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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 Sao 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.

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 Ribeirao Preto, State of Sao 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.

The incidence of skin cancer after liver transplant ranges from 3% to 16%, considerably higher than that observed in the general population. Skin cancer causes 25% of deaths in patients who have survived more than 3 years after liver transplant. The objective of this study was to identify differences regarding the level of sun exposure, knowledge of potential risk factors, and photoprotection measures among liver transplant candidates and recipients. We carried out a prospective cross-sectional study with 100 patients enrolled at a liver transplant program in a Brazilian center. The patients were interviewed and received oral information regarding skin care and sun exposure. Results reveal that measures of photoprotection and photoeducation are more prevalent among recipients than among candidates. High degrees of solar exposure were observed more frequently among candidates, although recipients showed better knowledge about the risks of sun exposure. Educational actions concerning skin cancer prevention should be part of the guidelines given by the multidisciplinary team to the liver transplant patients, in particular, by the nursing team.

RESUMO Objetivo Avaliar as necessidades de informação do cuidador familiar de candidatos, que aguardam em fila de espera a realização do transplante de fígado. Métodos Trata-se de estudo transversal, realizado em centro transplantador do interior paulista, no período de abril a outubro de 2012. Para a avaliação das necessidades de informação foi utilizado instrumento submetido à validade de face e conteúdo, o cuidador ordenou por importância, 10 assuntos que gostaria de aprender antes da realização do transplante pelo seu ente familiar, além do registro das características sociodemográficas. Para análise dos dados, utilizou-se a estatística descritiva. Resultados Participaram do estudo 42 familiares. As necessidades de informação sobre complicações da doença do fígado, complicações após o transplante e cuidados necessários no pós-operatório obtiveram maiores médias. Conclusões Conhecer as necessidades de informação dos cuidadores é relevante para planejar estratégias de ensino-aprendizagem, visando a melhoria da assistência aos pacientes e familiares em programas de transplantes. RESUMEN Objetivo Evaluar las necesidades de información de los cuidadores familiares delos candidatos en la lista de espera para trasplante hepático. Método Se trata de un estudio transversal realizado en el centro de trasplante en São Paulo, de abril a octubre de 2012. Para evaluar las necesidades de información, se aplicó un cuestionario sometido a la validación de apariencia y contenido y pedimos la orden de la familia por orden de importancia, los 10 temas que le gustaría aprender antes de un trasplante de hígado para su único familiar, así como el registro de las características socio-demográficas. Para el análisis de datos, se utilizó la estadística descriptiva. Resultados Se recogieron datos de 42 familias. Las necesidades de información de las complicaciones de la enfermedad hepática, complicaciones después del trasplante y el cuidado necesario después de la cirugía fueron las que tuvieron el mayor promedio. Conclusión El conocimiento de las necesidades de información de los cuidadores es valioso para la planificación de estrategias para la enseñanza y el aprendizaje, con el fin de mejorar la atención al paciente y la familia en los programas de trasplantes de órganos. ABSTRACT Objective To assess the information needs of family caregivers of candidates on the waiting list for a liver transplant. Methods It is a cross-sectional study conducted in a transplant center in São Paulo State in the period between April and October of 2012. For the assessment of information needed, an instrument submitted to face and content value was used. The caregivers put 10 subjects in order according to their importance and the amount of interest they had in learning about each, prior to the transplant their family member would be subjected to. Sociodemographic characteristics were also recorded. For data analysis, descriptive statistics were used. Results 42 families participated in the study. The information need about liver disease complications, complications after transplantation and care needed after surgery had higher averages. Conclusions Knowing the information needs of caregivers is important to plan teaching-learning strategies aimed at improving assistance to patients and families in transplant programs.

O transplante de fígado é considerado um dos procedimentos mais complexos da medicina moderna. O ensino do paciente é relevante no contexto da saúde e pode contribuir para o sucesso do tratamento. Dentre as atividades do enfermeiro, ressalta-se o papel de educador. No período pós-operatório de transplante de fígado, este profissional deve implementar intervenções educativas direcionadas para o preparo do paciente no enfrentamento das mudanças no estilo de vida, decorrentes de procedimento cirúrgico complexo. Para tal, o primeiro passo consiste no conhecimento das necessidades de informação indicadas pelos receptores de transplante de fígado. O objetivo geral do estudo foi avaliar as necessidades de informação de receptores de transplante de fígado em atendimento ambulatorial em hospital público. A amostra foi composta por 92 receptores de transplante de fígado atendidos em ambulatório de hospital público do interior do Estado de São Paulo. A coleta de dados ocorreu no período de fevereiro a junho de 2014, por meio da aplicação de instrumento adaptado. Os principais resultados da pesquisa indicaram que a maioria dos receptores de transplante de fígado era do sexo masculino (77,17%) e casada (76,09%). A idade média foi de 54,48 anos, a média de anos de estudo foi de 9,02 anos, sendo 70,65% dos receptores moradores na zona urbana. Dos 92 participantes, 46,74% estavam aposentados e 26,09%, afastados de suas atividades laborais e 36,96%, com renda familiar entre dois e três salários-mínimos. Em relação às características clínicas, observou-se que 47,83% dos receptores eram do grupo sanguíneo tipo O, 72,83% tinham escore MELD entre 20 e 29 pontos, 41,30% estavam com cirrose de etiologia viral (B ou C). Dos 92 pacientes, 45,65% tinham IMC entre 18,50 e 24,99 Kg/m2 (peso normal) e 33,70% estavam acima de 25 Kg/m2 (sobrepeso). A média de dias após o transplante foi de 1.508,85 dias, o tacrolimus era empregado como terapia medicamentosa de imunossupressão principal em 36,96% dos receptores e era associado ao micofenolato sódico em 38,04% dos pacientes. As necessidades de informação que obtiveram as médias maiores foram: sugestão de assunto no 3 (média 5,35) refere- se aos sinais e sintomas de complicações (rejeição, infecção, diabetes, hipertensão arterial, entre outras) agrupada na categoria manejo das potenciais complicações; sugestão no 2 (média 5,29) relativa aos efeitos colaterais e cuidados sobre medicamentos (categoria manejo dos medicamentos) e sugestão no 14, alimentação segura após o transplante (média 4,53), também agrupada na categoria manejo das potenciais complicações. Os resultados evidenciados oferecem subsídios sobre o perfil sociodemográfico e clínico de receptores de transplante de fígado na realidade nacional, bem como das necessidades de informação, as quais podem auxiliar o planejamento de intervenções educativas direcionadas para o processo de transplante de fígado, para principalmente melhorar a qualidade da assistência, a adesão ao tratamento e a prevenção de complicações após o transplante Liver transplantation is considered one of the most complex procedures in modern medicine. The patient education is relevant in the context of health and may contribute to the success of treatment. Among the activities of nurses, the role of educator is highlighted. In the postoperative period of liver transplantation, this professional must implement educational interventions directed to the preparation of the patient in coping with changes in lifestyle resulting from complex surgical procedure. For this, the first step consists in the identification of information needs indicated by liver transplant recipients. This study aimed to assess the information needs of liver transplant recipients in outpatient treatment at a public hospital. The sample consisted of 92 liver transplant recipients assisted in outpatient clinic at a public hospital in the state of São Paulo. Data collection was performed from February to June 2014, through the application of the adapted instrument. The main results indicated that most liver transplant recipients were male (77.17%) and married (76.09%). The average age was 54.48 years, the average years of schooling was 9.02; and 70.65% of recipients lived in the urban area. Of the 92 participants, 46.74% were retired, 26.09% were on leave from work and 36.96% had incomes between two and three minimum wages. Regarding clinical characteristics, 47.83% of recipients were type O blood group, 72.83% had MELD scores between 20 and 29 score points, and 41.30% had cirrhosis of viral etiology (B or C). Of the 92 patients, 45.65% had a BMI between 18.50 to 24.99 Kg/m2 (normal weight) and 33.70% greater than 25 Kg/m2 (overweight). Average days after the transplantation was 1508.85 days, the tacrolimus was used as the primary immunosuppression drug therapy in 36.96% of the recipients, and associated with mycophenolate sodium in 38.04% of the patients. Information needs with the highest averages were: suggestion of topic no 3 (5.35) which refers to the signs and symptoms of complications (rejection, infection, diabetes, hypertension, etc.), grouped in the category management of potential complications; suggestion no 2 (5.29) related to the side effects and care of medicines (category management of medicines); and suggestion no 14, safe food after transplantation (4.53), also grouped in the category management of potential complications. The results show subsidies on the sociodemographic and clinical profile of liver transplant recipients in the national reality and the information needs which may assist the planning of educational interventions directed to the process of liver transplantation, mainly aiming to improve quality of care, adherence to treatment and prevention of complications after transplantation

A necessidade de informação é definida como a deficiência de informação ou habilidade relacionada a um domínio de vida relevante para o paciente. O objetivo do presente estudo foi identificar as necessidades de informação de candidatos em fila de espera para o transplante de fígado. Trata-se de estudo descritivo, conduzido em centro transplantador brasileiro do interior paulista. A amostra foi constituída de 55 pacientes, e a coleta de dados foi realizada nos meses de março a junho de 2009. Os resultados evidenciaram que as necessidades de informação do período pré-operatório foram as que obtiveram pontuações médias maiores. O conhecimento de informações que o candidato ao transplante de fígado precisa é relevante para o planejamento do processo ensino-aprendizagem. La necesidad de información se define como la carencia de información o habilidades relacionadas con un dominio de la vida relevante para el paciente. El objetivo de este estudio fue identificar las necesidades de información de candidatos en lista de espera para el trasplante de hígado. El diseño del estudio es de una investigación descriptiva, llevado a cabo en un centro de trasplante en São Paulo - Brasil. La muestra abarcó a 55 pacientes y los datos fueron recolectados entre marzo y junio del 2009. Los resultados mostraron mayor puntuación promedio para las necesidades de información del periodo preoperatorio. El conocimiento de informaciones que el candidato a trasplante de hígado necesita es importante para planificar el proceso de enseñanza-aprendizaje. 'Information need' is defined as a deficiency of information or skill related to a domain of life that is relevant to the patient. This study's objective was to identify the information needs of candidates on the waiting list for a liver transplant. This is a descriptive study and was conducted at a transplant center in the State of São Paulo - Brazil. The sample consisted of 55 patients and data were collected from March to June 2009. The results showed higher average scores for information needs concerning the preoperative period. Identifying the information needs of liver transplant candidates is important to planning the teaching-learning process.

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 Sao 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.

'Information need' is defined as a deficiency of information or skill related to a domain of life that is relevant to the patient. This study's objective was to identify the information needs of candidates on the waiting list for a liver transplant. This is a descriptive study and was conducted at a transplant center in the State of São Paulo-Brazil. The sample consisted of 55 patients and data were collected from March to June 2009. The results showed higher average scores for information needs concerning the preoperativeperiod. Identifying the information needs of liver transplant candidates is important to planning the teaching-learning process.

Self-efficacy is defined as one's belief that one can perform the necessary behaviors to achieve one's goals. This belief is one of the most powerful motivational predictors of how well a person will perform at almost any endeavor. Limited information is available, however, about self-efficacy in the organ transplantation population. This study aimed to identify the self-efficacy belief among liver transplant candidates and recipients and compare these results with demographic characteristics. The authors analyzed 100 patients who were candidates and recipients for liver transplantation in a Brazilian center. The average self-efficacy score for the candidates was significantly lower than for the recipients. Future investigation is necessary to explore possible interventions to be taken before and after liver transplantation that could influence self-efficacy of the organ transplantation patients.

OBJETIVO: El objetivo del estudio fue analizar el conocimiento de candidatos sobre el proceso de trasplante de hígado, antes y después de la implementación de una intervención educativa. MÉTODO: Se trata de un estudio con diseño casi experimental, del tipo grupo único, antes y después. La muestra final abarcó a 15 sujetos. La recolecta de datos de la investigación, con duración de enero a marzo del 2010, fue llevada a cabo en tres etapas, que son: pre-test, implementación de la intervención educativa (dos encuentros) y post-test. RESULTADOS: Los resultados evidenciaron ganancia cognitiva significativa tras la intervención, con mejora en el desempeño de los participantes. CONCLUSIONES: El estudio evidencia que la implementación de una estrategia dirigida a la educación del paciente puede aumentar el conocimiento de candidatos sobre el proceso de trasplante de hígado y consecuentemente contribuir al éxito del tratamiento. OBJETIVO: o estudo teve como objetivo analisar o conhecimento de candidatos sobre o processo de transplante de fígado, antes e depois da implementação de intervenção educativa. MÉTODOS: trata-se de estudo com delineamento de pesquisa quase-experimental, do tipo grupo único, antes e depois. A amostra final foi composta por 15 sujeitos. A coleta de dados da investigação, cuja duração foi de janeiro a março de 2010, ocorreu em três etapas, a saber: pré-teste, implementação da intervenção educativa (dois encontros) e pós-teste. RESULTADOS: os resultados evidenciaram ganho cognitivo significativo após a intervenção, com melhora no desempenho dos participantes. CONCLUSÕES: o estudo traz evidências de que a implementação de estratégia direcionada para educação de paciente pode aumentar o conhecimento de candidatos sobre o processo de transplante de fígado e, consequentemente, contribuir para o sucesso do tratamento. OBJECTIVE: The objective in this study was to analyze candidates' knowledge on the liver transplantation process before and after putting in practice an educational intervention. METHOD: A quasi-experimental, one-group pretest-posttest research design was adopted. The final sample included 15 subjects. Research data were collected between January and March 2010 in three phases, which were: pretest, implementation of the educational intervention (two meetings) and posttest. RESULTS: The results evidenced significant cognitive gains after the intervention, with improvements in the participants' performance . CONCLUSIONS: The research presents evidence that putting in practice a patient education strategy can enhance candidates' knowledge on the liver transplantation process and consequently contribute to a successful treatment.