Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway within a multifaceted champion-based simulated educational training program for NICU staff and parents. Published outcomes and generated organizational data for program synthesis connected the gap in practice. Kolcaba's comfort theory served as the guiding framework to ensure a partnership in care. This quasi-experimental quantitative study used the generalized liner model for data analysis. Study findings indicated that KC occurred 2.4 more times after the intervention compared to before (p = 0.001). Descriptive data revealed that KC episodes for intubated patients nearly doubled after implementation (11.1% from 6.2%). Post-survey scores for nursing knowledge and comfort level also improved after the intervention. Although earlier KC practice was non-conclusive (p = 0.082), future trials should control groups for day of life since admission. Disseminating the KC pathway can have a positive social change on family-centered care by increasing NICU nurses' knowledge, comfort, and adoption of this evidence-based practice as an expected routine standard of care.

Familjecentrerad vård har visat sig leda till bättre hälsoresultat och tillfredsställelse hos patienten och dess familj. Inom familjecentrerad vård ska familjen ses som en helhet och där barnet, familjen och sjukvårdsteamet bildar ett partnerskap där alla parter ska känna sig respekterade och arbeta tillsammans. Många familjer ser det som deras rätt att vara närvarande vid återupplivning och invasiva procedurer. Därför behöver sjuksköterskor vara förberedda på att stödja familjen i dessa akuta situationer. Syftet var att beskriva vilken betydelse familjecentrerad vård har för vårdkvaliteten inom akutsjukvården för barn. En litteraturstudie med en strukturerad litteratursökning utfördes som metod. Studier som belyste familjecentrerad vård inom akutsjukvård för barn inkluderades med avsikt att svara på syftet. Studier med kvalitativ och kvantitativ ansats samt med mixad metod som integrerar både kvalitativ och kvantitativ data inkluderades. Datainsamlingen gjordes i databaserna PubMed och CINAHL och dataanalysen gjordes utifrån Whittemore och Knafls (2005) integrativa översiktsmetod. I denna studie identifierades två teman, partnerskap samt familjenärvaro. Delaktighet i vården och respekt för familjen utformades som underkategorier till partnerskap. Påverkan på vården skapades som underkategori till familjenärvaro. Resultatet i föreliggande studie visar på att familjemedlemmars delaktighet i barnets vård är en viktig faktor för familjecentrerad vård. Detta genom att familjemedlemmarna deltar aktivt, närvarar vid invasiva procedurer och återupplivning, är med och planerar och utför omvårdnad samt bidrar med information om barnet. Inom familjecentrerad vård är sjuksköterskans roll att finnas där och lyssna till familjen. Familjecentrerad vård kan vara en strategi för att förbättra akutsjukvården för barn. Denna studie visar på att ett partnerskap mellan sjukvårdspersonal och familjemedlemmar och familjenärvaro vid invasiva procedurer och återupplivning är betydelsefulla faktorer för familjecentrerad vård. Familjemedlemmars delaktighet i barnets vård och att familjen är närvarande i alla situationer och finns där för sitt barn hjälper både dem och barnet i dess akuta tillstånd. Sjuksköterskors inställning om att föräldrar har rätt att finnas där och att tid finns för sjuksköterskorna att stötta familjen spelar också roll inom den familjecentrerade vården. / Family-centered care has been shown to lead to better health results and satisfaction for the patient and their family. In family-centered care the family is seen as a whole unit and where the child, the family and the health care team form a partnership where all parties feel respected and work together. Many families see it as their right to be present during resuscitation and invasive procedures. Therefore nurses should be prepared to support the family in these acute situations. The aim was to describe which importance family-centered care has for the quality of care in the emergency care for children. A literature review with a structured literature research was conducted as a method. Studies which elucidated family-centered care in emergency care for children were included with the intention to answer the aim. Studies using qualitative and quantitative approach and the mixed method that integrates both qualitative and quantitative data were included. The data was collected in the databases PubMed and CINAHL, and the data analysis was based on Whittemore and Knafls (2005) integrative review method. In this study two themes, partnership and family presence were identified. Participation in the care and respect for the family were conceived as subcategories of partnership. Impact on health care was created as a subcategory of family presence. The results of the present study show that family members’ involvement in the child’s care is an important element of family-centered care. This is achieved by the family members being participating actively, being present during invasive procedures and resuscitation, being involved in planning and nursing and contributing with information about the child. In family-centered care the nurse’s role is to be there and listen to the family. Family-centered care can be a strategy to improve emergency care for children. This study shows that a partnership between medical staff and family members and family presence during invasive procedures and resuscitation are significant factors for family-centered care. Family members’ involvement in the child’s care and that the family is present in all situations and are there for their children helps both them and the child in its acute condition. Nurses’ attitude that parents have the right to be there and that time is available for the nurses to support the family also plays a role in family-centered care.

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No description available.

Introduktion: När ett barn diagnostiseras med cancer, oavsett ålder, ökar barnets behov av föräldrarnas stöd och trygghet. Därför är föräldrarnas delaktighet i vården betydelsefull och något som bör uppmuntras och stödjas av samtlig vårdpersonal. Omvårdnaden av svårt sjuka barn ställer höga krav på sjukvården och som sjuksköterska är det viktigt att arbeta familjecentrerat för att möta och tillgodose hela familjens behov. Familjecentrerad omvårdnad innebär att varje familj ska betraktas som unik och att vården ska anpassas efter familjens behov och situation. Syfte: Syftet var att beskriva hur föräldrar till barn med cancer upplever möjligheter och hinder i den familjecentrerade omvårdnaden vid långvarig sjukhusvistelse. Metod: En litteraturöversikt med deskriptiv design baserad på 13 kvalitativa artiklar. Artiklarna kvalitetsgranskades med SBU bedömningsmall för kvalitativ metodik. Databearbetningen av litteraturstudien utfördes enligt Popenoe et al. (2021) beskrivning av allmän litteraturstudie. Resultat: I resultatanalysen framkom fyra kategorier; relation, kunskap, delaktighet och information. Under respektive kategori utformades underkategorier vilka beskrev möjligheter och hinder med familjecentrerad omvårdnad.  Slutsats: Föräldrars upplevelser av möjligheter och hinder i den familjecentrerade omvårdnaden är mångfacetterade. En god vårdrelation, erfaren och kompetent vårdpersonal, främjad delaktighet och tillgodosett behov av information var möjligheter i den familjecentrerade omvårdnaden. Detta ställer krav på vårdpersonalens närvaro, engagemang samt deras förmåga att kommunicera och anpassa omvårdnaden - aspekter som annars utgjorde hinder för den familjecentrerade omvårdnaden. / Background: When a child is diagnosed with cancer, regardless of age, the child's need for parental support and security increases. Therefore, parents' participation in care is important and something that should be encouraged and supported by the staff. Nursing ill children places high demands on healthcare and as a nurse it is important to work family-centered to meet and satisfy the needs of the family. Family-centered care means that each family is considered unique, and that care must be adapted to the specific needs and situation. Aim: The aim was to describe how parents of children with cancer experience opportunities and obstacles in family-centered care during long-term hospital stay. Method: A literature review with descriptive design based on 13 qualitative articles. The articles were quality reviewed using the SBU assessment template for qualitative methodology. Data was analyzed using Popenoe et al. (2021) description of general literature review. Results: In the results analysis, four categories emerged; relationship, knowledge, participation and information. Under each category, subcategories were created which described possibilities and barriers for family-centered care. Conclusion: Parents' experiences of opportunities and obstacles in family-centered care are multifaceted. A good nursing relationship, experienced nursing staff, promoted participation and satisfied need for information were opportunities in family-centered nursing. This places demands on the care staff's presence, commitment and their ability to communicate and adapt the care - aspects that otherwise constituted obstacles for the family center regarding care.

BACKGROUND: People survive repeated health crises that used to be fatal and, at times, treatment intended to prolong life, prolongs death instead. Many people die in hospitals although they say they prefer to die at home. At the same time, research identifies multiple ways the American healthcare system is ill equipped to serve patients at the end of life. Presently, 20% of Americans die in Intensive Care Units (ICU), thus ICUs represent an important setting for learning about end-of-life care and death in America today. PURPOSE: To explore the nature of ICU care as perceived by family members, this qualitative study analyzed 693 reports from surveys mailed to family members of patients who died in the ICU of a major Boston hospital between 2009 and 2015. The study focused on experiences of received services as reported in responses to the survey’s three open-ended questions regarding helpful and unhelpful aspects of care surrounding the patient’s death. Family member experiences with social work services were also explored. METHODS: Data were assessed using the Family-centered Care (FCC) model, an emerging framework for provision of best practices in hospital settings. This framework emphasizes that patients, families, and health care providers work in partnership to set treatment goals. Since FCC has been correlated with better outcomes, one research objective here was to explore the extent to which family members’ experiences reflected the presence of FCC. The study also assessed family members’ experiences that fell outside the realm of FCC. Using NVivo software, analysis was guided by Braun and Clarke’s (2012) six-phase thematic analysis approach. FINDINGS AND IMPLICATIONS: Family members described numerous positive experiences. Deaths were humane and the delivery of FCC was evident. An in-depth data analysis provided illuminating details of FCC and explicated over 47 themes important to families’ ICU experiences. Families reported that they received emotional support, were well-informed, and were treated with respect. Findings suggest that FCC is possible in an ICU setting, supporting the use of FCC in ICU care and suggesting that it could profoundly improve the quality of end-of-life care. Responses concerning the role of social work were limited.

Bakgrund  Prognosen för barncancer är idag god och ca 80 procent av barn överlever sin diagnos även om en stor del drabbas av sena komplikationer. Familjecentrerad vård är ett begrepp som ser familjen som en enhet snarare än den individuella familjemedlemmen som genomgår behandling. Vidare har tidigare forskning visat på ett samband mellan måendet hos barn som undergår behandling och deras föräldrars mående då de är barnets primära stöd under behandlingen. Trots tidigare forskningsresultat är familjecentrerad vård inte fullt utnyttjat inom vård och missar potentiellt de positiva effekter det skulle kunna innebära för familjer med barn som undergår behandling för sjukdomar som cancer.       Syfte   Att beskriva föräldrars erfarenheter av att ha ett barn med cancer.   Metod Studien baserades på en icke-systematisk litteraturstudie av 19 artiklar. Artikelsökningen har genomförts i de tre vetenskapliga databaserna PubMed, CINAHL samt PsychInfo. Integrerad analys har utförts. De inkluderade artiklarna har genomgått en kvalitetsgranskning med Sophiahemmets Högskolas bedömningsunderlag för att säkerställa kvalitet och tillförlitlighet.      Resultat Resultaten antyder att det finns ett flertal olika stöd som föräldrar skulle kunna erhålla för att förbättra deras mående när deras barn har cancer. Att behålla sitt sociala liv samt ett relativt normalt arbetsliv var kopplade till positiva effekter på föräldrars mående. Majoriteten av artiklarna var samstämmiga kring att känslor kopplade till att vara förälder till ett barn med cancer inkluderade posttraumatiska stressymtom, depression, ångest och känslor av tappad kontroll över sin livssituation.    Slutsats Ett flertal olika stöd föreslås förbättra föräldrars mående. Stöd i form av kunskap och samtal mellan vårdpersonal och föräldrar ökar samt ger möjlighet att behålla ett socialt liv, den personliga sfären och relativt normalt arbetsliv föreslås också ha positiva effekter. / Background The prognosis for children's cancer is generally good and approximately 80 percent of children survive their diagnosis though many children are affected by late complications. Family centered care is a body of literature suggesting viewing the family as one unit, rather than focusing caregiving on the individual patient in need of physical care. Furthermore, previous research has shown that the mental health of children receiving care is connected to the mental health of their parents. This is mainly explained by the parental role of primary support to the child undergoing care, the mental health of the parent affecting the ability to provide the support needed for the child. Despite previous research findings, family centered care is underutilized within health care, potentially not realizing positive effects for families with children undergoing treatment for diseases such as cancer.   Aim To describe the experiences of parents to children undergoing treatment for cancer.   Method    The study was conducted using a non-systematic literature study of 19 articles. The article search has been conducted in the three scientific databases PubMed, CINAHL and PsychInfo. Integrated analysis has been performed. The included articles have been assessed with Sophiahemmet Universities assessment basis to ensure quality and reliability.     Results The results suggest that there are a number of different kinds of support that parents could receive in order to improve their mental well being during the treatment of their child. Maintaining a social life as well as the ability to keep working on a relatively normal level were suggested to contribute to parents’ well being. Furthermore the majority of the included articles were consistent on that feelings experienced as a parent of a cold with cancer were post traumatic stress symptoms, depression, anxiety and a feeling of loss of control of their life situation.      Conclusions  Several types of support could be offered to parents to improve their mental health. Support in knowledge about the disease and its treatment as well as support to maintain a social life, retaining the personal sphere and a relatively normal working life are all suggested to have a positive effect.

Bakgrund: Globalt uppskattas 55 miljoner vara i behov av palliativ vård. I Sverige erhåller cirka 60 000 människor palliativ vård. Syftet med den palliativa vården är att symtomlindra och bibehålla god livskvalitet. Det är av vikt att sjuksköterskan undersöker närståendes upplevelser av palliativ vård för att kunna bemöta och ge ett gott stöd. Syfte: Syftet var att beskriva närståendes upplevelser av palliativ vård i livets slutskede. Metod: En kvalitativ litteraturöversikt med induktiv ansats där 14 artiklar analyserades till resultatet. Resultat: Två teman och sex subteman identifierades. Temat behov av att känna trygghet med tillhörande subteman; Att få tillräcklig information, att ha en god relation till vårdteamet och att befinna sig i en trygg miljö. Temat behov av att känna stöd med tillhörande subteman; att känna sig trygg i vårdarrollen, att få vara inkluderad, att få stöd i att hantera dödens närvaro.    Slutsats: Närstående upplevde vikten av att känna trygghet och att få stöd. En meningsfull relation och tillräcklig information ansågs vara avgörande för att skapa känslan av trygghet. Behovet av att erhålla stöd från vårdpersonalen upplevdes vara viktigt för att få möjligheten att vara involverad och att ha ett inflytande inom vårdförloppet. Familjecentrerad vård återspeglades i resultatet genom att de centrala aspekterna framkom i sjuksköterskans och vårdteamets bemötande med närstående. / Background: Globally 55 million people are estimated to be in need of palliative care. In Sweden, approximately 60,000 people receive palliative care. The purpose of palliative care is to relieve symptoms and maintain a good quality of life. It is important that the nurse examines relatives' experiences of palliative care in order to be able to encounter relatives and provide good support. Aim: The aim was to describe relatives' experiences of palliative care at the end of life. Method: A qualitative literature review with an inductive approach where 14 articles were analyzed for the result. Result: Two themes and six subthemes were identified. The theme of need to feel secure with associated subthemes; to receive sufficient information, to have a good relationship with the care team and to be in a safe environment. The theme of need to feel supported with associated subthemes; to feel safe in the caregiver role, to be included and to be supported in dealing with the presence of death.  Conclusion: Relatives experienced the importance of feeling safe and receiving support. A meaningful relationship and sufficient information were considered crucial to creating a sense of security. The need to receive support from the care staff was felt to be important in order to have the opportunity to be involved and to have an influence within the care process. Family-centered care was reflected in the results by the fact that the central aspects emerged in the nurse’s and care team’s encounter with relatives.

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No description available.