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O compromisso do autocuidado e a presença de onicomicose nos doentes com distúrbios mentais
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INTRODUÇÃO: Algumas doenças mentais, como a depressão, estão associadas a comportamentos negativos de negligência no autocuidado. Sabe-se que, nos diabéticos, os benefícios dos comportamentos de autocuidado, incluem manter o nível de glicose no sangue a níveis recomendados, assim como prevenir possíveis complicações. Estudos revelam que o nível de conhecimento do doente mental, relativamente ao controlo da diabetes, tem uma relação direta com a sua capacidade cognitiva, o que poderá condicionar o autocuidado, especificamente nos cuidados aos pés. Independentemente das comorbilidades associadas, e devido às suas caraterísticas particulares, os idosos apresentam maior dificuldade e compromisso no autocuidado dos pés, principalmente quando existe espessamento da lâmina ungueal, em consequência da evolução da onicomicose. Ora, a presença deste fenómeno já foi associado em alguns estudos, precisamente ao défice de cuidados de higiene diários aos pés. OBJETIVOS Pretende-se identificar a relação entre os distúrbios mentais e as implicações no autocuidado dos pés, em particular nos doentes portadores de onicomicoses. MATERIAIS E MÉTODOS: Para esta revisão da literatura, foram efetuadas pesquisas com os descritores MESH durante os meses de janeiro e fevereiro de 2017, em Clinicalkey, ClinicalkeyforNursing e EBSCO. Como critérios de inclusão definiu-se o limite temporal dos últimos dez anos e todas as publicações sem distinção de género, idioma ou localização geográfica. RESULTADOS/DISCUSSÃO Desta pesquisa foram identificadas 96 citações que se enquadravam nos critérios. Dos 24 artigos elegíveis com texto completo, eliminou-se 18, porque não se enquadravam nos objetivos da revisão. Foram incluídos os resultados de 6 estudos. Um estudo publicado em 2012, analisou doentes amputados dos membros inferiores e a sua relação com a presença de distúrbios mentais secundários a esse evento. Cerca de 40% apresentou distúrbios emocionais, nomeadamente ansiedade e depressão, relacionadas, não só com a amputação, mas também pela dependência causada e inadaptação às suas atividades de vida diária. Publicado em 2014, um estudo efetuado numa população vulnerável, verificou taxas de prevalência de doença mental de 20 a 30%. Identificou também, que devido há falta de higiene e más condições de vida, estas pessoas apresentavam onicomicose e outras afeções dos pés. Ainda nesse ano, um estudo com um desenho de investigação quasi-experimental, foi realizado num pequeno grupo de doentes esquizofrénicos, o qual foi submetido à intervenção de banho e massagem dos pés três vezes por semana durante 4 semanas. Os resultados revelaram uma melhoria dos sintomas psiquiátricos, devido ao efeito de relaxamento da técnica aplicada. Identificou-se ainda um estudo comparativo, efetuado em pessoas com doença mental grave e com diabetes, o qual comparou os cuidados praticados habitualmente, com um programa de ensino e autogestão das doenças, realizado por enfermeiros de cuidados de saúde primários. Neste programa com onze sessões, estão incluídos os ensinos sobre os cuidados aos pés. Os resultados preliminares indicam viabilidade e boa aceitação dos participantes, assim como fiabilidade na implementação desta intervenção pelos enfermeiros educadores. Um estudo de 2016, realizado num grupo de pessoas diabéticas com depressão, procurou analisar de que forma a Terapia de Resolução de Problemas (PST) poderia melhorar comportamentos de autocuidado, nomeadamente os cuidados aos pés. Salienta-se que embora a depressão seja um forte preditor de má gestão do diabetes, mesmo controlando os sintomas depressivos os comportamentos sobre a diabetes não melhoraram. Reconhece ainda que a remissão da depressão não é uma condição suficiente, mas uma condição necessária para a mudança comportamental. Outro achado nulo foi a observado na relação entre o recebimento de PST e comportamentos de autocuidado, sugerindo que esta terapia pode não induzir de forma suficiente mudança de comportamento. Publicado no mesmo ano, uma investigação procurava verificar a relação entre o conhecimento da diabetes e os sintomas psiquiátricos descritos e relacioná-los com a sua doença mental. Os resultados enfatizam o papel do prestador de cuidados como elemento fundamental, na gestão da farmacoterapia, uma vez que alguns fármacos são potenciadores das alterações cognitivas existentes, e na promoção do descontrolo metabólico, o que poderá condicionar o conhecimento e o autocuidado do diabético. CONCLUSÃO: Nos estudos citados, constata-se uma relação importante entre os distúrbios mentais e a Diabetes. Estes procuram analisar as implicações do cruzamento destas doenças crónicas com o autocuidado de forma geral e não apenas dos pés. Embora esta revisão apresente algumas limitações, salienta-se que a referência em particular à abordagem da onicomicose nos doentes mentais e diabéticos é pouco explícita e muito escassa, o que evidencia a necessidade de investigação nesta área.
INTRODUCTION: Some mental illnesses, such as depression, are associated with negative behaviors of neglect of self-care. It is known that in diabetics, the benefits of self-care behaviors include maintaining blood glucose at recommended levels, as well as preventing possible complications. Studies have shown that the level of knowledge of the mental patient regarding the control of diabetes has a direct relation with their cognitive ability, which may condition self-care, specifically in foot care. Regardless of the associated comorbidities, and due to their particular characteristics, the elderly present greater difficulty and commitment in the self-care of the feet, especially when there is thickening of the nail plate, as a consequence of the onychomycosis evolution. The presence of this phenomenon has been associated in some studies with the lack of daily hygiene at the feet. GOALS/ AIM? It is intended to identify the relationship between mental disorders and the implications for feet self-care, particularly in patients with onychomycosis. MATERIALS AND METHODS: For this review of the literature, research was carried out with MESH descriptors during the months of January and February 2017, in Clinicalkey, ClinicalkeyforNursing and EBSCO. The inclusion criteria were defined as the temporal limit of the last ten years, and all publications without distinction of gender, language or geographical location. RESULTS / DISCUSSION From this research were identified 96 citations that fit the criteria. Of the 24-eligible full-text articles, 18 were eliminated because they did not fit the review objectives or proved to be irrelevant. Results from 6 studies were included. A study published in 2012 examined lower limb amputees and their relationship to the presence of mental disorders secondary to this event. About 40% presented emotional disturbances, namely anxiety and depression, related not only to amputation, but also due to their dependence and inadequacy to their daily life activities. Published in 2014, a study of a vulnerable population found rates of mental illness prevalence of 20-30%. It also identified that due to lack of hygiene and poor living conditions, these people present onychomycosis and other affections of the feet. In this year, a study with a quasi-experimental research design, was performed in a small group of schizophrenic patients, who underwent bath intervention and foot massage three times a week for 4 weeks. The results revealed an improvement in psychiatric symptoms due to the relaxation effect of the applied technique. It was also identified a comparative study conducted in people with severe mental illness and diabetes, which compared the usual care, with a program of teaching and self-management of Nurses. This eleven session program includes feet care instruction. The preliminary results indicate feasibility and good acceptance of the participants, as well as reliability in the implementation of this intervention by the educator nurses. A 2016 study, developed in a group of diabetic people with depression, sought to examine how Problem-Solving Therapy (PST) could improve self-care behaviors such as foot care. Although depression is a strong predictor of poor management of diabetes, even controlling for depressive symptoms, behaviors on diabetes have not improved. It further recognizes that remission of depression is not a sufficient condition, but a necessary condition for behavioral change. Another null finding was observed in the relation between the receipt of PST and self-care behaviors, suggesting that this therapy may not induce a sufficient behavior change. Published in the same year, a research which aimed to verify the relationship between the knowledge of diabetes and the psychiatric symptoms described and relate them to their mental illness. The results emphasize the role of the caregiver as a fundamental element in the management of pharmacotherapy, since some drugs are potentiators of existing cognitive alterations, and in promoting metabolic control, which may condition the knowledge and self-care of the diabetic patient. (3). CONCLUSION: In the cited studies, there is an important relationship between mental illness and Diabetes. These seek to analyze the implications of the intersection of these chronic diseases with self-care in general and not just feet. Although this review presents some limitations, it is noted that reference to the approach of onychomycosis in the mental and diabetic patients is not very explicit and very scarce, and thus it has evidenced the need for research in this area.
INTRODUCTION: Some mental illnesses, such as depression, are associated with negative behaviors of neglect of self-care. It is known that in diabetics, the benefits of self-care behaviors include maintaining blood glucose at recommended levels, as well as preventing possible complications. Studies have shown that the level of knowledge of the mental patient regarding the control of diabetes has a direct relation with their cognitive ability, which may condition self-care, specifically in foot care. Regardless of the associated comorbidities, and due to their particular characteristics, the elderly present greater difficulty and commitment in the self-care of the feet, especially when there is thickening of the nail plate, as a consequence of the onychomycosis evolution. The presence of this phenomenon has been associated in some studies with the lack of daily hygiene at the feet. GOALS/ AIM? It is intended to identify the relationship between mental disorders and the implications for feet self-care, particularly in patients with onychomycosis. MATERIALS AND METHODS: For this review of the literature, research was carried out with MESH descriptors during the months of January and February 2017, in Clinicalkey, ClinicalkeyforNursing and EBSCO. The inclusion criteria were defined as the temporal limit of the last ten years, and all publications without distinction of gender, language or geographical location. RESULTS / DISCUSSION From this research were identified 96 citations that fit the criteria. Of the 24-eligible full-text articles, 18 were eliminated because they did not fit the review objectives or proved to be irrelevant. Results from 6 studies were included. A study published in 2012 examined lower limb amputees and their relationship to the presence of mental disorders secondary to this event. About 40% presented emotional disturbances, namely anxiety and depression, related not only to amputation, but also due to their dependence and inadequacy to their daily life activities. Published in 2014, a study of a vulnerable population found rates of mental illness prevalence of 20-30%. It also identified that due to lack of hygiene and poor living conditions, these people present onychomycosis and other affections of the feet. In this year, a study with a quasi-experimental research design, was performed in a small group of schizophrenic patients, who underwent bath intervention and foot massage three times a week for 4 weeks. The results revealed an improvement in psychiatric symptoms due to the relaxation effect of the applied technique. It was also identified a comparative study conducted in people with severe mental illness and diabetes, which compared the usual care, with a program of teaching and self-management of Nurses. This eleven session program includes feet care instruction. The preliminary results indicate feasibility and good acceptance of the participants, as well as reliability in the implementation of this intervention by the educator nurses. A 2016 study, developed in a group of diabetic people with depression, sought to examine how Problem-Solving Therapy (PST) could improve self-care behaviors such as foot care. Although depression is a strong predictor of poor management of diabetes, even controlling for depressive symptoms, behaviors on diabetes have not improved. It further recognizes that remission of depression is not a sufficient condition, but a necessary condition for behavioral change. Another null finding was observed in the relation between the receipt of PST and self-care behaviors, suggesting that this therapy may not induce a sufficient behavior change. Published in the same year, a research which aimed to verify the relationship between the knowledge of diabetes and the psychiatric symptoms described and relate them to their mental illness. The results emphasize the role of the caregiver as a fundamental element in the management of pharmacotherapy, since some drugs are potentiators of existing cognitive alterations, and in promoting metabolic control, which may condition the knowledge and self-care of the diabetic patient. (3). CONCLUSION: In the cited studies, there is an important relationship between mental illness and Diabetes. These seek to analyze the implications of the intersection of these chronic diseases with self-care in general and not just feet. Although this review presents some limitations, it is noted that reference to the approach of onychomycosis in the mental and diabetic patients is not very explicit and very scarce, and thus it has evidenced the need for research in this area.
Descrição
Palavras-chave
Autocuidado Distúrbios mentais Mental disorders Onicomicose Onychomycosis Prevalence Prevalência Self-care
Contexto Educativo
Citação
Silva-Neves, V., Silva, M., & Teixeira, S. (2017). O compromisso do autocuidado e a presença de onicomicose nos doentes com distúrbios mentais. In M. M. Vieira, J. Neves-Amado, & S. Deodato (Eds.), 11th International Seminar on Nursing Research proceedings (pp. 45-46). Universidade Católica Portuguesa.
Editora
Universidade Católica Portuguesa
Licença CC
Sem licença CC