Few studies have explored how medical ethics works in practice specifically in terms of the social processes that result in a decision regarding an ethical problem. This is particularly so in the case of children’s intensive care. More than a decade of teaching healthcare ethics to both nurses and doctors prompted a study to examine how ethical problems are resolved in a children’s intensive care unit. This qualitative study addressed this question in a single large children’s intensive care unit in England. The study was guided by grounded theory in examining via individual face to face unstructured and semi-structured interviews what ethical problems were encountered and how they were resolved. Interviews were conducted mainly with doctors and nurses working on an intensive care unit. Two admitting consultant doctors and three parents were also interviewed. The analysis of data gathered in 20 interviews was developed using Strauss and Corbin’s (1998) framework. A theory emerged from the analysis of the data that revealed the most prominent ethical problems in children’s intensive care related to end-of-life situations. Most significant among these was the decision to withdraw life-preserving interventions from a child. The theory outlines a process by which health professionals involved in the care and treatment of a child in intensive care negotiated a consensus on the point at which it was no longer appropriate to continue life-preserving interventions. This consensus was then presented to parents. Parental assent to withdrawal was facilitated, when not immediately forthcoming, by a process of persuasion.

It takes several acute and planned transfers between children's intensive care and children's cardiology ward of the week, of children with heartdiseses. At the acute movements it can be difficult for the nurse to take time for the parents. When the nurses talk about how they communicate and take care of the parents, at the movements of the children, it may increase nurses' awareness regarding how parents are treated. The purpose of the study was to describe how nurses feel that parental perspective into account the movement of children with heart disease between the child intensive care and ward. The study was conducted with six nurses in two focus group interviews, and analyzed as a content analysis. The categories that emerged from the study were: information, availability and security. Nurses experienced parental perspective into account, through information on the movement. Accessibility to the nurses affected by the lack of time and that the movement was take at short notice. Time was an area that was identified as a problem, increased accessibility for the nurse to be there for the parents, would give them greater security. To lodge security, it was important for parents to get information about where they would be moved. Further research may lead to attention of the parental perspective and that nurses can influence and improve the way information is given to the parents and a better reporting of what information is given and what they need for further information. / Det sker flera akuta och planerade förflyttningar mellan barnintensiven (BIVA) och barnkardiologavdelningen varje vecka, av hjärtsjuka barn. Vid de akuta förflyttningarna kan det vara svårt för sjuksköterskan att ta sig tid till föräldrarna.Genom att sjuksköterskorna samtalar om hur de informerar och tar om hand föräldrarna, vid förflyttningar av barnen, kan det öka sjuksköterskors medvetenhet gällande hur föräldrar bemöts. Syftet med studien var att beskriva hur sjuksköterskorna upplever att föräldraperspektivet beaktas vid förflyttning av hjärtsjuka barn mellan BIVA och vårdavdelningen. Studien utfördes med sex sjuksköterskor i två fokusgruppsintervjuer, och analyserades enligt en kvalitativ innehållsanalys. Kategorierna som framkom i studien var information, tillgänglighet och trygghet. Sjuksköterskorna upplevde att föräldraperspektivet beaktades, genom information om förflyttning. Tillgänglighet till sjuksköterskan påverkas av tidsbrist även att beslut om förflyttning tas med kort varsel. För att inge trygghet var det viktigt för föräldrarna att få information om dit de skulle flyttas. Vidare forskning kan leda till att föräldraperspektivet uppmärksammas ytterligare och att sjuksköterskor kan påverka och förbättra sättet information ges till föräldrarna och en bättre över rapportering vad för information som är given och vad de behöver för fortsatt information

Bakgrund: År 2012 skapades Sveriges första nationella program och kunskapsstöd för palliativ vård. Den palliativa vården finns beskriven av Socialstyrelsen utifrån fyra hörnstenar, symtomlindring, multiprofessionellt samarbete, stöd till anhöriga samt kommunikation och relation. Det är oftast sjuksköterskan som identifierar behovet av palliation, men läkaren är den som fattar beslutet om palliation ska påbörjas. Detta kan vara en lång process och orsaka barnet onödigt lidande. Syfte: Att beskriva sjuksköterskans erfarenheter av att avsluta livsuppehållande behandling för att övergå till palliativ vård på barnintensiven. Metod: Studien genomfördes som en kvalitativ intervjustudie. Sex individuella semistrukturerade intervjuer med utbildade intensivvårdssjuksköterskor på en barnintensivvårdsavdelning i Sverige genomfördes. Dessa analyserades med utgångspunkt från Elo och Kygnäs metod för kvalitativ innehållsanalys och utmynnade i tre huvudkategorier. Resultat: Sjuksköterskornas erfarenheter av att avbryta livsuppehållande vård för att övergå till palliativ vård presenterades i resultatet utifrån tre huvudkategorier, Det oåterkalleliga livet, Sista tiden av livet samt Vad kan sjuksköterskan göra för anhöriga?. Slutsats: Att avbryta livsuppehållande vård för att övergå till palliativ vård är ett komplext och etiskt svårt beslut. / Background: In 2012 Sweden created its first natinal program and knowledge base for palliative care. Palliative care is described by the Swedish National Board through four bases, symptom relifes, multi-professional cooperation, support to relatives, and communication and relationship. It is usually the nurse that identifies the need for palliation, but the doctor is the one that makes the decision to begin palliative care. This can be a long process and cause the child unnecessary suffering. Aim: To describe the intensive care nurses experiences in ending life support and the transition to palliative care of children intensive care. Method: The study was conducted as a qualitative interview study. Six individual semi-structured interviews with intensive care nurses at a childrens intensive care unit in Sweden was carried out . These interviews were analyzed on the basis of Elo and Kygnäs method of qualitative content analysis and resulted in three main categories. Result: The nurses' experiences of withdrawing lifesustaining treatment and the transition to palliative care was presented in the result within three main categories, ”The irrevocable life”, ”The end of life” and ”What can the nurse do for the family?”. Conclusion: To discontinue life-sustaining care and transition to palliative care is a complex and difficult ethical decision.

Made available in DSpace on 2014-06-11T19:33:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2004Bitstream added on 2014-06-13T20:05:22Z : No. of bitstreams: 1 alves_mjf_dr_botfm.pdf: 954308 bytes, checksum: 60520840620d3fef82cfada4db2781b1 (MD5) / Os objetivos da Terapia Intensiva podem ser simplificados em: salvar pacientes com condições médicas reversíveis e humanizar o tratamento de pacientes terminais. Também é o restabelecimento de funções vitais, a fim de ganhar tempo para um tratamento definitivo além de permitir melhor qualidade de vida ao paciente. O desenvolvimento desta especialidade médica tem sido baseado em contatos multiprofissionais e no treinamento continuado. Uma das causas importantes de internação na Unidade é o trauma. Está patologia tem se tornado cada vez mais importante nos dias de hoje. A evolução da Terapia Intensiva e do tratamento ao politraumatizado provocou a necessidade de se entender que tipo de paciente necessitava deste tipo de tratamento, a quantidade de recursos utilizada e a qualidade do atendimento realizado. A capacidade mesmo de um intensivista capacitado em prever a evolução de um paciente é ruim. Vários sistemas de classificação clínica foram desenvolvidos para avaliar pacientes adultos e pediátricos. Quando se associa a patologia trauma aumentam muito os sistemas de escores para avaliar a gravidade destes doentes. Em crianças são mais utilizados: o TISS, um escore de intervenção terapêutica; o Prism e o PTS, escores de instabilidade fisiológica que permitem respectivamente o cálculo do risco de morte durante a internação na UTIP e avaliar especificamente o trauma; também podem ser utilizados escores de lesão anatômica tais como a AIS e o ISS, escores gerais de atendimento ao trauma, inicialmente criados para adultos como o escore RTS e as metodologias TRISS e ASCOT e os critérios de Disfunção de Múltiplos Órgãos e Sistemas... / The objectives of the Intensive Care can be simplified in: to save patient with reversible medical conditions and humanize the treatment of terminals patients. It is also the re-establishment of vital functions, in order to win time for a definitive treatment besides allowing better life quality to the patient. The development of this medical specialty has been based on multiple professional contacts and in the continuous training. One of the important causes of internment in the Unit is the trauma. It has been turning more and more important in the days today. The evolution of the Intensive Care and the treatment to the politrauma provoked the need to understand each patient type needed this treatment type, the amount of used resources and the quality of the accomplished attendance. The capacity even of an intensive care doctor qualified in foreseeing the evolution of a patient one it is bad. Several systems of clinical classification were developed to evaluate adult and pediatric patients. When associates trauma they increase the systems of scores a lot to evaluate the gravity. In children they are used: TISS, a score of therapeutic intervention; Prism and PTS, scores of physiologic stability that allow the calculation of the death risk respectively during the internment in UTIP and to evaluate the trauma specifically; scores of anatomical lesion can also be used such AIS and ISS, general scores of attendance to the trauma, initially for adults as the score RTS and the methodologies TRISS and ASCOT and the approaches of Dysfunction of Multiple Organs and Systems... (Complete abstract click electronic address below)

Children heart diseases can be divided into congenital and acquired heart defects. The acquired heart defects can be further divided into acquired heart defects, heart rhythm disorders, including hypertension, inflammatory heart diseases and heart failure. Children heart diseases can occur at any age, even if it is a congenital heart defect that is less severe. The goal of this thesis was to find out the specifics of nursing care of children with heart diseases who are hospitalized at ICU and to find out the most common nursing diagnoses according to NANDA II taxonomy, and their treatment in case of children with heart diseases who are hospitalized at ICU. During the realization of the research part, a qualitative research survey was conducted using semi-structured interviews with the nurses, participant observation and the method of content analysis, which provide a more complex view of the composition of the children with heart disease hospitalized at ICU. The interviews were conducted with the nurses at the children's ICU, where the participant observation and the method of content analysis took place as well. The results of the research show that nursing care differs in the case of cardiologic disordered children and otherwise disordered children in some areas, as well as the needs. In the research part it was found out what the most frequent nursing interventions in case of these children are and how much they differ from the interventions of children with other diseases, who are also hospitalized at ICU. Furthermore, the research shows that nurses have a negative opinion on nursing diagnoses, although they are used in the documentation. This was found not only in the semi-structured interviews with the nurses, but also during the participated observation and the content analysis of the documentation. The research also revealed that some nursing diagnoses are specific to cardiologic disordered children, but, for example, the nursing diagnosis of the risk of infection associated with invasive entry is used in case of all children hospitalized at ICU. The diploma thesis should inform nurses about nursing care in case of children with heart disease hospitalized at ICU.

Children heart diseases can be divided into congenital and acquired heart defects. The acquired heart defects can be further divided into acquired heart defects, heart rhythm disorders, including hypertension, inflammatory heart diseases and heart failure. Children heart diseases can occur at any age, even if it is a congenital heart defect that is less severe. The diploma thesis should bring nurses closer to the problems of nursing care of children with heart diseases hospitalized at the ICU. The goal of this thesis was to find out the specifics of nursing care of children with heart diseases who are hospitalized at the ICU and to find out the most common nursing diagnoses according to NANDA II taxonomy, and their treatment in case of children with heart diseases who are hospitalized at the ICU. During the realization of the research part, a qualitative research survey was used using semi-structured interviews with the nurses involved in the observation. And a summarization that provides a more comprehensive view of the composition of children with heart diseases hospitalized at the ICU. The interviews were conducted with the nurses at the children's ICU, where the participant observation took place as well. In the research section the most common nursing interventions in case of these children were described and how much they differ from interventions in case of children with other illnesses that are also hospitalized at the ICU. Further, we have also found out the most common nursing diagnoses of children with heart diseases hospitalized at the ICU.