Janine Schirmer

Transplante de órgãos e tecidos: responsabilidades do enfermeiro

In Brazil, more than 30,000 patients are awaiting organ transplantation. The complexity of this therapeutic treatment requires specialized training and constant involvement from health care providers involved in care for these patients. In everyday practice, nurses are challenged to provide high-quality care to patients and families. In view of the need to define the nurses role in the donation and transplantation process and the importance of disclosure in this field, we elaborated the present narrative review to discuss the role and responsibilities of the nurse working in an organ and tissue transplantation program. The literature found was read, summarized and organized into five thematic categories, namely: definition of the nurses role in transplantation, the difference between the nurse practitioner and coordinator, legal and ethical aspects; research and information on transplant nursing and education on transplantation. It is concluded that the nurse needs knowledge about the principles of good practices and have resources available to assess the merits, risks and social issues related to transplantation. DESCRIPTORS: Organ transplantation. Nurses role. Nursing care.In Brazil, more than 30,000 patients are awaiting organ transplantation. The complexity of this therapeutic treatment requires specialized training and constant involvement from health care providers involved in care for these patients. In everyday practice, nurses are challenged to provide high-quality care to patients and families. In view of the need to define the nurses role in the donation and transplantation process and the importance of disclosure in this field, we elaborated the present narrative review to discuss the role and responsibilities of the nurse working in an organ and tissue transplantation program. The literature found was read, summarized and organized into five thematic categories, namely: definition of the nurses role in transplantation, the difference between the nurse practitioner and coordinator, legal and ethical aspects; research and information on transplant nursing and education on transplantation. It is concluded that the nurse needs knowledge about the principles of good practices and have resources available to assess the merits, risks and social issues related to transplantation. DESCRIPTORS: Organ transplantation. Nurses role. Nursing care.

Relação entre a pressão muscular perineal no puerpério e o tipo de parto

OBJETIVO: relacionar o tipo de parto e as caracteristicas do perineo com valores da pressao muscular perineal (PMP) mensurada em primiparas nas posicoes deitada e sentada com a musculatura perineal em repouso e em contracao maxima. METODOS: estudo quantitativo do tipo transversal, realizado em maternidade conveniada ao Sistema Unico de Saude (SUS) do municipio de Sao Paulo. A casuistica, obtida por conveniencia, foi de 95 primiparas de termo. A avaliacao ocorreu entre o 40o e o 45o dia. Realizaram-se entrevista, exame fisico e mensuracao da PMP por meio do perineometro de Kegel. A mensuracao foi realizada nas posicoes deitada e sentada, com a musculatura em repouso e em contracao maxima, sendo considerada a media de tres afericoes para cada posicao e estado muscular. RESULTADOS: 76,8% (73) das primiparas tiveram parto vaginal e 23,2% (22) cesarea. No pos-parto vaginal, observou-se perineo integro em 18,9% (18), com rotura perineal em 24,2% (23) e com episiotomia em 33,7% (32). Os valores obtidos da PMP foram em: posicao deitada/musculatura em repouso, 18,9 mmHg; deitada/musculatura em contracao maxima, 30,7 mmHg; sentada/musculatura em repouso, 34,5 mmHg; sentada/musculatura em contracao maxima, 46,5 mmHg. CONCLUSAO: nao houve associacao entre o tipo de parto e as condicoes perineais e a pressao muscular perineal.

Vírus HPV e câncer de colo de útero

This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.

Doação de órgãos e tecidos: relação com o corpo em nossa sociedade

This is a study of literature review aimed to develop theoretical considerations on the donation of organs and tissues and on its relationship with the human body, in our society. Increasing donation rates depends on a perspective that goes beyond the technical issues of the process of donating organs and tissues. Several countries, with large time frame experience, working systematically in this process with an approach that incorporates social and ethical aspects, based on volunteers, and respecting the families right to autonomy of potential donors. Accompanying the body, after donation, usually requested by the family, represents the beginning of mourning for the death of a relative, which is part of the funeral ritual in the culture of our society. The actions to ensure an ethical-legal sequence, defined by the law of transplants, imply a commitment to quality and safety of the process of organ and tissue donation, which must be strictly followed by professionals working in this area. Thus, it is hoped that these attitudes can build a positive culture on the donation in the country, contributing in the long run to increase donation rates.Este estudo, de revisao bibliografica, objetivou tecer consideracoes teoricas sobre doacao de orgaos e tecidos e sua relacao com o corpo em nossa sociedade. O aumento da taxa de doacao depende de um olhar ampliado alem das questoes tecnicas do processo de doacao de orgaos e tecidos. Varios paises, com larga experiencia temporal e, que trabalham sistematicamente nesse processo, incorporaram a abordagem social e a perspectiva etica, baseadas no voluntarismo das familias e no respeito ao direito de autonomia dos potenciais doadores. O acompanhamento do corpo, pos-doacao, solicitado pelas familias, representa o inicio do luto pela morte de um parente, parte da pratica de ritual funebre cultuada em nossa sociedade. As acoes que asseguram uma sequencia etico-legal, definida na legislacao dos transplantes, pressupoem compromisso com a qualidade e seguranca do processo de doacao de orgaos e tecidos, que deve ser rigorosamente perseguida pelos profissionais que trabalham na area. Espera-se, assim, que essas atitudes construam uma cultura positiva sobre a doacao no pais, contribuindo, a longo prazo, para o aumento nas taxas de doacao.(AU) This is a study of literature review aimed to develop theoretical considerations on the donation of organs and tissues and on its relationship with the human body, in our society. Increasing donation rates depends on a perspective that goes beyond the technical issues of the process of donating organs and tissues. Several countries, with large time frame experience, working systematically in this process with an approach that incorporates social and ethical aspects, based on volunteers, and respecting the families right to autonomy of potential donors. Accompanying the body, after donation, usually requested by the family, represents the beginning of mourning for the death of a relative, which is part of the funeral ritual in the culture of our society. The actions to ensure an ethical-legal sequence, defined by the law of transplants, imply a commitment to quality and safety of the process of organ and tissue donation, which must be strictly followed by professionals working in this area. Thus, it is hoped that these attitudes can build a positive culture on the donation in the country, contributing in the long run to increase donation rates.(AU) Se trata de un estudio de revision de literatura dirigida a elaborar consideraciones teoricas sobre la donacion de organos y tejidos y su relacion con el cuerpo en nuestra sociedad. El aumento de la tasa de donacion depende de una vision que va mas alla de las cuestiones tecnicas en el proceso de la donacion de organos y tejidos. Varios paises con gran tiempo de experiencia, trabajando sistematicamente en este proceso con un enfoque que incorpora el punto de vista social y etico, basado en voluntarios y respetando en las familias el derecho a la autonomia de los posibles donantes. El acompanamiento del cuerpo, despues de la donacion, generalmente solicitado por la familia, representa el comienzo del luto por la muerte de un pariente, lo que hace parte del rito funerario en la cultura de nuestra sociedad. Las acciones que aseguren una secuencia etica-legal definida por la legislacion de trasplantes, presuponen un compromiso con la calidad y seguridad del proceso de la donacion de organos y tejidos, que debe ser rigurosamente seguida por los profesionales que trabajan en esta area. Asi, se espera que esas actitudes puedan construir una cultura positiva en materia de donaciones, en el pais, contribuyendo en el largo plazo al aumento de las tasas de donacion.(AU)

Violência intrafamiliar na adolescência na cidade de Puno - Peru

This is an epidemiological case-control study with the purpose to describe the epidemiological profile of intrafamily violence against pregnant and non pregnant adolescents. The study was carried out at the out clinic of a central assistance to the adolescent of the Regional Hospital Manuel Nunez Butron and at secondary schools in the city of Puno - Peru. The results were obtained by means of statistical analysis, verifying the statistically significant difference used for the occurrence of physical violence (p= 0,008) and violence sexualrape (p= 0.01). It was concluded that the majority of the adolescents were victims of different types of aggression, executed either by members of the family (intrafamily) or by individuals outside the family. (extrafamily), and the most frequent causes associated to this aggression were disobedience, late arrival at home, having friends/boyfriends and to do domestic chores slowly.This epidemiological case-control study aimed to describe the epidemiological profile of intrafamily violence against pregnant and non pregnant adolescents. The study was carried out at the outpatient clinic for central care to adolescents of the Regional Hospital Manuel Nuñez Butrón and at secondary schools in the city of Puno--Peru. The results were obtained by means of statistical analysis, verifying statistically significant differences for the occurrence of physical violence (p = 0.008) and sexual-rape violence (p = 0.01). The majority of the adolescents were victims of different types of aggression, executed either by members of the family (intrafamily) or by individuals outside the family (extrafamily). The most frequent causes associated to this aggression were disobedience, late arrival at home, having friends/boyfriends and doing domestic chores slowly.

Adaptación del modelo español de gestión en trasplante para la mejora en la negativa familiar y mantenimiento del donante potencial

The purpose of this study was to compare data related to professional education and profiles of transplant coordinators in Brazil and Spain in order to evaluate opportunities for improvement, due to family rejection and maintaining the potential donor within the country. A detailed evaluation was carried out which compares the formal education data of the transplant coordinator, the coordinator’s profile, and the transplant methodology of each country. In Brazil, there is an average of eight hours in training prior to beginning work with transplants, whereas in Spain, 42 hours are necessary. In Brazil 22.9 % of transplant coordinators are physicians, while in Spain 95% are physicians. The average length of time that the transplant coordinator has worked in Brazil was nine months and twenty-two days, while in Spain it was sixty months. The National Transplant Organization Management Model (El Modelo de Gestión de la Organizacion Nacional) may be adapted in Brazil as a way to improve transplant coordinator education and family rejection and maintenance losses. DESCRIPTORS: Organ donation. Transplantation. Credentialing. Nursing ADAPTAÇÃO DO MODELO ESPANHOL DE GESTÃO EM TRANSPLANTES PARA A MELHORA DA NEGATIVA FAMILIAR E MANUTENÇÃO DO POTENCIAL DOADOR RESUMO: O propósito do estudo foi comparar os dados relacionados à formação e perfil dos coordenadores de transplantes do Brasil e Espanha para avaliar oportunidades de melhorias em relação à recusa familiar e manutenção do potencial doador. Uma minuciosa avaliação foi realizada, comparando os dados de formação do coordenador de transplante, perfil do coordenador de transplantes e da metodologia de transplante em cada país. No Brasil, a média de horas de capacitação recebida antes de começar a trabalhar foi de oito horas e na Espanha foi de 42 horas. No Brasil, 22,9% dos coordenadores de transplante são médicos, na Espanha 95% são médicos. O tempo que atua o coordenador de transplante no Brasil foi nove meses e 22 dias, na Espanha, 60 meses. O Modelo de Gestão da Organização Nacional de Transplante pode ser adaptado no Brasil como forma de melhoria nas perdas por negativa familiar e por perdas na manutenção. DESCRITORES: Doação de órgãos. Transplante. Qualificação profissional. EnfermagemThe purpose of this study was to compare data related to professional education and profiles of transplant coordinators in Brazil and Spain in order to evaluate opportunities for improvement, due to family rejection and maintaining the potential donor within the country. A detailed evaluation was carried out which compares the formal education data of the transplant coordinator, the coordinators profile, and the transplant methodology of each country. In Brazil, there is an average of eight hours in training prior to beginning work with transplants, whereas in Spain, 42 hours are necessary. In Brazil 22.9 % of transplant coordinators are physicians, while in Spain 95% are physicians. The average length of time that the transplant coordinator has worked in Brazil was nine months and twenty-two days, while in Spain it was sixty months. The National Transplant Organization Management Model (El Modelo de Gestion de la Organizacion Nacional) may be adapted in Brazil as a way to improve transplant coordinator education and family rejection and maintenance losses.

Family, Patients, and Organ and Tissue Donation: Who Decides?

OBJECTIVE To identify who is responsible for the decision to donate organs and tissues from a deceased donor. METHODS This cross-sectional study was performed with 69 family members of deceased donors, identified by the Organ Procurement Organization. RESULTS The decision of the family regarding the request for donation took place after they had enough time to reflect on the matter (81.8%). The decision was made by the family (43.5%), by both family and donor (76.8%), by the family with previous knowledge about their deceased relatives wish (63.2%), or only by the donor (11.6%). There was familial conflict after the decision in about 7.2% of donations; 63.2% of the families were aware of their deceased relatives wish, and 90.5% were aware that their relatives wish helped them make the decision. Women were most frequently responsible for the decision to donate (55%). CONCLUSION The donation process is experienced by all the family, regardless of who signs the consent form. At times, it is precisely the discussion about what is conflicting that will enable the familial decision. The donors autonomy alone was shown to be a poor indicator, as the ones who decide about the donation are the family. This, therefore, legitimizes the alteration made to Law No. 9,434/97, which gives family members the responsibility for the decision about organ and tissue donation from their deceased relatives.

Organ and tissues donation: relation with the body in our society

This is a study of literature review aimed to develop theoretical considerations on the donation of organs and tissues and on its relationship with the human body, in our society. Increasing donation rates depends on a perspective that goes beyond the technical issues of the process of donating organs and tissues. Several countries, with large time frame experience, working systematically in this process with an approach that incorporates social and ethical aspects, based on volunteers, and respecting the families right to autonomy of potential donors. Accompanying the body, after donation, usually requested by the family, represents the beginning of mourning for the death of a relative, which is part of the funeral ritual in the culture of our society. The actions to ensure an ethical-legal sequence, defined by the law of transplants, imply a commitment to quality and safety of the process of organ and tissue donation, which must be strictly followed by professionals working in this area. Thus, it is hoped that these attitudes can build a positive culture on the donation in the country, contributing in the long run to increase donation rates.Este estudo, de revisao bibliografica, objetivou tecer consideracoes teoricas sobre doacao de orgaos e tecidos e sua relacao com o corpo em nossa sociedade. O aumento da taxa de doacao depende de um olhar ampliado alem das questoes tecnicas do processo de doacao de orgaos e tecidos. Varios paises, com larga experiencia temporal e, que trabalham sistematicamente nesse processo, incorporaram a abordagem social e a perspectiva etica, baseadas no voluntarismo das familias e no respeito ao direito de autonomia dos potenciais doadores. O acompanhamento do corpo, pos-doacao, solicitado pelas familias, representa o inicio do luto pela morte de um parente, parte da pratica de ritual funebre cultuada em nossa sociedade. As acoes que asseguram uma sequencia etico-legal, definida na legislacao dos transplantes, pressupoem compromisso com a qualidade e seguranca do processo de doacao de orgaos e tecidos, que deve ser rigorosamente perseguida pelos profissionais que trabalham na area. Espera-se, assim, que essas atitudes construam uma cultura positiva sobre a doacao no pais, contribuindo, a longo prazo, para o aumento nas taxas de doacao.(AU) This is a study of literature review aimed to develop theoretical considerations on the donation of organs and tissues and on its relationship with the human body, in our society. Increasing donation rates depends on a perspective that goes beyond the technical issues of the process of donating organs and tissues. Several countries, with large time frame experience, working systematically in this process with an approach that incorporates social and ethical aspects, based on volunteers, and respecting the families right to autonomy of potential donors. Accompanying the body, after donation, usually requested by the family, represents the beginning of mourning for the death of a relative, which is part of the funeral ritual in the culture of our society. The actions to ensure an ethical-legal sequence, defined by the law of transplants, imply a commitment to quality and safety of the process of organ and tissue donation, which must be strictly followed by professionals working in this area. Thus, it is hoped that these attitudes can build a positive culture on the donation in the country, contributing in the long run to increase donation rates.(AU) Se trata de un estudio de revision de literatura dirigida a elaborar consideraciones teoricas sobre la donacion de organos y tejidos y su relacion con el cuerpo en nuestra sociedad. El aumento de la tasa de donacion depende de una vision que va mas alla de las cuestiones tecnicas en el proceso de la donacion de organos y tejidos. Varios paises con gran tiempo de experiencia, trabajando sistematicamente en este proceso con un enfoque que incorpora el punto de vista social y etico, basado en voluntarios y respetando en las familias el derecho a la autonomia de los posibles donantes. El acompanamiento del cuerpo, despues de la donacion, generalmente solicitado por la familia, representa el comienzo del luto por la muerte de un pariente, lo que hace parte del rito funerario en la cultura de nuestra sociedad. Las acciones que aseguren una secuencia etica-legal definida por la legislacion de trasplantes, presuponen un compromiso con la calidad y seguridad del proceso de la donacion de organos y tejidos, que debe ser rigurosamente seguida por los profesionales que trabajan en esta area. Asi, se espera que esas actitudes puedan construir una cultura positiva en materia de donaciones, en el pais, contribuyendo en el largo plazo al aumento de las tasas de donacion.(AU)

Fatigue Effects in Daily Life Activities of Kidney Transplant Recipients

After undergoing kidney transplantation, some patients still face one symptom that continues after the dialysis sessions: fatigue (physical and mental tiredness that does not get better after resting). Fatigue effects in the everyday lives of kidney transplant patients can be beneficially modified early by changing this scenario. This is a quantitative study about the intensity and impacts of fatigue in kidney transplant patients admitted to the Hypertension and Kidney Hospital from October 2011 to March 2012. The fatigue pictogram was used to evaluate the level of fatigue interference in the daily life activities of kidney transplant patients. The sample consists of 39 patients, and was developed in 2 phases: data collection and attendance after and before the transplantation until hospital discharge. Descriptive statistical analyses were used. In the group at issue, we have noticed the following profile of the sample: 84.3% of transplantations with live donors, most were men, average age 36.5 years old, average hospitalization time 11.1 days, average time of renal failure 66.4 months, systemic arterial hypertension prevalence 66.7%, and the prevalence of at least 1.8 diseases in each individual. The self-referred causes of chronic renal failure were uncontrolled systemic arterial hypertension, glomerulonephritis, and overuse of anti-inflammatory drugs, among others. The study shows that fatigue is directly related to the level of activities of daily living, causing less ability to perform activities in the higher level of fatigue, which is in the immediate postoperative period and only settling fully on the 9th postoperative day.

THE EXPERIENCE OF PATIENTS WHO NEED RENAL TRANSPLANTATION WHILE WAITING FOR A COMPATIBLE ORGAN 1

The aim of this study was to understand the experience of patients with chronic renal failure, who were included in a list of subjects waiting for a kidney transplant. This is an exploratory, descriptive, and qualitative study, with phenomenology as theoretical basis. Twenty patients have undergone hemodialysis as a renal replacement therapy. These subjects were active while they waited for a kidney transplant. Analysis of material obtained in this study allowed us to understand the fear and insecurity of these patients in view of both dialysis treatment and the possibility that a compatible donor is not found. They have shown faith strength and courage while using self-care to stay well when transplanting arrived. They idealized a new life, a fresh start, away from the machine for hemodialysis. The present study has detected a need for monitoring, by an interdisciplinary team, of patients included in waiting lists in order to help them experiencing such wait. DESCRIPTORS: Nursing. Transplantation. Renal insufficiency, chronic.El estudio tuvo como objetivo comprender la vivencia del paciente con insuficiencia renal cronica en lista de espera por un trasplante renal. Tratase de una pesquisa exploratoria, descriptiva de naturaleza cualitativa, que uso como referencial teorico la fenomenologia. Los sujetos del estudio fueron veinte pacientes sometidos a hemodialisis como terapia substitutiva, que esperaban en la lista por un trasplante renal y que estaban activos en la lista de espera. El analisis del material obtenido nos permitio entender el miedo y la inseguridad de los pacientes ante la dialisis y la posibilidad de encontrar un donante compatible. Revelando fuerza y coraje, a traves de auto cuidado de mantener bien a la llegada del trasplante. La elaboracion de una nueva vida, un nuevo comienzo alejado de la maquina de hemodialisis. El presente estudio ha revelado la necesidad de acompanamiento del paciente en lista por el equipo interdisciplinario para ayudarle a vivenciar esa espera.