Family presence during resuscitation in emergency departments: professionals' attitudes in Brazil.

AIM: The study explored the views and attitudes of nurses and physicians on family presence during resuscitation in emergency departments in Brazil. BACKGROUND: International emergency associations endorse family presence during resuscitation; however, the extent to which it is practiced remains unclear, particularly in the Brazilian context. Research of emergency staff views and attitudes towards this practice is desirable so that actions can be identified to support families at the bedside. METHODS: A qualitative research was conducted. Thirty-two health professionals (11 physicians and 21 nurses) working in two emergency departments in southern Brazil were purposefully recruited in January 2015. In-depth interviews were conducted, and data were analysed using content analysis. FINDINGS: Nurses and physicians found family presence during resuscitation controversial and the general attitude towards this practice was negative. They reported that 'changes are needed' to adapt hospital infrastructures for family presence, and to train staff to respond to the information and emotional needs of families. DISCUSSION: Translating a family nursing framework into clinical practice involves the need for reassessing educational and management policies in clinical contexts. CONCLUSION: This research brings new understanding about the attitudes of some Brazilian nurses and physicians on the implementation of family presence during resuscitation and identifies the need to develop policies and strategies to improve family presence in emergency departments. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Hospital-based policies are required to improve family-centred care in emergency departments while providing a criterion of legality and safety to professionals to invite families to be present during invasive procedures. Also, family-focused education in health science degrees, continuing education and in the community is required.

Blood levels of pro-inflammatory and anti-inflammatory cytokines during an oral glucose tolerance test in patients with symptoms suggesting reactive hypoglycemia.

We evaluated the impact of postprandial glycemia on blood levels of pro-inflammatory and anti-inflammatory cytokines during an oral glucose tolerance test in non-diabetic patients with symptoms suggesting reactive hypoglycemia. Eleven patients with clinical symptoms suggesting reactive hypoglycemia received an oral glucose solution (75 g) Blood was collected at 0 (baseline), 30, 60, 120 and 180 min after glucose ingestion and the plasma concentrations of interferon-α (IFN-α), interferon-γ (IFN-γ), interleukin-1 receptor antagonist (IL-1RA), interleukin 2 (IL-2), interleukin-2 receptor (IL-2R), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10), interleukin-12 (IL-12), interleukin 13 (IL-13), interleukin 15 (IL-15), interleukin 17 (IL-17), IFN-γ inducible protein 10 (IP-10), monocyte chemotactic protein 1 (MCP1), monokine induced by IFN-γ (MIG), macrophage inflammatory protein-1α (MIP-1α), interleukin-1ß (IL-1ß), colony stimulating factor (G-CSF), granulocyte-macrophage CSF (GM-CSF), basic fibroblast growth factor (FGF-basic), eotaxin, tumor necrosis factor α (TNFα), epidermal growth factor (EGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), macrophage inflammatory protein-1α (MIP-1α), and 1ß (MIP-1ß) were evaluated. Overall, glycemic levels increased, reached its maximum at 30 min (phase 1), returned to baseline levels at 120 min (phase 2), followed by a mild hypoglycemia at 180 min (phase 3). During phase 1, cytokine blood levels were maintained. However, we observed a synchronous fall (P<0.05) in the concentrations of pro-inflammatory (IL-15, IL-17, MCP-1) and anti-inflammatory cytokines (FGF-basic, IL-13, IL-1RA) during phase 2. Furthermore, a simultaneous rise (P<0.05) of pro-inflammatory (IL-2, IL-5, IL-17) and anti-inflammatory cytokines (IL-4, IL-1RA, IL-2R, IL-13, FGF-basic) occurred during phase 3. Thus, mild acute hypoglycemia but not a physiological increase of glycemia was associated with increased blood levels of anti-inflammatory and pro-inflammatory cytokines.

Blood levels of pro-inflammatory and anti-inflammatory cytokines during an oral glucose tolerance test in patients with symptoms suggesting reactive hypoglycemia

We evaluated the impact of postprandial glycemia on blood levels of pro-inflammatory and anti-inflammatory cytokines during an oral glucose tolerance test in non-diabetic patients with symptoms suggesting reactive hypoglycemia. Eleven patients with clinical symptoms suggesting reactive hypoglycemia received an oral glucose solution (75 g) Blood was collected at 0 (baseline), 30, 60, 120 and 180 min after glucose ingestion and the plasma concentrations of interferon-α (IFN-α), interferon-γ (IFN-γ), interleukin-1 receptor antagonist (IL-1RA), interleukin 2 (IL-2), interleukin-2 receptor (IL-2R), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10), interleukin-12 (IL-12), interleukin 13 (IL-13), interleukin 15 (IL-15), interleukin 17 (IL-17), IFN-γ inducible protein 10 (IP-10), monocyte chemotactic protein 1 (MCP1), monokine induced by IFN-γ (MIG), macrophage inflammatory protein-1α (MIP-1α), interleukin-1β (IL-1β), colony stimulating factor (G-CSF), granulocyte-macrophage CSF (GM-CSF), basic fibroblast growth factor (FGF-basic), eotaxin, tumor necrosis factor α (TNFα), epidermal growth factor (EGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), macrophage inflammatory protein-1α (MIP-1α), and 1β (MIP-1β) were evaluated. Overall, glycemic levels increased, reached its maximum at 30 min (phase 1), returned to baseline levels at 120 min (phase 2), followed by a mild hypoglycemia at 180 min (phase 3). During phase 1, cytokine blood levels were maintained. However, we observed a synchronous fall (P<0.05) in the concentrations of pro-inflammatory (IL-15, IL-17, MCP-1) and anti-inflammatory cytokines (FGF-basic, IL-13, IL-1RA) during phase 2. Furthermore, a simultaneous rise (P<0.05) of pro-inflammatory (IL-2, IL-5, IL-17) and anti-inflammatory cytokines (IL-4, IL-1RA, IL-2R, IL-13, FGF-basic) occurred during phase 3. Thus, mild acute hypoglycemia but not a physiological increase of glycemia was associated with increased blood levels of anti-inflammatory and pro-inflammatory cytokines.

Fatores interferentes na taxa de adesão à farmacoterapia em idosos atendidos na rede pública de saúde do Município de Salto Grande - SP, Brasil / Factors interfering with the medication adherence rate of elderly patients in the public health system in the town of Salto Grande, São Paulo State, Brazil

O objetivo deste estudo foi determinar a taxa de adesão à farmacoterapia e identificar os fatores que interferem nesta taxa em pacientes idosos atendidos em uma Unidade Básica de Saúde (UBS) no município de Salto Grande, São Paulo. Foram recrutados 120 pacientes idosos para participar de estudo transversal, desenvolvido no período de maio a setembro de 2009. Foi aplicado questionário para determinar a taxa de adesão (MMAS-8) e identificar as características sócio-econômicas, de saúde autorreferidas, da farmacoterapia utilizada e da satisfação dos pacientes com os serviços de saúde da UBS estudada. Um total de 102 pacientes completo o estudo, sendo que a maioria dos indivíduos apresentou taxa de adesão insatisfatória (14,7% alta adesão, 48,0% adesão média e 37,3% baixa adesão). Apresentaram forte correlação com adesão, satisfação com os serviços de saúde (r= 0,884; p < 0,0001) e o Índice de Complexidade da Farmacoterapia (ICFT) (r= - 0,705; p < 0,001). O número de medicamentos consumidos (r= - 0,604; p < 0,001), número de doenças relatadas (r = - 0,604; p < 0,001) e número de moradores por residência (r= 0,428; p < 0,001) apresentaram correlação intermediária com adesão. Foi encontrada uma correlação fraca entre adesão e escolaridade (r= 0,263; p < 0,001), raça (r= 0,090; p < 0,001), sexo (r= 0,080; p < 0,001), renda familiar (r= 0,054; p < 0,001) e idade (r= -0,090; p < 0,001). Esses resultados indicam que a população estudada não adere adequadamente à farmacoterapia, com forte influência da satisfação dos pacientes com os serviços de saúde e ICFT nesses resultados.

The aim of this study was to determine the rate of adherence to pharmacotherapy and to identify the factors that interfere with this adherence in elderly patients attended at a local Health Center (BHU) in Salto Grande, a country town in Sao Paulo. One hundred and twenty patients were recruited to participate in a cross-sectional study, conducted from May to September 2009. A questionnaire was used to determine the adherence rate (MMAS-8) and to identify the socio-economic factors, health condition (self-reported), medication used and satisfaction of the patients with the health services provided at the BHU. A total of 102 patients completed the study, most of whom showed unsatisfactory adherence rates (14.7% high adherence, 48.0% mean adherence and 37.3% poor adherence). Adherence was strongly correlated with patient satisfaction with health services (r= 0.884; p < 0.0001) and the Medication Regimen Complexity Index (MRCI) (r= - 0.705; p < 0.001). The number of drugs consumed (r = - 0.604, p <0.001), number of reported diseases (r = - 0.604, p <0.001) and number of residents per house (r = 0.428, p <0.001) showed intermediate correlation with intermediate adherence. Weak correlation was found between adherence and education level (r = 0.263, p <0.001), race (r = 0.090, p <0.001), sex (r = 0.080, p <0.001), family income (r = 0.054, p <0.001 ) and age (r = -0.090, p <0.001). These results indicate that the population does not adhere adequately to medication prescribed at the BHU and that patients? satisfaction with health services and the MRCI influence these results strongly.

[Nursing assistance by a home care team after the death of the patient]. / Assistência de enfermagem domiciliar em equipe multiprofessional após o óbito do paciente.

This is report about an experience of continuation of home assistance to families after the patient's death who had determined the beginning of assistance. The present article shows the criteria used to provide a family with an "Assistance service and support to families of chronical patients of HUM" as well as discussions emerged and feelings experienced by the team when subjected to the possibility/proposal of the continuation of assistance. Furthermore the article considers the visitor's reaction at first visit made after death and finally it also presents the importance of continuation of assistance based on reports of verbal manifestation of the family and on evaluation of team members. The authors believe that due to the fact that the assistance to the family is still regarded as a topic which has been very little explored, discussions that might contribute somehow to the consolidation of its practicability must be made possible and stimulated.

[How nurses evaluate home nursing and family caregivers]. / Como os enfermeiros avaliam o cuidado/cuidador familiar.

The aim of this study was to assess the way used by nurses for evaluate the family care and the caregiver. The method used was a quali-quantitative one. A semi-structure interview was the instrument chosen to collect data. It was applied to 20 (twenty) nurses from a University Hospital within the months of April and May, 1996. Data analysis was based on the Bardin's Content Analysis Technique (1994). The results demonstrated that nurses are not systematic in evaluating family care and the caregiver, but they use their intuition, based on momentaneous decisions. This reveal a difficulty of integration between the formal and the informal care caused by lack of interaction or effective valorization of the family care process.

[Flashes of how pregnant mothers perceive pre-natal care in a university hospital]. / "Flashes" de como as gestantes percebem a assistência pré-natal em um hospital universitário.

This article was based on research carried out to characterize the pre- natal care offered to pregnant women at the outpatient unit of a university hospital. This qualitative study used ethnography, more precisely miniethnography. The methodological approach and data collection were done through participating observation. Results showed that pregnant in touch with health professionals are able to filter information and at t he same time, behave as nonparticipating clients, since they do not question the care offered to them even if the care is not good. Although women think that the care offered at this hospital is better than the one offered elsewhere, they admit that it does not respond successfully to their real expectations and needs. Generally speaking, they would like to receive more orientation and more personal assistance. They do not like this care very much mainly because of students' rotativity.

[Women's experiences in the late weaning of children]. / Vivência de mulheres sobre o desmame (tardio) da criança.

The aim of this study is to present the processes, concepts and women's experiences during "late" weaning process because women's experiences on natural weaning aren't reports in the literature. It's a qualitative study which methodological approach is the Grounded Theory and the data collect method is Participating Observation. Data about 60 women were collected through two techniques: open interview and non-structured observation. Late weaning occurs in the absence of physical, physiological or social problems and contains an experience of five sub-processes: "Believing in an age limit", "Skepticism in the feeding power of mother's milk", "Being influenced", "Weaning with tranquility" and "Some difficulties in weaning".

[Living the pregnancy: processes and subprocesses of a data-based theory]. / Vivenciando a gravidez: processos e subprocessos de uma teoria fundamentada nos dados.

This paper shows the results of a qualitative study, that adopted as a methodological line the "Grounded Theory" and as a method to the data collection the participating observation. The goal was to explore and understand the period of a pregnancy, as seen by pregnant women. The data were collected with four sample groups, including 96 women, from january to december 1987. Results of the study are a starting point to a substantive theory in development, "Living the Pregnancy": a dynamic process occurring in the woman's life within a context. Living such a process could be planned or not. Such course of living occurs along four sequential and interconnected stages, which were called Preceding the Beginning, the Beginning, the Middle, and the End of pregnancy.

[Preventive behavior in health: an exploration of the concept]. / Comportamento preventivo em saúde: exploração do conceito.

The purpose of this paper is: to show some aspects concerning preventive health behaviors, as well as determinants inducings and inbitings, component parts and phases; to contribute in the identification of influence of this behavior about the life and health personal's level; to subsidize with a theoretical fundamentation, the atuation of the nurse together patientes.