Nursing care to clients with venous ulcers an integrative review of the literature

Abstract

Objetivo: Descrever os cuidados de enfermagem recomendados na literatura aos clientes com úlcera venosa. Método: Revisão integrativa da literatura realizada nas bases Biblioteca Virtual de Saúde, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e Scientific Eletronic Library Online. Foram selecionados 10 artigos, baseando-se nos critérios de inclusão. Resultados: A análise dos artigos resultou na elaboração de categorias temáticas a importância do enfermeiro na avaliação do cliente com úlcera venosa e estratégias utilizadas no cuidado de clientes com úlceras venosas. A primeira aborda que as ações do enfermeiro vão além da realização de curativos, exigindo a avaliação do cliente em sua integralidade. A segunda descreve o uso de estratégias como a terapia física descongestiva, bota de unna, terapia de baixa potência empregando Light Emiting Diode, crioterapia e sistema de compressão multi-camada alta. Conclusão: A análise dos artigos evidenciou a preocupação em relação à avaliação do cliente em sua integralidade. Apesar da diversidade de tecnologias apresentadas na literatura, evidencia-se a necessidade realizar pesquisas com níveis de evidência significativos, visando a otimização do tempo de cicatrização, prevenção de recidivas, estímulo ao autocuidado e conforto do cliente. Descritores: Enfermagem; úlcera venosa; cuidados de enfermagem.

Integralidade no cuidado de enfermagem às pessoas com úlceras cutâneas

“…It is necessary to have mastery of the traditional knowledge of the health area, such as clinical, pathophysiology, nutrition, sanitary and therapeutic, but associating them in an interdisciplinary way to bioethics, biosafety, social sciences, with emphasis on sociology, anthropology and citizenship, to the human sciences, with study of modes of education and teaching-learning aimed at popular education in health, psychology and life protection. [32][33][35][36] In the first thematic category, one can analyze that the professional formation is intrinsically related to the teaching-learning process and the analysis of the studies suggests that the need for improvement for the care of people with chronic ulcers materializes in the search between university students and professionals for knowledge and practices, through the participation of courses, academic leagues, extension projects, seminars, congresses, among others. 29,[46][47] Reflecting and acting on care and education is a daily and continuous process that requires empathy and persistence, a transforming practice, which must be guided by horizontal and close relationships, based on the expanded clinical and the unique therapeutic project whose exchange of knowledge generates the enhancement of subjects by respecting their singularities and collaborating to foment and modify behaviors.…”

“…The focus on Nursing care should be integral care. [32][33]37 In the second thematic category, it is important to highlight that health care services and, consequently, their professionals prioritize the immediate and curative practices, with a focus on the biomedical model, fragmented and hierarchical, often performing a purely procedural care, that is, centered on the wound or an affected organ. [51][52] At the same time, it was observed that the scientific productions and the care practice label the subjects as "carriers" of venous ulcers, diabetes mellitus, diabetic foot, oncological wounds, thereby stigmatizing them, limiting them and ratifying the current health model.…”

“…39,46,[50][51][52] It is essential that teams question what skin ulcers represent to users, the impacts they cause, the repercussions on life, expectations and demands for care, since the best scientific evidence and technological procedures are not enough: it is vital to establish a dialogical, with sensitive and active listening, bonding, trust, attention to emotions, beliefs and social, cultural and economic issues. 15, [33][34]37,45,54 Health education is at the heart of primary health care; it is a light, present and effective tool whose purpose is to sensitize, revive and gradually modify harmful behaviors or establish adherence to health care such as balanced nutrition, glycemic monitoring and foot care from daily examination of the foot and the use of therapeutic footwear. 36,50 Interdisciplinarity and teamwork in health care become a major challenge to be won due to the assistance model that is perpetuated.…”

“…It is important to highlight that the same object defined by integrality in other articles as integral care was found, also presenting in the following ways: basic care; multidisciplinary work; user-centered care; subject in the collective context; holism; individualized care; Community level; primary care; individualized assistance; Health education; transformation of lived practices; self-care; autonomy and interdisciplinary interventions. [24][25][26][27][32][33][34][35][36][37][38] This study evidenced a few publications that strengthen the practice of Nursing in the perspective of integrality in the area of attention to people with cutaneous ulcers pointing dichotomy between theory, law, practice and assistance legitimacy. 20 The results reveal a defense to a care plan centered on the resoluteness of skin healing based on scientific evidence and performed by multidisciplinary team.…”

Measurement of the area of venous ulcers using two software programs

“…Considering this scenario, the nurse has an important role in the evaluation of these patients 2 - 3 and should use available technologies to conduct this process. Thus, the measurement is an objective way to evaluate the wound and identify the progress of healing.…”