No description available.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008. / Title from first page of PDF file (viewed Aug. 1, 2008). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 120-127).

Parents’ presence and participation in their child’s care in the paediatric intensive care unit (PICU) is now commonplace. Despite parents expressing a deep need to be with their child particularly during periods of crisis, it is precisely at these times that they are often prevented from staying. The growing debate regarding family presence during a cardiopulmonary (CPR) resuscitation attempt continues to be controversial and conflicting. Current knowledge is mostly derived from quantitative studies conducted in the adult intensive care or emergency environments. The experiences of parents of children in the PICU, and the nurses caring for them are unknown. Using van Manen’s hermeneutic phenomenological approach, this study describes the phenomenon of parental presence during resuscitation of a child in PICU for eight Australian parent couples and six nurses. Experiential descriptions, obtained in tape-recorded unstructured interviews were subjected to two layers of analysis. Thematic analysis provided the phenomenological description in seven themes. Four themes refer to the parents’ experience in Being only for a child; Making sense of a living nightmare; Maintaining hope: facing reality and Living in a relationship with staff. Three themes describe the nurses’ experience: Under the parents’ gaze; Walking in their shoes and Holding parents in mind. A second layer of hermeneutic analysis revealed parents’ and nurses’ collective experience to have their being in four elements of the phenomenon. These elements are Being in chaos; Struggling to connect; Being for another and Being complete. The final description of the parents’ and nurses’ experience of parental presence during resuscitation in PICU as Sharing and surviving the resuscitation is drawn from the findings from each of these layers of meaning. The findings from this study conclude that the parents’ inherent need to be with their child overrode their anxieties of the resuscitation scene, curbing their feelings of chaos. Parental presence however, was a complex and dynamic concept that required a new relationship between parents and nurses. Implications of this study include recommendations for improving staff knowledge and education, as well as practical interventions for enhanced support for both parents and nurses / Doctor of Philosophy (PhD)

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

This is a study of some of the families in the Loma Linda University Medical Center infant heart transplant program.

Background: When the Convention on the Rights of the Child became Swedish law, the requirements for children to be cared for by experienced staff increased, yet children are often cared for by nurses without pediatric training in emergency departments that primarily care for adults. Therefore, general nurses are expected to care for critically ill children, despite a lack of research examining their competence and preparedness. Purpose: To describe nurses' experiences of caring for critically ill children in an emergency department. Method: Qualitative interview study based on twelve participants who were selected through a convenience sample with a targeted selection strategy. The data analysis was done according to a qualitative content analysis and reported in a manifest content analysis. Results: The nurses were affected by a variety of challenges in the care of critically ill children in the emergency department. Which led to experiences of lack of competence, technical challenges, the nurses needed to consider more factors, make other reasonable judgments, and became dependent on manuals. The nurses also described a lack of training and education, problems with high staff turnover and a lack of specialist nurses in children. Conclusion: The nurses struggled to maintain clinical competence, which made them in need of a more stable introduction, education, and regular work in the children's emergency department. The lack of specialist nurses in children and the problem with staff turnover needed to be addressed, as they could be contributing factors to the nurses' feeling of lack of competence and insufficient performance.

No description available.

Thesis (M.A.)--State University of New York at Binghamton, Department of Philosophy, 2009. / Includes bibliographical references (leaves 55-56).

Les effets des catécholamines en réanimation sont peu prédictibles. La variabilité interindividuelle des observations est d’origine multifactorielle dont des facteurs pharmacocinétiques et pharmacodynamiques, dépendant de caractéristiques constitutionnelles et acquises de chaque individu. Les posologies de l’adrénaline et de la noradrénaline chez l’enfant sont extrapolées des données adultes. Pourtant l’âge est une source de grande variabilité liée au développement. Un modèle pharmaco- statistique de l’adrénaline et de la noradrénaline a été établi chez l’enfant en insuffisance circulatoire aigüe. Il a permis d’identifier des facteurs de variabilité entre les individus ainsi que de proposer des schémas de prescription des deux molécules en fonction de l’effet souhaité et des caractéristiques de l’enfant. La pharmacocinétique de l’adrénaline chez 39 enfants en prévention du syndrome de bas débit cardiaque postopératoire suivait un modèle monocompartimental. La clairance augmentait avec le poids selon le principe de l’allométrie. Les augmentations résultantes de la fréquence cardiaque et de la pression artérielle moyenne suivaient un modèle d’effet direct Emax. Elles étaient influencées par l’âge et la gravité des patients. Les augmentations de glycémie et lactatémie suivaient un modèle d’effet indirect. Pour la noradrénaline, chez 38 enfants atteints d’hypotension artérielle systémique, la pharmacocinétique était mono-compartimentale. La clairance était influencée par le poids (allométrie). L’augmentation induite de la pression artérielle moyenne suivait un modèle direct Emax. Elle était fonction de l’âge et de la gravité des patients. Les posologies de l’adrénaline et de la noradrénaline chez l’enfant devraient tenir compte du poids, de l’âge et de la gravité du patient : plus jeune est l’enfant et plus grave est son état, plus la posologie doit être élevée pour satisfaire les objectifs hémodynamiques. / The effects of catecholamines are difficult to predict. The between-subject variability observed in clinical setting is multifactorial including constitutional and acquired characteristics of each individual. Epinephrine and norepinephrine dosages are usually extrapolated from adult data. Yet, age is a source of high variability due to development- related phenomena. A population model of epinephrine or norepinephrine was developed in haemodynamically critically ill children. This allowed to identify between-subject variability factors as well as to propose individualized dosage regimens of these two catecholamines according to the desired effect and child characteristics. Epinephrine pharmacokinetics in 39 children at high risk of postoperative low cardiac output syndrome followed a one-compartment model. Clearance increased with bodyweight according to the allometric rule. The resulting increases in heart rate and mean arterial pressure followed a direct Emax model. These were related to age and illness severity. A turn-over model described the increases in blood glucose and lactate. Norepinephrine pharmacokinetics in 38 hypotensive critically ill children followed a one compartment model. Clearance increased with bodyweight (allometry). The resulting increase in mean arterial pressure followed a direct Emax model. This was a function of age and illness severity. The dosage of epinephrine and norepinephrine in children should take into account the bodyweight, age and illness severity of the patient: the younger the child and the more serious the condition, the higher the dosage in order to meet the haemodynamic goals.