Background: Inhaled Nitric Oxide (iNO) functions as a selective pulmonary vasodilator. It is an expensive treatment that is often employed as rescue therapy for refractory hypoxaemia in acute respiratory distress syndrome (ARDS) and pulmonary hypertension (PHT) following cardiac surgery. Objectives: To describe the response to treatment with iNO. Secondary observations were deaths, comorbidities of the patients treated, lengths of treatment and admission, and the cost of treatment. Methods: A retrospective descriptive study of all patients treated with iNO in the Paediatric Intensive Care Unit (PICU) at Red Cross War Memorial Children’s Hospital (RCWMCH) from 2011- 2015. Results: A total of 140 patients were treated with iNO during this time period, 82 were for PHT following cardiac surgery, 53 for ARDS and 5 for PPHN. A response to treatment was observed in 64% of the cohort as a whole, 80% of those with PPHN, 67% of those with PHT post-cardiac surgery, and 64% of those with ARDS. A longer duration of ICU and hospital admission, and higher in hospital mortality (53%) was seen in the group with ARDS, in particular those with adenoviral infection (63%), when compared to patients treated for PHT (18%) and for PPHN (20%). There is no protocol in place guiding the use of iNO in our unit, and it was found that response to treatment was not being objectively measured and documented and that practise varied between clinicians. Conclusions: Considering the cost of treatment and lack of evidence to support beneficial effects of iNO therapy, its continued use in our resource poor setting should be guided by protocol.

Of the 34,000 children who die annually, over 28,000 are four years old or younger. Nurses working in pediatric intensive care units (PICU) provide end of life (EOL) care before, during, and after death of these children. The purpose of this study was to determine thesuggestions PICU nurses have for improving EOL care for dying pediatric patients and their families. A sample of 1047 PICU nurses, who were members of the American Association of Critical-Care Nurses (AACN), were sent a 70-item questionnaire. One open ended item asked nurses to offer a suggestion for improving EOL care for dying PICU patients. Responses were received from 235 of the 474 (49.6%) nurses who returned the questionnaire. Eight themes were identified: (1) providing a better environment; (2) physician honesty about prognosis; (3) having a plan for dying; (4) ending futile care; (5) physicians on "same page;" (6)having more staff; (7) receiving more EOL education; and, (8) providing better pain control. Patient centered principles begin with creating an environment that allows the dying process to be centered on the family while fostering dignity. Fostering dignity includes providing an environment that is conducive to supporting quality EOL care. The importance of providing privacy and an appropriate place for the patient and family to feel more comfortable during the dying process was suggested. The need for better communication between providers and families, ending suffering, and having enough staff to support a "good death," were also high priorities. PICU nurses overwhelmingly suggested that the environment in which health care workers monitor, care for, and support patients and families during death is thegreatest area for improvement. Unit design teams need to assure that care areas for dying pediatric children are created to accommodate a dignified and peaceful passing to improve pediatric End-of-Life Care.

Bakgrund: När ett barn blir kritiskt sjukt och behöver intensivvård kan det innebära enorma kroppsliga och mentala påfrestningar för föräldrarna. Föräldrarna har oftast en central roll i barnets vård och tillfrisknande, men kan uppleva besvär med att få sina personliga behov uppfyllda under barnets vårdtid. Syfte: Beskriva föräldrars uttryckta behov av stöd från sjuksköterskor när deras barn vårdas på BIVA. Metod: Litteraturöversikt med analys av kvalitativ data. Resultat: Fem kategorier presenteras i studien; stöd i form av begriplig information, stöd till att bevara föräldrarollen, stöd i form av tillit till sjuksköterskor, stöd till kroppsligt välbefinnande samt emotionellt stöd. Slutsats: Föräldrar kan uppleva en förlorad känsla av kontroll när barnet vårdas på BIVA. Tankar och känslor, så som osäkerhet gällande barnets överlevnad, kan hindra dem från att ta hand om sig själva vilket i sin tur kan leda till utmattning. Information, delaktighet och goda relationer till sjuksköterskor uttrycks främja föräldrarnas välbefinnande, känsla av kontroll och trygghet. Klinisk betydelse: Resultatet i studien skulle kunna bidra till hur sjuksköterskor kan stödja och hjälpa föräldrar till sjuka barn. Resultatet skulle även kunna bidra till diskussion och reflektion över attityder och förhållningssätt inom hälso- och sjukvården när det kommer till föräldrars roll och välmående i vården av sjuka barn. / Background: When a child becomes critically ill and needs intensive care, it can involve enormous bodily and mental strain for parents. Parents often have a central role in the child's care and recovery, but can experience trouble with getting their personal needs met during the child's hospital stay. Aim: Describe parents expressed needs of support from nurses when their child is cared for in the PICU. Method: Literature review, analyzing qualitative data. Results: Five categories is presented in this study; support in the form of understandable information, support to preserve the parental role, support in the form of trust in nurses, support for bodily well-being and emotional support. Conclusion: Parents can experience a loss of control when the child is cared for in the PICU. Thoughts and feelings, such as uncertainty regarding the child's survival, can prevent them from taking care of themselves which can lead to exhaustion. Information, participation and trusting relationships with nurses can promote parents well-being, feelings of control and security. Clinical significance: The results of this study could contribute to how nurses can support and help parents of ill children. The results could also contribute to the discussion and reflection on the attitudes of health care when it comes to the role and well-being of parents in the care of ill children.

Introduction Paediatric Intensive Care has developed rapidly in recent years with a dramatic increase in survival rates. However, there are increasing concerns regarding the impact that admission to a Paediatric Intensive Care Unit (PICU) has on both the child and their family. Following discharge from PICU, children may be living with complex medical problems as well as dealing with the psychosocial impact that their illness has had on them and their family. Objectives To describe the long-term health outcomes of children admitted to a paediatric intensive care unit (PICU). Methods A full literature search was conducted including the databases; MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, (CENTRAL), Scopus, Web of Science, CINAHL, ERIC, Health Source Nursing/Academic, APA PsycInfo. All studies including children under 18 admitted to a PICU were included. Primary outcome was short- and longerterm mortality. Secondary outcomes were neurodevelopment/cognition/school performance; physical function, psychological function/behaviour impact, quality of life outcomes and social/family implications. Studies focused on Neonatal Intensive Care Admission and articles with no English translation were excluded. Results One hundred and five articles were included in the analysis. Mortality in PICU ranged from 1.3% to 50%. Mortality in high income countries reduced over time but the data did not show the same trend for low- and middle-income countries. Higher income countries were found to have lower Standardised Mortality Rates (SMRs) than low- and middle-income countries. Children had an ongoing risk of death for up to 10 years following PICU admission. Children admitted to PICU also have more ongoing morbidity than their healthy counterparts with more cognitive/developmental problems, more functional health issues, poorer quality of life as well as increased psychological problems. Their parents also have an increased risk of Post Traumatic Stress Disorder (PTSD). Discussion Most of the studies identified are from high income countries and only include short-term follow up. More data is needed from low- and middle-income countries and over longer terms. The studies were markedly heterogenous and were all observational. Agreement is needed regarding which outcomes are most important to measure as well as standardised methods of assessing them. Further research is needed to identify the risk factors which cause children to have poorer outcomes as well as to identify predictive and modifiable factors which could be targeted in practice improvement initiatives.

No description available.

Bakgrund:Att vara anhöriga till en person med psykisk sjukdom medför ofta en egen försämrad psykisk hälsa samt kan vara både tidskrävande och kostsamt. Känslor av skuld och skam samt stigmatisering från omvärlden är vanligt förekommande. Anhöriga önskar delaktighet i vården men exkluderas ofta. Det finns nationella riktlinjer och lagar som betonar vikten av anhörigas delaktighet, trots detta upplevs anhöriga ofta påträngande. De finns lite kunskap om anhörigas kontakt med psykiatriska intensivvårdsavdelningar. Syfte:Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av möten med anhöriga på psykiatriska intensivvårdsavdelningar Metod:Studien har en kvalitativ design med induktiv ansats. Sju sjuksköterskor på psykiatriska intensivvårdsavdelningar i Sverige intervjuades enligt semistrukturerade metod. Materialet analyserades med kvalitativ innehållsanalys. Resultat:Resultatet från intervjuerna utmynnade i fyra kategorier: Organisatoriska förutsättningar för att möta anhöriga, Olika syn på anhöriga, Utmaningar i mötet med anhöriga samt Att möta och kommunicera med anhöriga. Diskussion:Resultatet i studien diskuteras i relation till tidigare forskning och Andersheds teori om Delaktighet i Ljuset – Delaktighet i mörkret. I resultatet framkom aspekter som kan tänkas leda till både delaktighet i ljuset och i mörkret. / Background: Being a relative to someone with mental disorder often causes a decreased mental health and can be both time-consuming and costly. Feelings of guilt and shame and stigmatization from the surroundings are common. Relatives’ wishes to participate in care but often get excluded. National guidelines and laws emphasize the importance of relatives’ participation; despite this relatives' often get perceived as intrusive. Little is known about relatives contact with psychiatric intensive care units. Aim: The aim of this study was to describe nurses’ experiences from meeting relatives at psychiatric intensive care units. Method: This study has a qualitative design with an inductive approach. Seven nurses at psychiatric intensive care units in Sweden were interviewed with semistructured method. The material was analyzed using a qualitative content analysis. Results: The result from the interviews developed into four categories: Organizational requirements to meet relatives, Different views on relatives, Challenges in the meeting with relatives, and To meet and communicate with relatives. Discussions: The result is being discussed in relation to previous research and Andershed's theory of Involvement in the light – Involvement in the dark. In the result aspects emerged that can lead to both participation in the light and in the darkness.

Neonatal Intensive Care Unit and Pediatric Intensive Care Unit social workers are a particularly vulnerable group of professionals due to their chronic exposure to trauma. Current research has overlooked how social workers specifically can adopt certain strategies and coping mechanisms to prevent the symptoms associated with primary trauma, secondary trauma stress, compassion fatigue, and burnout. Thus, the study that follows was designed to explore the strategies and coping mechanisms utilized by NICU and PICU social workers. Data for this project was collected through the use of open-ended questions in an electronic survey format and analyzed through a conventional content analysis approach. Seven participants fully completed the survey and thus only their responses were considered in the analysis. Results of this study indicate the need for NICU and PICU social workers to gain additional education and training on primary trauma, secondary trauma stress, compassion fatigue and burnout so that they can actively participate in prevention. NICU and PICU social workers reported a range of strategies and coping mechanisms including the awareness of personal and professional barriers, consultation, exercise, among others. This study provides crucial information to an understudied area of research, provides a foundation for future research, and promotes the use of positive strategies and coping mechanisms by NICU and PICU social workers so that they can continue to provide the best services possible for the patients they serve.

No description available.

No description available.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-08-01T14:56:20Z No. of bitstreams: 1 FabioDoEgitoPedrosa_DISSERT.pdf: 2343856 bytes, checksum: f7c9828f837f00d98946d46c96c77909 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-08-09T11:20:27Z (GMT) No. of bitstreams: 1 FabioDoEgitoPedrosa_DISSERT.pdf: 2343856 bytes, checksum: f7c9828f837f00d98946d46c96c77909 (MD5) / Made available in DSpace on 2017-08-09T11:20:27Z (GMT). No. of bitstreams: 1 FabioDoEgitoPedrosa_DISSERT.pdf: 2343856 bytes, checksum: f7c9828f837f00d98946d46c96c77909 (MD5) Previous issue date: 2017-03-31 / Este trabalho prop?e um modelo de Or?amento Participativo para o Campus Picu? do Instituto Federal de Educa??o, Ci?ncia e Tecnologia da Para?ba, que contemple os anseios de sua comunidade acad?mica. Para tanto, teve como objetivos espec?ficos apresentar o IFPB Campus Picu? em termos de organiza??o administrativa, comunidade acad?mica e infraestrutura; descrever o atual processo de elabora??o, execu??o e controle da pe?a or?ament?ria do IFPB Campus Picu?; verificar a percep??o da comunidade acad?mica acerca dos benef?cios e limita??es do atual modelo, e seus anseios em termos de participa??o nas diversas etapas do processo or?ament?rio; e, indicar o formato e a din?mica de funcionamento do Or?amento Participativo que melhor se adeque ? realidade do Campus Picu?. Trata-se de um projeto de interven??o que adotou a pesquisa-a??o como principal estrat?gia de pesquisa, e de forma complementar a estrat?gia de entrevistas e levantamento (survey) para conhecer o atual processo or?ament?rio do Campus, a percep??o da comunidade acad?mica acerca da dessa pr?tica or?ament?ria, bem como seus anseios para a participa??o nesse processo. Tem-se que o atual modelo or?ament?rio adotado pelo Campus Picu? ? caracterizado por uma gest?o e processo decis?rio centralizado, n?o permitindo uma participa??o efetiva da sua comunidade acad?mica. Dentre os principais anseios verificados destaca-se a emerg?ncia de um modelo de Or?amento Participativo de car?ter consultivo, fiscalizat?rio e deliberativo, que inclua de maneira mais equitativa todos os segmentos da comunidade acad?mica. Constatou-se um elevado grau de interesse da comunidade em discutir todas as prioridades do campus e deliberar sobre a distribui??o dos recursos, especialmente, os que se refere ao custeio da institui??o, investimentos e assist?ncia ao educando, no entanto falhas no processo comunicativo foram apontadas como um dos principais limitadores dessa participa??o. Diante do contexto do IFPB Campus Picu?, dos limites encontrados no atual modelo de elabora??o, execu??o e controle da pe?a or?ament?ria adotado e dos anseios de sua comunidade acad?mica, prop?em-se um modelo de or?amento que permita uma efetiva participa??o da comunidade acad?mica do campus na defini??o das prioridades e na consequente aloca??o dos recursos or?ament?rios. Conclui-se apresentando diretrizes para a implementa??o do Or?amento Participativo no Campus, indicando, ainda, o formato e a din?mica de seu funcionamento. / This paper proposes a model of Participatory Budget for the Campus Picu? of the Federal Institute of Education, Science and Technology of Para?ba, that contemplates its knowledge of its academic community. In order to do so, it had the specific objectives of presenting the IFPB Campus Picu? in terms of administrative organization, academic community and infrastructure; Describe the current process of elaboration, execution and control of the budget piece of IFPB Campus Picu?; to verify the perception of the academic community about the benefits and limitations of the current model, and their wishes in terms of participation in the various stages of the budget process; and, indicate the format and dynamics of the Participatory Budget that best fits the reality of Campus Picu?. It is an intervention project that adopted action research as the main research strategy, and in a way that complements the strategy of interviews and survey to know the current budgetary process of the Campus, the perception of the academic community about this practice Their wishes for participation in this process. The current budget model adopted by Campus Picu? is characterized by a centralized management and decision-making process, not allowing an effective participation of its academic community. Among the main anxieties verified, it stands out of a Participatory Budget model of consultative, fiscal and deliberative character, that includes in a more equitable way all the followers of the academic community. There was a high degree of community interest in discussing all the priorities of the campus and deliberating on the distribution of resources, especially those related to the institution's costing, investments and assistance to the student, but failures in the communicative process were pointed out As one of the main limiters of this participation. In view of the IFPB Campus Picu? context, the limits found in the current model for the preparation, execution and control of the budget piece adopted and the aspirations of its academic community, propose a budget model that allows an effective participation of the academic community of the campus in the Priorities and the consequent allocation of budgetary resources. It concludes by presenting guidelines for the implementation of the Campus Participatory Budget, also indicating the format and dynamics of its operation.