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O perfil podológico de estudantes de enfermagem em ensino clínico : recomendações para o autocuidado
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Abstract(s)
Introdução. O ensino clínico é um ambiente potencialmente agressivo para o pé e tornozelo dos estudantes de enfermagem. A dor e desconforto nesta região tem consequências negativas para a qualidade de vida dos estudantes e pode contribuir para a intenção de desistir do curso. A capacidade de cuidar de si é essencial para cuidar dos outros, pelo que é importante ajudar os estudantes a implementarem intervenções de autocuidado, bem como dotarem as instituições de ferramentas eficazes nesse sentido. Atualmente, não existem recomendações específicas nesta área. Objetivos. Identificar a caracterizar o perfil podológico de estudantes de enfermagem em ensino clínico e desenvolver recomendações para o autocuidado com o pé. Métodos. A investigação foi dividida em cinco estudos: uma revisão scoping, para mapear as principais lesões no pé em enfermeiros; uma revisão narrativa, de forma a descrever características adequadas para calçado em enfermeiros; um estudo metodológico, para adaptação e validação de dois instrumentos associados à saúde do pé (Nurses Foot Care Knowledge test e Self-Administered Foot Health Assessment Instrument); um estudo longitudinal prospetivo, para avaliar a alteração do perfil podológico dos estudantes em Ensino Clínico; e um painel de peritos, para validação de uma versão preliminar das recomendações para autocuidado. Resultados. A lesão mais comum a nível do pé e tornozelo em contextos de ortostatismo prolongado é a dor, que pode ser mais prevalente do que noutras regiões, como a lombar ou cervical. Neste sentido, e atendendo também à fadiga muscular associada, o calçado suave, antiderrapante e com palmilhas amortecidas é o mais indicado. O estudo metodológico permitiu obter dois instrumentos com valores aceitáveis de validade interna e simples de utilizar pelos estudantes. O instrumento de autoavaliação da saúde do pé (IAASP) obteve um alfa de Cronbach de 0,653 e o do conhecimento acerca do cuidado ao pé (TCE-CP) um valor de 0,893. O estudo prospetivo realizado com 54 estudantes revelou que, após cinco meses de ensino clínico, cerca de 25% reportaram sintomatologia dolorosa pela primeira vez, com uma correlação positiva com ansiedade/depressão (0,540; p<0,05). Após cinco meses, as lesões reportadas pela primeira vez, ou com um aumento significativo em relação ao início, foram edema (11; 20,4%) e dor (23; 43,6%). Por outro lado, valores elevados de pressão no calcanhar correlacionaram-se positivamente com a força máxima e área de contacto, bem como com dor na coxa. A pressão foi considerada um preditor importante do perfil podológico dos estudantes. As recomendações de autocuidado devem focar o calçado personalizado, um programa de exercícios com recurso a imagens e vídeos, promoção da saúde através de avaliações pela saúde escolar e consciencialização das instituições para a temática. Conclusão. O perfil podológico dos estudantes de enfermagem expostos a contextos de ortostatismo prolongado é caracterizado por um aumento discreto na força máxima e área de contacto exercida, cujo preditor principal é a pressão, e cujos antecedentes primários são as lesões anatómico-funcionais do pé (ex.: calos, calosidades, deformidades menores). As principais recomendações que os estudantes devem seguir para cuidar do pé são: utilizar calçado personalizado, dependente não só do seu perfil podológico, como do estilo de vida que adota; avaliar a força e pressão que exercem obrigatoriamente uma semana antes do Ensino Clínico e, opcionalmente, aos três, seis e doze meses; praticar exercício físico frequente, focando os membros inferiores e pé.
Introduction. Clinical rotations are potentially aggressive environment for nursing students' feet and ankles. Pain and discomfort in this area has negative consequences for students' quality of life and can contribute to their intention to drop out of the course. The ability to take care of oneself is essential for taking care of others, so it is important to help students implementing self-care interventions, as well as providing institutions with effective tools in this regard. There are currently no specific recommendations in this topic. Objectives. Identify and characterize the podiatric profile of nursing students in clinical rotations and develop recommendations for foot self-care. Methods. The research was composed of five different studies: a scoping review to map the main foot injuries in nurses; a narrative review to describe suitable characteristics for footwear in nurses; a methodological study to adapt and validate two instruments associated with foot health (Nurses Foot Care Knowledge test e Self-Administered Foot Health Assessment Instrument); a prospective longitudinal study to assess changes in the foot profile of students in clinical rotations; and an expert panel to validate a preliminary version of the recommendations for self-care. Results. The most common foot and ankle injury in prolonged standing is pain, which can be more prevalent than in other areas, such as the lumbar or cervical spine. In this sense, and given the associated muscle fatigue, soft, non-slip footwear with cushioned insoles is the best option. The methodological study resulted in two instruments with acceptable internal validity and intuitive for students to use. The foot health self-assessment instrument (IAASP) obtained a Cronbach's alpha of 0.653 and the foot care knowledge instrument (TCE-CP) a value of 0.893. The prospective study of 54 students revealed that after five months of clinical rotations, around 25% reported painful symptoms for the first time, with a positive correlation with anxiety/depression (0.540; p<0.05). After five months, the injuries reported for the first time or with a significant increase compared to the beginning were edema (11; 20.4%) and pain (23; 43.6%). On the other hand, high values of pressure in the heel correlated positively with maximum force and contact area, as well as with pain in the thigh. Pressure was found to be an important predictor of students' podiatric profile. Self-care recommendations should focus on personalized footwear, an exercise program using images and videos, health promotion through school health assessments and raising awareness of the issue among institutions. Conclusion. The podiatric profile of nursing students exposed to prolonged orthostatic contexts is characterized by a slight increase in the maximum force and contact area exerted, whose main predictor is pressure, and whose primary antecedents are anatomical-functional foot injuries (e.g. corns, calluses, minor deformities). The main recommendations that students should follow in order to take care of their feet are to wear customized footwear, depending not only on their podiatric profile, but also on their lifestyle; to assess the force and pressure they exert obligatorily one week before the clinical rotations and, optionally, at three, six and twelve months; to practice frequent physical exercise, focusing on the lower limbs and feet.
Introduction. Clinical rotations are potentially aggressive environment for nursing students' feet and ankles. Pain and discomfort in this area has negative consequences for students' quality of life and can contribute to their intention to drop out of the course. The ability to take care of oneself is essential for taking care of others, so it is important to help students implementing self-care interventions, as well as providing institutions with effective tools in this regard. There are currently no specific recommendations in this topic. Objectives. Identify and characterize the podiatric profile of nursing students in clinical rotations and develop recommendations for foot self-care. Methods. The research was composed of five different studies: a scoping review to map the main foot injuries in nurses; a narrative review to describe suitable characteristics for footwear in nurses; a methodological study to adapt and validate two instruments associated with foot health (Nurses Foot Care Knowledge test e Self-Administered Foot Health Assessment Instrument); a prospective longitudinal study to assess changes in the foot profile of students in clinical rotations; and an expert panel to validate a preliminary version of the recommendations for self-care. Results. The most common foot and ankle injury in prolonged standing is pain, which can be more prevalent than in other areas, such as the lumbar or cervical spine. In this sense, and given the associated muscle fatigue, soft, non-slip footwear with cushioned insoles is the best option. The methodological study resulted in two instruments with acceptable internal validity and intuitive for students to use. The foot health self-assessment instrument (IAASP) obtained a Cronbach's alpha of 0.653 and the foot care knowledge instrument (TCE-CP) a value of 0.893. The prospective study of 54 students revealed that after five months of clinical rotations, around 25% reported painful symptoms for the first time, with a positive correlation with anxiety/depression (0.540; p<0.05). After five months, the injuries reported for the first time or with a significant increase compared to the beginning were edema (11; 20.4%) and pain (23; 43.6%). On the other hand, high values of pressure in the heel correlated positively with maximum force and contact area, as well as with pain in the thigh. Pressure was found to be an important predictor of students' podiatric profile. Self-care recommendations should focus on personalized footwear, an exercise program using images and videos, health promotion through school health assessments and raising awareness of the issue among institutions. Conclusion. The podiatric profile of nursing students exposed to prolonged orthostatic contexts is characterized by a slight increase in the maximum force and contact area exerted, whose main predictor is pressure, and whose primary antecedents are anatomical-functional foot injuries (e.g. corns, calluses, minor deformities). The main recommendations that students should follow in order to take care of their feet are to wear customized footwear, depending not only on their podiatric profile, but also on their lifestyle; to assess the force and pressure they exert obligatorily one week before the clinical rotations and, optionally, at three, six and twelve months; to practice frequent physical exercise, focusing on the lower limbs and feet.
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Conhecimento Estudantes de enfermagem Qualidade de vida Saúde do pé Ortostatismo prolongado Sapatos Foot health Health-related quality of life Knowledge Nursing students Prolonged standing Shoes
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