Influência da educação permanente em saúde no conhecimento e percepções dos enfermeiros da atenção primária sobre prevenção e cuidado com pé de pessoas com diabetes mellitus

Abstract

Diabetes mellitus is a chronic condition with a global impact and, when uncontrolled, can cause serious complications, including diabetic foot, one of the main causes of disability. Study with the objective of analyzing the influence of continuing health education on nurses' knowledge and perceptions about prevention, care for diabetic foot and the challenges for implementing preventive and assistance measures for people at risk of diabetic foot in their work process This is a quasi-experimental intervention study, with a quantitative-qualitative approach, based on the work process framework and ongoing health education. The intervention was a 120-hour hybrid qualification course. 36 nurses from a regional health board in the state of São Paulo participated. Data collected through sociodemographic and work characterization questionnaires, an instrument for assessing knowledge and perception before and after the intervention and guiding questions. Sociodemographic and work data were analyzed using descriptive statistics, and preand post-intervention comparisons were performed using McNemar's test to assess changes in the proportions of responses, and qualitative data were analyzed using reflective thematic analysis and strategic focal analysis. It was found that the training significantly increased nurses' knowledge about diabetic foot care. The availability of supplies (p-value 0.0455), the use of clinical tools, such as the 128 Hz tuning fork (p-value 0.00006), and the correct use of footwear (p-value 0.0001) and socks (p-value 0.0098) showed statistically significant results. It improved knowledge about multidisciplinary work, care protocols and care practices, including foot and footwear assessment, laboratory tests and guidance on lifestyle modification. The central theme was constructed from the qualitative analysis: Diabetic foot: a journey of knowledge and action - unveiling the challenges of management and care management, and two subthemes: Health system management: nurses' knowledge and perception of actions to prevent diabetic foot; and Care management: nurses' knowledge and perception of actions to prevent diabetic foot. In the subtheme, Health system management, the facilitators were training, knowledge of indicators, and the use of information systems. And the barriers were infrastructure, lack of investment, staff turnover, and work overload. In the subtheme, Care management, nursing consultation, health education, and teamwork were found to be facilitators, while patient adherence to self-care and lack of supplies were found to be barriers. Continuing education influenced nurses' knowledge and perception of prevention and care for diabetic foot. The research reveals that diabetic foot prevention and care actions are complex and require coordination between the management of the health system and care management, with a focus on training professionals, promoting teamwork and implementing public policies that guarantee access to comprehensive, quality care.