Sammanfattning För att ge förutsättningar till optimal tillväxt och utveckling vårdas idag, tillsammans med andra behandlingar, prematura barnen på neonatalavdelningar hud mot hud. Vård hud mot hud av det prematura barnet sker oftast på mammas eller pappas bröst och forskning visar att detta är en gynnsam miljö för barnets utveckling och hälsa. Det har också en positiv inverkan på föräldrarnas anknytnings process. En otrygg anknytning kan leda till ohälsa längre fram i livet och det är därför viktigt ur ett folkhälsoperspektiv att det finns forskning som visar hur personalen ska gå till väga för att ge stöd och hjälp till föräldrar att vårda sitt barn hud mot hud. Syftet med denna undersökning var att ta reda personalens uppfattning och erfarenheter av att vårda barn hud mot hud. För att undersöka detta genomfördes sju semistrukturerade intervjuer med barnsjuksköterskor och barnsköterskor på en neonatalavdelning på ett sjukhus i mellan Sverige. Materialet som intervjuerna gav analyserades genom kvalitativ innehållsanalys. I resultatet framkom tre kategorier: personalens syn på sin roll, barnperspektiv och föräldraperspektiv. Kategorierna resulterade i temat ”motstridiga känslor hos personalen”. Detta framkom genom att personalen i sin roll och med sin kunskap om hud mot hud även behöver förhålla sig till barnets behov och barnets rätt till bästa vård samt föräldrarnas behov och svårigheter. Sammanfattningsvis framkom att kunskap, kunskapsöverförande samt att ge föräldrar praktisk hjälp är viktiga för att öka antal timmar barnet vårdas hud mot hud.

Philosophiae Doctor - PhD (Nursing) / The number of healthcare institutions that has embraced Kangaroo Mother Care (KMC) as an effective and efficient method of neonatal care especially in Edo State, Nigeria has not multiplied even after more than a decade of its recommendation by the World Health Organisation (WHO) in 2003. Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying with over 700 newborn deaths per10, 000 live births. This is worrisome because Edo State is one of the 36 states in Nigeria that contribute about 6,700 neonatal deaths to the 255,500 mortality rate recorded in Nigeria annually. This has led to a concern about the knowledge and attitude of the key drivers in neonatal care of simplified methods aimed at reducing neonatal mortality despite previous training efforts. The development of a strategy to enhance the early implementation of the WHO KMC guidelines in all healthcare facilities across the state was therefore conceptualized. Strategies to increase implementation are considered important to the success of KMC because reducing neonatal mortality rate is contextual. This research aimed to explore and describe the application of the KMC guidelines by the nurses, administrators and parents of preterm infants in the care of premature babies and to develop strategies to enhance its early implementation in healthcare facilities in Edo State, Nigeria.

Made available in DSpace on 2014-12-17T15:40:38Z (GMT). No. of bitstreams: 1 RenataMV_TESE.pdf: 1551134 bytes, checksum: 5241bc9c940147eb3212cc19ebdea324 (MD5) Previous issue date: 2010-02-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The Kangaroo Program was implemented in Brazil in 2000 through the Unified Health System (Sistema ?nico de Sa?de SUS) sustained with a humanized rethoric of health care assistance. This program adopts the skin-to-skin contact contributing to the mother-infant bond, breastfeeding and promoting security in mother s care. The users of SUS are encouraged to live in the maternity ward to follow the baby health improvement. However, it was verified in previous observations that mothers participation in the Kangaroo Program has been done through an imposed practice. Therefore, this study intended to understand the texts that permeate the kangaroo practice. This research was developed through two studies: 1) an historic exploration of motherhood concept and an analysis of how the motherhood is presented in the official document that orients the program; 2) an analysis of institutional dynamic of Kangaroo Program, emphasizing the study about the health workers everyday practice, the mothers view about their life in the maternity wards, and the attendance practice. It is highlighted that the relation between this two studies allowed the comprehension abouthow the official discourses can influence the health workers behaviors and how their viewpoint and position can shape the everyday work in a public health program. This research, supported by Institutional Ethnography, considers that people s practices and experiences are socially organized and shaped by broad social forces. The discourse method was used in the documental analysis and in the analysis of qualitative data from empiric research. The research showed that the kangaroo program has been an excellent way to save resources and to improve some baby s biologic and psychological aspects. However, this program has failed to consider the social, economic and cultural complexity of mothers and the structural limitation of the health care system. The official document uses the economic and medical approach, following the hegemonic biomedical model and the life style of the people that don t use the public health system. Consequently, the program has not been successful because it is planned without people participation. On the other hand, it was verified that although some professionals are committed with their work, the mainly does not consider mothers participation as an active process, using the institutional power as a social control to keep mothers uninformed about the possibility to leave the maternity wards. As a result, the research also showed that mothers perceive the program as mandatory and not as option that can improve pleasure moments. It is, therefore, necessary to consider the complex social determinants of health that can increase mothers participation in the Kangaroo Program. Bringing these issues into debate can be a reflective exercise on citizenship and governance, allowing spaces for the improvement of public health programs / O Programa Canguru foi implantado no Brasil em 2000 atrav?s de uma pol?tica p?blica do Sistema ?nico de Sa?de (SUS), sustentado sob a ret?rica da humaniza??o dos servi?os de sa?de. Este programa adota a pr?tica de colocar o beb? prematuro e/ou de baixo peso em contato pele a pele com sua m?e com o intuito de fortalecer o v?nculo afetivo entre m?e e beb?, incentivar o aleitamento materno e promover maior seguran?a nos cuidados com seu filho. As m?es usu?rias do SUS s?o, dessa forma, solicitadas a residirem na maternidade, participando dos cuidados com o beb?, at? sua alta. No entanto, constatou-se, em observa??es pr?vias, que a participa??o no Programa Canguru tem sido geralmente uma imposi??o para essas usu?rias. Assim sendo, procurou-se interpretar os textos que permeiam o desenvolvimento da pr?tica Canguru. Essa pesquisa foi realizada atrav?s de dois estudos: 1) explora??o hist?rica do conceito de maternidade e an?lise de como a maternidade ? apresentada no m?dulo do documento oficial que orienta o programa; 2) an?lise da din?mica institucional que permeia o Programa Canguru, enfatizando o estudo acerca do processo de trabalho dos profissionais da sa?de e a compreens?o da percep??o das usu?rias sobre sua estadia na maternidade e sobre a din?mica de atendimento. Destaca-se que a rela??o entre esses dois estudos permitiu a compreens?o da forma que os discursos podem influenciar o comportamento dos profissionais de sa?de e que implica??es os discursos destes t?m na pr?tica cotidiana do atendimento em sa?de. A pesquisa, fundamentada na metodologia da Etnografia Institucional, considera as pr?ticas e experi?ncias como socialmente organizadas, procurando entend?-las na sua din?mica e interdepend?ncias. A perspectiva adotada para a an?lise documental, como tamb?m para o estudo dos dados qualitativos constru?dos na pesquisa emp?rica, foi a an?lise do discurso. A pesquisa mostrou que embora o Programa Canguru venha demonstrando resultados positivos, tanto em rela??o ? economia de recursos quanto aos aspectos psicol?gicos e biol?gicos do beb?, por outro lado ele falha em considerar a complexidade social, econ?mica e cultural das m?es e as limita??es estruturais do sistema de sa?de p?blica. O documento oficial deste programa apoia-se na racionalidade m?dica e econ?mica, cuja concep??o centra-se no modelo biom?dico hegem?nico e nas condi??es de vida e estrutura??o de fam?lia de uma popula??o que n?o ? usu?ria do Sistema ?nico de Sa?de. Essa disson?ncia dificulta o sucesso do programa, uma vez que suas a??es s?o planejadas e criadas sem considera??o ?s condi??es de vida e experi?ncias das pessoas que fazem uso desse servi?o. Com rela??o ? din?mica institucional, observou-se que, embora alguns profissionais se diferenciem no tratamento com as usu?rias, a maioria deles desconsidera o papel ativo da m?e nesse m?todo de interven??o. Por outro lado, a pesquisa mostrou que as m?es veem o programa como uma obriga??o e n?o uma op??o que implique em momentos prazerosos no ambiente hospitalar. Ressalta-se, assim, que a implanta??o deste programa requer n?o s? a presen?a e o treinamento para o bom atendimento da equipe de funcion?rios, como tamb?m deve ser levado em considera??o a complexa rede de determinantes sociais da sa?de que podem influenciar na participa??o das m?es no programa. Discutir e problematizar o cotidiano de programas como esse se constitui, dessa forma, um exerc?cio de reflex?o sobre cidadania e governan?a, permitindo espa?os para a melhoria dos programas de sa?de p?blica

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-06-15T18:02:17Z No. of bitstreams: 1 Laysa Gabrielle Silva Medeiros.pdf: 1788729 bytes, checksum: e020ca14a18dbb540c4e2962dcd57577 (MD5) / Made available in DSpace on 2016-06-15T18:02:17Z (GMT). No. of bitstreams: 1 Laysa Gabrielle Silva Medeiros.pdf: 1788729 bytes, checksum: e020ca14a18dbb540c4e2962dcd57577 (MD5) Previous issue date: 2016-02-23 / Introduction: Every year, 20 million of newborns born with low weight mainly as a result of premature births. This fact represents an important public health problem that reflects in high rates of neonatal and maternal morbimortality. Scientific advances in neonatal intensive care have contributed significantly to reduce perinatal mortality rates promoting an increase in the survival chance of newborns with low weight and the emergence of perinatal care models that improve the quality of care. One of the most important actions is the Kangaroo Method. Objective: Analyze the perceptions of mothers with preterms and/or low weight newborns about the second phase of Kangaroo Method and the coping strategies adopted in a public maternity in the interior of Paraíba. Methodology: A qualitative research was developed and were interviewed, from May to August 2015, ten mothers that were hospitalized in a Kangaroo Mother Accommodation experiencing the second stage of the method in integral way with their babies. The Data Saturation criteria was used to limit the number of participants. The data were collected using semi-structured interviews and were analyzed through Bardin's Content Analysis, from which emerged three categories: Baby hospitalization and maternal feelings; Kangaroo Mother Accommodation: maternal experiences; Experiencing the Kangaroo Mother Care. Results: With a hospitalized baby, mothers face a period a disturbance period involving suffering, fear, sadness, despair, fault and anger, resulting in impairment on their self confidence and self-esteem. However, despite these feelings, mothers can confront the difficulties through religious and/or family support. About to being close to the baby in the Kangaroo Method and deliver the her care, the mothers reported being happy and satisfied, emphasizing the child's improvement after the use of the method. To the mothers, this method was an opportunity to have a more intimate contact with the baby, but also brought difficulties such as distance and the missing of the family. In a general way, the mothers expressed to be satisfied as to the assistance given, the environment and operation, highlighting the role of staff, which contributed to the development of maternal safety. Final considerations: This study helped in understanding the maternal experiences and coping strategies within the Kangaroo Method, highlighting the necessity for reflection on the role of mothers in the context of the method, considering their entirety and individuality. / Introdução: Em todo o mundo, nascem anualmente 20 milhões de recém-nascidos de baixo peso, em consequência principalmente de partos prematuros. Tal fato configura importante problema de saúde pública refletido nas altas taxas de morbimortalidade neonatal e materna. Os avanços científicos, empregados à terapia intensiva neonatal têm contribuído significativamente para redução das taxas de mortalidade perinatal, promovendo um aumento da chance de sobrevida dos recém-nascidos de baixo peso e o surgimento de modelos de assistência perinatal voltado para a melhoria da qualidade do cuidado. Dentre essas ações, destaca-se o Método Canguru. Objetivo: Analisar as percepções das mães de recém-nascidos pré-termo e/ou baixo peso sobre a segunda etapa do Método Canguru e as estratégias de enfrentamento adotadas por elas, em uma Maternidade Pública no interior da Paraíba. Metodologia: Trata-se de uma pesquisa qualitativa, na qual foram entrevistadas, no período de maio a agosto de 2015, dez mães que estiveram internadas no Alojamento Mãe Canguru, vivenciando a segunda etapa do método de forma integral junto com seus bebês. Para delimitação do número de participantes foi utilizado como critério a saturação dos dados. Os dados coletados por meio de entrevista semiestruturada, foram analisados através da Análise de Conteúdo de Bardin, na qual emergiram três categorias: Hospitalização do bebê e sentimentos maternos; Alojamento Mãe Canguru: experiências maternas; Vivenciando o Método Canguru. Resultados: Com a hospitalização do bebê, as mães enfrentam um período que envolve sofrimento, medo, tristeza, desespero, culpa e raiva, resultando no comprometimento da autoconfiança e autoestima. Entretanto, apesar desses sentimentos, as mães conseguem lidar com as dificuldades, através da religiosidade e/ou apoio familiar. Quanto a estar junto ao bebê no Método Canguru e realizar os cuidados com ele, as participantes relataram estar felizes e satisfeitas, enfatizando a melhora do filho após o uso do método. Para as mães, o método foi uma oportunidade de ter um contato mais íntimo com o filho, mas que também trouxe dificuldades, como a distância e saudade da família. De forma geral, as mães expressaram estar satisfeitas quanto à assistência prestada, o ambiente e funcionamento, com destaque para papel da equipe, que contribuiu para o desenvolvimento da segurança materna. Considerações Finais: Este estudo auxiliou na compreensão das experiências maternas e estratégias de enfretamento no âmbito do Método Canguru, destacando a necessidade de reflexão sobre o papel das mães no contexto do método, considerando-as em sua integralidade e individualidade.

Small mammals are a keystone guild in arid ecosystems; often exhibiting top-down control of the diversity and structure of plant communities. However, changing climate, shifting fire regimes, and the invasion of exotic plants are modifying the structure of arid systems. Environmental changes in these arid systems are likely altering small mammal communities, and therefore, their ecological role. We examined two aspects of the community composition of small mammals in the Great Basin: changes in community composition since large scale sampling of the region began in 1930, and the current population of a sensitive species of small mammal, the dark kangaroo mouse (Microdipodops megacephalus). In Chapter 1, we compared diversity and composition of present day small mammal communities to communities sampled between the years of 1930 and 1980. We sampled 234 historical locations across the eastern Great Basin region during the summers of 2014 and 2015. Our results indicated that diversity, richness, and evenness of small mammals in the Great Basin have declined significantly over the last century (P=0.002, P=0.03, P=0.002). The relative abundance of generalist species has increased, while specialist species have declined (P<0.001, P<0.001). Also, community composition at each site has changed significantly over the past century. Alterations in the community structure of small mammals may have cascading implications for the future of the Great Basin ecoregion. In Chapter 2, we conducted a region-wide survey for the dark kangaroo mouse in western Utah. Four teams sampled 232 locations across western Utah during the summers of 2014-2015. Of the 232 sites sampled, only 5 sites resulted in dark kangaroo mouse captures, totaling 15 individuals. These results could indicate a state-wide population decline for this species, both compared to historic population levels and to the populations surveyed less than ten years ago. The rapid decline may be a result of habitat degradation associated with invasive plant species and increasing fire frequency, the effects of which are exacerbated by the dark kangaroo mouse's life history as an ecological specialist. Unless large-scale habitat restoration and preservation is conducted for remaining populations, it is likely the dark kangaroo mouse will continue to decline within the state.

The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses' attitudes and barriers in relation to SSC and RIC. The obstetric nurses received educational content related to SSC and RIC based on Kotter's model of change. A pre and postintervention evaluation showed a significant increase in the rates of SSC and RIC from pretest of 10%, to posttest of 96%; and RIC from pretest of 10% to posttest of 92%. Using a Wilcoxon test, a significant difference was found from pretest to posttest for every subscale score of the Mother-Newborn Skin-to-Skin Contact Questionnaire and Nurse Attitudes and Barriers to nonseparation Scale (p < 0.001), with the exception of belief about obstacles for SSC, which yielded a nonsignificant change (p = 0.57). This DNP project led to changes in the organization's culture, including the closure of the well-baby nursery. This project promoted social change across the organization, in that the team health care providers delivered evidence-based, standardized, unbiased, and family-centered care to the mother-baby dyad.

Many of the places that people value are the places they wish to visit and experience for themselves. However, each person that visits one of these places can cause impacts that reduce its value. A fimdamental aim of visitor management therefore is to ensure that each visitor's experience is a high quality one, and is sustainable. Various models have been designed to assist with this aim by linking visitor management planning, monitoring and decision making. However, there is a lack of published examples of how visitor management models have been implemented, what results they have yielded, and how well they have performed. There is also a lack of evidence of widespread application of such models. Without information and insight, there is only a theoretical case to argue for the greater use of visitor management models. The aim of this study was therefore to describe, analyse and explain the formulation and implementation of the most widely published visitor management models, with reference to case studies of Jenolan Caves (New South Wales) and Kangaroo Island (South Australia). The study involved: a literature review; personal observations by the author; in-depth interviews with those involved in developing and implementing the two case studies; and an objective analysis using a Goals Achievement Matrix. The thesis critically examined seven visitor management models with respect to their: evolution and definition; dimensions and planning and development approaches; documented applications in Australia and overseas; and limitations. This would appear to be the first time that these models have been critically examined in this way so that comparisons can be easily made between them. This would also appear to be the most comprehensive identification of examples of implemented visitor management models in Australia. The study identified five critical issues relating to development and implementation of visitor management models: 1. Poor planning hmeworks and poorly defined organisational culture, particularly in visitor and tourism management. 2. Lack of, or inconsistent human and financial resources. 3. Resistance to involving stakeholders in fimdamental decision-making. 4. Difficulty in choosing the right model for the situation. 5. Lack of strategic emphasis and technical ability. The study suggested that more effort needed to be made in the pre-development and implementation phases. Critical to such efforts is the development of an implementation plan, written as part of the development process. The implementation plan requires an individual(s) to take on a strategic coordination role that addresses marketing, staff development, budgeting, evaluation and areas for improvement. The study suggested that the conventional emphasis on technical expertise needs to be re-balanced with political skills to lobby for and protect the human and financial resources needed to implement a model long enough for it to prove its value. In the event where resourcing is too limited to fully operationalise an entire model at once, it was recommended to conservatively develop a portion of the chosen model all the way to the stage in which it delivers results that can be marketed to stakeholders. Finally, the study proposed a tool to assist visitor managers to clarify their need for a model, as well as their capability to develop and implement one. In the absence of sufficient information about the implementation of models, the tool empowers managers to consider the - merits of using a visitor management model further, and to select a model that best meets their needs.

<p>Aim: To examine the reaction of extreme preterm infants with regarding to body temperature and transepidermal water loss during skin-to-skin care according to Kangaroo Mother Care (KMC) during the infant’s first week of life. Method: This was a descriptive quantitatively designed study, which was a pilot study within the framework of a larger project. Nine children, with a median gestational age of 24.91 weeks, were examined by measuring body temperature (axilla and skin temperature) as well as transepidermal water loss before, during and after KMC. Results: The study showed that skin temperature tended to rise during KMC, especially for those children who were nursed with KMC for more than 60 minutes. Eight out of nine children had, after completing KMC, a normal axilla temperature. As was expected, transepidermal water loss was elevated when measured both pre and post test. Despite this, the children showed normal body temperature. Conclusion: The results of the study support that KMC can create a micro-climate that, for at least one hour, makes it possible for even extreme preterm infants to maintain a body temperature within the normal range during their first week of life.</p>

Aim: To examine the reaction of extreme preterm infants with regarding to body temperature and transepidermal water loss during skin-to-skin care according to Kangaroo Mother Care (KMC) during the infant’s first week of life. Method: This was a descriptive quantitatively designed study, which was a pilot study within the framework of a larger project. Nine children, with a median gestational age of 24.91 weeks, were examined by measuring body temperature (axilla and skin temperature) as well as transepidermal water loss before, during and after KMC. Results: The study showed that skin temperature tended to rise during KMC, especially for those children who were nursed with KMC for more than 60 minutes. Eight out of nine children had, after completing KMC, a normal axilla temperature. As was expected, transepidermal water loss was elevated when measured both pre and post test. Despite this, the children showed normal body temperature. Conclusion: The results of the study support that KMC can create a micro-climate that, for at least one hour, makes it possible for even extreme preterm infants to maintain a body temperature within the normal range during their first week of life.

Wireless network technology has advanced to the point that it is possible to use Internet connectivity to perform job tasks while moving in a city. We simulate and experimentally evaluate Dunham&rsquo / s Kangaroo Transaction (KT) model, and a modified version of it. Our results show that the modified-KT model does not have much communication overhead (although more than the original KT model) and it is more resilient to failures of base stations.