Effect of Polyhexamethylene Biguanide Solution on Bacterial Load and Biofilm in Venous Leg Ulcers: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to investigate the effect of polyhexamethylene biguanide (PHMB) solution as a wound cleanser on bacterial load and bacterial biofilm in venous leg ulcers. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The target population was adults attending the dermatology outpatient clinic of the Clinical Hospital of the Federal University of Minas Gerais, Brazil. The sample comprised 44 patients with venous leg ulcers recruited over a 6-month period. METHODS: Participants were divided into 2 groups: the intervention group had their wounds cleansed with PHMB, and the control group had their wound cleansed with a 0.9% saline solution. Tissue fragments of the wounds were collected for bacteriological analysis; transmission electron microscopy was used to identify the presence of biofilm. RESULTS: The bacterial load was reduced in both groups compared to baseline values; no significant difference was found when groups were compared. Correlation analysis between wound duration (months), wound area (cm²), necrosis (%), variables, and bacterial count (colony forming units [CFUs]/g) after cleansing showed a significant relationship between area of the wound and CFUs/g (P = .0070, r = 0.51). Transmission electron microscopy revealed the presence of bacterial biofilm in the wounds after cleansing with both solutions. CONCLUSIONS: The results of this study indicate that both PHMB and saline solution are effective in reducing the bacterial load in venous leg ulcers. However, bacterial biofilm was present after cleansing with both solutions. These findings provide important evidence regarding effectiveness of 2 common wound cleansers on bacterial presence in wounds.

Epistemology of nursing care: a reflection on its foundations. / Epistemologia do cuidado de enfermagem: uma reflexão sobre suas bases.

OBJECTIVE:: to reflect on nursing care and its epistemology from its historical, theoretical, philosophical, spiritual dimensions and as a social practice. METHOD:: discussions originated in the discipline "Epistemology of caring", from the graduate nursing program of the School of Nursing, Federal University of Minas Gerais, and in critical analysis of nursing literature together with the professional practice of the authors. RESULTS:: we identified the necessity of developing a critical conscience on health care provision, research, and teaching, as well as on challenges in maintaining high standards of working interpersonal relationships, which has a profound impact on population health. CONCLUSION:: we suggest the rescue of integrality, humanization, unity, and spirituality in researches and practices of individual, familiar, and community care, as an advance in incorporating epistemology of caring in nursing.

Epistemologia do cuidado de enfermagem: uma reflexão sobre suas bases / Epistemología del cuidado de enfermería: una reflexión sobre sus bases / Epistemology of nursing care: a reflection on its foundations

RESUMO Objetivo: refletir sobre o cuidado de enfermagem e sua epistemologia, partindo de suas dimensões histórica, teórica, filosófica, espiritual e como prática social. Método: discussões no decorrer da disciplina "Epistemologia do Cuidado", do Programa de Pós-Graduação em Enfermagem da Escola de Enfermagem da Universidade Federal de Minas Gerais e análise crítica de literatura científica da enfermagem agregada ao cuidado no exercício profissional das autoras. Resultados: identificou-se a necessidade do desenvolvimento de uma consciência crítica sobre as formas de cuidar no âmbito da assistência, pesquisa e ensino, bem como nos desafios que envolvem a qualidade das relações interpessoais no trabalho e no ambiente, como fator de impacto na saúde das pessoas, comunidades e populações. Conclusão: sugere-se o resgate da integralidade, da humanização, da unicidade, da espiritualidade nas pesquisas e práticas do cuidado do indivíduo, da família e da comunidade, como avanço na incorporação do conhecimento epistemológico do cuidar em enfermagem.

RESUMEN Objetivo: reflexionar sobre el cuidado de enfermería y su epistemología, partiendo de sus dimensiones histórica, teórica, filosófica, espiritual y como práctica social. Método: discusiones durante dictado de materia "Epistemología del Cuidado", del Programa de Posgrado en Enfermería de la Escuela de Enfermería, Universidad Federal de Minas Gerais y análisis crítico de literatura científica de enfermería, sumada al cuidado en ejercicio profesional de las autoras. Resultados: se identificó necesidad de desarrollar conciencia crítica sobre formas de cuidar en ámbitos de la atención, investigación y enseñanza, así como en desafíos que involucran la calidad de relaciones interpersonales laborales y ambientales, como factor de impacto en la salud de las personas, comunidades y poblaciones. Conclusión: se sugiere el rescate de la integralidad, la humanización, la unicidad, la espiritualidad, en investigaciones y prácticas de cuidado del individuo, la familia y la comunidad, como avance en la incorporación del conocimiento epistemológico del cuidar en enfermería.

ABSTRACT Objective: to reflect on nursing care and its epistemology from its historical, theoretical, philosophical, spiritual dimensions and as a social practice. Method: discussions originated in the discipline "Epistemology of caring", from the graduate nursing program of the School of Nursing, Federal University of Minas Gerais, and in critical analysis of nursing literature together with the professional practice of the authors. Results: we identified the necessity of developing a critical conscience on health care provision, research, and teaching, as well as on challenges in maintaining high standards of working interpersonal relationships, which has a profound impact on population health. Conclusion: we suggest the rescue of integrality, humanization, unity, and spirituality in researches and practices of individual, familiar, and community care, as an advance in incorporating epistemology of caring in nursing.

Vislumbrando “O Artífice” no cotidiano detrabalho das enfermeiras na gerência hospitalar / Glimpsing “The Architect” in the daily work of nurses inhospital management

Este estudo objetivou compreender o cotidiano de trabalho das enfermeiras no exercício da gerência em hospitais demédio porte, tomando como base e referência o processo de trabalho do artífice proposto por Richard Sennet. Trata-se deestudo qualitativo, descritivo, realizado por meio de um estudo de caso cujo cenário se constituiu de quatro instituiçõeshospitalares de médio porte situado na região do Norte de Minas Gerais. A coleta de dados foi realizada por meio deentrevista semiestruturada com todas os enfermeiros em cargos de gerência nos níveis intermediário e estratégico de umaorganização hospitalar. Participaram do estudo 12 enfermeiras gerentes que atendiam aos critérios de inclusão estabelecidos.Os dados foram submetidos à análise temática de conteúdo, operacionalizada em três fases: pré-análise, exploraçãodo material e tratamento dos resultados e interpretação. Na análise, evidenciaram-se as seguintes categorias empíricas: “aenfermeira na busca pela qualidade da assistência”, “a liderança como habilidade essencial da enfermeira gerente” e “aformação da enfermeira para o exercício da função gerencial”. Os resultados evidenciaram que as enfermeiras gerentesapresentam preocupação e interesse com a qualidade da assistência, visão da liderança como componente essencial nasrelações de trabalho e na comunicação. Além disso, foi ressaltada a importância da formação acadêmica para o desempenhodas funções gerenciais e as práticas cotidianas nesta função. Conclui-se que a enfermeira gerente compreende a suaimportância na instituição hospitalar, percebendo-se como profissional agregador e conhecedor das relações trabalhistase administrativas, propondo estratégias capazes de alcançar um cuidado planejado e de maior qualidade.

This study aimed at understanding the daily work of nurses in managerial practice in medium-sized hospitals, based onworking process proposed by the architect Richard Sennet. This is a qualitative descriptive study was conducted througha case study whose scenario consisted of four medium size hospitals in a city located in the northern region of MinasGerais. Data collection was conducted through semi-structured interviews with twelve nurses in management positionsin strategic and intermediate levels of a hospital organization. Study participants were 12 nurse managers that met theestablished inclusion criteria. Data were submitted to content analysis, and the study uncovered four empirical categoriesoperationalized in three stages: pre-analysis, material exploration and treatment of results and interpretation. The analysisshowed the following empirical categories, “the nurse in the search for quality of care,” “leadership as essential skill of thenurse manager” and “the formation of the nurse for the exercise of the managerial function. The results showed that nursemanagers have interest and concern for the quality of care, vision of leadership as a key component in working relationshipsand communication. In addition, they stressed the importance of academic training for the performance of managementfunctions and everyday practices in this function. We conclude that nurse managers understands their importance in thehospital, seeing themselves as professionals and experts of labor and administrative relationships, proposing strategies toachieve a planned care with a higher quality.