The topic of this thesis is Czech nuclear law. The purpose of the nuclear law is to regulate the conditions of use of nuclear energy and ionizing radiation in order to ensure protection of people and environment from the adverse effects of ionizing radiation. Because of highly technical nature of nuclear law, the first chapter is devoted to possibilities of use of ionizing radiation, and to outline few of relevant technical terms. The second chapter of this thesis deals with international cooperation in the area of use of nuclear energy and ionizing radiation. The third and fourth chapters are devoted to Czech nuclear law with main focus on environmental aspects. While the third chapter defines the principles and tools of environmental protection in the field of nuclear law and introduces the structure of legal norms in this area, the fourth chapter analyzes the regulation of specific activities related to the use of ionizing radiation. Included are chapters concerning construction of nuclear facilities, transport of radioactive substances, decommissioning of nuclear facilities and radioactive waste management. Disregarded is neither regulation of liability for nuclear damage. In conclusion, the thesis highlights weak points of the legislation and delineates possible solutions de lege ferenda,...

Bakgrund: Allt fler människor kommer att drabbas av någon form av demenssjukdom vilket bland annat leder till förlust av kognitiva förmågor. Detta innebär ökat behov av vård- och omsorgsboende för de personer som drabbats. Det centrala för personer med demenssjukdom är att vården är personcentrerad samt att den fysiska vårdmiljön är anpassad efter deras behov. Syfte: Att beskriva den fysiska vårdmiljöns betydelse för omvårdnad av personer med demens på vård- och omsorgsboende. Metod: En litteraturöversikt som grundades i kvalitativa (n=12), kvantitativa (n=1) samt mixade (n=2) studier. Studierna hade fokus på den fysiska vårdmiljöns betydelse för omvårdnaden av personer med demenssjukdom. Artiklarna kvalitetsgranskades, analyserades och indelades fyra huvudkategorier med sju underkategorier. Resultat: Resultatet visade att den fysiska vårdmiljön påverkade personer med demenssjukdom. Genom anpassning av måltidsmiljö, utomhusmiljö och inomhusmiljö främjades livskvalitén för personer med demenssjukdom. Att vårdmiljön utformades hemlik med välbekanta föremål gjorde det lättare för personer med demenssjukdom att göra sig hemmastadda och trivas på sitt nya boende. Detta påverkade självbestämmande och självständighet likväl som livskvalité och trygghet. Slutsats: Personer som diagnostiseras med demenssjukdom drabbas olika då det finns många varierande symtom och begräsningar. Forskning indikerar att det rör sig om kognitiv nedsättning vilket kan påverka personens integritet, självbestämmande och autonomi. Resultatet visar på att anpassning av den fysiska vårdmiljön kan minska konsekvenserna av kognitiv nedsättning för personer med demenssjukdom, samt ge en känsla av att vara hemma och frihet. Detta kan bidra till lugn, trygghet och autonomi för de som bor på vård- och omsorgsboendet. / Background: An increasing number of people will become suffering from dementia which means loss of cognitive abilities. Aging populations means an increased need for residential care. The most important thing for people with dementia is that the care is person-centered and the environment adapted to their needs. Purpose: To describe the importance of the physical care environment for caring of people with dementia in nursing homes. Methods: A literature review based on qualitative (n = 12), quantitative (n = 1) and mixed (n = 2) studies. The studies focused on the meaning of the physical care environment for the care of people with dementia. The articles were quality checked, analyzed and divided into four main categories with seven sub-categories. Results: Persons who are diagnosed with dementia are affected differently because there are many varying symptoms and limitations. By adapting the meal environment, the outdoor environment and the indoor environment the quality of life for people with dementia was promoted. When the care environment was designed home-like with familiar objects it made it easier for people with dementia to feel like home and enjoy their new home. This was shown to affect selfdetermination and independence as well as quality of life and security. Conclusions: People who suffer from dementia are not affected in the same way, there are many different symptoms and limitations. Research indicates that in all cases it is a cognitive impairment which affects the person's capability of integrity, self-determination and autonomy. The results show that adapting the physical care environment can promote cognitive decline for persons with dementia, and also give a feeling of being at home and freedom. This can contribute to tranquility, security and autonomy for those living at the nursing home

Bakgrund: Florence Nightingale (1820 - 1910) förespråkade vikten av vårdmiljön kring patienten för ett optimalt återhämtande. Den moderna vårdmiljön består av fysisk och psykosocial del där båda dessa delar är avgörande för patientens välmående. Postoperativ smärta som följer ett operativt ingrepp upplevs individuellt. Det är sjuksköterskans ansvarsområde i postoperativ omvårdnad att sörja för en god smärtlindring; omvårdnadsmässigt, genom manipulation av vårdmiljön och farmakologisk smärthantering.Syfte: Syftet är att beskriva vårdmiljöns betydelse för att lindra nyopererade patienters postoperativa smärtaMetod: En litteraturöversikt med kvalitativ ansats. Studiens resultat baseras på 15 vetenskapliga artiklar som är kvalitetsgranskade. De vetenskapliga artiklarna söktes på CINAHL, PubMed, Web of Science samt via manuell sökning.Resultat: I litteraturöversikten identifierades kategorierna fysisk vårdmiljö med underkategorierna patientrummet och kontakt med extern miljö. I kategorin psykosocial vårdmiljö framträdde underkategorierna; känsla av kontroll, relationer och musik som distraktion som smärtlindrande alternativ.Slutsats: Den fysiska och psykosociala vårdmiljön har en distraherande effekt och/eller har en lindrande effekt på postoperativ smärta. / Background: Florence Nightingale (1820 - 1910) was a major advocate for the importance of environment for optimal patient recovery. The modern healthcare environment typically consists of two components, one physical and one psychosocial, where both parts are considered crucial for the patient’s return to health. This is particularly important to bear in mind in the postoperative context and with the experience of postoperative pain, which varies from patient to patient. Nurses are responsible for providing postoperative pain relief, chiefly by nursing, utilizing the health care environment and administering pharmacological painkillers.Aim: The purpose of the study is to describe the importance of the health care environment in relieving newly operated patients postoperative pain.Method: A literature review with qualitative design. The results of the study are based on 15 scientific articles that have been quality reviewed. The scientific articles were searched on CINAHL, PubMed, Web of Science and via manual search.Results: The literature review identified physical care environment with subcategories; patient room and contact with the external environment. In the category psychosocial care environment subcategories; sense of control, relationships and music as distraction as pain-relieving alternatives.Conclusion: The physical and psychosocial health care environment act as a distractive element on the patient and/or have a relieving effect on the postoperative pain.

Bakgrund: Sjukhus upplevs för många som en främmande plats där vårdmiljön innehåller flera sömnstörande intryck. En störd sömn kan på sikt orsaka ohälsa, obehag och försämrad läkning hos patienter. Syfte: Syftet med denna studie var att belysa patienternas upplevelser av hur vårdmiljön påverkar sömnen på vårdavdelningar, samt utforska sjuksköterskornas upplevelser av hur vårdmiljön påverkar patienternas sömn. Metod: Syftet har besvarats med hjälp av en litteraturöversikt. De ingående artiklarna som inkluderats har varit av kvalitativ ansats samt multimetodsstudier med kvalitativa inslag. Litteratursökningen har genomförts i databaserna PubMed, CINAHL, PsycInfo, Svemed+ och Google Scholar. De inkluderade studierna i detta arbete har genomgått en kvalitetsanalys där de erhållit medel till hög kvalité. Resultat: Resultatet har sammanställts i fyra huvudkategorier med tillhörande underkategorier. I resultatet framkom det att vårdavdelningens klimat med allt från ljud och buller till ljus och en skiftande temperatur påverkade patienternas sömn. Avdelningens omvårdnadsrutiner och den medicintekniska utrustningen var orsaker till sömnstörningar och rubbad dygnsrytm. Det egna upplevda hälsotillståndet med såväl fysiska som psykiska aspekter, till följd av symtom och påfrestande tankar gjorde det svårt att sova. Patienterna och sjuksköterskorna upplevde att möten och interaktionen med andra patienter och vårdpersonal väckte känslor som i olika avseenden påverkade sömnen. Slutsats: Med anledning av studiens resultat kan slutsatser dras att området är komplext och att mer forskning behövs, i synnerhet på sedvanliga vårdavdelningar. En bredare kunskapsbild gällande sömn skulle därmed innebära att fler åtgärder tillämpas kliniskt i syfte att främja patienters sömn. / Background: The health facility environment is an unaccustomed place which is filled with sleep disturbing impressions. Disturbed sleep contributes to illness, discomfort and a decreased healing process for the patients. Aim: The aim of this study was to illustrate the patients experiences of how the health facility environment affects the sleep of patients in hospital wards and explore nurses experiences of how the health facility environment affects the patients sleep. Method: To answer the aim of this study a literature review was conducted with qualitative and multimethod studies. The literature search used the databases PubMed, CINAHL, Psycinfo, Svemed+ and Google Scholar. The included articles in this study has passed through a quality analysis and have received average- to high quality. Results: The results have been put together in four main categories with associated subcategories. The results showed that the ward climate with sound and noise to light and a changing temperature affected the patients sleep. Nursing care routines and the medical equipment were causes of sleep disorders and deranged circadian rhythm. The own state of health with physical and mental aspects, as symptoms and stressful thoughts were experiences that made it hard to sleep. The patients and nurses experienced that encounters and interactions with other patients and staff evoked emotions which in different ways affected the sleep. Conclusion: With reason to this study conclusions can be made that this field of care is complex and more research is needed, especially at customary wards. A wider knowledge regarding sleep would mean that more measures can be applied clinically to promote patients sleep.

Background: In today's healthcare, it is common for patients to be treated with other patients in a shared room. Patients' experience of being cared for in a shared room can be experienced differently from individual to individual. Purpose: The purpose of this literature review is to investigate patients’ experience of being cared for in a shared room. Method: Literature study with qualitative studies and quantitative studies from the databases CINAHL and PubMed. Results: The result is based on 13 studies with qualitative and quantitative methods. After reviewing all the articles, it resulted in three themes, “Privacy, Well-being and Environment”. The patients had a positive experience with the shared room as it brought a community between the patients in the ward, it created an opportunity to find comfort and think about something other than their health condition. High noise level, impaired sleep, room structure with limited access to windows were perceived as something negative for the patients' experience of being cared for in a shared room. The patients also felt that their integrity and dignity were not respected to the same extent in a shared room. Conclusion: Patients' experiences of being cared for in a shared room can differ greatly. In order for nurses to be able to adapt the care, when it is possible, to each individual patient's needs, it is important to know which factors are decisive for the patients' health. The care environment is of great importance for the psychosocial environment, shared room can both increase well-being but can also give a negative experience for the patient.

Master of Science / Department of Industrial & Manufacturing Systems Engineering / Jessica L. Heier Stamm / The main goal of public health emergency preparedness efforts is to mitigate the impact of events on the health of the population. However, decision-makers must also remain conscientious of the costs associated with these efforts. Planning is further complicated by uncertainty about the location and volume of demand that will need to be met in an emergency, the speed with which demand must be met, and the potential scarcity of needed items once an emergency occurs. To address these challenges, public health emergency planners often keep inventory stockpiles that are distributed when an event happens. Managing these stockpiles is a difficult task, and inefficient stockpile location and equipment distribution strategies can be costly both in terms of cost and public health impact. This research is motivated by challenges faced by state public health departments in creating stockpile location and equipment distribution strategies. The primary emphasis is on facemasks and respirators used by health workers during an influenza pandemic, but the approach is generalizable to other scenarios. The model proposed here uses a two-stage approach to generate a holistic solution to the problem. The first stage uses a pull distribution strategy to make stockpile location decisions. Additionally, it determines how counties should be assigned to stockpiles to minimize both storage and distribution costs. The second stage adopts a push distribution strategy to determine optimal delivery routes based on the county assignments made in stage one. This stage offers guidance for public health planners who have made location-allocation decisions but who then face a different distribution scenario than what was anticipated in the original planning phase. Recourse methods for managing demand uncertainty are also proposed. A case study of the state of Kansas is conducted using the methods introduced in the thesis. The computational results yield several significant insights into the tradeoffs and costs of various facility location-allocation and vehicle routing decisions: • For the tested range of storage and distribution cost parameters, multiple stockpile locations are preferred over a single location. • In a pull distribution system, storage costs play a greater role in location-allocation decisions than distribution costs. • In the push distribution system, finding an optimal vehicle routing plan is computationally intensive for stockpiles with a large number of assigned counties. • Efficient heuristics perform well to design recourse routing plans when realized demand is greater than expected. • In the event that planners wish to specify routes well in advance, the results of this research suggest adopting a robust routing plan based on higher-than-expected demand levels. This thesis makes three important contributions. The first is an optimization approach that considers multiple distribution strategies. This is especially relevant when stockpiling for an influenza pandemic where stockpiles need to be located significantly before the material is needed, during which time the distribution strategy may change. Second, the case study demonstrates that the proposed methods are applicable to a large-scale problem arising in practice. Finally, this research illustrates for decision-makers the tradeoffs between different stockpile management strategies and between optimal and heuristic methods.

Rising health care costs place increased burden on patients, health care personnel, administrators and policymakers. Decisions in health care are influenced by data which can be transferred into valuable information and knowledge. Data sets that facilitate data collection, information management and knowledge building are needed by nurse managers to support administrative decision- making. The Nursing Management Minimum Data Set (NMMDS,,¦) offers a standardized method to capture core data that can be collected in information systems, shared and reused for multiple purposes to support safe and cost-effective care. The purpose of this descriptive study was to adapt to Iceland and clinically test the NMMDS-ICE in all adult inpatient care units in the country of Iceland (excluding psychiatry). The aims of the study were to 1) translate the NMMDS from source language (English) to target language (Icelandic); 2) to validate the translated instrument; and 3) to describe the environment, nursing care resources, and financial resources across acute adult inpatient care units in Iceland. Instrument development consisted of translation, expert validation, and psychometric testing. The target population was all adult acute care units in hospitals in Iceland, and the nurse managers (n=38) representing these units. Data collection included a mailed survey. The sample equaled the population. Furthermore, 134 staff nurses on these units (excluding staff nurses at Landspitali) completed a job satisfaction survey. Return rate was 74% for nurse managers and 71% for staff nurses. Semantic and content equivalence of the NMMDS-ICE was established. Five of seven subscales of the instrument received Cronbach¡¦s alpha score of 0.70 or higher. Results indicated that it was feasible to collect the NMMDS-ICE in hospitals in Iceland, albeit, there was an issue with time commitment to do so. The specialty services that best described the patient population were medical-, surgical services, birthing, and geriatrics. Furthermore, nurse managers seem to perceive good control on their units, and both nurse managers and staff nurses are satisfied with their job. A positive correlation was found between autonomy and satisfaction with nursing management, nursing administration, and own level of autonomy. Statistical differences were identified in environmental and staffing resources between hospitals.

Les entérovirus (EV) sont des Picornavirus (virus nus à génome ARN positif), caractérisés par une grande diversité génétique et antigénique (116 types classés en 4 espèces taxonomiques EV-A à D) et une évolution rapide. Les infections humaines sont très fréquentes, hautement contagieuses à partir des selles et épidémiques. La plupart des infections sont asymptomatiques ou bénignes ; elles peuvent être graves voire mortelles, en particulier chez les jeunes enfants. La poliomyélite, modèle d’infection à EV, est en voie d’éradication grâce aux programmes de vaccination et de surveillance sous l’égide de l’OMS. La détection de poliovirus sauvages dans des pays déclarés exempts de polio depuis plusieurs années et l’émergence récente de plusieurs EV non poliomyélitiques (EV-A71, EV-D68) associés à des manifestations cliniques sévères dans plusieurs régions du monde montrent l’importance de surveiller la circulation des EV dans la population humaine. Le but de la thèse était de rechercher et caractériser les EV dans les eaux usées de l’agglomération de Clermont-Ferrand et de comparer les données à celles de la surveillance clinique pour avoir une image plus complète de la circulation virale dans la population générale. Une méthode de concentration virale à partir des eaux usées prélevées en entrée (eaux usées brutes) et sortie (eaux usées traitées) de station d’épuration a été mise au point, permettant la détection moléculaire des EV et de 6 autres virus entériques humains. La présence de génomes viraux a été détectée dans tous les échantillons d’octobre 2014 à octobre 2015, avec une médiane de 6 virus différents en entrée de station et de 4 virus en sortie. L’analyse phylogénétique des séquences d’EV et des virus des hépatites A et E présents dans les eaux usées et les prélèvements cliniques des patients hospitalisés au CHU de Clermont-Ferrand pendant la même période, a validé l’approche mise en place pour surveiller la circulation communautaire d’un virus entérique. La diversité des EV présents dans les eaux usées brutes a été analysée par séquençage d’amplicons avec une technique haut débit Illumina (metabarcoding). Les résultats montrent la présence d’une grande diversité d’EV et la circulation silencieuse de 25 types (notamment 9 EV-C, dont des séquences de poliovirus 1 vaccinal) dans la population générale. L’analyse phylogénétique des variants intra-typiques a mis en évidence plusieurs profils épidémiques parmi les principaux types ayant circulé pendant la période d’étude. Les données obtenues montrent la faisabilité et la sensibilité de la stratégie développée pour détecter et caractériser les EV présents dans les eaux usées. Ils permettent de discuter la place de la surveillance environnementale dans la surveillance des infections à EV non polio (études épidémiologiques, prévention des épidémies, alertes sanitaires). Surveiller conjointement les virus entériques dans l’environnement et chez les patients permet une meilleure compréhension de leur prévalence. Cette approche globale de la circulation virale et de l’écologie de la santé représente un engagement important de la part des laboratoires et nécessitera une intégration dans des réseaux structurés de collaboration nationales et internationales dépassant la seule surveillance des EV. / Enterovirus (EV) are Picornaviruses (non-enveloped, positive-sense RNA viruses), characterized by a large genetic and antigenic diversity (116 types classified within 4 taxonomic species EV-A to D) and rapid evolution. Human infections are frequent, highly contagious from stools and occur as outbreaks. The infections are mainly asymptomatic or benign but severe or fatal cases can be reported in young children. Poliomyelitis is the model EV infection. Combined with clinical and virological surveillance, mass vaccination is closer than ever to achieve the WHO program of the Global Polio Eradication Initiative. However, the detection of wild type polioviruses in polio-free countries and the recent worldwide emergence of non-polio enteroviruses (EV-A71, EV-D68) associated with severe clinical manifestations underscore the importance of surveilling EV circulation in the general population. The aim of the PhD thesis was the detection and identification of EV strains in wastewater treated in the sewage treatment plant at Clermont-Ferrand (France). The viral data were compared with those reported through clinical surveillance to obtain a comprehensive picture of the viral circulation in the local population. A method was developed to concentrate viruses from raw and treated wastewater and molecular assays were used to detect EVs and 6 other human enteric viruses. The viral genomes were detected in all samples from October 2014 to October 2015, with a median of 6 and 4 different viruses in raw and treated wastewater respectively. Phylogenetic analysis of viral sequences (EV, hepatitis A and E viruses) determined in wastewater and reported in patients during the sampling period, showed the efficiency of the method for surveilling enteric viruses in the community. The EV diversity in raw wastewater was analyzed by sequencing of amplicons with the Illumina high throughput technology (metabarcoding). The analysis revealed a large viral diversity and the silent circulation of 25 types not detected from hospital data (in particular 9 EV-C, of which sequences of vaccine poliovirus 1). The phylogenetic analyses of intra-typic variants showed different epidemic patterns in the predominant EV types circulating over the study period. The data demonstrate the feasibility and sensitivity of the strategy developed for the detection and characterization of EV in wastewater and provide a future prospect for the implementation of environmental surveillance of non-polio EV infections in epidemiological studies, epidemic prevention, and for health alert. Combining the surveillance of enteric viruses in the environment and in the clinical setting allows a better understanding of their prevalence. This global approach of virus circulation and ecological health represents an important investment for laboratories, which will require integration in national and international collaboration networks beyond the scope of enterovirus surveillance.

The study aimed to identify leading practices to promote environmentally friendly and efficient efforts in surgical healthcare. Despite widespread enthusiasm for going green in the U.S. economy, little information is available to inform the medical community on the effort. We explore safe and efficient strategies for hospitals and healthcare providers to protect the environment while delivering high-quality care. As part of the study design, we performed a systematic review of the literature using relevant Pubmed search terms and surveyed a panel of hospital managers and CEOs of healthcare organizations pursuing green initiatives. Recommendations were itemized and reviewed with each panelist for a consensus agreement. At the end, we identified forty-three published articles and obtained interview data from the 7-member expert panel. Five green recommendations for surgical practices were identified: (1) OR Waste Reduction and Segregation; (2) Environmentally Preferable Purchasing; (3) Energy Consumption Management; (4) Pharmaceutical Waste Management; (5) Reprocessing of Single Use Medical Devices. We concluded that the medical community has a large opportunity to implement green practices in surgical units. These practices can have significant benefits to both the healthcare community and the environment.

Made available in DSpace on 2015-05-08T14:47:26Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1747620 bytes, checksum: 88c9e140809a78996b2a6663c3d19fc2 (MD5) Previous issue date: 2011-03-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Childhood cancer is a chronic disease that, when diagnosed implies on major repercussions on the child and his family lives. The outpatient chemotherapy is an alternative to minimize damages relating to impaired family links, since the child is replaced by the possibility of receiving the proposed treatment and be released to return home after few hours. In pursuit of excellence in health care, it has been recently appointed that the influence of physical space on the different actors in the hospital environment, such as patients, staff and carers, is of growing importance. The Instituto de Pediatria e Pericultura Martagão Gesteira built a new area for the chemotherapy room which was remodeled and decorated based on the movie Finding Nemo, known now as Aquário Carioca (Carioca Aquarium). Therefore, this study aimed to investigate the influence of environment of the Carioca Aquarium in the perception of the child in relation to the context of the care and well being of the same during the sessions of chemotherapy. This is a qualitative, exploratory and descriptive research. The subjects were seven children of school age who had or were undergoing chemotherapy at the Carioca Aquarium. Data collection was performed in May 2010, using an adaptation of the story-drawing technique for the production of empirical data. To interpret the speech of children followed by the thematic analysis. Emerged from an empirical category: hospital ecology in Carioca Aquarium. The subcategories were: the process: from diagnosis to survival; the Carioca Aquarium environment; care in the aquarium. The results showed that cancer brings much suffering to children and their families at different stages from diagnosis to survival. However, the physical environment was significant and representative for adherence to treatment and was a significant tool for coping with the child and his family in childhood cancer. The children enjoyed playing around the place, even when their presence was not needed in the room. Moreover, stories and personal relationships created and experienced in that hospital ecology were essential to minimize the negative impact of cancer and its treatment in child development. Children, even in cancer chemotherapy, did not perceive themselves as sick, only when there was exacerbation of symptoms or troublesome toxicities. The games made a bridge between the professional and the child by providing a closer approximation, therefore the creation of links, through a careful and sensitive listening. The hospital ecology of the Carioca Aquarium initiatives strengthens the host of the professionals in the child and his family, providing the production of humanized and comprehensive care. It is recognized that the Carioca Aquarium can be a powerful therapeutic environment. / O câncer infantil é uma doença crônica que quando é diagnosticada traz repercussões para a vida da criança e de sua família. A quimioterapia ambulatorial é uma alternativa para minimizar danos relacionados à quebra de vínculos familiares, uma vez que a criança passa a ter possibilidade de receber o tratamento proposto e ser liberada para retornar ao lar após algumas horas. Na busca pela excelência na atenção à saúde, tem sido apontada recentemente a influência que o espaço físico tem sobre os diferentes atores no ambiente hospitalar, tais como os pacientes, o corpo técnico e os acompanhantes. O Instituto de Puericultura e Pediatria Martagão Gesteira destinou uma nova área para a sala de quimioterapia que foi reformada e decorada baseada no filme Procurando Nemo, denominada Aquário Carioca. Este estudo objetivou investigar a influência do ambiente do Aquário Carioca na percepção da criança em relação ao contexto do cuidado e bem estar da mesma durante as sessões de quimioterapia. Trata-se de pesquisa de abordagem qualitativa, exploratória e descritiva. Os sujeitos foram sete crianças em idade escolar, que fizeram ou estavam fazendo quimioterapia no Aquário Carioca. A coleta de dados foi efetuada no mês de maio de 2010, utilizando-se uma adaptação da técnica do desenho-estória para produção do material empírico. Para interpretação dos discursos das crianças seguiu-se os fundamentos da análise temática. Emergiu uma categoria empírica: Ecologia hospitalar no Aquário Carioca. As subcategorias foram: o processo: do diagnóstico à sobrevivência; o ambiente do aquário carioca; o cuidado no aquário carioca. Os resultados apontaram que o câncer traz muito sofrimento para a criança e sua família nas diferentes fases, desde o diagnóstico até a sobrevivência, contudo o espaço físico foi representativo e expressivo para a adesão ao tratamento e constituiu-se em ferramenta significativa para o enfrentamento da criança e sua família frente ao câncer infantil. As crianças gostavam de ficar brincando no local, mesmo quando não era necessária sua presença na sala. Ademais, as histórias e relações pessoais vividas e criadas nessa ecologia hospitalar foram imprescindíveis para minimização do impacto negativo do câncer e seu tratamento no desenvolvimento da criança. As crianças, mesmo em quimioterapia antineoplásica, não se percebiam como doentes, apenas quando havia exacerbação de sintomas ou toxicidades incômodas. O lúdico fez uma ponte entre o profissional e a criança proporcionando uma maior aproximação, portanto a criação de vínculos, por meio de uma escuta sensível e atenta. A ecologia hospitalar do Aquário Carioca fortalece as iniciativas de acolhimento dos profissionais frente à criança e sua família, possibilitando a produção do cuidado integral e humanizado. Reconhece-se o Aquário Carioca como um ambiente terapêutico.