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Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury.Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Therefore this research has the potential of informing the speciality practice of acute care pediatric nursing.Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse "works with" the child to maintain and advance medical stability. Nursing interactions are an important part of "working with", communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate.An effective working-relationship with a nurse and family is founded on trust. Trust is an accepted part of our day-to-day lives and how to develop a trusting working-relationship with the child and family has not been explored prior to this research. Grounded theory methods supported the process of exploring the social processes of "building trust" whilst "working with" families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to "work with" and support the re-establishment of the parenting role. The "stepping in and out" of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to "be with", using chat to get to know each other, involving and supporting the family to parent a "different" child and reassuring and giving realistic hope to help the child and parents cope with their changed future.A substantive theory of the concept of "building trust to work with" has been developed using grounded theory methods. The theory has been conceptualized using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident.

Syfte: Att beskriva och analysera sjuksköterskors kunskap, användning av och inställning till  avledning som en smärtlindrande omvårdnadsmetod vid procedursmärta hos barn.  Metod: Fyrtioen sjuksköterskor, varav sexton specialistutbildade, från tre olika pediatriska  slutenvårdsavdelningar besvarade en enkät som sedan analyserades med hjälp av innehållsanalys  samt i statistikprogrammet SPSS där t-tester och Spearman’s rangkorrelationskoefficient beräknats.  Resultat: En stor andel utav sjuksköterskorna hade hört talas om avledning och använde sig  regelbundet av metoden. Två tredjedelar, främst specialistutbildade, hade hög kunskap kring  avledning och ansåg sig använda metoden i hög utsträckning. Flertalet, främst specialistutbildade,  var positivt inställda till metoden. Specialistutbildade sjuksköterskor hade högre kännedom och  kunskap än grundutbildade sjuksköterskor. Ett samband fanns mellan positiv inställning till  avledning och hög användning av metoden.  Slutsats: De flesta sjuksköterskorna kände till avledning, men kunskapsnivån var dock inte lika  hög. Deltagarnas självrapporterade användning utav avledning var hög, men fler  observationsstudier behövs kring ämnet. Trots att flertalet var positiva till avledning fanns ett antal  sjuksköterskor som var negativa till metoden och för att höja sjuksköterskors kunskapsnivå och  inställning till avledning bör man belysa och implementera de forskningsresultat som finns till  klinisk verksamhet. / Aim: To describe and analyze nurses’ knowledge, use of and attitudes towards distraction therapy  as an analgesic nursing method during procedural pain in children.  Method: Forty-one nurses, including sixteen pediatric nurse specialists, from three different  pediatric wards completed a questionnaire which was analyzed using content analysis and the  statistical program SPSS where t-tests and Spearman's rank correlation coefficient was calculated.  Results: A large proportion of the nurses had heard of distraction therapy and used it regularly in  their practice. Two thirds of the participants, mostly pediatric nurse specialists, had a high level of  knowledge about the distraction therapy and reported that they used the method to a large extent.  The majority, primarily pediatric specialists, had a positive attitude toward the method. Pediatric  nurse specialists had higher awareness and knowledge than regular nurses. A correlation was found  between positive attitude to distraction therapy and high use of the method.  Conclusion: Most nurses had a high awareness about distraction therapy, but the level of  knowledge was not as high. The participants self-reported use of distraction therapy was high, but  there is a need of further observational studies regarding the subject. Although a majority were  positive toward distraction therapy, a number of nurses had a negative attitude toward the method  and to increase nurses’ knowledge and attitudes current research results should be emphasized and  implemented into clinical practice.

Thesis (M.A.)--Northern Kentucky University, 2009. / Made available through ProQuest. Publication number: AAT 1469954. ProQuest document ID: 1914856041. Includes bibliographical references (p. 40-43)

The unexpected admission of a child to the pediatric intensive care unit (PICU) creates feelings of uncertainty, distress, and fear and is a devastating experience for primary caregivers. Health care providers must address primary caregivers` concerns to enhance primary caregivers’ coping abilities. While a family-centred approach to care can assist in diminishing uneasy feelings experienced by primary caregivers, this philosophy of care is not consistently used in everyday practice. The PICU is a unique area of care that focuses on restoring the health of critically ill children with the use of machines and equipment. However, the use of technology for life sustaining measures creates additional responsibilities for health care providers, potentially compromising the quality of patient care. There is evidence to support that the involvement of the primary caregiver in the care of the critically child can address the gap that commonly exists between technology and holistic patient care. Furthermore, involvement in care increases primary caregivers’ satisfaction with the care their child receives and may also improve patient outcomes. Most importantly, the involvement of primary caregivers in the care of the critically ill child encompasses a family-centred approach to care. By increasing health care provider’s awareness of family-centred care within the PICU, primary caregiver’s needs may be more effectively addressed during this devastating and vulnerable time. Health care providers are key players in the promotion of family-centred care in the PICU; however, they are often faced with multiple challenges and barriers. Increasing health care providers’ awareness around the components of family-centred care can facilitate its implementation into practice by understanding how primary care givers define and experience ii family-centred care. Accordingly, a qualitative study guided by the philosophy of hermeneutic phenomenology was conducted to elicit a detailed description of the lived experience of family-centred care from the perspective of the primary caregiver. Participants in this study consisted of those primary caregivers who had previously had a child admitted to the PICU. Participants were recruited from a large mid-western hospital. In total nine primary caregivers ranging in age from 33 to 44 years with the mean age being 37 years participated in the study. Nine of the participants were mothers and two were fathers. All participants took part in semi-structured, open-ended interviews. A total of nine interviews were conducted with two of the interviews involving both parents. Demographic data and field notes were recorded. All field notes and interview data were transcribed. The transcripts were reviewed repeatedly for significant statements in an attempt to find meaning and understanding through themes. The data analysis revealed the essence of the lived experience of family-centred care to be being present. Three themes communicated the essence and included: (a) physical presence, (b) participation in care and, (c) advocating. Three themes from the data emerged around how primary caregivers defined family-centred care and included: (a) collaboration, (b) being updated and, (c) continuity of care. Finally, primary caregivers identified four conditions that needed to be in place to experience family-centred in the PICU which included: (a) being present for rounds, (b) caring behaviours, (c) feeling welcomed and, (d) support. The findings from this study may be used to guide policy around family-centred care and improve on, or bring new insights around interventions related to family-centred care. Future recommendation for nursing practice, education and research are presented.

The unexpected admission of a child to the pediatric intensive care unit (PICU) creates feelings of uncertainty, distress, and fear and is a devastating experience for primary caregivers. Health care providers must address primary caregivers` concerns to enhance primary caregivers’ coping abilities. While a family-centred approach to care can assist in diminishing uneasy feelings experienced by primary caregivers, this philosophy of care is not consistently used in everyday practice. The PICU is a unique area of care that focuses on restoring the health of critically ill children with the use of machines and equipment. However, the use of technology for life sustaining measures creates additional responsibilities for health care providers, potentially compromising the quality of patient care. There is evidence to support that the involvement of the primary caregiver in the care of the critically child can address the gap that commonly exists between technology and holistic patient care. Furthermore, involvement in care increases primary caregivers’ satisfaction with the care their child receives and may also improve patient outcomes. Most importantly, the involvement of primary caregivers in the care of the critically ill child encompasses a family-centred approach to care. By increasing health care provider’s awareness of family-centred care within the PICU, primary caregiver’s needs may be more effectively addressed during this devastating and vulnerable time. Health care providers are key players in the promotion of family-centred care in the PICU; however, they are often faced with multiple challenges and barriers. Increasing health care providers’ awareness around the components of family-centred care can facilitate its implementation into practice by understanding how primary care givers define and experience ii family-centred care. Accordingly, a qualitative study guided by the philosophy of hermeneutic phenomenology was conducted to elicit a detailed description of the lived experience of family-centred care from the perspective of the primary caregiver. Participants in this study consisted of those primary caregivers who had previously had a child admitted to the PICU. Participants were recruited from a large mid-western hospital. In total nine primary caregivers ranging in age from 33 to 44 years with the mean age being 37 years participated in the study. Nine of the participants were mothers and two were fathers. All participants took part in semi-structured, open-ended interviews. A total of nine interviews were conducted with two of the interviews involving both parents. Demographic data and field notes were recorded. All field notes and interview data were transcribed. The transcripts were reviewed repeatedly for significant statements in an attempt to find meaning and understanding through themes. The data analysis revealed the essence of the lived experience of family-centred care to be being present. Three themes communicated the essence and included: (a) physical presence, (b) participation in care and, (c) advocating. Three themes from the data emerged around how primary caregivers defined family-centred care and included: (a) collaboration, (b) being updated and, (c) continuity of care. Finally, primary caregivers identified four conditions that needed to be in place to experience family-centred in the PICU which included: (a) being present for rounds, (b) caring behaviours, (c) feeling welcomed and, (d) support. The findings from this study may be used to guide policy around family-centred care and improve on, or bring new insights around interventions related to family-centred care. Future recommendation for nursing practice, education and research are presented.

School-age children with Cystic Fibrosis (CF) possess valuable knowledge about themselves. They have experience and ability to offer insight about living with CF. Previous studies, exploring the perceptions of CF children, give little attention to eliciting and listening to their voices. Also, traditional data collection methods limit children from participating in research. The purpose of this study was to explore and describe how school-age children with CF see themselves in the world they live. The study utilized qualitative description methodology. Symbolic Interactionism served as the researcher’s philosophical lens. It is a perspective that seeks to understand the social world of others, as they perceive it. Photo elicitation was used as the primary data collection method. Each participant was asked to take photographs about “What it is like to be you”. Photographs were then used to stimulate and guide an audio-recorded interview and make a photo book for the child to keep. Data were analyzed using Boyatzis method of inductive thematic content analysis. Sixteen children with CF between the ages of 8 to 11 were purposively recruited from the Southeastern United States. Data saturation was achieved after 13 interviews. Rigor was maintained by a variety of ways including bracketing, peer evaluation, and member checking. Five themes emerged from the data Me Being Me, My Medicine and Treatments, My Family, My Friends and Other Key Relationships, and My World. Findings revealed that life does not revolve around CF, but instead centers on “me being me” and living a normal life. Additionally, photo elicitation empowered participants to be authors of their own stories, and promoted communication between them and the researcher. In knowing the reality of children, nurses and other multidisciplinary CF team members are better equipped to design and plan interventions that are meaningful, beneficial, and satisfying to the child and his or her parent. The results of this study demonstrate children can be active participants in research and provides opportunities to transform nursing care by developing and evaluating strategies for the delivery of care to children with CF. Recommendations for future research include expanding this study to other CF centers and including the perceptions of parents, nurses, and other CF health care providers. Additionally, because perceptions a person holds about them selves and the world change overtime, a follow-up study when participants reach adolescence and adulthood is suggested.