I-Poems: A Window Into the Personal Experiences of Family Caregivers of People Living With Advanced Cancer.

BACKGROUND: To date, there is little understanding of how caring during advanced cancer can be a transformational experience for personal becoming for family caregivers (FCGs). FCGs experience personal becoming as they create their own meaning of health and illness and choose patterns relating to the self-identity of the past while reaching forward into the unknowns. Gaining greater insight into a potentially positive aspect of cancer caregiving can contribute to family caregiver well-being and quality of life. OBJECTIVE: This paper identifies I-Poems within cancer caregiver narratives and explores them for themes of personal becoming. The narrative environment created space for FCGs to construct and share their voices; at the same time, the analytic method of poetic inquiry provided the voice of the FCGs to be seen, heard, and contextually explored. METHODS: As a secondary analysis, we used five cancer caregiver narrative texts obtained from the primary study to create individual I-Poems. Each of the I-statements within the cancer caregiver narrative texts was lifted and repositioned into a poem format while retaining the chronological order and voice of the participant. We then explored the I-Poems for converging themes of personal becoming as emerged from the primary narrative-thematic analysis. RESULTS: I-Poems were created from each of the five participants caregivers' narratives and then explored for themes of personal becoming. Each of the participant stories is briefly introduced, followed by their I-Poem. We found that the I-Poems converged with emergent themes and provided a first-person representation of their caring journey and transformation of being. DISCUSSION: I-Poems are a postmodern form of poetic inquiry that can be used alongside thematic analysis to explore personal meaning of caring for someone with advanced cancer and how FCGs experience personal transformation of self. While we found I-Poems to be a meaningful and useful form of analysis for some narrative data, we propose an evolved genre of poetic inquiry-We-Poems-to be used in dyadic nursing research and with FCGs who are in partnered relationships.

Themes of Liminality: Stories From Cancer Family Caregiver Narratives.

Cancer family caregivers dwell in an evolving landscape of ambiguity and in-betweenness, as "betwixt and between," in a space of unknowing. This space of unknowing exists within a transformational threshold of liminality, between what was known prior to the cancer and what will be known and embodied in the future. Theoretically grounded in Unitary Caring Science, this study used narrative inquiry alongside photo elicitation to cocreate cancer caregiver narratives and identify themes of liminality. Four thematic threads of liminality were identified as woven within and across the cancer caregiver narratives; stories of paradox, time warp, life disruption, and waiting in silence.

Art Unfolds Words: Expressing Hope Through Creative Art Among Adolescents and Young Adults Who Have Advanced Cancer.

Hope's role in the care of adolescents and young adults (AYAs) who have advanced cancer (AC) is not well understood. This study aimed to conceptualize the essence of hope among AYAs who have AC based on their lived experiences and illustrate hope through verbal and artistic depictions of the AYA's lived experiences. Fifteen AYAs, aged 12 to 21 years, diagnosed with AC completed two semistructured interviews to share their lived experiences of hope perspectives in the form of a descriptive narrative and a creative-art outcome. Participants who chose to draw pictures narrated the conceptual meanings based on elements of each picture. A board-certified art therapist performed a post hoc analysis of the drawings and participants' verbatim descriptions of their meanings. Five of the 15 AYA participants created drawings depicting their lived experiences of hope. The artistic process of mapping their cancer journey revealed distinct views of hope through nature landscapes and metaphors. Participants provided titles for their drawings such as "Over the Rainbow," "Growth in the Valley," and "The Light at the End of the Tunnel." The pictures embodied the AYAs' thoughts, perceptions, and lived experiences related to hope and its role during their cancer journey. Drawing is one simple art form that can facilitate an AYA's expression of well-being (including hope) beyond what may be verbally articulated. Creative art should be further researched as a screening tool to assess how AYAs with AC cope with an uncertain future and psychological and/or existential distress symptoms.

Aesthetic Knowing: Cut-Ups and Haiku Poems.

Enhancing course design and pedagogy to encourage engagement and creativity is fundamental in doctoral education. Using poetry is an innovative way to enrich nursing education through aesthetic knowing. The authors in this paper aim to describe an educational exercise utilizing the Cut-Up Method to create haiku poems. PhD nursing students used the Cut-Up Method to produce haiku poems describing the meaning of nursing science. Themes from the haiku poems include relationship building, caring and caring relationships, and the evolution of nursing. Learning activities promote aesthetic knowing to facilitate engagement, creativity, and collaboration. The Cut-Up Method and haikus are creative ways of developing aesthetic knowing.

The American Academy of Nursing 50th Anniversary of the Nursing Theory Guided Practice Expert Panel (NTGPEP): Exploring the Past-Re-envisioning the Future.

The Nursing Theory-Guided Practice Expert Panel (NTGP-EP), one of the 14 Expert Panels, is officially designated to advance the mission and strategic goals of the American Academy of Nursing. The NTGP-EP has created a forum for dialogue among nurse scholars interested in advancing nursing theory to promote health and wellbecoming. The purpose of this paper is to share the important work of the NTGP-EP and its history, contributions, and accomplishments, and to propose a member-driven agenda to re-envision our preferred future and the impact of the use of nursing theory to guide nursing education, research, practice, and policy.

The Lived Experiences With Hope From Adolescents and Young Adults Who Have Advanced Cancer.

OBJECTIVES: 1. Describe the concept of hope based on perspectives of AYAs who experienced advanced cancer. 2. Differentiate the role hope has for AYAs before, during, and after experiencing cancer. CONTEXT: In clinical care, addressing patients' hopes may stimulate conversations about their goals, concerns, and values; helping clinicians focus on patient-centered interventions to support the patient's psychological, spiritual, and existential needs. METHODS: This descriptive qualitative study used a phenomenology informed approach to depict experiences with hope by AYAs who have advanced cancer. The participants completed two semi-structured audio-recorded virtual interviews and co-created narratives and drawings about the role of hope before, during, and after experiencing cancer. Thematic analyses were performed on the narratives. RESULTS: Fifteen AYAs aged 12-21 years were recruited from an academic medical center and an online non-profit organization. During data collection participants had either completed treatments (60%), or were actively receiving treatments (40%). Approximately 67% of the sample experienced at least one relapse. A main theme identified from the narratives was Transitions of Hope. Participants described differences in their hope before and after experiencing cancer. Participants who experienced a relapse reported their past experiences helped them build hope during their relapse. Participants described a new sense of purpose after experiencing cancer, such as starting a non-profit organization, giving back to others, doing "what I'm passionate about", and honoring the legacies of others. CONCLUSION: Transitions in the role of hope occurred over time, becoming a source of mental sustenance during cancer treatment, and a source of altruism after experiencing cancer. This study adds to the understanding of hope for AYAs who have advanced cancer.

Capacidade funcional e qualidade de vida na doença renal crônica / Functional capacity and quality of life in chronic kidney disease

A doença renal crônica (DRC) é caracterizada por alterações heterogêneas, que afetam tanto a estrutura quanto a função renal, poderá decorrer com redução da capacidade funcional e da qualidade de vida dessa população. OBJETIVO: avaliar a capacidade funcional e qualidade de vida de pacientes com DRC hospitalizados. MATERIAIS E MÉTODOS: Estudo de natureza observacional, quantitativo, descritivo, transversal. Utilizou três questionários: um clínico, o SF36 para a avaliação da qualidade de vida, e o Health Assessment Questionnaire (HAQ), para avaliação da capacidade funcional. Os dados foram analisados através de estatística descritiva, considerando média, desvio padrão e porcentagem. RESULTADOS: A amostra foi composta por 11 pacientes com DRC (63,63% homens). Os piores scores no SF36, em ambos os gêneros, foram relacionados aos aspectos físicos (0) e emocionais (0). O HAQ evidenciou maior déficit funcional no sexo feminino (1,80). Em relação à idade, em todas as faixas etárias o SF-36 apontou "aspectos físicos" (0) e "emocionais" (0) com piores índices. O HAQ encontrou pior escore na faixa de 30-59 anos e nos indivíduos com mais de três doenças associadas, Doença Renal Crônica, Hipertensão Arterial e Diabetes (deficiência moderada 1,09/1,70, respectivamente). Também foram encontrados nesses indivíduos piores scores no SF36 para os domínios de "capacidade funcional" (66,20), "estado geral" (56,50), "vitalidade" (55,00) e "aspectos sociais" (43,50). CONCLUSÃO: Os indivíduos analisados com DRC apresentaram baixos escores relacionados à qualidade de vida, e capacidade funcional moderada nas mulheres e leve nos homens.

Chronic kidney disease (CKD) is characterized by heterogeneous changes, which affect both the structure and the renal function, may result in a reduction in the functional capacity and quality of life of this population. OBJECTIVE: To evaluate the functional capacity and quality of life of patients with CKD hospitalized. MATERIALS AND METHODS: Observational, quantitative, descriptive, cross-sectional study. It used three questionnaires: a clinical one, the SF36 for assessing quality of life, and the Health Assessment Questionnaire (HAQ), for assessing functional capacity. Data were analyzed using descriptive statistics, considering mean, standard deviation and percentage. RESULTS: The sample consisted of 11 patients with CKD (63.63% men). The worst scores in SF36, in both genders, were related to the physical (0) and emotional (0) aspects. The HAQ showed a greater functional deficit in females (1.80). Regarding age, in all age groups, the SF-36 pointed to "physical aspects" (0) and "emotional" (0) with the worst indexes. The HAQ found the worst score in the 30-59 age group and in individuals with more than three associated diseases, Chronic Kidney Disease, Arterial Hypertension and Diabetes and (moderate deficiency 1.09 / 1.70 respectively). These individuals also found worse scores in the SF36 for the domains of "functional capacity" (66.20), "general state" (56.50), "vitality" (55.00) and "social aspects" (43.50). CONCLUSION: The individuals analyzed with CKD had low scores related to quality of life, and moderate functional capacity in women and mild in men.

El Signo De Halo Invertido En Tomografía Computada De Tórax / The Inverted Halo Sign in Thoracic Computed Tomography

El signo del halo invertido se caracteriza por una opacidad central de vidrio esmerilado rodeado por una consolidación del espacio aéreo más densa en forma de una media luna o un anillo. El signo del halo invertido se ha informado en asociación con un am­ plia gama de enfermedades pulmonares, incluidas las infecciones fúngicas pulmonares invasivas, neumonía por pneumocystis, tuberculosis, neumonía adquirida en la comuni­ dad, granulomatosis linfomatoide, granulomatosis de Wegener, neumonía lipoidea y sarcoidosis. También se observa en neoplasmas pulmonares e infarto y después de ra­ dioterapia y ablación por radiofrecuencia de neoplasias malignas pulmonares. También es conocido como signo de halo en reversa o signo del atolón.

The reversed halo sign is characterized by a central ground­glass opacity surrounded by denser air­space consolidation in the shape of a crescent or a ring. The reversed halo sign has been reported in association with a wide range of pulmonary diseases, in­ cluding invasive pulmonary fungal infections, pneumocystis pneumonia, tuberculosis, community­acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomato­ sis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and in­ farction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. It is also known as a reverse halo sign or atoll sign

Práticas de cuidado com a saúde sexual de jovens universitárias / Sexual health care practices of university Young people / Prácticas de cuidado con la salud sexual de jóvenes universitarios

Objetivo: Analisar as práticas de cuidado com a saúde sexual de estudantes universitárias e a vulnerabilidade às infecções sexualmente transmissíveis e agravos de saúde. Método: trata-se de estudo descritivo, quantitativo, realizado com uma amostra de 123 universitárias do Rio de Janeiro. Aplicou-se um questionário e os dados foram organizados em planilha do software Excel. Os achados foram analisados com aplicação da estatística descritiva. Resultados: as jovens iniciaram a vida sexual entre 16 e 18 anos; praticavam sempre sexo seguro, apenas 5,6% já usou preservativo feminino; tinham parceiros fixos; faziam uso de preservativo com esses parceiros e fizeram o exame ginecológico recentemente. Conclusão: no grupo investigado existe um quantitativo expressivo de jovens assumindo um comportamento de risco. Os profissionais de saúde e a enfermagem tem um importante papel na educação em saúde dos jovens, com estímulo para o autocuidado e cuidado com a saúde sexual e reprodutiva

Objective: To analyze the sexual health care practices of university students and the vulnerability to sexually transmitted infections and health problems. Method: this is a descriptive, quantitative study carried out with a sample of 123 university students from Rio de Janeiro. A questionnaire was applied, and the data was organized in Excel spreadsheet. The findings were analyzed using descriptive statistics. Results: Young women started their sexual life between 16 and 18 years of age; always practiced safe sex, only 5.6% already used a female condom; they had fixed partners; used condoms with these partners and had recently undergone a gynecological examination. Conclusion: in the investigated group there is an expressive quantitative of young people assuming a risk behavior. Health professionals and nursing have an important role in health education for young people, with a stimulus for self-care and care for sexual and reproductive health

Objetivo: Analizar las prácticas de cuidado con la salud sexual de los estudiantes universitarios y la vulnerabilidad a las infecciones de transmisión sexual y agravios de salud. Método: se trata de un estudio descriptivo, cuantitativo, realizado con una muestra de 123 universitarias de Río de Janeiro. Se aplicó un cuestionario y los datos se organizaron en la hoja de cálculo del software de Excel. Los hallazgos fueron analizados con aplicación de la estadística descriptiva. Resultados: Las jóvenes iniciaron la vida sexual entre 16 y 18 años; siempre practicaban sexo seguro, sólo el 5,6% ya usó preservativo femenino; tenían socios fijos; y que el uso de condones con estos socios y el examen ginecológico recientemente. Conclusión: en el grupo investigado existe un cuantitativo expresivo de jóvenes asumiendo un comportamiento de riesgo. Los profesionales de salud y la enfermería tienen un importante papel en la educación en salud de los jóvenes, con estímulo para el autocuidado y cuidado con la salud sexual y reproductiva

Applying two minds theory to self-management of Type 1 diabetes.

Two minds theory (TMT) offers a new approach to changing health behavior. Here, TMT is applied to self-management of Type 1 diabetes. TMT can be conceptualized as a cycle where a stimulus produces an immediate Intuitive system response leading to health behavior, followed by a conscious narrative system response that is temporally delayed. Narrative responses do not produce behaviors directly but instead lead to conscious beliefs about past events and behavioral intentions for the future, both of which become part of the material considered by the intuitive system in selecting future behaviors. Because of the temporal delay between intuitive behavior and narrative interpretation, and the nonconscious nature of intuitive thought, there is often a gap between intentions and behaviors. This has implications for nursing practice. First, nurses should consider that patient-reported impressions of the past or future are fundamentally narrative system responses and understand that these may be less predictive of behavior than biopsychosocial measures that are more temporally immediate. Second, nurses can use TMT to inform new strategies for behavior change interventions. For diabetes self-management, nurses can encourage individuals to leverage environmental cues to prompt self-management (tricking the intuitive system), provide rewards for self-management (training the intuitive system), or engage the narrative system via planning, reframing, or attention practices for healthier future decisions. Overall, the TMT addresses the gap between intentions and behavior and should be further developed to inform behavioral health interventions.

'Waking up' to the symbolic: a psychoanalytic investigation into the effects of a music workshop for children with Pervasive Developmental Disorders (PDDs) / "acordar" para o simbólico: uma investigação psicanalítica sobre os efeitos de um ateliê musical para crianças com transtornos globais do desenvolvimento (tgd)

RESUMO: A pesquisa Os efeitos do ritmo como função de estruturação psíquica em crianças com TGD se propôs a acompanhar os efeitos de um ateliê musical sobre um grupo de crianças com Transtornos Globais do Desenvolvimento (TGD). Trabalhamos com a hipótese de que a atenção a propriedades musicais pode favorecer o desenvolvimento da linguagem e enlaçamento social nesses casos. A partir de recortes clínicos construídos à luz do método psicanalítico, o artigo discute de que maneira a música atrelada à psicanálise pode favorecer o surgimento do sujeito desejante.

Abstract: The research Rhythm effects as psychic structuring function in children with PDD aimed to follow the effects of a musical atelier on a group of children with Pervasive Developmental Disorders - PPD. We worked with the hypotheses that the attention to musical proprieties can favor language development and social binding in these cases. Starting from clinical clippings built through the psychoanalytic method, this article discusses in which way the music associated to psychoanalysis can favor the emergence of the desiring subject.

Da vibração ao encontro com o outro: psicanálise, música e autismo / From vibration to meeting with other: phychoanalysis, music and autism / De la vibración al encuentro con el otro: psicoanálisis, música y autismo

O estudo, partindo do princípio de que o ritmo permeia a estruturação psíquica, investigou os efeitos de um ateliê musical como formador de laço entre crianças autistas e seus semelhantes. O ateliê, com encontros semanais, era formado por crianças de dois a quatro anos. Foram interventores: psicólogas, psicanalistas, uma professora de música, uma fonoaudióloga e estudantes de psicologia da Universidade Ceuma. Os resultados foram descritos por meio de um estudo de caso, discutido sob o referencial da psicanálise. Conclui-se que a linguagem musical pode auxiliar no estabelecimento de vínculos, sendo esta linguagem não ameaçadora e intrusiva.

The study investigated the effects of a musical atelier as in instrument to create bond between autistic children with pairs. It was assumed that rhythm permeates psychic structuring. The atelier, which happened once a week, was composed by children aged two to four. The interventors were: one speech therapist, psychologists and students of the Psychology at Ceuma University. The results were described through a case study, done with a three year old child and discussed under the theoretical reference of psychoanalysis. It concluded that the musical language can help in the establishment of bond with autistic children, since this language is not threatening and intrusive.

El estudio investigó los efectos de un taller musical como formador de lazos entre los niños autistas y sus semejantes. Se supone que el ritmo impregna la estructura psíquica. Formaran parte del taller, con reuniones semanales, niños de dos a cuatro años. Los interventores fueron: psicólogos, psicoanalistas, un profesor de música, un terapeuta del habla y estudiantes de psicología de la Universidad Ceuma. Los resultados fueron presentados en un estudio de caso analizado desde la teoria psicoanálitica. Llegamos a la conclusión de que el lenguaje musical puede ayudar a formar una unión que no sea amenazadora y intrusiva.

The Colorado Collaborative for Nursing Research: Providing Trended Nurse-Sensitive Patient Outcome Data Across Entities.

Nurse leaders lack timely access to trended electronic health record (EHR) data to drive decision making. Robust nurse-sensitive patient outcome data are difficult to locate in EHRs and largely absent across entities. The Colorado Collaborative for Nursing Research is currently testing a federated data system to get nurse leaders the information they need, when they need it.

Use of Electronic Health Records by Nurses for Symptom Management in Inpatient Settings: A Systematic Review.

Symptom management is one of the essential functions of nurses in inpatient settings; yet, little is understood about the manner in which nurses use electronic health records for symptom documentation. Therefore, the purpose of this systematic review is to characterize nurses' use of electronic health records for documentation of symptom assessment and management in inpatient settings, to inform design studies that better support electronic health records for patient symptom management by nurses. We searched the Ovid Medline (1946-current), Cumulative Index to Nursing and Allied Health Literature (EBSCO, 1981-current), and Excerpta Medica Database (Embase.com, 1974-current) databases from inception through May 2015 using multiple subject headings and "free text" key words, representing the concepts of electronic medical records, symptom documentation, and inpatient setting. One thousand nine hundred eighty-two articles were returned from the search. Eighteen publications from the years 2003 to 2014 were included after abstract and full text review. Studies heavily focused on a pain as symptom. Nurses face challenges when using electronic health records that can threaten quality and safety of care. Clinical, design, and administrative recommendations were identified to overcome the challenges of nurses' electronic health record use. A call for interdisciplinary, comprehensive, systematic interventions and user-centered design of information systems is needed.

Neurobehavioral effects of vigabatrin and its ability to induce DNA damage in brain cells after acute treatment in rats.

RATIONALE: Vigabatrin (VGB) is a drug indicated mostly for the treatment of spasms in childhood and West's syndrome patients. This drug inhibits irreversibly the enzyme GABA-transaminase (GABA-T), increasing GABA concentrations and enhancing GABAergic neurotransmission in the brain, which is known to induce behavioral changes. OBJECTIVES: The aims of this study were to evaluate the effects of VGB in the short-term memory (STM), long-term memory (LTM), motivation, locomotion, and exploratory behavior tests and to detect deleterious or protective effects on DNA in target tissues of the drug. METHODS: Male Wistar rats were treated with a single dose of VGB (100, 250, or 500 mg/kg) or saline solution before the inhibitory avoidance and open-field tasks. DNA damage was evaluated using the alkaline comet assay in peripheral blood, cerebral cortex, and hippocampus after behavioral testing. RESULTS: There was no significant difference in the inhibitory avoidance task between the treated groups and the saline group. In all tested doses, VGB reduced the number of rearings in the open-field task. Besides, VGB 500 mg/kg affected locomotion, though it was not able to induce any DNA damage. CONCLUSIONS: VGB did not affect STM and LTM, but the drug impaired the exploration and locomotion likely associated with its sedative effect. In addition, no DNA damage in cortex and hippocampus was detected after behavioral testing, when brain GABA levels are already increased.

Capturing the Central Line Bundle Infection Prevention Interventions: Comparison of Reflective and Composite Modeling Methods.

BACKGROUND: The central line (CL) bundle interventions are important for preventing central line-associated bloodstream infections (CLABSIs), but a modeling method for testing the CL bundle interventions within a health systems framework is lacking. OBJECTIVES: Guided by the Quality Health Outcomes Model (QHOM), this study tested the CL bundle interventions in reflective and composite, latent, variable measurement models to assess the impact of the modeling approaches on an investigation of the relationships between adherence to the CL bundle interventions, organizational context, and CLABSIs. METHODS: A secondary data analysis study was conducted using data from 614 U.S. hospitals that participated in the Prevention of Nosocomial Infection and Cost-Effectiveness Refined study. The sample was randomly split into exploration and validation subsets. RESULTS: The two CL bundle modeling approaches resulted in adequate fitting structural models (RMSEA = .04; CFI = .94) and supported similar relationships within the QHOM. Adherence to the CL bundle had a direct effect on organizational context (reflective = .23; composite = .20; p = .01) and CLABSIs (reflective = -.28; composite = -.25; p = .01). The relationship between context and CLABSIs was not significant. Both modeling methods resulted in partial support of the QHOM. DISCUSSION: There were little statistical, but large, conceptual differences between the reflective and composite modeling approaches. The empirical impact of the modeling approaches was inconclusive, for both models resulted in a good fit to the data. Lessons learned are presented. The comparison of modeling approaches is recommended when initially modeling variables that have never been modeled or with directional ambiguity to increase transparency and bring confidence to study findings.

Evaluation of Toxicological Effects of an Aqueous Extract of Shells from the Pecan Nut Carya illinoinensis (Wangenh.) K. Koch and the Possible Association with Its Inorganic Constituents and Major Phenolic Compounds.

Background. Industrial processing of the pecan nut Carya illinoinensis K. Koch generated a large amount of shells, which have been used to prepare nutritional supplements and medicinal products; however, the safe use of shells requires assessment. This study evaluated the toxic, genotoxic, and mutagenic effects of pecan shell aqueous extract (PSAE) and the possible contribution of phenolic compounds, ellagic and gallic acids, and inorganic elements present in PSAE to induce toxicity. Results. Levels of inorganic elements like K, P, Cl, and Rb quantified using the Particle-Induced X-Ray Emission method were higher in PSAE than in pecan shells, while Mg and Mn levels were higher in shells. Mice showed neurobehavioral toxicity when given high PSAE doses (200-2,000 mg kg(-1)). The LD50 was 1,166.3 mg kg(-1). However, PSAE (50-200 mg·kg(-1)) and the phenolic compounds (10-100 mg·kg(-1)) did not induce DNA damage or mutagenicity evaluated using the comet assay and micronucleus test. Treatment with ellagic acid (10-100 mg·kg(-1)) decreased triglyceride and glucose levels, while treatments with PSAE and gallic acid had no effect. Conclusion. Pecan shell toxicity might be associated with high concentrations of inorganic elements such as Mn, Al, Cu, and Fe acting on the central nervous system, besides phytochemical components, suggesting that the definition of the safe dose should take into account the consumption of micronutrients.

Saberes e práticas de biossegurança entre tatuadores: uma contribuição do enfermeiro / Biosecurity knowledge and practices among tattooists: the nurse's contribution / Conocimientos y prácticas de bioseguridad entre tatuadores: una contribución del enfermero

Introdução: o objeto de estudo trata dos conhecimentos de tatuadores acerca das medidas de proteção, na manipulação de material biológico necessárias à prática de tatuagem. Objetivos: descrever os conhecimentos do tatuador acerca da biossegurança voltada para o procedimento característico de sua profissão e analisar a aplicabilidade desses conhecimentos para a manutenção da integridade do cliente. Método: estudo descritivo, qualitativo com 10 tatuadores de dois estúdios do Rio de Janeiro. Foi utilizada entrevista semiestruturada e observação direta do procedimento, de março a maio de 2016, com aplicação da análise de conteúdo aos depoimentos. Resultados: os cuidados se restringem ao descarte e não reutilização dos perfuro cortantes; há enfoque artístico em detrimento de princípios de biossegurança. Conclusão: aponta nova área de atuação para o enfermeiro, sendo necessária padronização do processo de trabalho.

Introduction: the study object is tattooists' knowledge of the protective measures necessary to the practice of tattooing, when handling biological material. Objectives: to describe tattoo artists' knowledge of biosafety directed to the procedure characteristic of their profession and analyze the applicability of this knowledge to maintaining client health. Method: this qualitative, descriptive study of 10 tattooists from two studios in Rio de Janeiro used semi-structured interviews and direct observation of the procedure, from March to May 2016, then applying content analysis to the declarations. Results: care was restricted to disposal and non-reuse of sharps; the approach is artistic to the detriment of biosafety principles. Conclusion: this points to a new area of work for nurses, where standardization of work processes is needed.

Introdución: el objeto de estudio trata de los conocimientos de tatuadores sobre las medidas de protección en el manejo de material biológico, necesarias para la práctica del tatuaje. Objetivos: describir los conocimientos que tiene el tatuador sobre bioseguridad con vistas al procedimiento característico de su profesión y analizar la aplicabilidad de estos conocimientos en cuanto a mantener la integridad del cliente. Método: estudio descriptivo, cualitativo junto a 10 tatuadores de dos estudios en Río de Janeiro. Se utilizaron entrevistas semiestructuradas y la observación directa del procedimiento, de marzo a mayo de 2016, con aplicación del análisis de contenido para el testimonio. Resultados: los cuidados se resumen al desecho y no reutilización de los cortopunzantes; el enfoque artístico se sobrepone a los principios de bioseguridad. Conclusión: se apunta a un nuevo campo de trabajo para los enfermeros, lo que requiere la estandarización del proceso de trabajo.

Testing the Quality Health Outcomes Model Applied to Infection Prevention in Hospitals.

OBJECTIVE: To test the Quality Health Outcomes Model to investigate the relationship between health care-associated infection (HAI) prevention interventions, organizational context, and HAI outcomes using structural equation modeling. METHODS: Variables for adherence to the central line bundle, organizational context, and central line-associated bloodstream infections (CLABSIs) were selected for this secondary data analysis from 614 US hospitals that participated in the Prevention of Nosocomial Infection and Cost-effectiveness-Refined study. One half of the dataset was used for exploration of the concepts, the second half for confirmation of the measurement models and testing of the structural model. RESULTS: The final model resulted in a good fit to the data (χ (1215) = 1906.86, P < .00; comparative fit index = 0.94; root mean square of error of approximation = 0.04). A significant relationship was noted between adherence to the central line bundle interventions and organizational context (ß = 0.23, P < .01), whereas the relationship between context and CLABSIs was not significant (ß = -0.20, P = .78). CONCLUSIONS: This study supports a relationship between greater adherence to HAI interventions and higher levels of organizational context and highlights the complexity of measuring organizational context. Given the importance of preventing HAIs, ongoing research is needed to reveal the exact aspects of context that influence interventions and outcomes.