Transplant Nursing.

These nurses coordinate care through the transplantation process.

The current state of transplant advanced practice providers: results of the advanced practice provider practice survey.

Advanced practice providers (APPs) are trained, licensed health care providers. The American Society of Transplant APP community of practice developed an electronic survey to investigate transplant APP demographics, scope of practice, and academic activities. We defined the top of scope of practice as delivering health care to the fullest extent of APP education and training as allowed by state laws and regulations. From July 11, 2020, to August 31, 2020, 307 invitations were e-mailed and survey links were distributed electronically on the community of practice hub and social media. Two hundred fifty-three APPs responded. APPs practice in inpatient and outpatient settings. Among the respondent APPs, 11.5% assist in the operating room (OR), 46.3% of inpatient and 46.6% of outpatient APPs perform procedures, and 17.8% run specialized APP clinics. 26.2% feel they do not function at the top of their scope of practice and 29.7% were expected to function as a coordinator some or all of the time. Forty-three percent gave invited lectures, 41.5% have published, and 69.2% teach physician trainees. 74.7% and 35.1%, respectively, would like to participate in research and teach but are limited by time, opportunity, and experience. APPs should practice at the top of their scope of practice. Clinical workloads and lack of time limit the ability of APP to teach and contribute to evidence-based practice.

Desafios da enfermagem em uma unidade de transplantes ante a Covid-19 / Nursing challenges in a transplant unit in the face of Covid-19 / Retos de la enfermería en una unidad de trasplante frente a Covid-19

Objetivo: Conhecer a percepção dos enfermeiros que atuam em uma unidade de transplantes sobre os desafios de sua atuação ante a COVID-19. Método: Estudo descritivo e exploratório, com abordagem qualitativa, desenvolvido em uma unidade de transplantes de um hospital referência do Ceará, entre março e junho de 2020, por meio de entrevista. Os dados foram analisados pelo software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ). Posteriormente, foi realizada a análise fatorial por correspondência (AFC) e gerada uma nuvem de palavras para a qual foram consideradas as evocações que apareceram com maior frequência. Resultados: Participaram do estudo 14 enfermeiros, a maioria do sexo feminino. O conteúdo analisado foi categorizado em três classes: organização do fluxo de atendimento de casos suspeitos, equipamento de proteção individual no contexto da pandemia da COVID-19, o emocional ante a pandemia. Conclusão: Constatou-se que os enfermeiros sofrem ante as fragilidades relacionadas ao momento vivenciado, pois estão sendo cotidianamente desafiados a se adaptarem às mudanças em suas rotinas de trabalho.

Objective: To understand how nurses who work in a transplant unit perceive the challenges of their role in the face of COVID-19. Method: This is an exploratory, descriptive, qualitative study conducted through interviews in the transplant unit of a reference hospital in Ceará, Northeastern Brazil, between March and June 2020. Data were analyzed in the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ). Subsequently, we performed a correspondence factor analysis (CFA) and generated a word cloud, taking into account the evocations with higher frequency. Results: Fourteen nurses participated in the study, most of them women. The content analyzed was categorized into three classes: organization of the care flow for suspected cases, personal protection equipment in the COVID-19 pandemic context, emotional state in the face of the pandemic. Conclusion: We found that nurses are suffering due to fragilities related to the moment they are experiencing, as they are daily challenged to adapt to changes in their work routines.

Objetivo: Conocer la percepción de los enfermeros que laboran en una unidad de trasplante sobre los desafíos de su desempeño ante el COVID- 19. Método: Estudio descriptivo y exploratorio, con abordaje cualitativo, desarrollado en una unidad de trasplante de un hospital de referencia en Ceará, entre marzo y junio de 2020, mediante entrevista. Los datos fueron analizados por el software IRAMUTEQ (Interface de R pour les Analyses Multimensionnelles de Textes et de Questionnaires). Posteriormente, se realizó el Análisis Factorial por Correspondencia (AFC) y se generó un Word Cloud para el que se consideraron las evocaciones que aparecían con mayor frecuencia. Resultados: participaron del estudio 14 enfermeras, la mayoría mujeres. El contenido analizado se categorizó en tres clases: Organización del Flujo de Servicios de Casos Sospechosos, Equipo de Protección Personal en el Contexto de la Pandemia de COVID-19, La Emocional Frente a la Pandemia. Conclusión: Se encontró que los enfermeros padecen las debilidades relacionadas con el momento vivido, ya que diariamente se enfrentan al desafío de adaptarse a los cambios en sus rutinas laborales.

Burnout and Resilience Among Transplant Nurses in 22 Hospitals in China.

BACKGROUND: In this study we assessed burnout and resilience levels among transplant nurses to analyze the relationship between these 2 variables, and to address whether demographic factors were associated with burnout. METHODS: A cross-sectional study was conducted using a questionnaire. The sample included transplant nurses at 22 hospitals in China. The questionnaire consisted of 3 sections: demographic characteristics; the Maslach Burnout Inventory (MBI); and the Connor-Davidson Resilience Scale (CD-RISC). All questionnaires were delivered by e-mail. Data were analyzed using Pearson's linear correlation analysis, with regression analysis sone using SPSS (version 21.0). RESULTS: A total of 600 questionnaires were delivered and 536 valid ones were completed and returned. The results showed a high level of emotional exhaustion in 36.8% of the nurses responding, a high level of depersonalization in 31.0%, and low personal accomplishment in 7.6%. The data were found to support a relationship between burnout and resilience in the sample (resilience-emotional exhaustion, r = -0.10; resilience-depersonalization, r = -0.05; resilience-personal accomplishment, r = 0.42). In addition, demographic characteristics, including age, marriage, having children, monthly income, title, position, and exercise, affected the level of burnout. CONCLUSION: Transplant nurses in China experience burnout. Resilience was negatively related to emotional exhaustion and depersonalization, and was positively associated with personal accomplishment. Older age, being married, and having children may increase the risk of burnout. Nurses with a high monthly income, high title or position, and adequate exercise are not likely to experience burnout.

A enfermagem intensivista frente à doação de órgãos: uma revisão integrativa / La enfermería intensiva frente a la donación de órganos: una revisiónintegrativa / Intensive nursing front of organ donation: an integrative review

Objective: To identify the productions that address the role of the intensive care nurse in the context of brain death, identifying their results and conclusions. Methods: It was used the literature integrative review in SciELO database with six stages, namely: problem formulation, data collection, data evaluation, analysis and interpretation of results and synthesis of knowledge. The data of the selected articles were organized into tables for better understanding of them. Results: There were 17 articles on theme, of these, 3 had the inclusion criteria of the study. Conclusion: One can see the relevance of a specific knowledge of health professionals, especially nurses, in donation and transplantation area, and the limited number of publications on the subject by the nurses and the precarious approach to donation and transplantation in the curriculum graduation.

Objetivo: Identificar as produções que abordam o papel do enfermeiro intensivista no contexto da morte encefálica, identificando seus resultados e conclusões. Métodos: Utilizou-se a revisão integrativa da literatura na base de dados Scielo com seis etapas, sendo elas: formulação do problema, coleta de dados, avaliação dos dados, análise e interpretação dos resultados e a síntese do conhecimento. Os dados dos artigos selecionados foram organizados em tabelas para melhor compreensão dos mesmos. Resultados: Foram encontrados 17 artigos sobre tema, destes, 3 apresentavam os critérios de inclusão da pesquisa. Conclusão: Pode-se perceber a relevância de um conhecimento específico dos profissionais da saúde, principalmente os enfermeiros, na área de doação e transplantes, bem como o limitado número de publicações sobre o tema por parte dos enfermeiros e a precária abordagem sobre doação e transplantes nos currículos da graduação.

Objetivo: Identificar las producciones que abordan el papel delenfermero de cuidados intensivos en el contexto de la muerte cerebral, la identificación de sus resultados y conclusiones. Métodos: Se utilizó la revisión integradora literatura en la base de datos SciELO con seis etapas, a saber: formulación del problema, recopilación de datos, evaluación de datos, análisis e interpretación de los resultados y síntesis del conocimiento. Los datos de los artículos seleccionados se organizaron en mesas para una mejor comprensión de las mismas. Resultados: Se encontraron 17 artículos sobre el tema de estos, 3 tenían los criterios de inclusión del estudio. Conclusión: Se puede ver la relevancia de un conocimiento específico de profesionales de la salud, sobre todo enfermeras, en la donación y el trasplante de área y el número limitado de publicaciones sobre el tema de las enfermeras y el enfoque precaria a la donación y el trasplante en los planes de estudios de pregrado.

Fragilidad y estado nutricional en el periodo pre-trasplante. ¿Existe relación? / Frailty and nutritional status in the pre-transplant period. Is there a relationship?

Introducción: La malnutrición en la enfermedad renal crónica (ERC) está asociada al aumento del riesgo de mortalidad y complicaciones. Sin embargo, el estado nutricional de los pacientes con ERC en lista de espera (LE) de trasplante renal (TR), y su relación con el estado de fragilidad ha sido poco evaluado. Objetivo: Analizar el estado nutricional y funcional de una cohorte de pacientes en lista de espera de trasplante renal y su relación con la fragilidad. Pacientes y Método: Estudio retrospectivo de los pacientes incluidos en LE de TR desde Junio 2016 hasta Junio 2017. Se evaluaron a los pacientes mediante distintas escalas de valoración, recogiendo parámetros antropométricos, analíticos y de bioimpedanciometría (BCM). Resultados: De los 177 pacientes incluidos, 55 (31.1%) se definieron como frágiles. Dicho grupo eran de mayor edad (64.2 vs 61.2 años; p=0.08), sexo femenino (56.4% vs 32.8%, p<0.01), IMC mayor (29.3±5.8 vs 27.3±5,6 kg/m²; p=0.03) y más frecuentemente diabéticos (DM2) (43.6% vs 30.3%; p=0.08). La evaluación mediante BCM demostró que los pacientes frágiles tenían menos índice de tejido magro (12.3±2.4 vs 14.1±4 kg/m²; p<0.01) y mayor índice de tejido graso (16.2±6.1 vs 11.8±5.6 kg/m²; p<0.01) que los no frágiles. Conclusión: En nuestra lista de espera de TR, los pacientes frágiles son de mayor edad, sexo femenino, mayor grado de obesidad, DMII y con menor masa muscular. Las estrategias encaminadas a liberalizar dietas, aumentar la ingesta proteica y fomentar el ejercicio físico pueden ser relevantes para mejorar los resultados a corto y largo plazo del TR (AU)

Introduction: Malnutrition in chronic kidney disease (CKD) is associated with increased risk of mortality and complications. However, the nutritional status of patients with CKD on the renal transplant waiting list and their relationship to the frailty status has been poorly evaluated. Aim: To analyze the nutritional and functional status of a cohort of patients on the waiting list for renal transplantation and its relation to frailty. Patients and method: Retrospective study of patients included in waiting list of renal trasplantation from June 2016 to June 2017. Patients were evaluated through different assessment scales, taking anthropometric, analytical and bioimpedancometry (BCM) parameters. Results: Of the 177 patients included, 55 (31.1%) were defined as frailty. This frailty group was older (64.2 vs 61.2 years, p = 0.08), higher number of females (56.4% vs 32.8%, p <0.01), higher BMI (29.3 ± 5.8 vs 27.3 ± 5.6 kg / m², p = 0.03) and more frequently diabetic (DMII) (43.6% vs 30.3%, p = 0.08). The BCM evaluation showed that the frailty patients had a lower index of lean tissue (12.3 ± 2.4 vs 14.1 ± 4 kg / m², p <0.01) and a higher fat index (16.2 ± 6.1 vs 11.8 ± 5.6 kg / m²; <0.01) than non-frailty ones. Conclusions: In our waiting list for renal transplantation, the frailty patients are older, female, more obese, DMII and with lower muscle mass. Strategies to liberalize diets, increase protein intake and promote physical exercise may be relevant to improve the short- and long-term results of the renal transplantation (AU)

Impacto en un programa de trasplante renal de un protocolo de donación tras muerte cardiaca controlada con soporte de ECMO / Impact of a donor protocol on a renal transplant program after controlled cardiac death with ECMO support

Objetivo: Analizar el impacto de un protocolo de donación tras muerte cardiaca controlada con soporte de sistema de oxigenación de membrana extracorpórea (PMCC-ECMO) en el programa de trasplante renal de nuestro centro. Material y Método: Estudio retrospectivo, observacional, descriptivo en una cohorte de injertos renales (IR) procedentes de un PMCC-ECMO. Se evalúan los IR procedentes de 8 pacientes con enfermedad irreversible (EI) en los que se aplica limitación del esfuerzo terapéutico y se consideran como potenciales donantes durante el último semestre del 2014 y el primer trimestre de 2015. Se excluyeron los IR enviados fuera de la comunidad. Se evaluaron indicadores del proceso de donación (IPD) y resultados clínicos de los injertos (RCI). Resultados: IPD: 100% hombres, edad media 60 años, tiempo medio agónico 9,37 minutos; causa EI 62,5% de origen pulmonar, 37,5% de origen neurológico. Se obtuvieron 13 riñones, 3 hígados y 2 pulmones: 2 IR fuera de la comunidad. Los IR provenientes del PMCC-ECMO supusieron un 20% de los IR del 2014 en nuestro centro. RCI: De los 11 IR trasplantados en nuestro centro, sólo 1 no fue viable por trombosis de las venas renales, y otro IR se retrasó la función renal por causas inmunológicas. Valores medios función IR al mes: creatinina sérica 1,88 mg/dl, aclaramiento creatinina 56,82 mL/min, urea 0,798 g/L. Conclusiónes: El PMCC-ECMO ha tenido un alto impacto en el programa de trasplante renal, tanto por incrementar la tasa de donación, como por la alta tasa de viabilidad de los injertos (AU)

Aim: To analyze the impact of a donor protocol after controlled cardiac death with support of extracorporeal membrane oxygenation (PMCC-ECMO) in the renal transplant program of our center. Material and method: Retrospective, observational, descriptive study in a cohort of renal grafts (RG) from PMCC-ECMO. RGs from 8 patients with irreversible disease (IE) in which therapeutic effort limitation is applied are evaluated and considered as potential donors during the last six months of 2014 and the first quarter of 2015. IRs sent out of the community were excluded. Indicators of the donation process (IDP) and clinical results of the grafts (CRG) were evaluated. Results: IDP: 100% men, mean age 60 years, mean agonizing time 9.37 minutes; cause of IE: 62.5% of pulmonary origin, 37.5% of neurological origin. We obtained 13 kidneys, 3 livers and 2 lungs: 2 RG outside the community. RGs from the PMCC-ECMO accounted for 20% of the total in 2014 at our center. CRG: Of the 11 RGs transplanted in our center, only 1 was not viable due to thrombosis of the renal veins, and another RG presented delayed renal function due to immunological causes. Mean values of RG function per month: serum creatinine 1.88 mg / dl, creatinine clearance 56.82 mL / min, urea 0.788 g / L. Conclusions: PMCC-ECMO has had a high impact on the renal transplant program, both for increasing the donation rate and for the high viability rate of the grafts (AU)

Consideraciones ético-jurídicas para el personal de enfermería. Testigos de Jehová: entre el principio de autonomía y el rechazo a los tratamientos / Legal considerations for nurses. The principle of autonomy and the rejection of therapy with blood: Jehovah´s witnesses

Aunque parece que el tema del derecho y la bioética ya se ha debatido extensamente, hoy día aún sigue generando entre el personal de enfermería dudas y conflictos sobre cuál es su regulación, sobre qué relación hay entre el derecho y la bioética, acerca de qué se debe saber sobre el consentimiento informado y el documento de voluntades anticipadas, si pueden los testigos de Jehová rechazar tratamientos, y de cómo estas decisiones influyen en la persona y cómo se relaciona con el principio de autonomía, cuando las decisiones del paciente sobre su salud están amparadas por un marco jurídico que le da mayor libertad y autonomía. Los testigos cristianos de Jehová son una comunidad cristiana descendiente de un grupo de estudiosos, que basan sus creencias en una interpretación particular de la Biblia y que, en España, al igual que otras confesiones, están inscritos en el Registro de Entidades Religiosas de la Dirección General de Asuntos Religiosos del Ministerio de Justicia. Por todo ello, el presente trabajo tiene la intención de analizar, a través de una revisión bibliográfica, los conceptos ético-jurídicos dentro del marco jurídico vigente, y de ver cómo las decisiones tomadas por las personas, incluso aquellas que ponen en riesgo su vida, tienen que aceptarse y protegerse mediante un amparo legal, sin menoscabo de las excepciones fijadas por la ley (AU)

Although it seems that the issue of law and bioethics has been much debated today, still raising doubts and conflicts among the nursing staff on what their regulation must relationship between law and bioethics, or that we should know about informed consent and advance directive, if the Jehovah’s Witnesses can refuse the treatments, and how these decisions affect the person and how it relates to the principle of autonomy, which are covered by a legal framework that gives greater freedom and autonomy to the patient’s decision. The Jehovah’s Witnesses are a Christian community descended from a group of scholars, who base their beliefs on a particular interpretation of the Bible and that, in Spain, like other denominations, are registered in the Registry of Religious Entities of the Directorate General of Religious Affairs of the Ministry of Justice. Therefore, this paper intends to analyze through a literature review the ethical and legal concepts within the existing legal framework, and how the decisions made by people, even still risking their life, must be accepted and protected by a legal remedy, without prejudice to the exceptions provided by law (AU)

Adolescentes em hemodiálise: repercussões do adoecimento e tratamento na saúde mental / Teens in hemodialysis: effects of the illness and treatment in mental health

A pesquisa teve como objetivo analisar as repercussões do adoecimento e tratamento na saúde mental dos adolescentes em hemodiálise.Estudo clínico-qualitativo, realizado em uma clínica de diálise do município de Fortaleza/CE de fevereiro a abril de 2013. Foram utilizados como instrumentos de produção de dados a entrevista semiestruturada e a observação não participante. Participaram da pesquisa oito adolescentes com diagnóstico de insuficiência renal crônica, submetidos ao programa de diálise e selecionados por amostragem intencional. Foi utilizada a análise de conteúdo temática de Bardin. Como resultado das entrevistas, tomando o corpus, emergiram duas categorias: Percepção do adolescente renal crônico em hemodiálise sobre a condição vivenciada: sentimentos e expectativas e Repercussões do tratamento hemodiálitico no estilo de vida e saúde mental dos adolescentes. Os resultados evidenciaram que, para os participantes do estudo, a saúde mental é afetada de forma intensa, pois inclui uma luta constante para superar as transformações ocasionadas pela doença e a necessidade de aprender a lidar com sentimentos que provocam desconforto. Conclui-se que o adoecimento e o tratamento hemodialítico repercutem na saúde mental, mas os efeitos negativos podem ser minimizados com a prestação de um cuidado humanizado e integral.

The research aimed at analyzing the impact of the disease and treatment in the mental health of adolescents on hemodialysis. This is a clinical qualitative study carried out in a dialysis clinic of the city of Fortaleza/Ceará from february to april 2013. Data were used as instruments of production to semistructured interviews and non-participant observation. The participants were eight teenagers diagnosed with chronic renal failure undergoing dialysis selected by intentional sampling. The analysis of thematic content of Bardin was used. As a result of theinterviews, taking the corpus, two categories emerged; 1 -Perception of chronic renal hemodialysis teen about the condition experienced: feelings and expectations and 2 -Impact of hemodialysis on lifestyle and mental health of adolescents. The results show that, among the study participants, mental health is affected intensively because in includes a constant struggle to overcome the changes caused by the disease and the need to learn to deal with feelings that cause discomfort. It is conclude that the illness and particularly the hemodialysis affects the mental health, but it can be minimized by the provision of a humanized and comprehensive care.

Morte encefálica e cuidados na manutenção do potencial doador de órgãos e tecidos para transplante / Brain death and care in maintaining the potential of organ and tissue transplant donors / Muerte encefálica y cuidados en el mantenimiento del potencial donante de órganos y tejidos para transplante

Este trabalho trata-se de estudo exploratório-descritivo com abordagem quantitativa e dados prospectivos que objetivou verificar o conhecimento dos profissionais de enfermagem sobre a Morte Encefálica (ME) e a manutenção do Potencial Doador (PD). A população constou de 55 profissionais de enfermagem. Destes, a maioria eram técnicos em enfermagem (74,5%); 78,2% informaram já ter trabalhado com PDs e 50,9% afirmaram estar preparados para cuidar desses pacientes. Das condições indispensáveis para a abertura do protocolo de ME, 49,1% afirmaram erroneamente a temperatura superior a 36ºC. No manejo dos distúrbios hidroeletrolíticos, 50,9% optaram incorretamente sobre a reposição de sódio, potássio e magnésio. Nos cuidados com córneas, 58,2% optaram erradamente sobre a proteção com gaze. E 52,7% afirmaram corretamente que o PD pode ser reanimado. O conhecimento sobre o diagnóstico de ME e manutenção ao PD era insuficiente entre os pesquisados, necessitando de educação sobre o tema a fim de aumentar a oferta de órgãos/tecidos para transplantes...

This is an exploratory-descriptive study performed using a quantitative approach and prospective data, with the objective to identify the knowledge of nursing professionals regarding brain death (BD) and maintaining the Potential Donor (PD). The study population consisted of 55 nursing professionals, mostly nursing technicians (74.5%); 78.2% reported having worked with PDs and 50.9% stated being prepared to take care of those patients. Among the conditions considered indispensible to open a BD protocol, 49.1% made a wrong statement of body temperature above 36ºC. Regarding the management of hydroelectrolytic disorders, 50.9% made a wrong choice concerning the reposition of sodium, potassium and magnesium. Regarding cornea care, 58.2% made a wrong decision about the protection using gauzes. Furthermore, 52.7% made the correct statement that the PD can be reanimated. It was observed that the subjects had insufficient knowledge regarding the diagnosis of BD and PD maintenance, thus requiring education on the topic in order to increase the offer of organs/tissue for transplants...

Estudio exploratorio, descriptivo, cuantitativo, con datos prospectivos, objetivando verificar el conocimiento de los profesionales de enfermería sobre Muerte Encefálica (ME) y el mantenimiento del Potencial Donante (PD). Población constituida por 55 profesionales de Enfermería. La mayoría (74,5%), técnicos de Enfermería; 72,8% refirió haber trabajado con PDs y 50,9% afirmó estar preparado para cuidar de tales pacientes. De las condiciones indispensables para apertura de protocolo de ME, 49,1% mencionó erróneamente temperatura superior a 36°C. En el manejo de disturbios hidroelectrolíticos, 50,9% optó incorrectamente sobre la reposición de sodio, potasio y magnesio. En el cuidado de córneas, 58,2% sugirió erróneamente sobre protección con gasas. Finalmente, 52,7% afirmó correctamente que el PD puede ser reanimado. El conocimiento sobre diagnóstico de ME y mantenimiento del PD fue insuficiente entre los investigados, necesitando ellos de educación sobre el punto, a efectos de aumentar la oferta de órganos y tejidos para transplantes...

On designing a usable interactive system to support transplant nursing.

Solid organ transplant has been steadily increasing in number both nationally and internationally. Caring for the transplant patients in the hospital setting, right after the patient is moved from the intensive care unit to the ward, is one of the most challenging tasks in nursing. It involves many procedures, rigid protocols, tight monitoring, and intensive data gathering for use by the other coordinating healthcare professionals. The complexity is further increased when a nurse has to take care of several transplant patients in a single shift. Of late, there has been a growth of computer applications in nursing and clinical information systems. Their acceptability and usability determine the ultimate success of computer support for this complex task. In this paper, we present a case study in which we combine two well-known software engineering techniques--namely, agile programming and user centered design--toward the goal of developing an interactive system for supporting the activities of transplant nurses in a hospital setting. This has resulted in a usable end-product and the user centered approach has motivated the nurses to move towards the use of computers in their jobs for better productivity. The product's usability was formally evaluated and is reported herein. The strengths and limitations of this approach are also discussed. The software product developed has been well accepted and is currently being planned to replace the manual methods followed in the transplant ward of a large metropolitan hospital.

Evolución y cuidados del trasplante intestinal en el postoperatorio inmediato / Course and cares of intestinal transplant in immediate post-operative period

Objetivo. Describir la evolución y cuidados del postoperatorio inmediato en pacientes con trasplante intestinal. Material y métodos. Estudio descriptivo prospectivo realizado en la Unidad de Cuidados Intensivos Polivalente de un hospital terciario durante un año. Variables analizadas durante las primeras 48 horas del postoperatorio: constantes vitales, saturación O2, tiempo de destete, diuresis, glucemia, catéteres, drenajes, ileostomía, gastrostomía, TISS, NEMS, cuidados de enfermería, APACHE II y SAPS II al ingreso. Análisis estadístico con SPSS 11.0. Resultados. Cuatro pacientes. Mujeres 50%, edad media 42 ± 8 años. Motivo trasplante intestinal: 75% poliposis adenomatosa familiar con tumor desmoides y 25% obstrucción arteria mesentérica. Recibieron alemtuzumab y tacrólimus. Todos los pacientes eran portadores de catéter venoso central, arterial y drenajes abdominales Jackson Pratt (50% dos, 50% tres). Tiempo intubación (mediana) 15 horas. APACHE II 10 ± 6 y SAPS II 16 ± 4. Medias primer y segundo día de: tensión arterial sistólica/diastólica 132 ± 23/73 ± 11; 130 ± 25/74 ± 13 mmHg; glucemia 136 ± 26/119 ± 25 mg/dl; diuresis 95 ± 34/125 ± 30 cc/hora; TISS28 49 ± 4/38 ± 11 y NEMS 27 ± 0/25 ± 10, respectivamente. Una reintervención por shock hemorrágico. Mediana de estancia en Unidad de Cuidados Intensivos 4 días. Conclusiones. 1) Son pacientes hemodinámicamente estables; con destete corto; no portan muchos catéteres; ileostomía funcionante desde el primer día y con TISS28 y NEMS en la media del rango. 2) Los cuidados más específicos del trasplante intestinal son: herida quirúrgica, drenajes, ileostomía, gastrostomía. 3) La necesidad de intensa inmunosupresión implica aislamiento estricto y una ratio de enfermería:paciente 1:1

Objective. Describe the course and immediate post-operative care in patients with intestinal transplant. Material and methods. Descriptive, prospective study conducted in the Polyvalent Intensive Care Unit of a tertiary hospital for one year. Variables analyzed during the first 48 hours of the post-operative period: vital signs, O2 saturation, weaning time, diuresis, glycemia, catheters, drains, ileostomy, gastrostomy, TISS, NEMS, nursing cares, APACHE II and SAPS II on admission. Statistical analysis with SPSS 11.0. Results. Four patients, 50% women, mean age 42 ± 8 years. Reason for intestinal transplant: 75% familial adenomatous polyposis with desmoid tumor and 25% mesenteric artery obstruction. They were administered alemtuzumab and tacrolimus. All the patients were carrier of central and arterial venous catheters, and Jackson Pratt abdominal drains (50% two, 50% three). Intubation time (median) 15 hours. APACHE II 10 ± 6 y SAPS II 16 ± 4. Means on first and second day of: systolic/diastolic blood pressure 132 ± 23/73 ± 11; 130 ± 25/74 ± 13 mmHg; glycemia 136 ± 26/119 ± 25 mg/dl; diuresis 95 ± 34/125 ± 30 cc/hour; TISS28 49 ± 4/38 ± 11 and NEMS 27 ± 0/25 ± 10, respectively. One re-operation due to hemorrhagic shock. Median study in Intensive Care Unit of 4 days. Conclusions. 1) They are hemodynamically stable patients with short weaning. They do not have many catheters, functioning ileostomy since the first day and TISS28 and NEMS in the middle of the range. 2) The most specific cares of the intestinal transplant are: surgical wound, drains, ileostomy, gastrostomy. 3) The need for intense immunosuppression implies strict isolation and nursing:patient ratio of 1:1

[The experiences of transplantation coordinators' practice].

PURPOSE: The purpose of this phenomenological study was to understand the experiences in the transplantation coordinators' practice. METHOD: Data was collected through a tape-recorded in-depth interview from nine participants who were transplantation coordinators of their hospitals. It was analyzed using the phenomenological method proposed by Colaizzi(1978). RESULTS: From significant statements, six categories of themes were integrated into the essential structure of the experiences of transplantation coordinators. Six categories of themes were 'continue to be professional during dash this way and rush that', 'burden due to persistent heavy work', 'the uniqueness in family care of the brain-dead patients', 'support of family and a professional group', 'worthiness and achievement of the patients' recovery', and 'establishment of self-confidence as a coordinator'. CONCLUSION: Although the transplantation coordinators played various roles, they had a conflict in role identity due to poor working environments. The results of this study suggested that development of an educational program, an increase in understanding for the coordinators' role, and institutional support for better working conditions are needed to get professional acknowledgement for transplantation coordinators.

The Experiences of Transplantation Coordinators' Practice / 간호학회지

PURPOSE: The purpose of this phenomenological study was to understand the experiences in the transplantation coordinators' practice. METHOD: Data was collected through a tape-recorded in-depth interview from nine participants who were transplantation coordinators of their hospitals. It was analyzed using the phenomenological method proposed by Colaizzi(1978). RESULTS: From significant statements, six categories of themes were integrated into the essential structure of the experiences of transplantation coordinators. Six categories of themes were 'continue to be professional during dash this way and rush that', 'burden due to persistent heavy work', 'the uniqueness in family care of the brain-dead patients', 'support of family and a professional group', 'worthiness and achievement of the patients' recovery', and 'establishment of self-confidence as a coordinator'. CONCLUSION: Although the transplantation coordinators played various roles, they had a conflict in role identity due to poor working environments. The results of this study suggested that development of an educational program, an increase in understanding for the coordinators' role, and institutional support for better working conditions are needed to get professional acknowledgement for transplantation coordinators.

¿Cómo perciben las enfermeras de transplantes las causas del estrés laboral? / How do organ transplantes nursing staff preceive the causes of the job stress?

Objetivo: Determinar los estresores laborales percibidos por las enfermeras que trabajan en áreas dedicadas al trasplante de órganos y las fuentes de recompensa profesional. Participantes y métodos: Estudio cualitativo, realizado con seis grupos de discusión (64 participantes en total) de enfermeras, que trabajaban en distintos hospitales del Estado. Las conversaciones fueron grabadas, transcritas y se realizó un análisis del discurso. Resultados: Los principales estresores identificados son los relacionados con la sobrecarga de trabajo, la presión de tiempo, el contacto con la muerte y sufrimiento, la falta de apoyo por parte de los compañeros y otros profesionales sanitarios, los problemas de interrelación con los pacientes y sus familiares. Se evidencia una falta de información adecuada para dar respuesta a las preguntas formuladas por los pacientes y familiares, sobre su estado clínico y pronóstico. Así como la falta de formación específica para prestar los cuidados necesarios al paciente pre y trasplantado. La fuente de recompensa profesional es el agradecimiento, por los cuidados prestados, mostrado por los pacientes y sus familiares. Conclusión: El personal de enfermería hospitalario está sometido a un gran número de estresores en su trabajo, la mayoría intrínsecos a su profesión

Objective: To determine the workplace stress factors perceived by the nurses, both male and female, who work in those areas of the hospital concerned with organ transplants and the sources of professional job satisfaction. Methods: Qualitative study, carried out with six discussion groups (64 participants in all) of male and female nurses, who work in different Spanish state run hospitals. Their conversations were recorded and then transcribed, and an analysis of the discourse was undertaken. Results: The main stress factors which were identified relate to: work overload and the time pressures, contact with death and suffering, a lack of support from colleagues and other health professionals, and the problems of inter-relationship with patients and their relatives. Likewise there is clearly a lack of sufficient information to be able to respond to the questions posed by the patients and family members as to their clinical state and their prognosis. Another stress factor is the lack of specific information relating to the characteristics of necessary care for the patient pre and post transplant. The principal source of professional job satisfaction is the thanks for the care which has been afforded to them, from patients and their families. Conclusion: The hospital nursing staff is subjected to a large number of stress factors in the course of its work, the majority of which are intrinsic to its profession