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Yes / Aim and Objectives: To explore fathers' views and experiences of providing Kangaroo Care (KC) to their baby cared for in a Neonatal Intensive Care Unit (NICU). Kangaroo Care has been known to improve the health outcome for preterm, low birth weight and medically vulnerable term infants and achieve the optimal perinatal health wellbeing for parents and infants. Historically, mothers are considered as the dominant KC providers, whereas fathers are spectators and have been overlooked. Little is known about the fathers' perspectives in providing KC in NICUs. Methods: Individual semi-structured interviews were conducted with 10 fathers who delivered KC to their baby when in the NICU. Data were analysed using Braun and Clarke's six-phase thematical framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed to report this qualitative study. Findings: Fathers in this study identified they were passing a silent language of love and connecting with their baby by the act of KC in a challenging environment. Three themes emerged: ‘Positive psychological connection’, ‘Embracing father-infant Kangaroo Care’ and ‘Challenges to father-infant Kangaroo Care’. Conclusion: The findings of this study show KC enhances the bonding and attachment between fathers and infants. The conceptualisation of the paternal role in caregiving to a newborn is evolving as a contemporary practice. Further research is warranted to confirm or refute the study findings. Policies and facilities should be modified to include father–infant KC within the fields of neonatal care. Relevance to Clinical Practice: It is important for nurses and other health professionals to support and enable fathers to give KC. Father–infant KC is recommended in neonatal care settings. / Open access publishing facilitated by University of South Australia, as part of the Wiley - University of South Australia agreement via the Council of Australian University Librarians.

Made available in DSpace on 2016-04-28T20:38:09Z (GMT). No. of bitstreams: 1 Renata Pereira Condes.pdf: 1004616 bytes, checksum: 460ce238a7269fa03b1ffc1a79d65fb3 (MD5) Previous issue date: 2012-05-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The current study emerges from my work as a psychologist in a Neonatal Intensive Care Unit (NICU) and deals with the possible interventions of a psychologist with the different characters in this scenery babies, parents, relatives and health team and in different situations, discussing how these interventions can have therapeutic and preventive effects in mental health. To achieve this goal, theoretical concepts, supporting different kinds of interventions, such as trauma, helplessness, anguish, mourning and symbolization were discussed, based on psychoanalytical references which help understand psychic phenomenons. In addition, a literature revision about psychological interventions with babies and in a NICU was done, articulating these ideas with the ones about care proposed by Figueiredo (2009). Using the qualitative method of research, with participant observation, field diary and analysis of cases/situations, some types of psychological interventions are theorized, revised and constructed in this scenery, taking into account the contextualization of this setting and activities performed there. Scenes of parents group and two cases of siblings visit were examined. Furthermore, two cases of parents-baby and also a case of a newborn s death received psychological attendance and were analyzed. It is evidenced, safeguarding the specificities of how to promote interventions with each character in this context, that the prime role of a psychologist is to enable the beginning of mourning and symbolizations, which are ruptured or touched by the traumatic situation and the paradox newborn facing life versus newborn facing death/disease. It is proposed the maintenance of the holding and testimony clinic (BENAVIDES; BOUKOBZA, 1997), performing the functions of holding (WINNICOTT, 1960) and rêverie (BION, 1962), rescuing, initiating or keeping the psychic activity working, besides offering network and chain care . All in all, it is worth pointing out that the crucial role of a psychologist is to set a space-time so that it allows thinking / O presente estudo emerge com base em minha prática como psicóloga em uma Unidade de Terapia Intensiva Neonatal (UTI neonatal) e versa sobre as possibilidades de intervenção do psicólogo com os diferentes personagens desse cenário bebês, pais, familiares e equipe de saúde e em variadas situações, discutindo como tais intervenções podem operar efeitos terapêuticos e preventivos em termos de saúde mental. Com a finalidade de atingir tal objetivo, percorrem-se conceitos teóricos, sustentados no referencial psicanalítico, que auxiliam na compreensão dos fenômenos psíquicos vigentes e embasam as modalidades de intervenção; são eles: trauma, desamparo, angústia, luto e simbolização. Ademais, faz-se uma revisão da literatura sobre intervenção psicológica com bebês e em UTI neonatal, articulando tais ideias com as funções de cuidado propostas por Figueiredo (2009). A partir do método qualitativo de pesquisa, com uso da observação participante, do diário de campo e da análise de casos/situações, busca-se teorizar, rever e construir modalidades de intervenção psicológica nesse cenário, considerando a contextualização desse ambiente e as atividades lá desenvolvidas. Analisam-se cenas do grupo de pais da unidade, dois casos de visita de irmãos, dois casos de atendimento pais-bebê e um caso de atendimento em situação de óbito do recém-nascido. Evidencia-se que, resguardadas as especificidades de como promover intervenções com cada personagem desse contexto, é função primordial do psicólogo possibilitar condições para a instalação de lutos e simbolizações, processos esses rompidos ou abalados pelo traumático da situação e do paradoxo recém-nascido para a vida versus recém--nascido diante da morte/doença. Propõe-se a sustentação de uma clínica do holding (BENAVIDES; BOUKOBZA, 1997) e uma clínica do testemunho, ao operar as funções de holding (WINNICOTT, 1960) e de rêverie (BION, 1962), resgatando, instaurando ou mantendo a atividade psíquica em funcionamento, além da oferta de cuidados em rede e em cadeia. Em última instância, constata-se como tarefa fundamental do psicólogo a instauração de um espaço-tempo para o pensar

With increased advances in technology, the overall survival rates in the Neonatal Intensive Care Unit (NICU) for premature infants at lower gestational ages, has also increased. Although premature infants survive at lower gestational ages, they are often discharged to home with unresolved medical issues. While the birth of a new baby for parents is a joyous occasion, they often have difficulty coping and transitioning into a parental role. Premature infants also have ongoing complications such as difficulty with feeding, developmental delays in growth, and long-term eye and respiratory complications. As a result of chronic health sequelae, premature infants require extensive utilization of hospital and community health resources. In addition, hospitals must coordinate between community resources, while preparing parents for specialized discharge teaching. Furthermore, individuals living in rural and underserved areas face unique challenges and barriers to access healthcare resources. An interpretive phenomenology study was conducted to bring insight and develop an understanding into how families perceive discharge readiness, accessing health care resources, and ability to cope at home after discharge from a Level III NICU located in Appalachia. Ten parents total were enrolled in the study and consisted of three couples, three married mothers, and two single mothers. Interviews were conducted over a period of six months and transcript analysis revealed development of major and minor themes. The studies overarching theme was Adapting to a New Family Roles, Finding Normalcy, which described parents experience of being prepared for discharge and their transition to home. Three major themes related to discharge readiness from detailed analysis included; 1) Riding out the storm, 2) Righting the ship, and 3) Safe port, finding solid ground. Subthemes that supported development of the major these were 1a) having the carpet pulled out from under me, 1b) things I lost, 1c) feel like an outsider, 1d) sink or swim, 2a) quest for knowledge, 2b) caring for me, care for my baby, 2c) customized learning, 3a) getting to know baby, 3b) becoming the expert, 3c) ongoing emotions, and 3d) adjusted parental role. Practice and research implications for discharge readiness include providing customized support for parents as they adjust to a new normal for their family, identify necessary resources, and become self-reliant once home.

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Significant relationships have been identified between elements of early parent-infant interactions and later skills or qualities in the child. Generally speaking, sensitive and responsive interactions between a mother and infant during the first year of life tend to be linked with improved child developmental outcomes (Barnard, 1996; Wyly, 1997). Research has examined the influence of infant and family risk factors on parent-infant interaction. Family risk factors including maternal depression can reduce a mother's sensitivity and responsiveness to her infant. Evidence is mounting that mothers of preterm infants experience higher rates of depression than mothers of fullterm infants (e.g. Miles et al., 1999). Although all infants may be vulnerable to the effects of maternal depression, the premature infant is at greater risk due to his/her decreased responsiveness and increased need for appropriate stimulation (Field, 1995). The purpose of this study was to examine maternal reports of depressive symptomatology and associated variables at two time points following a very preterm birth: at one-month postpartum (Phase 1); and 3 months after infant hospital discharge (Phase 2). Observational data were collected at Phase 2 to explore whether maternal depressive symptoms and associated factors influenced maternal-infant interaction. A two-phase prospective follow-up design involved surveying mothers of very premature infants (&It; 32weeks) who were admitted to a neonatal intensive care unit (NICU). Multiple measurements were collected at Phase 1 and Phase 2. Mother-infant observational data were collected at Phase 2. The subject population comprised all eligible mothers of very premature infants who were admitted to a 60 bed tertiary referral NICU of a major metropolitan hospital (n=62). Mothers completed a survey at Phase 1 and Phase 2. The questionnaire contained a number of validated instruments measuring depression, stress, social support and coping. Maternal and infant demographic data were collated from the hospital records. Observational data were collected and coded using the Nursing Child Assessment Feeding Scale (Barnard et al., 1989). Results indicated that 40% of women reported clinically significant depressive symptomatology at one month postpartum. High maternal stress and low maternal education and support from nursing staff were major factors explaining depression scores. At Phase 2, 17% of women continued to report clinically significant depressive symptomatology. Depression at Phase 1 and maternal stress at Phase 2 were important factors explaining Phase 2 depression scores. An exploratory analysis of the relationship between mother-infant interaction and Phase 1 and Phase 2 variables revealed that the mothers' coping strategies, both in hospital and at home, were important factors in explaining mother-infant interaction. The results support previous findings that many women suffer stress and depressive symptoms after very premature birth. The results indicate that maternal depression, at one month postnatally, can be predictive of maternal depression at three months after infant hospital discharge and that very premature infants are less responsive interactive partners. These findings highlight possible parenting difficulties particularly during the first year. This study has contributed to family centered research by highlighting the importance of early postnatal experiences to the longer-term psychological health of mothers and to the mother-infant relationship. Screening mothers of very premature infants for postpartum depression will enable early identification of symptoms and appropriate referral for treatment.

Orientador: Olga Maria Piazentin Rolim Rodrigues / Resumo: A unidade de terapia intensiva neonatal (UTIN), embora seja um ambiente de cuidados especiais para garantir a sobrevivência de recém-nascidos, tende a suscitar, nas mães e familiares percepções e sentimentos ambíguos sobre os eventos relacionados a internação e, ainda, alterar a saúde emocional dos envolvidos. Esses aspectos podem ser influenciados pelo tempo de internação do bebê. O presente projeto foi dividido em duas etapas. Na primeira Etapa 1 pretendeu-se elaborar e adequar instrumentos que possibilitassem a investigação da percepção e de sentimentos que mães de bebês internados em UTIN têm a respeito desta condição. O resultado foi a elaboração dos instrumentos: Protocolo para avaliação da percepção materna sobre a condição do bebê internado em UTIN, com 24 itens e, o Protocolo de avaliação de sentimentos, com três itens de múltipla escolha, para identificação da frequência e justificativa dos sentimentos emergidos no momento da notícia, durante e após a hospitalização. A Etapa 2 é composta por cinco estudos, com o objetivo de avaliar os sentimentos e a percepção materna sobre a internação, a saúde emocional materna, o apoio social percebido e as estratégias de enfrentamentos, relacionando-os com o tempo de internação. Os dados de todos eles foram obtidos de uma amostra de 50 mães de bebês internados em UTIN da Maternidade Santa Isabel, da cidade de Bauru/SP, há pelo menos três dias. Utilizou-se para a avaliação da saúde emocional materna a Escala de Estresse Percebido... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The neonatal intensive care unit (NICU), although it is a special care environment to ensure the survival of newborns, tends to raise in mothers and relatives ambiguous perceptions and feelings about hospitalization events and change the emotional health of those involved. These aspects can be influenced by the length of time the baby is hospitalized. This project was divided into two stages. In the first stage 1, it was intended to elaborate and adapt instruments that would enable the investigation of the perception and feelings that mothers of infants admitted to NICU have regarding this condition. The result was the elaboration of the instruments: Protocol for the evaluation of maternal perception on the condition of the baby hospitalized in NICU, with 24 items and the Protocol of feelings evaluation, with three multiple-choice items, to identify the frequency and justification of feelings emerged at the time of the news, during and after hospitalization. The Step 2 is composed of five studies, with the objective of evaluating maternal feelings and perceptions about hospitalization, maternal emotional health, perceived social support and coping strategies, relating them to length of stay. Data from all of them were obtained from a sample of 50 mothers of infants admitted to a NICU at Maternidade Santa Isabel, in the city of Bauru / SP, for at least three days. The Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Beck Depression Inventory were used to asse... (Complete abstract click electronic access below) / Mestre

L’environnement hospitalier diffère du milieu intra-utérin et contribue aux séquelles neurosensorielles menaçant le grand prématuré (GP). Sa sensibilité visuelle méconnue est évaluée par l’analyse de sa réactivité physiologique, comportementale et hémodynamique cérébrale (NIRS) aux stimuli visuels. La présence d’une réponse physiologique et comportementale montre que le GP réagit aux variations faibles d’éclairement qui peuvent altérer son bien-être, principalement en cas de protection lumineuse faible. Il existe une maturation progressive de l’intégration corticale des stimulations lumineuses de 32 SA (activation cérébrale inconstante) jusqu’au terme. Les différences de réponses observées à maturation égale entre les GP et les nouveau-nés à terme suggèrent que l’expérience postnatale pourrait modifier la trajectoire développementale de la fonction visuelle. Ces résultats plaident pour un ajustement de l’environnement visuel des GP à l’hôpital. / The environment of very preterm infant (VPI) greatly differs from intrauterine environment and contributes to his risk of altered neurodevelopment. Little is known about the visual sensitivity of VPI. It is evaluated through their physiological and behavioural responsiveness and cortical haemodynamic responses to visual stimuli. As shown by their physiological and behavioural responses, moderate light level variation can induce a VPI’s response and could alter its well-being, especially when light protection is insufficient. Cortical integration of visual stimuli maturates from 32 weeks post menstrual age to term. At term corrected age, differences in responses between VPI and term newborn suggest that postnatal experience can alter the developmental pathway of the visual function. Based on these results, VPI’s visual environment must be adjusted to the expectations and sensory capabilities of preterm infants.

Submitted by Ana Carla Almeida (ana.almeida@ucsal.br) on 2017-03-21T15:28:52Z No. of bitstreams: 1 Marcia Cristina Sousa Fonseca Dissertacao_V3.pdf: 2468543 bytes, checksum: 0106305f0507b539a4193e32fc414e57 (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-03-21T16:02:17Z (GMT) No. of bitstreams: 1 Marcia Cristina Sousa Fonseca Dissertacao V3.pdf: 2468543 bytes, checksum: 0106305f0507b539a4193e32fc414e57 (MD5) / Made available in DSpace on 2017-03-21T16:02:17Z (GMT). No. of bitstreams: 1 Marcia Cristina Sousa Fonseca Dissertacao V3.pdf: 2468543 bytes, checksum: 0106305f0507b539a4193e32fc414e57 (MD5) Previous issue date: 2016-12-02 / Esta pesquisa objetiva compreender de que forma é vivenciada a relação de humanização mãe/pai/bebê prematuro durante a hospitalização do recém-nascido na Unidade de Terapia Intensiva Neonatal. Buscou-se conhecer a construção de subjetividades, a partir da hospitalização e afastamento abrupto dos bebês. Foi utilizada uma abordagem descritiva, qualitativa, de cunho etnográfico. O material foi coletado por meio de observação no campo em uma instituição materno-infantil e pela realização de entrevistas utilizando-se um roteiro semiestruturado. A escolha das mães, dos pais e profissionais que participaram da pesquisa ocorreu por conveniência e na própria unidade de terapia intensiva. Foram realizadas entrevistas com sete mães, sete pais e sete profissionais que acompanharam e vivenciaram a experiência da separação precoce com seu recém-nascido, assim como o cuidado em sua prática cotidiana com neonatos prematuros, além de uma entrevista coletiva e não diretiva, com quatro mães que se encontravam no “Espaço Mãe”. O fundamento teórico foi o referencial de Winnicott, uma abordagem Psicanalítica de como se dá a construção do vínculo materno. As discussões e resultados permitiram: compreender os desafios encontrados pelas mães, pais e profissionais de saúde no processo de vinculação com o bebê internado; os sentimentos diante da separação precoce; as relações construídas entre as mães, pais e equipe de saúde no contexto hospitalar; questões atinentes à comunicação entre os profissionais com as mães, pais e familiares; estratégias de enfrentamento utilizadas pelas mães na aproximação com seu filho, bem como na travessia do sofrimento vivido. Procurou compreender a relação de humanização e o acolhimento direcionado às mães e aos pais pela equipe de saúde, ofertando estratégias de atenção mais humanizadas. Conclui-se que a intervenção oportuna, incorporada ao cuidado humanizado estabelecido pelo diálogo constante com a equipe de saúde, pode construir redes de apoio direcionadas à reaproximação do bebê com seus principais cuidadores no momento da separação, o que possivelmente resultará na redução da sua permanência na unidade hospitalar e de uma melhor qualidade do vínculo parental. / This research aims to understand how is experienced the relationship of humanization of the mother / father / premature baby during the hospitalization of newborns in the Neonatal Intensive Care Unit. This study aimed to know the construction of subjectivities since the hospitalization and the abrupt separation of the babies. A descriptive qualitative and ethnographic approach, was used. The material was collected by observation in the field in the Institution and by conducting interviews using a semi-structured script. The choice of mothers, parents and professionals who participated in the survey was for convenience and occurred in the intensive care unit. Interviews were conducted with seven mothers, seven fathers and seven professional who followed and lived the experience of the early separation of the newborn as well as took care of premature infants in their daily practice. The theoretical foundation was Winnicott reference, a Psychoanalytic approach of how is the construction of the maternal bond. The discussions and results allowed to: understand the challenges faced by mothers, parents and health professionals in the binding process with the hospitalized baby; feelings about the early separation; the relationships built between mothers, fathers and health professionals in the hospital setting; issues related to communication between professionals and the mothers, fathers and families; coping strategies used by mothers to approach their child, as well as the suffering experienced. The research looked for understanding the humanizing relationship and the support directed to mothers and fathers by the health team, offering more humanized care strategies. It concluded that early intervention, incorporated into the humanized care established by the constant dialogue with the healthcare team, can build support networks aimed at baby rapprochement with their primary caregivers at the moment of separation, which might result in a reduction of their stay in hospital and a better quality of parental bonding.

Risken för att drabbas av stressrelaterade sjukdomar är hög bland sjukvårdspersonal bland annat då kraven på kvalitet, effektivitet och arbetstempo har ökat. I diskussionen kring sjuksköterskors arbetssituation är saknas det aktuell kunskap om hur sjuksköterskor inom den neonatala intensivvården fördelar sin tid under arbetsdagen och vilka arbetsmoment som sjuksköterskorna utför i sitt dagliga arbete. Syftet med studien var att undersöka vilka arbetsmoment en sjuksköterska på neonatalintensiven utför under ett arbetspass samt kartlägga hur tidsåtgången fördelade sig mellan dessa arbetsmoment. En strukturerad tidsstudie genomfördes därför på en neonatal intensivvårdsavdelning i Sverige. Resultatet visade hur sjuksköterskorna fördelar sin tid mellan 69 olika arbetsmoment i 23 kategorier inom åtta kompetensområden samt hur omvårdnadsarbetet fördelade sig tidsmässigt mellan den direkt patientnära kontakten och övriga patientrelaterade uppgifter. 54 procent av den totalt arbetade tiden ägnades åt indirekt omvårdnad som förberedande arbete, hantering av material och samverkan i vårdkedjan medan 35 procent ägnas åt patientnära omvårdnad. Sjuksköterskearbetet är uppdelat mellan många olika arbetsmoment och arbetsområden, det är hög tid att se över sjuksköterskerollen och de uppgifter hon tilldelas som leder iväg från patientsängen. / The risk for acquire stress related diseases is high in medical staff since the demand on quality, efficiency and work pace has increased. There is not much recent knowledge about how nurses in neonatal intensive care spend their time and which work tasks the nurses perform in their everyday work. The aim of this study was to examine which work tasks a nurse in neonatal intensive care perform during their workday and present a survey to how the time divides between these different tasks. A structured time study was performed at a neonatal intensive care unit in Sweden. The result show how the nurses divide their time between 69 different work tasks divided in to 23 categories in eight areas of competence and how the nursing work divide in terms of time between direct patient care and other patient related tasks. Nurses spend 54 percent of the total worked time to indirect care like preparations for nursing tasks, material and cooperation with external caregivers while 35 percent where spent at direct bedside care. The nurses time is divided between many different tasks and areas of expertise, it is necessary to evaluate the nursing profession and the tasks that leads them away from the patients bed.