Empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates.

AIM: To analyze the empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates. BACKGROUND: Empathy is a fundamental skill for nursing practice and should be analyzed during the student's education. METHODS: Descriptive study with cross-sectional design. Participants were 968 undergraduate students, including 215 (22.2%) Brazilians from a university in the state of São Paulo and 753 (77.8%) Portuguese students from a higher education institution in central Portugal. The Portuguese and Brazilian versions of the Empathizing/Systemizing Quotient have good internal consistency and reliability. ETHICAL CONSIDERATIONS: In Brazil, approval for the study was obtained from the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (protocol 191/2016) and in Portugal, from the Ethics Committee of the Health Sciences Research Unit: Nursing, Coimbra Higher School of Nursing (protocol P362-09/2016). RESULTS: Most (86%) participants were female and aged between 20 and 24 years. In the general profile analysis between both groups, the domains "Social Skills," "Contents," and "Processes" scored higher. Gender differences exist for the feeling of empathy and systemizing, as women scored better on the short version of the Empathy Quotient and men on the Systemizing Quotient. CONCLUSION: As demonstrated in the domain scores for "Social Skills," "Contents," and "Processes," the undergraduate nursing students analyzed have the ability to deal intuitively and spontaneously with social situations; they are also characterized as methodical people, who like to follow rules, and experience practice better than theory, and the women have a higher empathetic level than men, who in turn are more systemizing.

Quality of life and ethics: A concept analysis.

BACKGROUND:: In health, ethics is an essential aspect of practice and care and guarantees a better quality of life for patients and their caregivers. OBJECTIVE:: To outline a conceptual analysis of quality of life and ethics, identifying attributes, contexts and magnitudes for health. METHOD:: A qualitative design about quality of life and ethics in health, considering the evolutionary approach in order to analyse the concept. To collect the data, a search was done using the keywords ethic*, quality of life and health. After, in total, 152 studies were found, finalizing seven relevant studies for the proposed concept analysis. FINDINGS AND DISCUSSION:: Of seven studies analysed, their main results were shown by means of antecedents, consequences and attributes of the concepts. The three final attributes that synthesize the concept of quality of life and ethics in health were highlighted: Ethics dilemmas and quality of life; Human ethics and quality of life; and Ethics of care and quality of life. In fact, the attributes and context clearly reveal that ethics and quality of life influence the ability to solve ethical dilemmas, guarantee human ethics in healthcare and impact ethics in healthcare for the production of effective health policies and care that encompasses professional quality of life as well. CONCLUSION:: The magnitude of ethical knowledge in each professional discipline permits cultivating a solidary attitude and developing the willingness to improve healthcare. The right to access, dignity and respect in care delivery are rooted in behaviours and are spontaneously applied in practice to the extent that they play an ethical role.

Construction of hypermedia to support the systematization of the nursing care education. / Construção de hipermídia para apoio ao ensino da sistematização da assistência de enfermagem.

OBJECTIVE: To describe the process of hypermedia construction to support the teaching of the Systematization of the Nursing Care (SNC). METHOD: Methodological research of educational technology development. The hypermedia construction stages were conducted from February 2015 to March 2016 and integrated theoretical studies, focus group with professors and educational technology development process in the light of the referential Theory of Significant Learning. RESULTS: Hypermedia consists of interactive content and shows a splash screen with a concept map that guides a free way of learning about four structuring aspects in the SNC learning: concept, history and benefits; ethical-legal aspects; operationalization; and nursing process: steps and technical integration in nursing. CONCLUSIONS: It was concluded that it is essential that the educational technologies are built from a pedagogical rationale to support your incorporation into educational environments.

GST transcriptional changes induced by a toxic Microcystis aeruginosa strain in two bivalve species during exposure and recovery phases.

Previous studies have demonstrated the modulation of glutathione transferases (GSTs) induced by microcystin (MC) alone or in combination with other cyanobacterial secondary metabolites in bivalves. However, interspecies information about which and how GST isoforms are affected by these secondary metabolites is still scarce, especially considering the dynamic process involving their uptake and elimination routes. In this context, the role of GSTs gene expression changes in response to a toxic Microcystis aeruginosa extract were examined for Mytilus galloprovincialis and Ruditapes philippinarum during exposure and recovery phases. The expression levels of sigma 1, sigma 2, pi and mu-class GST genes were analyzed in the hepatopancreas of both bivalve species during cyanobacteria extract exposure (24 h) and post-exposure (24 and 72 h). Only a significant induction of sigma 1-class GST expression was observed for R. philippinarum upon 24-hour exposure of both bivalve species to Microcystis extract. During the recovery phase, GST transcriptional changes for M. galloprovincialis were characterized by an early induction (24 h) of sigma 1 and sigma 2 transcripts. On the other hand, GST transcriptional changes for R. philippinarum during post-exposure phase were characterized by an early induction (24 h) of sigma 1 and mu transcripts and a later induction (72 h) of the four analyzed GST transcripts. Such differences reflect variable GST response mechanisms to cope with MC-producing cyanobacterial blooms exposure between these two bivalve species, revealing a higher sensitivity of R. philippinarum to Microcystis-induced stress than M. galloprovincialis. The results also suggest a much higher level of activity of the GST detoxification system during the recovery phase compared to the period of the stress exposure for both bivalve species.

Trends in Research on Simulation in the Teaching of Nursing: An Integrative Review.

AIM: The aim of the study was to identify and reflect on evidence regarding the use of simulation in nursing education. BACKGROUND: The use of simulation as a teaching strategy in nursing is expanding. It is important to check the evidence deriving from research. METHOD: Departing from a guiding question, an international literature search was undertaken between January 2008 and March 2014 in Portuguese, English, and Spanish. RESULTS: Out of 160 articles, 68.1 percent used simulated teaching to develop clinical reasoning; 31.9 percent used it to train skills. Most (about 91.8 percent) discussed positive aspects related to the use of simulation, including support for the teaching process and increased self-efficacy and self-confidence. CONCLUSION: The studies indicate that appropriate tools are needed to measure the true impact of the strategy on the teaching of nursing care and the training needed to use simulation as a teaching strategy.

Hospital microbial surface colonization revealed during monitoring of Klebsiella spp., Pseudomonas aeruginosa, and non-tuberculous mycobacteria.

Hospital environmental conditions, human occupancy, and the characteristics of the equipment influence the survival of microbial communities and raise a concern with regard to nosocomial infections. The objective of the present work was to use the monitoring of Pseudomonas aeruginosa, Klebsiella spp. and non-tuberculous mycobacteria as a strategy to improve knowledge on microbial colonization of non-critical equipment and surfaces, in a tertiary hospital from Central Portugal. A 3-month microbiological survey was performed in a district teaching hospital. A total of 173 samples were obtained from the wards Hematology, Urology, Medicine, and Renal Transplants, and 102 presumptive strains recovered. Per sampling, Pseudomonas Isolation agar showed 42.8 to 73.3% of presumptive P. aeruginosa colonies and MacConkey agar recovered mostly Staphylococcus. Most of the colonies recovered in Middlebrook 7H10-PANTA belonged to the genus Methylobacterium. Taps and WC shower curtains carry high bacterial species diversity. The Redundancy Analysis grouped the samples in those mostly handled by patients, and those mostly handled by healthcare staff or of mixed use. This study shows that the preferential users of the space and equipment seem to be important contributors to the microbial community. The most recovered genus was Methylobacterium, known as colonizer of the water distribution system therefore, it is possible that the water points and biofilms in taps also contribute as dispersion hotspots.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers.

OBJECTIVE: To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers. MATERIAL AND METHODS: Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: "no confidence"=1, "little confidence"=2, "confident"=3, "very confident"=4 and "completely confident"=5. Questionnaire called "Self- Confident Scale for Clean Intermittent Self-catheterization" (SCSCISC) was constructed based on literature and previously validated (appearance and content). RESULTS: The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers. CONCLUSION: The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

e-Health in palliative care: review of literature, Google Play and App Store.

AIM: To analyse the use of e-Health technologies and mobile apps in palliative care (PC). METHODS: Search on PubMed, using 'telemedicine', 'ehealth', 'mobile health', 'telecare', 'health information systems' and 'palliative care'. Original Portuguese, Spanish, French and English papers were included. Google Play and App Store (iOS) were searched for mobile apps using 'palliative care', 'medical apps' and 'symptom management'. RESULTS: Twenty-five papers and forty mobile apps were analysed. Teleconsultation is the principal e-Health technology. Mobile apps focus on communication, drugs, tools/clinical guidelines, hospice, symptom management and PC information. CONCLUSIONS: e-Health is an emergent topic in PC. Teleconsultation enhances communication among patients, families and PC teams, reinforces partnership and decreases the burden on families and use of the emergency services. IMPLICATIONS FOR PRACTICE: e-Health technologies are a good strategy in PC but further research based on different methodological approaches is needed to promote evidence-based practice.

The Comfort app prototype: introducing a web-based application for monitoring comfort in palliative care.

AIM: To introduce a web-based application for monitoring comfort in patients receiving palliative care. METHODS: Multi-phase electronic application development process that concluded with a pilot design to assess the feasibility and acceptability of the developed app (n=7 patients). RESULTS: The app is compatible with Android, iOS and Windows. The results from phases I and II provided the knowledge about monitoring comfort. In phase III, five experts analysed the content of the app. The assessment of comfort comprises 11 self-reported items (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, fear of the future, peace and the will to live). In phase IV, a total of 117 messages were retrieved. Participants considered the app simple, easy to use and useful. CONCLUSIONS: This prototype is feasible and user-friendly. Further research is needed to continue the app development, particularly in terms of data protection.

Evolutionary Analysis of the Concept of Comfort.

Although comfort is cited as an important component of nursing care, a definition that provides a firm conceptual foundation for research and nursing science is still needed, particularly in nursing classifications and taxonomies. This article provides a clear and evidence-based definition, improving research, development, and implementation of specific nursing interventions.

Quality of Life of Intermittent Urinary Catheterization Users and Their Caregivers: A Scoping Review.

AIMS: This study aimed to examine and map the scientific evidences regarding quality of life in neurogenic bladder patients and consequently their caregivers by means of a scoping review. DESIGN: This is a scoping review proposal of the Joanna Briggs Institute. METHODS: It was conducted to examine and map the scientific evidences about quality of life (QoL) in neurogenic bladder patients and their caregivers, to identify the meanings attributed to QoL and its relation with intermittent urinary catheterization. The following guiding question was: "What scientific evidence has been produced on the QoL of neurogenic bladder patients using intermittent urinary catheterization and their caregivers?" A total of 2945 research studies were identified using The Cochrane Library, CINAHL, LILACS, Academic Search Premier (via EBSCO platform), PubMed, SCOPUS, the platforms Web of Science, the b-on and Gray Literature. The keywords established were patient, intermittent urinary catheterization, neurogenic urinary bladder, quality of life and caregiver. RESULTS: From 2,945 studies, 13 studies were selected. Most of the selected studies that analyzed variables related to the patients' QoL were regarding the urinary catheterization technique, assessment of urinary incontinence, individual perceptions of the procedure and experiences with urinary catheter in childhood and adult life. The meanings attributed to QoL, when compared to adult and child individuals with normal bladder functioning, presented lower QoL scores. Concerning caregivers, the QoL of caregivers of children using intermittent urinary catheterization demonstrated low scores. LINKING EVIDENCE TO ACTION: The QoL of patient's who use intermittent urinary catheterization can be determined by improvement of urinary symptoms and self-confidence. Research related to QoL of patients who use urinary catheter indicates the importance of adequate professional support and appropriate health public policies.

Development of a theoretical-practical script for clinical simulation.

OBJECTIVE: To develop a theoretical-practical script based on the opinion of experts to be used in simulated clinical activities. METHOD: Qualitative study through analysis of content of interviews with experts on the theme in order to develop the proposed script. Of the 24 invited experts, 12 specialists from educational institutions in Brazil and abroad participated in the study in compliance with the ethical precepts. The experts responded to questions on the characterization of their study attributes and described the items required for the development of a simulated scenario. In view of the responses obtained, data content was analyzed and classified into units and subunits of significance. RESULTS: The items mentioned for the development of the script generated seven units of significance. The units and subunits of significance were gathered in three stages of the main components of the simulated scenario: prior, preparation, and finals. CONCLUSION: This study enables an innovative, stimulating teaching experience, making it easier for professors to use the simulation resource as a learning process in an effective and objective manner, as a guide to professors and researchers in the area of clinical simulation. OBJETIVO: Construir, com base na opinião de peritos, roteiro teórico-prático para uso em atividade clínica simulada. MÉTODO: Trata-se de um estudo qualitativo por meio de análise de conteúdo de entrevistas de peritos no assunto para construção do roteiro proposto. Seguido os preceitos éticos, entre os 24 peritos convidados pertencentes a instituições de ensino do Brasil e do exterior. Os peritos responderam a questões sobre a caracterização dos seus atributos de estudo e descreveram os itens imprescindíveis à construção de um cenário simulado. Diante das respostas obtidas, os dados foram analisados em relação ao seu conteúdo e organizados em unidades e subunidades de significância. RESULTADOS: Participaram 12 especialistas. Os itens mencionados para construção do roteiro originaram sete unidades de significância. As unidades e suas subunidades de significância foram ainda reunidas em três fases dos componentes principais do cenário simulado: prévios, preparo e finais. CONCLUSÃO: Este estudo permite um ensino inovador, estimulante e possibilita a facilidade ao professor, quanto à utilização do recurso de simulação, como processo de aprendizagem de maneira eficiente e objetiva, sendo um norteador aos docentes e pesquisadores na área de simulação clínica.

Meanings attributed by nurses to ensure the care of critical patients in the light of simulations' premises.

AIM: The aim of this study was to identify the feelings experienced by nurses in caring the first visit to a critical patient. BACKGROUND: Understand the ethical aspects from the first experiences in the nursing profession lead us to reflect on the teaching-learning methodologies and also their improvements. METHODS: A study with a mixed and exploratory approach was realized with the nurses. RESULTS: From 72 (100.0%) nurses who participated in the study, 56 (77.8%) did their first visit to critical patients in the clinical practice and did not feel prepared. The feelings mentioned were as follows: insecurity due to lack of skill, risk both to the patient and also the professional, feelings of fear, anxiety, discomfort and related aspects to ethical competence. CONCLUSION: The feelings experienced by professionals led us to reflect about the function of institutions, which must have the commitment and the responsibility of providing to the society able professionals who are acting safely and with technical and scientific expertise in valuing human integrity.

A Systematic Literature Review Toward the Characterization of Comfort.

Comfort integrates the taxonomies and the classifications of nursing knowledge. Its meaning is not yet clear, although it is an important construct from which theories are developed. This article aims to analyze comfort in nursing scientific literature. The results highlight a particular interest in comfort at crisis situations such as illness, palliative care, or intensive care. Comforting seems to be a complex intervention. More studies are needed to achieve its operational assimilation and implementation in clinical practice, as well as the evaluation of its efficiency and effectiveness.

Palliative care and nursing in dissertations and theses in Portugal: a bibliometric study.

OBJECTIVE: To identify the academic scientific production on palliative care in master dissertations and PhD theses carried out by nurses in Portugal. METHOD: A descriptive retrospective study of bibliometric type with search for the abstracts available in repositories of higher education institutions in the period 2000-2014. RESULTS: Of the 1814 papers identified, 249 met the inclusion criteria (ten doctoral theses and 239 master dissertations). The most representative methodological approach was quantitative (31.35%) and the most studied area was family/informal caregiver (20.69%). The most studied target population were the students/health professionals (38.51%). CONCLUSION: The academic scientific production in this area has been growing in spite of the need for continued investment in order to fill the identified gaps. OBJETIVO: Identificar a produção científica académica sobre cuidados paliativos nos estudos de mestrados e doutoramentos efetuados por enfermeiros em Portugal. MÉTODO: Estudo descritivo e retrospetivo, do tipo bibliométrico, recorrendo aos resumos disponíveis nos repositórios das instituições de ensino superior no período 2000-2014. RESULTADOS: Dos 1814 trabalhos identificados, 249 corresponderam aos critérios de inclusão (10 teses de doutoramento e 239 dissertações de mestrado). A abordagem metodológica mais representativa é a quantitativa (31,35%), a área mais estudada foi a família/cuidador informal (20,69%) e a população-alvo mais estudada foram os estudantes/profissionais de saúde (38,51%). CONCLUSÃO: A produção científica académica nessa área tem vindo a crescer. Embora exista necessidade de investimento contínuo de forma a colmatar as lacunas identificadas.

Transcriptional responses of glutathione transferase genes in Ruditapes philippinarum exposed to microcystin-LR.

Glutathione Transferases (GSTs) are phase II detoxification enzymes known to be involved in the molecular response against microcystins (MCs) induced toxicity. However, the individual role of the several GST isoforms in the MC detoxification process is still unknown. In this study, the time-dependent changes on gene expression of several GST isoforms (pi, mu, sigma 1, sigma 2) in parallel with enzymatic activity of total GST were investigated in gills and hepatopancreas of the bivalve Ruditapes philippinarum exposed to pure MC-LR (10 and 100 µg/L). No significant changes in GST enzyme activities were found on both organs. In contrast, MC-LR affected the transcriptional activities of these detoxification enzymes both in gills and hepatopancreas. GST transcriptional changes in gills promoted by MC-LR were characterized by an early (12 h) induction of mu and sigma 1 transcripts. On the other hand, the GST transcriptional changes in hepatopancreas were characterized by a later induction (48 h) of mu transcript, but also by an early inhibition (6 h) of the four transcripts. The different transcription patterns obtained for the tested GST isoforms in this study highlight the potential divergent physiological roles played by these isoenzymes during the detoxification of MC-LR.

Empathy in Brazilian nursing professionals: a descriptive study.

BACKGROUND: Essential for the help relation, empathy is the ability to understand, share, and perceive the subjective experience of other human beings. OBJECTIVE: The objective in this non-experimental, exploratory, and descriptive research was to verify, observe, and document empathy in nursing professionals. RESEARCH DESIGN: Non-experimental, exploratory, and descriptive research. Participants and research context: the study was conducted at two large hospitals, one public and the other private, across all shifts. The sample included 159 individuals. A questionnaire was used to identify sociodemographic characteristics and the empathy inventory was applied. ETHICAL CONSIDERATIONS: This study received approval from the Research Ethics Committee at the University of São Paulo at Ribeirão Preto College of Nursing, opinion 1348/2011, and authorization from the health institutions involved. FINDINGS: The association tests demonstrated that professionals working in the night shift and in a work scale rotation scheme, older professionals, and professionals with longer professional experience are less empathetic. On the other hand, professionals working in the day shift and in a single shift are more empathetic. Other influential factors are the time on the job, education, and work shift. CONCLUSION: There is a lack of empathy studies in professional practice contexts, in human resource development programs, and throughout the professional education process.

Proteomic profiling of cytosolic glutathione transferases from three bivalve species: Corbicula fluminea, Mytilus galloprovincialis and Anodonta cygnea.

Suspension-feeding bivalves are considered efficient toxin vectors with a relative insensitivity to toxicants compared to other aquatic organisms. This fact highlights the potential role of detoxification enzymes, such as glutathione transferases (GSTs), in this bivalve resistance. Nevertheless, the GST system has not been extensively described in these organisms. In the present study, cytosolic GSTs isoforms (cGST) were surveyed in three bivalves with different habitats and life strategies: Corbicula fluminea, Anodonta cygnea and Mytilus galloprovincialis. GSTs were purified by glutathione-agarose affinity chromatography, and the collection of expressed cGST classes of each bivalve were identified using a proteomic approach. All the purified extracts were also characterized kinetically. Results reveal variations in cGST subunits collection (diversity and properties) between the three tested bivalves. Using proteomics, four pi-class and two sigma-class GST subunits were identified in M. galloprovincialis. C. fluminea also yielded four pi-class and one sigma-class GST subunits. For A. cygnea, two mu-class and one pi-class GST subunits were identified, these being the first record of GSTs from these freshwater mussels. The affinity purified extracts also show differences regarding enzymatic behavior among species. The variations found in cGST collection and kinetics might justify diverse selective advantages for each bivalve organism.

Development of the e-Baby serious game with regard to the evaluation of oxygenation in preterm babies: contributions of the emotional design.

The present study aimed to describe the development process of a serious game that enables users to evaluate the respiratory process in a preterm infant based on an emotional design model. The e-Baby serious game was built to feature the simulated environment of an incubator, in which the user performs a clinical evaluation of the respiratory process in a virtual preterm infant. The user learns about the preterm baby's history, chooses the tools for the clinical evaluation, evaluates the baby, and determines whether his/her evaluation is appropriate. The e-Baby game presents phases that contain respiratory process impairments of higher or lower complexity in the virtual preterm baby. Included links give the user the option of recording the entire evaluation procedure and sharing his/her performance on a social network. e-Baby integrates a Clinical Evaluation of the Preterm Baby course in the Moodle virtual environment. This game, which evaluates the respiratory process in preterm infants, could support a more flexible, attractive, and interactive teaching and learning process that includes simulations with features very similar to neonatal unit realities, thus allowing more appropriate training for clinical oxygenation evaluations in at-risk preterm infants. e-Baby allows advanced user-technology-educational interactions because it requires active participation in the process and is emotionally integrated.

Subacute Neurotoxicity as an Adverse Reaction to Ceftazidime: A Case Report.

Neurotoxicity associated with cephalosporins is an increasingly recognized complication, although among cephalosporins, ceftazidime is rarely reported for such an adverse reaction. Moreover, subacute, rather than acute, presentation of neurotoxicity associated with cephalosporins is rare. A 77-year-old female patient with stage 4 chronic renal disease was admitted due to cellulitis in her right lower limb, multiorgan dysfunction complicated by oliguric acute kidney injury, and a need for hemodialysis via a central venous catheter. On the 13th day after admission, she became febrile, and bacteremia associated with a central venous catheter was identified, which prompted the initiation of empirical antibiotic therapy with vancomycin and ceftazidime. After 13 days of antibiotic therapy with vancomycin and ceftazidime, the patient became confused, with temporal-spatial disorientation and myoclonus, especially in the upper limbs, with worsening renal function. Ceftazidime was discontinued, and the patient's condition improved with complete remission of symptoms on the 8th day after symptom onset. Neurotoxicity associated with ceftazidime is a rare but probably underdiagnosed adverse reaction. It is more frequent in elderly patients with previous neurological dysfunction and end-stage kidney disease and/or acute kidney injury, and it usually manifests soon after starting treatment. Early identification and monitoring of risk factors and symptoms should lead the physician to a rapid withdrawal of the offending drug.