Made available in DSpace on 2014-12-17T14:46:35Z (GMT). No. of bitstreams: 1 LucianaFLMM.pdf: 513352 bytes, checksum: 63bb9a164ee30933cd308c443e49bc51 (MD5) Previous issue date: 2007-12-20 / This study focuses on the child within the hospital environment. Its purpose is to describe children s perceptions of their illness and time in hospital and to identify their main hardships during treatment. This study has a qualitative nature and is theoretically and methodologically supported by the creative and sensitive method developed by Cabral (1998), studies by Piaget, Vygotsky and Wallon on child development, and studies conducted by Pinto (2005), Collet (2004), Chiattone (2003), Silva (2002), Lima et.al (1999) on in-patient children. For this study, 13 children between the ages of 7 and 12 at a public hospital institution specialized in child care in the city of Natal, Rio Grande do Norte, were interviewed. As a criterion for taking part in this study the children would have to have been in hospital for over three days and be fully capable of physically and emotionally interacting with the researcher at the time the interview took place. Analysis drew on the study of the empirical material made up of interviews and a field diary where notes had been entered for the children s reactions, expressions and gestures. Results show that there is some understanding, on the part of these children, of their illness, with their parents as the main informants. They accept being in hospital because they need treatment, but they realize that life becomes different especially on account of the constraints resulting from the illness and the hospital itself. The main hardships during treatment are: lack of recreational activities in the evenings and on the weekends within the hospital environment; absence of family members, especially brothers and sisters; and lack of explanation on the part of health professionals regarding some procedures as these are being carried out. Our conclusion is that children perceive illness and the hospital environment as something that changes the rhythm of their lives bringing on them perturbations, fears and anxieties. Hence, we suggest that professionals working with in-patient children should be especially prepared to deal with these children and their parents, aiming at bringing down fears and anguishes, clear their doubts and, in addition, advise the parents in respect of their children s treatment while in hospital and after hospital discharge. The hospital environment should also be cheerful and colorful and have a toy room under the coordination of persons especially prepared for that purpose / O presente estudo focaliza a crian?a no ambiente hospitalar. Tem como objetivos descrever a percep??o de crian?as sobre sua doen?a e hospitaliza??o e identificar suas principais dificuldades com o tratamento. Trata-se de um estudo de natureza qualitativa, tendo como aporte te?rico/metodol?gico o m?todo criativo e sens?vel desenvolvido por Cabral (1998); os estudos de Piaget, Vygotsky e Wallon que abordam o desenvolvimento infantil; e os de Pinto et al. (2005), Collet (2004), Chiattone (2003), Silva (2002), Lima et al. (1999) que tratam acerca da crian?a hospitalizada. Para sua realiza??o, foram entrevistadas 13 crian?as, na faixa et?ria de 7 a 12 anos, de uma institui??o hospitalar p?blica, da cidade de Natal/RN, especializada em atendimento pedi?trico. Como crit?rio para participa??o deste estudo, as crian?as teriam que ter mais de tr?s dias de interna??o e plenas condi??es f?sicas e emocionais para interagirem com a pesquisadora, por ocasi?o da entrevista. A an?lise se processou a partir do estudo do material emp?rico que constou de entrevistas e um di?rio de campo onde eram anotadas as rea??es, express?es e gestos das crian?as. Os resultados demonstram a exist?ncia de alguma compreens?o, por parte destas crian?as, sobre sua doen?a, tendo nos pais seus principais informantes. Elas aceitam o hospital pela necessidade de tratamento, mas reconhecem que a vida fica diferente, principalmente, pelos limites resultantes da doen?a e do pr?prio hospital. As principais dificuldades com o tratamento s?o: a inexist?ncia de atividades recreativas no ambiente hospitalar ? noite e nos finais de semana, a aus?ncia dos familiares, principalmente, os irm?os, e a falta de explica??o dos profissionais de sa?de durante a realiza??o de alguns procedimentos. Conclu?mos que as crian?as percebem a doen?a e o ambiente hospitalar como algo que muda o ritmo de suas vidas e lhes causam transtornos, medos e apreens?es. Sugerimos, portanto, que os profissionais que trabalham com crian?as hospitalizadas devam receber uma forma??o especial para lidar com elas e seus pais, visando diminuir medos e ang?stias; respondendo ?s suas d?vidas, e, ainda, orientando os pais quanto ao tratamento de seu filho durante e ap?s a alta. O ambiente hospitalar deve ser tamb?m alegre, colorido, com sala destinada ? brinquedoteca, coordenada por pessoas preparadas para tal fim

Made available in DSpace on 2016-12-23T14:38:01Z (GMT). No. of bitstreams: 1 Dissertacao.pdf: 1242933 bytes, checksum: 6176e371eb60d735f23132dcf866d4fa (MD5) Previous issue date: 2007-09-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Child hospitalization may bring about psychological problems, such as depression and stress due to routine changes and invasive procedures. It is worth, then, identifying the hospitalization coping strategies, emphasizing the playing as a facilitator of the child adjustment to the hospital setting. The psychological assessment in the hospital environment implies in controlling several variables; and it is made easier by means of IT based resources. This research analyzed the hospitalization coping strategies and playful activities by means of IT instruments. Twenty-eight (28) children (20 boys; aged 6-12) admitted to a public hospital in the city of Vila Velha/ES and their parents were subjects of this research. They answered the Child Behavior Checklist (CBCL, aged 6-18) as well as provided data about the routine of their children who in turn answered Hospitalization Coping IT Based Instruments (AEHcomp), with 20 facilitating and non-facilitating hospitalization scenarios, in addition to the IT Based Assessment of Playing Activities in the Hospital (ABHcomp), with 20 playful activities. Data about pathologies and hospital admissions was gathered. Seventeen (17) children were referred to in the CBCL. The plays chosen most often (ABHcomp) were: watching TV (average = 3,4) and playing minigame (average = 3,0), supported by nonexplanatory answers (50,2%) or by the play context (19,6%). The AEHcomp, presented more facilitating answers to the hospitalization (average = 1,8), such as talking (100%) and taking medicine (100%), than non-facilitating (average = 0,9), as being sad (71,4%) and crying (75%). Among 13 coping strategies, rumination (28,6%) and distraction (20,1%) were the most common. There were no correlations between behavioral problems prior to the hospitalization and nonfacilitating behaviors. There was a significant correlation of facilitating behaviors only related to age and routine changes. This assessment may provide subsidies in intervention towards children, thus preventing emotional damages caused by the hospital setting. / A hospitalização infantil pode desencadear problemas psicológicos, como depressão e stress, por mudanças acentuadas na rotina e exposição a procedimentos invasivos. É relevante, então, identificar as estratégias de enfrentamento da hospitalização, com ênfase no brincar como facilitador da adaptação da criança. A avaliação psicológica no hospital implica controlar diversas variáveis, sendo facilitada pela informática. Esta pesquisa analisou as estratégias de enfrentamento da hospitalização e atividades lúdicas preferidas, por instrumentos informatizados. Participaram 28 crianças (20 meninos; 6-12 anos) internadas em hospital público de Vila Velha/ES e seus pais. Estes responderam o Child Behavior Checklist (CBCL 6-18 anos) e dados da rotina das crianças, que responderam instrumentos de Avaliação Informatizada do Enfrentamento da Hospitalização (AEHcomp), com 20 cenas facilitadoras e nãofacilitadoras da hospitalização, e Avaliação Informatizada do Brincar no Hospital (ABHcomp), com 20 atividades lúdicas. Obtiveram-se dados sobre patologias e internações. Foram referidas como clínicas 17 crianças na Escala de Síndromes do CBCL. As brincadeiras mais escolhidas (ABHcomp) foram: assistir TV (média = 3,4) e minigame (média = 3,0), justificadas por respostas não-explicativas (50,2%) ou pelo contexto da brincadeira (19,6%). No AEHcomp, houveram mais respostas 17 facilitadoras à hospitalização (média = 1,8), como conversar (100%) e tomar remédio (100%), do que não-facilitadoras (média = 0,9), como ficar triste (71,4%) e chorar (75%). Entre 13 estratégias de enfrentamento, ruminação (28,6%) e distração (20,1%) foram mais freqüentes. Não houve correlações entre problemas de comportamento anteriores à hospitalização e comportamentos nãofacilitadores. Houve correlação significativa dos comportamentos facilitadores somente com a idade e com as mudanças na rotina. Esta avaliação pode subsidiar intervenções com crianças, prevenindo danos emocionais gerados pela hospitalização.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-22T14:50:29Z No. of bitstreams: 1 luanavieiratoledo.pdf: 5557451 bytes, checksum: d6cf6bf176fecb08c54034dccee35705 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T18:54:57Z (GMT) No. of bitstreams: 1 luanavieiratoledo.pdf: 5557451 bytes, checksum: d6cf6bf176fecb08c54034dccee35705 (MD5) / Made available in DSpace on 2016-01-25T18:54:57Z (GMT). No. of bitstreams: 1 luanavieiratoledo.pdf: 5557451 bytes, checksum: d6cf6bf176fecb08c54034dccee35705 (MD5) Previous issue date: 2014-02-12 / O acesso aos serviços de saúde tem sido objeto de grande interesse na área da saúde coletiva, na qual diversos autores adotam diferentes conceitos para o tema, envolvendo aspectos relacionados aos serviços, aos usuários e a interação entre eles. Nesta pesquisa, com o objetivo de identificar como ocorre o acesso das crianças menores de 2 anos do município de Juiz de Fora aos serviços de urgência e internação hospitalar, utilizou-se como base a reflexão teórica de Mcintyre, Thiede e Birch (2009), que define o acesso sob a perspectiva da disponibilidade, da acessibilidade financeira e da aceitabilidade. Foram analisados os dados das entrevistas de um inquérito domiciliar realizado no referido município no ano de 2010, no qual participaram 325 responsáveis por crianças menores de 2 anos. Para este estudo foram selecionadas, entre essas crianças, aquelas que haviam sido atendidas pelo serviço de urgência e/ou estiveram internadas no período correspondente aos doze meses anteriores à pesquisa, somando-se respectivamente 88 e 54 crianças. As amostras foram divididas em sub-amostras, tendo como critério para a divisão a cobertura ou não de equipes de ESF. Após essa divisão procedeu-se a análise estatística por meio da Análise de Correspondencia (AC) e Análise de Cluster, nas quais foi possível identificar características distintas para as quatro sub-amostras, representando as dimensões de acesso estudadas. Entre os resultados, observa-se que a sub-amostra 1 é caracterizada principalmente pela dimensão de acessibilidade financeira, na qual a variável “presença de gastos com transporte”, é a mais significativa. A sub-amostra 2 também pode ser caracterizada pela dimensão de acessibilidade financeira, entretanto de forma indireta, pois a sua variável mais significativa refere-se ao “tempo de espera maior do que a média”. Em relação à sub-amostra 3, a dimensão de acesso que faz referência é a disponibilidade, tendo a variável 1, como representativa, expressando a presença de encaminhamento prévio por algum serviço de saúde. A sub-amostra 4, faz referência à dimensão mais subjetiva de acesso, a aceitabilidade, tendo como a variável mais significativa, a “presença de relatório médico explicativo após a alta hospitalar”. Buscando-se compreender a associação dos dados socioeconômicos com a utilização dos serviços de saúde, procedeu-se a regressão logística binária, na qual foi possível identificar que a idade da criança apresenta relação positiva com a procura pelo serviço de urgência caracterizada por um O.R. de 1,113 com valor p considerado <0,001. No que tange à internação hospitalar, a idade da criança mantém-se como uma variável relacionada, tendo um O.R. de 1,046 e valor p igual a 0,054, associada também à variável referente à presença do companheiro materno, que representa um fator de proteção para as internações, tendo um O.R. de 0,425 e um valor p igual a 0,008. Conclui-se que o acesso deve ser considerado em uma abordagem multidimensional, envolvendo fatores relacionados tanto à disponibilidade quanto aos aspectos socioeconômicos e culturais. Ao se pensar no acesso de crianças, características peculiares a elas devem ser consideradas na avaliação do acesso aos serviços de saúde. / Access to health services has been the subject of great interest in the field of public health, in which different authors adopt different concepts for the theme, including aspects related to services, users and their interaction. In this research, with the aim of identifying how the access of children under 2 years of the city of Juiz de Fora to services of emergency and hospitalization is, we used as a basis for theoretical reflection Mcintyre, Thiede and Birch (2009), defining access from the perspective of availability, affordability and acceptability. The interview data consisting of a household survey conducted in the municipality in 2010, responded by 325 parents of children younger than 2 years were analyzed. For this study we selected those children who had been treated by the emergency department and/or were hospitalized in the twelve months before the study period, amounting to 88 and 54 children respectively. The samples were divided into sub-samples, with the criterion for the division being the coverage or not by ESF (“Estratégia de Saúde da Família” – “Family Health Strategy”). Statistical analysis was performed using correspondence analysis and Cluster Analysis, in which it was possible to identify different characteristics for the four sub-samples, representing the access dimensions studied. Among the results, it is observed that the sub-sample 1 is mainly characterized by the dimension affordability, in which the variable indicating transportation costs is the most significant. The sub-sample 2 can also be characterized by the dimension affordability, however indirectly, because its most significant variable refers to waiting time higher than the average. Regarding the sub-sample 3, the access dimension that refers to availability is represented by the “presence of a previous referral from a health service”. The sub-sample 4, referring to the more subjective dimension of access, acceptability, was represented by the” presence of explanatory medical report after discharge”. Seeking to understand the association of socioeconomic data with the use of health services, we proceeded to binary logistic regression, in which we found that the child's age is positively related to the demand for emergency services characterized by an OR of 1,113 to p < 0.001. Regarding hospitalization, the child's age remains as an associated variable, with an OR of 1.046 (p= 0.054), also associated with the variable referring to the presence of a resident partner who is a protective factor for hospitalizations, with an OR 0.425 (p= 0.008). We conclude that access should be considered in a multidimensional approach, involving factors related both to the availability in terms of socioeconomic and cultural aspects. When one thinks about the access of children, peculiar children´s features should be considered in assessing access to health services.

Nowadays the parental presence in the pediatric intensive care units (PICU) is quite common. Building a fellowship between parents and health care staff and high quality parents' integration into the care is a very demanding process. First of all, the success of this process largely depends upon the nurse. It is the very nurse who leads, educates, supports and also professionally integrates parents into their child's care. In addition, critically ill child's care in cooperation with parents is complicated by a high parental stress level, child's serious condition and high professional and technical requirements posed to the nurse. The graduation thesis concentrates on the parents' integration into the care of a critically ill child from the nurse's point of view. The goal of this thesis was to describe the general conditions of parents' integration into the critically ill child's care and to map the actual state of the cooperation within the nurse ? parent ? critically ill child relation from the nurse's point of view. Other goals included the analysis of nurse's feeling of readiness for work with parents of critically ill children, and elaboration of a booklet concerning the initial introduction of an intensive care and resuscitation unit for infants and older children for better parents' awareness. In the research part of the thesis a qualitative research was used. The data collection technique was a semi-standardized interview. A research sample was represented by seven nurses working in the sphere of the critically ill children care in four selected hospitals in the Czech Republic. The study took place in the period starting May 2011 till July 2011. The research results revealed that the parental integration conditions are not quite optimal. First of all, in this sphere the nurses pointed to a limited accommodation capacity for parents, lack of supporting services and unsatisfactory site layout of the intensive care units. The nurses expressed their readiness to the closer cooperation with critically ill children's parents in the basic nursing sphere, mostly, thereafter, in the sphere of hygiene care. The parental cooperation in the special-care sphere was accepted rather negatively by the respondents. As the research results show, most of the nurses consider the work with parents psychologically very demanding and during their school education they had never been prepared for it by anybody. Findings flowing from the research results gave birth to the information booklet that is a basic informational and educational material for parents of children admitted to the intensive and resuscitation care unit for older children and infants in Hradec Králové University Teaching Hospital. It also represents a detailed instruction for a similar material for other facilities of this type and, last but not least, it facilitates the whole process of initial parents' education for nurses. This graduation thesis can also assist in the education of children's nurses, help students and nurses working with critically ill children's parents understand the "Family-centered care" principles and their practical introduction.