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RESEARCH01-01-2017
Stimulus-response time to alarms of the intra-aortic balloon pump: safe care practices
Revista Brasileira de Enfermagem. 2017;70(6):1206-1211
Abstract
RESEARCHStimulus-response time to alarms of the intra-aortic balloon pump: safe care practices
Revista Brasileira de Enfermagem. 2017;70(6):1206-1211
DOI 10.1590/0034-7167-2016-0432
Views0See moreABSTRACT
Objective:
To characterize the sound alarms of the Intra-Aortic Balloon Pump (IABP) during aortic counterpulsation therapy; to measure the stimulus-response time of the team to these; and to discuss the implications of increasing this time for patient safety from the alarm fatigue perspective.
Method:
This is an observational and descriptive study with quantitative and qualitative approach, case study type, carried out in a Cardiac Surgical Intensive Care Unit.
Results:
The most audible IABP alarm was the one of high priority increased-reduced diastolic blood pressure. The stimulus-response time was 33.9 seconds on average.
Conclusion:
Managing the alarms of these equipment is essential to minimize the occurrence of the alarm fatigue phenomenon and to offer a safer assistance to patients who rely on this technology.
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RESEARCH01-01-2017
Possibilities of care for serodiscordant couples for HIV who got pregnant
Revista Brasileira de Enfermagem. 2017;70(6):1199-1205
Abstract
RESEARCHPossibilities of care for serodiscordant couples for HIV who got pregnant
Revista Brasileira de Enfermagem. 2017;70(6):1199-1205
DOI 10.1590/0034-7167-2016-0344
Views0See moreABSTRACT
Objective:
Understanding the meaning of pregnancy for heterosexual couples facing serodiscordant situation for HIV, aiming at construction of care possibilities based on subjectivity.
Method:
Phenomenological research, theoretical-philosophical-methodological framework by Martin Heidegger. Research was conducted in a University Hospital in the countryside of Southern Brazil, from September 2013 to May 2014 through a phenomenological interview, with participation of eleven couples.
Results:
For the couples, pregnancy is part of life when they wish to have a child, even when one or both of them already have children from previous relationships. In addition, it is part of life when they consider the risks and do not want to have children in such circumstances anymore, but it happened unexpectedly.
Conclusion:
Understanding reproductive needs and demands of these couples is an aid for qualification and improvement of care as a contribution to nursing care planning towards reproductive health of these couples.
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RESEARCH01-01-2017
Interactive Theory of Breastfeeding: creation and application of a middle-range theory
Revista Brasileira de Enfermagem. 2017;70(6):1191-1198
Abstract
RESEARCHInteractive Theory of Breastfeeding: creation and application of a middle-range theory
Revista Brasileira de Enfermagem. 2017;70(6):1191-1198
DOI 10.1590/0034-7167-2016-0523
Views0See moreABSTRACT
Objective:
To describe a breastfeeding theory based on King’s Conceptual System.
Method:
Theoretical study that used analysis of concept, assertion synthesis, and derivation of theory for the creation of a new theory.
Results:
King’s system components were associated with elements of the breastfeeding process and a middle-range theory was created, which describes, explains, predicts, and prescribes breastfeeding by analyzing factors that precede and affect it, as well as their consequences on the breastfeeding process.
Conclusion:
The Breastfeeding Interactive Model is abstract enough to be applied in different social, cultural, political, and economic contexts, because it conceptualizes breastfeeding in systemic, dynamic, and procedural aspects. Based on a conceptual model of nursing, it contributes to the scientific construction of the subject; however it can also potentially be applied by other professionals involved in breastfeeding assistance.
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RESEARCH01-01-2017
Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods
Revista Brasileira de Enfermagem. 2017;70(6):1176-1183
Abstract
RESEARCHEfficiency of cleaning and disinfection of surfaces: correlation between assessment methods
Revista Brasileira de Enfermagem. 2017;70(6):1176-1183
DOI 10.1590/0034-7167-2016-0608
Views0ABSTRACT
Objective:
to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit.
Method:
a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm2 were found in culture; when ≥5 relative light units per cm2 were found at the ATP-bioluminescence assay.
Results:
720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods.
Conclusion:
the methods did not present a good correlation, neither quantitative nor qualitatively.
Keywords:Equipment ContaminationHealth Facility EnvironmentHousekeepingInfectious Disease TransmissionNursing AuditSee more -
RESEARCH01-01-2017
Cultural adaptation of The End-Stage Renal Disease Adherence Questionnaire for hemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(6):1169-1175
Abstract
RESEARCHCultural adaptation of The End-Stage Renal Disease Adherence Questionnaire for hemodialysis patients
Revista Brasileira de Enfermagem. 2017;70(6):1169-1175
DOI 10.1590/0034-7167-2016-0519
Views0ABSTRACT
Objective:
To describe the stages in the cultural adaptation of “The End-Stage Renal Disease Adherence Questionnaire” for use in Brazil.
Method:
A descriptive, transversal study with a quantitative approach. The cultural adaptation followed the steps of translation, professional committee, back translation, panel of patients and pretest.
Results:
the translation stage created a version in Portuguese that was analyzed by specialists, who suggested alterations in the title, seven sentences in the questions and three sets of answers. In the panel of patients phase, two questions were altered. The back translation considered the original characteristics of the instrument were maintained, likewise there were no modifications in the pretest phase. The third version written in Portuguese was considered to be the final version of the questionnaire.
Conclusion:
this instrument should facilitate nursing care management in hemodialysis, enabling the monitoring of adherence among these patients and also contribute to improving the indicators of morbidity and mortality.
Keywords:Adherence to MedicationChronic Renal InsufficiencyHemodialysisNephrology NursingPatient CooperationSee more -
RESEARCH01-01-2017
Revalidation of game for teaching blood pressure auscultatory measurement: a pilot study
Revista Brasileira de Enfermagem. 2017;70(6):1159-1168
Abstract
RESEARCHRevalidation of game for teaching blood pressure auscultatory measurement: a pilot study
Revista Brasileira de Enfermagem. 2017;70(6):1159-1168
DOI 10.1590/0034-7167-2016-0578
Views0ABSTRACT
Objective:
To adapt a pre-existing educational game, making it specific to the teaching of blood pressure auscultatory measurement, and to apply this game in a pilot study.
Method:
The original game cards were altered by the authors and submitted to content validation by six experts in the field. After redesigns, the game was applied to 30 subjects, who answered a questionnaire (pre-test and post-test) on auscultatory measurement. Data were analyzed descriptively and by the paired Student’s t-test and paired Wilcoxon test.
Results:
Throughout the content validation process, 17 of the 28 original cards were modified. Of these 17 cards, 13 obtained 80% agreement, and the rest were modified according to the judges’ suggestions. The obtained grades significantly increased between pre- and the post-test.
Conclusion:
It was concluded that the reformulated game presented satisfactory evidence of content validity. Its use as a teaching-learning method was effective for this sample.
Keywords:Determination of Blood PressureEducation in NursingEducational TechnologyExperimental GamesGames and ToysSee more -
RESEARCH01-01-2017
Validation of Family Management Measure for the Brazilian culture
Revista Brasileira de Enfermagem. 2017;70(6):1151-1158
Abstract
RESEARCHValidation of Family Management Measure for the Brazilian culture
Revista Brasileira de Enfermagem. 2017;70(6):1151-1158
DOI 10.1590/0034-7167-2016-0326
Views0See moreABSTRACT
Etjective:
To validate the Family Management Measure (FaMM) for Brazilian culture.
Method:
Quantitative research excerpt, following the recommendations for validation studies. The data presented refer to the last stage of the process.
Results:
The internal consistency of the items was analyzed through Cronbach’s alpha of the six domains: Child’s Daily Life (0.78); Condition Management Effort (0.51); Condition Management Ability (0.55); Family Life Difficulty (0.86); View of Condition Impact (0.56); and Parental Mutuality (0.80). Exploratory factorial analysis of the instrument was carried out, obtaining an acceptable adjustment, according to validation standards.
Conclusion:
The FaMM presents evidence of validation and can be used in the Brazilian culture under the name of Instrumento de Medida de Manejo Familiar, which was adjusted in eight domains, providing varied aspects of family management and a good evaluation of the fundamental aspects of family life in the context of childhood chronic conditions.
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ORIGINAL ARTICLE01-10-2024
Nursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
Abstract
ORIGINAL ARTICLENursing students and the internet: a reflection of digital ethics
Revista Brasileira de Enfermagem. 2024;77:e20230459
DOI 10.1590/0034-7167-2023-0459
Views0See moreABSTRACT
Objectives:
to identify how first-year nursing students use cyberspace and propose an orientation guide with criteria guiding the use of cyberspace.
Methods:
qualitative and descriptive research, carried out with 24 nursing students from a federal public institution in Rio de Janeiro. Data collection was carried out through semi-structured interviews. Data analysis occurred using IRAMUTEQ®. The research was approved by the institution’s Research Ethics Committee.
Results:
students use cyberspace to communicate, study, find “cool things”, share photos and memories. Furthermore, they are concerned about hate speech, intolerance and fake news. The good and bad sides and the types of technologies most used were also portrayed.
Final considerations:
the moral and ethical values of physical coexistence, together with awareness of individual responsibility, are the pillars for using cyberspace. The guide comes as an awareness tool.
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ORIGINAL ARTICLE01-10-2024
Maternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
Abstract
ORIGINAL ARTICLEMaternity behind and beyond bars: analysis from the perspective of protection bioethics
Revista Brasileira de Enfermagem. 2024;77:e20220576
DOI 10.1590/0034-7167-2022-0576
Views0See moreABSTRACT
Objective:
to analyze how motherhood is expressed in female prison units from the perspective of Bioethics of Protection.
Method:
qualitative research with an ethnographic approach, developed in two women’s prison units. Participantes were: six mothers deprived of liberty, 15 health professionals, and nine prison officers. For data collection, semi-structured interviews and descriptive observation were used. Data analysis was based on the Content Analysis technique, thematic category.
Results:
three categories emerged: women and children violated behind bars (inequities); mothers and children in prison exacerbating imbalances, tensions and conflicts; and limits and references for resocialization.
Final Considerations:
the Bioethics of Protection proposal appears as a valid tool for the analytical direction of the process of confronting issues in the scope of public health in prison units, considering vulnerable groups and aiming at equity and human dignity.
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ORIGINAL ARTICLE01-10-2024
Self-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
Abstract
ORIGINAL ARTICLESelf-harm in the two years of greatest restrictions during the covid-19 pandemic: a cross-sectional study
Revista Brasileira de Enfermagem. 2024;77:e20240289
DOI 10.1590/0034-7167-2024-0289
Views0See moreABSTRACT
Objective:
to analyze occurrence of self-harm, sociodemographic profile of victims and referrals in the first 24 months of the COVID-19 pandemic in São Paulo.
Method:
cross-sectional study carried out by the Notifiable Diseases Information System with data on self-harm in São Paulo. The period outlined was March 2020 to February 2022. R (4.0.2) software and chi-square test were used.
Results:
there were 15,946 incidents. Victims were young, white, single, heterosexual women. There was high incidence of people with previous mental disorders more than once and without clear motivation. The method used was poisoning/intoxication. There was a considerable number of referrals to the health network, although not totalitarian.
Conclusion:
the years of greater insecurity in relation to the pandemic have given rise to self-harm cases with peculiar characteristics. Agile health policies must be applied in atypical conditions, such as pandemics, especially for adolescents/young people with previous mental disorders.
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REVIEW01-10-2024
Health of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
Abstract
REVIEWHealth of quilombola children as a challenge for the Sustainable Development Goals: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20240106
DOI 10.1590/0034-7167-2024-0106
Views0See moreABSTRACT
Objective:
to map the literature on quilombola children’s health and its relationship with the Sustainable Development Goals.
Method:
a scoping review, which followed the JBI protocol and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in the LILACS, BDENF, Web of Science, Scopus, MEDLINE databases and Google Scholar platform. The research protocol was registered in the Open Science Framework.
Results:
eighteen articles out of 2,055 studies were selected as relevant for this study. The articles were grouped into four axes: Access to healthcare services; Nutritional aspects of quilombola children; Health problems of quilombola children; and Care for quilombola children. The relationship between these articles and SDGs 1, 3, 4, 6 and 10 was observed.
Final considerations:
the study provided an extremely important mapping of the theme of quilombola children’s health and themes related to the Sustainable Development Goals.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views0See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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ORIGINAL ARTICLE07-29-2024
Evidence of validity of the Risk Self-Medication Questionnaire focused on Health Literacy
Revista Brasileira de Enfermagem. 2024;77(3):e20230386
Abstract
ORIGINAL ARTICLEEvidence of validity of the Risk Self-Medication Questionnaire focused on Health Literacy
Revista Brasileira de Enfermagem. 2024;77(3):e20230386
DOI 10.1590/0034-7167-2023-0386
Views0See moreABSTRACT
Objectives:
to analyze the validity evidence of the internal structure of the Risk Self-Medication Questionnaire Focused on Health Literacy.
Methods:
a psychometric study with 499 adults. The internal structure was assessed with exploratory and confirmatory factor analysis to prove the adjustment. Internal consistency was measured by composite reliability and McDonald’s omega coefficient (ω).
Results:
the parameters revealed a model of 35 items distributed across four factors, explaining 56% of the total variance, with factor loadings ranging from 0.31 to 0.85 and adequate communalities. Accuracy (0.79
Conclusions:
an instrument was obtained with good evidence of structural validity for measuring self-medication.
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ORIGINAL ARTICLE07-29-2024
Nurses’ perspectives on nurses’ work methods
Revista Brasileira de Enfermagem. 2024;77(3):e20230374
Abstract
ORIGINAL ARTICLENurses’ perspectives on nurses’ work methods
Revista Brasileira de Enfermagem. 2024;77(3):e20230374
DOI 10.1590/0034-7167-2023-0374
Views0See moreABSTRACT
Objectives:
To analyze nurses’ perspectives on nurses’ work methods in the hospital context.
Methods:
A descriptive study with a qualitative approach was conducted in a hospital in northern Portugal, involving 17 nurses. Semi-structured interviews were used for data collection. Data collected between May and June 2023 underwent content analysis, supported by Atlas.ti software.
Results:
Three thematic areas emerged: “Nurses’ work methods in a hospital context,” highlighting the conception and components of work methods and the methods in use; “Implementation of nurses’ work methods,” emphasizing influencing factors and challenges to implementation; and “Impact of nurses’ work methods on patients, nurses, and institutions.”
Final Considerations:
Nurses’ work methods constitute the structure of nursing care. Some factors influence and some challenges arise in the implementation of these methods, producing impacts on patients, nurses, and institutions.
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ORIGINAL ARTICLE07-29-2024
Nursing Process for institutionalized older adults: contributions from knowledge awareness workshop
Revista Brasileira de Enfermagem. 2024;77(3):e20230349
Abstract
ORIGINAL ARTICLENursing Process for institutionalized older adults: contributions from knowledge awareness workshop
Revista Brasileira de Enfermagem. 2024;77(3):e20230349
DOI 10.1590/0034-7167-2023-0349
Views0See moreABSTRACT
Objective:
To analyze the knowledge of professionals working in a Nursing Home about the Nursing Process before and after the awareness workshop.
Methods:
This is strategic action research, developed with nursing professionals and managers of a Nursing Home in Rio Grande do Sul, Brazil. Data were collected between January and June 2023, through semi-structured interviews before and after an awareness workshop. Discursive textual analysis of the data was carried out.
Results:
The central category “Understanding about the Nursing Process in Nursing Homes” emerged, which was unitized into two units of meaning and three categories of analysis.
Conclusion:
Data revealed non-use and lack of knowledge of the Nursing Process before awareness raising. Afterwards, a deeper understanding of the topic and its importance was identified. Awareness-raising workshops contribute to transformation of knowledge.
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ORIGINAL ARTICLE07-29-2024
Excessive daytime sleepiness in nursing technicians: association with sleep quality and memory
Revista Brasileira de Enfermagem. 2024;77(3):e20230332
Abstract
ORIGINAL ARTICLEExcessive daytime sleepiness in nursing technicians: association with sleep quality and memory
Revista Brasileira de Enfermagem. 2024;77(3):e20230332
DOI 10.1590/0034-7167-2023-0332
Views0See moreABSTRACT
Objective:
to investigate excessive daytime sleepiness prevalence among nursing technicians and the association with sleep quality and memory.
Methods:
a cross-sectional, inferential study, carried out in a hospital unit in the state of Goiás between December 2020 and January 2021. Assessments were carried out using the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Prospective and Retrospective Memory Questionnaire, instruments validated for the Brazilian context. Bivariate and multivariate logistic regression analyzes were performed.
Results:
the sample consisted of 189 nursing technicians with a 40.9% excessive daytime sleepiness prevalence. In multivariate models, excessive daytime sleepiness was not associated with sleep quality, however there was a significant association with overall memory failures.
Conclusions:
study results demonstrate a high excessive daytime sleepiness occurrence, an association with overall memory failures and the need for psychosocial interventions for nursing technicians.
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ORIGINAL ARTICLE07-29-2024
Educational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
Abstract
ORIGINAL ARTICLEEducational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
DOI 10.1590/0034-7167-2023-0299
Views1See moreABSTRACT
Objectives:
to construct and assess an educational technology for managing patient waiting lists for multidisciplinary training.
Methods:
study supported by Instructional Design – ADDIE model, whose stages of construction of educational technology were developed in the form of a multi-professional training course. Its respective content assessment was carried out by a committee of experts from 2021 to 2022. The analysis occurred based on the proportion of content adequacy with 95% Confidence Interval.
Results:
seventeen products were created as educational technology learning objects: five storyboards; four videos; three comic books; two pedagogical action plans; a mind map; and a YouTube® playlist. Nine experts assessed content adequacy, which reached 0.89.
Conclusions:
this educational technology contributes to the performance of professionals who manage waiting lists by reducing inequalities, alleviating differences, in addition to promoting equity in care and good health for patients in the Brazilian Health System.
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ORIGINAL ARTICLE07-29-2024
Fuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections
Revista Brasileira de Enfermagem. 2024;77(3):e20230271
Abstract
ORIGINAL ARTICLEFuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections
Revista Brasileira de Enfermagem. 2024;77(3):e20230271
DOI 10.1590/0034-7167-2023-0271
Views0ABSTRACT
Objective:
To describe the possibility of applying Fuzzy Logic in analyzing the vulnerability of Women Who Have Sex with Women to Sexually Transmitted Infections/HIV/AIDS.
Methods:
We developed a Fuzzy Logic system with 17 input variables and one output variable, using data related to vulnerability in a municipality located in the Midwest region of the State of São Paulo, Brazil.
Results:
The factor with the greatest positive impact was the confirmation that a low understanding of Sexually Transmitted Infections/HIV/AIDS is associated with higher vulnerability. Conversely, the statement “Not disclosing sexual activity to healthcare professionals,” where individuals do not admit to having sex with women, had the least impact.
Conclusions:
Fuzzy Logic facilitates the identification of vulnerability, expressed through the analysis of interaction between variables in each dimension. This makes it a promising method to assist in analyzing the vulnerability of specific populations.
Keywords:Fuzzy LogicHealth VulnerabilityReproductive HealthSexually Transmitted DiseasesWomen Who Have Sex With WomenSee more -
ORIGINAL ARTICLE07-29-2024
University Student Depression Inventory, Brazilian Version, Construct Assessment
Revista Brasileira de Enfermagem. 2024;77(3):e20230232
Abstract
ORIGINAL ARTICLEUniversity Student Depression Inventory, Brazilian Version, Construct Assessment
Revista Brasileira de Enfermagem. 2024;77(3):e20230232
DOI 10.1590/0034-7167-2023-0232
Views0See moreABSTRACT
Objectives:
to assess the University Student Depression Inventory, Brazilian version (USDI-BR), construct.
Methods:
a methodological study carried out with a snowball probabilistic sample, consisting of 334 undergraduate and graduate students. Confirmatory factor analysis, reliability using McDonald’s omega coefficient and Cronbach’s alpha were performed. Principal component analysis was performed using the varimax rotation and oblimin rotation, using the Kaiser-Meyer-Olkin criteria, Bartlett’s test of sphericity and scree plot.
Results:
the USDI-BR presented an internal consistency of items of ω = 0.95 and remained with 30 items, with the addition of 1 factor (Death wish and social withdrawal), totaling 4 factors.
Conclusions:
the USDI-BR has evidence that points to its validity and also its internal consistency, deserving that new studies be carried out to expand the evidence of its psychometric properties.
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ORIGINAL ARTICLE07-29-2024
Family refusal of skin donation for transplantation: trends and associated factors
Revista Brasileira de Enfermagem. 2024;77(3):e20230209
Abstract
ORIGINAL ARTICLEFamily refusal of skin donation for transplantation: trends and associated factors
Revista Brasileira de Enfermagem. 2024;77(3):e20230209
DOI 10.1590/0034-7167-2023-0209
Views0See moreABSTRACT
Objectives:
to analyze the trends and factors associated with family refusal of skin donation for transplantation.
Methods:
this cross-sectional study was conducted in the State of São Paulo, with family authorization terms collected from 2001 to 2020. The variables analyzed included year, age, gender, cause of death, and type of institution. Data were analyzed using linear and multiple logistic regression, with the Odds Ratio estimated at p<0.05 for statistical significance.
Results:
1,355 individuals refused skin donation. The trend of refusals decreased between 2001 and 2009 in the age groups of 0-11 years and 12-19 years, but increased in the group aged ≥60 years. This trend continued to decrease in the 0-11 years group from 2010 to 2020, and increased in the 20-40 years group. Males and the age groups of 20-40 years, 41-59 years, and ≥60 years exhibited 27%, 34%, 47%, and 53% lower chances of refusal, respectively.
Conclusions:
there is an urgent need for measures to mitigate the high number of refusals associated with skin donation.
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