Advanced practices in comprehensive nursing care for people with skin ulcer

Cross-sectional study of the analysis of nursing consultation records for people with chronic wound treated at a Nursing Care Center from 1994 to 2015, from the perspective of Collective Health. The variables investigated were epidemiological, wound advanced treatment centers, abandonment and death.

Results

There was a high proportion of elderly, female, with complete elementary and middle school, white self-reported color, retirees, dependents on the Brazilian Unified Health System ( Sistema Único de Saúde ) and with chronic health diseases identified among the 343 patients medical records. Etiology of skin ulcer was higher in the neuropathic and venous areas without previous clinical resolution in the health services network. Healing occurred in 67.6% of wound by adoption focused on nursing care. A low rate of abandonment and death was observed.

Conclusion

There were satisfactory clinical outcomes of people with chronic skin ulcer as evidenced in nursing care records. Nursing consultation showed a potential strategy for advanced wound care.

Community health nursing; Skin ulcer; Integrality in health

Sociodemographic variables	n(%)
	100(343)
Mean Age (n=343)	60.1
Gender (n=343)
Male	168(48.9)
Female	175(51.1)
Marital Status (N=233)
Single	40(17.1)
Married	129(55.4)
Divorced	24(10.4)
Widow(er)	40(17.1)
Education level (N= 230)
Illiterate	19(8.3)
Incomplete elementary and middle school	44(19.1)
Complete elementary and middle school	66(28.7)
Incomplete High School	39(17)
Complete High School	18(7.8)
Higher Eduation	44(19.1)
Color (N=220)
White	145(65.9)
Black	22(10)
Others	53(24.1)
Occupation (N=285)
Retired	112(39.3)
Employed	106(7.2)
From the home	43(15.1)
Medical leave	13(4.6)
Unemployed	11(3.8)
Nationality (N=295)
Center-west	4(1.3)
Northeast	51(17.3)
North	5(1.7)
Southeast	223(75.6)
South	5(1.7)
Others	7(2.4)
Origin (N= 321)
Central	266(82.9)
East	49(15.2)
North	3(1)
West	2(0.6)
South	1(0.3)
Income (N= 197)
Less than 1 minimum wage	3(1.5)
From 2 to 3 minimum wages	161(81.7)
From 3 to 4 minimum wages	18(9.2)
From 5 to 6 minimum wages	8(4)
More than 6 minimum wages	7(3.6)
Religion (N=164)
Catholic	86(52.4)
Evangelical	26(15.8)
Spiritist	15(9.2)
Others	37(22.6)

Variables	n(%)
Wounds (n=332)
Yes	290(87.3)
No	42(12.7)
Number of wounds (n=286)
One	219(76.5)
Two	47(16.4)
Three	8(2.9)
Multiple	12(4.2)
Etiology (n= 300)
Pressure injury	14(4.7)
Neuropathic ulcer	111(37)
Venous ulcer	70(23.4)
Mixed ulcer	23(7.6)
Arterial ulcer	19(6.3)
Cancer	37(12.3)
Traumatic	10(3.3)
Leprosy	11(3.7)
Others	5(1.7)
Evolution time (n=297)
Up to 30 days	92(31)
From 30 to 90 days	103(34.6)
From 91 to 120 days	53(18)
Over 120 days	12(4)
Over 180 days	20(6.7)
More than 365 days	17(5.7)
Outcome (n=197)
Healing	133(67.6)
No healing	14(7.1)
Amputation	1(0.5)
Death	3(1.5)
Abandonment	4(2)
Under treatment	42(21.3)

Variables	Healed	Not Healed	Total	p-value
Variables	n(%)	n(%)	Total	p-value
Gender
Male	60(65.2)	32(34.8)	92	0.639
Female	73(69.5)	32(30.5)	105
Ignored	64
Age bracket
<60 years	51(68)	24(32)	75	0.939
>60 years	83(67.5)	40(32.5)	123
Ignored	63
Marital Status
Single	16(57.1)	12(42.9)	28	0.129
Married	47(59.5)	32(40.5)	79
Divorced	17(85)	3(15)	20
Widow(er)	10(52.6)	9(47.4)	19
Ignored	107
Educattion level
Illiterate	5(55.6)	4(44.4)	9	0.598
Incomplete elementary and middle school	26(66.7)	13(33.3)	39
Complete elementary and middle school	12(50)	12(50)	24
Incomplete High School	7(70)	3(30)	10
Complete High School	18(75)	6(25)	24
Higher Eduation	19(67.9)	29(32.1)	48
Ignored	110
Monthly Family income
Less than 1 minimum wage	0(0)	100(1)	1	0.527
From 2 to 3 minimum wages	68.9(62)	31.1(28)	90
From 3 to 4 minimum wages	56.3 (9)	43.8(7)	16
From 5 to 6 minimum wages	75(3)	25(1)	4
More than 6 minimum wages	60(3)	40(2)	5
Ignored	110
Arterial hypertension
Yes	68(64.8)	37(35.2)	105	0.761
No	38(65.5)	20(34.5)	58
Ignored	91
Diabetes
Yes	85(66.4)	43(33.6)	128	0.793
No	41(68.3)	19(31.7)	60
Ignored	71
Other Comorbities
Yes	2(100)	0(0)	2	0.414
No	55(62.5)	33(37.5)	88
Ignored	69
Past smoking
Yes	38(70.4)	16(29.6)	52	0.529
No	72(65.5)	38(34.5)	110
Ignored	87
Current smoking
Yes	16(69.6)	7(30.4)	23	0.784
No	94(66.7)	47(33.3)	141
Ignored	87
Past alcohol consumption
Yes	25(67.6)	12(32.4)	37	0.942
No	85(66.9)	42(33.1)	127
Ignored	110
Current alcohol consumption
Yes	17(89.5)	2(10.5)	19	0.027
No	93(64.1)	52(35.9)	145
Ignored	67

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Giovana Andrade Frederico. http://orcid.org/0000-0001-7754-8566. E-mail: giovanaafrederico@gmail.com