Scale for supported care in primary care: a methodological study. / Escala para o cuidado apoiado na atenção primária: um estudo metodológico.

OBJECTIVE: To develop a predictive scale for determining complications in adults with hypertension and actions for care supported in primary care. METHOD: Methodological research developed in the municipality of Curitiba-PR in 2013 and 2014, carried out in two stages, the first through the collection of data from 387 adults with hypertension through a structured interview and anxiety scales, depression, quality of life, medication adherence and social support. The second step was the construction of the scale from the statistically significant variables in the multivariate analysis. RESULTS: The scale consisted of age, sex, smoking, time of diagnosis, and risk classification in the health unit, medications in use and depression. Later, through literature review, actions were suggested for supported self-care. CONCLUSION: The scale enables identification of factors that may predict the development of complications of hypertension and provides actions to supported care.

Adherence of mental therapy for mental disorder patients to drug health treatment [corrected]. / Adesão do portador de transtorno mental à terapêutica medicamentosa no tratamento em saúde menta.

OBJECTIVE: To assess the adherence of mental disorder patients to drug therapy for mental health treatment and the association between demographic, socioeconomic, clinical and pharmacotherapeutic variables to treatment adherence. METHOD: A cross-sectional study conducted with mental disorder patients in two Psychosocial Care Centers in Curitiba/Paraná in 2014. Data from structured interviews and medical records were submitted to descriptive and bivariate analysis. RESULTS: 300 patients with mental disorders participated in the study. 51% of participants adhered to the drug therapy, the highest adherence was among males with no family history of mental disorder, diagnosed with schizophrenia, with disease duration of less than 1 year, who did not forget to take the medicine not even once in the previous month and who relied on family participation. Adherence was lower among the interviewees with individual income lower than one minimum wage, perception of regular and poor health, diagnosis of depression associated with another disorder, treatment time in the service over 2 years and with a history of attempted suicide. CONCLUSION: Low adherence to the drug therapy was observed. The variables associated with adherence were gender, individual income, family history of mental disorder, perception about their health, diagnosis of mental disorder, duration of illness and treatment, suicide attempt, failing to take the medication at least once in the previous month and family participation.

Foot ulceration in patients with diabetes: a risk analysis.

The study reported in this article aimed to analyse factors associated with the risk of ulceration in the feet of patients with diabetes using a conceptual hierarchic model. It was a cross-sectional study carried out with 1515 people with diabetes mellitus aged 40 years and older. The risk of foot ulceration was of higher significance in male patients with diabetes (adjusted odds ratio (OR)=1.39 (95% confidence interval (CI) 1.11 to 1.73); p=0.020), who did not practise a regular physical activity (adjusted OR=1.58 (95% CI 1.15 to 2.15); p=0.013), with time since diagnosis over 10 years (adjusted OR=1.42 (95% CI 1.10 to 1.86); p=0.011), who used insulin (adjusted OR=1.40 (95% CI 1.09 to 1.84); p=0.012), with retinopathy (adjusted OR=1.84 (95% CI 1.38 to 2.45); p=0.001) and who had had a previous stroke (adjusted OR=1.47 (95% CI 1.09 to 2.04); p=0.018). Mycosis on the nails and the interdigital spaces of the feet was statistically associated with ulceration risk independent of other variables of the model (adjusted OR=2.48 (95%CI 1.70 to 3.63); p=0.001). Finding the factors associated with ulceration contributes to the provision of quality care by nurses.

Experience of hypertensive patients with self-management of health care.

AIMS: The aim of this study was to interpret how hypertensive patients experience health care self-management. BACKGROUND: Hypertension is one of the most prevalent chronic diseases worldwide. The involvement of individuals in the management of their health care to treat this disease is fundamental, with aid and advice from healthcare professionals, especially nurses, so that hypertensive patients can effectively self-manage their health care. DESIGN: Qualitative study. METHODS: Hypertensive patients were recruited using theoretical sampling. The study sample consisted of 28 hypertensive patients aged 18-59 years who were registered in the e-Health programme of the Ministry of Health. Data were collected and analyzed between September 2012-October 2014 using a semi-structured interview based on the methodological framework of the constructivist grounded theory. FINDINGS: The participants' statements depicted an outline of their experience with the disease: the beginning of the illness; understanding the disease process; incorporating behaviour for self-management of the disease; experiencing attitudes and actions in the control and treatment of the disease; and being treated in the public healthcare system. A central phenomenon emerged, namely hypertensive patients' experience of self-management of health care. CONCLUSION: This phenomenon has paths, actions and interactions. When patients discover that they have the disease and become aware of the disease process, they assume the identity of being hypertensive and become proactive in their health care and in living with their families and in communities.

Nursing Case Management and Glycemic Control Among Brazilians With Type 2 Diabetes: Pragmatic Clinical Trial.

BACKGROUND: Type 2 diabetes mellitus is a chronic condition that requires ongoing, life-long care in order to be controlled. OBJECTIVES: The aims of the study were to assess the effect of nursing case management on glycated hemoglobin (HbA1c) levels compared to usual care in people with type 2 diabetes mellitus and to determine if effects of nursing case management varied by gender, age, duration of disease, education, and income. METHODS: This is a pragmatic clinical trial, conducted in the municipality of Bandeirantes, Paraná, Brazil, in 2011 and 2012. Eighty individuals were recruited and randomized equally to receive nursing case management or usual care. Covariates were sociodemographic and clinical factors. The outcome was HbA1c measured at baseline, 6 months, and 12 months. RESULTS: The sample consisted predominately of women; most had been diagnosed with type 2 diabetes mellitus within the previous 5 years. Mean age was 50.14 (SD = 7.00), with 5.27 (SD = 4.39) years of schooling and an average HbA1c of 9.90% (SD = 2.49). Hemoglobin A1c was reduced from an average of 10.33% to 9.0% (p < .01) in the nursing case management group and from 9.57% to 8.93% (p = .05) in the usual care group; the group by time effect was not significant. Case management effects varied by younger age (p = .05), duration of type 2 diabetes less than 5 years (p = .03), up to 4 years of schooling (p = .04), and being in the lowest-income stratum (p = .02). DISCUSSION: Both groups showed a statistically significant reduction of HbA1c at 6 and 12 months following baseline. The difference in proportional reduction of HbA1c between groups was not statistically significant.

[Social representations of illness among people with chronic kidney disease]. / Representações sociais sobre o adoecimento de pessoas com doença renal crônica.

OBJECTIVE: To describe the social representations of illness among people with chronic kidney disease undergoing haemodialysis. METHOD: Descriptive, qualitative research, anchored on the social representations theory. This study was conducted in the municipality of Ponta Grossa, Paraná State, Brazil, with 23 adults with chronic kidney disease. Data were collection between February and November 2012 by means of a semi-structured interview, and analyzed using Content Analysis. RESULTS: The interviews led to the categories "the meaning of kidney disease": awareness of finitude, and "survival": the visible with chronic kidney disease. The representation of illness unveiled a difference and interruption in life projects, and haemodialysis meant loss of freedom, imprisonment and stigma. CONCLUSION: Family ties and the individuals´ social role are determining representations for healthcare.

Generalized Resistance Deficits in inmates with hypertension: missing resources that limit health.

OBJECTIVE: to understand the Generalized Resistance Deficits of people deprived of liberty with hypertension in a Brazilian prison unit. METHOD: qualitative research, anchored in Salutogenesis, carried out with 38 people with hypertension from a Brazilian prison unit, from February to July 2022, with a semi-structured interview with open-ended questions, whose analysis was thematic, explaining the limitations to health in prison. RESULTS: 13 Generalized Resistance Deficits were reported, mostly related to the prison environment and, to a lesser extent, to the social group and the individual, respectively. Living in prison for people with hypertension implies living with a high number of Generalized Resistance Deficits, accentuating the movement towards the disease pole. FINAL CONSIDERATIONS: knowing Generalized Resistance Deficits allows directing health promotion to support the use of available Generalized Resistance Resources and contributes to the expansion of intersectoral policies.

[Conceptual self-management analysis of hypertensive individuals]. / Análise conceitual de autogestão do indivíduo hipertenso.

UNLABELLED: This research aimed to analyze the concept of self-management of hypertensive individuals. Theoretical and documentary study based on Walker and Avant's conceptual analysis by means of the Scientific Electronic Library Brazil and the Medical Literature Analysis and Retrieval System Online in the Coordination for Higher Education Personnel Development (CAPES, in Portuguese) and the National Library of Medicine websites. Fourteen (14) articles and one (1) thesis were selected and reviewed in Portuguese and English, in the period January 2007 to September 2012. BACKGROUND: missing doctor's appointments, non-compliance to blood pressure control treatment to recommendations to proper diet standards and stress. Attributer blood pressure control and disease management Consequences home monitoring of blood pressure with control improvement, accomplishment of disease management, compliance and sharing of the creation process of self-management goals and caring activities by the interdiscplinary team through individualized actions. It was concluded that the self-management concept is a dynamic, active process which requires knowledge, attitude, discipline, determination, commitment self-regulation, empowerment and self-efficiency in order to manage the disease and achieve healthy living.

Financial toxicity in people with chronic kidney disease undergoing hemodialysis treatment.

OBJECTIVE: to assess the financial toxicity of people with chronic kidney disease undergoing hemodialysis treatment. METHOD: a descriptive analytical cross-sectional study, carried out with 214 people, between February and May 2022. For data collection, a sociodemographic and clinical instrument and the COmprehensive Score for financial Toxicity were used. For analysis, the Odds Ratio, ANOVA and Cronbach's alpha tests were used. RESULTS: the mean financial toxicity score was 20.30. Women with a monthly family income of at most two minimum wages are more likely to have some degree of financial toxicity (Odds Ratio: 0.85; 0.76). CONCLUSION: financial toxicity was identified to different degrees and varied according to sociodemographic and clinical characteristics. Measuring financial toxicity can help nurses plan care and develop strategies to avoid interrupting treatment.

[Educational activities for people with chronic disease: grants for nursing]. / Atividades educativas para portadores de doença crônica: subsídios para a enfermagem.

This is an intervention study conducted in a Unidade Básica de Saúde (Basic Health Unit) in Colombo, Parana, Brazil from March to November 2009, with 35 carriers of chronic diseases aged between 18 and 60 years, and enrolled in the Hypertension and Diabetes Program. The objectives were to identify their knowledge about arterial hypertension and act through educational group activities. Data were collected though semistructured interviews and four group meetings, and the following categories emerged from the analysis: "Understanding of the disease" and "Ways of caring". It was found that users knew the disease, its risk factors and possible complications, and that educational activities favored the sharing of experiences,provided reflection and the possibility of treatment management. This is a strategy that should be used and promoted by nurses.

[The dissertations produced in the Graduate and Master's in Nursing Program at Universidade Federal do Paraná]. / Dissertações produzidas no Programa de Pós-Graduação e Mestrado em Enfermagem da Universidade Federal do Paraná

This descriptive, retrospective documental study was performed with the objective to analyze the dissertations produced in the Graduate and Master's in Nursing Program at Universidade Federal do Paraná, considering the adjustment of its lines of research. To do this, a critical reading was performed of the abstracts and thematic analysis was used to look at the dissertations and their inclusion in the lines of research, as well as the methods, approaches, subjects, location and research techniques used. A total 64 abstracts were analyzed from dissertations that were available online. Of the analyzed productions most make a qualitative focus and use interviews. It was found that the dissertations are in line with the lines of research proposed in the Master's Degree in Program and their analysis can contribute to re-dimensioning pathways, research lines and studies that the program has developed.

[User's representations of chronic diseases and educational practice]. / As representações dos usuários sobre a doença crônica e a prática educativa.

This is a qualitative research study held between October, 2008, and March, 2009, with 45 users over 60 years of age from a Health Unit, which aimed to identify their representations of chronic disease. Inerviews were carried out to collect chronic disease's representation. Three team meetings were also carried out, with an average of 8 users. Twenty-four (24) users participated in this step. The themes brought out of their discourses were: "The arrival of the disease: explanatory factors"; "The mystery of the bodyly changes: an obligation to change", and "The importance of learning and sharing the experience". Participants recognized the factors related to the disease onset and their commitments, the changes necessary to keep living and put off complications, and they also valued the exchange of experiences through dialogue in educational activities.

Perception of post-stroke patients on case management conducted by nurses.

OBJECTIVE: To identify the perception of post-stroke patients on the case management conducted by nurses. METHOD: Qualitative descriptive study with 13 post-stroke patients, followed-up with case management conducted by a nurse for six months, and interviewed at home one month after the end of the follow-up. The interviews were recorded, transcribed in full and analyzed with the help of a software. RESULTS: Of the 13 participants, 57.14% were men and 50% were between 50 and 59 years. Content analysis resulted in three categories: "Self-management of care", which addressed changes in attitudes towards treatment, mainly due to concern of recurrence in a short period of time; "Sequelae and late repercussions of the stroke", which presents participants' difficulties after the event; and "Support received after a stroke", which emphasizes the actions and attitudes of the case manager nurse during the follow-up period. CONCLUSION: Case management was perceived by the participant as a health-promoting tool capable of increasing treatment adherence.

Construct validity and reliability of the Brazilian version of Hypertension Knowledge-Level Scale.

OBJECTIVE: To validate the construct and test the reliability of the Brazilian version of Hypertension Knowledge-Level Scale. METHODS: Methodological research with 220 participants in a primary health care unit from Curitiba, Paraná. The data were collected with a social demographic questionnaire and the Brazilian version of the scale. The construct validity and reliability were assessed using Cronbach's Alpha, Pearson's Correlation and Analysis of Variance. The discriminant validity was verified comparing groups of people with hypertension and without, using T test. RESULTS: Cronbach's Alpha was 0.74. The groups comparison showed that people with hypertension had better results (p<0,001). Pearson's Correlation showed that the questions measure different aspects of the same construct, justifying its organization in subdimensions. CONCLUSION: The Brazilian version of Hypertension Knowledge-Level Scale is a reliable instrument, which had its construct and criterion validated to measure knowledge about hypertension among Brazilian people. It can help health professionals with planning educative actions.

[Nursing care to patients with comorbidity clinical and psychiatric in hospital emergency service]. / Cuidado de enfermagem ao paciente com comorbidade clínico-psiquiátrica em um pronto atendimento hospitalar.

Qualitative descriptive, exploratory research developed in 2009, in the emergency service of a general hospital in Curitiba, Paraná, Brazil. It aims to investigate how nurses take care of patients with clinical and psychiatric comorbidity. Six nurses, seven nursing technicians and 14 nursing assistants participated. We obtained data through semi-structured interviews and submitted to analysis of thematic content. The categories that emerged from the data were: Care is technical and without specificity; Safety and protection of patient; and Physical and chemical restraint as protective measures. The study revealed that nursing care of patients with clinical and psychiatric comorbidity does not have any specificity, with emphasis on basic care, physical and chemical restraint. We concluded that it is necessary to establish local training in mental health and make nurses aware of the care needs of this clientele.

[Current dynamics of nursing in Portugal: nurses' representations]. / Dinâmicas atuais da enfermagem em Portugal: a representação dos enfermeiros.

This research study, with a qualitative approach was carried out aiming to identify nurses' representation on current professional dynamics, evolutionary landmarks and the future outlook for Portuguese nursing with twenty nurses from Evora, Portugal, in April / May of 2009, through narrative testimony. Qualification obtained along the years as well as the Nurses' Association were mentioned as the central representative pillars in order to build up professional identity. Autonomy is part of daily caring routine, however hegemonic power issues in the health team still ground nurses' action and underpin their self and peer professional and social recognition. Future outlook addresses issues such as employment, career uncovering hope for some and uncertainty for others.

[The nursing process and the law of professional exercise]. / O processo de enfermagem e a lei do exercício profissional.

The necessity of the cientificity in the nursing's working process, pushed by the science's advance and enclosure in the job market, configured itself in the establishment of nursing's process. The purpose of this study was to analyze in the nursing's legal documents, the nurse's duty opposite the Brazilian society, in the perspective of the scientific methodology in the working process. In a historic approach, the laws and designation-laws that normalized the nursing usage in the period that the nursing process was being introduced in Brazil. We detected in the results that the nurses in the 1960's up to the 1980's saw themselves being pushed by the universities' contradictory collections, by the job market and the professional's exercise law, combining the administration care planning supervision and teaching.

Adult's perception of health care after myocardial infarction.

OBJECTIVES: to describe the Adult's perception of healthcare after Myocardium Infarction. METHODS: qualitative descriptive analysis carried out with 12 adults who had myocardial infarction and conducted from February to May 2018. The research design was based on the "Consolidated Criteria for Reporting Qualitative Research". Data collection was performed through semi-structured questionnaire, interview script and field diary. The interviews were encoded, and their content was analyzed using software support. RESULTS: three classes were obtained: "Fear, (un) certainty and (un) awareness"; "Lifestyle and beliefs of illness" and "Health care search". Unhealthy lifestyle habits, lack of health prevention / promotion, difficulties in accessing services and lack of knowledge about the disease generated fear and uncertainty about the future. Final Considerations: the perception of acute myocardial infarction is related to the trajectory of illness, lifestyle and the belief that the infarction only affects others.

Social representations of agressive men denounced for violence against women.

OBJECTIVES: To acknowledge the social representations of aggressive men denounced for violence against women. METHODS: A qualitative study based on the Theory of Social Representations, carried out with 12 men denounced for violence against women. Data were collected from February 2015 to April 2016, through an interview focused on the Special Women's Police Station (Delegacia Especial da Mulher) in of Guarapuava. The analysis was based on the transcription, coding and use of the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaire. RESULTS: Four categories were defined: from generation to generation: the spread of violence; feelings and behaviors in the face of violence; repercussions of violence on the aggressor; and, the aggressor and his victimization. FINAL CONSIDERATIONS: Men represent conjugal violence through victimizing and blaming women. The living of these men with violence comes from their childhood and the consequence feared by them is the prison.

[Nurses with chronic illness: relations with the illness, prevention and the work process]. / Enfermeiros com doença crônica: as relações com o adoecimento, a prevenção e o processo de trabalho.

Nurses work within the interface of the population's process of falling ill and of occupational diseases. In this setting, chronic diseases are evidenced, and they affect the work process. The purpose of this study was to identify, in nurses, the measures used to prevent health problems in the presence of a chronic disease, analyze the relation between their knowledge and attitudes toward chronic diseases, and the relation of risk factors with their work process. This is a quantitative and descriptive study, involving 23 nurses with chronic diseases, representing 76.6% of the 30 nurses diagnosed with a chronic illness at a Federal Hospital, 22 of whom are women. It was observed that the nurses comply with the treatment proposed for their disease and have effective strategies to cope with the fact of falling ill, changing their lifestyles. Furthermore, they reported there were factors in their work environment that contribute to worsen their illness.