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Nurses and physicians' agreements with evidence-based reccomendations for wound care of venous ulcer patients before and after two interventions: a Brazilian study

Maria H. Caliri, PhD, RN, University of Sao Paulo, Ribeirão Preto College of Nursing, Associate Professor, Bandeirantes Av, 3900, Campus da USP, Ribeirao Preto, 14040-902, Brazil and Eline L. Borges, PhD, ET, RN, Minas Gerais Federal University, Professor, Rua Pedro Barbosa Silva, 313, Cariocas II, Nova Lima, Minas Gerais, 34000-000, Brazil.

In Brazil, advances in national and international research have not been translated in the construction of guidelines for wound care of venous ulcers and there is variety in the physicians and nurses practices. In order to contribute to improvement of this situation, a three-phase study was done aimed to elaborate a guideline proposal, based on evidence from literature, as well as to evaluate nursing and medical specialists' agreements recommendations before and after interventions. This paper presents the results of the third phase, when a quasi-experimental design was adopted and data was collected by mail, after approved by IRB. The research questions were: do professional agree with guidelines recommendation about venous ulcer topic treatment? Did they change their opinion when they know the studies that support the evidence and the opinion of their peers? From the systematic review, the guideline had 82 recommendations, covering 8 domains: (1) patient and wound assessment, (2) documentation of clinical findings, (3) wound and surrounding skin care,(4) dressing indication,(5) use of antibiotics, (6) venous return improvement and relapse prevention, (7) patient referrals, (8) professional training. There were 73 participants: 42 physicians and 31 nurses certified in Dermatology or Enterostomal therapy. At the baseline, the highest agreement levels of the participants with recommendations were concentrated in four domains. After the first intervention, when the participants received the studies and the level of evidence for recommendations, agreement levels increased across all domains. After the second intervention, when the participants got to know their peers' opinions, agreement levels increased in most domains. The interventions brought statistically significant changes in domains 1, 3, 6 and 7. Both interventions were capable of changing the participants' position towards agreement on evidence-based recommendations for venous ulcer treatment.


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