FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Os recÃm-nascidos (RN) com malformaÃÃo congÃnita (MC) requerem dos profissionais de enfermagem atenÃÃo e cuidados especÃficos e individualizados. O estudo objetivou avaliar a prevalÃncia dos recÃm-nascidos com malformaÃÃes congÃnitas em instituiÃÃes pÃblicas e a assistÃncia de enfermagem prestada a essas crianÃas internadas na Unidade Neonatal (UN) nas primeiras 24 horas de vida. Estudo descritivo, transversal, quantitativo, realizado em trÃs Unidades Neonatais de instituiÃÃes hospitalares (A, B e C) de Fortaleza, Brasil. A amostra foi composta de 159 recÃm-nascidos, sendo 75 na instituiÃÃo A; 44 na B; e 40 na C. Os dados foram coletados em 2012, de janeiro a junho em A e B, e de marÃo a agosto em C. Investigou-se prontuÃrios e documentos nas unidades referidas e, posteriormente, eles foram registrados em formulÃrios prÃprios contendo variÃveis maternas e neonatais, apÃs a aprovaÃÃo pelos ComitÃs de Ãtica. Os resultados revelaram prevalÃncia de 3,3%, 2,1% e 3,6% de RN malformados nas instituiÃÃes, respectivamente. Da amostra, 53% eram masculinos, 57% com 37 a 41,6 semanas gestacionais, 52% pesando entre 2.500g e 3999g, 66% com estatura de 39 a 49 cm, Apgar no 1Â(60%) e 5Â(79%) minutos de sete a dez. Dentre as terapias implementadas ao RN, sobressaÃram-se oxigenoterapia sob Oxi-hood (42%); Dieta zero (37%); hidrataÃÃo venosa (36%); punÃÃo de acesso venoso central para infusÃes (44%); manuseio de trÃs em trÃs horas (89%) e nÃo realizaram cirurgias no perÃodo (75%). Dentre os curativos, o local destacado foi a regiÃo sacral (54%) e a cobertura com compressa estÃril (21%). As malformaÃÃes congÃnitas diagnosticadas foram categorizadas conforme classificaÃÃo do CID â 10, prevalecendo aquelas pertencentes ao Sistema Osteomuscular (30%) e Sistema Nervoso Central (SNC) (21,1%), ressaltando o PÃ torto congÃnito, Polidactilia, Hidrocefalia e Mielomeningocele. Destacaram-se as malformaÃÃes isoladas (61%) e os registros de cuidados de enfermagem envolvendo exames (24,4%) e oxigenoterapia (16,9%). Ocorreram associaÃÃes estatisticamente significantes entre as categorias de malformaÃÃes e algumas variÃveis especÃficas: (MC do SNC) x (IG, Terapia Medicamentosa); (MC do olho, ouvido, face, pescoÃo) x (IG, Uso de drogas e Escolaridade); (MC Aparelho CirculatÃrio) x (Uso de drogas e Terapia Medicamentosa); (MC Aparelho RespiratÃrio) x (Idade materna e Uso de drogas); (Fenda labial ou palatina) x (Idade materna e Uso de drogas); (Outras MC do Aparelho Digestivo) x (Modalidade VentilatÃria, Forma de NutriÃÃo e Cirurgia); (MC dos ÃrgÃos Genitais) x (Sexo, Renda familiar e Forma de NutriÃÃo); (MC Osteomuscular) x (NÃmero de GestaÃÃes e Modalidade VentilatÃria); (Outras MC) x (IG e Peso); e (Anomalias CromossÃmicas) x (Idade materna), todos com p<0,05. Concluiu-se que ainda se faz prevalente o nÃmero de MC em RN e que a equipe de enfermagem implementa cuidados de acordo com as condiÃÃes clÃnicas, da patologia e equilÃbrio hemodinÃmico de cada RN e nÃo especificamente para cada tipo de malformaÃÃo. / The newborns (NB) with congenital malformation (CM) requires from nursing professionals the performance of specific and individualized care. This study aimed at evaluating the prevalence of newborns with congenital malformation in public institutions and the nursing care provided to these children admitted to the Neonatal Unit (NU) in the first 24 hours of life. This is a descriptive, cross-sectional and quantitative study, which was conducted in three Neonatal Units of hospitals (A, B, C) from the city of Fortaleza-CE/Brazil. The sample was composed of 159 newborns; from which 75 belong to institution A; 44 to B; and 40 to C. The data were collected in 2012, from January to June in A and B, and from March to August in C. Records and documents were investigated in the aformentioned units and, subsequently, they were recorded in the proper forms containing maternal and neonatal variables, after approval by the Ethical Committee. Results showed prevalence of 3.3%, 2.1% and 3.6% of malformed newborns in the institutions, respectively. Of the sample, 53% were male, 57% with 37 to 41,6 gestation weeks, 52% weighing between 2,500 g and 3999g, 66% with height 39-49 cm, Apgar score at 1st (60%) and 5th (79%) minutes from seven to ten. Among the implemented therapies to the NB, it should be highlighted oxygenotherapy in Oxy-hood (42%); Zero diet (37%); intravenous hydration (36%); central venous access puncture for infusions (44%); handling for every three hours (89%) and did not undergo surgery throughout the period (75%). Among the dressings, the highlighted location was the sacral region (54%) and the coverage with sterile compress (21%). The diagnosed congenital malformations were categorized according to the classification of the ICD â 10, prevailing those ones belonging to the Musculoskeletal System (30%) and to the Central Nervous System (CNS) (21.1%) highlighting the Congenital clubfoot, Polydactyly, Hydrocephalus and Myelomeningocele. It should also be highlighted the isolated malformations (61%) and the nursing care records involving examinations (24.4%) and oxygenotherapy (16.9%). There were statistically significant associations between the malformations categories and some specific variables: (CM of the CNS) x (GI, Drug Therapy) (CM of the eye, ear, face, neck) x (GI, Drug use and Schooling); (CM of the Circulatory System) x (Maternal age and Drug use) (CM of the Respiratory System) x (Drug use and Drug therapy); (Cleft-lip and palate) x (Maternal age and Drug use); (Others CM of the Digestive System) x (Ventilation modality and Nutrition and Surgery forms); (CM of the Genitalia) x (Gender, Family Income and Nutrition form); (Musculoskeletal CM) x (Number of pregnancies and Ventilation modality); (Others CM) x (GI and weight), and (Chromosomal Abnormalities) x (Maternal age), all with p <0.05. We have concluded that the number of NB with CM it is still prevalent and the nursing staff implements the healthcare according to the clinical conditions, pathology and hemodynamic balance of each NB and not specifically for each type of malformation.

Sammanfattning Bakgrund: Idag närvarar pappor vid det akuta omhändertagandet av sitt barn och har en viktig roll i det nyfödda barnets vård. Närhet mellan föräldrar och barn är avgörande för välbefinnande, anknytning och bindning. Syfte: Syftet med undersökningen var att beskriva vad pappor upplever vid akut omhändertagande av sitt nyfödda barn. Metod: Tio pappor till nyfödda barn, där barnen i direkt anslutning till födseln krävt akut omhändertagande och inläggning på neonatalavdelning, har intervjuats. Intervjuerna har bearbetats med hjälp av kvalitativ innehållsanalys. Resultat: Huvudkategorin som framkom var: Att gå från kaos till kontroll. Underliggande kategorier som framkom var (1) rädsla för det okända, (2) otillräcklighet i förhållande till sig själv och andra, (3) overklighet i den nya situationen, (4) delaktighet i vården av sitt barn och (5) förtroende för vårdpersonalen. Slutsats: Papporna var från början rädda, kände sig otillräckliga och upplevde situationen som overklig. Med hjälp av egna och utifrån kommande resurser, bland annat barnsjuksköterskans omvårdnad och information, fann papporna efter olika lång tid en känsla av att vara delaktiga och ett förtroende för vårdpersonalen, som ledde till en högre känsla av sammanhang, det vill säga KASAM.   Nyckelord: Anknytning, delaktighet, KASAM, neonatalavdelning, / Summary Background: Today fathers are present during acute care of his newborn child and have an important role in the care of the newborn child. Closeness between child and parent is essential to promote wellbeing, attachment and bonding. Purpose: The purpose of the study was to describe what fathers' experience in acute care of their newborn baby. Method: Ten fathers of newborn children, where the child after the birth has been in need of emergency care and hospitalization in a neonatal department, have been interviewed. The interviews have been analyzed using qualitative content analysis. Result: The main category was: Going from chaos to control. The underlying categories that emerged were (1) fear of the unknown, (2) inadequacy in relation to himself and others, (3) unreality in the new situation, (4) participation in the care of his baby and (5) trust of health care staff. Conclusion: Fathers were initially afraid, felt inadequate and experienced the situation as unreal. Using proprietary and extrinsic resources, including pediatric nursing care and information, the fathers found at different phases a sense of ownership and confidence in the care that led to a greater sense of coherence, in other words Salutogenesis.Keywords: Attachment, Neonatal unit, Participation, Salutogenesis,

<p>The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. </p><p>For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. </p><p>The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV).</p><p>In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants. </p>

The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV). In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants.

Bakgrund: Mamman till ett prematurt barn behöver upprätthålla sin bröstmjölksproduktion med hjälp av en bröstpump, till dess att hennes barn orkar amma. Sedan 2004 har amningsstatistiken i Sverige minskat drastiskt för prematura barn, trots god amningskultur och fördelaktig föräldraförsäkring. Syfte: Syftet med studien var att beskriva hur mammor till barn födda före graviditetsvecka 35 upplevde upprätthållandet av bröstmjölksproduktionen under vårdtiden på neonatalavdelning. Metod: Studien utfördes som en integrerad litteraturstudie och bygger på tio vetenskapliga artiklar. Artiklarnas vetenskapliga kvalitet bedömdes, och innehållet analyserades sedan enligt en metod av Whittemore och Knafl. Resultat: Mammorna motiverades att starta upp sin bröstmjölksproduktion då de fick reda på fördelarna som bröstmjölken gav deras barn. Problem som att hitta rutiner för bröstpumpning och kunna upprätthålla mjölkmängden var förekommande. Vikten av information, samt av att ha gott stöd från parter, anhöriga och sjuksköterskor var stor. Konklusion: Sjuksköterskan har en viktig uppgift att stötta mamman genom information, individuellt stöd och hjälp att hitta fungerande strategier. / Background: The mother to a premature baby needs to maintain her breastmilk production with help of a breast pump, until her baby is mature enough to breastfeed. Since 2004, the statistics of breastfeeding premature babies in Sweden has fallen drastically, despite being known as a pro-breastfeeding country with beneficial parental financial support. Objective: The aim of the study was to describe how mothers to babies born before 35 gestational weeks experienced the maintenance of breastmilk production during their stay at the neonatal ward. Method: The study was conducted as an integrative literature review based on ten scientific articles. The scientific quality of the articles was assessed, and the content was analyzed by a method of Whittemore and Knafl. Results: The mothers were motivated to start their breastmilk production when they knew what benefits their breastmilk gave their baby. Problems with finding routines for breast pumping and maintaining their milk volume was common. There was great importance of receiving information, as well as having good support from their partner, relatives and nurses. Conclusion: The nurses have a great task to support mothers with information, individual support and help finding strategies.

Bakgrund: Upplevelsen av att bli förälder är i sig en omvälvande och känslosam tid. Om barnet behöver vårdas på neonatalavdelning blir det särskilt utmanande för de nyblivna föräldrarna. Neonatalvården utvecklas kontinuerligt och blir alltmer avancerad. Därmed blir också miljön som föräldrarna där möter mer högteknologisk. Detta har medfört att överlevnaden för barnet i behov av neonatalvård blir allt högre, samtidigt som det vårdas barn med vitt skilda diagnoser och i sköra tillstånd. Anknytningsteorin beskriver hur barn och föräldrar genom kontinuerlig interaktion knyter an och skapar band. Inom neonatalvården ställs denna process inför utmaningar för föräldrar och barn, relaterat till såväl den särskilda och högteknologiska miljön som till barnets tillstånd. Syfte: Syftet med denna systematiska litteraturstudie var att sammanställa befintlig vetenskaplig litteratur om föräldrars upplevelser av att knyta an till ett barn som vårdas på neonatalavdelning. Metod: Denna systematiska litteraturstudie utfördes i enlighet med metod och steg beskrivna i SBU (2020a &amp; 2020b). Resultat: Litteraturstudiens resultat utmynnades i fyra huvudteman bestående av: “När det oförutsedda händer”, “Anknytning främjas av välinformerade föräldrar”, “Utmaningar i neonatalvården” och “Relation till barnet växer fram”. Dessa huvudteman kunde i sin tur delas in i underteman för att tydliggöra de framstående beståndsdelarna i föräldrarnas upplevelser. Slutsatser: Genom kännedom om hur anknytningsupplevelsen på neonatalavdelning beskrivits av föräldrar, kan specialistsjuksköterskan stötta och arbeta på ett sådant vis att anknytningen främjas. Föräldrarnas upplevelser kan tas tillvara i det dagliga omvårdnadsarbetet, men också tas i beaktande vid planering för verksamhet och vårdmiljö för att tillvarata barnets bästa och skapa möjligheter för anknytning. / Background: The experience of becoming a parent is in and of itself a transformative and emotional time. If the child needs care in a neonatal unit, it becomes especially challenging for the new parents. Neonatal care is continuously developing and becoming increasingly advanced. Therefore, the environment that the parents meet there is becoming more highly technological. This has brought on that the survival for the child in need of neonatal care is increasing, all the while there are children cared for with a wide range of diagnoses and in fragile states. Attachment theory describes how children and parents through continuous interaction tie together and create bonds. In neonatal care this process is presented with challenges for parents and children, in relation to the special and highly technological environment as well as the condition of the child. Aim: The aim of this systematic review was to aggregate existing scientific literature about parents' experiences of attaching to a child being cared for in a neonatal unit. Method: This systematic review was carried out in accordance with method and steps described in SBU (2020a &amp; 2020b). Results: The results of the systematic review culminated in four main themes consisting of: “When the unexpected happens”, “Attachment is promoted by well-informed parents”, “Challenges of Neonatal Care” and “The relationship to the child evolves”. These main themes could in turn be divided into sub-themes to clarify the prominent features of the parents’ experiences. Conclusion: Through knowledge about how the attachment process in a neonatal unit is described by parents, the specialist nurse can support and work in such a way that the attachment is promoted. The parents’ experiences can be utilized in the daily work, but also be considered in planning for organization and care environment to protect what’s best for the child and create opportunities for attachment.

Föräldrar är inte alltid förberedda inför att graviditeten avslutas i en förtidsbörd vilket kan försvåra det inledande föräldraskapet. Omkring tio procent av alla barn som föds i Sverige per år kräver vård på en neonatalavdelning varav sex procent av de som föds är prematura. En neonatalavdelning är utformad för att förutom att vårda prematurfödda barn även vårda barn som är påverkade i sitt hälsotillstånd, där föräldrar betraktas som en central del i barnets vård.  Syftet med studien var att beskriva föräldrars upplevelser av delaktighet i vården av sitt prematura barn på en neonatalavdelning och delaktighetens påverkan på anknytning.  Metoden som användes var en litteraturöversikt, även kallad integrativ litteraturstudie. Sex databassökningar gjordes i databaserna PubMed, CINAHL samt PsycInfo vilka genererade i 14 artiklar. Även en manuell sökning utfördes där två artiklar hittades. Totalt inkluderades 16 artiklar av kvalitativ ansats vilka initialt kvalitetsgranskades och därefter sammanställdes. Artiklarna analyserades sedan med hjälp av en integrerad analys.  Resultatet genererade i fyra huvudkategorier med vardera två underkategorier. Det visades att föräldrar kände sig delaktiga i sitt prematura barns vård när de fick möjlighet till närvaro eller fysisk kontakt med barnet vid olika omvårdnadsmoment. Att vara delaktig och ha möjlighet att närvara eller spendera natten på neonatalavdelningen var viktigt för föräldrarollen och anknytningsprocessen. Svårigheter till fysisk kontakt genom hud-mot- hud uppkom vid situationer där barnet behövde vårdas i kuvös vilket beskrevs som en stressig upplevelse. Stöd, uppmuntran och ett gott samarbete med vårdpersonal gjorde situationen hanterbar, underlättade föräldrars delaktighet och upplevdes stärkande för föräldraskapet. Miljön antingen främjade eller hämmade delaktigheten.  Slutsats kan dras att föräldrar upplever att delaktigheten i det prematura barnets vård på en neonatalavdelning stärker dem i föräldrarollen och gynnar anknytningen samt relationen till barnet. Genom delaktighet upplever föräldrar att de har en viktig roll för barnets välbefinnande. En god interaktion med vårdpersonal, ett inbjudande förhållningssätt vid vårdaktiviteter samt kontinuerligt stöd i omvårdnadsmoment upplevs betydande för att vårdandet av det prematura barnet ska kännas hanterbart och därmed underlätta barnets omvårdnad. Familjecentrerad vård ses som kärnan för att åstadkomma detta. / Parents are not always prepared for the fact that the pregnancy ends in a premature birth, which can complicate the initial parenting. Approximately ten percent of all children born in Sweden per year require care in a neonatal unit, of which six percent of those are premature. In addition to care for premature infants, a neonatal unit is also designed to care for infants who have health problems, where parents are considered as a central part in the care of the infant.  The aim of this study was to describe parents ́ experiences of participation in the care of their premature infant in a neonatal unit and the participation ́s influence on infant attachment.  The method used was a literature review, also called integrative literature review. Six database searches were made in the databases PubMed, CINAHL and PsycInfo which generated in 14 articles. A manual literature search was also performed which gave two articles. A total of sixteen articles of qualitative approach were included, which initially were quality reviewed and thereafter synthesized. The articles were then analyzed using an integrative analysis.  The result generated four main categories with two subcategories each. It showed that parents felt involved in their premature infants' care when they were given the opportunity to be present or have physical contact with the infant during various care activities. Being involved and having the opportunity to attend or stay over the night in the neonatal unit was important for the parenting role and the attachment process. Difficulties to enable physical contact through skin-to-skin emerged in situations where the infant needed to be cared for in an incubator and was described as a stressful experience. Support, encouragement and a good cooperation with care staff made the situation manageable, made the parents ́ participation easier and was perceived as strengthening for the parenthood. The environment either promoted or inhibited the participation.  Conclusion can be drawn that parents feel that the participation in the premature infants’ care in a neonatal unit strengthens them in the parental role and strengthens the infant attachment as well as the relationship with the infant. Through participation parents feel that they have an important role in the infant’s well-being. A good interaction with care staff, an inviting approach and continuous support in care activities are experienced to be important for parents to manage and ease the infant's care. Family-centered care is seen as essential to achieve this.

Made available in DSpace on 2016-04-28T20:39:09Z (GMT). No. of bitstreams: 1 Ana Paula Marson.pdf: 673352 bytes, checksum: 9c50a1e9a8526b3c7e6ee5ad0a0cfb26 (MD5) Previous issue date: 2015-09-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study investigates the Kangaroo Care intervention possibilities concerning the mother's approach to her premature baby, surrounded by a technological barrier that permeates treatment. The survival and development of the baby depend on technology, medicines and health professionals, as they represent, in his early life, safety for him and his mother. In the face of the adversities of this situation, the aim of the study is to analyze the challenges of the implementation of the 1st phase of the Kangaroo Care in a neonatal unit. Kangaroo Care not only provides early skin-to-skin contact between the infant and the mother and father, allowing greater participation in caring, but also enables the organization of the neonatal environment as to noise and lighting, and pain control, in order to decrease the negative effects on the infant s development. The basis of Winnicott's thought shows that the consistency of maternal care ensures continuity of being or continuing baby's existence. Thus, the baby depends emotionally on the mother for his survival and, in the neonatal unit, depends on the professionals present there. Thus, the concern of this research is to look closer at the medical professionals who work in the neonatal unit, because the physical and mental health of the premature baby depends on them. The research was conducted at the Neonatal Unit of the University Hospital of the State University of Londrina. We used a qualitative research method, participant observation and interviews, contextualizing the first stage of the Kangaroo Care implementation through evaluation of benefits and difficulties / O presente estudo investiga as possibilidades de intervenção do Método Canguru no que diz respeito à aproximação da mãe com seu bebê prematuro, envolto em toda barreira tecnológica que permeia o tratamento. A sobrevivência e desenvolvimento do bebê dependem do maquinário, de medicamentos e de profissionais atuantes nesse contexto, visto que se tornam, no início da sua vida, a segurança para ele e para a sua mãe. Diante das adversidades que essa situação coloca, o interesse deste estudo consiste em analisar os desafios da implantação da 1ª etapa do Método Canguru em uma unidade neonatal. O Método Canguru proporciona o contato pele a pele precoce entre a mãe-bebê e o pai, permitindo uma maior participação desses no cuidado com seu bebê, como também permite toda a organização do ambiente neonatal no sentido de diminuição de ruídos, de luminosidade, controle de dor, a fim de minimizar os efeitos negativos no desenvolvimento do prematuro. A base de todo pensamento winnicottiano evidencia que a constância do cuidado materno assegura a continuidade do ser ou existência continuada do bebê. Sendo assim, o bebê depende emocionalmente da mãe para sua sobrevivência e, na unidade neonatal depende dos profissionais lá presentes. Desse modo, a preocupação desta pesquisa consiste em voltar um olhar mais atento aos personagens que participam da neonatal, pois deles dependem o seguimento da saúde física e mental do bebê prematuro. A pesquisa foi desenvolvida na Unidade Neonatal do Hospital Universitário da Universidade Estadual de Londrina. Para isso, utilizou-se do método qualitativo de pesquisa, com uso da observação participante e de entrevistas, contextualizando a primeira etapa da implantação do Método Canguru mediante avaliação de benefícios e dificuldades

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2018-09-20T16:10:05Z No. of bitstreams: 2 Dissertação - Ana Patrícia Batista Silva - 2018.pdf: 2014058 bytes, checksum: 3a654c39b228b74ae8ddbceb707e659e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-09-21T11:28:45Z (GMT) No. of bitstreams: 2 Dissertação - Ana Patrícia Batista Silva - 2018.pdf: 2014058 bytes, checksum: 3a654c39b228b74ae8ddbceb707e659e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-09-21T11:28:46Z (GMT). No. of bitstreams: 2 Dissertação - Ana Patrícia Batista Silva - 2018.pdf: 2014058 bytes, checksum: 3a654c39b228b74ae8ddbceb707e659e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-04-20 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / To analyze the work context and occupational damage, from the perspective of nursing staff professionals, in an Intensive Care Unit and Neonatal Intermediate Unit. METHODS: Cross-sectional, observational study with quantitative-qualitative approach performed at a large public health institution in the state of Goiás. The sample consisted of 44 workers from the neonatal units nursing team. Data collection was performed in the months of July and September of 2017 through observation and interview. For the data analysis, descriptive and analytical statistics were used using Student's t test and ANOVA for associations and Pearson's test for correlations, with a significance level of 5% (p ≤ 0,05). RESULTS: As for the professional profile, eight (18,2%) were nurses, 27 (61,4%) technicians and nine (20,4%) nursing assistants, female (100%), and mean age of 41,7 (± 9,7) years. The work context, from the perspective of the workers, was considered critical. For the organization of work, the items "excessive work rate" and "strong collection by results" presented higher averages (4,2±1,0), classified as severe. Concerning the working conditions, the highest averages corresponded to the "uncomfortable physical environment" (4,0±1,3), "a lot of noise in the environment" (4,1±1,1) and "inadequate physical space" (3,4±1,4). In the socio-professional relations, the highest averages involved "non-existent autonomy" (3,5±1,3) and "disputes among professionals" (3,5±1,1). A significant statistical difference was found between the two units for work organization factors (p=0,048), working conditions (p=0,046) and socio-professional relationships (p=0,0001). Regarding the occupational damage, the critical evaluation prevailed, with the psychological one having the highest mean (3,9±2,0) in the Intensive Care Unit. Already In the Neonatal Intermediate Unit, greater mean was identified for physical damage (2,6±1,4). There was a significant statistical difference between the Intensive and Intermediate Unit Care for the psychological (p=0,0002) and social (p=0,0009) damages. There was an association between the "work organization" domain and wage income variables (p=0,044) and hourly unit load (p=0,009); for "working conditions", the variables employment bond (p=0,016) and wage income (p=0,0001) were statistically significant. As well as for "physical damages" and the variables performed domestic activity (p=0,009), time acting on the unit (p=0,04) and wage income (p=0,02); for "psychological damages" and "social damages", there was an association with the variables working hours (p=0,02) and work shift (p=0,04/0,005). It was found a moderate and significant correlation between: physical damage and work organization (r=0,5721, p=0,0001), psychological damage and working conditions (r=0,5614, p=0,0001), psychological damage and socio-professional relations (r=0,6687, p=0,0001) and high and significant correlation between social and psychological damage (r=0,9072, p=0,0001). CONCLUSION: The work context of the neonatal units presents unfavorable elements and in inadequacy with the health and safety regulations of the worker, predisposing them to physical, psychic and social damage. / OBJETIVO: Analisar o contexto de trabalho e os danos ocupacionais, na perspectiva dos profissionais da equipe de enfermagem, em uma Unidade de Terapia Intensiva e Intermediaria Neonatal. METODOLOGIA: Estudo observacional, de corte transversal, com abordagem quantiqualitativa, realizado em uma instituição pública de saúde de grande porte do estado de Goiás. A amostra foi constituída por 44 trabalhadores da equipe de enfermagem de unidades neonatais. A coleta de dados foi realizada nos meses de julho e setembro de 2017 por meio de observação e entrevista. Para análise dos dados utilizou-se estatística descritiva e analítica por meio dos testes t “student” e ANOVA para associações e o teste de Pearson para as correlações, com nível de significância de 5% (p ≤ 0,05). RESULTADOS: Quanto ao perfil profissional, oito (18,2%) eram enfermeiros, 27 (61,4%) técnicos e nove (20,4%) auxiliares de enfermagem, do sexo feminino (100%), e com média de idade de 41,7 (±9,7) anos. O contexto de trabalho, na perspectiva dos trabalhadores, foi considerado crítico. Para o fator organização do trabalho, os itens “ritmo de trabalho excessivo” e “forte cobrança por resultados” apresentaram maiores médias (4,2±1,0), classificados como grave. Referente às condições de trabalho, as maiores médias corresponderam aos itens “ambiente físico desconfortável” (4,0±1,3), “muito barulho no ambiente” (4,1±1,1) e “espaço físico inadequado” (3,4±1,4). Nas relações sócio profissionais, as maiores médias envolveram “autonomia inexistente” (3,5±1,3) e as “disputas entre os profissionais” (3,5±1,1). Identificou-se diferença estatística significante entre as duas unidades para os fatores organização do trabalho (p=0,048), condições de trabalho (p=0,046) e relações sócio profissionais (p=0,0001). Em relação ao dano ocupacional prevaleceu a avaliação crítica, sendo o psicológico o com maior média (3,9±2,0) na UTIN. Já na UCIN, identificou-se maior média para o dano físico (2,6±1,4). Verificou-se diferença estatística significativa entre a UTIN e UCIN para os danos psicológico (p=0,0002) e social (p=0,0009). Houve associação entre o domínio “organização do trabalho” e as variáveis renda salarial (p=0,044) e carga horaria na unidade (p=0,009); para “condições de trabalho”, as variáveis vínculo empregatício (p=0,016) e renda salarial (p=0,0001) foram estatisticamente significativas. Como também para “danos físicos” e as variáveis realiza atividade doméstica (p=0,009), tempo que atua na unidade (p=0,04) e renda salarial (p=0,02); para os “danos psicológicos” e “danos sociais” houve associação com as variáveis carga horaria de trabalho (p=0,02) e turno de trabalho (p=0,04/0,005). Constatou-se correlação moderada e significativa entre: dano físico e organização de trabalho (r=0,5721; p=0,0001), dano psicológico e condições de trabalho (r=0,5614; p=0,0001), dano psicológico e relações sócio profissionais (r=0,6687; p=0,0001) e correlação alta e significativa entre dano social e psicológico (r=0,9072; p=0,0001). CONCLUSÃO: O contexto laboral das unidades neonatais apresenta elementos desfavoráveis e em inadequabilidade com as normativas da saúde e segurança do trabalhador, predispondo-os ao dano físico, psíquico e social.

Bakgrund: Prematurfödda eller sjuka nyfödda barnet som vårdas på neonatalavdelningar utsätts regelbundet för separationer från sina föräldrar trots att forskning visar på en mängd negativa konsekvenser för både barnet och föräldern till följd av separationen. Syfte: Att undersöka vårdpersonalens inställning till nollseparation och vilka faktorer som främjar respektive hindrar nollseparation mellan barn och förälder under den neonatala perioden. Syftet var dessutom att undersöka vårdpersonalens inställning till nollseparation i relation till Barnkonventionen. Metod: En tvärsnittsstudie med deskriptiv design. Mixad metod användes för att svara på studiens frågeställningar. Totalt deltog 16 vårdpersonal i studien. Enkätstudien kompletterades med en systematisk litteraturstudie. Resultat: Viktigaste faktorerna som främjade nollseparation mellan barn och förälder var hud-mot-hudkontakt, föräldramedverkan i vården, samvård och möjlighet att utföra lättare neonatalvård hos föräldrarna på BB- avdelning. Viktiga faktorer som hindrade nollseparation var vårdmiljön som inte var anpassad för nollseparation, bristande tillgång på övernattningsmöjligheter för föräldrarna, personalbrist samt kompetens-och kunskapsbrist hos vårdpersonalen. Vårdpersonalens inställning till nollseparation i relation till Barnkonventionen varierade. Slutsats: Stor del av vårdpersonalen ansåg att separation mellan barn och föräldrar bör undvikas. Dock utmanades vårdpersonalens arbete mot nollseparation av ett stort antal hinder så som faktorer rörande vårdorganisation, vårdpersonal, föräldrar och barn. För framtidens neonatalvård blir det därför viktigt att identifiera och eliminera dessa hinder för att möjliggöra nollseparation mellan barn och föräldrar i alla lägen, samt för att uppfylla Barnkonventionen. / Background: Preterm or newborn babies in need of neonatal care are often separated from their parents. However, research show that separation are associated with negative consequences for both child and parental health. Aim: To examine nurses’ beliefs about factors that promote and hinder zero separation between parent and child during the neonatal period. The aim was also to examine nurses’ perceptions about zero separation in relation to the Convention on the Rights of the Child. Method: A mixed methods, cross-sectional study. A total of 16 nurses completed a survey. In addition, a supplemental literature overview was conducted. Results: Important factors that positively impacted zero separation between parent and child were skin-to-skin care, parental participation in nursing of the child and the possibility to perform minor neonatal care at the maternity unit. Important factors that negatively impacted zero separation were the environment not being optimal, lack of overnight accommodations, staff shortages and lack of competence and knowledge in the staff. There was a variation in the thoughts about zero separation in relation to the Convention on the Rights of the Child. Conclusions: Most part of the nursing staff believed that separation of the child from the parent should be avoided. Nevertheless, minimising separation was challenging because of various obstacles such as factors regarding organisation, staff, parents and child. Neonatal units must identify and eliminate these obstacles in order to make zero separation between parent and child possible and to fulfill the guidelines of the Convention on the Rights of the Child.