Evidências do cuidado de enfermagem para o conforto/bem-estar dos clientes com dermatoses imunobolhosas: ensaio clínico / Evidences of nursing care for the comfort/well-being of clients with immunobullous dermatoses: a clinical trial

O contato com pessoas acometidas por dermatoses imunobolhosas (DI) é impactante devido ao visível sofrimento causado pelo desconforto/mal-estar e comprometimento da autoimagem. Trata-se de um grupo de doenças de evolução crônica cuja manifestação primária e fundamental consiste no desenvolvimento de bolhas e menos frequentemente de vesículas na pele e/ou mucosas. O desafio de cuidar desta clientela justifica-se pelo caráter desfigurante e desconfortante, complexidade e vulnerabilidade a complicações, dentre as quais infecções e infestações, principalmente no ambiente hospitalar, fato agravado pelas drogas imunossupressoras utilizadas para o tratamento. Neste contexto, sobreleva-se a necessidade de ampliação do cuidado de enfermagem, sem limitar-se ao cumprimento das prescrições dos demais profissionais de saúde, objetivando atender às necessidades desta clientela e contemplá-la em todas as suas dimensões. Assim, este estudo teve como objetivo geral: propor uma Tecnologia de Cuidados de Enfermagem ao Cliente com Dermatoses Imunobolhosas (TCECDI) que reconheça padrões de conforto/bem-estar do cliente hospitalizado, antes e após a sua aplicação. A necessidade de trabalhar com dados imprecisos como a subjetividade do conforto/bem-estar, e com um grupo de doenças de incomum acometimento às pessoas, despertou o interesse pela lógica fuzzy, uma teoria que auxilia na compreensão dos conceitos que extrapolam as barreiras da lógica formal, permitindo estabelecer diferentes graus de pertinência dos atributos julgados relevantes, representando uma ferramenta que pode capturar informações subjetivas convertendo-as em valores de pertinência. Os atributos estabelecidos para avaliação do conforto nos três momentos foram: dor, mobilidade, padrão de sono, exposição do corpo e das lesões, conhecimento sobre a doença e autocuidado. Trata-se de um estudo quase experimental, interinstitucional, realizado no período de junho de 2012 a abril de 2013, em unidades de internação especializadas em dermatologia localizadas no Rio de Janeiro e no Mato Grosso do Sul. O delineamento alternativo para o ensaio clínico utilizado foi destinado a um único grupo não randomizado do tipo série temporal. As aferições foram realizadas antes (T0), 24 horas após (T1) e uma semana após (T2) o recebimento da intervenção. Como inexiste grupo controle, em cada sujeito considerou-se o seu próprio controle. Baseando-se nas classificações advindas da lógica fuzzy, na definição de conforto e nos três sentidos técnicos preconizados por Kolcaba: alívio, calma e transcendência,constatou-se a redução significativa no padrão de desconforto. Assim, pode-se afirmar que a implementação da TCECDI interferiu de forma expressiva e positiva nas necessidades de conforto dos sujeitos do estudo. Ao privilegiar a autonomia do enfermeiro e o seu saber específico, esta pesquisa contribuiu para a enfermagem como profissão, preenchendo lacunas nesta área do conhecimento, possibilitando o ensino qualificado, além de estimular entre os profissionais de saúde a reflexão, compreensão e desenvolvimento de outras pesquisas sobre a prática do cuidado em saúde, principalmente em dermatologia.

The contact with people affected by immunobullous dermatoses (ID) is stunning due to the evident suffering caused by the discomfort/poor welfare, as well as the commitment of the self-image. That is a group of chronic diseases, whose primary and fundamental manifestation consists in the development of blisters and, less frequently, vesicles in the skin and/or mucosae. The challenge of taking care of these clients is justified by the deforming and uncomfortable nature, as well as its complexity and vulnerability to complications, including infections and infestations, mainly in hospital environment, a fact that is worsened by the immunosuppressive drugs used in its treatment. In this context, the need to increase the nursing care becomes evident, without failing to observe the prescriptions by the other healthcare professionals, with a view to meeting the needs of these clients and fulfilling these needs in all of their dimensions. Therefore, the aim of this study is to propose a Nursing Care Technology for the Client with immunobullous dermatoses (TCECDI) that acknowledges comfort/welfare standards of the inpatient before and after its application. The constraint of working with inaccurate data such as the subjectivity of comfort/welfare, and with a group of diseases that affect people in an uncommon manner, has sparked the interest by the fuzzy logic, a theory that helps understand the concepts that extrapolate the barriers of formal logic, thus enabling the establishment of different degrees of pertinence of the attributes deemed relevant, representing a tool that may collect subjective data and convert them into pertinence values. The attributes established to assess the comfort in the three moments were: pain, mobility, sleep pattern, exposure of the body and the injuries, knowledge on the disease and self-care. That is a quasi-experimental, interinstitutional study, carried out from June 2012 to April 2013, in inpatient units specialized in dermatology located in the states of Rio de Janeiro and Mato Grosso do Sul. The alternative design for the clinical trial used was intended to a single non-randomized group of the time-series type. The calculations were made before (T0), 24 hours later (T1) and one week later (T2) receiving the intervention. As there is no control group, each subject was regarded as his/her own control group. Based on the classifications derived from fuzzy logic, in the definition of comfort and in the three technical senses define by Kolcaba: relief, ease and transcendence, we observed a significant reduction in the discomfort pattern. Therefore, we may affirm that the implementation of the TCECDI interfered, in a explicit and positive manner, on the comfort needs of the study subjects. By favoring the autonomy of the nurse and his/her specific knowledge, this research contributed to nursing as a profession, filling gaps in the field of knowledge, enabling qualified training, as well as stimulating, among the healthcare professionals, the reflection, understanding and development of further research on the healthcare practice, mainly in dermatology.

El contacto con personas acometidas por dermatoses inmunoampollosas (DI) es impactante debido al sufrimiento causado por el desconforto/malestar y comprometimiento de la autoimagen. Se trata de un grupo de enfermedades de evolución crónica cuya manifestación primaria y fundamental consiste en el desarrollo de ampollas y menos frecuentemente de vesículas en la piel y/o mucosas. El desafío de cuidar de esta clientela se justifica por el carácter de desfiguración y desconforto, complejidad y vulnerabilidad a complicaciones, entre las cuales infecciones e infestaciones, principalmente en el ambiente hospitalario, hecho agravado por las drogas inmunosupresoras usadas para el tratamiento. En este contexto, se destaca la necesidad de ampliación del cuidado de enfermería, sin limitarse al cumplimiento de las prescripciones de los otros profesionales de salud, objetivando atender a las carencias de esta clientela considerada en todas sus dimensiones. Por eso, este estudio tuvo como objetivo general: proponer una Tecnología de Cuidados de Enfermería al Cliente con Dermatoses Inmunoampollosas (TCECDI) que reconozca patrones de conforto/bienestar del cliente hospitalizado, antes y despues de su aplicación. La necesidad de trabajar con datos imprecisos como la subjetividad del conforto/bienestar, y con un grupo de enfermedades de acometimiento incomún a las personas, suscitó el interés por la lógica fuzzy, una teoría que ayuda en la comprensión de los conceptos que extrapolan las barreras de la lógica formal, permitiendo establecer diferentes grados de pertinencia de los atributos considerados relevantes, representando una herramienta que puede capturar informaciones subjetivas transformadas en valores de pertinencia. Los atributos establecidos para evaluación del conforto en los tres momentos fueron: dolor, movilidad, patrón de sueño, exposición del cuerpo y de las lesiones, conocimiento sobre la enfermedad y autocuidado. Se trata de un estudio casi experimental, interinstitucional, realizado de junio de 2012 a abril de 2013, en unidades de internación especializadas en dermatología localizadas en Rio de Janeiro y Mato Grosso do Sul ­ Brasil. El delineamiento alternativo para el ensayo clínico utilizado fue destinado a un grupo único no randomizado del tipo serie temporal. Las afericiones hechas antes (T0), 24 horas despues (T1) y una semana después (T2) del recibimiento de la intervención. Como no hay grupo control, en cada sujeto se consideró su proprio control. Con base en las clasificaciones oriundas de la lógica fuzzy, en la definición de conforto y en los tres sentidos técnicos preconizados por Kolcaba: alivio, calma y transcendencia, se constató reducción significativa en el patrón de desconforto. Así se puede afirmar que la implementación de la TCECDI interfirió de forma expresiva y positiva en las necesidades de conforto de los sujetos del estudio. Privilegiando la autonomía del enfermero y su saber específico, esta investigación contribuyó para la enfermería como profesión, rellenando lagunas en esta área del conocimiento, posibilitando la enseñanza calificada, allén de estimular entre los profesionales de salud la reflexión, comprensión y desarrollo de otras pesquisas sobre la práctica del cuidado en salud, y en dermatología.

[The treatment of blisters caused by friction while hiking the Road to Santiago]. / Cura de ampollas por fricción. A propósito del Camino de Santiago.

This article deals with a practical experience treating blisters caused by friction on feet of pilgrims who hiked the Road to Santiago. To design this treatment plan, the authors considered the peculiarities a hike which lasts over many days has: comfort criteria, security and prevention of complications. The study subjects were pilgrims, travelling companions of the authors. These stand out as main differentiating characteristics of this proposed treatment, the precocious debridement of the skin of the blister, the use of a wet cure which has nitrofurazone in it and the application of a bandage. Following this procedure, the authors of this study tended to 16 lesions, carrying out a total of 112 cures which showed a favorable evolution within six days and no significant differences in the improvement of the lesion.

Cura de ampollas por fricción. A propósito del camino de Santiago / The treatment of blisters caused by friction while hiking the road to Santiago

Se recoge una experiencia práctica de tratamiento de ampollas por fricción en los pies de peregrinos del Camino de Santiago. En el diseño del plan de tratamiento se consideraron las peculiaridades de una marcha que se prolonga durante días: criterios de comodidad, seguridad y prevención de complicaciones. Los sujetos de estudio son peregrinos, compañeros de viaje de los autores. Como principales características diferenciales del método propuesto se destacan el desbridamiento precoz de la piel de la ampolla, la utilización de una cura húmeda con nitrofurazona y la fijación con un vendaje. Siguiendo este método se atendieron 16 lesiones, realizándose un total de 112 curas, registrando una evolución favorable en seis días y sin diferencias significativas en la mejoría de la lesión

this article deals with a practical experience treating blisters caused by friction on feet of pilgrims who hiked the Road to Santiago. To design this treatment plan, the authors considered the peculiarities a hike which lasts to over many days has: comfort criteria, security and prevention of complications. The study subjects were pilgrims, traveling companions of teh authors. these stand out as main differentiating characteristics of this proposed treatment, the precocious debridement of the skin of the blister, the use of a wer cure which has nitrofurazone in it and the application of a banage. following this procedure, the authors of this study tended to 16 lesions, carrying out a total of 112 cures which showed a favourable evolution within six days and no significant differences in the improvement of the lesion

Wound care for burn patients in acute rehabilitation settings.

Caring for patients who are recovering from severe burns is not common in most inpatient rehabilitation settings. Nursing challenges include patients' physical and psychological changes and their high care demands. Harborview Medical Center (HMC), a regional Level 1 burn and trauma center in Seattle, WA, accepted these nursing challenges and developed a successful plan of care consistent with current evidence. This article describes HMC's nursing experiences while caring for patients with burns. Our experiences may assist other rehabilitation units that serve burn patients. Says one burn survivor: "Nurses make a huge difference in recovery, as they are there 24 hours a day. It is their touch, their caring, and their listening that aids the patient in his journey from fire victim to burn survivor."

Deroofing minor burn blisters--what is the evidence?

It is estimated that 150000 new patients per year will attend an A&E Department or Minor Injury Unit (MIU) with a minor burn injury (Wardrope & Edhouse 1999). There is often conflicting 'evidence' for the management and treatment of minor burns blisters and this can cause variations in the treatment provided within an A&E department resulting in confusion for staff and patients.

Treatment of a heel blister caused by pressure and friction.

The treatment of heel blisters caused by pressure, friction, and shear is a complex subject. Issues such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose, need to be considered. As nurses are increasingly aware of the emphasis that has been placed on the importance of ensuring that clinical practice is based on evidence, this article attempts to shed some light on these areas of debate. It is important to highlight that during the literature search very little research was found to exist on blister care and it became clear that further research into the nursing care of a blister caused by pressure would be useful to aid nursing care and patient comfort.

Fracture blisters: a review of the literature.

Following orthopaedic trauma, fracture blister formation creates a disruption in skin integrity for the injured patient and unique care challenges for the nurse and physician. These blisters may delay surgery, alter the optimum treatment plan, promote wound infection, delay wound healing, and ultimately prolong recovery. This article presents a review of the current literature and includes a discussion of the anatomy of the skin, pathophysiology of fracture blisters, and a review of current research. The complications, prevention, treatment, and implications for nursing care are also examined.

Using the nursing process to solve a problem: post-op tape blisters.

ET nursing consultation was requested for the treatment of ten cases of tape blisters within six months, the majority of which were post-op following hip surgery. When the ET nursing staff was asked to develop a standard treatment protocol for these blisters, they used the nursing process. They identified the problem, assessed the situation, planned and implemented a response, and evaluated the results in an ongoing manner. It was then theorized that lack of "stretch" in the tape might be causing the tape blisters. After five stretch tapes were assessed for ease of removing the paper backing, handling, application, flexibility, and adhesion, one tape was preferred by the operating room and nursing unit staffs and was put into routine use in October 1992. No further blisters have been noted since this change was made. By using the nursing process, the authors ultimately eliminated post-op tape blisters in the facility.