RESUMO
OBJECTIVES: to identify care strategies developed by professionals from critically ill patients' units in communicating BD with parents of children and adolescents. METHODS: an exploratory and descriptive research with a qualitative approach, carried out in two health institutions between October and December 2019, through semi-structured interviews. Data analysis took place through content analysis. RESULTS: twenty-one professionals participated. Three care strategies were identified: actual clinical situation in suspected brain death; sensitizing families to the real clinical situation after brain death diagnosis; and time to assimilate the death information. FINAL CONSIDERATIONS: the care strategies for communicating brain death to families identified in this study present the possibility of subsidizing health managers in training and support promotion for professionals in care practice. Moreover, they can be incorporated and validated in the care practice of the studied context.
Assuntos
Morte Encefálica , Pais , Adolescente , Criança , Comunicação , Estado Terminal , Humanos , Pesquisa QualitativaRESUMO
ABSTRACT Objectives: to identify care strategies developed by professionals from critically ill patients' units in communicating BD with parents of children and adolescents. Methods: an exploratory and descriptive research with a qualitative approach, carried out in two health institutions between October and December 2019, through semi-structured interviews. Data analysis took place through content analysis. Results: twenty-one professionals participated. Three care strategies were identified: actual clinical situation in suspected brain death; sensitizing families to the real clinical situation after brain death diagnosis; and time to assimilate the death information. Final Considerations: the care strategies for communicating brain death to families identified in this study present the possibility of subsidizing health managers in training and support promotion for professionals in care practice. Moreover, they can be incorporated and validated in the care practice of the studied context.
RESUMEN Objetivos: identificar las estrategias de atención desarrolladas por profesionales de pacientes críticos en la comunicación de la muerte encefálica con los padres de niños y adolescentes. Métodos: investigación exploratoria y descriptiva con enfoque cualitativo, realizada en dos instituciones de salud entre octubre y diciembre de 2019, a través de entrevistas semiestructuradas. El análisis de los datos se llevó a cabo a través del análisis de contenido. Resultados: participaron 21 profesionales. Se identificaron tres estrategias de atención: situación clínica real ante la sospecha de muerte encefálica; sensibilizar a la familia sobre la situación clínica real tras el diagnóstico de muerte encefálica; y tiempo para asimilar la información de la muerte. Consideraciones Finales: las estrategias de cuidado para comunicar la muerte encefálica a las familias identificadas en este estudio presentan la posibilidad de subsidiar a los gestores de salud en la promoción de la formación y apoyo a los profesionales en la práctica del cuidado. Además, pueden ser incorporados y validados en la práctica asistencial del contexto estudiado.
RESUMO Objetivos: identificar estratégias de cuidados desenvolvidas pelos profissionais das unidades de pacientes críticos na comunicação da morte encefálica junto aos pais de crianças e adolescentes. Métodos: pesquisa exploratória e descritiva com abordagem qualitativa, realizada em duas instituições de saúde entre outubro e dezembro de 2019, por meio de entrevistas semiestruturadas. A análise dos dados ocorreu através da análise de conteúdo. Resultados: participaram 21 profissionais. Foram três estratégias de cuidados identificadas: real situação clínica na suspeita de morte encefálica; sensibilizando a família da real situação clínica após o diagnóstico de morte encefálica; e tempo para assimilar a informação da morte. Considerações Finais: as estratégias de cuidados para comunicação de morte encefálica às famílias identificadas neste estudo apresentam a possibilidade de subsidiar gestores de saúde na promoção de capacitações e apoio aos profissionais na prática assistencial. Além disso, podem ser incorporadas e validadas na prática assistencial do contexto estudado.
RESUMO
ABSTRACT Objective to understand the health team's experience with parents of children and adolescents during the brain death protocol stages. Method a qualitative and exploratory research developed in two health institutions of high complexity and reference in the care of children and adolescents with polytrauma. Participants were health professionals from critical patient units. Data collection took place between October and December 2019 through semi-structured interviews. For content analysis, we used the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires as support. Results twenty-one professionals (physicians, nurses and nursing technicians) participated in the study. The general corpus consisted of 21 texts, separated into 123 segments, with the emergence of four classes. The study shows feelings of support and compassion at all brain death protocol stages. In the protocol opening stage, the team's emotions are focused on the actions of clarifying and revealing information in this process, in addition to pointing out the need for the team to detail the step by step of the exams to be performed. In the communication of death stage, the feeling of being, caring for and welcoming the family relates to other feelings experienced by them. Conclusion the study reveals that the health team experiences unique feelings during the brain death protocol in the reality of children and adolescents, revealing the team's concern with being with the family, paying attention and caring for the pain of loss.
RESUMEN Objetivo comprender la experiencia del equipo de salud con los padres de niños y adolescentes durante las etapas del protocolo de muerte encefálica. Método investigación con enfoque cualitativo y exploratorio desarrollada en dos instituciones de salud de alta complejidad y referencia en la atención de niños y adolescentes con politraumatismo. Los participantes fueron profesionales de la salud de unidades de pacientes críticos. La recolección de datos ocurrió entre octubre y diciembre de 2019 a través de entrevistas semiestructuradas. Para el análisis de contenido se utilizó como soporte el software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados participaron del estudio 21 profesionales (médicos, enfermeros y técnicos de enfermería). El corpus general estuvo compuesto por 21 textos, separados en 123 segmentos, surgiendo cuatro clases. El estudio muestra sentimientos de apoyo y compasión en todas las etapas del protocolo de muerte cerebral. En la etapa de apertura del protocolo, las emociones del equipo están enfocadas en las acciones de esclarecimiento y revelación de información en este proceso, además de señalar la necesidad de que el equipo detalle el paso a paso de los exámenes a realizar. En la etapa de comunicación de la muerte, el sentimiento de ser, cuidar y acoger a la familia se conecta con otros sentimientos vividos por ellos. Conclusión el estudio revela que el equipo de salud vive sentimientos únicos durante el protocolo de muerte encefálica en la realidad de los niños y adolescentes, revelando la preocupación del equipo por estar con la familia, prestar atención y cuidar el dolor de la pérdida.
RESUMO Objetivo: compreender a vivência da equipe de saúde junto aos pais de crianças e adolescentes durante as etapas do protocolo de morte encefálica. Método: pesquisa exploratória de abordagem qualitativa desenvolvida em duas instituições de saúde de alta complexidade e referência no atendimento a crianças e adolescentes com politrauma. Os participantes foram profissionais de saúde das unidades de pacientes críticos. A coleta de dados ocorreu entre os meses de outubro e dezembro de 2019 por meio de entrevistas semiestruturadas. Para análise de conteúdo, utilizou-se como apoio o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: participaram do estudo 21 profissionais (médicos, enfermeiros e técnicos de enfermagem). O corpus geral foi constituído por 21 textos, separados em 123 segmentos, emergindo quatro classes. O estudo mostra sentimentos de apoio e compaixão em todas as etapas do protocolo de morte encefálica. Na etapa da abertura do protocolo, as emoções da equipe estão voltadas às ações de clarificar e transparecer informações deste processo. Além de apontar a necessidade de a equipe detalhar o passo a passo dos exames a serem realizados. Na etapa da comunicação da morte, a sensação de estar, cuidar e acolher a família se conecta com outros sentimentos experimentados por eles. Conclusão: o estudo revela que a equipe de saúde vivencia sentimentos únicos durante o protocolo de morte encefálica na realidade de crianças e adolescentes. Revela também a preocupação de a equipe em estar com a família, atentar e cuidar ante a dor da perda.
RESUMO
OBJECTIVE: To analyze evidence capable of supporting best practices available in the literature to create dialogues about organ and tissue donation with parents of deceased children and adolescents. METHODS: An integrative literature review performed using Scopus, Cochrane, PsycINFO, PubMed/MEDLINE, Web of Science database, and SciELo electronic libraries from November of 2013 to November of 2018, using keyword syntax for each database. The categories were developed using the Alicante model. RESULTS: A total of 745 articles were identified, with 7 selected for analysis. The information obtained was grouped into 3 categories: death communication, which indicates the importance of using simple and clear words; emotional support, which reveals the need to respect family time and the importance of empathy and compassion; and donation information, which punctuates the importance of dissociating communication about the death from that regarding organ donation. CONCLUSIONS: Evidence shows that best practices are the use of simple language, respect for the family during the grieving process, and the importance of establishing different situations in which to communicate about the death and the donation process.
Assuntos
Morte , Família/psicologia , Relações Profissional-Paciente , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Adolescente , Atitude Frente a Morte , Criança , Comunicação , Seleção do Doador , Prática Clínica Baseada em Evidências , Humanos , Lactente , Masculino , Enfermeiras e Enfermeiros , Transplante de Órgãos , Pais/psicologiaRESUMO
OBJECTIVE: To identify the health needs of the patient and family facing the perspectives of discharge, health care, and adaptation to the new reality at home. METHODS: This was a quantitative and qualitative, exploratory, descriptive study conducted at a reference hospital for liver transplantation. The participants were patients undergoing liver transplant in this hospital unit from 2011 to June 2019. A semistructured interview script was used for data collection, and data were analyzed according to guidelines proposed for content analysis. RESULTS: Twenty patients participated, with a mean age of 40.2 years; 76% were men. The interview data enabled the development of 3 categories: daily health care, warning signs, and adaptation to the new health care routine. The data obtained from the categories showed that the main health needs include difficulties in blood glucose management, insulin administration, the importance of awareness of the warning signs, and obtaining support from the health care team to deal with food restrictions and high doses of medication. CONCLUSION: The health needs are focused on identifying strategies to develop daily care, in addition to seeking better strategies to adapt to the new reality. The study showed the need for individualized discharge planning by the health care team, based on the health needs of each patient.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Transplante de Fígado , Alta do Paciente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao PacienteRESUMO
CONTEXT: Our group previously reported the photoinstability of some desonide topical commercial formulations under direct exposure to UVA radiation. OBJECTIVE: This study aimed to prepare and characterize a gel-cream containing desonide, with greater photostability than the commercial gel-cream (C-GC). Benzophenone-3 (BP-3) was used as a photostabilizing agent. METHODS: The gel-cream developed (D-GC) containing BP-3 at 0.1% was prepared and characterized regarding its pH, drug content, spreadability, viscosity, in vitro drug release and in vitro permeation. The in vivo anti-inflammatory effect was assessed by ear edema measurement, croton oil-induced acute skin inflammation and myeloperoxidase assay. RESULTS AND DISCUSSION: D-GC presented characteristics compatible with topical application, appropriate drug content and good spreadability, and non-Newtonian behavior with pseudoplastic flow. D-GC showed a good photostability profile, presenting a desonide content of 95.70% after 48 h of exposure to UVA radiation, and stability under room conditions during 60 days. The amount of desonide released from D-GC and C-GC was 57.8 and 51.7 µg/cm2, respectively, measured using the vertical Franz cell. The in vitro skin permeation showed that desonide reached the site of action of the topical corticosteroids, from both formulations; however, the desonide amount retained in the dermis was lower with D-GC. The in vivo evaluation of topical anti-inflammatory activity indicated that D-GC presented the same biological effect as C-GC. CONCLUSION: D-GC represents a promising approach to treat dermatological disorders, since it presented satisfactory physicochemical characteristics, the same biological activity as C-GC and superior photostability, conferred by the addition of BP-3 at 0.1%.
Assuntos
Benzofenonas/química , Dermatite de Contato/tratamento farmacológico , Desonida/química , Desonida/farmacologia , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacologia , Química Farmacêutica , Óleo de Cróton/toxicidade , Fármacos Dermatológicos/química , Fármacos Dermatológicos/farmacologia , Modelos Animais de Doenças , Orelha , Géis , Glucocorticoides/química , Glucocorticoides/farmacologia , Humanos , Masculino , Camundongos , Pele/efeitos dos fármacos , Creme para a Pele/química , Creme para a Pele/farmacologia , Raios UltravioletaRESUMO
Realizou-se um ensaio objetivando investigar a viabilidade da produção do cogumelo comestível Pleurotus sajor-caju (Fr.) Singer em substratos cuja principal fonte de carbono fosse o resíduo do beneficiamento têxtil do algodão. Foram avaliadas duas composições de substrato: C1 (resíduo do beneficiamento têxtil do algodão, farelo de trigo, gesso e calcário) e C2 (resíduo do beneficiamento têxtil do algodão, farelo de trigo, palha de feijão, gesso e calcário). O experimento foi estabelecido em delineamento inteiramente casualizado, com nove repetições por tratamento e os dados de produção e eficiência biológica foram analisados utilizando-se o procedimento ANOVAG do pacote estatístico SAEG. O resíduo do beneficiamento têxtil do algodão, como principal ingrediente do substrato, mostrou-se eficiente para a produção do cogumelo P. sajor-caju, apresentando valores satisfatórios de produtividade (0,56 e 0,55 kg/kg substrato) e eficiência biológica (55,76 e 55,39 por cento), respectivamente para C1 e C2, podendo ser recomendado como alternativa menos onerosa de substrato comercial para a espécie Pleurotus sajor-caju.
The experiment was conducted to investigate the viability of the production of the edible fungus Pleurotus sajor-caju (Fr.) Singer in substrates in which main source of carbon was the cotton textille mill waste. Two substrates compositions were tested: C1 (cotton textille mill waste, wheat bran, plaster and limestone) and C2 (cotton textille mill waste, wheat bran, bean straw, plaster and limestone). A DIC experimental design was used, with nine repetitions for treatment and the production data and biological efficiency were analyzed being used the procedure ANOVAG of the statistical package SAEG. The cotton textille mill waste improvement, as the main ingredient of the substrate, was shown efficient for the production of the mushroom P. sajor-caju, presenting satisfactory values of productivity (0,56 and 0,55 kg/kg substratum) and biological efficiency (55,76 and 55,39 percent), respectively for C1 and C2. These results showed us that cotton textille mill waste, could be recommended as less onerous alternative of commercial substrate for the species Pleurotus sajor-caju.