Anxiety and Stress Levels on Liver Transplantation Candidates.

The objective of the present study was to determine the anxiety and stress levels of liver transplant candidates during the preoperative period. A cross-sectional, prospective study was conducted on 52 liver transplantation candidates seen at a specialized public hospital outpatient clinic in the interior of the state of São Paulo, Brazil. Data were collected from November 2014 to April 2015 using a self-applicable questionnaire for the assessment of anxiety (State-Trait Anxiety Inventory, short version) and stress (Perceived Stress Scale), in addition to sociodemographic and clinic characterization. The mean (±SD) anxiety level detected was 23.06 ± 5.51 points, with 1.92% of the subjects showing minimum levels (0 to 12 points), 59.62% a medium level (12 to 24 points), 36.54% a moderate level (24 to 36 points), and 1.92% a severe level (36 to 48 points) of anxiety. The mean level on the stress scale was 12.10 ± 5.62 points, with 7.69% of the subjects showing high stress levels. When individuals with good and poor stress levels were compared, a significant difference was observed between them (P = .0004). The Spearman correlation test showed that the higher the stress, the higher the levels of anxiety (r = 0.4258), P < .0001. The present study contributes to the analysis of the mental health of liver transplantation candidates in view of the need for interventions for the improvement of anxiety and stress levels since the waiting period for the organ generates emotional changes that can affect the quality of life of the patient and the success of this complex therapeutic modality.

Sleep Quality Assessment and Daytime Sleepiness of Liver Transplantation Candidates.

OBJECTIVE: The goal of this study was to evaluate the sleep quality and daytime sleepiness of patients eligible for liver transplants. METHODS: A cross-sectional prospective study was conducted on liver transplant candidates from a transplant center in the interior of São Paulo State. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires were applied to obtain demographic and clinical characteristics and to assess sleep quality and daytime sleepiness. RESULTS: The mean (±SD) score on the Epworth Sleepiness Scale of the 45 liver transplantation candidates was 7.00 ± 2.83 points, with 28.89% having scores >10 points, indicating excessive daytime sleepiness. The mean score on the Pittsburgh Sleep Quality Index was 6.64 ± 4.95 points, with 60% of the subjects showing impaired sleep quality, with scores >5 points. The average sleep duration was 07:16 h. Regarding sleep quality self-classification, 31.11% reported poor or very poor quality. It is noteworthy that 73.33% of patients had to go to the bathroom, 53.33% woke up in the middle of the night, and 40.00% reported pain related to sleeping difficulties. Comparison of subjects with good and poor sleep quality revealed a significant difference in time to sleep (P = .0002), sleep hours (P = .0003), and sleep quality self-classification (P = .000072). CONCLUSION: Liver transplant candidates have a compromised quality of sleep and excessive daytime sleepiness. In clinical practice, we recommend the evaluation and implementation of interventions aimed at improving the sleep and wakefulness cycle, contributing to a better quality of life.

Relevance of anxiety and stress levels on sleep quality after liver transplantation.

The goal of this study was to assess the effects of anxiety and stress on sleep quality in liver transplantation recipients. A prospective cross-sectional study was performed including 45 recipients enrolled at a liver transplantation program at Ribeirão Preto, State of São Paulo, Brazil. Anxiety and stress were evaluated by using a reduced version of the State-Trait Anxiety Inventory and the Perceived Stress Scale, respectively. Sleep quality and excessive daytime sleepiness were evaluated by using the Brazilian Portuguese versions of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Thirty-two (71.11%) recipients presented with compromised sleep quality and 5 (11.11%) presented with excessive daytime sleepiness. Recipients with bad sleep quality had anxiety (mean, 26.91 points) and stress (mean, 17.88 points) levels that were higher than the levels of patients with normal sleep quality patterns, with anxiety levels presenting with statistically significant differences (P = .0420). Patients with above-average stress levels also had increased anxiety (mean, 28 points) and compromised sleep quality (mean, 7.03 points). In conclusion, a liver transplantation recipient who experiences bad sleep quality also has higher levels of anxiety and stress, suggesting a relationship between the sleep-wakefulness cycle and anxiety/stress. Planning strategies aimed at reducing such emotional shifts among recipients is of paramount importance. Therefore, new strategies focusing on improving the sleep pattern of patients are necessary because unhealthy sleep behavior may impair postoperative recovery.

Organ donation: acceptance and refusal among users of the public health system from Brazil.

The present study sought to identify the perception of a given group of users of the Brazilian Public Health System (Sistema Unico de Saúde) regarding organ donation and to implement an educational policy. Structured interviews were conducted with the aim of describing the profile of donor and nondonor subjects, the importance of organ donation, and the knowledge regarding donation and brain death. One hundred subjects were interviewed: 33% of them considered themselves potential donors; 40% were donors; 13% were nondonors; and 14% were ill-informed potential donors. However, only 40% of users have already officially expressed to their families a willingness to donate. Regarding their knowledge about the propitious moment for organ donation, only 64% of them associated the donation act with brain death. Although the present results revealed that users of the Brazilian Public Health System are prone to organ donation, there actually was a high amount of refusals, which may be due to lack of information and knowledge regarding the donation-transplantation process.

[Communication with the patient. A question of quality]. / Comunicación con el paciente. Una cuestión de calidad.

Interpersonal communication as a means to promote health and well-being is presented as a strategical orientation in the nursing care process. Meanwhile, in our medium, we have observed the development of communication from a perspective much more related to complying with a service. This article has these objectives: a) to investigate this theme by highlighting analytical instruments of interaction found in bibliographical references, b) to disclose the results of research about nurse-patient communication indicators, in the context as a forum for reflection, bearing in mind the quality of treatment. The authors highlight the need to assume a responsibility shared by teaching nurses and assistants, with the goal to constantly seek to develop communicative competence and thus to contribute to a greater efficiency and an improvement in the quality of nursing care.

[Analysis of expectations on the nurse's leadership in the light of Grid's theories]. / Análise de expectativas sobre a liderança do enfermeiro à luz das teorias Grid.

Based on the understanding that leadership is a fundamental resource for nurses in health institutions, the aim of the authors was to analyze, under the light of Blake & Mouton's Grid Theories, the expectations of the Nursing team regarding nurse's leadership. The analysis was based on four investigations performed in different contexts of Brazilian Nursing and data were collected through the application of the "Grid & Leadership in Nursing Instrument" developed by Trevizan. Results show that the subjects prefer the Grid style 9.9. The authors discuss the results and emphasize the need for the development of leadership in Nursing.

[Perioperative nursing: identification of the nursing diagnosis of risk for infection based on the Levine's conceptual model]. / Enfermagem perioperatória: identificação do diagnóstico de enfermagem risco para infecção fundamentada no modelo conceitual de Levine.

The pre-operative visit consists in the first phase in the systematization of perioperative nursing care. This study aimed at identifying, during the pre-operative visit and more frequently, a nursing diagnosis of clients submitted to general surgery. The selected theoretical framework was Levine's conceptual model based on the four conservation principles, which are: energy conservation, structural integrity conservation, personal integrity conservation and social integrity conservation. In order to reach the proposed objective, an instrument was previously elaborated and validated for data collection. The sample consisted of 30 patients, males and females, who had been submitted to general surgery. The nursing diagnosis Infection Risk obtained 100% of frequency during the pre-operative visits to surgery patients. As to related factors that were identified, we point out: the site of invasion by organisms after the surgery and invasive procedures. Thus, the identification of this diagnosis can help nurses with the planning and implementation of preventive and infection control care, especially if risk factors are identified in the preoperative period.

[Emergency unit nurse of private hospitals: several considerations]. / O enfermeiro de unidade de emergência de hospital privado: algumas considerações.

The qualifications of the professionals who work in emergency care units in Brazil became a relevant aspect since the 80s; therefore, the scarcity of nursing studies in the national literature on this theme determines the need of further investigations. This study aimed at presenting the activities performed by the emergency care unit nurse of a private hospital and making considerations on the leadership as a strategy to improve the management of the nursing care delivered to the patient/client. In view of the experienced reality, authors pointed out the importance of these professionals to rethink about their professional practice and of leadership as a way to implement the required changes.

Controlled hydrolysis of cheese whey proteins using trypsin and alpha-chymotrypsin.

This study examined the production of protein hydrolysates with controlled composition from cheese whey proteins. Cheese whey was characterized and several hydrolysis experiments were made using whey proteins and purified beta-lactoglobulin, as substrates, and trypsin and alpha-chymotrypsin, as catalysts, at two temperatures and several enzyme concentrations. Maximum degrees of hydrolysis obtained experimentally were compared to the theoretical values and peptide compositions were calculated. For trypsin, 100% of yield was achieved; for alpha-chymotrypsin, hydrolysis seemed to be dependent on the oligopeptide size. The results showed that the two proteases could hydrolyze beta-lactoglobulin. Trypsin and alpha-chymotrypsin were stable at 40 degrees C, but a sharp decrease in the protease activity was observed at 55 degrees C.

[Health care reform and changes in nursing practice in philanthropic hospitals in Ribeirão Preto (SP), Brazil]. / A reforma do setor da saúde e as transformações da prática da enfermagem em hospitais filantrópicos no Município de Ribeirão Preto (SP), Brasil.

This paper describes part of a multicenter study sponsored by the Pan American Health Organization to assess health care reforms and their implications for nursing in several countries. The objective of this research was to learn the views of nurses working in philanthropic hospitals in Ribeirão Preto, in the state of São Paulo, Brazil, regarding the changes in nursing practice coming from Brazil's health care reform and implementation of the Unified Health System (UHS). Data were obtained through structured interviews with seven nurses who met the selection criteria, from the three philanthropic hospitals in Ribeirão Preto. The nurses reported a decline in the quality of care and in the number of beds for UHS patients. The nurses reported that UHS implementation initially led to infrastructure improvements in the philanthropic hospitals. However, the reforms eventually shifted toward improving the care of private and privately insured patients. In addition, the nurses emphasized their heavy work loads and low pay. The nurses' reports indicated that Brazil's UHS is going through a crisis. In general, the nurses linked this crisis to problems in funding and allocation of resources.

[Analysis of proxemic factors in the communication with laryngectomized patients]. / Análise dos fatores proxêmicos na comunicação com o paciente laringectomizado.

The present study analyzed the proxemic factors of interactions between health professionals and laryngotomized patients in mediate post-surgery. We used the non-participant observation technique with pre-established guidelines. Data were analyzed according to Hall's theoretical framework. The speakers' sex or color did not influence the distance maintained in the interactions; the nursing technical care category was predominant; the attitude adopted was compatible with the meeting goals; instrumental touch with visual contact was predominant, voice tone was adequate to the distances maintained and the authors observed the presence of obstacles in some interactions, which demonstrated that communication was impaired.

[Leadership and communication: essential strategies for the management of nursing care in the hospital context]. / Liderança e comunicação: estratégias essenciais para o gerenciamento da assistência de enfermagem no contexto hospitalar.

Leadership and communication are strategies that enable nurses to improve the management of nursing care within the hospital context. The present study aimed at reporting a Continuing Education Program developed by nurses from a private hospital on leadership and communication and to present the application of situational leadership in their professional practice. The technique of critical incidents was applied in data collection. The subjects evaluated positively the contributions of the Program and authors found the viability of the application of situational leadership in nursing daily practice.

[Leadership and communication: opinion of nurses in charge of nursing services at a public hospital]. / Liderança e comunicação: opinião dos enfermeiros responsáveis pelos serviços de enfermagem de um hospital governamental.

In the actual nursing scenery, we believe that leadership and communication are the essential strategies for nurse's professional practice. The present study aimed at identifying the opinion of nurses responsible for the nursing services of a government hospital about the theme of leadership and communication. Data were obtained in february and march of 1999 through structured interviews with twelve nurses. Findings showed that the opinions are mostly the same as the concepts found in the literature on the theme. The study had the purpose to give elements for other investigations as we believe in the need of investments for the improvement of the formation of nurses leaders for the future.

[Leadership and communication: development of a measurement tool for graduating nursing students]. / Liderança e comunicação: construção de instrumento de medida para alunos de graduação em enfermagem.

Leadership and communication are themes of importance for the development of Nurse's work so that the upbringing of this professional needs to begin in the undergraduate course and continue through professional life. The present study aimed to identify the knowledge of students of the 4th year of the Nursing School of a public University about leadership na communication. In order to achieve this goal, the authors elaborated an instrument and submitted it to apparent and content validation, pilot test and statistic treatment. Data was collected through the application of the instrument to 67 students in October of 1998. The analysis of the results indicated that the students showed knowledge about leadership and communication, although they did not affirm that what they had learned it in the Undergraduate Course about it was enough.

[Invasion of the personal space of hospitalized patients: adaptation of an instrument of measurement in Brazilian culture]. / Invasão do território e espaço pessoal do paciente hospitalizado: adaptação de instrumento de medida para a cultura Brasileira.

The invasion of patient's territorial and personal space and its effects have been object of several international studies. In view of its importance and searching for an instrument of measure to develop research in this area, the present study aimed at adapting the instrument "anxiety due to territory and space instrucsion questionnaire" to the brazilian culture. Authors fully described the phases of this process and utilized the software SPSS for the psychometric analysis.

[Situational leadership: structures of reference for the work of head nurses in a hospital context]. / Liderança situacional: estrutura de referência para o trabalho do enfermeiro-líder no contexto hospitalar.

Authors studying the theme of leadership developed models that can be applied in the organizational context. In the present study, we selected the model proposed by Hersey and Blanchard, named Situational Leadership. Through the technique of critical incidents, we identified and analyzed the behaviour of nurses from surgical units. Based on the analysis of data, we were able to infer that situational leadership can be used as a theoretical structure to base nurses' leadership skills, in order to improve the quality of nursing care and the development of nursing personnel.

[Establishment of an ambulatory surgery service; the nurses' role in this scenario]. / Implantação de um serviço de cirurgia ambulatorial: o papel da enfermagem nesse cenário.

The purpose of the present study is to present the trajectory of a nurse in establishing a service of ambulatory surgeries in a general hospital. It approaches the importance of such a service in the contemporary context, considering the activities developed by the nurse and nursing staff, as well as the challenges and conquests found in daily work.

[Leadership of nurses in the XXI century: various considerations]. / A liderança do enfermeiro no século XXI: algumas considerações.

The present article approaches the theme of leadership in it essential aspects and considers the transformations contemporary organizations are experiencing. Based on the literature authors found the role of the nurse--leader of the future and the importance of the auxiliary personnel--led to the efficacy of the leading process and the need of learning on leadership.

[Situational leadership: a model for application in Brazilian nursing]. / Liderança situacional: um modelo para aplicação na enfermagem brasileira.

Leadership is a very important theme to the management of nursing care provided to the patient. This study aimed at presenting key-concepts of the leadership model developed by Hersey and Blanchard, entitled Situational Leadership. We believe that this model can bring relevant contributions to nurse's leadership skills.

[The leadership style exercised by nurses in surgical wards focuses on situational leadership]. / O estilo de liderança exercido pelo enfermeiro de unidade de internação cirúrgica sob o enfoque da liderança situacional.

The present study was oriented to the leadership theme focussing nurses inside surgical ward unities. As a theoretical reference, the authors used the Situational Leadership Model proposed by Hersey and Blanchard. This study aimed at analysing the correspondence between the opinions of nurses and auxiliary personnel about the leadership style exerted by nurses in the surgical ward unit regarding the six categories of the assistance activity that were studied. Authors noticed that nurses, from the two studied hospitals, adopted the directive leadership styles (E2/selling or E1/telling) with the auxiliary personnel.