Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2009. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-12-07T15:53:37Z No. of bitstreams: 1 grazieledalmolin.pdf: 981219 bytes, checksum: f09576db8d0ef1f52b105a69863c7eab (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2012-12-09T23:39:41Z (GMT) No. of bitstreams: 1 grazieledalmolin.pdf: 981219 bytes, checksum: f09576db8d0ef1f52b105a69863c7eab (MD5) / Made available in DSpace on 2012-12-09T23:39:41Z (GMT). No. of bitstreams: 1 grazieledalmolin.pdf: 981219 bytes, checksum: f09576db8d0ef1f52b105a69863c7eab (MD5) Previous issue date: 2009 / O cotidiano da enfermagem, freqüentemente, é permeado por situações conflituosas, as quais se constituem em fonte de dilemas morais e sofrimento moral para as enfermeiras. Dessa forma, apresentou-se como objetivo geral conhecer a produção científica acerca do sofrimento moral na enfermagem, na literatura científica nacional e internacional publicada nos últimos 10 anos; e como objetivos específicos: conhecer as implicações do sofrimento moral para a vida das enfermeiras; identificar aproximações entre as manifestações de sofrimento moral e burnout; e, conhecer as possíveis estratégias de enfrentamento do sofrimento moral. A metodologia utilizada foi a revisão integrativa, realizada em cinco fases: formulação e identificação do problema; coleta de dados; avaliação dos dados; análise e interpretação dos dados coletados; e, apresentação dos dados. Para a coleta de dados, utilizou-se as palavras-chave: sofrimento moral, burnout e enfermagem, nas bases de dados da CINAHL, MEDLINE e SAGE, tendo sido selecionados um total de vinte e um artigos, submetidos à análise, realizada em quatro etapas: redução dos dados com sua organização em subgrupos; visualização dos dados, em que os dados foram agrupados em quadros de exibição, explicitando os mais relevantes de acordo com o problema de pesquisa; comparação dos dados, quando foram analisados os quadros de visualização dos dados, identificando temas e relações; e, verificação e esboço da conclusão, em que foram elaboradas graduais generalizações para cada subgrupo analisado, ou os dados foram categorizados e resumidos de maneira integrada. Dessa forma, após a análise de dados, foram construídas duas categorias: 1) O Sofrimento Moral na Enfermagem, com sua associação, principalmente, à prestação de cuidados fúteis, a questões organizacionais e, aos diferentes ambientes de atuação das enfermeiras e aos tipos de pacientes cuidados; e, 2) Implicações do Sofrimento Moral para a vida das enfermeiras e aproximações com o burnout, na qual foram identificadas manifestações emocionais, como frustração, impotência, culpa, raiva, ressentimentos, humilhações, vergonha, tristeza, angústia, ansiedade, medo, insegurança e depressão; e manifestações físicas, como dores de cabeça, perda do sono, pesadelos, crises de choro, taquicardia, dores musculares, suores, tremores, distúrbios gastrointestinais e estresse, numa aproximação com o burnout. As estratégias de prevenção e enfrentamento do sofrimento moral focaram-se nas dimensões educativa, comunicativa e organizacional. Parece evidente a necessidade de desenvolvimento de alternativas e estratégias que possibilitem modificações nos ambientes de atuação das enfermeiras, tanto nas questões éticas e organizacionais, como na educação em enfermagem e na implementação de novas pesquisas sobre a temática, para que estas profissionais possam atuar de um modo mais autônomo, expressando seus valores e saberes, em defesa dos valores profissionais e dos direitos dos pacientes. / The daily routine of nursing is frequently permeated by conflicting situations, which are constituted of sources of moral dilemmas and moral distress for nurses. This way, the general objective was to analyse the scientific production of the national and international scientific literature published in the last 10 years that concerns moral distress in nursing work; and the specific objectives were: to get familiar with the implications of the moral distress for the nurses' life; to identify similarities between the manifestations of moral distress and burn-out; and, to determine the possible strategies to face moral distress. The research method was the integrative review, which has been accomplished in five phases: formulation and identification of the problem; data collection; data evaluation; analysis and interpretation of the collected data; and, presentation of the data. For the data collection, it has been used the following keywords in CINAHL, MEDLINE and SAGE databases: moral suffering, burn-out, and nursing. A total of twenty-one articles has been selected, and submitted to the analysis, which has been carried out in four stages: reduction of the data with its organization in subgroups; visualization of the data, in which the data were set in exhibition pictures, pointing out the most relevant ones according to the research problem; comparison of the data, when the data visualization pictures were analysed, identifying themes and relations; and, verification and conclusion sketch, in which gradual generalizations have been elaborated for each analyzed subgroup, or the data have been classified and summarized in an integrated way. This way, two categories were built after the data analysis: 1) Moral Distress in Nursing, with its association, mainly, to the rendering of futile cares, to organizational issues and, to the nurses' various performance atmospheres, and the types of patients being looked after; and, 2) Implications of Moral Distress for nurses' life and similarities with burn-out, in the which it has been identified emotional manifestations such as frustration, impotence, guilt, rage, resentments, humiliations, shame, sadness, anguish, anxiety, fear, insecurity, and depression; and physical manifestations such as headaches, loss of the sleep, nightmares, crying fits, palpitation, muscular pains, perspirations, tremors, gastrointestinal disturbances, and stress, in a close relation to burn-out. The strategies for preventing and facing the moral distress focused in the educational, communicative and organizational dimensions. It seems to be evident the need of development of alternatives and strategies that enable modifications in the environment of the nurses' performance, not only in the ethical and organizational issues, but also in the nursing education and in the implementation of new researches on the theme, so that these professionals can work in a more autonomous way, expressing their values and knowledge, in defence of the professional values and of the patients' rights. / La práctica de la enfermería frecuentemente, está atravesada por situaciones de conflicto, que constituyen una fuente de dilemas morales y sufrimiento moral para las enfermeras. Así, presentó como objetivo general el conocimiento científico sobre el sufrimiento moral en la enfermería, en la literatura científica nacional e internacionalmente publicada en los últimos 10 años; y como objetivos específicos: conocer las implicaciones de sufrimiento moral para la vida de las enfermeras; identificar similitudes entre las manifestaciones del sufrimiento moral y burnout y, conocer las posibles estrategias de enfrentamiento del sufrimiento moral. La metodología utilizada fue la revisión integradora, realizada en cinco etapas: formulación e identificación del problemas; colecta de datos; evaluación de datos; análisis e interpretación de los datos colectados; y presentación de datos. Para colecta de los datos, fueron utilizadas las palabras clave: sufrimiento moral, burnout e enfermería, en las bases de datos CINAHL, MEDLINE y SAGE, se seleccionó un total de veintiún artículos, sometidos a análisis en cuatro etapas: reducción de datos con su organización en subgrupos; visualización de los datos, en que los datos fueron agrupados en cuadros de exhibición, destacando los más relevantes de acuerdo con el problema de la investigación; visualización de los datos, donde los datos fueron agrupados en cuadros de exhibición, identificando los más relevantes temas relacionados a la investigación; comparación de los datos, cuando fueron analizados los cuadros de verificación de los datos, identificando temas y relaciones; y, verificación e esbozo de la conclusión, los cuales fueron desarrollados graduales generalizaciones para cada subgrupo analizado, o los datos fueron clasificados y resumidos de manera integrada. Así, después de análisis, se construyeron dos categorías: 1) Sufrimiento Moral en Enfermería, con su composición, principalmente para proporcionar cuidados en vano, las cuestiones de organización y los diferentes ambientes de actuación de las enfermeras y los tipos de pacientes cuidados; y, 2) Implicaciones del Sufrimiento Moral para la vida de las enfermeras y las proximidades con el burnout, que fueron identificadas las manifestaciones emocionales, como la frustración, desesperanza, culpa, ira, resentimiento, humillación, vergüenza, tristeza, ansiedad, miedo, inseguridad y la depresión; y las manifestaciones físicas, como dolores de cabeza, pérdida del sueño, pesadillas, ataques de lloro, taquicardia, dolores musculares, sudoración, temblores, trastornos gastrointestinales y estrés, en una aproximación con el burnout. Las estrategias para la prevención y enfrentamiento del sufrimiento moral centrado en las dimensiones educativas, comunicativa y organizacional. Esto pone de relieve la necesidad de desarrollar alternativas y estrategias para facilitar los cambios en el ambiente de actuación de las enfermeras, tanto en los temas éticos y organizacionales, como en la educación de enfermería y la implementación de nuevas investigaciones sobre el tema, para que estos profesionales pueden actuar en un de una manera más autónoma, expresando sus valores y conocimientos, en defensa de los valores profesionales y los derechos de los pacientes.

Chemical eye burns are among the most frequently reported causes of ocular damage. These lesions may range from mild conjunctival or corneal unilateral epithelial damage to damage to the conjunctiva and cornea with risk of vision loss. Knowing the importance of new treatment proposals for this affection, the objective was to investigate the potential of membranes based on gelatin / usnic acid / liposomes to promote the healing of corneal burns using animal model. Analysis of the biological activity of gelatin membranes containing usnic acid/liposomes was performed by means of the chorioallantoic membrane (CAM) assay where Gallus domesticus and Ross lineage eggs. For evaluation of ocular tolerance of the gelatin membrane, the Chicken Eggs Test - Coronary Membrane Test (HET-CAM). For the study in animals, 13 female New Zealand rabbits, aged 3 months and weighing 2 kg, were used. The chemical lesion on the corneas of the animals was performed by exposure to absolute ethanol for 30 seconds. The animals were divided into two study groups: group with lesion treated with gelatin membrane containing usnic acid / liposomes (n = 7) and group with lesion treated with gelatin membrane without acidic / liposomes (n = 6). To evaluate the healing, the injured area was demarcated with 1 (one) drop of eye drops fluorescein, later realized the registry. In order to identify dead cells in the cornea, 1 drop of Bengal Rose eye drops (1.0%) was instilled in the eye to be evaluated, after being topically anesthetized, after 1 minute the animals were exposed to white light and then performed the records. Hematoxylin-eosin staining for standard histopathological evaluation and Gomori trichrome stain for evaluation of collagen fibers were used for histological evaluation. It has been observed that the membrane of gelatin containing usnic acid/liposomes promotes neovascularization without promoting toxicity and is biocompatible with the ocular system by CAM and HET-CAM methods. In addition to not promoting ocular irritability, the membranes promoted improved healing of alkaline corneal chemical burn, as well as reduction in the number of dead cells and conjunctival irritability in the treated group when compared to the control group. Moreover, in animals treated with gelatin membrane containing single acid, there was absence of granulation tissue, in addition to organized collagen bundles, a different result from that found in animals treated with the membrane without single acid. Therefore, this work showed that the membrane of gelatin containing usnic acid promotes corneal healing caused by alkaline chemical burn efficiently in rabbits, accompanied by a reduction in the presence of dead cells in the injured cornea and improvement of conjunctival irritability. / As queimaduras oculares químicas estão entre as causas mais frequentemente relatadas de lesões oculares. Essas lesões podem variar desde dano epitelial unilateral leve conjuntival ou corneano até danos à conjuntiva e córnea com risco de perda da visão. Sabendo da importância de novas propostas de tratamento para tal afecção, objetivou-se investigar o potencial de membranas à base de gelatina contendo ácido úsnico carreado em lipossomas em promover cicatrização de queimaduras da córnea utilizando modelo animal. A análise da atividade biológica das membranas de gelatina contendo ácido úsnico foi realizada por meio do ensaio da membrana corioalantóica (MCA) na qual ovos de galinha da espécie Gallus domesticus e da linhagem Ross. Para avaliação de tolerabilidade ocular da membrana de gelatina foi realizado o Teste de Ovos de Galinha - Teste de Membrana Corioalantóica (HET-CAM). Para a realização do estudo em animais, foram utilizadas 13 coelhas da espécie New Zealand, com idade de 3 meses e pesando 2 kg. A lesão química na córnea dos animais foi realizada por exposição ao etanol absoluto durante 30 segundos. Os animais foram divididos em dois grupos do estudo: grupo com lesão tratado com membrana de gelatina contendo ácido úsnico carreado em lipossomas (n=7) e grupo com lesão tratado com membrana de gelatina sem ácido úsnico (n=6). Para avaliação da cicatrização a área lesada foi demarcada com 1 (uma) gota de colírio fluoresceína e exposição à luz de cobalto e então realizado o registro. Afim de identificar células mortas na córnea, 1 (uma) gota de colírio Rosa Bengala (1,0%) foi instilada no olho a ser avaliado, após ser anestesiado topicamente, após 1 minuto os animais foram expostos à luz branca e então realizados os registros. Para avaliação histológica foi utilizado coloração hematoxilina-eosina para avaliação histopatológica padrão e corante tricrômico de Gomori para avaliação de fibras de colágeno. Observou-se que a membrana de gelatina contendo ácido úsnico carreado em lipossomas promove neovascularização sem causar toxicidade e são biocompatíveis com o sistema ocular pelos métodos da MCA e HET-CAM. Além de não promover irritabilidade ocular, as membranas promoveram melhor cicatrização de queimadura química alcalina corneana, bem como uma redução do número de células mortas e irritabilidade conjuntival no grupo tratado quando comparado ao grupo controle. Além disso, nos animais tratados com membrana de gelatina contendo ácido úsnico foi observado ausencia de tecido de granulação, além de feixes de colágeno organizados, resultado diferente do encontrado nos animais tratados com a membrana sem ácido úsnico. Sendo assim este trabalho mostrou que a membrana de gelatina contendo ácido único carreado em lipossoma promove cicatrização corneana provocada por queimadura química alcalina de maneira eficiente em coelhos, acompanhado de uma redução na presença de células mortas na córnea lesada e da melhora da irritabilidade conjuntival. / Aracaju

O estresse orgânico decorrente da queimadura é intenso e prolongado. O hipercatabolismo e o hipermetabolismo secundários alteram o sistema de pró e anti-oxidantes. Pela necessidade de reepitelização da área doadora e receptora, a cirurgia reparadora pode desencadear ou perpetuar o estresse oxidativo. Objetivos: Em pacientes vítimas de trauma térmico agudo (Grupo Queimadura) e naqueles em pós-operatório de seqüelas de queimaduras (Grupo Seqüela), comparar o estresse oxidativo e os níveis de anti e pró-oxidantes com os obtidos no pré-operatório de pacientes com seqüelas de queimaduras (Grupo Controle). Casuística e métodos: O estudo foi conduzido na Unidade de Queimados do HCFMRPUSP. O Grupo Queimadura (n=11) incluiu pacientes com 48 horas do trauma térmico agudo, SCQ 10%. Os pacientes que necessitaram de correção cirúrgica das seqüelas do trauma térmico, ocorrido 1ano (n=8), foram avaliados no pré-operatório (Grupo Controle) e após 48 horas da cirurgia (Grupo Seqüela). Todos os voluntários foram submetidos à antropometria e quantificação da ingestão alimentar. Foi realizada a avaliação laboratorial do estado nutricional, dos marcadores da atividade inflamatória e dos anti e pró-oxidantes. Resultados: Em pacientes vítimas de trauma térmico agudo, foi documentado estresse orgânico caracterizado pelo aumento das proteínas de fase aguda como a PCR [8,76 (0,91 34,54) vs 0,40 (0,01 0,97)mg/dL, p=0,0004] e ferritina (254,45 ± 84,25 vs 145,10 ± 88,80ng/mL, p=0,014), além da diminuição da albumina (3,55±0,65 vs 4,16±0,26g/dL, p=0,004), da transferrina (110,67±55,13 vs 238,70±67,99mg/dL, p=0,0003), do colesterol (126,82 ± 32,19 vs 193,75 ± 51,64mg/dL, p=0,002) e triglicérides séricos (95,54 ± 36,84 vs 168,75 ± 54,83mg/dL, p=0,003), ferro [30,00 (6,00-73,00) vs 109,00 (70,00 - 252,00)µg/dL, p=0,0004] e zinco (63,55 ± 23,34 vs 92,72 ± 16,65mg/dL, p=0,014). O estresse oxidativo diminuiu os níveis séricos das vitaminas C [0,45 (0341,30) vs 0,93 (0,48 1,30)mg/dL, p=0,016], A (1,55 ± 0,87 vs 3,35 ± 0,72µmol/L, p=0,0002) e da vitamina E (9,49 ± 3,4 vs 4,96 ± 1,60µmol/g lipídeo, p=0,003). Não houve modificação nos níveis do GSH [40,37 (30,27 87,46 ) vs 49,90 (10,09 54,95)µmol/L, p= 0,48] e do MDA [1,75 (1,15 2,74) vs 1,77 (1,62 6,82nmol/g proteína), p=0,043]. O procedimento cirúrgico para correção das seqüelas de queimaduras determinou aumento da proteína C reativa [0,40 (0,01 0,97) vs 2,53 (0,56 4,70)mg/dL, p=0,01], mas não alterou os níveis de anti e pró-oxidantes, exceto a diminuição dos níveis séricos de vitamina A (3,35 ± 0,72 vs 2,52 ± 0,90µmol/L, p=0,006) Conclusões: O estresse orgânico decorrente do trauma térmico agudo diminuiu as respostas anti-oxidantes. Exceto pela queda nos níveis séricos de vitamina A, a cirurgia reparadora acarretou estresse orgânico, sem modificação na resposta anti e pró-oxidante. / Organic stress due to burns is intense and prolonged, Secondary hypercatabolism and hypermetabolism alter the pro- and anti-oxidant system. Due to the need for reepithelialization of the donor and recipient areas, reparative surgery can trigger or perpetuate the oxidative stress. Objectives: To compare the oxidative stress and the levels of anti- and pro-oxidants in patients victims of acute thermal trauma (Burn Group) and in patients during the postoperative period after surgery for burn sequels (Sequel Group) with those obtained preoperatively in patients with burn sequels (Control Group). Cases and methods: The study was conducted at the Burn Unit of HCFMRPUSP. The Burn Group (n=11) consisted of patients studied 48 hours after acute thermal trauma, SCQ 10%. The patients who required surgical correction of the sequels of thermal trauma suffered 1 year before (n=8) were assessed during the preoperative period (Control Group) and 48 hours after surgery (Sequel Group). All volunteers were submitted to anthropometry and to quantitation of food intake. Laboratory evaluation of nutritional status, of the markers of inflammatory activity and of the anti- and pro-oxidant levels was performed. Results: Organic stress was documented in the patients victims of acute thermal trauma, characterized by an increase of acute phase proteins such as C-reactive protein (CRP) [8.76 (0.91 34.54) vs 0.40 (0.01 0.97) mg/dL, p=0.0004] and ferritin (254.45 ± 84.25 vs 145.10 ± 88.80 ng/mL, p=0.014) and by a reduction of serum cholesterol (126.82 ± 32.19 vs 193.75 ± 51.64 mg/dL, p=0.002), triglycerides (95.54 ± 36.84 vs 168.75 ± 54.83 mg/dL. p=0.003), iron [30.00 (6.00 73.00) vs 109.00 (70.00 252.00) µg/dL, p=0.0004], and zinc (63.55 ± 23.34 vs 92.72 ± 16.65 mg/dL, p=0.014). Oxidative stress reduced the serum levels of vitamins C [0.45 (0341.30) vs 0.93 (0.48 1.30) mg/dL, p=0.016] and A (1.55 ± 0.87 vs 3.35 ± 0.72 µmol/L, p=0.0002), and did not modify the levels of vitamin E (9,49 ± 3,4 vs 4,96 ± 1,60µmol/g lipídeo, p=0,003)or of the anti-oxidant substance GSH [40.37 (30.27 87.46 ) vs 49.90 (10.09 54.95) µmol/L, p= 0.48, but caused a fall in MDA levels [1.04 (0.75 1.39) vs 1.26 (1.07 4.30 nmol/L), p=0.007]. The surgical procedure for the correction of burn sequels caused an increase in CRP [0.40 (0.01 0.97) vs 2.53 (0.56 4.70) mg/dL, p=0.01], but did not change the levels of anti- or pro-oxidants, except for a reduction of serum vitamin A levels (3.35 ± 0.72 vs 2.52 ± 0.90 µmol/L, p=0.006) Conclusions: The organic stress due to acute thermal stress reduced the antioxidant responses. Except for the fall in serum vitamin A levels, reparative surgery caused organic stress, with no change in the anti- or pro-oxidant response.

D.Phil. / This study investigates the management of burnout among ministers of religion in the Dutch Reformed Church ("NG Kerk") Synod of Southern Transvaal. Burnout is a common metaphor for a state of mental exhaustion, usually work-related. The traditional, and most frequently used definition describes burnout as "a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do 'people work' of some kind" (Maslach & Jackson, 1986: 1). Research literature describes the general symptomatology of the syndrome, its preconditions, and the domain in which it occurs. From the literature it becomes apparent that burnout is a persistent, negative, work-related state of mind in 'normal' individuals that is primarily characterised by exhaustion, which is accompanied by distress, a sense of reduced effectiveness, decreased motivation, and the development of dysfunctional attitudes and behaviours at work. This psychological condition develops gradually but may remain unnoticed for a long time by the individual involved. Often burnout is self-perpetuating because of inadequate coping strategies associated with the syndrome. The more recent multidimensional theory describes burnout as an individual's stress experience embedded in a context of social relationships involving the person's conception of both the self and others. According to this view burnout is a psychological syndrome of emotional exhaustion (stress component), depersonalization (otherevaluation component), and reduced personal accomplishment (self-evaluation component), the product of a major mismatch between the nature of the job and of the person who does the job, and the index of the dislocation between what people are and what they have to do. Six areas of organizational life are identified which can cause the imbalance, mismatch or misfit between the person and work: Workload, control, reward, sense of community, fairness and values. According to the multidimensional view burnout is also seen as a syndrome of exhaustion, negativity, hostility, cynicism and distance, and inefficiency on one side of a continuum, while the opposite and positive side of the continuum is represented by a state of engagement, characterised by energy, positive and supportive involvement and a sense of efficacy and accomplishment. Burnout is not a trivial problem but an important barometer of a major social dysfunction in the workplace that says more about the conditions of their job than it does about the workers. It is therefore not only a problem of the individual worker, but involves the complex interaction between organization and employees, on personal and interpersonal level, and also of specific working conditions and the context in which the work is being done. This interaction shapes the way people see and do their work, and impacts on the well-being of the workers and the organization. Burnout is therefore not only related to negative outcomes for the individual, including depression, a sense of failure, fatigue, and loss of motivation, but also to negative outcomes for the organization, including absenteeism, turnover rates, and lowered productivity.

Thesis(M.Tech.: Homoeopathy)-Dept of Homoeopathy, Durban Institute of Technology, 2005 xxiii, 96 leaves / The purpose of this double blind placebo controlled study was to evaluate the efficacy of homoeopathic simillimum in the treatment of job burnout in the human services field. / M

The problem of this investigation was threefold: ascertaining differences in degrees of burnout as a function of registered nurses' educational tracks in Texas, ascertaining degrees of burnout for registered nurses as a function of job tenure, and examining certain demographic variables and their relationships with registered nurses' educational tracks. Nurses were classified by educational track (diploma, associate degree, baccalaureate degree) and employment (full time, part time, not active). The instrument employed comprised the Pines and Aronson Tedium-Burnout Diagnosis, for which reliability and validity were previously established, and a demographic questionnaire.

Background: We are facing a global lack of working nurses since nurses end their carrier earlier than their planned retirement. The psychosocial work environment is a big problem in the nursing field and affects the nurses´ health status, suffering and stress level. Aim: The aim with this study was to describe nurses´ perceptions of factors that affects their psychosocial working environment. Method: A literature overview Results: The collegial relationships, the workplace manager, the structure of the working hours and the organization and staffing makes the ground for however the nurses will appreciate and stay at their workplace, or if they are going to dislike the work and leave either the workplace or the nursing-field entirely. Conclusion: Adequate staffing, good relations with the co-workers, a manager that sees and appreciates the nurses is work environmental factors that increase the chances that the nurses is going to appreciate their work, and remain at their workplace. To achieve a good work environment there should be enough time for the nurses´ to take good care of the patients and colleagues. There should also be a supporting management at the work place and a good cooperation in the working team. A mean manager, understaffing, bad relationships with colleagues, and a lack of trust and independence increases the risk that the nurses will leave both the workplace and the entire nursing field.

La peau est un organe sensoriel qui permet notamment à l’organisme de s’adapter à son environnement. Ainsi, de nombreuses fibres nerveuses sont présentes au sein de cette peau permettant de détecter différents stimuli tels que la pression, la douleur ou encore une variation de température. A la suite d’une brûlure profonde, ces terminaisons nerveuses sont détruites et la repousse de ces fibres lors du processus de cicatrisation est inadéquate conduisant à des handicaps souvent sérieux chez les patients. Dans un premier travail, la réalisation d’une brûlure chez des animaux présentant ou non une neuropathie périphérique induite par la résinifératoxine a permis d’étudier le rôle de l’innervation lors de la cicatrisation. Chez les animaux traités, une cicatrisation plus lente et un défaut de réinnervation par rapport aux animaux contrôles étaient observés. Pour approfondir le rôle de l’innervation dans la cicatrisation, des études in vitro ont ensuite été réalisées afin d’évaluer les interactions possibles entre les cellules neuronales et les fibroblastes dermiques. Même en l’absence de contacts directs, il a été montré que les cellules neuronales sont capables d’induire la différenciation des fibroblastes en myofibroblastes. Au vue de l’implication de l’innervation sur la différenciation des fibroblastes et sur la cicatrisation, il semble important de pouvoir proposer aux patients brûlés, pour leur traitement, un nouveau concept de substitut cutané favorisant une repousse axonale fonctionnelle au sein du tissu cicatriciel. / The skin is a sensitive organ which notably allows the body to adapt to its environment. Many nerve fibers are present in the skin and are implicated in the detection of various stimuli such as pressure, pain or temperature variation. After a deep burn injury, these nerve fibers are destroyed and their regrowth during the wound healing process is imperfect which induces serious disabilities for patients. In a first study, a burn model was developed on animals presenting or not a peripheral neuropathy induced with resiniferatoxin and had allowed to study the role of sensory innervation on wound healing. On animals treated with resiniferatoxin, wound healing was delayed and nerve regeneration was imperfect compared to control animals. To further investigate the role of innervation in wound healing, in vitro studies were then performed to evaluate possible interactions between neuronal cells and dermal fibroblasts. Even in the absence of direct contacts, it has been shown that neuronal cells are able to induce the differentiation of fibroblasts into myofibroblasts. Considering the involvement of innervation on the differentiation of fibroblasts and on wound healing, it seems important to provide burned patients with a new concept of skin substitute promoting functional axonal regrowth in the scar tissue.

Bakgrund: En svår brännskada innebär en djup hudskada där kroppens underliggande organ kan komma att påverkas vilket kan resultera i ett kritiskt tillstånd. Skadan kan ge konsekvenser som berör den fysiska, psykiska, sociala och existentiella hälsan. Då en svår brännskada bedöms utifrån varje enskilt fall utgår sjuksköterskans omvårdnadsinsatser från de olika konsekvenser som brännskadan medfört. Med sjuksköterskans holistiska förhållningssätt i omvårdnaden kan det identifieras olika aspekter och faktorer i patientens hälsotillstånd som denne upplever vara av ett lidande. Det är då av vikt att sjuksköterskan ser till patientens hälsorelaterade livskvalitet, då detta beskrivs som ett subjektivt mått på hälsa och utgör således patientens unika upplevelser av sitt välbefinnande. Syfte: Att beskriva den hälsorelaterade livskvaliteten hos vuxna personer efter en svår brännskada. Metod: En litteraturöversikt har gjorts enligt Fribergs analysmetod. Tio vetenskapliga artiklar har valts ut med samtliga bestående av kvantitativ design. Artiklarna har sökts fram i databaserna CINAHL Complete och PubMed. Som en teoretisk utgångspunkt har Katie Erikssons omvårdnadsteori valts ut och använts som en referensram i resultatdiskussionen. Resultat: Tre huvudteman med underteman har identifierats: fysiska aspekter av livskvalitet med underteman ”smärta och rörelseförmåga” och “faktorer som påverkar den fysiska livskvaliteten”, psykosociala aspekter av livskvalitet med underteman “psykisk ohälsa” och “faktorer som påverkar den psykosociala livskvaliteten” samt generella aspekter av livskvalitet med underteman “sjukhustiden, vårdinsatser och tid sedan skadetillfället” och “ålder/kön”. Diskussion: I metoddiskussionen har författarna diskuterat för- och nackdelar med utförandet av denna litteraturöversikt. I resultatdiskussionen har det diskuterats de resultat som har varit mest intresseväckande hos författarna. Dessa har diskuterats utifrån Katie Erikssons omvårdnadsteori, litteraturöversiktens bakgrund och tidigare forskning. / Background: A severe burn is defined as a deep dermal damage in which the body's underlying organs can become affected and can result in a critical condition. The consequences of a burn can affect the physical, psychological, social and existential health. Since a severe burn is evaluated on a case to case basis, the nurse's caring interventions are based on the specific consequences from the burn. With the nurse's holistic approach on caring, he/she can identify different aspects and factors in the patient’s general health of which the patient experiences as suffering. Therefore it is of great importance that the nurse cares for the patient's health-related quality of life, since this is described as a subjective measurement of health and compounds the patient’s unique experiences of his/her wellbeing. Aim: To describe the health-related quality of life among adults with a severe burn injury. Method: A literature review was done in accordance with the Friberg analytical method. Ten scientific articles were selected, all of which consisted of a quantitative design. The articles were found in the CINAHL Complete and PubMed databases. As a theoretical base, Katie Eriksson’s caring theory was selected and used as framework in the results discussion. Results: Three main themes with subthemes were identified; physical aspects of quality of life with subthemes “pain and movement capability” and “factors that affect the physical quality of life”, psychosocial aspects of quality of life” with subthemes “psychological ill-health” and “factors that affect the psychosocial quality of life” and general aspects of quality of life with subthemes “length of hospital stay, caring interventions and time since injury” and “age/gender”. Discussion: In the method discussion the authors have discussed the pros and cons of the execution of this literature review. In the results discussion, the results that were of greater interest to the authors have been discussed, in accordance with Katie Eriksson's caring theory as well as the background in this literature review and previous research.

The diploma thesis is concerned with the burnout syndrome in the case of teachers at elementary schools in Prague. The main target is to define the rate of burnout among teachers according to the grade of the school, level of education and the length of their practice. Also their sex and age were evaluated. The thesis is divided into two parts. The theoretical part deals with the specifics of teachers' profession with their extra requirements. There is drawn a comparison between the teachers at the 1st and the 2nd grade focused on the difficulty of their profession connected to the burnout syndrome. There are also defined the stressful situations which influent the burnout syndrome. The problem of burnout syndrome is described in general and aimed at the teachers, too. The practical part contents the empirical research of data obtained from the written questionnaire - quantitative method. The data were processed and analysed with a computer programme. I checked the result reliance on sex, age, level of education, length of practice and the grade of the school where the teacher affects. I compared my results with specialized literature. The results of the research have shown that the burnout syndrome is influenced by sex, level of education and the grade of the school. On the other hand it is not...