Conhecimento sobre o diabetes e atitude para o autocuidado de idosos na atenção primária à saúde

Financial protection and equity in the healthcare financing system in Iran: a cross-sectional study among slum dwellers with type 2 diabetes

OBJECTIVES

This study was conducted to assess financial protection and equity in the healthcare financing system among slum dwellers with type 2 diabetes (T2D) in Iran in 2022.

DESIGN

Cross-sectional study.

SETTING

Primary care centres in Iran were selected from slums.

PARTICIPANTS

Our study included 400 participants with T2D using a systematic random sampling method. Patients were included if they lived in slums for at least five consecutive years, were over 18 years old and did not have intellectual disabilities.

PRIMARY AND SECONDARY MEASURES

A self-report questionnaire was used to assess cost-coping strategies vis-à-vis T2D expenditures and factors influencing them, as well as forgone care among slum dwellers.

RESULTS

Of the 400 patients who participated, 53.8% were female. Among the participants, 27.8% were illiterate, but 30.3% could read and write. 75.8% had income below 40 million Rial. There was an association between age, education, income, basic insurance, supplemental insurance and cost-coping strategies (p<0.001). 88.2% of those with first university degree used health insurance and 34% of illiterate people used personal savings. 79.8% of people with income over 4 million Rial reported using insurance to cope with healthcare costs while 55% of those with income under 4 million Rial reported using personal savings and a combination of health insurance and personal savings to cope with healthcare costs. As a result of binary logistic regression, illiterate people (adjusted OR=16, 95% CI 3.65 to 70.17), individuals with low income (OR 5.024, 95% CI 2.42 to 10.41) and people without supplemental insurance (OR 1.885, 95% CI 0.03 to 0.37) are more likely to use other forms of cost-coping strategies than health insurance.

CONCLUSIONS

As a result of insufficient use of insurance, cost-coping strategies used by slum dwellers vis-à-vis T2D expenditures do not protect them from financial risks. Expanding universal health coverage and providing supplemental insurance for those with T2D living in slums are recommended. Iran Health Insurance should adequately cover the costs of T2D care for slum dwellers so that they do not need to use alternative strategies.

Adolescents and type 1 diabetes: A grounded theory on adolescents' experiences of adaptation to type 1 diabetes

PURPOSE

Type 1 diabetes influences adolescents' health status and therapeutic management. Adaptation for adolescents with type 1 diabetes is considered a significant issue for this cohort group and is based on many factors, including availability of resources, and family and community support. Thus, this study aimed to explore Palestinian adolescents' experiences of adaptation to type 1 diabetes in the West Bank.

DESIGN AND METHODS

A qualitative grounded theory approach was adopted. The purposive sample consisted of fourteen adolescents aged from 12 to 18 years and diagnosed with type 1 diabetes. The data were collected using semi-structured and face-to-face individual interviews during the period from March to June 2023. A constant comparative method was used to analyze data.

FINDINGS

The core category had emerged with categories and subcategories. There were three categories and ten subcategories including difficulties in the management of type 1 diabetes, for example, "insulin injections, dietary management, and control of HbA1c levels", burdens of type1 diabetes, for example, "burden regarding follow-up treatment, the burden of interaction and communication, emotional burden, and economic burden", and fears and worries of unexpected future life, for example, "worries about disease complications, worries regarding social relationships, and worries about marriage and parenthood".

CONCLUSION

Adolescents diagnosed with type 1 diabetes suffer from difficult experiences influencing their adaptation to this disease.

PRACTICE IMPLICATIONS

Counseling programs concerning self-care management for those adolescents need to be developed in addition to support programs. Health education programs are needed to develop their adaptation and coping skills to these experiences.

Development and validation of a case study to aid in the diagnostic reasoning of nursing students and nurses

PURPOSE

The aim of this study is to develop and validate a case study to aid in the diagnostic reasoning of nursing students and nurses.

METHODS

It is a validation study using a case study based on Lunney's method including (1) content validation of the case study by nurse experts through the Delphi technique, (2) identification of nursing diagnoses (NDs) in the case, (3) evaluation of diagnostic accuracy, and (4) establishment of a priority diagnosis by nurse experts.

FINDINGS

The case study was developed from the findings of a narrative literature review on the cues of the NDs with a prevalence > 50% in patients with peripheral arterial occlusive disease. Two rounds of expert evaluation were required to validate the case study. The experts identified 18 NDs with different degrees of accuracy. The highly accurate diagnoses most frequently identified by the experts were: Ineffective peripheral tissue perfusion (100%), impaired walking (83%), impaired comfort (50%), and chronic pain (50%). The diagnosis considered a priority by all experts was ineffective peripheral tissue perfusion.

CONCLUSIONS

The case study was developed and had its content validated. High-accuracy diagnoses were identified, and a priority was determined.

IMPLICATIONS FOR NURSING PRACTICE

The validated case study may be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in practice, teaching or research.

Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program

Most patients are diagnosed as having diabetes only after experiencing diabetes complications. Educational attainment might have a positive relationship with diabetes prognosis. The diabetes pay-for-performance (P4P) program-providing comprehensive, continuous medical care-has improved diabetes prognosis in Taiwan. This retrospective cohort study investigated how educational attainment affects the presence of diabetes complications at diabetes diagnosis and mortality risk in patients with diabetes enrolled in the P4P program. From the National Health Insurance Research Database, we identified patients aged >45 years who had received a new diagnosis of type 2 diabetes during 2002-2015; they were followed up until the end of 2017. We next used logistic regression analysis to explore whether the patients with different educational attainments had varied diabetic complication risks at diabetes diagnosis. The Cox proportional hazard model was employed to examine the association of different educational attainments in people with diabetes with mortality risk after their enrollment in the P4P program. The results indicated that as educational attainment increased, the risk of diabetes complications at type 2 diabetes diagnosis decreased gradually. When type 2 diabetes with different educational attainments joined the P4P program, high school education had the highest effect on reducing mortality risk; however, those with ≤ 6th grade education had the lowest impact.

An Update on the Interdisciplinary Dental Care Approach for Geriatric Diabetic Patients

Diabetes mellitus is a prevalent health issue escalating worldwide that gives rise to numerous problems. Periodontal disorders are recognized as the sixth consequence associated with diabetes mellitus. Research shows that dental health affects overall health, and this knowledge is changing the dental field. The correct choice of glucose goal levels and the optimal selection of glucose-lowering medications are determined by a comprehensive geriatric assessment, an estimate of life expectancy, and a rationale for therapy at regular intervals in elderly diabetics. This article provides an overview of the correlation between diabetes and oral health, with a specific emphasis on xerostomia, periodontal disease, and dental caries. Thus, dentists play a significant role within the allied health profession by contributing to the provision of oral care for those diagnosed with diabetes, with a special focus on geriatric patients.

The impact of patient navigation on glycemic control, adherence to self-care and knowledge about diabetes: an intervention study

BACKGROUND

Patient navigation helps with better adherence to treatment, as well as better knowledge about diabetes and greater interest in performing, monitoring, and seeking health care. Therefore, this study aims to evaluate the effect of patient navigation on glycemic control, disease knowledge, adherence to self-care in people with type 1 diabetes mellitus.

METHODS

This is an intervention study using a single group pre-test post-test design, carried out in a tertiary public teaching hospital in Southern Brazil. Participants over 18 years of age and diagnosed with type 1 diabetes were included. In total, three teleconsultations and one face-to-face consultation were carried out, with three-month intervals, until completing one year of follow-up. The nurse navigator conducted diabetes education based on the guidelines of the Brazilian Diabetes Society and the Nursing Interventions Classification. The differences between glycated hemoglobin, adherence to self-care, and knowledge about initial and final diabetes were estimated to verify the effect of patient navigation by nurses, according to the tool applied in the first and last consultations. Interaction analyses between variables were also performed. Student's t-test, Generalized Estimating Equations, Wilcoxon test, and McNemar test were used.

RESULTS

The final sample consisted of 152 participants, of which 85 (55.9%) were women, with a mean age of 45 ± 12 years, and diabetes duration of 23.6 ± 11.1 years. Nurse navigators conducted 812 teleconsultations and 158 face-to-face consultations. After the intervention, glycemic control improved in 37 (24.3%) participants (p < 0.001), and knowledge about diabetes also improved in 37 (24.3%) participants (p < 0.001). Adherence to self-care increased in 82 (53.9%) patients (p < 0.001). The analysis of the interaction between glycemic control and the results from the questionnaire of knowledge about diabetes showed an interaction effect (p = 0.005). However, we observed no interaction effect between glycemic control and the results from the questionnaire on adherence to self-care (p = 0.706).

CONCLUSIONS

Our results showed improvement in glycemic control, adherence to self-care, and knowledge of diabetes in the study participants. In addition, they suggest that patient navigation performed by nurses is promising and feasible in improving care for patients with type 1 diabetes.

Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil

Objective

To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus.

Subjects and methods

A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression.

Results

Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705).

Conclusion

Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.

Turkish Validity and Reliability of the Self-care of Hypertension Inventory (SC-HI) among Older Adults

PURPOSE

To assess the psychometric properties of the Turkish version of the Self-care of Hypertension Inventory (SC-HI) among older adults with hypertension.

DESIGN

This was a methodological study.

METHODS

The study sample enrolled 176 older adults. The study carried out preliminary psychometric analyses.

FINDINGS

Item-level content validity index ranged between 0.87 to 1.0, and the index of content validity was 0.98. The Cronbach's α for the total scale was 0.84.

CONCLUSION

The cross-cultural adaptation of SC-HI has been realized successfully in Turkish.

CLINICAL EVIDENCE

Health care providers may utilize the scale to evaluate "older individuals" hypertension self-care abilities.

Clinical validation of the nursing diagnosis decreased diversional activity engagement in patients with diabetes

BACKGROUND

Diagnostic accuracy studies are important to identify the best set of defining characteristics for a given nursing diagnosis. The reliability of nursing inferences can be increased by using clinical indicators with high prediction capacity helping nurses to be more accurate in their clinical practice.

OBJECTIVE

To clinically validate the nursing diagnosis Decreased diversional activity engagement in adult patients with diabetes.

METHOD

A diagnostic accuracy study with a cross-sectional design was carried out patients with type 2 diabetes. A latent class model with random effects was used to measure the sensitivity and specificity.

RESULTS

The diagnosis of Decreased diversional activity engagement was present in 62.2% of the patients. The defining characteristics with high sensitivity (good indicators for confirmation) were discontent with situation, physical deconditioning, and altertion in mood. Boredom, flat affect, discontent with situation, and frequent naps were the defining characteristics with the highest specificity values. These factors are considered good integrating components of the diagnosis under investigation in patients with diabetes.

CONCLUSION

The nursing diagnosis decreased diversional activity engagement is frequent in patients with diabetes, and discontent with situation can be considered a good predictor of its occurrence due to its high values of specificity and sensitivity.

IMPACT

The use of accurate clinical indicators in the diagnostic reasoning of nurses contributes to the achievement of outcomes centered on the patient's human responses.

Tendência temporal das complicações do pé diabético e da cobertura da Atenção Primária à Saúde nas capitais brasileiras, 2008–2018

Introdução: Complicações diabéticas são condições preveníveis em sua maioria, sendo o pé diabético uma das mais comuns. O manejo adequado do pé diabético mitiga eventos incapacitantes e maiores gastos ao sistema de saúde. As intervenções efetivas na Atenção Primária à Saúde (APS) possibilitam prevenir as complicações diabéticas. Objetivo: Analisar a tendência das complicações do pé diabético e sua relação com a cobertura da APS nas capitais brasileiras, entre 2008 e 2018. Métodos: Estudo ecológico de séries temporais das incidências acumuladas de complicações do pé diabético nas 27 capitais utilizando dados do Sistema de Informação sobre Hipertensos e Diabéticos. As variáveis independentes foram ano, cobertura da APS e da Estratégia Saúde da Família. Empregou-se modelo de regressão de Prais-Winsten. Resultados: No Brasil, ocorreram 45.095 casos de complicações do pé diabético no período, com média de 0,57 casos/100.000 habitantes (p<0,001) — estável em 14 capitais (p>0,05) e crescente em 13 capitais (p<0,05). Há associação entre elevação do nível de cobertura da APS e estabilidade na evolução das complicações diabéticas (p<0,05). Conclusões: Evidencia-se aumento da ocorrência das complicações do pé diabético, contudo, nas capitais com crescimento da cobertura da APS, houve controle da progressão.

Health self-care practices among community older adults with morbidity

OBJECTIVES

to describe sociodemographic and health characteristics of older adults with morbidity, identify self-care practices and verify the association of sociodemographic variables with those related to health and self-care practices.

METHODS

a quantitative, analytical and cross-sectional household survey, developed in the urban area in the countryside of Minas Gerais, from 2017 to 2018. A total of 796 older adults were assessed using validated instruments, such as Geriatric Depression Scale: short form, Brazilian Questionnaire for Functional and Multidimensional Assessment, International Physical Activity Questionnaire, Instrument for Assessing Attitude Towards Taking Medications. Multiple logistic regression (p<0.05) was used.

RESULTS

negative self-perceived health was associated with low income and education. As for self-care in health, being physically active associated with the age group 60 |-| 79 years and higher education.

CONCLUSIONS

sociodemographic variables such as sex, age group, income, education, marital status, housing arrangement were related to health status and self-care practice.

The importance of elderly people knowing basic first-aid measures

Background

In the event of a sudden illness or injury, elderly individuals are often dependent on self-help and mutual assistance from partners. With poor access to medical services during natural and other disasters, the importance of first aid knowledge of elderly individuals increases even more. We assessed the opinions of different generations of Slovenian population regarding the importance of knowing the basic first aid measures. In addition, we aimed to examine the knowledge of first aid in the most common emergencies that threaten elderly people’s health and lives, focusing on the knowledge of elderly.

Methods

A structured questionnaire was conducted with a representative Slovenian adult population (n = 1079). Statistically significant differences in average ratings of the importance of first aid knowledge were compared among different age groups with one-way ANOVA followed by a post hoc test. Significant differences in percentages of correct answers in particular cases of health conditions between different age groups were determined using the χ ² test followed by post hoc tests.

Results

Slovenes are well aware of the importance of first aid knowledge and feel personally responsible for acquiring this knowledge. The general opinion is that older retirees need less first aid knowledge than individuals in younger populations. We found a high level of knowledge about symptoms and first aid measures for some of the most common health conditions that occur in old age. The level of knowledge in the group of the oldest respondents was comparable with that of younger age groups. However, their recognition of health conditions was also somewhat worse, especially when recognising the symptoms and signs of hypoglycaemia and heart attack. Most of the tested knowledge did not depend on a person’s age but on the time since that person was last educated in first aid.

Conclusions

The knowledge of people older than 80 years is somewhat poorer than that in the younger population, mainly because too much time has passed since they were last educated in first aid. Public awareness of first aid needs to be increased and appropriate guidelines should be given with a focus on the elderly population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00675-9.

Práticas de autocuidado em saúde entre pessoas idosas com morbidade da comunidade

RESUMO Objetivos: descrever as características sociodemográficas e de saúde dos idosos com morbidade, identificar as práticas de autocuidado e verificar a associação das variáveis sociodemográficas com as relacionadas à saúde e às práticas de autocuidado. Métodos: inquérito domiciliar quantitativo, analítico e transversal, desenvolvido na zona urbana no interior de Minas Gerais, de 2017 a 2018. Avaliados 796 idosos por instrumentos validados, como Escala de Depressão Geriátrica abreviada, Questionário Brasileiro de Avaliação Funcional e Multidimensional, Questionário Internacional de Atividade Física, Instrumento de Avaliação da Atitude Frente à Tomada de Remédios. Utilizou-se regressão logística múltipla (p<0,05). Resultados: a autopercepção de saúde negativa associou-se às baixas renda e escolaridade. Quanto ao autocuidado em saúde, ser ativo fisicamente associou-se à faixa etária 60 |-| 79 anos e à maior escolaridade. Conclusões: as variáveis sociodemográficas, como sexo, faixa etária, renda, escolaridade, estado conjugal, arranjo de moradia, relacionaram-se à condição de saúde e à prática de autocuidado.

Factores sociodemográficos, clínicos y psicosociales relacionados con el autocuidado de la diabetes

Introducción: Aunque la ciencia ha descubierto diversos factores que intervienen en el autocuidado de la diabetes, todavía quedan algunos vacíos sobre todo en lo que respecta a los comportamientos de autocuidado entre personas con diferentes características socioeconómicas. El objetivo del presente estudio fue identificar la adherencia al autocuidado de la diabetes y su correlación con factores sociodemográficos, clínicos y psicosociales entre los usuarios del sistema de salud suplementaria en Sao Paulo. Materiales y métodos: Se realizó un estudio transversal con 214 participantes que padecían diabetes tipo 2, en el que se utilizaron las versiones brasileñas del cuestionario de actividades de autocuidado en diabetes, el cuestionario de actitudes sobre diabetes y la escala de empoderamiento de la diabetes. Se empleó un modelo de regresión lineal múltiple (método regresión stepwise) para delinear las correlaciones entre las variables. Resultados: Los participantes mostraron una adherencia moderada al autocuidado global. Factores como ser mujer, estar casado/en unión libre estable, ser jubilado, tener más tiempo de diagnóstico y mostrar una actitud más positiva frente a la diabetes explicaron el 93.0% de la varianza en el autocuidado global. Discusión: El estudio es inédito en la caracterización del autocuidado de la diabetes entre los usuarios del sistema de salud complementaria en Brasil. Si bien los resultados son similares a los de estudios nacionales e internacionales, estos se sugieren que, dada la complejidad de la enfermedad, el autocuidado de la diabetes se descuida constantemente y se requiere una mayor formación entre los profesionales de la salud para tratar los aspectos psicosociales asociados. Conclusión: Los resultados sugieren que las intervenciones educativas para la promoción del autocuidado deben diseñarse teniendo en cuenta el perfil sociodemográfico y clínico de los participantes, así como la promoción de la autoeficacia para disminuir la actitud negativa hacia la diabetes. Como citar este artículo: Brevidelli, Maria Meimei; Oliveira, Adriana Bueno de; Rodrigues, Gilcelli Vascom Girotto; Gamba, Monica Antar; DeDomenico, Edvane Birello Lopes. Fatores sociodemográficos, clínicos e psicossociais correlacionados ao autocuidado em diabetes. Revista Cuidarte. 2021;12(2):e2057 http://dx.doi.org/10.15649/cuidarte.2057   

Pouteria ramiflora leaf extract on emulgel in wound healing activity in diabetic rats

The genus Pouteria has been studied because it presents various activities, among which is its anti-inflammatory potential. The effects of Pouteria ramiflora Carbopol gel on the healing of skin wounds in diabetic rats were evaluated by microscopic imaging. Streptozotocin was administered intraperitoneally in animals that had fasted for 12 hours, a situation confirmed by the glycemic index (˃ 240 mg dL-1). An excision on the back of the animals was performed and three groups were formed: Control (Gel), Ethanolic extract (Ext) and Gel + extract 2% (Ext+gel); the histopathological evaluation occurred on the 7th, 14th, 21st and 30th days after the post-operative period. The results of the phytochemical prospecting of P. ramiflora extract demonstrated the major presence of phenolic compounds and flavonoids; the assessment of the inflammatory infiltrate on the 7th day was higher on group Ext and Ext+gel when compared to group Control; on the 14th day control and Ext (p<0.05). The quantification of fibroblasts was higher on the 7th day among the three treatments, control and Ext (p<0.05), on the 21st day. Angiogenesis showed a higher number of vessels in Ext+gel group (p<0.05) on the 7th day; in Control, Ext and Ext+gel (p<0.05) on the 14th day; and Control and Ext (p<0.05)on the 21st day. The histopathological results showed that the formulation Ext+gel was efficient in tissue reparation and decrease in inflammatory cells on the diabetic's animals.

Conhecimento e atitude sobre diabetes mellitus em pacientes hospitalizados

Introdução: a educação em diabetes mellitus tem como objetivo orientar as pessoas e ajudar a enfrentar e atuar ativamente na prevenção de complicações que podem surgir com a doença.Objetivo: caracterizar os pacientes com diagnóstico de diabetes mellitus (DM) internados em um hospital terciário do Sul do Brasil por meio da análise dos seus escores de conhecimento e atitudes em relação à doença.Métodos: realizou-se um estudo transversal com 69 pacientes entre os meses de setembro de 2019 e janeiro de 2020. Para coleta de dados, foram utilizados três questionários: um sobre conhecimento do DM (DKN-A), outro acerca das atitudes psicológicas sobre a doença (ATT-19) e um último constituído por perguntas objetivas aplicadas por meio de entrevista, o qual avalia as características clínicas e sociodemográficas de cada paciente. Para a análise estatística, foram utilizados os testes qui-quadrado ou Exato de Fisher.Resultados: em relação ao questionário DKN-A, 49 pacientes avaliados (71%) obtiveram boa pontuação (escore superior a 8 pontos), a qual está associada a um bom conhecimento do DM. Verificou-se que esses pacientes realizavam acompanhamento médico do DM de forma mais regular, consultando, no mínimo, três vezes ao ano (p=0,036). 66 participantes (95,7%) apresentaram baixa pontuação no questionário ATT-19.Discussão: grande parte dos pacientes avaliados têm bom conhecimento sobre o DM, entretanto, a baixa pontuação no questionário ATT-19 apresentada pela maioria dos pacientes indica dificuldade de enfrentamento da doença. O acompanhamento médico mais regular do diabetes mellitus pode estar associado a maior envolvimento do paciente no tratamento da doença, assim como maior e mais frequente fluxo de informações entre médico e paciente.

Incidence and Prediction of Unstable Blood Glucose Level among Critically Ill Patients: A Cohort Study

PURPOSE

To evaluate the incidence and the prediction of unstable blood glucose level among critically ill patients hospitalized in an intensive care unit.

METHODS

A cohort study was conducted with 62 adult patients hospitalized at an intensive care unit of a hospital located in Minas Gerais, Brazil, between March and July of 2017. Patient's demographic information, along with scores for Simplified Acute Physiology Score III, primary medical diagnosis, discharge status, diagnosis of diabetes and/or sepsis, length of stay, glycemic variability, type of nutrition, types of medications and treatments, and oxygen therapy were collected daily. A daily venous blood sample was collected to measure blood glucose levels during the patient's hospitalization period. Bivariate analysis was used to explore the association among the potential diagnostic indicators and the outcome of unstable blood glucose levels. Multivariate Cox regression was used to identify the potential predictors for the outcome.

FINDINGS

Of the total of 62 participants, 45.1% (n=28) had unstable blood glucose level. Among the 28 patients with unstable blood glucose levels, half of them (n=14, 50%) had hypoglycemia and the other half had hyperglycemia (n=14, 50%). Decreased number of days hospitalized and the use of intensive glucose control with regular insulin were associated with decreased odds of developing hyperglycemia. The presence of mechanical ventilation was associated with a higher risk for the development of hypoglycemia.

CONCLUSIONS

This study provides knowledge and evidence of diagnostic indicators for unstable blood glucose levels that are not currently included in the NANDA-International terminology for the nursing diagnosis Risk for unstable blood glucose level (00179).

IMPLICATIONS FOR NURSING PRACTICE

This study identified important diagnostic indicators that nurses can observe during the assessment to identify patients that are at risk for developing unstable blood glucose level and provide the appropriate care.

Aplicação da teoria de Orem no âmbito das feridas: uma revisão integrativa

Objetivos: Caracterizar a produção científica sobre a aplicação da teoria do autocuidado no âmbito das feridas. Método: Revisão integrativa da literatura com os artigos disponíveis na íntegra que evidenciem a temática. Foram utilizados os seguintes recursos informacionais: BVS, CINAHL, Scopus, Cochrane, PubMed e SciELO. Foram elencados os seguintes descritores: Autocuidado, Teoria de enfermagem, Ferida e Úlcera, em suas versões em inglês e português. A amostra final constou de 10 publicações. Os dados foram coletados utilizando um instrumento validado. A avaliação e a síntese dos dados foram produzidas através de descrição e avaliações estatísticas simples. Resultados: Os estudos analisados foram desenvolvidos em quatro países, o idioma inglês predominou e as publicações tiveram início em 2004. A teoria foi aplicada na sistematização da assistência de enfermagem como estratégia de ensino para o autocuidado e como referencial teórico. Os artigos relacionaram a teoria com pé diabético, úlcera venosa, úlceras de perna/ membros inferiores (sem especificar o tipo), queimaduras e lesão por pressão. Conclusão: A teoria de Orem foi aplicada a uma diversidade de sujeitos e contextos, sua aplicabilidade no âmbito das feridas é algo concreto, independentemente do tipo de lesão.

Application of Orem’s theory on wounds: an integrative review

Objective: To characterize the scientific production on the application of Orem’s self-care theory in the scope of wounds. Method: Integrative literature review with the available articles that highlight the theme. The following informational resources were used: VHL, CINAHL, Scopus, Cochrane, PubMed and SciELO. The following descriptors were listed: Self Care, Nursing Theory, Wound and Ulcer, in their English and Portuguese versions. The final sample consisted of 10 publications. Data were collected using a validated tool. Evaluation and data synthesis were produced through description and simple statistical evaluations. Results: The analyzed researches were developed in four countries; English language was predominant; publications began in 2004. The theory was applied in nursing care systematization, as a teaching strategy for self-care and as a theoretical framework. The articles linked the theory to diabetic foot, venous ulcer, leg/lower limb ulcers (no specification of type), burns and pressure injury. Conclusion: Orem’s theory was applied to a variety of individuals and contexts, its applicability within the scope of wounds is something concrete, regardless of the type of injury.

Knowledge, Attitude and Practice of Elderly Outpatients with Type 2 Diabetes Mellitus in National Geriatric Hospital, Vietnam

BACKGROUND

Diabetes-related complications have become increasingly prevalent and complicated to manage, especially among frail older adults with co-morbidities, poor physical function, and impaired cognition. Thus, knowledge, attitude, and practice (KAP) of elderly diabetic patients play an essential role in controlling the disease and its complications.

PATIENTS AND METHODS

A cross-sectional study was conducted on 176 diabetic patients at the outpatient clinics, National Geriatric Hospital, Hanoi, Vietnam from August to November 2015. Patients' knowledge, attitude, and practice regarding diabetes mellitus were assessed using a structured questionnaire. Exploratory factor analysis and multivariate Tobit regression model were used to identify factors associated with knowledge, attitude, practice about diabetes mellitus.

RESULTS

Of 176 diabetic patients, patients' knowledge was divided into two main groups: "Diabetes definition and management" (mean score = 57.7 ± 25.6) and "Targets for diabetic control" (mean score = 66.1 ± 30.4). Patients scored high points of attitudes toward diabetes severity and its complications (mean score = 95.8 ± 13.0); however, knowledge and practice scores were only moderate (mean score = 68.1 ± 16.8). There were only 8.5% of people having daily self-blood glucose monitoring. Advanced age, low educational level, rural area, and duration of diabetes less than 5 years were negative associated with knowledge, attitude, and practice regarding diabetes mellitus. This study also shows that frailty and co-morbidities/diabetic complications could impair patients' knowledge.

CONCLUSION

Older patients with diabetes had high levels of perceived severity attitudes on diabetes mellitus. However, the knowledge and practice levels were still inadequate. Pragmatic diabetic health literacy, counseling and education programs, as well as home-based treatments are viable options to improve health outcomes.