Surgical procedures that require general anesthesia can be stressful and create needless anxiety for school-age children. Interventions aimed at reducing preoperative anxiety can improve cooperation and enhance postoperative outcomes by lowering anxiety levels prior to induction of general anesthesia. The purpose of this study was to examine the effects of behavioral interventions versus drug therapy in reducing pre-operative anxiety in children. The secondary purpose was to compare methods used to integrate anxiety reduction interventions into pre-operative care and to evaluate the most widely used and effective strategy for clinical practice. A literature review exploring behavioral based stress reduction interventions and drug therapy targeted at reducing preoperative anxiety was conducted from various online databases. Peer reviewed articles, published in the English-language between 2006 and 2015 that focused on postoperative outcomes in which preoperative interventions to reduce anxiety in children age two years and older, as well as the parent’s perspective of the outcome, were included for synthesis. Results from 9 randomized controlled trials that used behavioral based interventions implemented on the day of surgery, prior to anesthesia induction were compared for effectiveness at anxiety reduction versus the use of drug therapy prior to surgery. The studies suggest more successful post-surgical outcomes related to shorter length of stay and post-operative delirium for behavioral interventions to reduce anxiety prior to surgery and demonstrated even greater optimal outcomes for combined behavioral interventions. Drug therapy alone to decrease anxiety prior to anesthesia induction showed mixed results in reduction of physiologic and general outcomes following surgery. No significant difference between behavioral based interventions versus drug therapy was shown in any of the reviewed studies to have a significant effect on post-surgical outcomes. However, potentially promising behavioral based interventions such as clowns, electronic devices, parental presence and music over drug therapy prior to surgery, require further evaluation for their use in decreasing pre-operative anxiety in school-age children and having a positive impact on post-operative outcomes.

INTRODUCTION: Acute infusion reactions from antineoplastic agents can include hypersensitivity reactions, anaphylaxis, and cytokine release infusion reactions. Severe acute infusion reactions happen in about 5% of the oncology patient population and nurses are responsible for assessment and management of the reaction. This is a high-stress task for a nurse magnified by the lack of exposure. This project explores nursing knowledge and perceived comfort level of acute infusion reactions caused by antineoplastic agents. METHODOLOGY: An original survey was created to test nursing knowledge and assess comfort level. Nursing knowledge was broken down into six subscales: general knowledge of acute infusion reactions, signs and symptoms of hypersensitivity, anaphylaxis, and cytokine release infusion reaction, and drugs most likely to cause hypersensitivity and anaphylactic reactions and cytokine release infusion reactions. Comfort questions were asked on a 6-point Likert scale from extremely uncomfortable to extremely comfortable. There was an additional section in the survey related to nurses’ distress and support in situations with acute infusion reactions. The questions were presented using a 6-point Likert scale ranging from strongly disagree to strongly agree. There were two open-ended questions that were designed to allow the nurses to share any additional information about their experiences with acute infusion reactions. Oncology nurses working with adults and pediatric populations were invited to participate. Descriptive statistics were used to analyze the survey results. T tests were used to compare groups and Pearson R statistics were used to examine relationships between total knowledge, knowledge subscale score, and comfort level. RESULTS: 20 nurses completed the survey. 12 were from the adult nurse population and 8 were from the pediatric nurse population. The typical participant was forty-four years of age, had sixteen years experience as a Registered Nurse, and thirteen years experience in the oncology setting. The average total knowledge score was a 56% based on 84 possible points. The basic knowledge section and the anaphylactic signs and symptoms were the highest scoring subscales, both scoring a 62%. Cytokine release infusion reaction signs and symptoms was the lowest scoring subscale with a 45%. There were no significant differences in knowledge between groups. The nurses chose an overwhelming agree/strongly agree when asked to choose the signs and symptoms related to each type of infusion reaction. The total comfort level score indicated that nurses were very comfortable managing acute reactions. There was no significant difference between the adult and pediatric setting comfort level scores. There was no statistically significant relationship between total knowledge score and total comfort level score. DISCUSSION: The knowledge score showed knowledge deficits while the comfort score indicated confidence in management of acute infusion reactions. The high frequency of agree/strongly agree for all three subscales of signs and symptoms indicates that the nurses at least know what to look for even if they cannot assign the specific sign and symptom to the type of infusion reaction. Knowledge about signs of specific types of drug reactions may not be necessary as long as a basic understanding of what to look for and how to manage a reaction is present.

Childhood obesity is a prevalent problem in the United States. Obesity increases the risk for many diseases. Obese children are likely to become obese adults with additional comorbidities. Studies have reported mixed findings regarding associations between reading nutrition labels and improved dietary behaviors/healthy weight status. The purpose of this study is to determine whether the frequency of children reading nutrition labels is related to frequency of performing 12 dietary behaviors. De-identified baseline data from a previous quasiexperimental pilot study were analyzed. Data were collected from 4th and 5th graders (n = 42) at an after-school program. An adapted paper survey was administered to the children to measure the number of days (0–7) they read nutrition labels and performed 12 dietary behaviors over the preceding week. Due to non-normal distribution of data, non-parametric Spearman rho correlations were conducted to determine relationships between frequency of reading nutrition labels and dietary behaviors. Positive correlations were found between frequency of reading nutrition labels and eating fruit for breakfast; eating vegetables at lunch/dinner; eating whole grain/multigrain bread (p < .05); eating fruit for a snack; eating vegetables for a snack (p < .01). Frequency of reading nutrition labels was inversely related to drinking soda/sugar-sweetened beverages (p < .05). Significant relationships were found between frequency of reading nutrition labels and several dietary behaviors associated with childhood obesity prevention. Findings are promising and support the need for further intervention research to determine potential direct influences of children reading nutrition labels on dietary behaviors.

Children are considered a vulnerable population in society. While thermoregulation in children is similar to that of an adult, children are vulnerable to heat-related illness. Student athletes have been found to be particularly vulnerable to heat-related illness for numerous reasons, including intense outdoor play. Football players are perhaps the most at-risk population of student athletes due to the intense physical requirements, outdoor practice during the hottest months of the year, and the extensive protective equipment required. By conducting a literature review on the subject of pediatric heat illness, the purpose of this thesis is to explore evidenced based research and guidelines regarding heat-related illness prevention. This review of literature was conducted through the utilization of the University of Central Florida's online databases using the EBSCOhost platform of: CINAHL Plus with Full Text, Cochrane Database of Systematic Reviews, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, PsycINFO and SPORTDiscus. This thesis is unique because it does not focus on an individual sport; rather, it focuses on pediatric athletes from various disciplines. The prevalence, pathophysiology, prevention, and treatment of heat-related injuries are complex phenomena requiring the attention of law makers, athletic associations, school officials, coaches, athletic trainers, parents, and students.

Aim: To evaluate the efficacy of therapeutic play in alleviating pain or anxiety in the pediatric cancer patient. Background: Therapeutic play is an intervention often incorporated within the care of pediatric cancer patients and children with other disease processes to promote well-being. Even though play therapy is supported by research, nurses have the option to implement nursing care interventions in a play-like manner. Therapeutic play is an individualized technique that provides an intentional opportunity for children to express their emotional responses in a controlled environment. Method: The databases used in this search included CINAHL, MEDLINE, APA PsycINFO, ERIC, and Education sources. A total of 59 articles were kept for review. One additional article held for review was obtained through a secondary search of the same databases listed. Articles that did not specifically address cancer were not included. Key Issues: Including therapeutic play interventions in the treatment of pediatric oncology patients is not a mandatory practice. If nurses perceive play therapy as an effective treatment option, an increased value may be placed on the approach. The usefulness of the intervention and the nurse's ability to execute it is essential in determining the overall efficacy. Conclusions: Therapeutic play contributes to many favorable outcomes when used in practice during pediatric cancer treatment. While the reduction of pain and anxiety is supported, other beneficial effects include increased positive coping mechanisms, patient satisfaction, compliance, self-efficacy, social skills, and improved communication. Keywords: Therapeutic play, play therapy, cancer, oncology, pain, anxiety, pediatric, nurse

Pediatric obesity has become a major health care concern over the last several decades. This condition can lead to detrimental life-long physical and mental comorbidities. Pediatric primary care providers have a unique opportunity to both prevent and treat pediatric obesity in their clinics. However, discussing this topic with families can be uncomfortable and time consuming. Time efficient resources to educate and increase confidence are needed to improve the management of pediatric obesity. This quality improvement project integrated the Healthy Care for Healthy Kids by the National Institute for Children's Healthcare Quality (2014) into the electronic medical record at a pediatric primary care office in rural East Tennessee. This toolkit included handouts, management algorithms, and provider education for pediatric obesity. After an 8-week implementation period, improvements in lab draws and evaluation of a family's readiness to change were noted. Overall, providers reported the toolkit was helpful and improved patient interaction. Currently, the clinic is still utilizing the integrated resources and handouts.

<p>To date most research on long-term outcomes of childhood trauma has focused on traumatic brain injuries, but less is known about traumatic injuries not involving the brain. Since traumatic brain injuries can have persistent effects on child behaviour, I investigated whether other types of traumatic injuries could also affect child behaviour in the long term. Currently, limited information is available on possible associations between family function and child behaviour after child trauma; knowledge of the long-term costs of pediatric trauma is also lacking. The main goal of this study was to determine whether family function was associated with behaviour in children who experienced a traumatic injury eight to ten years ago. Additional goals were to determine current expenditures and use of health and social services by child trauma victims and their parents. Pediatric trauma victims were selected from a trauma database at a tertiary care hospital in the Hamilton-Wentworth region. The parents of these children were interviewed to obtain children’s current behaviours and the family’s use of health and social services. The results showed that injury severity was not associated with child behaviour, but associated with family functioning. No relationship was found between health and social service expenditures for children and their injury severity, but there was a relationship between parent health and social service expenditures and child injury severity. The results do not support an association between child behaviour and injury severity following trauma, but they do suggest that expenditures and use of services by injured children and their families are affected long-term. The results suggest that future health and social service uses of injured children and their families may be better understood and planned for by recognizing the continuing effects of trauma. This information could help making appropriate health and social service programs more available to this population.</p> / Master of Science (MSc)

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-02-02T15:50:34Z No. of bitstreams: 1 Tathiana Silva de Souza Martins.pdf: 471753 bytes, checksum: 963e2a90769dbffd29d2beefe4974c5a (MD5) / Made available in DSpace on 2016-02-02T15:50:34Z (GMT). No. of bitstreams: 1 Tathiana Silva de Souza Martins.pdf: 471753 bytes, checksum: 963e2a90769dbffd29d2beefe4974c5a (MD5) Previous issue date: 2007 / C Farma / Mestrado Profissional em Enfermagem Assistencial / A punção venosa em pediatria é para a criança um procedimento doloroso e extremamente estressante para os familiares acompanhantes. Observando na prática diária da assistência pediátrica as punções de repetição para manutenção de um acesso pérveo na administração de medicamentos com período prolongado e sabendo que o sistema de pagamento ao hospital pelo Sistema Único de Saúde é por patologia, aguçou-me o interesse desenvolver uma pesquisa exploratória, descritiva com abordagem quantitativa sobre os custos do Dispositivo Intravascular Periférico na internação em Pediatria. Objetivos: Levantar os custos do Dispositivo Intravascular Periférico utilizado durante a internação em uma unidade pediátrica; Identificar as causas de substituição do Dispositivo Intravascular Periférico nos acessos venosos durante a internação em uma unidade pediátrica e Correlacionar o custo do Dispositivo Intravascular Periférico na composição da remuneração final das internações pediátricas pagas pelo Sistema Único de Saúde. O cenário da pesquisa foi uma Enfermaria Pediátrica de um Hospital Universitário. Amostra: dezenove crianças internadas no período de outubro de 2006 a abril de 2007. Os dados foram analisados e organizados em três categorias: I. Perfil Demográfico e Epidemiológico das Crianças internadas na Enfermaria de Pediatria do HUAP; II. Os Custos do DIP no Processo de Hospitalização em Pediatria no HUAP; e III. Os Custos do DIP na composição da remuneração final das internações pediátricas pagas pelo SUS. Na primeira categoria foram apresentados dados que fossem capazes de caracterizar e traçar o perfil da clientela internada na Enfermaria de Pediatria. Na segunda categoria foram apresentados dados que demonstrassem as principais causas da perda de um acesso venoso periférico, traçando assim um paralelo com a média de tempo de duração de um acesso venoso, os locais de punção venosa efetiva e os custos oriundos dessas falhas infusionais. Na terceira categoria foram apresentados dados que mostrassem o tempo de permanência pago pelo SUS por cada patologia X o tempo real de permanência de cada cliente, os custos dos acessos venosos durante o período de cada internação e os custos dos DIP quando comparados aos custos da internação. O que se pretendeu, em uma pesquisa na qual as conclusões emanaram de dados numéricos e porcentagens, foi à busca de alternativa (s) para a redução de custos tangíveis e intangíveis com acessos venosos. Portanto, urge prosseguir investigando nessa linha teórica-metodologica para favorecer o processo de consolidação da enfermagem como profissão reconhecida e prestigiada pelos seus componentes (os profissionais) e seus dependentes (a população) / The venous puncture in pediatrics is for the child a painful and extremely stress procedure for the familiar companions. Observing in practical daily of the pediatric assistance the puncture of repetition for maintenance of a pérveo access in the medicine administration with drawn out period and knowing that the system of payment to the hospital for the Only System of Health is for pathology, it sharpened me the interest to develop a exploratory, descriptive research with quantitative boarding on the costs of Peripheral the Intravascular Device in the internment in Pediatrics. Objectives: To raise the costs of used Peripheral the Intravascular Device during the internment in a pediatric unit; To identify the causes of substitution of Peripheral the Intravascular Device in the venous accesses during the internment in a pediatric unit and To correlate the cost of Peripheral the Intravascular Device in the composition of the final remuneration of the paid pediatrics internments for the Only System of Health. The scene of the research was a Pediatric Infirmary of a University Hospital. Sample: nineteen children interned in the period of October of 2006 the April of 2007. The data had been analyzed and organized in three categories: I. Demographic profile and Epidemiologist of the Children interned in the Infirmary of Pediatrics of the HUAP; II The Costs of the DIP in the Process of Hospitalization in Pediatrics in the HUAP; e III. The Costs of the DIP in the composition of the final remuneration of the paid pediatrics internments for the SUS. In the first category they had been presented given that was capable to characterize and to trace the profile of the clientele interned in the Infirmary of Pediatrics. In the second category they had been presented given that they demonstrated the main causes of the loss of a peripheral access venous, thus tracing a parallel with the average of time of duration of a venous access, the places of effective venous puncture and the deriving costs of these infusionais imperfections. In the third category they had been presented given that showed to the paid time of permanence for the SUS for each pathology X the real time of permanence of each customer, the costs of the venous accesses during the period of each internment and the costs of the DIP when compared with the costs of the internment. What if it intended, in a research in which the conclusions had emanated of numerical data and percentages, were to the search of alternative (s) for the reduction of tangible and intangible costs with venous accesses. Therefore, it urges to continue investigating in this line theoretician-methodological to favor the process of consolidation of the nursing as profession recognized and sanctioned by its components (the professionals) and its dependents (the population)

Introdução: A criança que requer cuidados intensivos deve ser considerada tanto no aspecto biológico como no seu desenvolvimento, os processos que podem agredi-la devem ser minimizados, ou eliminados, e ela deve ser apoiada sempre que enfrente alguma situação potencialmente estressante, para seu atendimento não se tornar iatrogênico, buscando atender suas necessidades e pautar na perspectiva da integralidade, o que significa um cuidado além da prática biomédica. Objetivo: Descrever e analisar o cuidado da enfermeira à criança hospitalizada na Unidade de Terapia Intensiva Pediátrica (UTIP), com foco no desenvolvimento infantil. Método: Estudo qualitativo, descritivo e exploratório, realizado numa UTIP, de um hospital privado de grande porte, filantrópico, geral, localizado na cidade de São Paulo e aprovado pelo Comitê de Ética e Pesquisa. A coleta de dados em oficinas pedagógicas incluiu oito enfermeiras, cada uma participando de dois encontros. Dados submetidos à análise temática de conteúdo, interpretados de acordo com o referencial das necessidades essenciais da infância. Resultados: A categoria Concepções e práticas da enfermeira no cuidado para o desenvolvimento infantil na UTIP descreve as ações das enfermeiras e aspectos relativos à situação da internação que impactam sobre a criança e, portanto, devem ser considerados em suas atividades de cuidado, visando as necessidades da criança para além do motivo da hospitalização. Contudo, as enfermeiras não nominam essas ações como cuidado de enfermagem e sim como comportamentos naturais, e, deste modo, são realizados de acordo com a visão de cada enfermeira, sem sistematização, ou constância. A categoria Facilidades e dificuldades da enfermeira no cuidado para o desenvolvimento infantil na UTIP descreve os aspectos facilitadores nas práticas institucionalizadas como atenção ao conforto físico, à história e hábitos da criança, o brincar, as informações fornecidas na admissão, os laços entres os familiares, aspectos que fortalecem o cuidado e o processo de hospitalização. Inclui também as dificuldades, decorrentes do modelo hegemônico biomédico, que vão de encontro ao cuidado para a promoção do desenvolvimento, e atividades burocráticas existentes no contexto de trabalho que reduzem o tempo da enfermeira voltado ao cuidado da criança e da família. A categoria Perspectivas da enfermeira sobre o cuidado para o desenvolvimento da criança na UTIP descreve a necessidade de uma filosofia, teoria e instrumentos para orientar o cuidado, comuns a toda a equipe multiprofissional, a partir da mudança de compreensão dos profissionais acerca do cuidado integral à criança, que poderia ser alcançada por meio de reflexão sobre o fazer envolvendo a todos, em atividades como workshops e cursos sobre promoção do desenvolvimento e cuidado integral. Conclusões: Embora as enfermeiras se percebam realizando ações favoráveis ao desenvolvimento da criança reconhecem que garantir o desenvolvimento infantil saudável, na situação de hospitalização na UTIP, é algo a ser alcançado, mediante ações sistematizadas e norteadas por objetivos comuns a toda a equipe de saúde e reconhecidas como cuidado profissional. As oficinas pedagógicas contribuíram para a reflexão, troca de experiência e proposição de ações de melhoria do cuidado à saúde da criança, referidas como estratégias formativas que podem favorecer tais mudanças. / Introduction: Children who require intensive care should be considered both in their biological aspect as in their development; procedures that may hurt them should be minimized or eliminated and they should be supported all the times they face some potentially stressing situations. This provides a non iatrogenic care which attends their needs and support the perspective of integrality, what means a care beyond the biomedical practice. Objective: to describe and analyze the care of the nurse towards child hospitalized in the Intensive Care Unit Pediatric (ICUP), with focus on the child development. Method: qualitative, descriptive and exploratory study, done in the ICUP of a private, large sized, philanthropic and general hospital situated in São Paulo City and approved by the Ethics Research Committee. Data were collected in pedagogical workshops with eight nurses, each one taking part in two meetings, and were submitted to the thematic analyses of contents and interpreted according to the referential of essential needs of the childhood. Results: The category Nurses conceptions and practices to care for the child development in the ICUP describes actions of the nurses and aspects of hospitalization that have impact on the child and so should be considered in their care activities aiming the needs of the child beyond the reason for the hospitalization. However, the nurses do not nominate these actions as nursing care but as natural behaviors and, so, they are performed according to the vision of each nurse, without any systematization or constancy. The category Facilities and difficulties of the nurse to care for the child development in the ICUP describes aspects in the institutionalized practices that strengthen to care for child development as attention to the physical comfort, to know the child story and habits, the playing, the information given in the reception, and relationships between relatives. It also includes the difficulties related to the hegemonic biomedical model that opposes the care for the promotion of development and bureaucratic activities that reduce the nurses time dedicated to child and family care. The category Perspectives of the nurse about the care for the child development in the ICUP describes the need of a philosophy, or theory, and instruments to guide the comprehensive care, common to all the multi professional team. This could be reached through reflection about the work in ICUP involving all the professionals in activities like workshops and courses on promotion of development and integral care. Conclusions: Although the nurses feel doing actions in favor to the development of the child, they realize that to ensure the healthy development of the child, in the situation of hospitalization in the ICUP, is something to be reached, through systematized actions and guided by common objectives to the whole health team and recognized as Professional care. The data collection workshops contributed to the reflection, exchange of experiences and proposals of actions to improve the care for children, and so nurses indicated them as formative strategies which can encourage such changes.

O propósito da pesquisa foi desvelar o fenômeno: a enfermeira no cuidado à família da criança hospitalizada. Este estudo de natureza qualitativa teve como objetivos: conhecer a vivência do enfermeiro no cuidado às famílias de crianças hospitalizadas em unidades pediátricas e apreender o típico da vivência dos enfermeiros em ações que envolvem este cuidado. Foi utilizado como referencial teórico filosófico a abordagem da Fenomenologia Social de Alfred Schütz. Foram realizadas entrevistas com 16 enfermeiras que atuavam em unidades de emergência pediátricas, terapia intensiva pediátrica e neonatal, berçário e unidade de internação de um hospital universitário da cidade de São Paulo, tendo como foco sua vivência no cuidado às familias de crianças hospitalizadas. A análise conduzida segundo a teoria motivacional de Schütz, possibilitou identificar o tipo vivido da enfermeira no cuidado à família da criança hospitalizada, que é apresentado em duas condutas motivacionais. Na primeira o cuidado da enfermeira é caracterizado por Incluir a família, pois para ela pensar na família é fundamental. Com isso, sente necessidade de atender às demandas da família durante a hospitalização e de aprimorar seus conhecimentos quanto à abordagem da família. Na segunda conduta, o cuidado da enfermeira se caracteriza por Engajar a família na assistência prestada à criança. Para ela a presença da família é importante, e a necessidade de integrar a família no cuidado e atender às demandas da criança são modos de garantir o cuidado futuro da criança. O estudo revelou que a experiência de cuidado à família da criança hospitalizada prestado pela enfermeira não é uniforme, a motivação ainda se dá como prática individual, conforme a bagagem de conhecimento e os propósitos de cada profissional. A implementação de um modelo de cuidado centrado na família, apresenta desafios que demandam superação, individual e institucional, para que também a família seja considerada como unidade de cuidado durante a hospitalização de um seus membros. / The purpose of this research was to reveal the phenomenon: the nurse in caring for families of hospitalized children. This qualitative study aimed to understand the experiences of nurses in caring for families of hospitalized children and learn the typical experience of nurses\' actions involving such care. It was used as a theoretical philosophical approach the Social Phenomenology of Alfred Schutz. Interviews were conducted with 16 nurses working in pediatric emergency, pediatric intensive care, newborn nursery and pediatric unit at a university hospital in São Paulo city, focusing on their experience in caring for families of hospitalized children. The analysis conducted according to the motivational theory of Schütz, enabled us to identify the experienced type of nurse in caring for families of hospitalized children, which is presented in two motivational behaviors. The first is characterized by Including family in care: the nurse think family as fundamental, needs to meet the demands of the family during hospitalization and improve knowledge to approach the family. The other is characterized by Engaging the family in care: for the nurse, the family presence is important and she needs to integrate the family in care and meet the demands of the child as a way of ensuring the future care of the child . The study revealed that nurses\' experience in caring for families of hospitalized children is not uniform, that motivation has emerged as solo practice, in accordance with the baggage of knowledge and purposes of each professional. The implementation of a family-centered care model, presents challenges to overcome, so that the family is considered as the unit of care during the hospitalization of one its members