Orientador: Luciana de Lione Melo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-25T21:43:25Z (GMT). No. of bitstreams: 1 Souza_MarcelaAstolphi_M.pdf: 1886866 bytes, checksum: 6c3cd70af27e31397d74a3297693c36d (MD5) Previous issue date: 2014 / Resumo: A adolescência deve ser considerada como um momento existencial para além da idade cronológica, da puberdade e das transformações físicas, porquanto não existe uma única adolescência sem temporalidade. Promover, prevenir e cuidar da saúde do adolescente no Brasil é um desafio, pois embora existam políticas públicas, estas não se constituem em garantia de direitos. O adolescente com doença crônica é uma realidade considerando-se o perfil de morbimortalidade atual que evidencia o aumento das doenças crônicas e a diminuição das doenças infectocontagiosas e parasitárias. Como a maioria das doenças crônicas na infância, a insuficiência renal crônica pode ser progressiva e fatal, requerendo cuidados especializados permanentes e submetendo o adolescente a hospitalizações durante o processo de crescimento e desenvolvimento. A insuficiência renal crônica não desencadeia apenas desequilíbrios no organismo, mas interfere na qualidade de vida dos adolescentes, podendo contribuir para o aparecimento de transtornos emocionais relacionados aos impactos negativos oriundos das dificuldades que envolvem a relação com os pares, a participação social e a manutenção das atividades diárias, levando-os a sentimentos de inferioridade e baixa autoestima. O objetivo deste estudo foi compreender o ser-com o adolescente com insuficiência renal crônica a partir do seu discurso de ser-no-mundo. Trata-se de um estudo fenomenológico, fundamentado na Fenomenologia Existencial de Martin Heidegger, realizado com seis adolescentes que estavam vivenciando a insuficiência renal crônica e que são atendidos num hospital de ensino, público, localizado no interior do Estado de São Paulo. Os adolescentes foram entrevistados a partir da questão norteadora "como é ser adolescente com insuficiência renal crônica?" A compreensão dos discursos se deu por meio das descrições das experiências vividas e de acordo com a modalidade de pesquisa qualitativa adotada ¿ análise da estrutura do fenômeno situado. A partir da escuta dos discursos dos adolescentes com insuficiência renal crônica foi possível apreender algumas facetas de como é ser-adolescente-com-insuficiência-renal-crônica, emergindo os seguintes aspectos existenciários deste ser-aí: Sentindo-se diferente, Vivenciando a insuficiência renal crônica por meio da terapia renal substitutiva e Buscando a normalidade. A partir destes eixos temáticos, buscou-se alcançar o sentido heideggeriano do fenômeno em questão. Para os adolescentes, a factualidade é ter a insuficiência renal crônica e esta determina as suas ocupações dentro de um mundo que acontece e que ele se encontra lançado. Ocupam-se com o tratamento e com os cuidados que a doença implica em suas vidas e demonstram que estas ocupações fazem parte de suas existências. Ao apresentarem-se envolvidos na sua factualidade, eles mostram as formas do seu sendo-no-mundo-com-insuficiência-renal-crônica de modo singular. Os jovens associaram a questão do viver com a insuficiência renal crônica à sua própria condição ôntica e a partir de referências já inseridas no seu mundo-vida, apresentaram tentativas de normalizar a situação da doença, ocultando aquilo que se mostra para eles mesmos, da sua própria condição. Diante disto, foi possível apreender que os modos de lidar com as questões existenciais são diferentes e consideram a historicidade e a temporalidade para um ter-que-ser. Assim, diante do ter-que-ser-adolescente-com-insuficiência-renal-crônica, a Enfermagem precisa compreender os modos-de-ser-no-mundo dos adolescentes e (re)pensar o que pode ser realizado e de que maneira, para melhorar o cuidado ao adolescente que, como sujeito de sua história, é permeado por fragilidades e singularidades próprias, em que o adolescente tem sempre a possibilidade de ser e também de poder-não-ser / Abstract: Adolescence should be considered as an existential moment beyond the chronological age of puberty and physical changes, because there is no single adolescence without temporality. Promotion, prevention and care of adolescent health in Brazil are a challenge, because although there are public policies, they do not constitute a guarantee of rights. The adolescent with a chronic illness is a reality considering the current morbidity and mortality profile that reflects the increase in chronic diseases and the reduction of infectious and parasitic diseases. Like most chronic childhood disease, chronic kidney disease can be progressive and fatal, requiring continuous specialist care and subjecting the adolescent hospitalizations during the process of growth and development. Chronic renal failure not only initiate imbalances in the body, but it interferes with the quality of life of adolescents and may contribute to the onset of emotional disorders related to negative impacts from difficulties involving peer relations, social participation and maintenance activities daily, leading them to feelings of inferiority and low self-esteem. The aim of this study was to understand the being-with adolescents with chronic renal failure from your speech being in the world. This is a phenomenological study based on the Existential Phenomenology of Martin Heidegger, accomplished with six teenagers who were experiencing chronic renal failure and are treated in a teaching hospital, public, located in the upstate State of São Paulo. Adolescents were interviewed from the guiding question "how to be a teenager with chronic renal failure?" Understanding discourses occurred through the descriptions of experiences and in accordance with the mode adopted qualitative research - analysis of the structure of the phenomenon located. From listening to speeches of adolescents with chronic renal failure was possible to understand some aspects of how it is be-teen-with-chronic-renal-failure, emerging the following existenciários aspects of being-there: Feeling different, Experiencing failure by chronic kidney of renal replacement therapy and Seeking normalcy. From these themes, we sought to achieve the heideggerian sense of the phenomenon in question. For teenagers, the actuality is having chronic renal failure and this determines their occupations within a world that happens and he is released. Dealing with the treatment and care that the disease causes in their lives and show that these occupations are part of their existence. At present themselves involved in its actuality, they show the forms of your being-in-world-with- chronic renal insufficiency - a unique way. Young people associated the matter of living with the chronic condition to its own ontic renal failure and from references already entered in your world life presented attempts to normalize the disease situation, concealing what is shown for themselves, of their own condition. Given this, it was possible to learn ways of dealing with existential issues are different and consider the historicity and temporality for take-that-be. Thus, before the take-that-be-teen-with-chronic renal failure, nursing needs to understand the modes-of-being in the world of teenagers and (re)consider what can be done and how to improve care to the teenager who, as the subject of his story, is permeated by weaknesses and singularities, where the teenager always has the possibility of being and also reach-non-being / Mestrado / Enfermagem e Trabalho / Mestra em Ciências da Saúde

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-19T19:22:30Z No. of bitstreams: 1 André Luiz Gomes de Oliveira.pdf: 3548914 bytes, checksum: c2b62382d4c68632b5ed574b52bed126 (MD5) / Made available in DSpace on 2016-05-19T19:22:30Z (GMT). No. of bitstreams: 1 André Luiz Gomes de Oliveira.pdf: 3548914 bytes, checksum: c2b62382d4c68632b5ed574b52bed126 (MD5) Previous issue date: 2015 / Mestrado Profissional em Enfermagem Assistencial / O objetivo geral desta pesquisa é produzir um manual de orientação sobre diagnósticos e intervenções de enfermagem, para a clientela das unidades de internação de um hospital público pediátrico do Estado do Rio de Janeiro. Objetivos específicos: identificar os diagnósticos de enfermagem nos prontuários das crianças internadas; estabelecer a prevalência dos diagnósticos de enfermagem das crianças internadas; levantar nos prontuários de crianças as intervenções de enfermagem relacionadas aos respectivos diagnósticos de enfermagem. Material e método: pesquisa realizada obedecendo à resolução 466/12, com parecer circunstanciado nº 849.957 do CEP do HUAP e CAAE nº 35037314.3.0000.5243. Tipo de Estudo: documental, exploratório, retrospectivo, com abordagem quantitativa. Cenário: um Hospital Público Pediátrico do RJ. Critérios de Inclusão: prontuários de crianças que foram internados no hospital entre janeiro e dezembro de 2013. Critérios de Exclusão: prontuários de crianças que permaneceram menos de 48h de internação, de crianças que permaneceram internadas na emergência e de neonatos. Amostra: 333 prontuários. Análise: tabulados utilizando-se o Excel® 2010 e analisados pelo software S.A.S® System, versão 9.3.1. Resultados: observa-se prevalência de prontuários de crianças entre 1 mês a 5 anos, sendo 75,97% da amostra, no entanto, foram utilizados prontuários de crianças até 13 anos. Tempo médio de internação 8,55 dias. Identificada a ocorrência de 105 registros como diagnósticos de enfermagem. Diagnósticos NANDA-I mais frequentes: risco de infecção, hipertermia e integridade da pele prejudicada. Intervenções de enfermagem mais frequentes: verificar sinais vitais, registrar queixas de dor e características, registrar frequência e características das eliminações. A partir dos resultados produziu-se o manual de orientação aos enfermeiros nos formatos impresso e e-book. O manual aborda as necessidades humanas de Horta e em relação às intervenções de enfermagem, complementou-se com outras fontes, principalmente a NIC. Está dividido em 03 partes de acordo com a faixa etária. Contribuições: espera-se contribuir com a gerência de enfermagem à qualificação, documentação e visibilidade da enfermagem da instituição estudada e servir de subsídio para pesquisas sobre Sistematização da Assistência de Enfermagem e sua implementação nos serviços de saúde pediátricos / The general objective of this research is to produce a guidance manual on diagnoses and nursing interventions for the costumers of inpatient units of a pediatric public hospital in the state of Rio de Janeiro. As specific goals: to identify nursing diagnoses in medical records of inpatient children; to establish the prevalence of nursing diagnoses of inpatient children; to survey in the children medical records the nursing interventions related to the respective nursing diagnoses. Materials and methods: A survey performed obeying the Resolution 466/12, with detailed opinion No. 849.957 of HUAP CEP and CAAE No. 35037314.3.0000.5243. Study Type: documentary, exploratory, retrospective with a quantitative approach. Scenario: a Pediatric Public Hospital of Rio de Janeiro. Inclusion criteria: children medical records that were hospitalized in the Hospital from January to December of 2013. Exclusion criteria: medical records of children that spent less than 48 hours of hospitalization in the hospital wards, medical records of children who remained hospitalized in emergency and medical records of neonates. Sample: composed of 333 medical records. Analysis: they were plotted using the Microsoft Excel 2010 software and analyzed by S.A.S® System software, version 9.3.1. Results: it is observed the prevalence of child medical records between 1 month to 5 years, being 75.97% of the sample, however, medical records of children up to 13 years were used. The average length of hospitalization was 8.55 days. Identified the occurrence of 105 medical records as nursing diagnoses, being the most frequent NANDA-International nursing diagnoses: infection risk, hyperthermia and integrity of damaged skin. Most frequent nursing interventions: check vital signals, filing complaints of pain and characteristics, filing frequency and nature of the deletions. From the results produced the guideline manual for nurses in print and e-book formats. The manual addresses the human needs of Horta and in relation to nursing interventions, as well as, supplemented with other sources, especially the NIC. It is divided into 03 shares according to age group. Contributions: it is expected to contribute to the nursing management in order to facilitate the qualification, documentation and visibility of nursing service of the studied institution and provide support for research in the field of systematization of nursing care and its implementation in pediatric health services

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Qualitative research, exploratory, descriptive study aimed to understand the implications of caring for a Child with Special Needs Health for the family. Data were collected with ten families, between January and February 2012, through triangulation techniques, collecting records, semi-structured interview and the construction of the genogram and eco-map. The analysis followed the principles of thematic content analysis. The results showed that disclosure of the diagnosis has implications for the family, especially when it comes to late diagnosis. For social networks and specific restricted, the difficulties faced by the families of these children access to health services and education. These difficulties highlighted reverberate in the daily care of children with health needs and in time, give way to routine and adapting to everyday life for their families, triggering changes in restructuring involving familial. We conclude that the reorganization of families happens from the disease condition of the child established. The difficulties faced by these families are related to the completeness and accessibility of health services and actions and can generate repercussions on living conditions of children and their families and the need for reconfigurations for family care. It is recommended the recognition and appreciation of the family as the unit of care, promotion and coordination of support networks for family reorganization and actions centered on the health of the child and his family. / Pesquisa qualitativa, exploratória, descritiva que objetivou compreender as implicações do cuidar de uma Criança com Necessidades Especiais de Saúde para a família. Os dados foram coletados com dez famílias, entre janeiro e fevereiro de 2012, por meio da triangulação de técnicas: coleta em prontuários, entrevista semiestruturada e a construção do genograma e ecomapa. A análise seguiu os princípios da análise de conteúdo temática. Os resultados apontaram que a descoberta do diagnóstico traz implicações para a família, principalmente quando se trata do diagnóstico tardio. Para as redes sociais restritas e específicas, as dificuldades enfrentadas pelas famílias dessas crianças no acesso aos serviços de saúde e educacionais. Essas dificuldades evidenciadas repercutem no cuidado diário das crianças com necessidades de saúde e com o tempo, cedem lugar à rotina e à adaptação à vida cotidiana de suas famílias, desencadeando mudanças que implicam na reestruturação familial. Concluí- se que a reorganização das famílias acontece a partir da condição de doença da criança estabelecida. As dificuldades enfrentadas por estas famílias relacionam-se à integralidade e acessibilidade aos serviços e ações de saúde e pode gerar repercussões na condição de vida da criança e sua família e a necessidade de reconfigurações para o cuidado familial. Recomenda-se o reconhecimento e valorização da família como unidade de cuidado, a promoção e articulação das redes de apoio para a reorganização familiar e ações centradas na saúde da criança e sua família.

The purpose of this study was: (1) to evaluate the level of grief experienced by healthcare providers in a pediatric subacute facility, (2) to compare the levels of grief between different groups of healthcare providers (Certified Nurses' Aides, Licensed Nurses, and Respiratory Care Practitioners), and (3) to describe the personality/demographic factors that influence a healthcare provider's ability to cope effectively with compound grief.

This study uses a descriptive survey design to describe and examine the relationship among school nurses’ level of education, years of experience, knowledge of asthma and identification of the school nurse’s level of proficiency based on Benner’s (1984) model of Novice to Expert. A convenience sample of school nurses employed in public schools within the state of Massachusetts with an RN degree (registered nurse) were sampled. The demographic data revealed that of the 325 participants who participated in the study, the majority of school nurses were female ranging in age from 40 to 50 (M=47.0). The majority of nurses had a bachelor’s degree in nursing and were employed in the nursing profession on an average of twenty-two years and in school nursing for ten years. Since the majority of the school nurses did not have a master’s degree, they were not certified by a national certifying body. The majority of participants indicated that they had received certification through the Board of Education in Massachusetts. Most school nurses worked full time in a public school and were responsible for between six hundred and a thousand students. The majority of nurses indicated that they did not have a school-based clinic on site, nor did they have a school-based health center or clinic to refer students. There was little variability among sample characteristics with school nurses employed in Massachusetts being a fairly homogenous group. Those surveyed were sent a packet containing four questionnaires including one on demographics, as well as an asthma questionnaire, a questionnaire assessing chronic health problems in the schools, and a self-reporting questionnaire based on Benner’s (1984) model. Further results of this study revealed that the majority of the school nurses had an average to above average knowledge of asthma. The three most common interventions performed by school nurses as well as non medical personnel for those students with chronic illness are nebulizations, inhalers, and peak flow meters. Based on the self-report model of Benner’s (1984), these same nurses viewed themselves as expert in their level of practice. Mezirow’s Adult Learning Theory as well as Benner’s (1984) model of Novice to Expert were used to support the nurses level of practice based on experience, intuition and a constellation of meaning schemes developed from previous exemplars. Results of the study indicated that although the nurses surveyed were expert in their knowledge of basic nursing concepts, none had advanced practice level courses in advanced health assessment or clinical decision making in order to effectively manage the complexities of chronic illness such as ADHD, diabetes, and epilepsy, as well as asthma, the most common chronic illness in schools today.

Over 13 million adolescents sustain traumatic injuries yearly, resulting in functional disability, disfigurement, psychosocial problems and fractures. These fractures are increasingly being treated with orthopedic external fixation devices (EFDs). The purpose of this study was to describe the experience of traumatically injured adolescents treated with EFDs. The 4 aims of the study focused on the circumstances leading to the traumatic event, experiences following the traumatic event, the impact of EFD treatment, and adolescents’ role in pin-care self-management, which is crucial to preventing infection. This longitudinal, qualitative descriptive study used purposive sampling to recruit 5 male and 4 female adolescents, 13-20 years old, from a New England level-1 trauma center. Participants were injured in motor vehicle crashes (including an all-terrain vehicle), falls, by gunshot, trampoline and football trauma. Interview questions were framed by two themes from a study of adult recovery from physical injury, i.e., the event and fallout. Participants were interviewed within days of the injury, 2 weeks after returning home, and within one month of EFD removal. Data were coded from verbatim transcripts using NVIVO and organized into themes guided by the principles of qualitative analysis. An overarching theme of “old self no more; forever changed” emerged from 26 interviews. The participants’ experience affected all tasks of adolescence: independence from parents, accepting body image, peer relations, and forming an identity. Major themes included “what risk?”, regarding circumstances leading to the traumatic event, mastering the environment, was 2 part first, processing the event, where determining fault and realizing everything has changed, they were ambivalently lucky, and not invincible. Secondly “suck it up and deal with it”, where strategies to deal with traumatic injury emerged (i.e. medication, channeling outlets, and slow caution). EFD experience revealed “Space age robot” and “they’ll do it themselves” as emergent themes. EFDs were described as painless, robotic, no big deal and necessary. One draining pin-site was noted. Findings related to use of self-administered analgesics, information technology, recall of detail, and gender differences in coping may lead to future interventions. These findings lay the groundwork for future studies that may improve care of adolescents during acute recovery from traumatic injury.

Bakgrund: Besöken på akutmottagningar för barn i Sverige ökar hela tiden. För att möta detta har allt fler sjukhus börjat använda sig av sjuksköterskebesök. Syfte: Att beskriva barnsjuksköterskans erfarenhet av att självständigt bedöma och behandla sjuka barn på en akutmottagning. Metod: En kvalitativ intervjustudie med induktivt förhållningssätt. Urvalet bestod av elva barnsjuksköterskor med erfarenhet av sjuksköterskebesök. Materialet analyserades med manifest innehållsanalys. Resultat: Barnsjuksköterskans erfarenhet av sjuksköterskebesök visade sig vara positiva. Hen ansåg att sjuksköterskebesök innebar att arbetet blev mer stimulerande och utvecklande. Barnsjuksköterskan hade en betydande uppgift i att barnen kom till rätt vårdnivå både för barnets bästa och för att verksamheten skulle fungera på ett bra sätt. Det fanns potential och vilja att utveckla sjuksköterskebesök på akutmottagning för barn. Slutsats: Sjuksköterskebesök är positivt för barnsjuksköterskan, för att det bidrar till att barnsjuksköterskan utvecklas i sin profession vilket i sin tur skapar arbetsglädje. På grund av sjuksköterskebesök kan barnen som inte är i behov av en läkarbedömning få hjälp snabbare vilket leder till kortare väntetider på akutmottagningarna. / Background: Visits in the Swedish emergency units for children are increasing. In order to meet this, more and more hospitals are using nurse-led consultations. Aim: The purpose of this study was to describe the pediatric nurse´s experience of independently assess and treat children in the emergency department for children. Method: A qualitative interview study with inductive approach. The sample consisted of eleven pediatric nurses with experience of nursing visits. The material was analyzed with manifest content analysis. Results: The pediatric nurse´s experience of nurse-led consultation turned out to be positive. He/she considered that nurse-led consultations meant that the work became more stimulating, interesting and developing. The pediatric nurse had a significant task in that the children reached the right level of care both for the child's best interests and the activities. There was potential and willingness to develop nurse-led consultations to the emergency department for children. Conclusion: Nursing visits are positive for the pediatric nurse, because they contribute to the pediatric nurse developing in her profession, which in turn creates job satisfaction. Due to nurse visits, children who do not need a medical assessment can get help more quickly, which leads to shorter waiting times in the emergency department. In addition, the business benefits as nurse visits are more cost-effective.

Purpose: The purpose of this study was to explore the way(s) in which family management of childhood asthma is affected by contextual influences as described in the Family Management Style Framework (FMSF) and to explore additional factors that affect family asthma management. Specific Aims: The specific aims of this study were 1) to describe the everyday experiences of childhood asthma management within families, 2) to explore the way(s) in which family management of childhood asthma is affected by contextual influences (social network, care providers & systems and resources) as described in the FMSF, and 3) to explore additional sociocultural factors (supported by the literature but not currently described in the FMSF) that affect asthma management in families. Framework: The Family Management Style Framework guided this study. Design: A qualitative descriptive design was used to gather data from a purposive sample of female primary caregivers. Demographic data were collected, and individual interviews were conducted using a flexible interview guide. Results: The findings support the contextual influences as described in the FMSF. An additional three contextual themes were identified: environment, emerging threats to health and work-life conditions. The themes are interrelated demonstrating the complexity of asthma management. Conclusion: Family management of asthma is challenging and complex. The findings move towards understanding the connection between family asthma management and the social determinants of health. Nurses can support families managing childhood asthma by considering each of the contextual influences when planning interventions and working on policy initiatives that support the health of children with asthma.

The improvement in cancer remission rates in children and adolescents due to advances in cancer treatment and therapy has led to the development of guidelines that address long-term follow up for survivors of childhood cancers. Adolescents often experience negative emotions related to the fear of uncertainty about long-term survival after cancer remission, yet often report feelings of hope and optimism for the future more than adult cancer survivors. The purpose of this study was to understand the role of self-efficacy and coping in adolescents after remission of cancer. A secondary purpose was to analyze which coping strategies supported long-term survival goals after cancer remission in adolescent populations. A systematic literature review was conducted from the following online databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature On-line (MEDLINE), Education Resources Information Center (ERIC), and PsycInfo. Selected articles included those published between 2000-2016 that were written in English and were peer-reviewed. The results of the study revealed that most adolescents with cancer remission do not experience long term psychosocial issues related to their cancer diagnosis and treatment. However, a large percentage of adolescent cancer survivors report intermittent depression, suicidal ideation and a lower quality of life due to survival after remission. The literature indicates that multiple, integrative forms of behavioral therapy: cognitive, psychosocial, and family based treatment models, help to enhance long term quality of life in adolescent cancer survivors. Strategies that use positive coping methods and improve self-efficacy related to long term survival after remission have demonstrated improvement in psychosocial behaviors in adolescents and promote a better outlook on planning for the future. Future research that analyzes the most effective coping skills to practice after cancer remission and that optimize self-efficacy related to long term survival can positively influence quality of life for adolescent cancer survivors.

The purpose of this study was to conduct an integrated review of the literature examining the use of non-pharmacologic pain management strategies in premature neonates and to explore the relationship between health outcomes and time to discharge from the neonatal intensive care unit (NICU). Non-pharmacologic pain management strategies include human touch, facilitated tucking, non-nutritive sucking, and kangaroo care. A systematic review of the literature was conducted from multiple online databases. Peer reviewed, English-language articles containing the keywords ‘pain management’, ‘neonatal intensive care unit’, and ‘non-pharmacologic’ were included for synthesis. Exclusion criteria included articles with a focus on infants not admitted to the NICU and infants with a gestational age greater than 37 weeks. Results revealed positive outcomes when alternative pain-relieving methods, rather than drug therapy, were used in the NICU. A majority of articles suggest facilitated tucking is very successful in lowering a preterm infant’s pain. However, facilitated tucking alone was significantly less effective in relieving procedural pain compared to facilitated tucking in combination with oral sucrose administration. Kangaroo care and gentle human touch also proved to reduce physiologic and behavioral signs of pain in neonates. The literature reveled an overall positive outcome when non-pharmacologic pain interventions are used in the NICU, with some behavioral interventions showing better efficacy than others at relieving neonatal pain. None of the reviewed articles explored the relationship between reduced length of stay and parameters assessing health outcomes based on pain control in neonates. The literature indicated nurses play a significant role in the use of pain-relieving methods in neonatal populations. Implications for future research that focuses on successful behavioral based pain management strategies that assists in refining neonatal pain relief would be of great benefit to improving health outcomes related to infant survival after discharge from the NICU.