Practices for self-care in Hansen's disease: face, hands and feet. / Práticas de autocuidado em hanseníase: face, mãos e pés.

OBJECTIVE: To analyze the self-care practices on the face, hands and feet carried out by people affected by Hansen's disease. METHODOLOGY: A qualitative study, carried out in reference units for Hansen's disease in Pernambuco, between May 2014 and April 2015, with 24 people. Data was collected through the semi-structured interview and content analysis was carried out. RESULTS: Two categories emerged: Knowledge and execution of self-care practices in Leprosy and Singularities and challenges for self-care. The study found that respondents are familiar with information about face, hand and foot care, but report difficulties such as low income to acquire material for self-care, lack of time, and some lack of interest. Most of them already presented a degree of incapacity. CONCLUSIONS: The training of professionals who work on the empowerment of people facing the disease, guidelines on prevention of disabilities and access to inputs for carrying out self-care are necessary.

Assistive technologies for improving the oral hygiene of leprosy patients residing in a former leprosy colony in Betim, Minas Gerais, Brazil.

BACKGROUND: This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments. METHODOLOGY: Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices. PRINCIPAL FINDINGS: Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided. CONCLUSIONS: This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients.

Práticas de autocuidado em hanseníase: face, mãos e pés / Prácticas de autocuidado en hanseniasis: cara, manos y pies / Practices for self-care in Hansen's disease: face, hands and feet

Resumo OBJETIVO Analisar as práticas de autocuidado em face, mãos e pés realizadas por pessoas atingidas pela hanseníase. METODOLOGIA Estudo qualitativo, realizado em unidades de referência para hanseníase em Pernambuco, entre maio de 2014 e abril de 2015, com 24 pessoas. Os dados foram coletados por meio da entrevista semiestruturada e realizada a análise de conteúdo. RESULTADOS Emergiram duas categorias: Conhecimento e realização de práticas de autocuidado em Hanseníase e Singularidades e desafios do autocuidado. O estudo apontou que os entrevistados conhecem as informações sobre os cuidados com a face, mãos e pés, mas relatam dificuldades como baixa renda para adquirir material para o autocuidado, falta de tempo, e alguns falta de interesse. A maior parte já apresentava grau de incapacidade. CONCLUSÕES É necessário a capacitação de profissionais que atuem no empoderamento das pessoas frente à doença e orientações sobre prevenção de incapacidades e acesso à insumos para realizar o autocuidado.

Resumen OBJETIVO Analizar las prácticas de autocuidado en cara, manos y pies realizadas por personas afectadas por la hanseniasis. METODOLOGÍA Estudio cualitativo, realizado en unidades de referencia para hanseniasis en Pernambuco, entre mayo de 2014 y abril de 2015, con 24 personas. Los datos fueron recolectados por medio de la entrevista semiestructurada y realizada el análisis de contenido. RESULTADOS emergieron dos categorías: Conocimiento y realización de prácticas de autocuidado en Hanseniasis y Singularidades y desafíos del autocuidado. El estudio apuntó que los entrevistados conocen las informaciones sobre los cuidados con la cara, manos y pies, pero relatan dificultades como bajas rentas para adquirir material para el autocuidado, falta de tiempo, y algunos falta de interés. La mayor parte ya presentaba grado de incapacidad. CONCLUSIONES Es necesario la capacitación de profesionales que actúen en el empoderamiento de las personas frente a la enfermedad y orientaciones sobre prevención de discapacidades y acceso a insumos para realizar el autocuidado.

ABSTRACT OBJECTIVE To analyze the self-care practices on the face, hands and feet carried out by people affected by Hansen's disease. METHODOLOGY A qualitative study, carried out in reference units for Hansen's disease in Pernambuco, between May 2014 and April 2015, with 24 people. Data was collected through the semi-structured interview and content analysis was carried out. RESULTS Two categories emerged: Knowledge and execution of self-care practices in Leprosy and Singularities and challenges for self-care. The study found that respondents are familiar with information about face, hand and foot care, but report difficulties such as low income to acquire material for self-care, lack of time, and some lack of interest. Most of them already presented a degree of incapacity. CONCLUSIONS The training of professionals who work on the empowerment of people facing the disease, guidelines on prevention of disabilities and access to inputs for carrying out self-care are necessary.

The Use of Assistive Technology to Promote Care of the Self and Social Inclusion in Patients with Sequels of Leprosy.

BACKGROUND: This study is about the contribution of occupational therapy inside a rehabilitation group, and we focus on the autonomy of patients with disabilities due to leprosy. There are few studies on the use of assistive technology by leprosy patients; to our knowledge, none of them aim to have a subjective approach of care. Our purpose was to analyze the repercussions of assistive technology on autonomy of care of the self in patients with sequels of leprosy. METHODS: A qualitative, descriptive exploratory study with a semi-structured interview and a field observation as a research method was conducted between November 2014 and February 2015 at a University Hospital in Rio de Janeiro. FINDINGS: Eight patients from the service of Occupational Therapy were interviewed, and 44 hours of observation were performed. Interviews followed a semi-structured script and a field journal was used to take notes. Analysis was conducted by the hermeneutic approach. Costs were obtained after a global cost analysis of the fixed and variable expenses and direct and indirect costs to the manufactured products with an amount of 100 dollars. Results were grouped according to the following categories: contribution of the adapted devices for the care of the self and feelings and sensations provoked by the use of self-help devices. The reports revealed feelings, perceptions and meaningful contents about the social, familiar and individual dimensions, also the stigma coupled with leprosy. However, forms of re-signification were elaborated. CONCLUSIONS: Assistive technology empowers the subject to perform care of the self and promotes social inclusion.

The pathway to foot ulceration in diabetes.

It should now be possible to achieve a reduction in the incidence of foot ulceration and amputations as knowledge about pathways that result in both these events increases. However, despite the universal use of patient education and the hope of reducing the incidence of ulcers in high-risk patients, there are no appropriately designed large, randomized controlled trials actually confirming that education works. It has been recognized for some years that education as part of a multidisciplinary approach to care of the diabetic foot can help to reduce the incidence of amputations in certain settings. Ultimately, however, a reduction in neuropathic foot problems will only be achieved if we remember that the patients with neuropathic feet have lost their prime warning signal­pain­that ordinarily brings patients to their doctor. Very little training is offered to health care professionals as to how to deal with such patients. Much can be learned about the management of such patients from the treatment of individuals with leprosy: if we are to succeed, we must realize that with loss of pain there is also diminished motivation in the healing of and prevention of injury.

Self care groups and ulcer prevention in Okegbala, Nigeria.

OBJECTIVE: To assess the impact of the three self-care Groups on ulcer prevalence and readmission rates in Okegbala hospital. DESIGN: A retrospective, descriptive study. The evaluation combined four data collection methods namely (i) records survey, (ii) semi-structured interviews of individual members of self-care groups, (iii) group discussions and (iv) key informant interviews. RESULTS: Record surveys show that the ulcer prevalence has decreased by almost 75% since the adoption of the self-care group; admissions to hospital for ulcer care have reduced, and the mean interval between admissions has increased by 7 months. Semi structured interviews and group discussions show that all members have a greater sense of control of their ulcers and general health; and that self-care groups have a potential of catalysing community solidarity and development. CONCLUSIONS: This small study shows that self-care groups are valuable for reducing ulcers and giving members a greater sense of control of their ulcers and general health resulting in fewer hospital admissions. We recommend a multi-centre, controlled, prospective study incorporating different settings (e.g. urban, rural, near hospitals, within field leprosy programmes) to test these findings. Such a study has the potential of influencing policy and health-service reorientation of ulcer care in future.

Assistive devices for people affected by leprosy: underutilised facilitators of functioning?

OBJECTIVES: People affected by leprosy and their families face social and economic problems. The focus of interventions is often on prevention of disabilities and socioeconomic rehabilitation. The objective of this study was to explore to what extent the potential of assistive devices to facilitate activities and participation of people affected by leprosy has been utilised. DESIGN: Published literature was reviewed and the findings analysed. RESULTS: Considerable attention has been given to the protecting role of assistive devices. The focus of assistive devices facilitating functioning has been on mobility aspects of self-care and domestic life. CONCLUSIONS: The findings indicate that the potential of assistive devices to facilitate activities and participation in life areas such as work and employment is still waiting to be utilised on a broad scale.

[Leprosy assessment: experience report of nursing students]. / Avaliação da Hanseníase: relato de experiência de acadêmicos de enfermagem.

Brazil is the second in the world in new cases of Leprosy. The eradication continues to be a defiant goal. It has sought describe the morphologic profile of lesion formations and analyze the procedures in the care of wounds from a group of people with sequelae of Hansen asylum in an institution non-governmental. The experience of teaching-learning was longitudinal, based on Scientific Methodology of Nursing Assistance, involving people with swellings and health repercussions of Hansen's disease, residents in an institution of Goiás State. All the residents presented disabling swellings and health repercussions associated to the Leprosy: visual impediment, swelling of the eyebrows; fall of the nasal pyramid, total reabsorption of fingers and toes, amputation of both legs, ulna grip, perforating plantar disease. Abrasive soaps and toxic antiseptic were applied directly on the lesion, causing damages to the scarring.

Avaliação da Hanseníase: relato de experiência de acadêmicos de enfermagem / Evaluación de la Lepra: relato de experiencia de estudiantes de enfermería / Leprosy assessment: experience report of nursing students

O Brasil é o segundo no mundo em novos casos de hanseníase. O controle da doença continua sendo uma meta desafiante. Buscou-se descrever o perfil morfológico de lesões cutâneas e outras seqüelas e analisar a conduta adotada no cuidado de feridas de um grupo de pessoas com seqüelas de hanseníase asiladas em uma instituição não governamental. A experiência de ensino-aprendizagem foi longitudinal, fundamentada na Metodologia Científica da Assistência de Enfermagem, envolvendo pessoas com seqüelas de Hanseníase asilados em uma instituição não governamental do estado de Goiás. O perfil morfológico das lesões foi: déficit visual, madarose, desabamento da pirâmide nasal, reabsorção de dedos e artelhos, amputação de membros, mal perfurante plantar e garra ulnar. Detectou-se prejuízo da cicatrização devido à aplicação direta e rotineira de sabões abrasivos e anti-sépticos nas lesões.

Brazil is the second in the world in new cases of Leprosy. The eradication continues to be a defiant goal. It has sought describe the morphologic profile of lesion formations and analyze the procedures in the care of wounds from a group of people with sequelae of Hansen asylum in an institution non-governmental. The experience of teaching-learning was longitudinal, based on Scientific Methodology of Nursing Assistance, involving people with swellings and health repercussions of Hansen's disease, residents in an institution of Goiás State. All the residents presented disabling swellings and health repercussions associated to the Leprosy: visual impediment, swelling of the eyebrows; fall of the nasal pyramid, total reabsorption of fingers and toes, amputation of both legs, ulna grip, perforating plantar disease. Abrasive soaps and toxic antiseptic were applied directly on the lesion, causing damages to the scarring.

Brasil es el segundo país en el mundo en nuevos casos de Enfermedad de Hansen (Lepra). La eliminación continúa siendo una meta desafiadora. Buscamos describir el perfil morfológico de lesiones cutáneas y secuelas y analizar la conducta adoptada para cuidado de las heridas de un grupo de personas con secuelas de Enfermedad de Hansen de un asilo no gubernamental. La experiencia de enseñanza-aprendizaje se longitudinal, fundamentado en la Metodología Científica de la Asistencia de Enfermería, incluyendo personas con lesiones y secuelas de lepra, internadas en una institución del Estado de Goiás. Todos los internos presentaban lesiones y secuelas de incapacidad asociadas a la lepra: déficit visual, madarosis; caída de la pirámide nasal, reabsorción total de dedos y dedos de los pies, amputación de ambas piernas, mal perforante plantar y garra ulnar. Jabones abrasivos y antisépticos tóxicos eran aplicados directamente en las lesiones, causando prejuicios a la cicatrización.

Self-care programme to prevent leprosy-related problems in a leprosy colony in Champa, Chattisgarh.

A self-care programme aimed at preventing leprosy-related physical disabilities in a leprosy colony in Champa, Chattisgarh, India, is described. Once the initial resistance was overcome through persistent and caring attitudes, the residents accepted the challenges for self-care. The outcome at the end of one year showed significant decline (41%) in ulcer rates, significant use of MCR footwear (43%), and significant proportion (over 90%) of patients and their families practising and helping in self-care activities.

Management of simple plantar ulcers by home based self-care.

Seeking a solution to bring down the prevalence of simple plantar ulcers in the field, Damien Foundation India Trust (DFIT), Chennai, developed a curriculum to teach the field staff of all its projects. The purpose was to make patients self-reliant in the care of their plantar ulcers in their homes. The strategy used was to make patients take care of their ulcers using tools found in their homes and surroundings and become responsible for the care of their limbs. This strategy was implemented in eight projects of DFIT and the programme was followed regularly for one year. Regular monitoring and evaluation showed that under this strategy the prevalence of plantar ulcers was reduced by about 50%.

Increasing self-confidence through self-talk.

There are varied opinions on the commonness of self-talk. Some feel self-talk is engaged in more by persons who feel insecure and question their performance (Cauchon, 1994). Others feel self-talk is a process people use continually to describe and interpret the world, accurate or inadequate as the case may be. (Hansen, Rhode, and Wolf-Wilets, 1991; Braiker, 1989). Regardless of how much self-talk the nurse is aware of in interacting with clients and intrapsychically, it is important to assess thoughts for their logic or illogicality. Illogical thoughts should be replaced by positive words of encouragement, which will in turn raise the client's or nurse's self-concept and level of self-confidence. Making self-talk positive is always good nursing practice.