Analisar o autocuidado com a fístula arteriovenosa / Analysis of self-care behaviors in patients with arteriovenous fistula / Análisis del autocuidado de una fístula arteriovenosa

Resumo Enquadramento: A hemodiálise constitui uma forma de tratamento da doença renal crónica, exigindo a construção de fístula arteriovenosa. Esta requer cuidados por parte do doente, devendo o enfermeiro capacitar para comportamentos de autocuidado. Objetivo: Analisar os comportamentos de autocuidado à fístula arteriovenosa da pessoa em programa de hemodiálise. Metodologia: Estudo transversal analítico, realizado em 131 doentes de três clínicas de hemodiálise do norte de Portugal. Para tal recorreu-se à Escala de Avaliação de Comportamentos de Autocuidado com a Fístula Arteriovenosa. Resultados: Os comportamentos de autocuidado à fistula arteriovenosa obtiveram uma média de 74,5 pontos, a gestão de sinais e sintomas 85,27 e a prevenção de complicações 68,26 num máximo de 100 pontos. O grau académico e o agente de ensinamento associaram-se com os comportamentos de autocuidado. A idade e grau académico relacionaram-se com a prevenção de complicações. Conclusão: O autocuidado à fistula arteriovenosa ficou abaixo do pretendido. Sugerimos sessões de educação para o autocuidado em função da idade e das habilitações literárias por uma equipa multidisciplinar.

Abstract Background: Hemodialysis is a form of treatment for chronic kidney disease that requires arteriovenous fistula creation. Given that patients are required to care for their arteriovenous fistulae, nurses should teach them these self-care behaviors. Objective: To analyze the self-care behaviors of patients with arteriovenous fistula undergoing hemodialysis. Methodology: Analytical cross-sectional study with 131 patients from three hemodialysis clinics in the north of Portugal using of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis Scale. Results: Arteriovenous fistula-related self-care behaviors scored an average of 74.5 points, the Management of signs and symptoms subscale scored 85.27 points, and the Prevention of complications 68.26 points out of a maximum of 100 points. Education level and teaching agent were associated with self-care behaviors. Age and education level were related to the prevention of complications. Conclusion: The self-care behaviors of patients with arteriovenous fistula were below expected levels. We suggest that a multidisciplinary team should provide self-care training to these patients adjusted to their age and education level.

Resumen Marco contextual: La hemodiálisis es una forma de tratamiento de la enfermedad renal crónica que requiere la realización de una fístula arteriovenosa. Esto implica cuidados por parte del paciente, y los enfermeros deben formarlos en conductas de autocuidado. Objetivo: Analizar las conductas de autocuidado de las personas sometidas a hemodiálisis por fístulas arteriovenosas. Metodología: Estudio transversal analítico de 131 pacientes de tres clínicas de hemodiálisis del norte de Portugal. Para ello, se utilizó la Escala de Evaluación de Conductas de Autocuidado con Fístula Arteriovenosa. Resultados: Las conductas de autocuidado de la fístula arteriovenosa obtuvieron una media de 74,5 puntos, la gestión de signos y síntomas 85,27 y la prevención de complicaciones 68,26 sobre un máximo de 100 puntos. El nivel académico y el agente docente se asociaron a las conductas de autocuidado. La edad y el nivel académico se asociaron a la prevención de complicaciones. Conclusión: El autocuidado de la fístula arteriovenosa estuvo por debajo del objetivo. Proponemos sesiones de educación para el autocuidado según la edad y el nivel educativo a cargo de un equipo multidisciplinar.

Capacitar para Cuidar ­ Projeto de Intervenção Comunitária dirigido a cuidadores informais de uma Unidade de Cuidados na Comunidade (UCC) / Empowering to Care ­ Community Intervention Project aimed at informal caregivers from a Community Care Unit (CCU)

O envelhecimento demográfico, que marca a atualidade a nível global, tem-se traduzido num aumento progressivo das taxas de doenças crónicas, resultando num número cada vez mais expressivo de pessoas em situação de dependência no autocuidado e paralelamente, faz com que os cuidadores informais sejam um grupo vulnerável. É neste contexto que se apresenta este documento, que segue uma metodologia descritiva, crítica e reflexiva, espelhando todo o caminho percorrido para a aquisição e desenvolvimento de competências em Enfermagem de Saúde Comunitária na área de Saúde Comunitária e de Saúde Pública (EEECSCSP), com foco na capacitação dos cuidadores, através do treino de conhecimentos. Os ensinos clínicos decorreram numa Unidade de Saúde Pública (USP) da Administração Regional do Centro e numa Unidade de Cuidados na Comunidade (UCC) da Região Centro, sob a visão da Teoria de Dorothea E. Orem (2001), recorrendo à metodologia do planeamento, tendo seguido sequencialmente as suas etapas designadamente: diagnóstico da situação, definição das prioridades, delineamento dos objetivos, escolha das estratégias, elaboração e execução do projeto e avaliação, que se traduziu no desempenho e implementação de um Projeto de Intervenção Comunitária dirigido a cuidadores informais, com a designação "Capacitar para Cuidar." Esta intervenção foi sustentada com a realização de uma revisão integrativa da literatura, com vista a uma prática baseada na evidência. O grande objetivo deste projeto é o de promover a capacitação dos cuidadores informais para a prestação de cuidados com foco na aquisição de conhecimentos através de um projeto de intervenção numa UCC. Foi operacionalizado num grupo de seis cuidadores informais, tendo sido aplicado o Questionário de Avaliação das Capacidades do Cuidador Informal (Dixe, 2021), antes e após a implementação do mesmo. Com a aplicação do projeto os cuidadores informais ficaram mais capacitados em todas as áreas do cuidar, sobressaindo o aumento de competências nas áreas mais problemáticas: Cuidar: Mobilidade passou de um score médio de 1,99±1,07 para 3,15±0,58; Cuidar: Transferências passou de um score médio de 2,10±1,10 para 3,61±0,52; Cuidar: Higiene Sanitária passou de um score médio de 2,17±0,99 para 3,68±0,46; Cuidar: Alimentação passou de um score médio de 2,57±0,85 para 3,62±0,50; Cuidados de higiene e conforto passou de um score médio de 2,88±0,92 para 3,75. Estes resultados reforçam a relevância do EEECSCSP na aposta em ganhos em saúde dirigidos a grupos vulneráveis, nomeadamente os cuidadores informais.

Demographic aging, which marks the current global situation, has resulted in a progressive increase in the rates of chronic diseases, resulting in an increasingly significant number of people in a situation of dependence on self-care and, at the same time, makes informal caregivers a vulnerable group. It is in this context that this document is presented, which follows a descriptive, critical and reflective methodology, mirroring the entire path taken towards the acquisition and development of skills in Community Health Nursing in the area of Community Health and Public Health (EEECSCSP), with focus on training caregivers through knowledge training. The clinical teachings took place in a Public Health Unit (USP) of the Central Regional Administration and in a Community Care Unit (CCU) in the Central Region, under the vision of the Theory of Dorothea E. Orem (2001), using the planning methodology , having sequentially followed its steps, namely: diagnosis of the situation, definition of priorities, outline of objectives, choice of strategies, preparation and execution of the project and evaluation, which resulted in the performance and implementation of a Community Intervention Project aimed at informal caregivers , with the designation "Empowering to Care." This intervention was supported by carrying out an integrative literature review, with a view to evidence-based practice. The main objective of this project is to promote the training of informal caregivers to provide care with a focus on acquiring knowledge through an intervention project in a UCC. It was implemented in a group of six informal caregivers, with the Informal Caregiver Capabilities Assessment Questionnaire (Dixe, 2021) being applied before and after its implementation. With the implementation of the project, informal caregivers became more qualified in all areas of care, highlighting the increase in skills in the most problematic areas: Caring: Mobility went from an average score of 1.99±1.07 to 3.15±0 .58; Caring: Transfers went from an average score of 2.10±1.10 to 3.61±0.52; Caring: Sanitary Hygiene went from an average score of 2.17±0.99 to 3.68±0.46; Caring: Food went from an average score of 2.57±0.85 to 3.62±0.50; Hygiene and comfort care went from an average score of 2.88±0.92 to 3.75. These results reinforce the relevance of EEECSCSP in investing in health gains aimed at vulnerable groups, namely informal caregivers.

Necesidades y demandasde servicios de salud por parte del cuidador principal del paciente inmovilizado / Needs and demands for health services by the main caregiver of the immobilized patient

Objetivo: Evaluar las necesidades y las demandas de servicios desalud del cuidador principal de pacientes inmovilizados en el Centrode Salud de Caranza. Metodología: Estudio descriptivo transversalsobre los cuidadores principales de pacientes inmovilizados, mediantela identificación de inmovilizados y captación de 39 cuidadoresprincipales que voluntaria y anónimamente participaron. Inclusiónde variables de calidad (≥ 2 visitas/año), clínicas (sobrecarga, apoyo,estrés, ansiedad y depresión), sociodemográficas y de satisfaccióncon el servicio. Resultados: El indicador de calidad se superó en el89,8% de inmovilizados. Entre sobrecarga y parentesco (p = 0,040),nivel de cobertura (p = 0,012) o tiempo de respuesta (p = 0,015) seobservaron diferencias estadísticamente significativas. También hubodiferencias estadísticamente significativas entre apoyo social y nivelde cobertura (p < 0,001), tiempo de respuesta (p = 0,022), sobrecarga(p = 0,003), ansiedad (p = 0,046) o depresión (p = 0,040). Por último,se apreciaron diferencias estadísticamente significativas entre nivel deestrés y género (p = 0,035). Conclusiones: El presente trabajo muestraque las necesidades y demandas de servicios de salud se deben dirigir adisminuir el elevado nivel de sobrecarga, estrés y depresión detectado.De este modo, el estudio pone en evidencia el tipo de actuacionesmultidisciplinarias que los servicios de salud deben implementar paramejorar la calidad de vida y mitigar los problemas de salud de loscuidadores principales de pacientes inmovilizados. (AU)

Objective: Assess the needs and demands for health servicesof the main caregiver of immobilized patients at the CaranzaHealth Center. Methodology: Cross-sectional descriptive studyon the main caregivers of immobilized patients, through theidentification of immobilized patients and recruitment of 39main caregivers who voluntarily and anonymously participated.Inclusion of quality variables (≥ 2 visits/year), clinical (burden,support, stress, anxiety, and depression), sociodemographic, andsatisfaction with the service. Results: The quality indicator wasexceeded in 89.8% of fixed assets. Between burden and kinship(p = 0.040), level of coverage (p = 0.012) or response time(p = 0.015), statistical differences were observed. There were alsostatistically significant differences between social support andcoverage level (p < 0.001), response time (p = 0.022), overload(p = 0.003), anxiety (p = 0.046) or depression (p = 0.040). Finally,statistically significant differences were observed between stresslevel and gender (p = 0.035). Conclusions: The present workshows that the needs and demands of health services shouldbe aimed at reducing the high level of overload, stress anddepression detected. In this way, the study highlights the type ofmultidisciplinary actions that health services must implement toimprove the quality of life and mitigate the health problems of themain caregivers of immobilized patients. (AU)

Intervenciones de conciliación para evitar la sobrecarga de la cuidadora familiar en paciente con esquizofrenia / Conciliation interventions to avoid the burden of the family caregiver in a patient with schizophrenia

Caso: mujer de mediana edad con sobrecarga personal debido a los cuidados permanentes que tiene que prestar a su hija con esquizofrenia. Objetivo: evitar o paliar la sobrecarga o sentimientos negativos que ocasionan en la cuidadora familiar la atención de su hija con esquizofrenia. Metodología: búsqueda de evidencias siguiendo el modelo PRAXIS. Recomendaciones de buena práctica: a) Acudir a sesiones psico-educativas para conseguir un efecto en el bienestar de la cuidadora, b) apoyarse en las estrategias más frecuentes que usan otros cuidadores para afrontar el estrés, c) valoración de la sobrecarga en cuidadores familiares de pacientes con esquizofrenia antes y después de un programa psicoeducativo, d) apoyarse en material audiovisual y material escrito, e) facilitar el acceso a la prestación de apoyos por parte del sector social para suplir temporalmente las funciones de la cuidadora familiar llamados "Servicios respiro", y f) poner en contacto a la cuidadora con diferentes organizaciones de la comunidad para obtener servicios de carácter no remunerado. Prácticas de autocuidado: conocer las técnicas de autocuidado de la persona cuidadora, compartir sentimientos y experiencias de la cuidadora con el entorno social y grupos de ayuda, y utilización de los recursos que hay a su disposición. (AU)

Case: middle-aged woman with personal burden due to the permanent care she must provide to her daughter with schizophrenia. Objective: avoiding or alleviating the burden or negative feelings that the care of her daughter with schizophrenia causes in the family caregiver. Methodology: searching for evidence following the PRAXIS model. Good practice recommendations: a) Attending psychoeducational sessions to achieve an effect on the well-being of the caregiver, b) relying on the most frequent strategies used by other caregivers to cope with stress, c) assessing burden in family caregivers of patients with schizophrenia before and after a psychoeducational program, d) relying on audio-visual and written material, e) facilitating access to the benefit of support by the social sector to temporarily replace the functions of the family caregiver called "Break Services", and f) putting the caregiver in contact with different community organizations to obtain unpaid services. Self-care internship: getting to know the caregiver's self-care techniques, sharing feelings and experiences of the caregiver with the social environment and support groups, and using the resources available to her. (AU)

O efeito do treinamento multimídia na função social de pacientes queimados no Hospital Shahid Motahhari, Teerã: um estudo clínico / The effect of multimedia training on social function of burned patients in Shahid Motahhari Hospital, Tehran: A clinical trial study

Introdução: a queimadura é uma lesão tecidual que afeta o convívio social e os relacionamentos. Complicações de queimaduras levam à ruptura das relações sociais e, consequentemente, à disfunção social. Objetivo: este estudo objetiva determinar o efeito do treinamento multimídia no comportamento social de pacientes queimados no hospital Shahid Motahhari em Teerã. Métodos: este estudo clínico investigou 100 pacientes queimados. O grupo de intervenção recebeu, na alta hospitalar, um treinamento de autocuidados em multimídia num CD, além das informações de rotina. A função social da qualidade de vida foi examinada em ambos os grupos antes da intervenção, três meses e seis meses após a intervenção. Conclusões: os resultados mostraram que, antes da intervenção, o escore médio da função social da qualidade de vida no grupo intervenção e controle foi de 1/55 ± 0/46 e 1/92 ± 0/6, respectivamente, o que foi estatisticamente significativo (p<0,001). A média e o desvio-padrão da função social da qualidade de vida nos grupos intervenção e controle três e seis meses após a intervenção foram 2/47±0/56, 4/05±0/77, 2/15±0/39 e 29/3±0/95, respectivamente, também estatisticamente significativo (p<0,001)

Introduction: Burn is a tissue injury and affects social functioning and relationships. Complications of burns lead to disruption of social relationships and, consequently, social dysfunction. Objective: This study aims to determine the effect of multimedia training on burned patients' social functioning in Shahid Motahhari hospital in Tehran. Methods: This clinical trial study assessed 100 burned patients. The intervention group received multimedia self-care discharge training on a CD in addition to the standard education. The social function of the quality of life was examined in both groups before the intervention, 3 months and 6 months after the intervention. Conclusions: Results showed that before the intervention, the mean score of social function of quality of life in intervention and control group was 1/55± 0/46, 1/92± 0/6, respectively, which was statistically significant (p <0.001). Mean and standard deviation of social function of quality of life in the intervention and control groups three and six months after intervention were2/47± 0/56, 4/05± 0/77, 2/15±0/39, 3/29 ± 0/95, also statistically significant (p<0.001).

Medidas de bioseguridad para la manipulación de citotóxicos y signos clínicos y síntomas de la exposición a estos medicamentos en personal de enfermería / Biosafety measures for handling cytotoxic drugs and signs and symptoms of risk exposure in nursing Staff / Medidas de biossegurança no manuseio de medicamentos citotóxicos e sinais e sintomas de exposição a eles na equipe de enfermagem

Introducción. Las terapias ofrecidas a los pacientes con cáncer, incluidos los medicamentos citotóxicos, generan un alto riesgo para los profesiona-les de la salud involucrados en el proceso de atención del paciente; por tanto, todo el personal, incluido el de enfermería, debe contar con las medidas de seguridad necesarias para evitar la aparición o el aumento de efectos no deseados para su salud.Objetivo. Describir las medidas de bioseguridad adecuadas para la ma-nipulación de medicamentos citotóxicos y los signos clínicos y síntomas producto de la exposición a estos fármacos en el personal de enfermería de una institución de salud para adultos de Envigado, Colombia.Materiales y métodos. Se realizó un estudio descriptivo de corte trans-versal en el personal de enfermería que tuviera a su cargo el cuidado de pacientes oncológicos en una institución de salud de alta complejidad del municipio de Envigado durante el primer semestre del 2018. A los partici-pantes se les aplicó una encuesta autodiligenciable, en la cual se registra-ron datos sociodemográficos, laborales, de salud y medidas de protección personal para la administración y manipulación de citostáticos. Se realizó un análisis descriptivo de los datos.Resultados. Participaron 51 trabajadores con una mediana de edad de 33 años (RIQ=8); el 90 % pertenecía al servicio de hospitalización. Los síntomas manifestados más frecuentes fueron cefalea (64,7 %), dolor ab-dominal (25,5 %) y mareo (25,5 %). El 98 % de los participantes contaba con los suministros y elementos personales para la manipulación de cito-tóxicos, pero solo el 19,6 % había recibido capacitación sobre el manejo de estos medicamentos.Conclusiones. Se deben realizar capacitaciones al personal de salud para que identifiquen en su área de trabajo los riesgos a los que se encuentran expuestos y así adopten las medidas de bioseguridad necesarias para des-empeñar sus labores diarias.

Introduction: Therapies currently being offered to cancer pa-tients such as cytotoxic drugs, generate a high risk for health ca-re staff involved in patient-caring process. Consequently, Nur-sing staff must have the necessary safety measures to avoid the appearance and, or increase of adverse effects on their healthObjective: To describe the biosafety measures for handling cytotoxic drugs, signs, and symptoms of risk exposure in nur-sing staff at a health institution for adults in Envigado, Colombia Methodology: A descriptive, cross-sectional study was carried out in nursing staff caring for cancer patients at a high-com-plexity health institution in the city of Envigado during the first semester of 2018. A survey was conducted to collect sociode-mographic, employment, and health data as well as personal protection measures for management and handling of cytosta-tic drugs. Descriptive analysis of the data was presented.Results: There were 51 participants. The median age was 33 years (IQR 8) and 90% of the participants in this study worked in hospitalization services. The most frequent signs and symp-toms included headache (64.7%), abdominal pain (25.5%), and dizziness (25.5%). 98% of the participants in this study had the necessary supplies and personal elements to handle cyto-toxic drugs and 19.6% expressed having undergone training for handling of cytotoxic drugs.Conclusions: Health care staff training ought to be focused on risk-identification in their work area, allowing for the imple-mentation of all necessary biosafety measures.

Introdução. As terapias oferecidas aos pacientes com câncer, incluindo drogas citotóxicas, criam um alto risco para os pro-fissionais de saúde envolvidos no processo de atendimento ao paciente; portanto, todos os trabalhadores da saúde, incluin-do enfermeiros, devem ter as devidas medidas de segurança necessárias para evitar o aparecimento ou aumento de efeitos indesejados à sua saúde.Objetivo. Descrever as medidas apropriadas de biossegurança para o manuseio de medicamentos citotóxicos e os sinais e sin-tomas resultantes da exposição a esses medicamentos na equi-pe de enfermagem de uma instituição de saúde de adultos em Envigado, Colômbia.Materiais e métodos. Foi realizado um estudo descritivo de corte transversal na equipe de enfermagem encarregada do cuidado de pacientes com câncer em uma instituição de saúde de alta com-plexidade no município de Envigado durante o primeiro semestre de 2018. Informações sociodemográficas, trabalhistas, de saúde e de proteção individual no manuseio de citostáticos, foi realizada uma análise descritiva dos dados obtidos em questionario. Resultados. Participaram 51 trabalhadores com uma media de idade de 33 anos (RIQ = 8); 90% pertenciam ao serviço de hospitalização. Os sinais e sintomas mais frequentes foram ce-faleia (64,7%), dor abdominal (25,5%) e tontura (25,5%). 98% dos participantes possuíam suprimentos e itens pessoais para o manuseio de medicamentos citotóxicos, mas apenas 19,6% ha-viam recebido treinamento no manuseio desses medicamentos.Conclusões. O pessoal de saúde deve ser treinado para que possa identificar os riscos a que se expõe e adotar as medidas de biossegurança necessárias para realizar suas tarefas diárias.

Temporomandibular disorders: Guidelines and Self-Care for Patients During COVID-19 Pandemic / Desordem Temporomandibular: Orientações e Autocuidados para Pacientes Durante a Pandemia do COVID-19

Background: Temporomandibular disorder (TMD) belongs to a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, musculature and adjacent components. These conditions can generate signs and symptoms and be influenced by an altered biopsychosocial condition. Objective: This study aims to seek information to assist the patient in the presence of TMD signs and symptoms and Orofacial Pain, associated with the period of social isolation during the COVID-19 pandemic. Material and methods: For the preparation of this manual, a bibliographic search was performed in the databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science and The Cochrane Library, using the keywords: orofacial pain, temporomandibular disorders, bruxism, stress, anxiety, biopsychosocial, diagnosis, self-care with important information on how to reduce and control the signs and symptoms of TMD and Orofacial Pain in this moment of pandemic that we are experiencing a social detachment. Results: The results show that the pandemic of COVID-19 and the need for social isolation, generates psychological impact that raises the pattern of anxiety and can directly affect patients with bruxism and TMD. Conclusion: Psychological factors associated with the pandemic can lead to an increased risk of developing, worsening and perpetuating bruxism, especially waking bruxism and TMD, so dentists should be aware of the occurrence of signs and symptoms to manage the multifactorial aspects of this condition. At that time, individual self-management strategies are advised for the patient, which consist of self-massage techniques, body education, exercise practices, sleep hygiene, meditation also the use of mobile apps and online tools that facilitate this activity. (AU)

Introdução: A Desordem Temporomandibular (DTM) pertence a um grupo heterogêneo de condições musculoesqueléticas e neuromusculares envolvendo o complexo articular temporomandibular, a musculatura e os componentes adjacentes. Essas condições podem gerar sinais e sintomas e serem influenciadas por uma condição biopsicossocial alterada. Objetivo: Esse estudo teve como objetivo buscar informações que possam auxiliar ao paciente na presença de sinais e sintomas de DTM e Dor Orofacial associado ao período de isolamento social durante a pandemia do COVID -19. Material e Métodos: Para a elaboração deste manual, foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science e The Cochrane Library, utilizando as palavras-chaves: dor orofacial, desordem temporomandibular, bruxismo, estresse, ansiedade, biopsicossocial, diagnóstico e autocuidados, com informações importantes sobre como reduzir e controlar os sinais e sintomas de DTM e Dor Orofacial nesse momento de pandemia que estamos vivenciando um distanciamento social. Resultados: Os resultados mostram que a pandemia de COVID-19 e a necessidade de isolamento social, gera impacto psicológico que eleva o padrão de ansiedade e pode afetar diretamente pacientes com bruxismo e DTM. Conclusão: Fatores psicológicos associados à pandemia podem levar a um maior risco de desenvolver, piorar e perpetuar o bruxismo, principalmente bruxismo de vigília e DTM, por isso os cirurgiões-dentistas devem estar atentos a ocorrência de sinais e sintomas para gerenciar os aspectos multifatoriais dessa condição. Aconselha-se, nesse momento, estratégias individualizadas de autogerenciamento para o paciente que consistem em técnicas de automassagem, educação corporal, práticas de exercícios, higiene do sono e meditação. Além do uso de aplicativos digitais e ferramentas online facilitadores dessa atividade (AU)

A enfermagem de reabilitação na capacitação da pessoa para os autocuidados / Rehabilitation Nursing in the Training for Self-Care

O estágio final foi realizado num serviço de medicina, onde foi desenvolvido o projeto que visou caracterizar a funcionalidade em doentes com alterações neurológicas, implementar planos de reeducação para os autocuidados e identificar resultados sensíveis aos cuidados de enfermagem de reabilitação. O autocuidado define-se como uma atividade da pessoa direcionada para um objetivo e desenvolvida a favor da vida, da saúde e do bem-estar. O acidente vascular cerebral é uma das causas mais comuns de dependência a longo prazo. Estudo de caso, participaram quatro doentes com acidente vascular cerebral, com alterações na funcionalidade e dependência nos autocuidados. A média de evolução na capacitação para os autocuidados dos participantes, variou entre 0,75 pontos e 1,75 pontos, com evolução mais favorável ao nível dos autocuidados: alimentação, higiene, vestir a metade superior e uso do sanitário. Os resultados demonstraram sensibilidade aos cuidados de enfermagem de reabilitação na diminuição da dependência.

The final clinical traineeship was taken place in an internal medicine service, where we developed the project that aimed to characterize the functionality of patients with neurological changes, implement rehabilitation plans for self-care re-education and identify sensitive outcomes of nursing care rehabilitation. Self-care is defined as a person activity direct toward a goal and developed in aid of life, health and well-being. The stroke is one of the most common causes of long-term dependency. Case study, participated four stroke patients with functionality changes and self-care dependence. The evolution median training for self-care of the participants, ranged between 0.75 points and 1.75 points, with the most favorable developments at the level of self-care: food, hygiene, dress up the told half and use the toilet. The results demonstrated sensitivity to rehabilitation nursing care in reducing dependence.

[Family, socioeconomic status and health services: Clues to health care in diabetic patients with lower limb amputations in Andalusia. A qualitative study]. / Familia, economía y servicios sanitarios: claves de los cuidados en pacientes con diabetes y amputación de miembros inferiores. Estudio cualitativo en Andalucía.

AIM: To examine the experience of diabetic care in patients undergoing lower limb amputation. DESIGN: A qualitative study using the phenomenological approach. SETTING: Cadiz Health District. PARTICIPANTS: A total of 16 patients (11 men and 5 women) diagnosed with diabetes mellitus type 2 and with non-traumatic lower limb amputation. METHODS: Semi-structured interviews were performed, followed by a content analysis according Graneheim and Lundman. RESULTS: Four categories were identified: 1. The family is the cornerstone for diabetic care. 2. The socio-economic and working conditions determine the quality of self-care. 3. The patient-health professional interaction facilitates patient care. 4. Limitations in the provision of health services. CONCLUSION: Family, economic and working conditions, along with health system-related factors are the most important elements in the care of patients with diabetes and amputations. Social, economic and working conditions determine diabetic complications. In order to enhance health care impact on the prevention of diabetes mellitus complications, health system policy makers must take these facts seriously into consideration and in a more personalised manner.

[Self-medication, self-prescription and medicating «by proxy¼ in paediatrics]. / Automedicación, autoprescripción y medicación «por poderes¼ en pediatría.

INTRODUCTION: Self-prescribing or medicating 'by proxy' is not an autonomous, free and voluntary decision in the case of children. On the contrary, in this case it is based on the subjective interpretation of symptoms made by the mother or by a third person who is legally responsible for the minor. In our opinion, to analyse this situation is of great importance in order to know the determining factors, perceptions, and realities related to this problem. METHODS: Our proposal is to perform a prospective observational study for analysing maternal and familiar determinant factors related to self-prescribing and self-medicating 'by proxy' in paediatrics. A validated survey was developed to be applied to mothers of children aged 0 to 14 who are users of the Paediatric Emergency Department in a hospital. RESULTS: A total of 1,714 mothers were recruited in a random period of time. This sample included 345 mothers who exclusively self-medicated their children (case group), and 1,369 mothers (control group) who did not meet this requirement. The overall percentage of medicating 'by proxy' was 32.8%. There is a significant association between self-medicating and educational level of the mother, the number of children, and the birth order among siblings. Neither maternal age nor social-occupational level are related to this problem. Most frequently used drugs include antipyretics and 'anticatharrals', usually administered as a monotherapy. CONCLUSIONS: Our results seem to indicate that the educational level and the parental experience acquired with previous children could generate the required confidence in parents to choose the medication by themselves. Almost 85% of these drugs come from the 'home first-aid kit.'

Avaliação da prática do autocuidado domiciliar em hanseníase / Evaluation of household self-care pratice in leprosy

O objetivo deste estudo foi verificar se indivíduos acometidos pela hanseníase realizavam adequadamente a prática do autocuidado e possíveis fatores interferentes. Trata-se de um estudo documental, observacional e descritivo de inquérito domiciliar. A amostra abrangeu todos os onze pacientes detectados durante um ano, em um município com 120.000 habitantes no interior do estado de SP. Foram coletados os dados clínicos e cuidados prescritos dos prontuários. A entrevista e a observação das práticas de autocuidado foram realizadas no domicílio. Foi solicitado aos participantes para identificarem os problemas decorrentes da doença, descreverem quais, como e quando faziam o autocuidado, o qual foi classificado como: realizado adequadamente, parcialmente ou não realizado. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (Nº 06/2007). Dos cinco que apresentavam grau 2 de incapacidades, três realizavam parcialmente e dois não realizavam o autocuidado. Demonstraram dificuldades em aceitar o comprometimento físico e de incorporar as práticas diárias por fatores multicausal o mesmo aconteceu com aqueles com grau 1. A necessidade da manutenção do trabalho laboral, com exposição a traumas físicos e em período integral, pode levar a ocultação da doença, seja para si ou para a sociedade, e dificultar as ações de autocuidado, tanto pela falta de tempo quanto pela não aceitação da doença. O modelo paternalista, fragmentador e mecânico da assistência em saúde, sugere uma tendência à dependência dos serviços institucionais, desconstruindo a autonomia e a responsabilidade individual sobre seu estado de saúde, desmotivando as ações do autocuidado domiciliar.

This study aimed to determine whether individuals affected by leprosy properly performed self-carepractice and possible interfering factors. It is a documentary, observational and descriptive study of household survey.The sample covered all the eleven patients during one year, of a municipality with120.000 inhabitants in SP state. Clinical data and prescription care records were obtained from the medical forms. The interview and observation of self-care practices were held at home.The participants were asked to identify the problems resulting from the disease, describing which, how and when theydid the necessary self-care, being classified as: held properly, partially or not performed. The study was approved by the Committee of Ethics in Research (Nº 06/2007). Of the five who presented level 2 disabilities, three partially performed; two did not perform self-care. They demonstrated difficulties in accepting the physical commitment and incorporate the daily practices for multiple causes factors, sodid those with level 1. The need for maintaining labor work, with full-time exposure to physical trauma, can lead to concealment of disease, either for themselves or for society, and hinder self-careactions, either by lack of time as for not accepting the disease.The paternalistic model, fragmenting andmechanical of health care, suggests a tendency by leading to rely on institutional services, deconstructing the autonomy and individual responsibility for their health status, discouraging self-careactions at home.

Cuidados de enfermagem de reabilitação no doente com AVC isquémico e a demora média de internamento hospitalar / Rehabilitation nursing care in patients with ischemic stroke and the average length of hospital stay

O AVC é uma doença que acarreta elevados períodos de internamento, recursos e despesas de saúde. É uma das principais causas de morte e de incapacidade deixando inúmeras sequelas que restringem a funcionalidade e a independência nas atividades de vida diária. O Enfermeiro Especialista em Enfermagem de Reabilitação é detentor de um conjunto de competências que permitem responder às necessidades específicas destes doentes, prevenindo, recuperando e habilitando de novo. Estamos perante um quadro de forte restrição orçamental em que há uma elevada contenção de gastos públicos. Contudo, é-nos exigido eficiência e resposta às necessidades de saúde dos cidadãos ao nível da prestação de cuidados e sem perda de qualidade. A demora média de internamento hospitalar é um indicador importante para aferir a eficiência e qualidade dos estabelecimentos de saúde. O objetivo principal deste estudo é verificar se a intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação nos doentes com AVC isquémico interfere na demora média de internamento hospitalar. Para a concretização deste objetivo foi desenhado um estudo descritivo, correlacional de natureza quantitativa que decorreu no Centro Hospitalar Tâmega e Sousa EPE. A amostra foi constituída por 436 doentes com o diagnóstico de AVC isquémico internados no serviço de Medicina Unidade Funcional três dos meses de maio a dezembro dos anos de 2006 a 2011 sendo que, nos anos de 2006 a 2010 não houve intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação e no ano de 2011 houve intervenção. Como instrumento de colheita de dados foi utilizado o sistema informático de apoio à prática de enfermagem e dados dos processos clínicos recorrendo à classificação por GDH. Dos resultados obtidos, verificou-se que a demora média de internamento hospitalar no ano de 2011 foi uma das menores de todos os anos (6,74 dias) só superada pelo ano de 2007 (5,97 dias) e 2008 (6,46 dias). Analisados os autocuidados higiene, uso do sanitário, transferir-se, deambular e alimentar-se, verificou-se evolução positiva na dependência dos mesmos no ano de 2011. O Enfermeiro Especialista em Enfermagem de Reabilitação torna-se imprescindível num serviço de Medicina conseguindo com as suas intervenções eficácia suficiente, traduzindo-se numa diminuição da demora média nos doentes com AVC isquémico.

The stroke is a disease that causes increased length of hospital stay, resources and health expenses. It is a major cause of death and disability leaving countless sequels that restrict the functionality and independence in activities of daily living. The Rehabilitation Nurse holds a set of skills that allows to bridge the specific needs of these patients preventing, recovering and rehabilitate them. We are facing a framework for strong economical constraint where there is a high containment of public spending, however we are required efficiency and response to the health needs of the citizens to the level of care without loss of quality. The average length of stay in hospital is important to assess the efficiency and quality of the health services. The main purpose of this study is to assess whether the intervention of the Rehabilitation Nurse in patients with ischemic stroke interferes with the average length of hospital stay. To achieve this goal there was designed a descriptive, correlational and quantitative nature study that took place in Hospital Tamega e Sousa EPE with a sample with 436 patients with a diagnosis of ischemic stroke hospitalized in the service of Medicine Functional unit 3 in the months from May to December of the years 2006-2011. There was no intervention of Rehabilitation Nurse between 2006 to 2010, just in the year of 2011. Was used the Support System for Nursing Practice and clinical processes using the Diagnostics Homogeneous Groups for data collect. Results: the average length of hospital stay in 2011 was one of the lowest of all years (6.74 days), only in 2007 (5.97 days) and 2008 (6:46 days) the average was lower. After analyzed the followings self-cares: bathing, using the toilet, transferring, walk and eating, there was an improve of the levels of dependency in 2011 with the Rehabilitation Nurse intervention. The Rehabilitation Nurse is essential in services of Medicine achieving efficacy with their intervention and decreased the average of length of stay in hospital of patients with ischemic stroke.

Autocuidado para el control de la hipertensión arterial en adultos mayores ambulatorios: una aproximación a la taxonomía NANDA-NOC-NIC / Self-Care for hypertension in elderly outpatients, an approach to the NANDA-NOC-NIC taxonomy

El uso de un lenguaje común es una característica que distingue a los profesionales. Así, la conformación y el uso de un lenguaje técnico coadyuva al desarrollo gremial, en este sentido hacer uso de las teorías del cuidado y de clasificaciones validadas por asociaciones internacionales de profesionales sintetizan y facilitan la comprensión y el avance del conocimiento. Cuando los profesionales de enfermería aplican teorías y clasificaciones para discutir sobre la gestión del cuidado, el nivel de comunicación mejora y los pacientes se ven beneficiados con la continuidad de su tratamiento. El propósito de éste trabajo, es mostrar de manera explícita como se puede vincular la teoría del autocuidado de Orem, con los diagnósticos de enfermería propuestos por la Asociación Norteamericana de Diagnósticos de Enfermería; la Clasificación de Resultados de Enfermería; y la Clasificación de Intervenciones de Enfermería. Con base en lo anterior, se proponen cuatro esquemas que pueden ser aplicables al cuidado de adultos mayores ambulatorios con hipertensión arterial.

A characteristic among professionals is the use of common language. Therefore the conformation of a technical language usage contributes to professional development, in this way, the use of care theories and classifications validated by international professional associations summarize and facilitate the comprehension and advance of knowledge. When nursing professionals apply theories and classifications to discuss about care management, the level of communication improves and patients get favored with the continuity of their treatment. The purpose of this paper work is to show in an explicit manner how Orem's theory of self care can be linked with nursing diagnosis purposed by the North American Nursing Diagnosis Association, the Nursing Outcomes Classification and the Nursing Interventions Classification. Based on previous said, five diagrams are suggested to be applied in the care of elderly outpatients with high blood pressure.

El uso de las terapias alternativas y complementarias en población mexicana con trastornos depresivos y de ansiedad: resultados de una encuesta en la Ciudad de México / The use of alternative and complementary therapies on the Mexican population with depressive and anxiety disorders: results of a survey in Mexico City

The use of therapeutic methods and assistance different from the officially recognized ones, in addition to self-care practices, has remained constant throughout history. The extensive interest in so-called alternative or complementary medicine (ACM) has occurred as a result of their growing use in various countries. International literature reports the growing use of alternative and/or complementary treatments by persons with emotional disorders, particularly depression or anxiety. Commonly mentioned alternatives include relaxation techniques, physical therapies, herbal treatment, chiropractice and spiritual healing. The National Survey on Psychiatric Epidemiology undertaken in Mexico (2002) reported that 6.5% of the individuals with affective disorders in the 12 months prior to the study used some kind of alternative medicine. This occurred in 7.3% of the individuals with anxiety disorders and 3.9% of those with disorders associated with substance use. Information from surveys conducted in Mexico City showed that from 18% to 20% of the individuals with depressive disorders, 18% had physical disorders and over a quarter of those with anxiety problems seek a solution to their suffering in various types of alternative medicine. The aim of this study is therefore to determine the therapeutic resources used by the population to treat emotional problems and to analyze the prevalence of these practices in individuals with anxiety or depressive disorders. Method The study was conducted on the inhabitants of six neighborhoods in Mexico City. They were all selected on the basis of the criteria established in a multi-stage, stratified random sample design. The stratification variable used was socio-economic level. The questionnaire included four sections: 1) socio-demographic characteristics; 2) use of 10 self-care and/or alternative service resources related to the presence of emotional disorder; 3) characteristics of the resources or services use and 4) prevalence of depressive and anxiety disorders. The ethical guidelines followed in this research included obtaining verbal informed consent and providing a clear explanation about the objectives of the research, and the way the dwelling and the persons were selected. The researchers stressed the interviewee's freedom to cancel the interview and guaranteed the confidential handling of the information. The diagnoses of mental disorders were obtained on the basis of the ICD-1 0 criteria. For the analysis of service use, the therapies were grouped into two categories, self care (home remedies, self-medication, physical activities, etc.) and alternative and/or complementary services (self-help groups, traditional Mexican medicine, clergy, etc.). Results Of the 361 of the individuals interviewed, 45.9% were men and 54.1% women, the mean age being 45 years old. The 54% of participants represent the high-middle class, and the 46% the low class. Nineteen point two percent of the sample met the diagnostic criteria for one or more disorders, at least once in their lifetime (12.7% in the men's group and 25.1% in the women's group). The prevalence of depressive episodes for women was 9.2% as opposed to 3.0% for men. In the case of anxiety disorders, the prevalence was 16.3% and 9.0%, respectively. Of the total sample 52.5% engaged in some form of self-help, while 28.2% had resorted to alternative systems for coping with emotional disorders at least once in their lives. Among the most commonly used self-help strategies were: enrolling in a physical activity (33.5%), seeking help from informal networks (28.5%) and using household remedies (16.1%). The use of alternative services included visiting a clergy (11.1%) and attending self-help groups (10.2%). The use of self-help and alternative therapies was more common among women. An analysis was undertaken of the type of service used among persons that had met the diagnostic criteria for one or more disorders and those that failed to do so. The group characterized by the presence of disorders undertook more self-help actions than those with no disorders (72.9% and 47.6%). The same trend was observed in the use of alternative services (52.9% and 22.1%). An analysis of the disorders, divided into two main groups, anxiety disorder and depressive episodes, showed that the prevalence of self-care practices (76.6% and 72.7% respectively) and the use of alternative medicines (53.2% and 59.1%) was similar. Most of the group with anxiety disorders reported that it used informal support networks (59.6%) and engaged in physical activities (53.2%). The 45.5% of those that experienced depressive episodes engaged in physical activities, 47.8% visited relatives and friends and 26.1% consulted a priest. The prevalence of self-care practices conducted in the 12 months prior to the survey showed a similar pattern throughout lifetime. Two logistic regression models were used to analyze factors related to the practice of self-care and the use of alternative and/or complementary therapies. The variables included in the models were sex, age, educational level, occupation and the presence of an anxiety or depression disorder. The logistic regression analysis showed that the probability of using self-care practices is higher in persons with an anxiety disorder (OR=3.11), women (OR= 1.74) and persons with a higher educational level (OR=1.93). The likelihood of using an alternative or complementary medicine increases among people experiencing a depressive episode (OR = 3.23) and anxiety disorders (OR=3.45). The people that sought help from relatives, friends or a priest stated that their reasons were <>, <> or <> The reasons for visiting the self-help groups were feeling sad or depressed, or trying to deal with problems related to their alcohol consumption. Those who used home remedies sought to soothe their <> and overcome their insomnia. The main reason for engaging in physical activity or performing curative practices adapted from other cultures, such as Bach Flowers or Reiki was to relax and <> Interviewees used vitamins or food supplements to cope with the <> or <> all of which are concepts underlying the idea of <> their state or condition. Discussion The use of self-care practices in response to the perception of emotional disorders is common in the interviewed population. This suggests that this type of practices could be regarded as a significant component of mental health care and should therefore be examined with more detail. The main focus should be the link between individuals' perception of their emotional illness or problems and the orientation of their self-care actions. An analysis of the group with disorders showed that a significant percentage of the population with one or more depressive episodes (26.1%) and anxiety disorders (26.1%) used alternative therapies in the 12 months previous to the study. The analysis conducted throughout this study suggests the need for health personnel to have basic knowledge of self-care practices and alternative medicine and to find out about the use of the latter by patients. It has been shown that having this knowledge can significantly improve the doctor-patient relationship, have a positive impact on treatment and help prevent potentially damaging interactions between conventional and alternative treatments. It also provides a better understanding of people's concepts of health and illness, and what they seek in the various medical systems. However, we still have a great deal to learn about the needs, expectations and demands of those that engage in these practices.

El uso de instancias asistenciales y terapéuticas diferentes a las oficialmente reconocidas, además de las prácticas de autocuidado, han mostrado su vigencia a lo largo de la historia. En la bibliografía nacional e internacional se reporta un creciente uso de medicinas alternativas y/o complementarias, principalmente entre personas con trastornos de depresión o ansiedad. Derivado de lo anterior, el objetivo del presente trabajo es conocer, mediante una encuesta en hogares, cuáles son los recursos terapéuticos y asistenciales que utiliza la población para tratar problemas emocionales, así como analizar la prevalencia de estas prácticas en personas con trastornos de ansiedad o depresión. Método La investigación se realizó entre los habitantes de seis colonias de la Ciudad de México. El trabajo de campo comprendió el periodo de agosto de 2006 a marzo de 2007. La selección de los entrevistados se hizo con un diseño muestral aleatorio estratificado y multietápico. La variable de estratificación fue el nivel socioeconómico. Originalmente se planteó la inclusión de tres niveles con el objetivo de hacer comparaciones entre ellos. Sin embargo, debido a la dificultad de acceder a la población de estrato alto, se seleccionaron colonias representativas de nivel socioeconómico bajo y medio alto. El instrumento estuvo conformado por cuatro secciones:1) datos sociodemográficos; 2) uso de diez recursos de autoatención y/o servicios alternativos ante la presencia de malestares emocionales; 3) características de los recursos o servicios utilizados y 4) prevalencia de trastornos depresivos y de ansiedad (a partir de los criterios del ICD-10). Entre los cuidados éticos se consideró el consentimiento informado de manera verbal y se enfatizó en la libertad del entrevistado para suspender la entrevista. Se aseguró el manejo confidencial de la información. Para el análisis del uso de servicios, las terapias se agruparon en dos categorías: prácticas de autocuidado (remedios caseros, automedicación, actividades físicas, etc.) y servicios alternativos y/o complementarios (grupos de autoayuda, medicina tradicional mexicana, consejeros espirituales, etc.). Resultados De las 361 personas entrevistadas, el 45.9% fueron hombres y el 54.1 % mujeres. La media de edad fue de 45 años, el 54% representó al estrato medio-alto y el 46% al bajo. El 19.5% de la muestra cumplió los criterios diagnósticos de uno o más trastornos alguna vez en la vida (12.7% hombres y 25.1% mujeres). La prevalencia de episodios depresivos fue de 9.2% para las mujeres y 3.0% para los hombres, y de trastornos de ansiedad 16.3% y 9.0%, respectivamente. En relación con la prevalencia de uso de servicios alguna vez en la vida, ante un malestar emocional, el 52.5% del total de la muestra realizó alguna práctica de autocuidado y el 28.2% recurrió a los sistemas alternativos. El uso de autocuidados y terapias alternativas fue más frecuente entre las mujeres. Se encontró que el grupo caracterizado por la presencia de trastornos realizó acciones encaminadas a los autocuidados (72.9%) en mayor proporción a aquellos sin trastornos (47.6%). La misma tendencia se observó en el uso de servicios alternativos (52.9% y 22.1% respectivamente). Además, se realizó un análisis de regresión logística cuyos resultados mostraron que existe una mayor probabilidad de realizar prácticas de autocuidado entre las mujeres (OR=1.74), cuando el nivel de escolaridad es mayor o igual a bachillerato (OR=1.93) y cuando se presenta algún trastorno de ansiedad (OR =3.11). La probabilidad de usar alguna medicina alternativa o complementaria aumenta 3.23 veces en personas con depresión y 3.45 con ansiedad. Discusión Los resultados de este trabajo hacen evidente la necesidad de capacitar al personal de salud sobre las medidas de autocuidado y las medicinas alternativas. Estos conocimientos pueden mejorar la relación médico-paciente e impactar positivamente en el tratamiento. Asimismo, los resultados de esta investigación permiten comprender mejor los conceptos que tienen las personas sobre salud y enfermedad, y las razones para acudir a los diversos sistemas médicos. Sin embargo, todavía tenemos que aprender mucho sobre las necesidades, las expectativas y las demandas de las personas que buscan esta ayuda.

Salud-competencia familiar en el autocuidado en pacientes con Diabetes Mellitus tipo 2 / Health and family competency in the selfcare of patients with type 2 diabetes

Introducción. La Diabetes Mellitus Tipo 2 (DM2) es una enfermedad crónica degenerativa que afecta a la población de nuestro país; el Sistema Nacional de Salud ha creado estrategias para fomentar el autocuidado de las personas con esta enfermedad. El personal de Enfermería es integrante clave en los equipos multidisciplinarios en el desarrollo de estas estrategias, por ello es importante estudiar los elementos que conforman y promueven el autocuidado, entre los que se consideran como los más importantes el nivel de conocimientos de la enfermedad y el apoyo familiar (en este caso determinado por la Salud-Competencia Familiar) con la que cuenta la persona con DM2. Propósito: Identificar la influencia de la Salud-Competencia Familiar en el autocuidado y el nivel de conocimientos que tenga el paciente con DM2 Metodología: Investigación transversal, descriptiva, con una muestra representativa no probabilística de 30 personas con DM2. El análisis de datos se llevó a cabo con el paquete estadístico SPS. Discusión y Conclusiones: El estudio concuerda con resultados de otras investigaciones realizadas. El Nivel de Salud Competencia Familiar y el nivel de conocimientos de la enfermedad influyen en el auto cuidado, puesto que el Nivel de Salud Competencia Familiar es un muro de contención para que el paciente pueda llevar a cabo su Autocuidado, si la persona con DM2 cuenta con un medio familiar estable entonces la adherencia al tratamiento farmacológico y medico será mejor.

Introduction. The Diabetes Mellitus Tip 2 (DM2) is a degenerative chronic disease that affects the population of our country; the National System of Health has created strategies to foment the self care one of the people with this disease. The infirmary personnel is integral key in the multidisciplinary equipment in the development of these strategies, for that reason it is important to study the elements that conform and promote the self care one, between that consider themselves as the most important level of knowledge of the disease and the familiar support (in this case determined by Familiar HealthCompetition) with which counts the person with DM2. Objective: To identify the influence of Familiar Health-Competition in self care and the level of knowledge that the patient with DM2 has. Methodology: Cross-sectional, descriptive investigation, with nonprobabilística a representative sample of 30 people with DM2. The analysis of data was carried out with statistical package SPS. Discussion and Conclusions: The study agrees with results of other made investigations. The Level of Health Familiar. Competition and the level of knowledge of the disease influence in the taken care of car, since the Level of Health Familiar. Competition is a retaining wall so that the patient can carry out his self care, if the person with DM2 has an average then stable relative the adhesion to the pharmacologic treatment and medical it is better.