Cath Lab Digest

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Compassion is the desire that moves the individual self to widen the scope of its self-concern to embrace the whole of the universal self. — Arnold Toynbee

     Maria Helena Larcher Caliri, RN, BSN, PhD, São Paulo, Brazil has been an Associate Professor at Ribeirao Preto College of Nursing, University of São Paulo since 1996. A member of Sigma Theta Tau International Nursing Honor Society and former president of the society’s Brazilian Chapter, Rho Upsilon, Maria also has been an active member of the Brazilian Nursing Association since 1976. Before completing her PhD at the University of São Paulo, she spent a year at the University of Illinois (Urbana-Champaign, IL) as both supervisor and head nurse of various small hospitals. When she started her teaching career at the University of Sao Paulo, Maria initiated research related to pressure ulcer and wound care in addition to coordinating a research group of undergrad, masters, and doctoral students.

     Maria’s experiences allow her to compare healthcare in Brazil to other countries. Sectors of healthcare in Brazil are vastly different than those in the US. “Most people in Brazil depend on the public segment formed by institutions linked to federal, state, and local governments,” Maria explains. “These range from primary healthcare to secondary health centers and large tertiary hospitals that are arranged hierarchically according to a level of complexity and type. There are no nursing homes like in the US. We have some small long-term health institutions for private patients, many regulated by religious institutions. Equipment and material for adequate pressure ulcer prevention and treatment are scarce within most of these institutions; therefore, pressure ulcer incidence is high. Families of these patients are usually the caregivers following discharge. Although pressure ulcer incidence is sometimes lower in Brazil’s autonomous private healthcare segment where individuals or corporate health plans pay for care, statistics are not well maintained in either system.”

     Maria says Brazilian healthcare providers have access to many products from international companies. “We use hydrocolloids, hydrogel, calcium alginates, dressings with silver, and also some products manufactured here as sulfadiazina (Silvadene),” she says. “Negative pressure therapy is used, but not as frequently as in the US. Special beds and mattresses are not common. Foam egg-crate and air overlays are used infrequently. Special beds and mattresses are not common, even for patients with Stage III and Stage IV ulcers, because only private hospitals and wealthy patients can afford the cost of adequate equipment. Prevention is still not the focus of care in most institutions and many people do not have adequate knowledge of evidence-based care. We acquire most of our wound care information from articles and from company presentations during conferences and vendor demonstrations. Convincing hospital administrators of the importance of some products is not easy, seeing that regulations in Brazil are still not as strong as they are in US, Canada, or the UK.”

     For example, Maria was first introduced to the Braden Scale in 1991 during her internship in America. Observing nursing practice was not one of her PhD requirements, nor was it related to her studies at the time. But in late 1995, while preparing for her job at University of São Paulo, Maria decided to research pressure ulcer risk factors and incidence at the University Hospital. While preparing her literature review, she learned about the National Pressure Ulcer Advisory Panel (NPUAP) and Agency for Healthcare Research and Quality (AHRQ) guidelines.