Introdução: Apesar dos avanços e uniformização preconizada pelas diretrizes mundiais de ressuscitação cardiopulmonar (RCP), ainda é insuficiente o conhecimento da efetividade da RCP intra-hospitalar no Brasil. Neste estudo avaliamos variáveis clínicas e demográficas de pacientes submetidos à RCP e preditores independentes associados à sobrevivência imediata (recuperação da circulação espontânea acima de 24h), sobrevivência até a alta hospitalar, em seis e doze meses. Métodos: este estudo transversal incluiu, de forma prospectiva, 763 pacientes em parada cardiorrespiratória (PCR) entre 1º de novembro de 2007 a 1º de novembro de 2010, ocorrida no ambiente intra-hospitalar de 17 hospitais gerais e institutos de especialidades. As manobras de RCP foram executadas em 575 pacientes. Resultados: A modalidade de PCR mais frequente foi a assistolia (40,7%), seguida de atividade elétrica sem pulso (39,3%). A sobrevivência imediata foi de 48,8%, sobrevivência até a alta hospitalar foi de 13%, de 4,3% em seis e de 3,8% em doze meses. Os preditores independentes associados à sobrevivência imediata foram o ritmo inicial em fibrilação ventricular ou taquicardia ventricular sem pulso (Razão de Taxas RT 1,31; IC 95% 1,10 a 1,55; p=0,002); presença de sinais de consciência da vítima, ao chegar a equipe atendimento (RT 1,37; IC95% 1,16 a 1,61; p<0,001); uso de epinefrina durante a RCP (RT 1,61; IC 95% 1,32 a 1,98; p < 0,001); hipoglicemia como causa da PCR (RT 1,68; IC 95% 1,11 a 2,55; p=0,014). Foram preditores independentes associados à menor sobrevivência imediata: hipotensão como causa da PCR (RT 0,74; IC 95% 0,61 a 0,90; p=0,003); sedentarismo como antecedente à PCR (RT 0,76; IC 95% 0,66 a 0,88; p< 0,001) e tempos da duração da RCP: maiores tempos com menor sobrevivência. Como preditores independentes associados à sobrevivência até a alta hospitalar, foram identificados: presença de médicos e enfermeiros treinados em ACLS e/ou BLS na equipe de atendimento (HR 3,07; IC 95% 1,39 a 6,78; p=0,006) e ritmo sinusal após a recuperação da circulação espontânea (HR 1,44; IC 95% 1,26 a 1,75; p=0,002). Como preditores independentes para maior sobrevivência em seis meses identificou-se: uso de epinefrina (HR 4,09; IC 95% 1,14 a 14,69; p=0,030), ritmo sinusal após a recuperação da circulação espontânea (HR 4,09; IC 95% 1,14 a 14,69; p=0,030) e antecedente de infarto do miocárdio (HR 4,08; IC 95% 1,51 a 11,06; p=0,006). Não foram identificados preditores independentes para sobrevivência em doze meses. Conclusões: Foram identificados como preditores independentes para sobrevivência imediata o ritmo inicial em fibrilação ventricular ou taquicardia ventricular sem pulso, presença de sinais de consciência da vítima, uso de epinefrina durante a RCP, hipoglicemia como causa da PCR. Como preditores independentes associados à sobrevivência até a alta hospitalar a presença de médicos e enfermeiros treinados em ACLS e/ou BLS e o ritmo sinusal após a recuperação da circulação espontânea. Os achados sugerem perfil multicêntrico nacional da ressuscitação, fornecendo dados potencialmente representativos da ressuscitação cardiopulmonar intra-hospitalar no Brasil. / Introduction: in spite of the advances and worldwide standardization for cardiopulmonary resuscitation recommended by international guidelines, knowledge on the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) is not yet sufficient in Brazil. In this study, we evaluated both demographic and clinical variables in patients underwent cardiopulmonary resuscitation and independent predictors associated to immediate (recovery of spontaneous circulation up to 24 h), until hospital discharge, six and twelve months survival rates. Methods: This cross-sectional study included, prospectively, 763 patients who presented in-hospital cardiac arrest between November 1st 2007 and 01 November 1st 2010, from 17 general hospitals and specialty institutes. CPR procedures were performed in 575 patients. RESULTS: The cardiac arrest modality most frequently found was asystole (40.7%), followed by pulseless electrical activity (39,3%). Immediate survival was 48,8%, survival until hospital discharge was 13%, 4.3% in six months and 3.8% in twelve months. Independent predictors associated with higher immediate survival were: ventricular fibrillation or ventricular tachycardia without pulse as the initial rhythm of cardiac arrest (Rate Ratio- RR 1.31; IC 95% 1.10 to 1.55; p = 0.002); presence of victim consciousness signs when arrival of the emergency staff (RR 1.37; IC95% 1.16 to 1.61; p < 0.001); use of epinephrine during CPR (RR 1.61; IC 95% 1.32 to 1.98; p < 0.001); hypoglycemia as cause of cardiac arrest (RR 1.68; IC 95% 1.11 to 2.55; p = 0.014). Independent predictors associated with lower immediate survival were: hypotension as cause of cardiac arrest (RR 0.74; IC 95% 0.61 to 0.90; p = 0.003); sedentary lifestyle prior to cardiac arrest (RR 0.76; IC 95% 0.66 to 0.88; p < 0.001) and duration of the cardiopulmonary resuscitation: the longer the duration, the lower the survival. Independent predictors associated with hospital discharge survival were: presence of doctors and nurses with ACLS and/or BLS previous training, in the emergency team (HR 3.07; IC 95% 1.39 to 6.78; p = 0.006) and sinus rhythm after recovery of spontaneous circulation (HR 1.44; IC 95% 1.26 to 1.75; p = 0.002). Independent predictors of higher six-month survival rate were use of epinephrine (HR 4.09; IC 95% 1.14 to 14.69; p = 0.030), sinus rhythm after return of spontaneous circulation (HR 4.09; IC 95% 1.14 to 14.69; p = 0.030) and previous myocardial infarction (HR 4.08; IC 95% 1.51 to 11.06; p = 0.006). Independent predictors of 12-month survival were not identified. Conclusion: As independent predictors for immediate survival we identified: ventricular fibrillation or ventricular tachycardia without pulse as the initial rhythm, presence of signs of awareness of the victim, use of epinephrine during RCP, hypoglycemia as cause of PCR. As independent predictors associated survival until discharged the presence of doctors and nurses trained in ACLS and BLS and the sinus rhythm after recovery of spontaneous circulation (ROSC). These findings suggest a multicentre and national resuscitation profile, providing relevant information, potentially representative of the in-hospital cardiopulmonary resuscitation in Brazil.

Orientador: Maria José D'Elboux / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T02:20:00Z (GMT). No. of bitstreams: 1 Pergola-Marconato_AlineMaino_D.pdf: 6010690 bytes, checksum: 45ae36cd11e1369ccd7bd4efb047650e (MD5) Previous issue date: 2013 / Resumo: Introdução. A eficácia na aplicação dos primeiros socorros com a participação do leigo nas situações de emergência determina a sobrevivência das vítimas e aponta para a relevância de sua capacitação. Em âmbito nacional não existe programa modelo desta capacitação. Objetivos. Comparar o conhecimento dos alunos que participaram da capacitação em primeiros socorros do Curso de Formação de Condutores (CFC) com aqueles que participaram do curso elaborado e ministrado por profissional da saúde; adaptar, validar o conteúdo e testar a confiabilidade de questionário para avaliar conhecimentos de primeiros socorros de leigos; propor e aplicar programa para esta capacitação; identificar retenção do conteúdo dos participantes em ambos os cursos; e, comparar assimilação e retenção do conteúdo de ambos os grupos conforme a idade. Sujeitos e método. Estudo experimental em que se elaborou programa de capacitação teórica em primeiros socorros para leigos e o aplicou aos alunos do CFC divididos aleatoriamente em: Grupo Intervenção (GI) - participou do programa elaborado e Grupo Controle (GC) - do CFC. Mesmo questionário, composto por 29 questões fechadas, foi aplicado: Etapa I - antes, Etapa II - após e, Etapa III - três meses após participação na capacitação; adaptado e submetido à validação e teste de confiabilidade (estabilidade). Após a coleta, houve rearranjo conforme idade (GIA/GCA - idade inferior a 50 anos; GIB/GCB - superior ou igual a 50 anos). Atribuiu-se nota às respostas e o desempenho de cada indivíduo foi classificado: qualificado (7,1 a 10,0), pouco qualificado (5,0 a 7,0) e não qualificado (0 e 4,9). Resultados. Nove juízes (três leigos e seis especialistas) validaram o conteúdo e apenas 1/9 (11,2%) não considerou a parte do suporte básico de vida (SBV) abrangente devido à ausência de questão sobre reconhecimento da parada cardiorrespiratória. Dezesseis questões obtiveram concordância de 100,0% para clareza. No domínio Abordagem da vítima, 10/27 (37,0%) das questões apresentaram concordância perfeita (Kappa=1,0) e no SBV, 5/9 (55,6%) boa. Obteve se Coeficiente de Correlação Intraclasses indicativo de boa concordância para todo o instrumento (0,63). Amostra de 367 sujeitos (GI=182 e GC=185), homogênea quanto variáveis sociodemográficas entre grupos. Observou-se ascensão das notas médias da Etapa I (7,7) para a II (8,1) e, decréscimo na III (7,9) no GI. No GC também ocorreu esta oscilação, mas com notas menores (I - 5,3; II - 7,0; III - 6,3). No GI não houve nenhum classificado como não qualificado nas Etapas II e III. No GC, houve redução dos sujeitos não qualificados de 73/185 (39,5%) na I para 16/185 (8,6%) na II, mas na III ainda havia 25/185 (13,5%). Predominaram sujeitos qualificados no GIA. A comparação da classificação de desempenho entre grupos mostrou diferença significativa nas Etapas II e III (p<0,0001). Conclusão. Apesar de a capacitação ser apenas teórica, possibilitou aumento significativo de qualificados nas Etapas II e III do GI. A capacitação proposta propiciou assimilação e retenção adequada. Considerações finais. Sugere-se a aplicação deste programa, pois os resultados evidenciaram boa assimilação e retenção. Não houve amostra considerável de idosos, mas é essencial que recebam atenção especial na capacitação. Estudo inserido na Linha de Pesquisa Processo de Cuidar em Saúde e Enfermagem / Abstract: Background. The effective use of first aid with the lay people involvement in emergencies determines the survival of victims and points to the relevance of their training. Nationally there is no standard for this training program. Aims: Compare the knowledge of the students who participated in the Driver's License Course (DLC) first aid training with those who attended the course prepared and delivered by a health professional; adapt, validate the content and test the questionnaire reliability to assess knowledge of first aid laity; propose and apply this training program, identify retention of the content from the participants in both courses, and compare assessment and content retention from both groups according to age. Subjects and method. Experimental study where theoretical training program in first aid was developed and applied randomly for DLC lay students DLC, divided into Intervention Group (IG) - participated in the prepared program, and Group Control (GC) - CFC. A questionnaire consisting in 29 closed questions was applied: Stage I - before Stage II - after, and Stage III - three months after participation in the training, tailored and subject to validation and reliability testing (stability). Afterward, there was rearrangement with age (IGA / CGA - age under 50 years; IGB / CGB - greater than or equal to 50 years). A grade was assigned to responses, and performance of each individual was classified: Qualified (7.1 to 10.0), unskilled (5.0 to 7.0) and unskilled (0 and 4.9). Results. Nine judges (three nonprofessionals and six experts) validated the content, and only 1/9 (11.2%) did not consider part of the basic life support (BLS) due to the absence of comprehensive question in recognizing cardiopulmonary arrest. Sixteen questions had agreement of 100.0% for clarity. In the victim approach method, 10/27 (37.0%) of the questions were perfect agreement (Kappa = 1.0) and BLS, 5/9 (55.6%) good. It obtained intraclass correlation coefficient indicative of good agreement for the entire instrument (0.63). A sample of 367 subjects (IG = 182 and CG = 185), as homogeneous sociodemographic variables between groups. It was observed a rising of average marks of Stage I (7.7) for II (8.1) and decrease in III (7.9) in IG. CG also occurred in this oscillation, but with lower grades (I - 5.3 II - 7.0 III - 6.3). In IG there was no classified as unskilled in Stages II and III, and between skilled. In CG, a reduction of subjects unqualified 73/185 (39.5%) in the I to 16/185 (8.6%) in II, III but there was still 25/185 (13.5%). A comparison of the performance rating showed a significant difference between groups in Stages II and III (p <0.0001). Conclusion. Despite being just theoretical training, quality significantly increased in Stages II and III of the IG. The proposed training provided proper assimilation and retention. Final considerations. The implementation of this program is suggested, as the results pointed good uptake and retention. There was not a considerable sample of elderly, but it is essential that they receive special attention in training. This study was inserted on Line Research Process in Nursing and Health Care / Doutorado / Enfermagem e Trabalho / Doutora em Enfermagem

Hjärtstopp är en oväntad och traumatisk händelse, där återupplivning är en nödvändig åtgärd. Tidigare riktlinjer har varit att anhöriga skulle ledas ut från rummet där återupplivning pågick. Numera rekommenderas det att anhöriga ska få möjligheten att närvara under återupplivning om de önskar det. Det förekommer skilda meningar bland vårdpersonal huruvida det är främjande för anhöriga att närvara under återupplivning och därmed behövs en fördjupad förståelse inom området. Studiens syfte var att beskriva anhörigas erfarenheter av att närvara under återupplivning. Studien är utförd som en allmän litteraturstudie. Genom bearbetning av vetenskapliga artiklar, framkom fyra kategorier: Kommunikation vid närvaro under återupplivning, Stöd vid närvaro under återupplivning, Insikt av döden vid närvaro under återupplivning och Bearbetning av närvaro under återupplivning. Resultatet påvisade vikten av vårdpersonalens stödjande roll, genom att upprätthålla en god kommunikation med den anhöriga. Dessutom visade resultatet att anhöriga som fick möjlighet att närvara under återupplivning hade en lägre grad av depression, ångest, posttraumatisk stressyndrom och underlättad sorgeprocess, jämfört med reaktionerna hos de anhöriga som inte närvarat under återupplivning. Ökad kunskap krävs för att vårdpersonal ska kunna utöva ett professionellt omhändertagande av anhöriga under återupplivning. / Cardiac arrest is an unexpected traumatic event, in which resuscitation is a necessary practice. Previous guidelines have recommended family-members to be taken outside of the room. Nowadays it is recommended that they are given the chance to be present during resuscitation. There are different opinions among healthcare professionals in the field, therefore there is a need of in-depth understanding of it. The aim of this study was to describe family-members experiences when being present during resuscitation. This study is conducted as a general literature study. Through the analysis of scientific articles, four categories emerged: Communication when present during resuscitation, Support when present during resuscitation, Understanding of death when present during resuscitation, Processing when present during resuscitation. The result showed the importance of the healthcare professionals supporting role, by maintaining a good communication with the family members. Furthermore, the result showed that having family-members present at the time of resuscitation, led to a lower grade of depression, anxiety, posttraumatic stress disorder, along with an eased grief process, compared with the family-members reactions, who weren’t present during resuscitation. Increased knowledge is required for healthcare professionals to be able to practice a professional disposal of family- members during resuscitation.

The thesis deals with an overview of the history of First Aid, focusing on the development of cardiopulmonary resuscitation. It is a historical-comparative work of theoretical nature. The intention is to map the knowledge and experience that can be used effectively to develop and study the issue. When writing a thesis, an analysis of the available literature, both historical and contemporary, foreign and Czech, was used. Articles from professional periodicals and monographs were searched. The work was, for the sake of completeness, supplemented with period pictures and diagrams. The introduction justifies the choice of the topic and depicts the current state of knowledge in the field of First Aid. The next chapter explains the basic concepts which are important for orientation in the issue. Following a historical study First Aid aimed at developments providing cardiopulmonary resuscitation. The chapter is divided into subchapters describing the chronology of events to present recommendations for resuscitation and First Aid, so called CPR Guidelines 2015. The last chapter deals with the basic legal minimum. The outcome of this work is an extremely comprehensive overview of mapping the formation and development of First Aid from its history to current recommendations for resuscitation. This thesis...

Cardiopulmonary resuscitation (CPR) and defibrillation are the interventions performed by health care professionals in order to preserve the life of a patient suffering cardiac arrest. These tasks are important to the role of nurses because they are the most common first responders to in-hospital cardiac arrest scenarios. The early initiation of CPR and defibrillation is essential in increasing the likelihood of a patient surviving cardiac arrest. Despite possessing the knowledge, skills, training, and professional obligation to deploy CPR and defibrillation independently, nurses may hesitate to perform the appropriate actions in a timely manner. This topic has been studied previously; however, there have been no studies directly examining this issue in the Ontario context. This thesis explored the factors that influence the behaviour of nurses in the first responder role by employing a mixed-methods research design. The quantitative portion of the study consisted of a series of scales on an online survey that examined teamwork factors and nurses’ experience with CPR events. The qualitative part of the study consisted of open-ended questions on the survey as well as individual interviews with nurses to understand the barriers and enablers to the role of nurses in the enactment of basic life support (BLS). The qualitative data were analyzed with a modified grounded theory approach. The qualitative data analysis followed the guidelines developed by Charmaz (2006) and employed the conceptual framework on optimizing scopes of practice developed by the Canadian Academy of Health Sciences (2014) to extrapolate findings on the influence of nurses’ scope of practice on their behaviour. This study revealed a number of contextual factors in Ontario influencing nurses’ deployment of CPR and defibrillation including variations in hospital unit types, geography, workload, the availability and quality of technology, legislation and regulation, accountability, as well as economic constraints.

Introduktion: Hjärtstopp är ett livshotande tillstånd med hög dödlighet där hjärtats pumpförmåga har upphört att fungera. Under 2019 utfördes hjärt- och lungräddning (HLR) på 8404 personer till följd av ett hjärtstopp i Sverige. Patienterna som överlever hjärtstopp kan drabbas av komplikationer som kan påverka deras återhämtning och livskvalitet. Syfte: Att beskriva patienters upplevelser efter att ha överlevt ett hjärtstopp med utförd HLR. Metod: En litteraturstudie baserat på tio kvalitativa originalartiklar från databaserna APA PsycInfo och PubMed. Resultat: Fyra kategorier och tolv subkategorier identifierades. Mötet med vården beskriver upplevelser av bemötandet från vårdpersonal, patienternas informationsbehov och att utskrivningen från sjukhuset var en kritisk period. Påverkan efter hjärtstopp innefattar de fysiska och kognitiva besvär patienten upplever. Känslor efter hjärtstopp beskriver att patienterna upplevde oro och rädsla efter hjärtstoppet samt att synen på livet och döden förändrades. Vägen tillbaka innefattar hur patienten bearbetar händelsen och strävar efter en återgång till normalitet. Slutsats: Att överleva ett hjärtstopp är en livsomvälvande händelse som medför en ny syn på livet. Patienterna upplevde oro och rädsla inför risken för ännu ett hjärtstopp. Brist på information skapar osäkerhetskänslor hos patienterna som påverkar dem i sin vardag. Genom tillräcklig information kring händelsen och känslorna som uppstår kan sjuksköterskan minska patientens oro. Genom kunskap om förändrade familjerelationer kan sjuksköterskan bättre möta patienter och anhöriga och hjälpa dem med de nya rollerna de numera behöver inta. / Introduction: Cardiac arrest is a life-threatening condition with a high mortality where the heart’s ability to contract has ceased to function. In 2019 cardiopulmonary resuscitation (CPR) was performed on 8404 cardiac arrest patients in Sweden. Survivors face potential complications that can affect their recovery and quality of life. Aim: To describe the experiences after surviving a cardiac arrest with performed CPR.  Method: A literature review based on ten qualitative original articles from the databases APA PsycInfo and PubMed. Result: Four categories and twelve subcategories were identified. The meeting with healthcare describes experiences of the treatment from healthcare workers, patients' need for information and that the discharge was a critical time. Effects after cardiac arrest includes patients’ experiences regarding physical and cognitive difficulties. Feelings after cardiac arrest describes that the patients experienced anxiety and fear after the cardiac arrest and a changed view on life and death. The way back includes the processing of the event and the strive for normality. Conclusion: Surviving a cardiac arrest is a life-changing event that entails a new view on life. The patients experienced anxiety and fear due to the risk of another cardiac arrest. Lack of information created feelings of uncertainty in the patients that affected them in their everyday life. Through sufficient information regarding the event and the emotions that follows the nurse can ease the patients concerns. Through knowledge about changed family relations the nurse can better aid patients and relatives in their new roles.

Le pronostic à court terme des patients d'oncohématologie admis en réanimation s'est notablement amélioré au cours des deux dernières décennies. Ces progrès sont le fait d'une diversification importante de l'arsenal thérapeutique relatif à l'oncologie et l'hématologie mais aussi d'une meilleure prise en charge de ces patients au sein des réanimations. Notre travail de recherche s'est centré sur la devenir de ces malades et les facteurs associés à celui-ci.Dans ce cadre, nous avons conduit plusieurs études observationnelles pronostiques portant sur des patients neutropéniques admis en réanimation. Nous avons montré que les facteurs indépendamment associés à la mortalité hospitalière étaient une allogreffe de moelle, le recours à la ventilation mécanique invasive, le recours à l'épuration extra-rénale ainsi qu'une documentation microbiologique positive. De plus, chez les patients neutropéniques admis en réanimation pour sepsis sévère/choc septique, les facteurs indépendamment associés à la mortalité en réanimation étaient une antibiothérapie initiale inappropriée, un délai d'initiation de l'antibiothérapie en réanimation > 1h, une documentation microbiologique positive à bacille gram négatif non fermentant et à un score SOFA élevé dès l'admission en réanimation. La désescalade du traitement antibiotique initial, réalisable dans 44% des cas,était sans répercussion significative sur le pronostic à court et long-terme. Enfin, chez les patients neutropéniques admis en réanimation pour détresse respiratoire aiguë, le seul facteur indépendant associé à la mortalité hospitalière était le recours à la ventilation mécanique alors que l'utilisation de corticostéroïdes les jours précédant l'admission en réanimation et l'une admission dans un contexte de sortie d'aplasie étaient protecteurs.Finalement, nous avons montré dans une récente revue de la littérature que le pronostic du patient d'oncohématologie admis en réanimation s'était amélioré au cours du temps et que la neutropénie ne semblait pas être un facteur pronostique dans ce contexte.En conclusion, nous avons montré que le patient neutropénique est à haut risque de complications sévères infectieuses, respiratoires et immunologiques. Ces complications impactent le pronostic des patients de manière significative. Nos résultats vont donner lieu à plusieurs essais randomisés chez le patient neutropénique admis en réanimation notamment autour de la désescalade antibiotique au cours du sepsis et des stratégies d'oxygénothérapie en cas de détresse respiratoire. / The short-term prognosis of patients with onco-hematological diseases and neutropenia admitted to intensive care has significantly improved over the last two decades. This progress is the fact of a significant diversification of the armamentarium on oncology and hematology but also a better management of these patients in the ICUs. Our research has focused on the outcome of these patients and its prognostic factors. In this context, we have conducted several prognostic observational studies of neutropenic patients admitted to intensive care units. We showed that factors independently associated with hospital mortality were the bone marrow transplantation, the use of invasive mechanical ventilation, the use of renal replacement therapy and a positive microbiological documentation. Moreover, in neutropenic patients admitted to intensive care for severe sepsis / septic shock, factors independently associated with ICU mortality were inappropriate initial antibiotic therapy, a delay of antibiotic treatment > 1h, a positive microbiological documentation with non-fermenting gram negative bacilli, a high SOFA score on admission in ICU. The de-escalation of initial antibiotic treatment feasible in 44% of cases had no significant impact on the short and long-term outcomes. Otherwise, in neutropenic patients admitted to intensive care for acute respiratory failure, the only independent factor associated with hospital mortality was the need for mechanical ventilation, while the use of corticosteroids in the days before ICU admission and a admission during neutropenia recovery period were protective. Finally, we have shown in a recent review of the literature that the outcome of hematology-oncology patient admitted to intensive care had improved over time and that neutropenia did not seem to be a prognostic factor in this context. In conclusion, we have shown that the neutropenic patient is at high risk of severe infectious,respiratory and immunological complications. These complications significantly impact the outcome of these patients. Our results could lead to the planning of several randomized trials in neutropenic patients admitted to intensive care in particular about the escalation antibiotic in sepsis and oxygentherapy strategies for respiratory distress.

Background One of the most stressful and frightening healthcare experiences for a parent is a cardiorespiratory arrest of their child. Each year, almost 16,000 American children experience cardiorespiratory arrest and attempted resuscitation in hospitals. This experience is traumatic for parents and may lead to a post-traumatic stress response as they fear their child will die or be seriously harmed. Post-traumatic stress response can ultimately lead to deficits in family functioning. There is limited knowledge about the experience of parents during a child’s resuscitation. We do not know how parents respond to a child’s resuscitation or if family functioning is affected after the event. Parent stress and family functioning after a child’s resuscitation has not been studied. While the available research on parents’ experience at their child’s resuscitation in the Emergency Department and Pediatric Intensive Care Unit provides some information, there is a gap in the knowledge about the experience of parents in general pediatric care units and Labor and Delivery areas. In order to develop interventions that support parents’ experience during emergency resuscitation of their child in the hospital setting, it is important to know parents’ experience in all settings where resuscitation of a child happens. Objectives The purpose of this qualitative descriptive study was to elucidate the experiences of parents during their child’s resuscitation and the potential consequences this traumatic event has on parental stress and family functioning after the event. Specific Aim 1: Describe the experiences of parents during the resuscitation of their child in the Emergency Department, Pediatric Intensive Care Unit, General Pediatric Care Unit, Neonatal Intensive Care Unit or Labor and Delivery. Specific Aim 2: Explore parent and family outcomes after parents experience a child’s resuscitation in the Emergency Department, Pediatric Intensive Care Unit, General Pediatric Care Unit, Neonatal Intensive Care Unit or Labor and Delivery by exploring parents’ stress response and family functioning at least one month after the experience using Impact of Events Scale – Revised (IES-R) (post-traumatic stress) and Family Problem Solving and Communication Index (FPSC) (family functioning) and Family Distress Index (FDI) (family functioning). Methods The setting for this study was a 280 bed Midwestern children’s hospital Emergency department (ED), Pediatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit (NICU), Labor and Delivery (L&D) and inpatient pediatric units. Participant inclusion criteria were parents or legal guardians, age 18 or older and English speaking whose children experienced resuscitation within the hospital in a variety of settings. Participants included both parents who were present in the room during the resuscitation and those who were not in the child’s room but nearby. For the purpose of this study, resuscitation was defined as any emergency intervention required providing respiratory or cardiovascular support, including positive pressure airway support, ventilation, cardiac compressions and / or emergency medication administration. Qualitative descriptive methodology, using semi-structured qualitative interviews to generate data was used to provide a deeper understanding of the experience of parents while present during their child’s resuscitation. A small collection of quantitative survey data provided additional information about stress reactions of parents and family functioning at least one month after the event. In this study, measures of stress (Impact of Events scale) and family functioning (Family Problem Solving and Communication Index) and Family Distress Index) were assessed at a time between one and twelve months after the resuscitation experience. Analysis was completed with thematic analysis of the qualitative data and descriptive statistics were described for the quantitative data. Results Parents describe a sense of overwhelming chaos during their child’s resuscitation. However, they have a need to be with their children during this traumatic event. Some parents enter into the experience with an alternate reality, with disbelief that things are as bad as they look. Other parents are thrust abruptly into the experience as they are a participant in the resuscitation that starts outside of the hospital setting. As the experience unfolds, despite the overwhelming, scary experience, parents have identified things that help them get through the experience. Mothers who experience their newborn infant’s resuscitation in the delivery room have a different experience; they feel as though they were physically present, but unable to be a part of the experience. These women describe their unmet expectations. After parents experience their child’s resuscitation, some identify the event as a turning point in their lives that changed them as parents and as a family; some report a new outlook on life or even changed relationships with their significant other. Some parents get to successful resolution of their feelings after the experience, yet others are left feeling anger and resentment. Some parents even wonder if they could have done something different to effect a different outcome. While the outcomes for some parents and families are positive and show that families are stronger after the experience, it is evident that parental post-traumatic stress after a child’s resuscitation, as well as family distress are potential consequences for parents and families after experiencing a child’s resuscitation. Conclusions A thematic analysis of qualitative data about parents’ experience during their child’s resuscitation resulted in three overarching themes including “Overwhelming chaos”, “Getting through it”, “Cognitive presence” and “Joy mixed with heartache”. Each overarching theme was supported with several subthemes. In addition, parent stress and family functioning outcomes were described in two major themes of “Turning point – It changes you” and “After the experience – Resolution vs non-resolution”. Analysis of the quantitative survey data from the IES-R, FPSC index and FDI combined with the qualitative thematic analysis indicate that parent post-traumatic stress and family distress is a potential consequence for families who experience their child’s resuscitation. This study provides foundational knowledge of parent stress and family functioning after a child’s resuscitation and demonstrates that this is an important phenomenon for further study. In addition, the parents’ experience reported in this study also lays a foundation for development, standardization and implementation of interventions to support parents during and after this experience.

UTBILDNING I BARN-HLR TILL FÖRÄLDRAR MED SVÅRT SJUKA BARN -Intervjustudie om sjuksköterskors erfarenheterHELENE JÖNSSONJönsson, H. Utbildning i barn-HLR till föräldrar med svårt sjuka barn – Intervjustudie om sjuksköterskors erfarenheter. Examensarbete i Omvårdnad 15 högskolepoäng avancerad nivå. Malmö Universitet: Fakulteten för hälsa och samhälle, institutionen för Vårdvetenskap, 2018.Bakgrund: Föräldrar till svårt sjuka barn som erbjuds förebyggande föräldrautbildning i barn-HLR före hemgång från sjukhus upplever ökad trygghet samt medför en ökad säkerhet för de sjuka barnen i hemmet. Det saknas kunskap huruvida sjuksköterskor på barnkliniker i Sverige har erfarenhet av att erbjuda denna föräldragrupp utbildning i barn-HLR och hur den i så fall bedrivs. Syfte: Syftet med studien var att undersöka sjuksköterskors erfarenheter av att utbilda föräldrar med svårt sjuka barn i barn- HLR, i samband med sjukhusvistelse.Metod: En kvalitativ semistrukturerad intervjustudie utfördes, med totalt elva sjuksköterskor från de större barnklinikerna i Sverige. Med induktiv innehållsanalys analyserades materialet enligt Burnard.Resultat: Temat som framkom var: Sjuksköterskor har en nyckelroll i föräldrautbildning, samt följande kategorier: Sjuksköterskans undervisande funktioner, Föräldrar och närståendes utbildningsbehov, Utbildningsstrategier, Resultat och konsekvenser av utbildningen. Sjuksköterskornas erfarenhet var att föräldrar till svårt sjuka barn inte alltid får tillräcklig undervisning inför hemgång, de påvisade stress över att inte kunna hantera akuta situationer. Föräldrarna upplevdes tryggare när de fick information och kunskap. Det utbildningsprogram i barn-HLR som finns upplevdes som otillräckligt då det inte täcker behovet som föräldrautbildning till svårt sjuka barn. Slutsats: En standardiserad preventiv föräldrautbildning för barn-HLR till svårt sjuka barn saknas - med de individuella behov som de barnen kan ha. Ansvarsfördelningen är otydlig om vem som tar beslutet om föräldrautbildning ska erbjudas, samt sjuksköterskorna har en nyckelroll i föräldrautbildningen men har ett svagt mandat att bedriva undervisning då stöd från riktlinjer saknas.Nyckelord: Barn-HLR, föräldrautbildning, sjuksköterskors erfarenheter, svårt-sjuka barn. / EDUCATION IN CPR TO CHILDREN FOR PARENTS WITH HIGH-RISK CHILDREN -INTERVIEW STUDY OF NURSES´ EXPERIENCEHELENE JÖNSSONJonsson, H. Education in CPR to children for parents with high-risk children – Interview study of nurses´ experience. Degree project in nursing 15 credits - advanced level. Malmö University: Faculty of Health and Society, Department of Care Science, 2018.Background: Parents with high-risk children who are offered preventive parental education in Cardiopulmonary resuscitation (CPR) for children before departure from hospitals experience increased security and result in increased safety for the sick children in the home. There was no knowledge whether nurses at children's clinics in Sweden had experience in offering this parent group training in CPR for children or, if so, how it was conducted. Aim: The aim of the study was to investigate nurses´ experiences of educating parents with high-risk children in CPR for children, during hospitalization.Methods: A qualitative study incorporating semi-structured interviews was performed, with a total of eleven nurses from the major children’s clinics in Sweden. The interview material was analyzed through inductive content analysis according to Burnard.Results: The theme that emerged was: Nurses have a key role in parental education, and following categories were: Nurse's educational functions, Parents and relatives´ educational needs, Educational strategies, Results and consequences of education. Parents to high-risk children are not always adequately taught pre-departure, they demonstrate of stress over not being able to cope with emergency situations. Parents was felt safer when they received information and knowledge. The educational program of CPR for children that exist were perceived as insufficient as it does not cover the need for parental education to high-risk children. Conclusion: A standardized preventive parental training in CPR for children is lacking, with the individual needs that high-risk children may have. Responsibilities are unclear on who takes the decision on parental education and who will be offered, the nurses have a key role in parental education but have a weak mandate to carry out teaching when support from recommendation was lacking.Keywords: Cardiopulmonary-resuscitation, high-risk child, nurse-experience, parents-education.

Bakgrund: Möjligheten för anhöriga att närvara vid återupplivningsförsök är ett omdiskuterat ämne och rutinerna kring detta skiljer sig åt beroende länders olika riktlinjer kring ämnet. Det finns ett större antal kvantitativa studier som behandlar upplevelser av anhörigas närvaro vid återupplivningsförsök. Däremot finns det inte lika många kvalitativa studier som berör ämnet. Därför kan det vara relevant att studera dessa kvalitativa studier närmare och belysa de anhörigas upplevelser i relation till sjukvårdspersonalens.Syfte: Syftet med denna litteraturstudie var att belysa både anhörigas och sjukvårdspersonalens upplevelser av att anhörigas närvaro vid ett återupplivningsförsök på en närstående.Metod: En litteraturstudie baserad på tio kvalitativa artiklar som belyser både sjukvårdspersonalens och de anhörigas perspektiv. Artikelsökningen genomfördes i databaserna PubMed och CINAHL.Resultat: Fyra huvudkategorier med två underkategorier vardera identifierades. Delaktighet; Aktivt deltagande och Insyn och stöd, Information och kommunikation; God kommunikation och Bristande kommunikation, Trauma; Oro för familjen och Risker, Förutsättningar; personal- och platsbrist och Personalens upplevelse av utsatthet.Slutsats: I resultatet framkom både positiva och negativa effekter av att anhöriga närvarar vid ett återupplivningsförsök på en närstående. Möjligheten att ha fått vara närvarande kunde underlätta sorgearbetet för familjen och hjälpa dessa att acceptera situationens utfall. Närvaron kunde även ge familjen en chans att agera stöd åt patienten. De största orosmomenten för sjukvårdspersonalen handlade om hur familjens beteende eventuellt kunde påverka arbetet med patienten samt eventuella negativa effekter för familjens psykiska hälsa i framtiden. / Background: The opportunity for families to be present during resuscitation is a well discussed subject. The routines regarding family witnessed resuscitation (FWR) depends on the national guidelines. Research has been conducted regarding experiences of FWR. The majority of this previous research used quantitative methods. Therefore, it ́s relevant to further explore the existing qualitative research regarding FWR.Aim: The aim of this study was to illuminate families ́ and health care professionals ́ experiences of FWR.Method: A literature review based on ten qualitative articles obtained from PubMed and CINAHL.Results: Four main categories with two subcategories each were identified. Participation; Active participation and Transparent & support, Information and communication; Good communication and Lack of communication, Trauma; Concerns for the family and Risks, Conditions; Lack of staff and space and The staff ́s sense of exposure.Conclusion: The result that emerged showed both positive and negative effects of FWR. The opportunity to be present could help the family accept the outcome of the procedure and help to ease the grieving process. Family ́s presence could also function as a source of support for the patient. The health care professionals ́ biggest concerns were about the family's behavior and how it possibly could affect the situation in a negative way and also the risk of negative effects on the family ́s psychic health in the future.