Bakgrund: Barn som föds för tidigt mår i allmänhet bäst av att vårdas av sina föräldrar dygnet runt. Att övergå från öppna rum till familjerum innebär en omställning för personal. Det finns få svenska studier som belyser hur personalen upplever denna förändring. Syfte: Syftet med studien var att beskriva personalens upplevelser av arbete och arbetsmiljö efter en genomförd flytt till nya lokaler och införandet av samvård. Metod: Studien genomfördes med kvalitativ metod med 12 deltagare fördelade på två fokusgruppsintervjuer samt 4 enskilda intervjuer med nyckelpersoner. Dataanalyserades med kvalitativ innehållsanalys. Resultat: I resultatet framkom ett övergripande tema" Realiteten som hinder för att uppleva visionen" med två huvudkategorier som beskrev personalens upplevelser efter den genomförda flytten "Visionen om arbetsmiljön som inte uppfylldes" och "Visionen om föräldrar och barn". Därtill identifierades 12 underkategorier som beskrev personalens upplevelser av förändringsarbetet och processen det inneburit med flytten till en ny vårdbyggnad. Det fanns svårigheter och utmaningar för personalen att gå från öppna rum till enskilda familjerum och införandet av familjecentrerad samvård. Personalen ansåg att lokalerna var dåligt planerade och de hade önskat att deras erfarenheter och åsikter hade vägt tyngre i planeringen. Dock upplevdes vården bättre för barn och familjer efter att familjerum blev tillgängliga. Slutsats: Det finns svårigheter och utmaningar för personalen med att införa samvård som en ny vårdform. Personalen anser ändå att det är det bästa för barnet och familjen. Att involvera personalen och använda deras kunskap och erfarenhet är viktigt vid byggandet av en ny avdelning och införande av samvård eftersom det påverkar deras arbetsmiljö. Nyckelord: Neonatalvård, Familjecentrerad samvård, Samvård, Arbetsmiljö, Anknytning / Bakground: Children born prematurely are in general best cared for by their parents around the clock. The transition from an Open-Bay to a Single-Room unit entails a new way to care for the family and collaboration with staff. There are few studies that illustrates how staff perceive this change. Aim: The aim of the study was to describe staff's experiences of the working environment and working with Family-centered care in a Single-Family-Room unit. The method: The study was conducted with a qualitative design, in which two focus groups with 12 participants and four individual interviews were conducted. Data were analyzed using qualitative content analysis. The result: The result showed an overall theme "Reality as a barrier for experiencing the vision". Two main categories described the staff's experiences after completed the move:"The vision of the work which was not fulfilled" and "The vision of parents and children". In addition, 12 subcategories were identified that described the staff's difficulties and challenges in moving from working in Open-Bay to Single-Room unit. The staff felt that the premises were poorly planned and they had hoped that their opinions had been taken in to account in the planning process. With regard to the care for the family, staff experienced beneficial improvements after introducing Single-Rooms. Conclusion: There are difficulties and challenges for the staff to introduce rooming as a new form of care. The staff believe that it is best for the child and the family. Involving staff and use their knowledge and experience is important in the construction of a new department and the introduction of rooming because it affects their working environment. Nyckelord: Neonatal Nursing, Family Centered Care, Rooming, working environment, Attachment

The purpose of this dissertation is to explore potential barriers nurses experience in providing effective pain management for preterm and critically ill infants in neonatal intensive care units (NICUs). The specific aims of the study conducted are to examine (a) NICU caregivers’ knowledge about pain, (b) scales used to evaluate pain in infants, (c) NICU nurses’ documented pain practices, and (d) bias in treating pain of certain types of infants. This dissertation is comprised of three manuscripts. The first manuscript is an integrated review of the literature describing caregiver knowledge, barriers, and bias in the management of pain in neonates. The second manuscript is a systematic review of multidimensional pain scales developed for use in preterm and critically ill infants. The final manuscript reports a descriptive exploratory study designed to examine nurses’ knowledge of pain, knowledge of intensity and appropriate management of procedural pain, bias in treating pain of certain types of infants, and documented pain management practices. Over the past 25 years, caregiver knowledge of pain in preterm and critically ill infants has advanced from beliefs that neonates do not feel pain, to the knowledge that preterm infants experience more pain than term infants, older children, and adults. Nine multidimensional pain scales with varying levels of reliability and validity have been developed, yet a gold standard for pain assessment in preterm and critically ill neonates has not emerged. In this study, baccalaureate prepared nurses (BSN) and nurses with higher total years of nursing experience had better knowledge of pain in this population than associate degree nurses (ADN). However, pain management was inconsistent, resulting in pain that was untreated as often as 80% of the time. Nurses reported that physician practice was the primary obstacle to providing effective pain management. Additional concerns included knowledge deficits of nurses and physicians, lack of communication and teamwork, and rushed care. Nurses reported biases in managing pain and were less likely to invest time and energy treating the pain of infants experiencing neonatal abstinence syndrome.

Breastfeeding is the gold standard of infant feeding and its benefits extend beyond the mother and child. Multiple organizations recommend exclusive breastfeeding for the first six months of an infant’s life. Exclusive breastfeeding rates nationally and in the state of Kentucky fall below the Healthy People 2020 goals. A mother’s intention to breastfeed has been shown to impact actual breastfeeding behavior. The current state of the measurement of intention was explored through a literature review. A majority of the measures were single item scales. The reliability and validity of the scales should be further tested in diverse populations. The purposes of this dissertation were to: a) explore the role of breastfeeding intention on duration of exclusive breastfeeding, and b) determine the common modifiable factors among women who breastfeed exclusively for at least four months. English speaking mothers 18 years of age and older were asked to participate if they had delivered a healthy infant in the last 72 hours and if they intended to feed their baby some amount of breast milk (n = 84). Mothers were followed for 16 weeks or until they weaned their infant, whichever came first. Social support, breastfeeding self-efficacy and breastfeeding intention were measured at baseline. Breastfeeding support and breastfeeding self-efficacy were measured at four and 16 weeks. Results indicated that mothers with stronger intention to breastfeed were more likely to breastfeed exclusively for a longer period of time. Mothers who breastfed their infant exclusively for 16 weeks were asked to participate in one of two focus group meetings (n = 15). The following five themes emerged from the data: 1) knowledge, 2) peer experience, 3) support, 4) perseverance, and 5) the public.

Bakgrund: Allt fler prematura barn överlever. En trygg anknytning är positivt för barnets utveckling både fysiskt och socialt. Syfte: Syftet med studien var att beskriva anknytning mellan föräldrar och prematura barn samt sjuksköterskans betydelse vid anknytning. Syftet var även att granska kvalitén gällande datainsamlingsmetod i de valda artiklarna. Metod: En beskrivande litteraturstudie som är baserad på 14 artiklar, varav hälften var kvantitativa och hälften kvalitativa. Artiklarna är sökta och påträffade i databaserna PubMed och Cinahl. Analys av artiklarnas resultat ledde fram till fem rubriker.      Resultat: Föräldrar till ett nyfött prematurt barn erhåller inte samma närhet, som föräldrar till ett fullgånget barn. Barnets storlek och hälsa är en begränsande faktor för närhet till barnet hos både mammor och pappor. Sjuksköterskan på en neonatalavdelning har en betydande roll i anknytningen mellan föräldrar och prematura barn. Slutsats: En prematur födsel innebär ett ofrivilligt hinder i anknytningen mellan föräldrar och barn. En betydande del för att främja anknytning är att sjuksköterskan involverar båda föräldrarna i omvårdnaden av det prematura barnet. / Background: More premature infants survive. A secure attachment is beneficial for the child’s social and physical development. Aim: The aim with the study was to describe the attachment between parents and premature infant, and the importance of the nurse related to attachment. The aim was also to examine the quality of the data collection methods, in the selected articles. Method: The design is a descriptive literature study based on 14 articles, where half of the articles has a quantitative approach and the other half has a qualitative approach. The articles were searched and found in the databases’ PubMed and Cinahl. Five subjects’ were identified after analysis of the articles’ results.  Results: Parents of a newborn premature infant does not receive the same proximity, as parents of a full-term baby. The child's size and health is a limiting factor in proximity to the child with both mothers and fathers. Nurses’ at a Neonatal Intensive Care Unit has an essential role in the attachment between parents and preterm infant. Conclusion: A premature birth implies obstruction in attachment between infant and parents. A key element to promote attachment is that the nurse involves parents in the care of the preterm infant.

Despite advances in obstetric care, hypertensive disorders continue to complicate pregnancies at a high rate. Worldwide, hypertensive disorders affect up to 10% of pregnancies. The United States has seen a 25% increase in the incidence of hypertensive disorders over the last two decades (American College of Obstetricians and Gynecologists, 2017). These complications constitute one of the greatest causes of maternal and perinatal morbidity and mortality with an estimated 50,000 to 60,000 deaths per year across the world (American College of Obstetricians and Gynecologists, 2017). Although the etiology of hypertensive disorders remains unclear, there may be an association with both maternal biological and psychological distress in the development of the disorder. Although both distress and biomarkers have been identified in association with a hypertensive disorder, little data exist examining the components of distress and the alterations in biomarkers in women developing these disorders. Due to the limited evidence, a critical need exists to examine the relationship of perceived maternal distress and biomarker measures in the development of a hypertensive disorder during pregnancy in order to better understand this phenomenon. The purposes of this dissertation were to: 1) understand the experience of having a hypertensive disorder during pregnancy; 2) to investigate the association of perceived stress and changes in immune response via biomarker measures in women who develop a hypertensive disorder during pregnancy; 3) to review, summarize, and evaluate the literature examining the relationship between perceived maternal distress (stress, anxiety, and depression) and the development of a hypertensive disorder; and 4) to investigate the association of perceived distress in the development of a hypertensive disorder during pregnancy. Data obtained from a qualitative study of women with a hypertensive disorder during pregnancy placed on bed rest reported several stressors associated with the experience. These stressors related to differing and often conflicting management plans by different providers and not feeling providers heard their concerns. The evidence supports these women experience stress during this pregnancy complication. Analysis of data obtained at each trimester of pregnancy did identify differences in biomarker levels based on perceived stress and women with a hypertensive disorder and those without a hypertensive disorder. Evidence from a systematic review of literature supporting maternal distress in the development of a hypertensive disorder was mixed. However, few studies existed and of those reviewed, most lacked rigor. Analysis of data obtained early and late in pregnancy did not indicate a relationship between psychological distress and the development of a hypertensive disorder in pregnancy. Women with a higher BMI were 12% more likely to develop a hypertensive disorder. The factors associated with the development of a hypertensive disorder are complex. Maternal perceived stress and inflammatory responses differ between women with a hypertensive disorder and those without a hypertensive disorder in pregnancy; however maternal distress did not differ between groups. Body mass index was associated with the development of hypertension in pregnancy. Clinicians need to include assessment of maternal BMI as a modifiable risk factor in the development of a hypertensive disorder during pregnancy. In addition, although psychological distress was not associated with the development of a hypertensive disorder, women still suffer with components of distress. Clinicians could identify and support women experiencing distress thereby promoting a healthier pregnancy.

The purpose of this research was to identify the values influencing the nurse's perception and choice of behavior in a hypothetical clinical situation. The theoretical framework was Rokeach's (1973) Theory on the Nature of Human Values and Value Systems. A descriptive study using a mailed survey was conducted on a random sample of 331 members of the National Association of Neonatal Nurses. Data on individual nurses' values, perception of information and behavioral choices were collected with an investigator developed questionnaire, consisting of a values scale (alpha =.82) and an information scale and choice alternatives related to three hypothetical vignettes: a low birthweight infant (alpha =.75), an infant with trisomy-13 (alpha =.70) and a chronically ill infant (alpha =.68). Results of this study indicate that (1) nurses identified a hierarchy of values related to their practice; "doing right" (x = 6.1), beneficence (x = 5.4), and justice (x = 4.8), (2) information related to the infant was consistently most important; however, in uncertain situations, rules or external protocols had an increased influence on the behavioral choice process, (3) the behavioral choice option with the greatest agreement was different for each situation, and a consistently negative association between the options within each vignette indicates that nurses have clearly defined choice preferences, (4) model testing revealed a consistent relationship among the variable of justice and protocol, doing right and infant characteristics, and infant characteristics and the choice options across the three vignettes (p <.05). The major findings include the identification of the value dimension, "doing right" and a lack of congruence between the values the nurse identifies as important and the actions the individual implements in practice. The phenomenon of "doing right" is a combination of items originally hypothesized to measure nurse autonomy, family autonomy and beneficence. The convergence of these items results in an unique dimension that represents the nurse's internally directed motivation or sense of duty to the infant/family unit. The lack of congruence between the identified values and the behaviors implemented in practice represents the sense of frustration and feeling of powerlessness experienced by nurses (n = 97) as they balance the role of professional and the role of employee.

Although a relationship has been found in some studies between paternal attachment and female sexual behavior, knowledge of this relationship in African Americans has been limited. The purpose of this research was to determine if there was a relationship between father-daughter attachment, parent teen sexual risk communication and early sexual activity, condom use, history of sexually transmitted infection, global/sexual self-esteem and teen pregnancy in African-American females. An anonymous consent and survey was administered online to N=113 African American college women (age 18-21) attending a southeastern university. Measurements included the Parent Attachment Questionnaire (Father), Rosenberg’s Self-Esteem, Sexual Self-Esteem Inventory (short scale), the PTSRC and a sexual history. Findings of high levels of father attachment were found in this mostly middle class sample but neither attachment nor parent teen sexual risk communication was related to age of vaginal/oral initiation, condom use or sexually transmitted infections. However, attachment was predictive of global self-esteem. In addition, those with a high level of attachment were 1.0 times more likely to also have a positive pregnancy test history when maternal support for the father–daughter relationship was low. No relationship was found between sexual self-esteem and paternal attachment or between sexual self-esteem and condom use. Paternal monitoring was associated with older ages of vaginal initiation. Conclusion: Higher paternal attachment coupled with paternal monitoring may facilitate global self-esteem and be a protective factor against early sexual initiation (vaginal). Fathers are in need of education as to how to stay connected with daughters and to engage in direct and indirect sexual risk communication. Nevertheless, prevention strategies utilizing fathers could be effective in delaying onset of sexual activity. This document was originally created in Microsoft Word 2000 and later modified in Microsoft Word 2007 (compatibility mode). SPSS 17.0 statistical software was used for analysis and N-Query 6.0 was utilized for power analysis.

Background: Due to the profound and life-changing aspects of giving birth and to each woman’s individualized birthing experience, it is important to understand the myriad of factors that contribute to a positive childbirth experience. The aims of this study were to: (1) identify factors related to a positive childbirth experience; (2) to examine relationships among women’s perceptions and personal evaluations of their childbirth experience, stress associated with labor pain, support from the nursing staff, initial contact with the baby following birth, support from partners, education, age, and obstetric history; and (3) to identify predictors of a positive childbirth experience. Method: A cross-sectional correlational study was conducted using a sample of 122 new mothers recruited over a 3-month period. Data were collected using self-report questionnaires. The three questionnaires used in this study consisted of: (a) the Questionnaire Measuring Attitude About Labor and Delivery Experience (QMAALD 29 items); (b) the Questionnaire Measuring Stress Associated with Labor Pain [SLPS (version 2)]; and (c) Personal Information Questionnaire (Demographic data). The Cronbach’s alpha coefficient for the 29 item QMAALD in this study was .82 and the Cronbach’s alpha coefficient of the SLPS (version 2) in this study was .89. The SPSS statistical software version 16.0 for Windows was used for data analysis. Results: Participants reported a low degree of stress associated with labor pain and a moderate amount of support received from the nursing staff. They reported holding and touching their baby immediately after birth. A positive childbirth experience was inversely related to stress associated with labor pain. The reduction of stress due to support received from the nursing staff was found to be positively related to a positive childbirth. Education was related to a positive childbirth experience; but not a significant predictor of a positive childbirth experience. Maternal age, initial contact with the baby following birth, number of labor and delivery experiences, duration of labor, interventions during labor, attendance at prenatal classes, and support from a partner did not relate to a positive childbirth experience. The regression analysis results indicated that the stress associated with labor pain, the reduction of stress due to the support received from the nursing staff, and attendance at prenatal classes were significant predictors of a positive childbirth experience. Conclusion: Stress associated with labor pain and the reduction of stress due to support received from the nursing staff were key factors contributing to a positive childbirth experience. Further research is needed to better understand the factors influencing women’s positive perceptions of the childbirth experience.

This study addresses the question, "What is the lived experience of Southeast Asian immigrant women who live in the United States related to domestic violence, including the relationships with their partners, their knowledge of domestic violence, and the existence of domestic violence in the Asian community?" Fourteen Thai women engaged in semistructured interviews during which they were asked to describe their experience. This study chose the phenomenological approach, using content analysis that identified six major themes representing essential aspects of the experience, as described by the participants: (a) Knowledge about Domestic Violence and Sources of Information, (b) The experience of Domestic Violence, (c) The existence of Domestic Violence among Thai Women, (d) Factors Considered to be Violence-protective, (e) Life as a Thai Wife, and (f) Ability to Perform Duties as a Woman. Ten of the participants had not experienced domestic violence by their husbands; two had been abused in previous marriages; one was currently being abused by her husband; and one had abused her husband early in their marriage. The women defined domestic violence as abusive actions identified by physical, verbal, emotional, psychological, and sexual abuse, including assault and threatening behavior. The women's knowledge of domestic violence was based on personal experience, witnessing abusive behavior in other relationships, or reports in mainstream media sources. The study's findings confirm the existence of domestic violence in the Thai community. The participants identified the husband's infidelity as the main cause, followed by family background creating a generational chain of abusive behavior. Protective factors that prevent domestic violence are the husband's supportive characteristics, the wife's financial independence, and confidence in the U.S. legal system. Although the majority of the study participants did not experience domestic violence, they encountered various constraints, such as feelings of frustration and helplessness, attributed to the challenges of immigrant women adapting to a new society and culture. Despite limitations involving recruitment, this study expands the knowledge of domestic violence among Thai immigrant women, providing valuable insight for healthcare professionals interested in improving culturally sensitive resources for these women. The study's findings also provide important evidence that suggests the need for further research to examine domestic violence among Southeast Asian immigrant women living in the United States.

O nascimento de um bebê malformado, especialmente, quando a aparência é defigurada, provoca um impacto nos profissionais que prestam atendimento ao recémnascido, imediatamente, após o nascimento, repercutindo na qualidade da assistência prestada. Este estudo foi motivado pela inquietação da pesquisadora procurar compreender as ações e reações dos enfermeiros quando assistem o nascimento de recém-nascidos com malformação desfigurante no contexto da sala de parto. O estudo teve como objetivo: compreender a experiência dos enfermeiros que assistem o nascimento de um recém-nascido com malformação desfigurante. Optou-se por realizar uma pesquisa com abordagem qualitativa, estudo de caso coletivo, e os dados foram analisados à luz do referencial teórico do Interacionismo Simbólico. A coleta de dados ocorreu por meio de entrevista semi-estruturada com enfermeiros que atuam no centro obstétrico de um Hospital Municipal, situado na zona sul da cidade de São Paulo. As entrevistas foram gravadas em fita cassete, posteriormente, transcritas em sua íntegra e analisadas. A análise dos dados permitiu identificar categorias conceituais que compuseram os dois temas: Compartilhando com a equipe médica a assistência ao recém-nascido e Assumindo a responsabilidade da assistência ao binômio mãe-recém-nascido. Os resultados do estudo salientaram a dificuldade enfrentada pelo enfermeiro na assistência do nascimento de um bebê malformado em decorrência do despreparo na formação profissional, relacionada ao processo de comunicação enfermeiro-paciente e dificuldade de lidar com as próprias emoções / The birth of a malformed child, specially when the malformation affects the baby appearance, provokes impact on caregivers who attend the baby immediately after childbirth and on quality of attendance. This study was motivated by the necessity of understanding the performance of nurses when they attend babies with visible congenital malformation. The aim of this study was to understand the nurse`s experience for attending babies with visible congenital disfigurement in the context of delivery room. The qualitative methodological approach used in this study was the Collective Case Study and to analyse data it was used the Symbolic Interactionism theoretical framework. The sample was composed by ten nurses that work at the birth center of a public hospital located in the south district of São Paulo city. Data was obtained by interview that was recorded, transcripted and analysed. From data analysis categories emerged that composed two themes: Sharing the newborn care with medical staff and Assuming the responsibility of the mother-infant care. The results point out the difficulties faced by the nurses when they need to take care of the babies who have visible congenital disfigurement due to their unprepared formation related to the nurse-patient relationship and the difficulties to deal with their emotions