Nursing Process for Elderly Women with Open Fractures, Victims of Violence: An Experience Report

Population aging is defined by the modification of the age structure,
characterized by an increase in the number of individuals over
60 years or older...

in the elderly were women [6]. The violence is a complex and multifaceted phenomenon, which is found in several forms (aggression, psychological, sexual, abandonment, financial), results in or has a high risk of death, injury, psychological damage, with repercussions on the victims' quality of life [5,7]. Physical violence, when force is used to cause harm [7,8], is the most evident, corresponding to between 56% and 87.8% of cases [5,6]. Thus, the damage resulting from violence results in fractures, a consequence of several other risks (falls, domestic accidents, musculoskeletal problems) that the elderly are subject to since it is a common problem in the elderly [7,8].
The nursing team must be able to use the Nursing Care Systematization (NCS), which organizes the professional work regarding the method, guiding the nursing actions and ensuring the client a holistic care, so that the nurse must recognize the problems related to violence against elderly people [9]. To do so, it has the operationalization of the Nursing Process (NP), using its five guiding steps, from investigation or history with detecting the patient's problems, description of the nursing diagnoses, planning the expected results until the implementation of care and the assessment of the goals set and the patient's evolution [10].
Thus, the objective of this study is to report the experience of the implementation and elaboration of the Nursing Process in the care of an elderly woman with an open fracture, a victim of violence.

Method
It is an experience report on the elaboration of the stages of the nursing process to an elderly woman, living in the rural area of the state of Bahia, with low level of education and socioeconomic status, married and with seven children, who presented an open fracture in left lower limb, victim of domestic violence (she was hit by her partner, according to the patient's information). This study was carried out in the period of July 2019 after providing care to a patient at the Surgical Clinic of a public hospital, the main of the Alto Sertão Produtivo Bahia, during the curricular practices of the Bachelor of Nursing course. Thus, the elaboration of the NP was carried out, based on information on the patient's needs, through a checklist adopted by the hospital in question, which is adopted on the admission of any patient in the sector, bringing a possible plan of care for the patient victim of an exposed fracture resulting from violence based on the needs presented. In this sense, in addition to the information on the checklist, which was constituted as data for the construction of the results, the search for scientific articles was carried out, to subsidize the care to be implemented and to base the reflection and discussion of the results, from the By using only publicly available data, without identifying the person and without risk to the study patient, being public domain data, submission to the Research Ethics Committee (CEP) was waived.

Results
During the practice period in the surgical clinic, there was a need to discuss nursing care for a patient victim of violence with open fractures or any other type of physical injury, as well as to elaborate nursing diagnoses to determine an appropriate care plan for choosing interventions and expected results as set out in the two (Tables 1 & 2) below. Table 1: Stages of the nursing process related to the consequences of violence suffered by elderly women.

Anxiety
Anxiety, related to death threat, characterized by increased tension.
Offer psychological support, promote a calm and peaceful environment.
You will look relaxed and your anxiety will be eased to a bearable level.

Insomnia
Sleep pattern disorder related to nonrestorative sleep pattern characterized by difficulty maintaining sleep.
Assist in stressful situations before bedtime; Discuss comfort measures and lifestyle changes with the patient / Family.

Improved sleep pattern.
Low self-esteem Low situational self-esteem, related to a pattern of helplessness characterized by self-negative verbalizations.
Search support groups; Encourage the identification of specific life values. Improved self-esteem. Assist in the elaboration of the medication therapeutic plan for pain relief; Control environmental factors capable of intensifying pain.
It will show comfort by reducing pain.
Immobility; restriction to bed Impaired bed mobility related to pain and musculoskeletal impairment, evidenced by impaired ability to reposition in bed.
To assist in walking and activities; To refer and Collaborate with the physiotherapist in the development of an exercise program.
It will demonstrate techniques and behaviors that enable the resumption of its activities.
risk of skin pressure injury Risk of impaired skin integrity associated with reduced physical mobility in bed.
Pay attention to the appearance of ischemic regions in the limbs; Perform the decubitus change (3 / 3h); Provide an appropriate mattress to relieve pressure on the skin; Daily monitor the skin and mucous membranes.
It will present a reduced risk of damaging the skin during the hospital stay.

difficulty bathing
Deficit in self-care for the bath associated with musculoskeletal impairment due to the fracture, evidenced by the inability to perform self-hygienization.
Perform the person's bath in bed; Promote oral hygiene; Monitor skin conditions while bathing.
You will have your body hygiene performed effectively with the help of the nursing team.

Risk of infection
Risk of infection related to the intravenous catheter and prolonged hospital stay.
Wash hands before and after each patient care activity.
It will present a reduced risk of acquiring infection.

Deficient nutritional intake; Slimming
Imbalanced nutrition: less than the bodily needs related to lack of appetite, characterized by loss of interest in food and weight loss.
Request the support and attention of the nutrition team; Assist in the elaboration of the food plan consistent with the current clinical condition.
It will demonstrate an increased appetite during meals offered in order to satisfy your bodily needs in order to prevent weight loss.

Discussion
In any care environment, nurses have an outstanding role in caring for elderly people who are victims of violence, mainly because they have greater contact with the community within health institutions and are primarily responsible for the development of NP, in order to guarantee a well-founded practice.
at (NCS), in addition to being frequently the first professional to identify situations of violence [7,12]. It is emphasized that the systematization of the assistance made possible by the NP, will allow safe and adequate care to the needs and singularities of any person, as it will direct the entire team to do the service with quality from violence with emotional support, as well as to stimulate the denunciation as well as make the notification [13].
When addressing the topic of physical violence, it should be noted that in addition to physical damage, it is common for psychological / emotional disorders to arise which can evolve into more serious problems, so it is necessary to make a careful assessment with the collection of information on admission along with the history / investigation [7]. In physical disorders, in turn, the individual's mobility, functional independence, and self-care will be compromised after an open fracture, which changes their daily routine and prevents them from performing activities that require mobility, making them dependent on others and restricted.
The sleep and rest pattern of people who suffered an open fracture is also impaired due to pain [15]. Despite the prescribed pharmacotherapy, pain control is difficult due to environmental factors capable of intensifying it or the psychic disorders that lead to the somatization of symptoms [13].