Barns uppfattning av delaktighet i vården är utforskat, men när det gäller vårdkvalitet är källan till uppgifterna sällan barnen själva. En förutsättning för ett barnperspektiv i vården är att barn själva deltar i utvärderingen. Studier visar att det är angeläget att ta del av åsikter gällande delaktighet i vården då barns uppfattning inte nödvändigtvis överensstämmer med föräldrars uppfattning. Studiens syfte var att undersöka barn och föräldrars uppfattning om barns delaktighet i vården. Två frågeformulär, ett avsett för barn och ett för föräldrar har använts i studien, som genomfördes med kvantitativ metod och med deskriptiv design. Enkätundersökningen genomfördes på barnavdelningar och barnmottagningar vid ett mellanstort sjukhus i västra Sverige. Totalt ingick 19 barn åldern 10-17 år samt 18 medföljande föräldrar i studien. Barn och föräldrars svar indikerar gynnsamma förutsättningar för delaktighet och en majoritet av barnen upplevde sig delaktiga. Dock ses tendenser som pekar på att det föreligger viss skillnad mellan barns upplevelse av delaktighet, relaterat till barnets ålder. Viss diskrepans mellan barns och föräldrars svar kan även skönjas. Att enbart förlita sig på föräldrars utsago om barns uppfattningar anses därför inte tillräckligt. Vidare kartläggning av barns delaktighet i verksamheter riktade till barn är önskvärt. / Children's perception of participation in health care is rarely based on the children’s experiences. A prerequisite for a child-centered perspective in health care is that children themselves participate in evaluations. Studies show that it is important to take part of opinions regarding participation in health care due to the fact that children and parents' perceptions not always are consistent. The aim of this study was to investigate how the child and their parent perceive the child's participation in health care. Two questionnaires, one intended for children and one for the parents were used in the study. The study was conducted using a quantitative method with descriptive design. The survey was carried out in pediatric wards and child clinics at a midsize hospital in western Sweden. 19 children in the age of 10-17 years and 18 accompanying parents participated in the study. Children’s and parents' responses indicate favorable conditions for participation. A majority of the children stated an experience of involvement. However, trends indicate that there is some difference between children's experience of participation, related to the age of the child. Some discrepancies can be discerned between the children’s and the parents' responses. Relying solely on the parents' admission of the child's perception is therefore not sufficient. Further research of children's participation in activities directed to children is desirable.

Purpose: The purpose of this study is to examine the baseline oral health status of infants and the level of their caregiver's oral health knowledge for families who received preventive oral health services in a medical setting. Methods: Using a prospective cohort study, children 0-3 years of age received an oral health screening, risk assessment, caregiver education, and a fluoride varnish treatment in an ambulatory pediatric medical clinic. A 16-item oral health knowledge and socio-demographic questionnaire was delivered to the caregiver of child. This questionnaire included knowledge, behavior and opinion items on risk factors for dental diseases, care of child's teeth, and socio-demographic characteristics of the family. Six-months after the medical visit, dental claims were examined to see if children had made a dental visit. Results: One hundred and ninety-five children received preventive oral health services in this clinic. Of these, 103 caregivers agreed to complete the oral health knowledge and socio-demographic questionnaire. Twenty-percent of children screening had visible signs of tooth decay, according to risk-assessment 72% were categorized as high-risk for tooth decay, and 83% received a fluoride varnish treatment. At 6-months, 9% of children were found to have had a dental visit. According to the caregiver questionnaire the likelihood of having a dental visit was correlated with the caregiver's knowledge of when a child should have their first dental visit and having been told by a medical professional when their child should be going to the dentist. Conclusion: Children are more likely to have a dental visit when caregivers are aware of the age 1 dental visit, or when advised to seek care by a medical professional. With increased education of medical providers, starting in medical residency training, more children can be seen for preventive oral health care resulting in an earlier establishment of a dental home.

Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess a theoretical framework to see if pediatric hospital specialization is associated with improved outcomes for pediatric inpatient care. The theory suggests that not all ways of organizing are equally effective, and that organizational performance is maximized when there is alignment between organizational structure (specialization) and external contingencies (care complexity). A sample of 1,317 U.S. hospitals was included in the study. Data from two sources - the 2003 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) and the American Hospital Association's (AHA) Annual Survey Database for fiscal year 2003 - was used in a factor analysis to generate a measure of hospital pediatric specialization. The results of the factor analysis were then used in regression models to examine the effect hospital pediatric specialization had on patient safety and effectiveness of care at multiple levels of care complexity. Results suggest that there are two dimensions of hospital pediatric specialization - a pediatric focused element and a complex pediatric care element - and that these dimensions appear to have opposing influences on measures of inpatient care quality. Focusing primarily on the treatment of pediatric patients seems to improve the level of care provided, but specializing in the care of complex pediatric conditions has a small but significant association with higher patient safety event rates and longer than expected lengths of stay.

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the ‘mobile and transitory’ discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators – and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the ‘in-between’ discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or ‘difficult’ parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

Ett stort antal barn utsätts regelbundet för fysiska övergrepp i hemmet. De allra flesta uppsöker BVC flera gånger under sina första sex levnadsår. Sjuksköterskan ges därmed goda möjligheter att undersöka och observera barnet samt skapa en bra relation till föräldrarna. Barn som utsätts för fysiska övergrepp upptäcks många gånger inte förrän det är för sent, när något allvarligt redan inträffat som leder till akut kontakt med hälso- och sjukvården. Det är viktigt att de utsatta barnens situation upptäcks så tidigt som möjligt i vårdkedjan, helst redan i samband med rutinbesök på barnavårdscentralen [BVC]. Syftet med studien var att beskriva hur sjuksköterskan på BVC upptäcker och hanterar att ett barn är utsatt för fysiska övergrepp i hemmet. Studien gjordes med en induktiv, deskriptiv kvalitativ ansats.  Genom ett strategiskt urval intervjuades sju informanter. Intervjuerna transkriberades ordagrant, texten analyserades med manifest innehållsanalys. Under arbetets gång växte tre kategorier fram: använder sina sinnen, möter olika hinder och söker stöd för att anmäla. Resultatet visade att upptäckten och hanteringen när ett barn är utsatt för fysiska övergrepp var en svår och komplex uppgift för sjuksköterskan som ofta kände sig villrådig och osäker på att fatta rätt beslut. Som svar på forskningsfrågan växte ett tema fram: genom att våga se och agera, som beskriver processen sjuksköterskan går igenom från det att hon får den första misstanken till dess att hon beslutar sig för att göra en anmälan. Författarna har under arbetets gång fått insikt i vikten av att sjuksköterskan har modet och förmågan att våga se och agera när ett barn är utsatt för fysiska övergrepp. Förhoppningen är att studien ska belysa vilka verktyg och strategier som krävs för att hantera den känslomässiga påfrestning och de dilemman som upptäckten innebär så att misstänkta övergrepp förhoppningsvis kan upptäckas, ifrågasättas och anmälas mycket tidigare för barnets bästa. / A large number of children are regularly physical abused in their homes. Most of them visit the child health center on several occasions during their first sex years. During this period of time the nurse has good opportunities to examine and observe the child and also to establish a good relationship to the parents. Abused children are often not recognized until the damage is already a fact, which usually occurs in connection to an emergency visit at the health care services. It is of most importance that these children are recognized as early as possible, preferably already at the regular check-ups at the child health center. The purpose of this study was to describe how the nurse on the child health center recognizes and deal with a child that has been physical abused in the home. The study has been done with a inductive, descriptive and qualitative approach. By a strategic selection seven informants were interviewed. The interviews were literally transcribed followed by a thorough analysis with focus on the manifest content. Through the process of the study three categories revealed: using their senses, meets various obstacles and seeking support for filing a report. The result showed difficulties in recognizing an abused child but also difficulties in how to deal with it once discovered. The nurse often feels hesitant and insecure in how to proceed and whether the right decision is made. In response to the research question a theme developed: by daring to look and act - describing the process a nurse goes through from getting the first suspicion until she decides to file a report. During the process of the study the authors have gained knowledge in the importance of the nurses´ courage and ability to see and act when a child has been physical abused. Hopefully this study will enlighten the necessary tools and strategies that are required to handle the emotional strain and the dilemma which the discovery means. And hopefully our study will contribute to an improvement in recognition, questioning and filing report of abused children at a much earlier stage.

Submitted by Luis Guilherme Macena (guilhermelg2004@gmail.com) on 2012-11-22T16:12:19Z No. of bitstreams: 1 Joselia_Giordani_Hespanhol_Duarte.pdf: 1113728 bytes, checksum: 1ef6121c37e3547293ab750175dd0554 (MD5) / Made available in DSpace on 2012-11-22T16:12:19Z (GMT). No. of bitstreams: 1 Joselia_Giordani_Hespanhol_Duarte.pdf: 1113728 bytes, checksum: 1ef6121c37e3547293ab750175dd0554 (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil / Introdução: Apesar das mudanças no perfil da atenção pediátrica observadas nos últimos anos em decorrência dos avanços nos métodos diagnósticos e terapêuticos e da redução das internações por doenças infecto-contagiosas, a produção científica voltada para a avaliação do perfil e principais demandas das internações pediátricas ainda é escassa. Objetivo: Identificar as características e os procedimentos diagnósticos e terapêuticos das internações pediátricas em quatro hospitais do Ministério da Saúde (MS) no município do Rio de Janeiro. Método: Estudo observacional, de caráter descritivo. A pesquisa foi desenvolvida nos serviços de Pediatria de quatro hospitais do Ministério da Saúde que integram a Rede Hospitalar Federal no Rio de Janeiro. A amostra foi constituída de 170 internações ocorridas nas enfermarias de pediatria no período de janeiro a dezembro de 2008 de crianças desde o nascimento até 17 anos 11 meses e 29 dias. Resultados: As informações obtidas evidenciaram elevada freqüência de crianças portadoras de doenças crônicas (47.6%) no conjunto das internações estudadas. De forma semelhante, esses serviços também apresentaram elevado percentual de pacientes com histórico de reinternação (35.3%). A análise por unidade mostrou que apenas um serviço de pediatria, entre os quatro serviços estudados, apresentou menor proporção de crianças portadoras de doenças crônicas, média etária mais baixa e menor freqüência de reinternações. Nas outras três unidades hospitalares, em mais da metade do grupo estudado, as causas de internações encontradas, estavam ligadas às doenças crônicas. Para os procedimentos diagnósticos e terapêuticos, no total da amostra, foram encontrados percentuais mais altos para hemocultura (23.5%), suporte de O2 (17%), transfusão de sangue e hemoderivados (12.4%) e procedimentos cirúrgicos de alta complexidade (11%). Os resultados confirmam a necessidade de organização dos serviços pediátricos no sentido de estarem preparados com tecnologia adequada para o manejo, tratamento e acompanhamento do paciente portador de doença crônica. / Introduction: Changes in the profile of pediatric care have been observed in the past couple of years due to the technological advances in therapeutic and diagnostic methods and the reduction of hospitalization cases of infectious and contagious diseases. Yet, scientific research that evaluates the main needs of pediatric hospitalizations is rare. Goal: Identify the diagnostic and therapeutic procedures and the profile of pediatric hospitalization in four hospitals of the Health Ministry in the city of Rio de Janeiro. Method: Observational and descriptive study. The present research was developed at the pediatric services of four hospitals which are part of the Federal Hospitals Chain of the Health Ministry in Rio de Janeiro. The sample was comprised of 170 hospitalizations of children aged from birth to 17 years, 11 months, and 29 days. All hospitalizations occurred in the pediatric infirmaries of the aforementioned hospitals from January to December of 2008. Results: The collected data presented a high frequency of children with chronic diseases (47.6%). Likewise, the pediatric services also showed a high percentage of patients with a history of rehospitalization (35.3%). The analysis per hospital unit demonstrated that only one pediatric service, among the four unit services studied, presented a lower rate of children with chronic diseases, a lower average age rate, and a lower frequency of rehospitalizations. On the other three hospital units, more than half of the patients in each unit presented 30 reasons for hospitalization connected to chronic conditions. Upon analyzing diagnostic and therapeutic procedures, higher percentages for hemoculture (23.5%), oxygen therapy (17%), blood and hemoderivatives transfusion (12.4%), and high-complexity surgical procedures (11%) were found. The results confirm the necessity of better organization of the pediatric services in an effort to be prepared with the appropriate technology for the handling, treatment, and follow-up of patients with chronic conditions.

Child care is one of the most important tasks important for the health of entire population. Many social structures are involved in comprehensive child care. The family is an irreplaceable part of society. However, in the health sector, pediatric represents the basic part of childcare, as a field of development of an individual. The largest volume of health services represents ambulatory primary care, ie General practitioner for children and adolescents in cooperation with a nurse. The nurse organizes and manages nursing care in pediatrics, takes care of healthy and sick children, and focuses on cooperations with families of the children. The main of the thesis was to find out what is the content of nursing care provided by a nurse in primary pediatric care. Among other things, we were also interested in the staffing of GPs for children and adolescents area and, last but not least, the possibilities of further education of nurses in this area. Then we have put five research questions. We gained the necessary data for processing the empirical part of this thesis through a semi-structured interview. Altogether, 15 interviews with respondents from the South Bohemian Region were analyzed. From the research data we were able to answer research questions. The research showed that the dominant activities of the nurse's work in the general practitioner's office for children and adolescents are preventive examinations, vaccinations, education, documentation, and good office practice. In addition, we found out that nurses do not have nursing documentation, most nurses do not perform patient care at home and do not recommend vaccination against rotavirus infections. Both pediatric and pediatric nursing carers they rated as being of a good quality, compared to the world. However, what they do not like is the current nursing education. We believe that this thesis could be very useful as a study material for medical students and also for the general public, as an outline of the nurse's work contents in GPs for children and adolescents.

Background: The number of children with life-threatening illness in need of palliative care is increasing worldwide. At the same time, a wide range of childhood diseases is challenging healthcare to provide care based on children’s special needs. Through family centered care nurses can consider the whole family surrounding the child. Aim: To describe families’ experiences and perspectives of living with a child at the end of life. Method: This study is a literature review. Fifteen scientific articles with a qualitative approach were analyzed thematically. Results: The thematic analysis resulted in two main themes and four sub themes. The result is described through the main themes: Family involvement in care and The changing existence of the family. A child with a life-threatening disease often has extensive care needs where all members of the family where involved in caring for the sick child in different ways. The impending death triggered a wide range of emotions in family members who found different ways of handling the situation together. Conclusions: Families experiences revolved around the need to cherish family life. A family centered approach can contribute to valuable insights about the child’s disease and wishes at the end of life and to the family’s sense of being involved. There are indications for future research where focus should be on family members other than parents. / Bakgrund: Antalet barn med livshotande sjukdom i behov av palliativ vård ökar i världen. Samtidigt innebär mångfalden av barnsjukdomar en utmaning för sjukvården att vårda utifrån barns särskilda behov. Genom familjecentrerad omvårdnad så kan sjuksköterskan ta hänsyn till hela familjen som omger barnet. Syfte: Att beskriva familjers erfarenheter och upplevelser av att leva med barn i livets slutskede. Metod: Studien är en allmän litteraturstudie. Femton vetenskapliga artiklar med kvalitativ ansats analyserades tematiskt. Resultat: Den tematiska analysen resulterade i två huvudteman och fyra subteman. Resultatet beskrivs utifrån dessa huvudteman: Familjens delaktighet i vården och Familjens föränderliga tillvaro. Ett barn med livshotande sjukdom har ofta ett omfattande vårdbehov, där hela familjen på olika sätt involverades i det sjuka barnets vård. Den stundande döden framkallade många känslor hos familjemedlemmarna, som tillsammans fann olika sätt att hantera den föränderliga tillvaron. Slutsatser: Familjers upplevelser kretsade kring behovet att värna om familjelivet. Ett familjecentrerat förhållningssätt kan bidra med värdefulla insikter om barnets tillstånd och önskemål i livets slutskede samt bidra till familjens känsla av delaktighet. Indikationer för framtida forskning finns, där fokus bör ligga på att fånga upp övriga familjemedlemmar utöver föräldrar.

Bakgrund: När ett barn blir svårt sjukt är förloppet hastigt och kräver snabba insatser från personalen. Det ställs stora krav på sjuksköterskorna i barnsjukvården för att tillgodose patientens och föräldrars behov. Vid akuta händelser kan det vara svårt att tillgodose behoven.    Motiv: Forskning visar att sjuksköterskor kan uppleva akuta händelser som drabbar barn som traumatiskt. Kunskap om sjuksköterskors erfarenheter av att vårda barn som har drabbats av en akut händelse är viktigt för att förbättra vården av det drabbade barnet och barnets säkerhet.    Syfte: Syftet med studien var att belysa sjuksköterskors erfarenhet av att i en akut situation vårda svårt sjuka eller skadade barn på barnklinik.  Metod: Kvalitativ metod med semistrukturerade intervjuer genomfördes med fem grundutbildade sjuksköterskor och fem specialistsjuksköterskor inom barn och ungdom på två medelstora sjukhus i Sverige. Intervjuerna genomfördes via Zoom och samtalen spelades in med mobiltelefon. Intervjuerna transkriberades och analyserades med kvalitativ innehållsanalys enligt beskrivning av (Graneheim & Lundman, 2004).   Resultat: Analysen av intervjuerna resulterade i tre kategorier som i sin tur baserades på sex subkategorier. Kategorin ”Att vara förberedd” innehöll subkategorierna ”erfarenhet som kunskap” samt ”träning och prioritering”. Kategorin ”Att Agera” innehöll subkategorierna ”hinder och möjligheter i samarbetet” samt ”hinder och förutsättningar i kommunikationen”. Den sista kategorin ”Att reflektera och behöva stöd” baserades på subkategorierna ”utmanande känslor” och ”bearbetning”.   Konklusion: Studien bidrar till kunskap om att vårda barn i en akut situation på barnklinik och kan bidra till förståelse hur personalen utvecklas med händelser de erfar. Studien skulle också kunna öppna upp för att arbetet med svårt sjuka eller skadade barn består av en helhet med lika viktiga delar. Om organisationen tog hänsyn till alla delarna skulle detta kunna bidra till att stressen och sjukskrivningarna minskade. / Background: When a child becomes seriously ill, the process is rapid and requires quick action from the staff. Great demands are placed on the nurses in pediatric care to meet the needs of the patient and parents. In the event of an emergency, it can be difficult to meet this needs.   Motive: Research shows that nurses can experience emergencies that affect children as traumatic. Knowledge of nurses' experiences of caring for children who have been affected by an emergency is important to improve the care of the affected child and its safety.   Aim: The aim of this study was to shed light on nurses' experiences of caring for seriously ill or injured children in a pediatric clinic in emergencies.   Methods: Qualitative method with semi-structured interviews was conducted with five undergraduate nurses and five specialist nurses in children and adolescents at two medium-sized hospitals in Sweden. The interviews were conducted via Zoom and the conversations were recorded with a mobile phone. The interviews were transcribed and analyzed with qualitative content analysis as described by (Graneheim & Lundman, 2004).   Result: The analysis of interviews resulted in three categories which were based on six subcategories. The category "To be prepared" contained subcategories "experience as knowledge" and "train and prioritize". The category "Acting" contained subcategories "obstacles and opportunities in cooperation" and "obstacles and conditions in communication". The last category "Reflecting and needing support" was based on subcategories "challenging emotions" and "processing".   Conclusion: The study contributes to knowledge about caring for children in emergencies at pediatric clinic’s and can contribute to an understanding of how staff develop with events they experience. The study also claims that working with seriously ill or injured children consists of equally important parts that together creates a whole. If the organization took the parts into account, this could help to reduce stress and burnouts.

Background: The capacity in the country's pediatric intensive care units is limited, which means that a large number of children are cared for in general intensive units. Intensive care nurses must be able to care for all patients with failure in one or more organs and be able to assess changes in the patient's condition. The care of children differs from the adult patient in several ways. For the intensive care nurse, it can be an inexperienced situation. Previous research describes the perspective of nurses in the pediatric intensive care unit and parents of a sick child, as well as children's experiences of being a patient. Aim: The aim is to describe intensive care nurses experiences of caring for children up to the age of seven years in a general intensive care unit. Method: A qualitative interview study with inductive approach. Eight intensive care nurses from a intensive care unit in Mellansverige participated. Data was analysed using manifest content analysis. Results: The results are presented in two categories; “Being in an unusual situation” and “Meeting the child’s needs with the family as a resource”, each category has two subcategories. Conclusion: Intensive care nurses experience the care of children as challenging. A common thread in the result is to work from the child's perspective and needs. The theoretical perspective is prominent in the result although the concept of child centered care is not mentioned. The need for knowledge and experience is clearly prominent in intensive care nurses which demonstrates the importance of competence development within the area of operation.