Syfte:Att beskriva föräldrars upplevelse av faktorer om har inverkan på deras närvaro hos sitt extremt underburna barn som vårdats på intensivvårdssal på neonatalavdelning. Material och metod: Semistrukturerade djupintervjuer utifrån en intervjuguide genomfördes under 2010 och 2011. Tretton föräldrar deltog i studien. De inspelade intervjuerna transkiberades ordagrant, och bearbetades med kvalitativ innehållsanalys. Resultat:Föräldrar till extremt underburna barn som vårdais på intensivvårdssal beskrev skilda upplevelser av vården och uttryckte olika behov. Vårdtiden innebar ett känslomässigt pendlande från chock till en känsla av kontroll. Faktorer som underlättade närvaron hos barnet var möjlighet till boende på avdelningen. Att få ökade kunskaper och ta över vården av barnet stärkte föräldrarna i föräldrarollen och ökade motivationen till att vara hos barnet. Genom att känguruvårda barnet kände sig föräldrarna behövda vilket ökade deras närvaro. Försvårande faktorer var miljön på intensivvårdssalen som ibland upplevdes stressfylld med oacceptabelt hög ljudnivå vilket gjorde det svårt att sova och övernatta hos barnet. Personalens arbetssituation hade inverkan på möjlighet till känguruvård eftersom det ledde till väntan på att få hjälp vid förflyttning av barnet från kuvös till förälder. Närvaro vid smärtsamma procedurer upplevdes som försvårande för många av informanterna. / Aim:To describe parents’ experiences of factors that have an impact on their presence with their extremely premature infant who is cared in an intensive care nursery at a neonatal unit. Materials and method:Semi structured interviews based on an interview guide were conducted in 2010 and 2011. Thirteen parents participated in the study. The recorded interviews were transcribed verbatim and processed by qualitative content analysis. Result: Parents of extremely preterm infants, who wore treated in an intensive care nursery, had different experiences of care and expressed different needs. The infant’s hospital stay was an emotional pendulum from chock to a sense of control. A factor that facilitated the parents’ presence with the child was the possibility to live in the neonatal unit. Attainment of more knowledge and taking over their infants’ care empowered the parents in their parental role, which increased their motivation to stay with their infant. Kangaroo Mother Care made parents feel needed which increased their presence. A hindering factor was the environment in the intensive care nursery. This was sometimes experienced as stressful with unacceptable levels of sound which rendered in sleeping difficulties and made it hard for the parents to stay over the night with the infant. Staff working conditions had an impact on their opportunities for Kangaroo Mother Care because this sometimes meant that parents had to wait for assistance with transfer of the infant from incubator to parent. Presence during painful procedures was perceived as an obstacle by several informants.

The trend towards patient-and family-centered care (PFCC) invites families of critically ill patients to participate more fully in the care and recovery of their loved ones through partnerships with the medical team and personalized care that respects the values, beliefs and experiences of the individual. In response to the growing needs of families, healthcare institutions are re-designing the way patient and family care is delivered in terms of policy, culture and the physical environment. Despite the many benefits that come with closer collaboration, nurses report that "challenging" families are a key source of workplace stress. This exploratory case study documents some of these challenges as perceived by staff nurses at Emory University Hospital's Neuro ICU while examining the role the built environment plays in shaping such perceptions. Through a series of ethnographic interviews and observational methodologies, the study identifies some of the challenges and benefits that come with balancing patient and family needs. Nurse strategies developed to reassert spatial and temporal control over work environments are also identified. The second phase of research compares communication patterns generated from two different ICUs to explore the link between unit design and the frequency and quality of nurse-family interactions. Findings suggest that space plays a role in moderating the degree of nurse exposure to the often unstructured and unpredictable aspects of family interactions. These encounters, set within a highly charged critical care setting, may contribute to these perceived challenges. Healthcare stands at an important moment of transition in which attitudes, behaviors and expectations are changing. Together these results reinforce the need for adequate tools, training and education to further support nurses in the transition to this new care culture.

Bakgrund: Familjer har inte alltid deltagit i omvårdnaden på det sätt de gör idag. Under de senaste decennierna har begreppet familjefokuserad omvårdnad lyfts fram och blivit till en central del inom barnsjukvården. Familjefokuserad omvårdnad lägger tonvikt på familjers deltagande och engagemang i sitt barns vård. Syfte: Syftet är att undersöka hur familjer och sjukvårdspersonal beskriver familjers delaktighet inom barnsjukvården i Norden. Metod: Litteraturstudie av tio vetenskapliga artiklar med kvalitativ design. Resultat: Resultatet presenteras utifrån tre huvudteman. Stöd var en av de viktigaste beståndsdelarna och som också väckte intresse till ökad delaktighet i barnsjukvården. Stöd presenteras i avsnittet familjernas behov av stöd. När ett barn blir sjukt är det inte bara barnets liv som påverkas, utan en hel familjs, vilket presenteras i avsnittet en livsvärld som vänds upp och ner. En svår tid följde de flesta familjer under tiden de försökte vänja sig vid sin nyfunna livssituation. I avsnittet att vårda en hel familj presenteras att varje familj var unik och att de hanterar olika situationer på olika sätt.  Slutsats: Resultatet i denna litteraturstudie har visat på att stöd är en viktig faktor för familjer när ett barn är sjukt. Både stöd från vården och socialt stöd från släkt och vänner är viktigt när det kommer till att stärka familjer samt att få familjen delaktig i barnets omvårdnad. Klinisk betydelse: Denna litteraturstudie kan bidra bredare med kunskap om familjefokuserad omvårdnad samt familjers delaktighet inom barnsjukvården. Calgarymodellen i den familjefokuserade omvårdnaden kan hjälpa sjukvårdspersonal att göra familjer delaktiga genom hela omvårdnadsprocessen. / Background: Families has not always been a part of the pediatric care. Family-centered care is a phenomenon which has been highlighted during the past decades and has become a central part of pediatric care as it is today. Family-centered care includes family participation and family involvement in the child’s care. Aim: To explore how families and nurses define family participation in Nordic Pediatric care.  Method: The aim was answered with a literature review of ten scientific qualitative articles. Results: The result is presented in three head themes. Support was one of the most important elements and contributed to participation in the pediatric care. Support is presented in the theme families’ need for support. When a child becomes ill it’s not only the child’s, but the whole families lifeworld that gets affected, which is presented in another theme, a lifeworld up-side-down. Most families had a hard time adjusting to their new life situation. In the third theme, to care for the whole family, we present that every family is unique and handle situations different.  Conclusion: The result of this literature review has shown that support is an important factor when a child is ill. Good support from health care and social support from family and friends is important to the family members, especially when it comes to family strengthening and to encourage families to participate in the care. Clinical significance: This literature review can contribute knowledge about family-centered care and participation in pediatric care. The Calgary Family Assessment Model can help create good family-centered care and encourage family members to participate in care.

Growing up in a family environment that includes child maltreatment can result in an array of negative consequences for children, including health, behavioral, developmental, and social difficulties, and these consequences can persist over the lifetime. Families who have come to the attention of child welfare services for child maltreatment are at particularly high risk for experiencing multiple concurrent problems, including intimate partner violence, substance abuse, and mental health issues, as well as other family challenges. It is essential to intervene effectively with this population. However, there are few qualitative studies of parent experiences in the child welfare system through which to better understand parents' perspectives and identify additional or more effective points of intervention. This exploratory study utilized a mixed-methods design, primarily focusing on in-depth qualitative interviews with parents in the child welfare system, to explore participants' lived experiences within the continuum of child welfare services. Participants in this study experienced a range of interconnected stressors that impacted both their ability to effectively parent their children as well as successfully complete the services required of them by the child welfare system. Qualitative interviews revealed that parents experienced an overall lack of empowerment, effective communication, and support through their experience with the child welfare system, until they accessed the therapeutic services they were required to attend near the end of their time in the system. Parents were more responsive when services were more supportive, rather than punitive, and individualized to their needs and strengths. This study suggests that systematically implementing more individualized, family-centered services throughout the continuum of services provided by the child welfare system would be effective in intervening with families. Findings also indicate the need for continued qualitative research with parents to address both areas of intervention for families who have already maltreated their children and the prevention of maltreatment and other related stressors in families who are at risk.

Addressing the sub-optimal breastfeeding initiation and duration rates has become a national priority. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration between providers such as lactation professionals, nurses, pediatricians, and the family. The purpose of this exploratory study was to understand International Board Certified Lactation Consultants' (IBCLCs) perceived barriers to managing early breastfeeding problems. This qualitative study was guided by the symbolic interactionist framework through a grounded theory methodological approach. In-depth interviews were conducted with 30 IBCLCs from across Florida. IBCLCs were from a range of practice settings, including hospitals, WIC clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers were identified and grouped into the following categories: indirect barriers such as social norms, knowledge, attitudes; direct occupational barriers such as institutional constraints, lack of coordination, and poor service delivery; and direct individual barriers including social support and mother's self-efficacy. A model was developed to illustrate the factors that influence the role enactment of IBCLCs in terms of managing breastfeeding problems. IBCLCs overwhelmingly wish to be perceived as valued members of a health care team, but often find interprofessional collaboration is a struggle. However, IBCLCs find creative strategies to navigate challenges and describe their role as pivotal in empowering mothers and their families to meet their breastfeeding goals. Though rarely actualized, IBCLCs place strong value on coordinated, team approaches to breastfeeding management that employ transparent communication between providers and focus on empowering and educating mothers. Strategies for better collaboration and communication between IBCLCs and other providers are needed. Findings provide insight into the management issues of early breastfeeding problems and may lead to future interventions to reduce early weaning, thus increasing the lifelong health benefits of breastfeeding to the infant and mother.

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No description available.

Stroke är en av de vanligaste orsakerna till död och funktionsnedsättning. Det är främst personer över 65 år som drabbas. Fysisk, psykisk och social påverkan förekommer ofta. Hjärninfarkt och hjärnblödning är de två orsakerna till stroke och högt blodtryck är en bidragande orsak. Symtom på stroke kan till exepmpel vara förlamning eller talsvårigheter. Att bli sjuk eller uppleva ohälsa innebär påfrestningar och omställningar i livet för hela familjen. Syftet var att beskriva hur partnern påverkas av att leva med en person som drabbats av stroke. Litteraturöversikt har valts som design och tolv artiklar, som är kvalitetsgranskade och etiskt godkända, har inkluderats i resultatet. De databaser som användes var CINAHL, Medline och PsycInfo. Artiklarna analyserades i fem steg. I resultatet framkom sex teman: Förändringar i hälsan, Förändringar i relationen, Förändringar i vardagslivet, Förändringar inför framtiden, Vägen tillbaka till det tidigare livet och Behovet av stöd och information. Det framkom att deltagarna upplevde stora individuella förändringar som var fysiskt och psykiskt påfrestande. Partners upplevde att deras hälsa också påverkades negativt. De upplevde även sociala förändringar, till exempel isolering i hemmet. Det framkom i artiklarna att god kunskap och information hade underlättat bearbetningen av situationen. Partnerna upplevde att deras ansvar för sin livskamrat hade ökat i samband med strokehändelsen. I diskussionen diskuterades vikten av information och kunskap för att upprätthålla god hälsa. / Stroke is one of the most common causes of death and disability. It´s most common that people who are older than 65 years is affected. Physical, mental and social symptoms are common occurrences. Cerebral infarction and haemorrhage are the two causes of stroke and may occur because of high blood pressure, among other factors. Symptoms may present themselves as paralysis and dysarthria. Being sick or experience poor health can cause stress in life for the whole family. The aim of this study was to describe how the spouse is affected by living with a person affected by stroke. Literature review has been chosen as design, twelve articles, that has been quality and ethical approved is included in the result. Databases used in this study were CINAHL, Medline and PsycInfo. These articles were analyzed with five steps. In the result, six themes emerged: Changes in health, Changes in the relationship, Changes in everyday life, Changes for the future, Finding a way back to a normal life and The need for information and support. The result of the studies showed that the participants experienced individual changes that physical and mentally demanding. The spouses experienced that their health was affected negatively. They also experienced social changes in their lives, such as isolation. It emerged from the studies that knowledge and information was important, but was inadequate. The participants experienced that their responsibility for their sick partner had increased after the stroke. The importance of information and knowledge to maintain good health was also discussed in the conclusion.

Bakgrund: Anknytningen underlättas mellan barn och föräldrar om de kan vara tillsammans redan från förlossningen. Teamarbete förbättrar kvalitén och bidrar till helhetsperspektiv i vården. En god arbetsmiljö och ett gott samarbete mellan personal är viktigt för effektiviteten av samvård. Att undersöka personalens förväntningar inför ett nytt arbetssätt är betydelsefullt eftersom det kan avspegla sig i den vård som senare ges.Syftet med studien var att belysa personalens förväntningar inför sammanslagning av olika vårdavdelningar och att samtidigt införa samvård.Metoden var en kvalitativ metod med totalt 14 deltagare i tre fokusgruppsintervjuer. Datainsamlingen analyserades med en kvalitativ innehållsanalys.Resultatet sammanfattades med temat ”Tryggt och välkänt eller nytt och osäkert – förändringsarbetets balansgång” som beskrev personalens känslor inför sammanslagningen. Kategorierna ”Att få en bra miljö för föräldrar och personal”, ”Att samarbeta med familjen i fokus”, ”Att förena två kliniker och kulturer” och ”Att genomgå en arbetsplatsförändring” beskrev de förväntningar och farhågor personalen uttryckte.Slutsatser: Resultatet visade på förväntningar av att vård- och arbetsmiljö skulle förbättras samt att samarbetet mellan klinikerna skulle bli mer effektivt. Det framkom att det var av betydelse att ha fungerande informationsflöden, uppleva delaktighet samt ha en tydlig ledning i en genomgripande organisationsförändring. / Background: The bonding between child and parent is aided when child and parent can be together as soon as possible from delivery. Teamwork improves quality and contributes to a holistic-perspective on nursing. A good work environment and good cooperation between staff is important for the efficiency of family-centered care. It is significant to investigate the expectations of the staff before introducing a new way of working, since it may reflect in the quality of care later given.The aim of this study was to illustrate the staffs’ expectations on the fusion of care units and whilst introducing family-centered care.The method was a qualitative method, with three focusgroup interviews of a total of 14 participants. Data was analyzed using qualitative content analysis.The result was summarized with the theme “safe and common or new and uncertain – the balance of change” that described the feelings of the staff before the fusion. The categories “achieving a good environment for parents and staff”, “to cooperate focusing on the family”, “uniting two clinics and cultures” and “to experience a change in establishment” described the expectations and fears of the staff.Conclusions: Results showed expectations of improved care- and work environment, and that the cooperation between clinics would become more efficient. It was important having a clear flow of information, to feel participant and to have a straight-forward management in order to create a functioning way of work in family-centered care.

Background: In Havana, Cuba, they have established a great availability of health centers that work close to the patients and their families, both geographically and socially. Family-centered nursing is something that is sought within the health care in the Western world. Numerous studies have shown that family-centered nursing increases patient safety and patient satisfaction and to provide psychological support to family members has shown to contribute to a better well-being to both them and the patient. Aim: To describe nurses’ experiences of involving family members in home-based care provided through consultorios in Havana, Cuba. Method: A qualitative study was completed with semi-structured interviews with five nurses that was currently working or had been working at consultorios in Havana, Cuba. Analysis was done according to qualitative content analysis based on the approach presented by Graneheim and Lundman. Results: The data resulted in two main-themes. The family members were presented as informants to the nurses, psychological support to the patients and as an asset to the nurse. The nurses further explained the importance of seeing the whole picture of their patient’s situation, how they educate family members to be involved in the care and how they support the family members psychologically. Discussion: The nurses’ experience of family members' role and their work to involve them was discussed in relation to previous research and the concept of family-centered care as presented by Benzein, Hagberg and Saveman. / Bakgrund: I Havanna, Kuba, har de upprättat en stor tillgänglighet av sjukvårdsinstanser och hälsocenter som arbetar nära patienterna och deras familjer, både geografiskt och socialt, så kallade consultorios. Familjecentrerad omvårdnad är något som eftersträvas inom sjukvård i västvärlden. Ett flertal studier har visat att familjecentrerad omvårdnad ökat patientsäkerheten och patientens tillfredställelse av vården och att psykologiskt stöd för anhöriga bidrar till en bättre hälsa både för dem och patienten. Syfte: Att beskriva sjuksköterskors erfarenheter av att involvera familjemedlemmar i hemsjukvård som bedrivs utifrån consultorios i Havanna, Kuba. Metod: En kvalitativ studie med semistrukturerade intervjuer genomfördes och fem sjuksköterskor som arbetade eller har arbetat på consultorios i Havanna, Kuba, deltog. Resultatet bearbetades utifrån kvalitativ innehållsanalys baserad på den strategi som beskrivits av Graneheim och Lundman. Resultat: I resultatet framkom två huvudteman. Familjemedlemmarna presenterades dels som informanter men också som en tillgång i sjuksköterskans arbete samt som ett psykologiskt stöd till patienterna. Vidare berättade sjuksköterskorna vikten av att se hela bilden av deras patienters situation, hur de utbildar familjemedlemmar i omvårdnaden och hur de stödjer familjemedlemmar psykologiskt. Diskussion: Sjuksköterskornas upplevelse av familjemedlemmars roll och deras arbete med att involvera dessa diskuterades i relation till tidigare forskning och begreppet familjecentrerad omvårdnad som det beskrivits av Benzein, Hagberg och Saveman.