Self-care for people with slow-healing wounds on the lower limbs^a

Abstract

Objective  To analyze self-care among people with hard-to-heal lower limb wounds receiving care from Family Health Strategy teams.

Method  We conducted a qualitative, descriptive, exploratory study with 21 participants who had hard-to-heal lower limb wounds in a municipality in Minas Gerais, Brazil. Data were collected in 2025 through semi-structured interviews, participant observation, and field notes. We used a sociodemographic and clinical data collection form and interview prompts; the interviews were audio-recorded and transcribed, and the data was analyzed using thematic analysis as described by Minayo and interpreted the findings in light of Orem’s Self-Care Deficit Nursing Theory.

Results  The analysis yielded four thematic categories: “Compromised self-care: the visible and invisible marks left by a hard-to-heal wound”; “Seeking competence in wound management: a solitary path toward self-care”; “The nursing system’s potential to support self-care among people with wounds”; and “Self-care among people with wounds: challenges to equity in the care process.”

Final considerations and implications for practice  Self-care is a complex process involving both self-care agency and self-care deficits influenced by biopsychosocial, spiritual, and systemic factors. The findings can inform nurses’ practice by supporting the development of an individualized, shared care plan integrating attentive listening, dialogic communication, and participatory planning.

Keywords:
Self Care; Wounds and Injuries; Nursing; Chronic Disease; Family Health Strategy

Resumo

Objetivo  analisar o autocuidado de pessoas com feridas de difícil cicatrização nos membros inferiores acompanhadas nas Estratégias Saúde da Família

Método  estudo qualitativo, descritivo e exploratório. Participaram 21 pessoas de um município de Minas Gerais com feridas de difícil cicatrização nos membros inferiores. Dados coletados em 2025, por entrevistas semiestruturadas com formulário de caracterização sociodemográfica e clínica e questões norteadoras, gravadas, transcritas, fundamentadas pela Análise Temática de Minayo e interpretadas pela Teoria do Déficit de Autocuidado de Dorothea Orem, diário de campo e observação.

Resultados  construídas quatro categorias: “Autocuidado comprometido: reflexo das marcas visíveis e invisíveis da ferida de difícil cicatrização”; “A busca pela competência para o manejo da ferida: uma trajetória solitária para o autocuidado”; “Potencialidades do sistema de enfermagem como suporte para promoção do autocuidado de pessoas com feridas”, “Autocuidado de pessoas com feridas: desafios à equidade no processo terapêutico”.

Considerações finais e implicações para a prática  o autocuidado constitui processo complexo, que perpassa pela agência da pessoa, coexiste com déficits de autocuidado influenciados por fatores biopsicossociais, espirituais e sistêmicos. Contribui para o processo de trabalho do enfermeiro, na construção de um projeto terapêutico singular que integra a escuta qualificada, dialogicidade e o planejamento participativo.

Palavras-chave:
Autocuidado; Ferida; Enfermagem; Doença Crônica; Estratégia Saúde da Família

Resumen

Objetivo  analizar el autocuidado de personas con heridas de difícil cicatrización en los miembros inferiores acompañadas en las Estrategias de Salud de la Familia.

Método  estudio cualitativo, descriptivo y exploratorio. Participaron 21 personas de un municipio de Minas Gerais con heridas de difícil cicatrización en los miembros inferiores. Los datos fueron recolectados en 2025 mediante entrevistas semiestructuradas con un formulario de caracterización sociodemográfica y clínica y preguntas orientadoras, grabadas y transcritas, fundamentadas en el Análisis Temático de Minayo e interpretadas desde la Teoría del Déficit de Autocuidado de Dorothea Orem, con diario de campo y observación.

Resultados  se construyeron cuatro categorías: "Autocuidado comprometido: reflejo de las marcas visibles e invisibles de la herida de difícil cicatrización"; "La búsqueda de competencia para el manejo de la herida: una trayectoria solitaria hacia el autocuidado"; "Potencialidades del sistema de enfermería como apoyo para la promoción del autocuidado en personas con heridas"; "Autocuidado de personas con heridas: desafíos a la equidad en el proceso terapéutico".

Consideraciones finales e implicaciones para la práctica  el autocuidado constituye un proceso complejo que atraviesa la agencia del individuo, coexistiendo con déficits de autocuidado influenciados por factores biopsicosociales, espirituales y sistémicos. Contribuye al proceso de trabajo del enfermero en la construcción de un proyecto terapéutico singular que integra la escucha calificada, la dialogicidad y la planificación participativa.

Palabras clave:
Autocuidado; Heridas y Lesiones; Enfermería; Enfermedad Crónica; Estrategia de Salud Familiar

INTRODUCTION

Hard-to-heal lower limb wounds are a major public health problem. More than 50 million people may have wounds by 2050, and an estimated 2% to 6% of the world’s population is affected by wounds associated with population aging.¹

The term “hard-to-heal wound” refers to lesions that do not respond to evidence-based care specific to their etiology; normal tissue repair is disrupted across the inflammatory, proliferative, and remodeling phases by factors such as impaired angiogenesis, inadequate innervation, impaired cell migration, or metabolic disorders.² The term also includes lesions that have not fully closed after three months of appropriate treatment.³

The chronicity of these lesions affects the biopsychosocial and spiritual dimensions of a person’s life. People often experience distress because of changes in body image, pain, limitations in activities of daily living, time away from work, and financial instability. Exudate and wound odor may lead to social isolation and exclusion, with adverse effects on quality of life and well-being.⁴

In the Family Health Strategy (ESF), health care team members—particularly nurses and nursing technicians—care for people with these wounds while promoting health, preventing disease, and supporting recovery. Nursing care can help people take an active role in managing the resources needed to support their health and self-care.⁵ The study setting, however, faces shortages of human and material resources and inadequate infrastructure. Nurses also manage numerous responsibilities, while specialized knowledge of wound care remains limited. The resulting vulnerability compromises health equity and comprehensive care.

These conditions can interfere with self-care among people with hard-to-heal wounds, since self-care is essential to survival and quality of life and consists of actions people undertake for their own benefit to maintain life, health, and well-being.⁶ When addressing human needs, nurses should support self-care. This involves user embracement, attentive listening, building a therapeutic relationship, and using the Expanded Clinic approach to develop a Singular Therapeutic Project (PTS)—an individualized, shared care plan.⁷

According to Orem’s Self-Care Deficit Nursing Theory, nursing care is needed when therapeutic self-care demand exceeds a person’s self-care agency. When planning interventions that support autonomy, the nursing team—particularly in the ESF—must consider self-care agency, existing deficits, basic conditioning factors, and developmental and health-deviation self-care requisites. Self-care agency is a person’s capacity to engage in self-care.⁸

During six years of practice as an ESF nurse, the first author repeatedly encountered the difficulties involved in caring for people with hard-to-heal lower limb wounds. That experience led the first author to investigate their self-care and look more closely at the circumstances in which it occurs. It also prompted a search for ways to improve care through a nursing theory that supports self-care, well-being, and autonomy. Although the literature on the subject is extensive, recent studies of self-care in this setting are lacking. Evidence from this context may inform municipal health policies.

Two questions guided the study: What is everyday life like for a person living with a hard-to-heal lower limb wound? How does a person with such a wound engage in self-care?

The study also aligns with the Pan American Health Organization Strategic Plan 2026–2031, particularly Strategic Objective 3: “better care for people with noncommunicable diseases and mental health conditions and survivors of violence and unintentional injuries.”⁹

The study examined self-care among people with hard-to-heal lower limb wounds receiving care from ESF teams.

METHOD

Conducted in the ESF network of a medium-sized municipality in southern Minas Gerais, Brazil, this qualitative, descriptive, exploratory study involved 21 people with hard-to-heal lower limb wounds. All were receiving care from one of the municipality’s 19 ESF teams.

We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).¹⁰

Participants were adults of either sex, aged 18 years or older, who had been living with a hard-to-heal lower limb wound for at least six months and were receiving care from an ESF team in the municipality. People were excluded if they were hospitalized or physically debilitated during data collection, including those who were bedridden or had difficulty communicating. Exclusion also applied when a person could not be located after three attempts at prearranged home visits. Nursing staff from the municipal ESF teams identified potential participants, who were selected through convenience sampling.

From March through July 2025, the first author visited participants in their homes to collect the data. At the time, the first author was a master’s student and had no previous relationship with the participants. Training consisted of simulated data collection sessions conducted under the thesis advisor’s supervision.

The research team prepared a form to collect sociodemographic information on sex, age, educational attainment, occupation, marital status, and whether participants had children or a caregiver. Other items addressed comorbidities, current medications, physical activity, smoking status, alcohol use, the etiology of the lower limb wound, and wound duration.

Three prompts guided the interviews: “How do you feel about this wound?”; “How have you been caring for yourself while living with this wound?”; and “What is it like for you to receive treatment through the ESF?”

The home visits also provided the setting for participant observation. The researcher noted nonverbal aspects of the encounters and features of the home context. After each interview, observations, impressions, and reflections were recorded in a field journal.

With each participant’s permission, the researcher recorded the interview on a mobile phone using the Voice Recorder application. Zapia AI software produced the transcripts, which were compared with the audio recordings before analysis to ensure accuracy. Each participant was interviewed once. The average interview lasted 10 minutes, not counting the time needed to complete the sociodemographic and clinical form. Only the participant and the researcher were present, and the transcripts were not returned to participants for validation.

During data collection, information began to recur, with no new elements that would substantially alter or add to the understanding of self-care among people with hard-to-heal wounds. The researchers considered that the internal logic of the phenomenon had been captured and that additional participants were not needed to meet the study objectives.¹¹ The research group also discussed the data; these exchanges contributed to the decision on the final number of participants and to author reflexivity.

We summarized the sociodemographic and clinical data using simple descriptive statistics and reported absolute frequencies and percentages.

Qualitative material from the interviews, participant observation, and field journal was organized and analyzed using thematic analysis as described by Minayo.¹¹ The process comprised three stages: 1) Data ordering: The interview transcripts and field journal entries were compiled. Each account was read in full and then compared across the dataset. Initial impressions were recorded, and the material was systematically organized. 2) Data classification: Repeated readings allowed recurring ideas to be identified. Text fragments were selected to form recording units; related units were developed into themes and subsequently grouped into categories. 3) Data analysis and interpretation: The themes were interpreted in light of Orem’s Self-Care Deficit Nursing Theory. This final stage allowed core meanings to be identified and the multiple facets of lived experience to be examined, with experience understood as being reinterpreted through analysis.

The Research Ethics Committee of the Federal University of Alfenas approved the study under Opinion No. 7,448,594 on March 18, 2025. Ethical principles governing research involving human participants were followed throughout the study. All participants provided written informed consent before data collection. The first author assigned pseudonyms to preserve participants’ anonymity.

RESULTS

All 21 people with hard-to-heal wounds receiving care from the municipality’s ESF teams were invited to participate. All accepted, and no one withdrew after data collection began.

Most participants were women (12; 57.1%), and their ages ranged from 47 to 86 years. Fourteen (66%) reported a monthly income of one minimum wage, 16 (76.19%) were retired, and 14 (66%) were Catholic. Ten (47%) were widowed. Regarding educational attainment, 11 (52.38%) had not completed elementary school, and five (23.81%) reported no formal schooling.

The most prevalent comorbidities were systemic arterial hypertension, reported by 11 participants (52.38%), and diabetes mellitus, reported by 10 (47.62%). Fifteen (71.43%) reported not smoking, whereas six (28.57%) reported smoking; 20 (95.24%) reported no alcohol use. Twenty participants (95.24%) reported taking long-term medications. Antihypertensive medications were the most common (11; 55%), followed by oral hypoglycemic agents (7; 35%) and insulin (4; 20%). Mean wound duration was 15 years.

The qualitative analysis yielded four thematic categories, presented below.

Compromised self-care: the visible and invisible marks left by a hard-to-heal wound

This thematic category captures participants’ feelings about living with a hard-to-heal wound and the ways in which the wound affected their lives.

The wound was often experienced as a symbol of loss. Participants described losses related to identity and femininity, as reflected in Elisângela’s wish to wear shoes, as well as limitations on their ability to work and participate socially.

[…] Oh, I wish I could wear a really pretty pair of shoes (looks toward her left foot and continues looking at it) […]. Wear a nice pair of shoes—I used to love that so much (lowers her head and looks at her left leg). It all swells up here (points to her left foot) […] (Elisângela).

The severe physical limitations imposed by a hard-to-heal wound affected participants’ sense of autonomy and ability to function. Their accounts conveyed feelings of incapacity and powerlessness.

[…] You feel… how can I put it (long pause) kind of powerless, right? […] (Eliane).

[…] To tell you the truth, I feel incapable… I can’t do anything. I can’t put weight on my foot, I can’t […] I can’t do the things I’m used to doing, so (long pause) incapable, because (looks at the wound) […] (Fátima).

The wound’s long duration and the perception that treatment is slow and sometimes ineffective—because daily care has brought no visible improvement—can cause discouragement, frustration, and emotional exhaustion.

[…] Awful, right? Oh, I feel awful (long pause) I just want to get rid of this (looks toward her left leg) […] this bandage, my God! […] (Elisângela).

[…] Oh, I feel kind of down, you know? (long pause) You think it’s never going to heal (long pause) […] (Raimundo).

Among these feelings, social exclusion emerged as a silent but deeply painful experience.

[…] Oh, you feel kind of left out. Because you have to stay still so much, right? Like me, I was used to working all the time, and now I have to stay still like this… You end up kind of shut in. […] Not being able to do things yourself, you know? Like, being used to leaving early and coming home from work in the afternoon… You have to stay practically still, shut in, right? With nothing to do, because there’s no other way, right? […] (Joel).

[…] There’s no way I can go to church because of this problem (refers to the wound as a problem) right? Just look at it (long pause). It smells so strong, right? How can I go to church like this? […] It smells strong! […] (Wagner).

The category reveals the singular experience of people with hard-to-heal lower limb wounds and how the wound’s visible marks affect their feelings.

Seeking competence in wound management: a solitary path toward self-care

This category focuses on participants’ practical actions and behaviors concerning wound care and their overall health.

[…] If anything comes up over the weekend, I take care of it myself here (refers to his home). I do it on my own. […] I use the supplies I have there—the ones I get from the clinic up the road […] I keep them here, and if anything happens, I take care of it myself here […] (Anderson).

[…] I pour saline on it, then wet the gauze and wipe around it. Then I take another piece of gauze, wet it, and put some of this ointment on it (points to the ointment on the counter). These days, I’ve been doing it myself […] (João).

Home self-care routines show an attempt to maintain control over the wound-healing process.

[…] When I take a shower, I always wrap my foot carefully in plastic like this (points to his left foot). See? It stays nice and dry (points to the wound) […] (Sebastião).

[…] Sometimes I put a little bag—a plastic bag—over my foot to keep it from getting wet, you know? I have a smaller bathroom out back. So I put the bag on, sit in a chair, you know? And prop my foot up on the toilet. That way my foot doesn’t get wet […] (Eliane).

The absence of guidance based on dialogue and expressed in clear, objective language may contribute to harmful practices and self-care deficits, as the following account illustrates:

[…] I wash it with soap—bar soap, Ypê soap. You know what that is? I thought Ypê soap was stronger—it has soda in it […] But it softens it more; it keeps cleaning it, wearing it away […] (Diego).

Diego’s account illustrates how a self-care deficit can become a harmful self-care routine.

A self-care deficit may also arise when participants have not learned how to care for the wound or lack the practical skills or supplies needed to perform the care correctly:

[…] Then I learned on my own and started doing it myself […] Then my foot started acting up a little, and I think it was because (long pause) I didn’t have much practice […] (Anderson).

[…] I was doing it at home, but it seemed like it wasn’t working, you know? […] I was very careful, but, I don’t know, I would put a lot of ointment on it. I don’t know how much you’re supposed to use. I would cover it with ointment […] Then I’d cover it up, you know? With gauze and everything […] (Aline).

Aline’s account illustrates her limited knowledge of wound self-care. Overall, this category describes the ways participants sought to manage their wounds as part of their self‑care.

The nursing system’s potential to support self-care among people with wounds

This category describes the ESF—particularly the nursing team—and participants’ family support networks as sources of support that help compensate for self-care deficits.

[…] They’re really good (referring to the ESF staff), the people there. Wow, they really help, you know? They give us supplies, everything just right. When there’s a longer holiday, they give us extra supplies […] See the saline over there (points to the shelf), see? I keep it there […] And the dressing supplies—the bandages and gauze—are all in there, in the bedroom […] (Marlene).

[…] I hardly ever went there (ESF). I was impressed […] I was treated very well (long pause). They treat you very well […] I’ll tell you, I didn’t expect the care to be that good […] They treat you really well there, you know! I liked it, you know […] I liked it, you know […] (Raimundo).

Participants’ trust in the team grew when they saw concrete results and attributed them directly to staff competence, as Jésus’s account shows.

[…] So, she (mentions the nursing technician’s name) is […] She’s […] exceptionally skilled […] So much so that she was the one who (looks toward the wound) The doctor couldn’t (laughs) couldn’t get it to close […] The medications couldn’t get it to close […] In two weeks, half of it had already closed […] Now look at the size of it—did you see? […] Compared with how big it was […] That woman (referring to the nursing technician) is a real pro […] (Jésus).

[…] Oh, I think it’s good, you know? Yes, I think it’s good […] Because I was doing it at home, and it seemed like it wasn’t working […] (Aline).

In addition to providing technical care, the nursing team uses a supportive-educative nursing system to guide and teach people with hard-to-heal lower limb wounds and their families. This support allows wound care to continue when the health service is unavailable.

[…] My wife does it (the dressing change) the way the nurse taught her at the clinic. The nurse showed her how […] (Severino).

[…] On holidays, I do the dressing changes myself, very carefully. They have to be changed, right? I don’t let them get contaminated or anything. That’s all […] (Marlene).

These accounts suggest that the supportive-educative nursing system was effective. The nurse not only performed the procedure but also taught Severino’s wife how to provide wound care, helping ensure continuity of care at home and strengthening the family support network.

The participants’ accounts revealed the potential of nursing agency to support self-care.

Self-care among people with wounds: challenges to equity in the care process

This category includes a field journal excerpt and describes several basic conditioning factors identified in participants’ accounts. These factors may affect each participant’s self-care agency and contribute to vulnerability.

Wagner’s housing conditions, troubled family relationships, and lack of housing stability appeared to directly influence his ability to perform self-care. Even so, he was willing to share his difficulties, showing the extent to which problems in his broader circumstances affected wound care (Field note, April 7, 2025).

[…] I can’t go grocery shopping (long pause). I buy a food basket at the gate, and it costs 700 reais. My money isn’t enough […] Well, I can’t eat the things I need and would like to eat […] So it’s hard […] (Elizângela).

[…] I spend—let me see (raises his head while gathering his thoughts) on these ointments I’m using now. They cost 80 reais for 30 grams. Sometimes the ESF runs out of bandages, so I have to pay for them myself, right? (long pause) (Raimundo).

[…] You call for the car. They filled out the form at the (long pause while gathering his thoughts) ESF, so now their car is supposed to take me there and bring me back, but it doesn’t work! You call, leave a message—it goes to voicemail—and nobody answers […] (Wagner).

[…] That’s just like what happened to me with that city hall car […] I’d wait here for the car, getting angry and all worked up, and it wouldn’t come pick me up. I called the woman at city hall, and she told me they weren’t required to […] (Joel).

Chronic pain and difficulty walking are direct physical barriers that limit participants’ ability to perform self-care and access health care services.

[…] I hardly go out anymore, because if I stay on my feet too long, it hurts too much […] Some days I don’t even feel like going, because just walking up there makes it start hurting. But I get there and sit for a little while, you know? […] Then they change my dressing, and I make my way back slowly […] (Marlene).

Within this context of multiple vulnerabilities, faith and religious practice stood out as the strongest positive conditioning influence. For many participants, faith was the main source of strength, comfort, and hope.

[…] I’m doing well, thank God […] Nothing is impossible for God! Isn’t that right, my son? I’m Catholic […] (Sandra).

[…] I make a habit of praying at home […] I’m Catholic […] So, look over there (points to a makeshift altar with a light on) […] My God! […] I have a lot of faith […] (Jésus).

This category showed that self-care among people with hard-to-heal lower limb wounds was shaped by a set of basic conditioning factors. These factors contributed to a context of vulnerability and directly affected self-care agency and autonomy.

DISCUSSION

Living with a hard-to-heal wound leaves marks that extend beyond the body, affecting both visible and unseen aspects of life, and the psychosocial burden may profoundly affect a person’s sense of self.¹²

Discouragement, frustration, and loss of autonomy recurred throughout participants’ accounts, since the prolonged course of the wound and the perception that treatment had stalled were major sources of emotional distress. This cycle of hopelessness may, in turn, weaken the motivation required for self-care.

The wound also came to represent multiple losses related to professional identity, femininity, autonomy, and social participation. Recognizing this subjective dimension of suffering is essential to planning nursing care that is comprehensive, individualized, and effective.¹³ Persistent pain, changes in body image, limitations in daily activities, and social isolation may also hinder the fulfillment of universal and developmental self-care requisites.⁸

Other factors contributing to self-care deficits included fragmented health services, limited access to appropriate health technologies and wound dressings, shortages of specialists, and discontinuity of care across levels of the health system. These conditions create an unfavorable environment for wound healing and increase the burden on people with wounds and their caregivers.⁸,¹³,¹⁴

Despite these adversities, participants sought to exercise their self-care agency in several ways, showing skill and, above all, resilience. Many developed their own wound-care routines, particularly when health services were unavailable or wound care supplies were scarce.

People devised low-cost solutions using materials such as plastic wrap, bags, or towels and adapted their homes to make care possible. These actions reflect a complex self-care operation, ranging from assessing the problem to developing creative solutions. However, knowledge gaps resulting from inadequate guidance or limited educational attainment often led participants to adopt harmful practices based on personal experience in an attempt to manage a chronic condition, such as cleansing the wound with bar soap. The “soda” in the product acts as a chemical agent that damages tissue and severely impairs wound healing.

Some participants recognized the importance of ointments and gauze but did not know how to apply them correctly, particularly how much ointment to use. Although they intended to provide “better care,” the practice itself could harm the wound. Among participants with limited educational attainment, wound self-care was therefore compromised and often proceeded by trial and error, shaped by personal beliefs, individual creativity, and the health education they had received.

Home self-care routines thus served as an adaptive response and reflected participants’ efforts to retain control over their health. This was beneficial when they put the technical guidance provided by the nursing team into practice. By observing, learning, and applying the technique at home, participants turned health education into practical skill and fully exercised their self-care agency.⁸ By contrast, the persistence of inappropriate practices indicated a self‑care deficit and the need for nursing interventions. These deficits took different forms and required different nursing systems, particularly when participants did not understand the guidance well enough to apply it safely and therefore engaged in potentially dangerous practices.⁸

Within Orem’s Self-Care Deficit Nursing Theory, emotional states and negative perceptions are not merely consequences of the wound; they are basic conditioning factors that directly impede self-care agency. Socioeconomic vulnerability adds to these difficulties: limited income restricts access to essential resources, including adequate nutrition, wound care supplies, and transportation, forcing people to make difficult choices that may delay recovery.¹⁴ Persistent pain and reduced mobility also create physical and psychological barriers to accessing health services and participating in social life and are associated with adverse clinical outcomes and poorer quality of life.⁵,¹⁵,¹⁶

Addressing these challenges requires nursing systems that strengthen self-care agency. Public policies should ensure reliable access to wound care supplies and health services, as well as ongoing professional training in current wound care technologies. Effective self-care also depends on understanding each person’s circumstances and developing care plans that address their needs more effectively. Therefore, the nursing approach should be planned as a supportive‑educative system, focusing not only on the wound but also on validating the person’s feelings, restoring self-esteem, and strengthening their identity beyond the health condition.⁶,⁸

Within the ESF team, nursing care for these wounds primarily operates through a partly compensatory nursing system.⁸ This form of support is essential to reduce self-care deficits, promote autonomy, and sustain treatment at home while strengthening people’s ability to manage their own health. The ESF is therefore a fundamental source of wound care supplies and education.¹¹,¹²

By delivering technically competent care and building trust, the nursing team can improve treatment adherence and patient safety. Through skilled interactions, ESF nursing staff provide follow-up care to people with hard-to-heal wounds according to their needs, combining clinical care and education to support resilience and self-care.

Participants described faith and spirituality as positive conditioning factors that offered strength, comfort, and hope amid adversity. Their accounts suggest that spirituality gave many of them a reason to continue living and a way to cope with suffering. It also appeared to strengthen their willingness to engage in self-care by providing motivation that clinical treatment alone may not always generate.¹⁷ As an element of care, spirituality can help people make sense of pain and preserve hope during prolonged treatment and uncertain prognoses, thereby supporting continuity of care over time, quality of life, and overall well-being.

FINAL CONSIDERATIONS AND IMPLICATIONS FOR PRACTICE

This study showed that self-care among people with hard-to-heal lower limb wounds is a complex process that involves individual agency while coexisting with self-care deficits influenced by biopsychosocial, spiritual, and systemic factors. The findings can inform nurses’ work in developing a Singular Therapeutic Project—an individualized, shared care plan—that integrates attentive listening, dialogue, and participatory planning to motivate people to engage in self-care and promote autonomy, as advocated by Orem’s Self-Care Deficit Nursing Theory.

One limitation of this study was its limited timeframe, imposed by the academic program’s schedule. This constraint precluded longitudinal follow-up, which would have made it possible to assess whether wound self-care practices at home were sustained over time. Although the researcher sought to build a cordial and trusting relationship with participants during data collection, the interviews lasted an average of 10 minutes. Asking participants about how they cared for their wounds in daily life may have limited the dialogue, as they may have feared that their self-care practices were being evaluated. Accordingly, participant observation and a field journal were also used to complement the interviews.

Future studies should include longitudinal follow-up of home-based wound self-care practices. Such research could provide data to improve health education activities.

The findings also reinforce the urgent need to rethink the care model for people with hard-to-heal wounds in the ESF. The focus should shift from simply providing dressing supplies and performing procedures to building a nursing system that provides care in partnership with other members of the health care team and promotes dialogue and comprehensive care centered on each person’s needs and strengths.

Because multiple factors influence self-care, public policies should support care for these individuals. Health service managers should ensure an adequate number of professionals to serve each ESF catchment area, regular professional training, appropriate facilities, and the materials and supplies required for treatment.

Nursing education should prepare nurses to take a broader view of care and self-care, apply the nursing process grounded in a theoretical framework, and address the complexity of human responses to hard-to-heal lower limb wounds, especially when gaps exist between self‑care demands and a person’s ability to perform the required self-care.

ACKNOWLEDGMENTS

We are deeply grateful to everyone who contributed, directly or indirectly, to this study and to the preparation of this manuscript, which was derived from a master’s thesis.

We extend our special thanks and deepest respect to the study participants—people with hard-to-heal lower limb wounds—who generously shared their experiences and made this study possible. Their participation lies at the heart of this work.

We also thank the Universidade Federal de Alfenas (UNIFAL-MG), particularly the faculty members of its Graduate Program in Nursing, for sharing their knowledge and providing an excellent academic environment that contributed significantly to our professional and scientific development.

Finally, we thank all the authors and researchers whose work informed the theoretical foundation of this study and enriched the discussion and interpretation of the findings.

DATA AVAILABILITY RESEARCH

Because of the risk of participant identification, the data are available from the corresponding author upon request by email.

• a
  Extracted from the master’s thesis Self-care among people with hard-to-heal lower limb wounds receiving care from Family Health Strategy teams in a municipality in southern Minas Gerais, submitted to the Graduate Program in Nursing at the Universidade Federal de Alfenas (UNIFAL) in 2025.
• FINANCIAL SUPPORT
  This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

References

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Edited by

• ASSOCIATED EDITOR
  Camila Pureza Guimarães da Silva https://orcid.org/0000-0002-9957-6944

• SCIENTIFIC EDITOR
  Marcelle Miranda da Silva https://orcid.org/0000-0003-4872-7252

Publication Dates

• Publication in this collection
  18 Sept 2026
• Date of issue
  2026

History

• Received
  13 Nov 2025
• Accepted
  30 July 2026