A Booklet on the Assessment, Prevention, and Treatment of Incontinence-Associated Dermatitis.

OBJECTIVE: Printed materials have been used as educational resources to assist healthcare professionals in evidence-based clinical practice by providing guidelines for treatment, prevention, and self-care. The aim of this study was to develop and validate a booklet on the risk assessment, prevention, and treatment of incontinence-associated dermatitis. METHODS: This was a descriptive, analytic, and quantitative study. The booklet was developed in six steps: situational diagnosis, development of the research question, integrative review of the literature, synthesis of knowledge, structuring and design, and validation of the content. An expert panel composed of 27 experienced nurses carried out content validation using the Delphi technique. The content validity index (CVI) and Cronbach α coefficient were calculated. RESULTS: The mean Cronbach α for the evaluation questionnaire was .91, indicating excellent internal consistency. The evaluators classified the content of the booklet from "inadequate" to "totally adequate" (overall CVI, 0.91) in the first round of consultation and from "adequate" and "totally adequate" (overall CVI, 1.0) in a second round of consultation. The booklet was therefore considered validated. CONCLUSIONS: A booklet on risk assessment, prevention, and treatment of incontinence-associated dermatitis was created and validated by an expert panel, obtaining 100% consensus among the evaluators in the second round of consultation.

Unna boot therapy impact on wellbeing, hope and spirituality in venous leg ulcer patients: a prospective clinical trial.

OBJECTIVE: To assess the impact of Unna boot therapy on subjective wellbeing, hope and spirituality in patients with venous leg ulcers (VLU). METHOD: This was a prospective, descriptive, analytical, multicentre clinical trial conducted in a nursing care and education centre, an outpatient wound care clinic and a primary health care unit in Brazil. Adult patients with VLUs took part in the study. Patients with diabetic foot ulcers and mixed ulcers were excluded. A questionnaire assessing sociodemographic and religious characteristics of patients, the Subjective Wellbeing Scale, the Spirituality Self-Rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all patients. RESULTS: A total of 60 patients (63.3% female; 86.7% aged ≥60 years) participated. Before Unna boot therapy, 65%, 66.7% and 65% of patients reported a score of one on positive affect, negative affect and life satisfaction, respectively, indicating poor subjective wellbeing. After one month of compression therapy, 66.7%, 50.0%, and 80.0% of patients reported a score of three for each element positive affect, negative affect and life satisfaction, respectively, showing a significant improvement in subjective wellbeing (p=0.029). A significant increase in total SSRS scores (p=0.017) was found between baseline (mean: 9.77) and one month of treatment (mean: 25.47), indicating a significant increase in a sense of spirituality. There was also a significant increase in total HHI values (p=0.009) between baseline (mean: 15.68) and one month of compression therapy (mean: 39.38), suggesting a significant increase in hope among patients. CONCLUSION: Patients with VLUs treated with Unna boot therapy in this study showed significant improvement in subjective wellbeing, spirituality and hope for cure.

Frailty syndrome and functional disability among older adults with and without diabetes and foot ulcers.

OBJECTIVE: To assess frailty and disability among older adults with and without diabetes or foot ulcers. METHOD: A descriptive, comparative, controlled, multicentre study. Equal numbers of participants were allocated to three groups: (I) no diabetes/no foot ulcers (control), (II) diabetes but no foot ulcers or (III) diabetes and foot ulcers. Individuals with arterial, venous, pressure or mixed ulcers were not included. We collected data using three methods: a sociodemographic questionnaire and the validated Brazilian versions of the Edmonton Frail Scale and Stanford Health Assessment Questionnaire 20-item Disability Scale (HAQ-20). RESULTS: A total of 150 older people took part in the study. The majority of participants were female (n=84, 56%), married (n=86, 57%) and did not exercise (n=94, 63%). Their age ranged from 67.7-71.5 years. In group I, 32 (64%) patients showed no evidence of frailty. In group II, 18 (36%) patients and 12 (24%) patients were 'apparently vulnerable' and 'mildly frail', respectively and in group III 21 (42%) patients and 15 (22%) patients had 'moderate' and 'severe frailty', respectively. The mean total HAQ-20 scores were 0.24, 0.52, and 2.44 for groups I, II, and III, respectively. Patients in group III reported significantly higher scores on all HAQ-20 categories compared with patients in groups I and II. CONCLUSION: Older patients with DFUs showed frailty and physical disability in activities of daily living.

Preventing and treating trench foot: validation of an educational manual for military personnel.

OBJECTIVE:: To develop and validate an educational manual on the prevention and treatment of trench foot for military personnel. METHOD:: This is a prospective, descriptive, observational study. A manual was developed based on a literature review of books, theses and articles published in the last 10 years. The manual was evaluated by an expert committee of the Brazilian Army, and tested and validated by military students from an Army Sargent School in Brazil. Students evaluated the following parameters: definition of trench foot, risk of trench foot development among the military, risk factors, identification of trench foot, preventive measures, treatment of trench foot, and final considerations. RESULTS:: A total of 99 military students participated in the testing. Some parameters were exclusively evaluated by the experts, 12 physicians and 11 nurses, and rated as 'good or very good' as follows: thematic content (100%), graphic display (100%), topic sequence (100%), clarity of language and comprehension of information (91.3%) and illustrations (95.6%). Other parameters were rated as 'good or very good' by both the experts and military students, as follows: definition of trench foot (100% and 85.8%), risk of trench foot among the military (95.6% and 86.8%), risk factors (100% and 82.8%), identification of trench foot (100% and 86.8%), preventive measures (100% and 81.8%), treatment (95.6% and 84.8%) and final considerations (95.6% and 81.82 %), respectively. Cronbach's alpha was 0.891 for consistency and 0.854 for reliability. CONCLUSION:: The educational manual was validated by health professionals, tested by military students, and showed to be a consistent, reliable and valid educational instrument for the prevention and treatment of trench foot.

Developing a Mobile App for Prevention and Treatment of Pressure Injuries.

OBJECTIVE: This descriptive study describes the planning and development of a mobile application (app) for prevention and treatment of pressure injuries for use by providers in a university research center. The app delineates risk factors for pressure injury development, provides an evaluation of the wound, recommends wound cleansing procedures, performs pressure injury staging, and recommends treatment interventions. METHODS: A mobile app was developed using a contextualized instructional design, which involves a constructivist proposal and planning, developing, and applying specific didactic situations, thus incorporating mechanisms that favor contextualization. A literature search was conducted to identify relevant studies for the construction of the mobile app. The development process involved the selection of app tools, definition of the navigation structure, and planning of the environment configuration. The environment for downloading the app software on the Internet and installing it on the mobile device was created. MAIN RESULTS: The literature search yielded 18 articles, 2 books, and 1 master's degree thesis. A mobile app was created with an easy-to-use graphic interface. The app stores the patient's demographic characteristics and provides an evaluation of his/her wound, a list of risk factors for pressure injury development, wound cleansing procedures, and treatment interventions. CONCLUSIONS: The developed app may be useful in clinical practice, helping to prevent pressure injuries and promote select nursing interventions for the treatment of patients with pressure injury.

Association of Sociodemographic Factors with Spirituality and Hope in Patients with Diabetic Foot Ulcers.

OBJECTIVE: To evaluate levels of spirituality and hope in patients with diabetic foot ulcers (DFUs) according to sociodemographic factors. DESIGN: This was a primary, prospective, descriptive, analytical, and clinical study. Questionnaires assessing sociodemographic and clinical characteristics of the patients, the Spirituality Self-rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all participants. SETTING: University-affiliated skilled nursing center and outpatient wound care clinic in Pouso Alegre, Brazil. PATIENTS: Fifty adult patients with DFUs participated in the study. Patients with ischemic diabetic foot and mixed ulcers were excluded from the study. MAIN RESULTS: On average, patients with DFUs had low levels of spirituality (mean SSRS score, 12.6) and low hope for cure (mean HHI, 16.5). Patients younger than 60 years reported significantly lower levels of spirituality (mean SSRS scores, 11.0), and those older than 70 years had significantly lower hope for cure (mean HHI, 12.5) than other age groups (P = .040). Level of spirituality was significantly lower among women (P = .015) and those living with an ulcer for more than 2 years, who also reported significantly lower hope for cure (P = .029) compared with patients having an ulcer for less than 2 years. CONCLUSION: On average, patients with DFUs, especially women and older adults, had a low sense of hope and spirituality. Except for gender, age, and ulcer duration, other sociodemographic and ulcer characteristics had no significant effect on the study population's spirituality and hope.

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.

Cross-cultural adaptation and validation of the neonatal/infant Braden Q risk assessment scale.

AIM: To translate into Brazilian Portuguese and cross-culturally adapt the Neonatal/Infant Braden Q Risk Assessment Scale (Neonatal/Infant Braden Q Scale), and test the psychometric properties, reproducibility and validity of the instrument. There is a lack of studies on the development of pressure ulcers in children, especially in neonates. METHODS: Thirty professionals participated in the cross-cultural adaptation of the Brazilian-Portuguese version of the scale. Fifty neonates of both sexes were assessed between July 2013 and June 2014. Reliability and reproducibility were tested in 20 neonates and construct validity was measured by correlating the Neonatal/Infant Braden Q Scale with the Braden Q Risk Assessment Scale (Braden Q Scale). Discriminant validity was assessed by comparing the scores of neonates with and without ulcers. RESULTS: The scale showed inter-rater reliability (ICC = 0.98; P < 0.001) and intra-rater reliability (ICC = 0.79; P < 0.001). A strong correlation was found between the Neonatal/Infant Braden Q Scale and Braden Q Scale (r = 0.96; P < 0.001). CONCLUSION: The cross-culturally adapted Brazilian version of the Neonatal/Infant Braden Q Scale is a reliable instrument, showing face, content and construct validity.

Association of sociodemographic factors with hope for cure, religiosity, and spirituality in patients with venous ulcers.

OBJECTIVE: The objective of the study was to evaluate the association of sociodemographic factors with hope for cure and levels of religiosity and spirituality in patients with venous leg ulcers (VLUs). DESIGN: This was a primary, prospective, descriptive, analytical, clinical, nonrandomized study. SETTING: The study was performed at a nursing care and education center of a university hospital in interior Minas Gerais, Brazil. PATIENTS: A convenience sample of 50 adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 participated in the study. Patients with mixed ulcers, arterial ulcers, and diabetic foot ulcers were excluded from the study. MAIN OUTCOME MEASURES: A questionnaire assessing sociodemographic and clinical characteristics of patients, the Spirituality Self-rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all patients. MAIN RESULTS: The mean SSRS score was 10.20, and the mean HHI was 25.5, corresponding to low levels of spirituality and moderate hope for cure, respectively. Patients aged between 50 and 59 years, men, nonsmokers, and those who were unemployed had the lowest mean SSRS scores. The lowest mean HHI values were reported by patients whose ulcers had exudate and odor, those aged 20 to 39 years, retired, and living with the wound for 1 year or less. Patients who had no religion or were not practicing a religion and those who considered living with an ulcer as a punishment reported low SSRS scores. CONCLUSION: The results showed that most patients with VLUs had low levels of spirituality, did not perceive divine intervention in their daily life or practice religious activities such as prayer, and had moderate hope for cure.

Evaluation of pain in patients with venous ulcers after skin grafting.

AIM: Pain was assessed in patients with venous leg ulcers treated with either split-thickness skin grafts or conventional treatment to evaluate to what extent skin grafting reduces pain in this population. METHODS: A controlled prospective clinical trial was conducted from July 2008 to June 2011 in two hospitals in São Paulo, Brazil. Two hundred patients with venous leg ulcers were divided into two treatment groups of 100 patients each: control group (conservative treatment) and surgery group (skin grafting). Patients were assessed at baseline (day 0) and after 30, 90, and 180 days. RESULTS: The surgery group reported significantly lower pain intensity (VAS pain scores) at postoperative days 30, 90 and 180 days compared with controls (P = 0.0001). The McGill Pain Questionnaire was used to assess the sensory, affective, evaluative, and miscellaneous dimensions of pain in both groups; there were significant differences between groups at the time points 30, 90 and 180 days (P = 0.0001). CONCLUSION: The patients with venous leg ulcers treated with split-thickness skin grafts reported significantly lower pain intensity compared with those who received conservative treatment.

Feelings of powerlessness in individuals with either venous or diabetic foot ulcers.

AIM: To assess feelings of powerlessness in patients with either venous or diabetic foot ulcers. METHODS: This was an exploratory, descriptive, cross-sectional study conducted from May 2010 to August 2012. Two hundred adult patients with either venous leg ulcers (N=100) or diabetic foot ulcers (N=100) were consecutively recruited from an outpatient wound care clinic of a university hospital in the city of São Paulo (Brazil). Eligibility criteria included patients with type 1 and 2 diabetes and foot ulcers, and those with venous leg ulcers and ankle-arm index between 0.8 and 1.0. Patients unable to respond to a questionnaire due to physical or cognitive deficit were excluded. Two instruments were used for data collection: a questionnaire assessing sociodemographic and clinical characteristics, and the Powerlessness Assessment Tool (PAT) for adult patients. RESULTS: Most patients were women, aged 60-70 years, and smokers. Fifty-seven patients (57%) with diabetes had had foot ulcers for 3-6 years and 55 (55%) patients had had venous ulcers for 7-10 years. Wound odor and exudate were present in most ulcers. The total PAT score was significantly higher (P=0.002) for patients with foot ulcers (mean, 57.10) than for patients with venous ulcers (mean, 55.12). The highest mean scores for patients with venous and diabetic foot ulcers were 58.09 and 58.10, respectively, on the "self-perception of decision-making capacity" domain. CONCLUSION: Patients with venous and diabetic foot ulcers had very strong feelings of powerlessness, but these feelings were significantly stronger in those with foot ulcerations.

Impact of skin grafting of venous leg ulcers on functional status and pain.

BACKGROUND: Disability and pain were assessed in patients with venous leg ulcers treated with split-thickness skin grafts to evaluate to what extent skin grafting improves functional status in this population. METHODS: A prospective, nonrandomized, multicenter case-control study was conducted from July 2008 to December 2010 in two hospitals in Brazil. One hundred patients with venous leg ulcers were divided into two treatment groups of 50 patients each: the control group (conservative treatment) and the surgery group (skin grafting). Patients were assessed at baseline (day 0) and on days 30, 90, and 180. Disability was measured with the Disability Index of the Health Assessment Questionnaire (HAQ-DI). The visual analog scale (VAS) and McGill Pain Questionnaire (MPQ) were used to assess pain. RESULTS: Surgery group patients reported significantly lower (p = 0.0001) overall HAQ-DI scores (lower disability levels) 180 days postoperatively (HAQ-DI = 0.18) compared with baseline (HAQ-DI = 2.65); mean overall HAQ-DI scores for control patients was 1.70 on day 180, with a significant difference between groups (p = 0.0001). The surgery group showed significant improvement on all HAQ-DI categories and reported significantly lower pain intensity (VAS pain scores) on days 30, 90, and 180 compared with controls (p = 0.0001). The MPQ was used to assess the sensory, affective, evaluative, and miscellaneous dimensions of pain in the two groups; there were significant differences between groups on days 30, 90, and 180 (p = 0.0001). CONCLUSIONS: Patients with venous leg ulcers treated with split-thickness skin grafts showed improvement in functional status compared with controls.

[Not Available].

UNLABELLED:  Objective. To assess sleep quality in a population of patients with diabetic foot ulcers. METHODS: This was an exploratory, descriptive, cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality in 60 patients with diabetes mellitus and foot ulcers. RESULTS: Seventeen (28.3%) patients had a global PSQI score less than 5, indicating that they were good sleepers, while 43 (71.7%) patients were considered poor sleepers. The patients reported going to bed between 9:00 pm and 11:00 pm (n = 40, 66.70%), taking from 16 minutes to 30 minutes to fall asleep (n = 25, 41.70%), and waking up after 4 hours to 5 hours of sleep (n = 40, 66.70%). CONCLUSION: Patients with diabetic foot ulcers have poor sleep quality. .

Sleep Quality Among Patients With Venous Ulcers: A Cross-sectional Study in a Health Care Setting in São Paulo, Brazil.

 This was an exploratory, descriptive, cross-sectional study to assess sleep quality in 100 patients with venous ulcers using the Pittsburgh Sleep Quality Index (PSQI). Thirty-six (36%) patients had a global PSQI score < 5, indicating that they were good sleepers, while 64 (64%) patients were considered poor sleepers. Fifty-three (53%) patients reported going to bed between 9:00 pm and 11:00 pm, 63 (63%) taking from 16 to 30 minutes to fall asleep, and 41 (41%) waking up after 4 to 5 hours of sleep. Sixty (60%) patients regarded sleeping as a necessity. Most patients with venous ulcers experienced poor sleep quality. .

Construction and validation of an algorithm for disinfection of ambulances transporting patients with contagious infectious diseases.

OBJECTIVES: to develop and validate an algorithm to guide professionals in cleaning and disinfecting ambulances after transferring patients with contagious infectious diseases. METHODS: the study was conducted between September and November 2021. The developed algorithm was validated by 104 judges, including nurses, physical therapists, and physicians who care for patients with contagious infectious diseases. It used the Delphi technique and content validity index. RESULTS: in the first evaluation, the judges considered the algorithm "unsuitable" and "fully suitable". The algorithm reviewed according to the judges' suggestions was rated between "suitable" and "fully suitable" in the second evaluation. The overall content validity index was 0.960 and 0.998 in the first and second evaluations. CONCLUSIONS: the algorithm to guide the cleaning and disinfection of ambulances after transferring patients with contagious infectious diseases was developed and validated by specialists in the field, with consensus among the judges in the second evaluation.

Self-esteem in patients with diabetes mellitus and foot ulcers.

AIM: To evaluate self-esteem in individuals with diabetes mellitus (DM) and foot ulcers. METHODS: This was a controlled, cross-sectional, analytical study. We selected 50 individuals with DM and foot ulcers (study group), as well as 50 with DM and without foot ulcers (control group). Self-esteem was evaluated using the Federal University of São Paulo/Paulista School of Medicine Portuguese-language version of the Rosenberg Self-Esteem Scale, on which scores range from 0 to 30, higher scores indicating lower self-esteem. RESULTS: Of the individuals evaluated, 27 (54%) of those in the study group and 31 (62%) of those in the control group were classified as being of low socioeconomic status (monthly income at or above, but less than double, the national minimum wage). In addition, 27 (54%) of the study group patients had type 2 DM, compared with 29 (58%) of those in the control group. Hypertension was observed in 31 (62%) of the study group patients and 29 (58%) of the control group patients. Of the patients in the study group, 33 (66%) had been diagnosed with heart disease, compared with 23 (46%) of those in the control group. High Rosenberg Self-Esteem Scale scores (21-30) were more common in the study group, being observed in 30 (60%) of the patients, whereas 33 (66%) of the control group patients had low scores (0-10). CONCLUSION: Foot ulcers appear to have a negative impact on the self-esteem of patients with DM.

Prevention of facial injuries caused by personal protective equipment during the COVID-19 pandemic.

OBJECTIVE: Develop and validate a leaflet to guide health professionals in preventive measures related to injuries caused by the use of personal protective equipment during the COVID-19 pandemic. METHODS: For the construction of the brochure, an integrative review was carried out in the main databases. The evaluation of the leaflet was made by 59 health professionals (nurses, physiotherapists, and doctors), using the Delphi technique. RESULTS: In the first evaluation cycle, the items in the brochure were considered by the judges to be "inadequate" to "adequate"; the Content Validity Index was 0.80-1.0. After the adjustments suggested by the judges were implemented, the leaflet was sent back to the second evaluation cycle, in which all items were considered "adequate", resulting in a Content Validity Index of 1.0. CONCLUSION: The developed brochure has content validity and can assist health professionals in preventing injuries caused by the use of personal protective equipment the developed brochure has content validity and can assist health professionals in preventing injuries caused by the use of personal protective equipment.

[Emergency room: The daily experiences with the death and dying for the health care professionals]. / Sala de emergência: o cotidiano das vivências com a morte e o morrer pelos profissionais de saúde.

OBJECTIVE: To know the feelings experienced by the nursing professionals who work together and with the death in the emergency unit, providing a moment of reflection on the significance of these. METHOD: This is a qualitative research, with phenomenological approach, held from through interviews with nursing professionals who work in the emergency room in a public hospital in the city of São Paulo. RESULTS: The analysis of the data collected made it possible to realize that the professionals to vivenciarem the process of death and dying, showed feelings: sadness, helplessness, loss, failure and fear. CONCLUSION: the professional nursing is not prepared to deal with such feelings because assume a commitment for the preservation of life. Also, we can say that the subjects of the search live the mourning with the death of patients who care.

[Feelings of nursing professionals who work in emergency units]. / Sentimentos vivenciados pelos profissionais de enfermagem que atuam em unidade de emergência.

OBJECTIVE: to know the meanings fo the work in an emergency unit for nursing professionals. METHOD: qualitative research with phenomenological approach. Data collection was obtained by means of 14 interviews with nursing professionals. RESULTS: coexisting feelings of nursing professionals are fatigue, exhaustion, anguish and revolt for the work overload and resources limitations face the situations that involve death risk. CONCLUSION: although stress faced by nursing professionals during the daily work, they keep the commitment in assisting with quality and humanization, existing a trend for emotional exhaustion, loss of heart and feelings of anguish, what reaffirms the importance of heath prevention in work environment.