que realiza o curativo, neutralizando odores desagradáveis advindos do leito da lesão; é segura para ser usada em seres humanos, uma vez que não causa sinais de irritação nem infecção; remove com facilidade sujidades do leito da lesão; e, facilita a limpeza da área perilesional. Sugere-se que sejam realizadas outras pesquisas com maior número de sujeitos.