O perfil podológico de estudantes de enfermagem em ensino clínico

: recomendações para o autocuidado

Abstract

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.

Date of Award	13 Sept 2024
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Sponsors	Fundação para a Ciência e a Tecnologia
Supervisor	Sílvia Caldeira (Supervisor) & Arménio Guardado Cruz (Supervisor)