Análise acústica da voz: comparação entre dois tipos de microfones / Acoustic voice analysis: comparison between two types of microphones

RESUMO Objetivo Comparar os valores das medidas acústicas da voz, extraídas de gravações vocais realizadas com dois tipos de microfones. Métodos Participaram da pesquisa 103 pessoas do sexo feminino, com idades entre 18 e 54 anos. Foram coletadas amostras da vogal sustentada /e/, captadas por dois microfones, simultaneamente: Shure SM58 e Karsect HT-9. Foi realizada a análise acústica das vozes, com a extração de valores de frequência fundamental (F0), variação da frequência (Jitter) e variação de amplitude dos segmentos fundamentais da voz (Shimmer) e proporção Glottal to Noise Excitation (GNE). Resultados Houve diferenças entre os microfones apenas na medida de Shimmer, com predomínio de valores mais altos captados pelo Karsect HT-9. Porém, os resultados de ambos os microfones estiveram dentro dos padrões de normalidade do software utilizado. Conclusão Os resultados da análise acústica extraídos a partir da gravação de voz realizada com os microfones Shure SM58 e Karsect HT-9 foram semelhantes, concluindo-se que ambos os microfones podem ser utilizados para gravação do sinal sonoro na análise acústica.

ABSTRACT Purpose To compare acoustic measurements of voice recorded by two types of microphones. Methods The study counted with 103 women from 18 to 54 years old. The recorded sample was the sustained vowel /ɛ/. The acoustic signal was picked up simultaneously by two unidirectional microphones: the Shure SM58 and the Karsect HT-9. The acoustic analysis was performed on these edited vocal samples. The measured parameters were F0, Jitter, Shimmer and Glottal to Noise Excitation (GNE) ratio. Results Recurrent differences between the microphones were observed only in Shimmer measurement (p=0.026); the Karsect HT-9 presented higher values. However, the acoustic measures were within the normal range for healthy voices, despite of the microphone used. Conclusion The acoustic analysis results extracted from the voice recording performed with the Shure SM58 and the Karsect HT-9 microphones were similar. Hence, it can be deduced that, connected to a high-quality interface, both microphones can be used in the acoustic analysis to record the sound signal.

Perspectivas otimistas na comunicação de notícias difíceis sobre a formação fetal / Optimistic perspectives in communicating difficult news on fetal development / Perspectivas optimistas en la comunicación de noticias difíciles sobre la formación fetal

A comunicação de notícias diagnósticas em contextos de saúde é um evento potencialmente impactante para todos os envolvidos. Contudo, apesar de constante no contexto médico-paciente, essa tarefa ainda é escassamente tratada na formação clínica. Assim, os objetivos deste estudo foram os de descrever e avaliar como as notícias difíceis podem ser comunicadas de forma mais abrandada em casos de síndromes e/ou de malformações fetais em consultas de aconselhamento genético. Para isso, foram analisadas 33 interações naturalísticas (i.e. situações reais de consultas), gravadas e transcritas, pela perspectiva teórica e metodológica da Análise da Conversa de base etnometodológica. Essas interações consistiram em consultas da genética clínica com gestantes atendidas em um serviço de medicina fetal de um hospital materno-infantil de referência do Sistema Único de Saúde (SUS). A análise evidenciou que a entrega de notícias difíceis pode ser acompanhada por perspectivas otimistas escalonadas conforme a gravidade de cada situação. Na ausência de diagnóstico, o fechamento das consultas pode ser realizado com aspectos positivos, como recomendações de cuidados paliativos, de forma que a paciente sempre saia da consulta com algum tipo de recomendação. Propõe-se, com este estudo, inovar e alargar o escopo de estudos sobre a comunicação de notícias difíceis na relação médico-paciente no Brasil, justamente ao desenvolver uma análise de interações reais de atendimento e, assim, prover subsídios interacionais para a formação de profissionais da saúde que têm essa tarefa em sua rotina.

Communicating diagnostic news in health contexts is a potentially difficult event for all parties involved. However, despite this task's presence in the physician-patient context, it is rarely addressed during clinical training. The current study thus aimed to describe and evaluate how difficult news can be toned down during genetic counseling sessions involving cases of fetal syndromes and/or malformations. The study analyzed 33 naturalistic interactions (i.e. real situations), taped and transcribed, according to the theoretical and methodological perspective of Conversation Analysis, with an ethnomethodological basis. These interactions consisted of sessions in clinical genetics with pregnant women seen at the fetal medicine service of a reference hospital for maternal and child health in the Brazilian Unified National Health System (SUS). The analysis showed that communicating difficult news can be accompanied by optimistic perspectives that are scaled-up according to each situation's severity. In the absence of a positive diagnosis, the appointments can conclude with positive aspects such as recommendations for palliative care, so that the patient always leaves the appointment with some kind of recommendation. This study proposes to innovate and expand the scope of studies on communicating difficult news in the physician-patient relationship in Brazil, precisely by developing an analysis of real interactions in genetic counseling and thus providing interactional backing for training health professionals that deal with this challenge in their routine work.

La comunicación de noticias diagnósticas en contextos de salud es un evento potencialmente impactante para todos los involucrados. No obstante, a pesar de ser constante en el contexto médico-paciente, esta tarea todavía es escasamente tratada en la formación clínica. Por ello, los objetivos de este estudio fueron los de describir y evaluar cómo las noticias difíciles pueden ser comunicadas de una forma más mitigada, en casos de síndromes y/o de malformaciones fetales en consultas de asesoramiento genético. Para este fin, se analizaron 33 interacciones naturales (p.ej. situaciones reales de consultas), grabadas y transcritas, mediante la perspectiva teórica y metodológica del Análisis de la Conversación con base etnometodológica. Estas interacciones consistieron en consultas de genética clínica con gestantes atendidas en un servicio de medicina fetal de un hospital materno-infantil de referencia, perteneciente al Sistema Único de Salud brasileño (SUS). El análisis evidenció que la comunicación de noticias difíciles puede ser acompañada de perspectivas optimistas escalonadas, conforme la gravedad de cada situación. En ausencia de diagnóstico, el final de las consultas puede realizarse con aspectos positivos, como recomendaciones de cuidados paliativos, de forma que el paciente siempre salga de la consulta con algún tipo de recomendación. Se propone, con este estudio, innovar y alargar el alcance de estudios sobre la comunicación de noticias difíciles, en la relación médico-paciente en Brasil, justamente al desarrollar un análisis de interacciones reales de atención y, así, proveer ayudas para la formación de profesionales de la salud que tiene esa tarea como parte de su rutina.

Grounded Theoretical Analysis on the Hospital Accreditation Experience of Head Nurses in General Hospitals / 간호행정학회지

PURPOSE: The purpose of this study was to conduct a grounded theoretical analysis on the hospital accreditation experience of head nurses in order to understand their behavior on the adaption of this new system. METHODS: The participants were 8 head nurses with more than 3 years of experience. The data were collected through in-depth interviews using audiotape recording analyzed by the constant comparative method described in Strauss and Corbin's methodology. RESULTS: There were 113 concepts, 26 subcategories and 12 categories identified through the open coding process. In the axial coding, the following paradigm model was proposed: 1) the causal conditions were ‘hardware problem’ and ‘software problem’, 2) the contextual conditions were ‘vertical relationship’, ‘individual preference’, and ‘family support’, 3) the intervening conditions were ‘passive conditions’ and ‘active conditions’, 4) the action/interaction strategies were ‘leading role’ and ‘dependent role’, 5) the consequences were ‘positive acceptance’ and ‘negative acceptance’, 6) the central phenomenon was ‘difficult situation’ and 7) the core category was ‘leading in harmony’. CONCLUSION: The new system led head nurses having difficulties as the middleman between the hospital administration and general nurses, but they made a continuous effort to overcome and adapt to it through a number of strategies.

The effects of unrelated offspring whistle calls on capybaras (Hydrochoerus hydrochaeris) / Os efeitos do chamado de assobio de filhotes não aparentados em capivaras (Hydrochoerus hydrochaeris)

Parent-offspring vocal communication, such as the isolation call, is one of the essential adaptations in mammals that adjust parental responsiveness. Thus, our aim was to test the hypothesis that the function of the capybara infants' whistle is to attract conspecifics. We designed a playback experiment to investigate the reaction of 20 adult capybaras (seven males and 13 females) to pups' whistle calls – recorded from unrelated offspring – or to bird song, as control. The adult capybaras promptly responded to playback of unrelated pup whistles, while ignoring the bird vocalisation. The adult capybaras took, on average, 2.6 ± 2.5 seconds (s) to show a response to the whistles, with no differences between males and females. However, females look longer (17.0 ± 12.9 s) than males (3.0 ± 7.2 s) toward the sound source when playing the pups' whistle playback. The females also tended to approach the playback source, while males showed just a momentary interruption of ongoing behaviour (feeding). Our results suggest that capybara pups' whistles function as the isolation call in this species, but gender influences the intensity of the response.

A comunicação vocal entre pais-filhotes, tal como os chamados de isolamento, é uma das adaptações essenciais nos mamíferos para o ajuste da resposta parental. Assim, nosso objetivo foi testar a hipótese de que a função do chamado de assobio em filhotes de capivara é para atrair co-especificos. Delineamos um experimento via playback para investigar a reação de 20 capivaras adultas (sete machos e 13 fêmeas) ao chamado de assobio de filhotes não aparentados e como controle usamos o chamado de um pássaro. As capivaras adultas prontamente responderam ao playback de assobios de filhotes não aparentados, enquanto ignoraram as vocalizações de pássaro. As capivaras levaram, em media 2,6 ± 2,5 segundos (s) para mostrar a resposta para os assobios, não havendo diferença entre machos e fêmeas. No entanto, fêmeas permanecem mais tempo (17,0 ± 12,9 s) do que os machos (3,0 ± 7,2 s) para retornar da fonte sonora após o playback de assobio iniciar. As fêmeas também tendem a aproximar-se da fonte sonora, enquanto os machos fazem uma breve interrupção do comportamento que estão engajados (comendo). Os resultados sugerem que a função do chamado de assobio de filhotes de capivaras é um chamado de isolamento na espécie e que o gênero influencia a intensidade da resposta.

Representations of nurses regarding sexuality of women treated for breast cancer in Brazil / Representações das enfermeiras sobre a sexualidade de mulheres tratadas de câncer de mama / Concepciones de enfermeras sobre la sexualidad de las mujeres tratadas por cáncer de mama

The development of new treatments has improved survival and quality of life among cancer patients. Nurses are expected to answer questions and to provide orientation regarding patients' sexuality since it is an important aspect of life. The main objective of this paper is to understand the representations of sexuality among nurses working with women who survive breast cancer after diagnosis and during treatment assuming that their representations may affect communication with the patient. This is a qualitative study using an in-depth guideline which involved interviews with 28 nurses living and working in the southeast of Brazil. The narratives were submitted to a content analysis and categories of representations were identified and are discussed here. Several representations of sexuality were found in the nurses' discourses. Some of the nurses' representations may be expected to hinder their ability to provide helpful orientation regarding the sexual lives of these patients.

O desenvolvimento de novos tratamentos melhorou a sobrevivência e a qualidade de vida dos pacientes de câncer. Espera-se que as enfermeiras forneçam orientações sobre a sexualidade dos pacientes, considerada importante aspecto da vida. O principal objetivo deste artigo é compreender as representações da sexualidade entre as enfermeiras que trabalham com as mulheres sobreviventes ao câncer de mama depois do diagnóstico e durante o tratamento, considerando que estas representações possam afetar a comunicação com o paciente. Este é um estudo qualitativo que entrevistou 28 enfermeiras que vivem e trabalham no Sudeste do Brasil. As narrativas foram submetidas à análise de conteúdo e as categorias das representações foram identificadas e discutidas. Várias representações sobre sexualidade foram encontradas nos discursos das enfermeiras. Algumas delas podem ocultar a habilidade de transmitir orientação em relação à vida sexual desses pacientes.

El desarrollo de nuevos tratamientos mejoró la supervivencia y la calidad de vida de los pacientes con cáncer. El estudio analiza las orientaciones que proporcionan las enfermeras sobre sexualidad a las pacientes, puesto que se considera un importante aspecto de la vida. El principal objetivo de este artículo es comprender las concepciones sobre sexualidad entre las enfermeras que trabajan con mujeres que han superado un cáncer de mama, después del diagnóstico y durante el tratamiento, considerando que estas concepciones pueden afectar la comunicación con el paciente. Este es un estudio cualitativo que entrevistó a 28 enfermeras que viven y trabajan en el sureste de Brasil. Las narraciones fueron sometidas a un análisis de contenido y se identificaron y discutieron las categorías de las concepciones. Se encontraron varias concepciones sobre sexualidad en los relatos de las enfermeras. Algunas de ellas pueden ocultar su habilidad para transmitir orientaciones relacionadas con la vida sexual de estas pacientes.

Hospital Workers' Experience with Hospital Evaluation Program: A Focus Group Study

PURPOSE: The purpose of the study was to understand and describe the hospital workers' experience related to the hospital evaluation program implemented in Korea between 2004 and 2009. METHODS: During 2010, data were collected using focus group interviews. Four focus group interviews were held with a total of 28 hospital workers participating. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis. RESULTS: Nine themes emerged from the analysis: 1) Positive change in the necessity of the evaluation; 2) Improvement in the hospital system, facilities, and human resources; 3) Unity through cooperation among departments; 4) Nursing work overload; 5) Lack of physicians' awareness and responsibilities; 6) Unfair and unrealistic evaluation items; 7) Lack of credibility of the outcome; 8) Shifting responsibility for negative outcomes to the workers; 9) Lack of pragmatic utility. CONCLUSION: The results of the study demonstrate that the hospital evaluation program played a key role in improving some work environments and communication among departments. At the same time, they show various negative themes resulting from the context of very authoritarian hospital systems and a connection-oriented society in Korea.

Recollections of learning-disabled adolescents of their schooling experiences : A qualitative study.

Background: Little is known about the actual impact of the schooling experience on adolescents with specific learning disability (SpLD). Aims: To analyze the recollections of adolescents with SpLD who were undergoing education in regular mainstream schools. Settings And Design: Prospective interview-based study conducted in our clinic. Materials And Methods: Adolescents' responses to a semi-structured interview were audio-taped, transcribed verbatim and interpreted by content analysis. The number of participants was determined by 'saturation sampling,' resulting in a total of 30 adolescents. Results: Twelve (40%) adolescents had 'overall' neutral recollections, 9 (30%) had 'overall' positive recollections and 9 (30%) had 'overall' negative recollections about having SpLD during their schooling. Fourteen (46.7%) adolescents stated 'getting provisions' as good features, whereas 7 (23.3%) stated 'feeling different from classmates' and 6 (20%) stated 'being teased by classmates about their disability' as bad features of having SpLD. Nineteen (63.3%) adolescents remembered classroom teachers being supportive, while 7 (23.3%) remembered being insulted by them. Of the 21 adolescents who had undergone remedial education, only 10 (47.6%) acknowledged that it had benefited them. Twenty-one (70%) adolescents stated that availing provisions helped in getting better marks in examinations. Ten (33.3%) adolescents had negative recollections about their parents' behavior in relation to their disability. Twenty (66.7%) adolescents wanted changes in their school to help students with SpLD. Conclusion: Improving the knowledge of classroom teachers, classmates and family members about SpLD and about the rationale of provisions will help reduce the unpleasant experiences students with SpLD undergo during their schooling years.

Contribuições da Análise da Conversa para os estudos sobre o cuidado em saúde: reflexões a partir das atribuições feitas por pacientes / Contributions by Conversation Analysis to healthcare studies: reflections based on patients' attributions

Este estudo deriva de um projeto de pesquisa maior que investiga interações entre médicos e pacientes na saúde da mulher. Neste artigo, ao investigarmos dados naturalísticos, que consistem de 144 gravações, transcritas em sua íntegra, de interações face a face entre ginecologistas/obstetras e pacientes mulheres, propomos: (1) apresentar a abordagem teórico-analítica da Análise da Conversa aos estudos na área de saúde do Brasil; (2) refletir sobre como a Análise da Conversa pode revelar como questões macro (i.e., das Políticas Nacionais de Humanização) são traduzidas (ou não) para as práticas interacionais em nível mais micro (i.e., das relações interpessoais) e, assim, dar visibilidade às questões de linguagem e comunicação, apenas brevemente discutidas no Plano HumanizaSUS; e, finalmente, (3) analisar como um fenômeno interacional específico, o da "atribuição" (i.e., explicações voluntárias de pacientes sobre as causas de seus problemas de saúde e/ou sintomas), pode descrever práticas cotidianas concretas de humanização nos atendimentos à saúde.

This study is part of a larger research project aimed at investigating physician-patient interactions in women's health. In this article, by looking at naturalistic data, which consists of 144 fully transcribed audio recordings of face-to-face interactions between gynecologists/obstetricians and female patients, we propose to: (1) present the theoretical and methodological approach of Conversation Analysis to health studies in Brazil; (2) discuss how Conversation Analysis can reveal how "macro" questions (e.g. National Policy for the Humanization of Healthcare) are (or are not) translated into interactional practices at the "micro" level and, thus, emphasize the issues of language and communication, only briefly discussed in the HumanizaSUS documents; and (3) analyze how a specific interactional phenomenon, "attribution" (i.e. voluntary explanations about the possible causes of their problems), might describe ordinary and concrete humanization practices in healthcare services.

Healing Effects of the Forest Experience on Alcoholics

PURPOSE: The purpose of this study was to explore and describe healing effects of the forest on alcoholics through a forest experience program. METHODS: The qualitative data was gathered from one focus group discussion with 6 alcoholics and individual interviews with 8 alcoholics. They had all participated in a "healing forest" program. All interviews were recorded and transcribed according to thematic content analysis processes. RESULTS: The four main themes on the attributes of forest were "a lively living being", "placidity and tranquility", "acceptive atmosphere", and "beautifulness as it is" which revealed the participants' perceived nature of the forest which was attributed to the healing effects. Eight other themes on participants' positive changes included "revived senses", "aspired to live", "relieved and relaxed from being tense", "gaining insight on self", "having an acceptive attitude", "becoming compliant with his/her life", "learning that life is being together" and "recognizing the value of one's existence". CONCLUSION: The findings of the study illustrated the participants' self-healing processes through interactions with the nature of the forest. Nursing interventions utilizing healing atmospheres such as "healing forest" programs can be considered helpful in providing a venue to alcoholics to reflect on their lives affirmatively.

Influência da velocidade articulatória e da intensidade na inteligibilidade de fala / Influence of speech rate and loudness on speech intelligibility

TEMA: existem evidências de que as pistas contextuais intrínsecas aos estímulos de fala elevam os escores de inteligibilidade, entretanto, a influência de pistas dependentes do sinal acústico, como a velocidade e a intensidade com as quais os diferentes estímulos são produzidos, são pouco conhecidas. OBJETIVO: investigar se a redução da velocidade articulatória e o acréscimo da intensidade da fala, em diferentes tipos de estímulos, influenciariam os escores de inteligibilidade. MÉTODO: participaram do estudo 30 falantes e 60 ouvintes, todos sem distúrbios da comunicação. Os falantes foram gravados durante a repetição de três listas de estímulos (frases, palavras e pseudopalavras). As médias da velocidade articulatória (sílabas por segundo) e da intensidade da fala (decibel) foram calculadas por falante, para cada lista. A inteligibilidade foi mensurada pelo método de transcrição ortográfica das amostras pelos ouvintes, sendo os escores calculados em percentagem de palavras corretamente transcritas. RESULTADOS: diferenças estatisticamente significantes da velocidade articulatória foram encontradas entre os três tipos de estímulos, contudo, os estímulos produzidos com menor velocidade (pseudopalavras seguidas pelas palavras) não conduziram a escores superiores de inteligibilidade. Em relação à intensidade, apenas as pseudopalavras apresentaram valores estatisticamente superiores aos demais estímulos, porém este acréscimo também não elevou os escores de inteligibilidade da fala. CONCLUSÃO: nem a redução da velocidade articulatória nem o acréscimo da intensidade da fala influenciaram os escores de inteligibilidade dos sujeitos avaliados, sinalizando que as pistas contextuais exercem mais efeito sobre a inteligibilidade da fala que as informações independentes do sinal acústico.

BACKGROUND: contextual cues intrinsic to speech stimuli can have an influence on speech intelligibility measurements; however, the influence of cues that depend on the acoustic signal, such as speech rate and vocal loudness, need further investigation. AIM: to examine whether possible reductions in the articulatory rate and increase in vocal loudness, associated to the production of different speech stimuli, can have an influence on speech intelligibility measurements. METHOD: participants of this study were thirty normal speakers and sixty normal listeners. Speakers were recorded during the repetition of three lists of speech stimuli (sentences, words and pseudo words). The averages of the articulatory rate (syllables per second) and of the vocal loudness (decibel) were calculated for each speaker according to their performance in each repetition task. Speech intelligibility was measured based on the orthographic transcription of the speech samples; the score was calculated in terms of percentage of correctly transcribed words. RESULTS: it was observed that articulatory rates were statistically different between the three types of stimuli; however, the stimuli produced with the lowest articulatory rate (pseudo words followed by words) did not present higher speech intelligibility scores. Vocal loudness was statistically higher during the repetition of pseudo words; however, this increase did not have an influence on the speech intelligibility scores. CONCLUSION: the reduction of the articulatory rate or the increase of vocal loudness did not have an influence on the speech intelligibility measurements, indicating that contextual cues have a greater impact on speech intelligibility than the independent cues given by the acoustic signal.

Being a nurse after having been a nursing student-worker: an approach of social phenomenology / Ser enfermeiro tendo sido estudante-trabalhador de enfermagem: um enfoque da fenomenologia social

OBJECTIVE: To understand the transition from being a nurse after having been a nursing student-worker in the face-to-face relationship with other nurses from conventional graduation. METHODS: This is a study using qualitative approach founded on the Phenomenological Sociology proposed by Alfred Schutz. Fifteen interviews were carried out, of which eight were performed with nursing student-workers, and seven with nurses who underwent conventional graduation and held supervision or leader positions in nursing units. The reports were analyzed according to this theoretical-methodological framework. RESULTS: Being a nurse after having been a nursing student-worker in a world with other nurses means experiencing a transformation in not only one's everyday routines, but also one's inner being, behavior, and social relationship. CONCLUSIONS: There is a need for educational organizations and hospital institutions to invest in continuous education with a view to look carefully at nursing student-workers who are studying to become a nurse.

OBJETIVO: Compreender a transição de ser enfermeiro tendo sido estudante-trabalhador de enfermagem na relação face a face com outros enfermeiros de formação convencional. MÉTODOS: Estudo de abordagem qualitativa fundamentada na Sociologia Fenomenológica de Alfred Schutz. Foram realizadas 15 entrevistas, sendo oito com enfermeiros que foram estudantes-trabalhadores de enfermagem e sete com enfermeiros de formação convencional que exerciam supervisão ou chefia de unidades de enfermagem. Os discursos foram analisados segundo esse referencial teórico-metodológico. RESULTADOS: Ser enfermeiro tendo sido antes estudante-trabalhador de enfermagem em um mundo com outros enfermeiros significa vivenciar uma transformação não somente no seu fazer cotidiano, mas também transformar seu próprio meio interno, seu comportamento e relacionamento social. CONCLUSÕES: Há necessidade de investimento por parte dos órgãos formadores e da educação continuada das organizações hospitalares no sentido de um olhar atentivo para o estudante-trabalhador de enfermagem que está se formando enfermeiro.

OBJETIVO: Comprender la transición de ser enfermero habiendo sido estudiante-trabajador de enfermería en la relación frente a frente con otros enfermeros de formación convencional. MÉTODOS: Se trata de un estudio con abordaje cualitativo fundamentado en la Sociología Fenomenológica de Alfred Schutz. Se llevó a cabo 15 entrevistas, de las cuales ocho con enfermeros que fueron estudiantes-trabajadores de enfermería y siete con enfermeros de formación convencional que ejercían supervisión o jefatura de unidades de enfermería. Los discursos fueron analizados según ese referencial teórico-metodológico. RESULTADOS: Ser enfermero habiendo sido antes estudiante-trabajador de enfermería en un mundo con otros enfermeros significa vivenciar una transformación no sólo en su quehacer cotidiano, sino también en su propio medio interno, su comportamiento y relación social. CONCLUSIÓNS: Hay necesidad de inversión por parte de los órganos formadores y de la educación continuada de las organizaciones hospitalarias en el sentido de una mirada atenta al estudiante-trabajador de enfermería que se está formando como enfermero.

Hospital Nurses' Experience of Do-Not-Resuscitate in Korea / 간호학회지

PURPOSE: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. METHODS: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. RESULTS: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. CONCLUSION: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

A Phenomenological Study on the Experience of Hurt and Forgiveness of Clinical Nurses in Korea after Loss of Employment / 간호학회지

PURPOSE: The purpose of this study was to understand and analyze the experience of hurt and forgiveness of clinical nurses in Korea. METHODS: A phenomenological research method guided data collection and analysis. The subjects were a total of 5 nurses who had experienced hurt and forgiveness. Data was collected through individual in-depth interviews. All interviews were audio taped and transcribed verbatim. Coding was used to establish different concepts and categories. RESULTS: The following three common constituents have been found as a retrospective focus based on the primary hurt related to the clinical situation; recognizing their personal values, obtaining their view about forgiveness, as well as their view of self. CONCLUSION: The results of this study may contribute to health professionals working in various clinical settings to understand Korean nurses with hurt and forgiveness experiences.

A Grounded Theory Study on Women's Menopause Experiences / 기본간호학회지

PURPOSE: Purpose of this study was to explore the process of menopause experiences in middle-aged women. METHOD: The grounded theory methodology by Strauss & Corbin was the basis for this study. The participants were 15 middle-aged women selected by theoretical sampling. The data were collected by in-depth interviews using audiotape recording analyzed simultaneously by the constant comparative method described in Strauss and Corbin's methodology. RESULTS: Experiencerelated to menopause in middle-aged women is caused by cognition of the aging process, difficult problems in family that occur with limitation of social activity, and perception of changingseasons. The central incident of menopause in middle-aged women was loss of the woman's identity. Intervening conditions, which are action/interactional strategies for menopause, are related to social support. Action/interactional strategies related to menopause management included medical treatment, mind control, and participation in social activity. Experiencerelated to menopause in middle-aged women resulted in comfort or discomfot of physical and emotional condition. CONCLUSION: The findings of this study may contribute to the development health promotion strategy for middle-aged women. There is need to develop family support systems and preventive nursing interventions to avoid negative coping strategy.

A percepção do cliente em hemodiálise frente à fístula artério venosa em seu corpo / La percepición del cliente en hemodiálisis delante a la fístula arterío venosa en su cuerpo / The hemodyalisis client's perception about having an arteriovenous fistula

OBJETIVO: Identificar as percepções sensoriais dos clientes frente à fistula artério-venosa (FAV) e descrevê-las a partir dos sentidos sócio comunicantes do corpo. MÉTODOS: Aplicação de técnicas criativas durante sessão de hemodiálise com cinco pacientes. Foi pedido que desenhassem algo que representasse a presença da fístula artério-venosa e em seguida foram expostas seis gravuras, cada uma com um sentido corporal, sendo argüidos sobre sentimentos provocados pela fístula artério-venosa diante de cada sentido. Os depoimentos foram gravados em fita magnética. RESULTADOS: Com a aplicação das técnicas criativas foram apontados sentimentos como tristeza, amargura e dependência, advindos da presença da fístula artério-venosa e das abordagens no convívio social. CONCLUSÃO: Ao valorizar os sentidos do paciente no convívio com a FAV, o enfermeiro redimensiona o cuidado a ele prestado.

OBJECTIVE: To identify the sensorial perceptions of the patients towards the arteriovenous fistula and describe them from their social-communicating senses. METHODS: Creative techniques were performed during hemodialysis session with five patients. Participants were asked to draw something that represented having an arteriovenous fistula. After drawing, six pictures were displayed, each with a body sense, and patients were questioned about the feelings toward arteriovenous fistula for each of the senses. Their statements were recorded on magnetic tape. RESULTS: The creative techniques allowed for identifying feelings like sadness, bitterness, and dependence, caused by having an arteriovenous fistula and the approaches in social life. CONCLUSION: When valuing the patient's senses whilst living with an arteriovenous fistula, the nurse re-estimates the care that is delivered.

OBJETIVO: Identificar las percepciones sensoriales de los clientes frente a la fístula arteriovenosa (FAV) y describirlas a partir de los sentidos sóciocomunicantes del cuerpo. MÉTODOS: Aplicación de técnicas creativas durante la sesión de hemodiálisis con cinco pacientes. Fue pedido que dibujen algo que represente la presencia de la fístula arteriovenosa y a seguir que expusieran seis grabaciones, cada una con un sentido corporal, siendo examinados sobre los sentimientos provocados por la fístula arteriovenosa frente a cada sentido. Las declaraciones fueron grabadas en cinta magnética. RESULTADOS: Con la aplicación de las técnicas creativas se apuntaron sentimientos como tristeza, amargura y dependencia, generados por la presencia de la fístula arteriovenosa y de los abordajes en la convivencia social. CONCLUSIÓN: Al valorizar los sentidos del paciente en la convivencia con la FAV, el enfermero redimensiona el cuidado que presta.

Interactions between malaria workers and clinical malaria patients in Jepara District, Indonesia.

In a one-year longitudinal study of all clinical malaria cases treated by the Village Malaria Workers (VMWs) during 1999-2000, data on health-seeking behavior during a seven-day illness period were collected using a diary; 24 interactions were audiotaped. The results showed that 87% of cases had been treated by the VMWs on day four of the illness period. On day two, the percentage not treated was significantly higher in male as compared with female cases (p = 0.01) and in those below 15 years of age as compared with those 15 years and older (p < 0.001). "Not doing anything" and "using VMWs only" were the two most common actions. Interactions between the VMWs and the patients focused on medical tasks, and low compliance with treatment was a common concern of the VMWs. The concept of preventive measures and the role of mosquitoes were lacking in the interactions.

A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients.

Pain is not the sole reason for fear of dentistry. Anxiety or the fear of unknown during dental treatment is a major factor and it has been the major concern for dentists for a long time. Therefore, the main aim of this study was to evaluate and compare the two distraction techniques, viz, audio distraction and audiovisual distraction, in management of anxious pediatric dental patients. Sixty children aged between 4-8 years were divided into three groups. Each child had four dental visits--screening visit, prophylaxis visit, cavity preparation and restoration visit, and extraction visit. Child's anxiety level in each visit was assessed using a combination of four measures: Venham's picture test, Venham's rating of clinical anxiety, pulse rate, and oxygen saturation. The values obtained were tabulated and subjected to statistical analysis. It was concluded that audiovisual distraction technique was more effective in managing anxious pediatric dental patient as compared to audio distraction technique.

Functional Phases and Patterns of Dialogue Sequence in Nurse-Patient Conversation about Medication / 간호학회지

PURPOSE: Effective communication is an essential aspect of nursing care. This qualitative study was performed to analyze nurse-patient conversations about medication. METHOD: The nurse-patient dialogue was collected by video tape recording during the nurse's duty time in an internal medicine ward. One hundred seventy-eight episodes were extracted from the conversation. Using conversational analysis, the functional phases and patterns of dialogue sequence pertaining to medication were analyzed. RESULTS: Conversations about medication were very brief dialogues, so 68.8% of the dialogue had a duration of less than 20 seconds. However, it was a systematic and comprehensive dialogue which had structures and sequential dialogue patterns. Four functional phases were explored: greeting, identifying the patient, medicating, finishing. The medicating phase was essential, in which the nurse gave the drug to the patient and provided information initiated by the nurse simultaneously. The patterns of the dialogue sequence represented were the nurse provided information first, and then, patients responded to the nurse as accepting, rejecting, raising an objection, or asking again later. CONCLUSION: As the results of this study show, a nurse's role is important as an educator. For effective conversation about medication, the development of an educational program should be considered, which includes knowledge about medication and communication skills.

A Descriptive Study for Developing a Program to Promote Compliance with Regular Breast Self-Examination(BSE) / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify knowledge, facilitators, and barriers of breast self -examination(BSE) in Korean couples for developing a continuous regular BSE promotion program. METHOD: This descriptive study was undertaken with a focus group methodology including 27 couples of husbands and wives recruited by convenience-sampling. Data transcribed from audiotapes was analyzed to identify common themes. RESULTS: Knowledge of breast cancer and BSE included 'the risk factors of breast cancer', 'prevention of breast cancer', and 'how to do BSE'. Facilitators to BSE included 'self, health professional, and spouse-facilitating factors'. Barriers to BSE included 'cognitive, psychological, informational, and physical barriers'. CONCLUSION: To promote compliance with BSE among women, tailored programs according to the stage of change of BSE adoption are crucial, not only reflecting the specific needs of the individual by the stage of change, but also utilizing husbands as facilitators.

A Conversational Analysis about Patient's Discomfort between a Patient with Cancer and a Nurse / 간호학회지

PURPOSE: The purpose of this study was to describe and to analyze real communication about a patient's discomfort between a patient with cancer and a nurse. METHOD: A dialogue analysis method was utilized. Fifteen patients and 4 nurses who participated in this research gave permission to be videotaped. The data was collected from January, 3 to February 28, 2006. RESULTS: The communication process consisted of 4 functional stages: 'introduction stage', 'assessment stage', 'intervention stage' and 'final stage'. After trying to analyze pattern reconstruction in the 'assessment stage' and 'intervention stage', sequential patterns were identified. In the assessment stage, if the nurse lead the communication, the sequential pattern was 'assessment question-answer' and if the patient lead the communication, it was 'complaint-response'. In the intervention stage, the sequential pattern was 'nursing intervention-acceptance'. CONCLUSION: This research suggests conversation patterns between patients with cancer and nurses. Therefore, this study will provide insight for nurses in cancer units by better understanding communication behaviors.