Autoeficácia e qualidade de vida de pessoas com úlcera venosa

Venous ulcers (UV) are the result of deep venous insufficiency or obstruction leading to venous hypertension in the lower limbs and lesions. Self-efficacy is the belief in the ability to successfully perform a given task or exhibit behavior that leads to a desirable outcome. Nursing needs to know and explore the influence of self-efficacy on quality of life (QOL) of people with UV, seeking to exercise holistic care. Thus, this study aimed to analyze the correlation of self-efficacy for pain control and functionality with the QOL of people with UV in primary health care. It is a cross-sectional, analytical, quantitative study with people with UV in family health strategy and mixed units in Natal / RN. We used the instruments: sociodemographic and health questionnaire, domains self-efficacy for pain control and self-efficacy for functionality of Scale of Self-Efficacy for Chronic Pain (SFCD) and the Charing Cross Venous Ulcer Questionnaire (CCVUQ). The sample included 101 people in the self-efficacy scale for functionality and 89 in self-efficacy for pain, for twelve patients reported no pain at the time of collection, and therefore were excluded from the application of the scale of selfefficacy for pain. The project was approved by the ethics committee of the Federal University of Rio Grande do Norte (CAAE No. 07556312.0.0000.5537), serving Resolution 466/12. Women predominated (66.3%), elderly (61.4%), married or in a stable relationship (63.4%), low income (90.1%) and education (85.1%), inactive (75.2%), associated chronic diseases (60.4%), more than six hours of sleep / day (82.2%), non-drinkers / smokers (80.2%), chronic injury (73.3%) and moderate to severe pain (76.2%). Self-efficacy for pain (mean 67.3, SD 26.6) was less committed to the self-efficacy for functionality (mean 59.4 SD 25.9), with statistical difference (pvalue = 0.011). No significant associations were found between self-efficacy for pain control and functionality with the sociodemographic and health characteristics. When considering the total mean CCVUQ (mean 52.1, SD 16.6), QOL of respondents tended to worsen, with the aesthetic domain the most committed (mean 57.6, SD 24.0), followed by emotional state (mean 57.0, SD 25.7), social interaction (mean 48.4, SD 21.4) and household activities (mean 43.6, SD 23.3) . We found negative and significant correlations between self-efficacy for pain and CCVUQ total score (r = -0,324; p = 0,001), the social interaction domain (r = -0,278; p = 0,008), household activities (r = - 0,285; p = 0,007) and state emotional (r = -0,247; p = 0,019). Likewise, between selfefficacy for functionality and the CCVUQ total score (r = -0,553; p < 0,001), the social interaction domain (r = -0,553; p < 0,001), household activities (r = -0,594; p < 0,001) and emotional status (r = -0,259; p = 0,009). The aesthetic domain showed negative correlation but weak and not significant with self-efficacy for pain (r = -0, 155; p = 0,147) and functionality (r = -0,189; p = 0,058). It became evident the correlation between self-efficacy for pain control and functionality and the domains social interaction, household activities and emotional state, the quality of life of people with UV

História oral de vida de pessoas com úlcera venosa nos serviços de atenção primária à saúde

The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

Perfil socioeconômico de pessoas com úlcera venosa: aspectos relevantes para a enfermagem

Traçar o perfil socioeconômico dos pacientes com úlcera venosa. Método: estudo quantitativo, transversal e descritivo, realizado com 50 pessoas no ambulatório de clínica cirúrgica do Hospital Universitário Onofre Lopes/HUOL, localizado no município de Natal/RN/Nordeste do Brasil, utilizando-se um roteiro de entrevista. Os dados coletados foram tabulados e armazenados numa planilha do software Excel e analisadas pela estatística descritiva. O estudo foi aprovado pelo Comitê de Ética em Pesquisa, CAAE 0038.0.294.000-11. Resultados: idade média de 59,72 anos, 66% pertenciam ao sexo feminino, 60% possuíam companheiro, a média de estudos foi de 4,98 (±3,36) anos e a renda familiar 2,3 salários mínimos. Encontrou-se, portanto, o perfil de pessoas com úlcera venosa semelhante ao evidenciado na literatura. Conclusão: é imprescindível conhecer as características dessa clientela para desenvolver estratégias visando à melhoria de suas condições de saúde

Perfil socioeconômico de pessoas com úlcera venosa: aspectos relevantes para a enfermagem

Traçar o perfil socioeconômico dos pacientes com úlcera venosa. Método: estudo quantitativo, transversal e descritivo, realizado com 50 pessoas no ambulatório de clínica cirúrgica do Hospital Universitário Onofre Lopes/HUOL, localizado no município de Natal/RN/Nordeste do Brasil, utilizando-se um roteiro de entrevista. Os dados coletados foram tabulados e armazenados numa planilha do software Excel e analisadas pela estatística descritiva. O estudo foi aprovado pelo Comitê de Ética em Pesquisa, CAAE 0038.0.294.000-11. Resultados: idade média de 59,72 anos, 66% pertenciam ao sexo feminino, 60% possuíam companheiro, a média de estudos foi de 4,98 (±3,36) anos e a renda familiar 2,3 salários mínimos. Encontrou-se, portanto, o perfil de pessoas com úlcera venosa semelhante ao evidenciado na literatura. Conclusão: é imprescindível conhecer as características dessa clientela para desenvolver estratégias visando à melhoria de suas condições de saúde

PROVIDING OPTIMUM WOUND HEALING CONDITIONS DURING THE PROLIFERATIVE STAGE USING KERRAFIBRE

Abstract : In order to analyze the role of a new structured fibrous dressing in the proliferative stage of chronic wound healing in hard to heal wounds, a case study was performed on a stagnant venous ulcer, which remained non-healed in the past 7 months. All chronicity factors that could affect wound healing were excluded, including biofilm (with the use of polihexanide+betaine, Prontosan range), and compression therapy was provided. The results were very interesting with healing achieved in 7 weeks of treatment. Most of times it is not easy to find/select a dressing to promote granulation and epithelisation, once ideal cleaning/debridement and bioburden control are achieved. Some dressings do not provide a good healing rate, lead to bioburden elevation during time and recurrence in the use of antimicrobials. Other options to promote proliferation are very expensive and need a secondary dressing. Treatment with kerrafibre showned to be very cost effective. Its is also implicit the important role of advanced wound care centers versus conventional care.This case study was originally presented as a poster at Wounds UK 2014 Conference, at Harrogate, England, United Kingdom.

Venous leg ulcer recurrence : deciphering long term patient adherence to preventive treatments and activities

To better understand long term adherence to self-care activities to prevent the recurrence of venous leg ulcers, participants (n=80) were recruited to a prospective longitudinal study after experiencing healing of a venous leg ulcer. Data on demographics, health, psychosocial measures and adherence to prevention strategies (compression therapy, leg elevation and lower leg exercise) were collected every three months for one year after healing. Multivariable regression modelling was used to identify the factors that were independently associated with adherence. Over the year, a significant decline in adherence to all three strategies was observed, predominantly between 6–12 months after healing (p<0.01). Several factors were associated with adherence to more than one preventive activity. Regular follow-up care and a history of multiple previous ulcers were related to improved adherence (p<0.05), while scoring at higher risk for depression and restricted mobility were related to decreasing adherence over time (p<0.05). Patients with osteoarthritis had significantly reduced adherence to compression hosiery (p=0.026). These results provide information to assist care providers plan strategies for prevention of recurrent venous leg ulcers; and suggest a need for regular follow-up care which addresses both the physical and mental health of this population.

Predicting the likelihood of non-healing : a venous leg ulcer risk assessment tool

This project developed, validated and tested reliability of a risk assessment tool to predict the risk of failure to heal of patients with venous leg ulcers within 24 weeks. The risk assessment tool will allow clinicians to be able to determine realistic outcomes for their patients, promote early healing and potentially avoid weeks of inappropriate therapy. The tool will also assist in addressing specific risk factors and guide decisions on early, alternative, tailored interventions.

Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach : a longitudinal study

Background The high recurrence rate of chronic venous leg ulcers has a significant impact on an individual’s quality of life and healthcare costs. Objectives This study aimed to identify risk and protective factors for recurrence of venous leg ulcers using a theoretical approach by applying a framework of self and family management of chronic conditions to underpin the study. Design Secondary analysis of combined data collected from three previous prospective longitudinal studies. Setting The contributing studies’ participants were recruited from two metropolitan hospital outpatient wound clinics and three community-based wound clinics. Participants Data were available on a sample of 250 adults, with a leg ulcer of primarily venous aetiology, who were followed after ulcer healing for a median follow-up time of 17 months after healing (range: 3 to 36 months). Methods Data from the three studies were combined. The original participant data were collected through medical records and self-reported questionnaires upon healing and every 3 months thereafter. A Cox proportion-hazards regression analysis was undertaken to determine the influential factors on leg ulcer recurrence based on the proposed conceptual framework. Results The median time to recurrence was 42 weeks (95% CI 31.9–52.0), with an incidence of 22% (54 of 250 participants) recurrence within three months of healing, 39% (91 of 235 participants) for those who were followed for six months, 57% (111 of 193) by 12 months, 73% (53 of 72) by two years and 78% (41 of 52) of those who were followed up for three years. A Cox proportional-hazards regression model revealed that the risk factors for recurrence included a history of deep vein thrombosis (HR 1.7, 95% CI 1.07–2.67, p=0.024), history of multiple previous leg ulcers (HR 4.4, 95% CI 1.84–10.5, p=0.001), and longer duration (in weeks) of previous ulcer (HR 1.01, 95% CI 1.003–1.01, p<0.001); while the protective factors were elevating legs for at least 30 minutes per day (HR 0.33, 95% CI 0.19–0.56, p<0.001), higher levels of self-efficacy (HR 0.95, 95% CI 0.92–0.99, p=0.016), and walking around for at least three hours/day (HR 0.66, 95% CI 0.44–0.98, p=0.040). Conclusions Results from this study provide a comprehensive examination of risk and protective factors associated with leg ulcer recurrence based on the chronic disease self and family management framework. These results in turn provide essential steps towards developing and testing interventions to promote optimal prevention strategies for venous leg ulcer recurrence.

The benefits of a self-management telephone based intervention for promoting exercise and healing rates for venous leg ulcer patients

Venous leg ulcers are a significant cause of chronic ill-health, whilst patients often experience reduced mobility and poor quality of life. This research investigated exercise as a tool for improving outcomes for adults with venous leg ulcers. The results showed that patients who adhere to an exercise program as an adjunct treatment to standard care are more likely to heal than those who do not adhere to an exercise program. This research has the potential to improve the health of venous leg ulcer patients and decrease health care costs.

Translation, cultural adaptation to Brazil and validation of the venous leg ulcer quality of life questionnaire (VLU-QoL-Br)

Objetivo:traduzir o instrumento Venous legulcer quality of life questionnaire (VLU-QoL), adaptá-lo culturalmente para o português do Brasil e validá-lo com pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu (FMB) da Universidade Estadual Paulista (Unesp). Métodos:o questionário foi traduzido por um tradutor profissional e por dois dermatologistas especialistas na área de úlceras venosas (UV), sendo reformulado em reunião com os três tradutores. O constructo (VLU-QoL-Br) foi submetido a pré-entrevista com 10 portadores de UV para a adaptação da linguagem. Posteriormente, foi aplicado em pacientes do HC-Unesp, e como teste-reteste para verificação de sua reprodutibilidade. Resultados:foram avaliados 82 pacientes, sendo 56 (68%) do sexo feminino. A idade média foi de 67,3 anos. O questionário foi traduzido, adaptado e aplicado aos pacientes. O constructo apresentou alta consistência interna (alfa= 0,94) e adequada correlação item-total. Quando avaliados os 32 retestes, observou-se correlação intraclasse para concordância de 0,78 (p < 0,01), indicando boa reprodutibilidade do constructo. A análise fatorial confirmatória corroborou as dimensões do questionário original: atividades, psicológico e sintomas. Escores do VLU-QoL-Br se associaram, independentemente, à área total das úlceras e a menor escolaridade dos sujeitos (p < 0,01). Conclusão:a tradução, a adaptação e a validação do questionário VLU-Qol-Br demonstrou boa performance psicométrica, permitindo seu uso clínico no Brasil. É importante avaliar seu desempenho em outras regiões e em diferentes amostras de indivíduos.

Factors associated with recurrence of venous leg ulcers : a survey and retrospective chart review

Background: Chronic venous leg ulcers have a significant impact on older individuals’ well-being and health care resources. Unfortunately after healing, up to 70% recur. ----- Objective: To examine the relationships between leg ulcer recurrence and physical activity, compression, nutrition, health, psychosocial indicators and self-care activities in order to provide information for preventive strategies. ----- Design: Survey and retrospective chart review Settings: Two metropolitan hospital and three community-based leg ulcer clinics. ----- Subjects: A sample of 122 community living patients with leg ulcer of venous aetiology which had healed between 12 and 36 months prior to the survey. ---- Methods: Data were collected from medical records on demographics, medical history and previous ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer recurrences and history, compression and other self-care activities. All variables significantly associated with recurrence at the bivariate level were entered into a logistic regression model to determine their independent influences on recurrence. ----- Results: Median follow-up time was 24 months (range 12–40 months). Sixty-eight percent of participants had recurred. Bivariate analysis found recurrence was positively associated with ulcer duration, cardiac disease, a Body Mass Index ≤20, scoring as at-risk of malnutrition and depression; and negatively associated with increased physical activity, leg elevation, wearing Class 2 (20–25mmHg) or Class 3 (30–40mmHg) compression hosiery, and higher self-efficacy scores. After adjusting for all variables, an hour/day of leg elevation (OR=0.04, 95% CI=0.01–0.17), days/week in Class 2 or 3 compression hosiery (OR=0.53, 95% CI=0.34–0.81), Yale Physical Activity Survey score (OR=0.95, 95% CI=0.92–0.98), cardiac disease (OR=5.03, 95% CI=1.01–24.93) and General Self-Efficacy scores (OR=0.83, 95% CI=0.72–0.94) remained significantly associated (p<0.05) with recurrence. ----- Conclusions: Results indicate a history of cardiac disease is a risk factor for recurrence; while leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence.

Compression for preventing recurrence of venous ulcers

Background: Up to 1% of adults will suffer from leg ulceration at some time. The majority of leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or weakness of the valves in the veins of the leg. Prevention and treatment of venous ulcers is aimed at reducing the pressure either by removing / repairing the veins, or by applying compression bandages / stockings to reduce the pressure in the veins. The vast majority of venous ulcers are healed using compression bandages. Once healed they often recur and so it is customary to continue applying compression in the form of bandages, tights, stockings or socks in order to prevent recurrence. Compression bandages or hosiery (tights, stockings, socks) are often applied for ulcer prevention. Objectives To assess the effects of compression hosiery (socks, stockings, tights) or bandages in preventing the recurrence of venous ulcers. To determine whether there is an optimum pressure/type of compression to prevent recurrence of venous ulcers. Search methods The searches for the review were first undertaken in 2000. For this update we searched the Cochrane Wounds Group Specialised Register (October 2007), The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library 2007 Issue 3, Ovid MEDLINE - 1950 to September Week 4 2007, Ovid EMBASE - 1980 to 2007 Week 40 and Ovid CINAHL - 1982 to October Week 1 2007. Selection criteria Randomised controlled trials evaluating compression bandages or hosiery for preventing venous leg ulcers. Data collection and analysis Data extraction and assessment of study quality were undertaken by two authors independently. Results No trials compared recurrence rates with and without compression. One trial (300 patients) compared high (UK Class 3) compression hosiery with moderate (UK Class 2) compression hosiery. A intention to treat analysis found no significant reduction in recurrence at five years follow up associated with high compression hosiery compared with moderate compression hosiery (relative risk of recurrence 0.82, 95% confidence interval 0.61 to 1.12). This analysis would tend to underestimate the effectiveness of the high compression hosiery because a significant proportion of people changed from high compression to medium compression hosiery. Compliance rates were significantly higher with medium compression than with high compression hosiery. One trial (166 patients) found no statistically significant difference in recurrence between two types of medium (UK Class 2) compression hosiery (relative risk of recurrence with Medi was 0.74, 95% confidence interval 0.45 to 1.2). Both trials reported that not wearing compression hosiery was strongly associated with ulcer recurrence and this is circumstantial evidence that compression reduces ulcer recurrence. No trials were found which evaluated compression bandages for preventing ulcer recurrence. Authors' conclusions No trials compared compression with vs no compression for prevention of ulcer recurrence. Not wearing compression was associated with recurrence in both studies identified in this review. This is circumstantial evidence of the benefit of compression in reducing recurrence. Recurrence rates may be lower in high compression hosiery than in medium compression hosiery and therefore patients should be offered the strongest compression with which they can comply. Further trials are needed to determine the effectiveness of hosiery prescribed in other settings, i.e. in the UK community, in countries other than the UK.

The impact of psychosocial factors on adherence to compression therapy to prevent recurrence of venous leg ulcers

Aims To identify self-care activities undertaken and determine relationships between self-efficacy, depression, quality of life, social support and adherence to compression therapy in a sample of patients with chronic venous insufficiency. Background Up to 70% of venous leg ulcers recur after healing. Compression hosiery is a primary strategy to prevent recurrence, however, problems with adherence to this strategy are well documented and an improved understanding of how psychosocial factors influence patients with chronic venous insufficiency will help guide effective preventive strategies. Design Cross-sectional survey and retrospective medical record review. Method All patients previously diagnosed with a venous leg ulcer which healed between 12–36 months prior to the study were invited to participate. Data on health, psychosocial variables and self-care activities were obtained from a self-report survey and data on medical and previous ulcer history were obtained from medical records. Multiple linear regression modelling was used to determine the independent influences of psychosocial factors on adherence to compression therapy. Results In a sample of 122 participants, the most frequently identified self-care activities were application of topical skin treatments, wearing compression hosiery and covering legs to prevent trauma. Compression hosiery was worn for a median of 4 days/week (range 0–7). After adjustment for all variables and potential confounders in a multivariable regression model, wearing compression hosiery was found to be significantly positively associated with participants’ knowledge of the cause of their condition (p=0.002), higher self-efficacy scores (p=0.026) and lower depression scores (p=0.009). Conclusion In this sample, depression, self-efficacy and knowledge were found to be significantly related to adherence to compression therapy. Relevance to clinical practice These findings support the need to screen for and treat depression in this population. In addition, strategies to improve patient knowledge and self-efficacy may positively influence adherence to compression therapy.

Identification of factors contributing to recurrence of venous leg ulcers

Background and Significance Venous leg ulcers are a significant cause of chronic ill-health for 1–3% of those aged over 60 years, increasing in incidence with age. The condition is difficult and costly to heal, consuming 1–2.5% of total health budgets in developed countries and up to 50% of community nursing time. Unfortunately after healing, there is a recurrence rate of 60 to 70%, frequently within the first 12 months after heaing. Although some risk factors associated with higher recurrence rates have been identified (e.g. prolonged ulcer duration, deep vein thrombosis), in general there is limited evidence on treatments to effectively prevent recurrence. Patients are generally advised to undertake activities which aim to improve the impaired venous return (e.g. compression therapy, leg elevation, exercise). However, only compression therapy has some evidence to support its effectiveness in prevention and problems with adherence to this strategy are well documented. Aim The aim of this research was to identify factors associated with recurrence by determining relationships between recurrence and demographic factors, health, physical activity, psychosocial factors and self-care activities to prevent recurrence. Methods Two studies were undertaken: a retrospective study of participants diagnosed with a venous leg ulcer which healed 12 to 36 months prior to the study (n=122); and a prospective longitudinal study of participants recruited as their ulcer healed and data collected for 12 months following healing (n=80). Data were collected from medical records on demographics, medical history and ulcer history and treatments; and from self-report questionnaires on physical activity, nutrition, psychosocial measures, ulcer history, compression and other self-care activities. Follow-up data for the prospective study were collected every three months for 12 months after healing. For the retrospective study, a logistic regression model determined the independent influences of variables on recurrence. For the prospective study, median time to recurrence was calculated using the Kaplan-Meier method and a Cox proportional-hazards regression model was used to adjust for potential confounders and determine effects of preventive strategies and psychosocial factors on recurrence. Results In total, 68% of participants in the retrospective study and 44% of participants in the prospective study suffered a recurrence. After mutual adjustment for all variables in multivariable regression models, leg elevation, compression therapy, self efficacy and physical activity were found to be consistently related to recurrence in both studies. In the retrospective study, leg elevation, wearing Class 2 or 3 compression hosiery, the level of physical activity, cardiac disease and self efficacy scores remained significantly associated (p<0.05) with recurrence. The model was significant (p <0.001); with a R2 equivalent of 0.62. Examination of relationships between psychosocial factors and adherence to wearing compression hosiery found wearing compression hosiery was significantly positively associated with participants’ knowledge of the cause of their condition (p=0.002), higher self-efficacy scores (p=0.026) and lower depression scores (p=0.009). Analysis of data from the prospective study found there were 35 recurrences (44%) in the 12 months following healing and median time to recurrence was 27 weeks. After adjustment for potential confounders, a Cox proportional hazards regression model found that at least an hour/day of leg elevation, six or more days/week in Class 2 (20–25mmHg) or 3 (30–40mmHg) compression hosiery, higher social support scale scores and higher General Self-Efficacy scores remained significantly associated (p<0.05) with a lower risk of recurrence, while male gender and a history of DVT remained significant risk factors for recurrence. Overall the model was significant (p <0.001); with an R2 equivalent 0.72. Conclusions The high rates of recurrence found in the studies highlight the urgent need for further information in this area to support development of effective strategies for prevention. Overall, results indicate leg elevation, physical activity, compression hosiery and strategies to improve self-efficacy are likely to prevent recurrence. In addition, optimal management of depression and strategies to improve patient knowledge and self-efficacy may positively influence adherence to compression therapy. This research provides important information for development of strategies to prevent recurrence of venous leg ulcers, with the potential to improve health and decrease health care costs in this population.