The Impact of Venous Leg Ulcers on Body Image and Self-esteem.

OBJECTIVE: To evaluate self-esteem and body image in patients with venous leg ulcers (VLUs). DESIGN: A multicenter, prospective, descriptive, analytical, clinical study. SETTINGS: A nursing care and education center of a university hospital, a health center, and an outpatient wound care clinic in Brazil. PATIENTS: Fifty-nine consecutive adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 were recruited for the study. Exclusion criteria were mixed ulcers, arterial ulcers, and diabetic foot ulcers. MAIN OUTCOME MEASURES: A questionnaire assessing sociodemographic and clinical characteristics of patients, the Brazilian version of the Body Investment Scale, and the Rosenberg Self-esteem (RSE)/UNIFESP-EPM (São Paulo da Universidade Federal de São Paulo-Escola Paulista de Medicina) scale were administered to all patients. MAIN RESULTS: Most participants were women, aged between 60 and 70 years, and smokers; 33 (56%) were divorced, widowed, or single, and 26 (44%) were married. The patients had the ulcer for a mean of 5.42 years. Exudate and foul odor were present in most cases. Twenty-one ulcers (36%) measured 29 cm or less in surface area, and 17 (29%) ulcers measured between 30 and 49 cm (mean, 3.39 cm). The mean RSE score was 22.66, indicating low self-esteem. The mean Body Investment Scale total score was 27.49, and the scores on the body image and body touch subscales were also low, indicating negative feelings about the body. CONCLUSION: Patients with VLUs had low self-esteem and negative feelings about their bodies.

Feelings of powerlessness in patients with diabetic foot ulcers.

UNLABELLED: The purpose of this study was to assess feelings of powerlessness in patients with diabetic foot ulcers. Chronic wounds affect the emotional state of patients, who may experience negative emotions including a sense of loss and powerlessness. The assessment of these feeling should contribute to the planning of interventions aimed at minimizing the impact of diabetic foot ulcers on the daily lives of these patients. METHODS: Fifty patients ≥ 18 years of age with type 1 or type 2 diabetes and foot ulcers were selected from 2 outpatient wound-care clinics to participate in the study. Of these patients, 50% were 61-70 years old, 72% were women, 74% were smokers, 10% were alcoholics, 40% had a diabetic foot ulcer for 3-6 years, and 22% for 7-10 years. Wound odor and exudate were present in 82% of patients. Individuals who were unable to respond to a questionnaire due to physical or cognitive deficit were excluded. All participants responded to the Powerlessness Assessment Tool for adult patients (PAT), with scores ranging from 12-60, with higher scores corresponding to feelings of more intense powerlessness. RESULTS: Total PAT scores ranged from 31-40 for 5 (10%) patients, 51-60 for 28 (56%) patients and from 41-50 for 17 (34%) patients. All patients reported total and subscale PAT scores ≥ 34 (moderate to high scores), with a mean total score of 50.12. The maximum PAT score of 60 was reported on the "self-perception of decision-making capacity" domain. CONCLUSION: These results indicate that patients with diabetic foot ulcers had strong feelings of powerlessness.