Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-04-04T17:45:28Z No. of bitstreams: 1 Leandro Silva Dias.pdf: 1153525 bytes, checksum: 8458e50ad0b542866cb54c89ea0006de (MD5) / Made available in DSpace on 2017-04-04T17:45:28Z (GMT). No. of bitstreams: 1 Leandro Silva Dias.pdf: 1153525 bytes, checksum: 8458e50ad0b542866cb54c89ea0006de (MD5) Previous issue date: 2012 / Conselho Regional de Enfermagem - RJ / Mestrado Profissional em Enfermagem Assistencial / A terapia com vários fármacos é a regra na quimioterapia antineoplásica e no tratamento de determinadas doenças infecciosas. Nesses casos os objetivos consistem na melhora da eficácia terapêutica e no retardo da emergência de células malignas ou de microrganismos resistentes aos efeitos dos fármacos disponíveis. Nas prescrições, das crianças internadas com patologias oncológicas, identificou-se como principal quimioterápico o Metotrexato (MTX), perfazendo um total de 3 a 4 doses por prescrição no tratamento de linfomas não Hodgkin e leucemias linfoides agudas. A interação farmacológica ocorre, quando um fármaco interfere com outros, alterando o efeito esperado, podendo ser prejudicial, á medida que causa aumento de riscos ao paciente. As interações farmacêuticas, também chamadas incompatibilidades medicamentosas, caracterizam-se por ocorrerem in vitro, isso é antes da administração no organismo, quando misturado dois ou mais fármacos em uma mesma seringa, equipo de soro ou outros recipientes. Objeto de estudo: As incompatibilidades físico-químicas dos medicamentos durante o ciclo de infusão do MTX endovenoso na clientela pediátrica com LLA e Linfoma não Hodgkin. Hipotese: O aprazamento de medicamentos concomitante a infusão do Metotrexato (MTX), realizado pelo enfermeiro, podem causar incompatibilidades que diminuem ou potencializam o efeito terapêutico deste quimioterápico. Objetivos: Traçar o perfil do tratamento farmacológico das crianças com LLA e LNH, durante o ciclo do MTX internadas na unidade pediátrica; verificar a prevalência das incompatibilidades físico-químicas entre os medicamentos administrados via endovenosa nas crianças com LLA e LNH, internadas na UP; estabelecer diretrizes para a Gerência do Cuidado de Enfermagem à crianças com LLA e LNH em uso de MTX endovenoso com a criação de um protocolo de aprazamento e administração. Foi um estudo observacional transversal, com abordagem quantitativa dos dados. A mostra foi composta por 13 pacientes com LLA e LNH, que atenderam os critérios de inclusão deste estudo, dos quais emergiram 86 prescrições. Os dados foram coletados no período de janeiro de 2008 à dezembro de 2011 e sofreram estatística descritiva e foi calculado a prevalência das incompatibilidades medicamentosas. O sexo masculino apresentou 61,5% da amostra, enquanto o feminino 38,5%; LLA com 85,6% e LNH com 15,2%; 100% de acessos centrais monolumen. Os eletrólitos apresentaram o maior numero de doses administradas, seguido do antiemético, e dos quimioterápicos. A interação medicamentosa do tipo farmacêutica, de maior prevalência foi a entre o cloridrato de ondansetrona e o bicarbonato de sódio a 8,4%, seguida da entre o cloridrato de midazolan e o bicarbonato de sódio. A pesquisa contribui para que o enfermeiro, se aproprie ainda mais dos conhecimentos relacionados a farmacocinética, farmacodinâmica e farmacêutica, assim como sobre as reações adversas medicamentosas, para que possam realizar a gerência do cuidado, no que tange toda a dinâmica da terapia medicamentosas, ou seja, uma assistência de enfermagem segura, livre de danos, sejam eles temporários ou permanentes, assegurando que os pacientes permaneçam o mínimo possível no ambiente hospitalar, assim como ter uma terapêutica medicamentosa com o resultado final que é a prevenção ou cura de doenças, e também eficácia nos tratamentos paliativo / Therapy with multiple drugs is the rule in cancer chemotherapy and in the treatment of certain infectious diseases. In such cases the objectives consist in improving the therapeutic efficacy and delay the emergence of malignant cells or microorganisms resistant to the effects of available drugs. In the prescriptions of children with oncological diseases, was identified as the main chemotherapeutic methotrexate (MTX), making a total of 3 to 4 doses per prescription in the treatment of non-Hodgkin lymphomas and acute lymphoid leukemias. The pharmacological interaction occurs, when a drug interferes with other, changing the desired effect and may be harmful, as will cause the patient to increased risks. The drug interactions, also called drug incompatibilities, characterized by occur in vitro that is prior to administration in the body, when two or more components mixed in one syringe, serum catheter or other containers. Object of study: The physico-chemical incompatibilities of drugs during the course of intravenous infusion of MTX in pediatric clients with ALL and non-Hodgkin's lymphoma. Hypothesis: The scheduling of drugs concomitant infusion of methotrexate (MTX), performed by the nurse, can cause incompatibilities that reduce or enhance the therapeutic effect of chemotherapy. Objectives: To describe the pharmacological treatment of children with ALL and NHL, during the cycle of MTX admitted to the pediatric unit and verify the prevalence of physical and chemical incompatibilities between drugs administered intravenously in children with ALL and NHL, admitted in UP; establish guidelines for the Management of Nursing Care for children with ALL and NHL in MTX intravenously with the creation of a protocol for scheduling and administration. It was an observational cross-sectional quantitative data approach. The show was comprised of 13 patients with ALL and NHL, who met the study inclusion criteria, 86 of which emerged prescriptions. Data were collected from January 2008 to December 2011 and suffered descriptive statistics and calculated the prevalence of drug incompatibilities. The male group showed 61.5% of the sample, while females 38.5%, 85.6% with ALL and NHL with 15.2%, 100% hits central monolumen. Electrolytes showed the highest number of doses administered, followed by an anti-emetic, and chemotherapy. The type of pharmaceutical drug interaction, was the most prevalent of the ondansetron hydrochloride and sodium bicarbonate to 8.4%, followed by between midazolam hydrochloride and sodium bicarbonate. The research contributes to the nurse, to appropriate further knowledge related to pharmacokinetics, pharmacodynamics, and pharmaceutical, as well as on adverse drug reactions so that they can carry out care management, regarding the dynamics of drug therapy, or is a safe nursing care, free of damage, whether temporary or permanent, ensuring that patients remain as little as possible in the hospital environment, as well as having a drug therapy with the end result is the prevention or cure of diseases, and also effective in the palliative treatment

The Peripherally Inserted Central Catheter (PICC), or Peripherally Inserted Central Venous Catheter (PICVC), is an intravenous device inserted through a superficial vein of the extremity that progresses for the blood flow and for insertion procedures, until the third distal of the vena cava, stayed in central level. Currently, the nurse is the main responsible for assessing the need of the use of this device and is the most professional directly involved in the insertion, maintenance and prevention of complications. The aim of this study was: to understanding the role of nurses in the use of PICC in neonates and children in a teaching hospital. The specific aims were: to describe the role of nurses in the use of PICC in neonates and children in a teaching hospital; to analyze the risks and benefits of using PICC considering the patient safety in neonates and children in a teaching hospital and to discuss the limits and possibilities of the use of PICC in neonates and children in the context of a teaching hospital. It was a qualitative and exploratory-descriptive study realized of April to May 2012. The subjects were 20 nurses from the Pediatric Inpatient Unit, Neonatal Intensive Care Unit and Pediatric, Emergency Room Pediatric and Center of Bone Marrow Transplantation, of a teaching hospital in the southern Brazil. The Creative Sensitive Method, using three dynamics of sensitivity and creativity: Tree of Knowledge, Knowledge Body and Almanac. Data were sumitted to Discourse Analysis in this current French. The ethical aspects of the research were respected in accordance with Resolution 196/96 of the National Health Council, and the project was approved with the protocol number 00541812.6.0000.5346. The results indicate that the nurse holds a prominent position in the use of PICC in neonates and children, being that its preparation starts in the graduation, complemented with the legal training and extends into daily practice, racioning clinically and evaluating risks and benefits. The incorporation of new technologies in intravenous therapy brought the concern with the patient safety. The nurses have care to stabilize the child hemodynamically, manipulate your body the little possible and not to expose them to risk of infection, with observation of asseptic techniques. So, they choose carefully the acess and not exceed three attempts. In order to prevent the stress of the patient, family and group, should be pay attention in the guidance, analgesia and sedation. It is recommended to invidualization / uniqueness of each case with the implementation of the Systematization of Nursing Care (SNC), it enables the SNC, records and highlights the work of nurses. Thus, it is expected that this professional can assume and maintain autonomy in the face of indications, insertion, maintenance and removal of the PICC, working with technical and legal competence. Thus the nurse should be prepared for this activity developing it responsibly, conscious and preventive. / O Cateter Central de Inserção Periférica (CCIP), ou Peripherally Inserted Central Venous Catheter (PICC) é um dispositivo intravenoso inserido através de uma veia superficial da extremidade que progride, por meio da ajuda do fluxo sanguíneo e de procedimentos de inserção, até o terço distal da veia cava, ficando a nível central. Atualmente, o enfermeiro é um dos principais responsáveis pela avaliação da necessidade do uso desse dispositivo, além de ser o profissional mais diretamente envolvido na construção de protocolos institucionais. Assim, delimitou-se como objeto de estudo: a atuação das enfermeiras na utilização do PICC em neonatos e crianças em um hospital de ensino. O objetivo geral deste estudo foi compreender a atuação de enfermeiros na utilização do PICC em neonatos e crianças em um hospital de ensino. Os objetivos específicos foram: descrever as bases para a atuação dos enfermeiros na utilização do PICC em neonatos e crianças em um hospital de ensino; analisar os riscos e benefícios da utilização do PICC no cenário de estudo e discutir os limites e possibilidades da utilização do PICC em neonatos e crianças no contexto de um hospital de ensino. Tratou-se de um estudo qualitativo de caráter exploratório-descritivo, realizado de abril a maio de 2012. Os sujeitos foram 20 enfermeiros da Unidade de Internação Pediátrica, Unidade de Terapia Intensiva Neonatal e Pediátrica, Pronto Socorro Pediátrico e Centro de Transplante de Medula Óssea, de um hospital de ensino no sul do Brasil. Foi aplicado o Método Criativo Sensível, por meio de três Dinâmicas de Sensibilidade e Criatividade: Árvore do Conhecimento, Corpo Saber e Almanaque. Os dados foram submetidos à Análise de Discurso em sua corrente francesa. Os resultados apontam que o enfermeiro ocupa posição de destaque na utilização do PICC em neonatos e crianças, sendo que seu preparo inicia na graduação, complementa-se com a capacitação legal e estende-se na prática diária, raciocinando clinicamente e avaliando riscos e benefícios. A incorporação de novas tecnologias em terapia intravenosa traz a necessidade de atenção redobrada com a segurança do paciente. As enfermeiras tem o cuidado de estabilizar, hemodinamicamente, a criança, manipular o mínimo possível seu corpo e não a expor ao risco de infecção, com observação de técnicas assépticas. Para tanto, escolhem criteriosamente o local de acesso e não excedem três tentativas. Para prevenir o estresse do paciente, equipe e familiares deve-se atentar para as orientações, a analgesia e a sedação. Recomenda-se a invidualização/singularização de cada caso com a implementação da sistematização da assistência de enfermagem, pois esta viabiliza, registra e evidencia o trabalho do enfermeiro. Assim, espera-se que esse profissional possa assumir e manter a autonomia diante da indicação, inserção, manutenção e retirada do PICC, atuando com competência técnica e legal. Desse modo, o enfermeiro deve buscar capacitação continuada para assumir esta atividade desenvolvendo-a de forma responsável, consciente e preventiva.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Children with Special Health Care Needs (CSHCN) represent an emerging customer demands have care at home, indicating the relevance of preparing the family for this care. It is a qualitative research aimed to describe the demands of health education of family members caregivers necessary for the process of home care of the CSHCN; to describe the process of care developed by the family/caregivers to these children; discuss the implications of the clinical fragility and vulnerabilities of CSHCN for professional care the child and his family from the perspective of health education for the maintenance of everyday life. For the production of the data we chose the Creative Sensitive Method (SAM) mediated by the dynamics of creativity and sensitivity (DCS). Consolidated the DCSs combine qualitative research techniques such as press conference, participant observation and group discussion. The DCSs were developed body know sewing stories and dynamics. The first aims to scale the process of home care in space and the second is to indicate individual problems and difficulties that may have roots social collective. The study subjects were ten family members/caregivers of children admitted to the Pediatric Inpatient Unit (IPU), University Hospital of Santa Maria (HUSM) at the time of compiling the data. Data were submitted to Discourse Analysis (DA) in its current French. In conducting the study was followed by Resolution 196/96, which regulates the conduct of research involving humans. The results show two dimensions of the process of care of children: a subjective and objective. At first, the family/caregivers develop a care to preserve the lives of these children, based on (pre)occupation. Through the (super)protection of the child, family members believe they can reduce health risks to the child. In this regard, careful (about) comes from the natural sum of efforts of the family, which perform continuous care of nature, complex to maintain the child's life, giving up their professional activities and personal desires. Spirituality emerged as a support to alleviate the suffering. In the objective dimension, has been the network of children and familial restricted to close relatives such as parents, grandparents, aunts and godmothers, and that the demands of education in health care for part of the experience, knowledge of the experience made , and the network of primary health care is disjointed, unable to meet the demand of its clientele. We conclude that for family members/caregivers of children the subjective dimension of the care process overlaps with the technical knowledge. For them, rather than performing a procedure, the important thing is to learn to live with the new situation and in maintaining the child's life. It is recommended restructuring the system of reference and counter and that nurses recognize the subjective dimension of the process of care of children by family members/caregivers in the context of the home, enabling these children a life with more quality. / As crianças com necessidades especiais de saúde (CRIANES) representam uma clientela emergente que possui demandas de cuidados no domicílio, apontando a relevância de preparar o familiar para esse cuidado. Trata-se de uma pesquisa qualitativa que objetivou conhecer as demandas de educação em saúde dos familiares/cuidadores necessárias para o processo de cuidado domiciliar às CRIANES; descrever o processo de cuidado desenvolvido pelos familiares/cuidadores a estas crianças; discutir as implicações da fragilidade clínica e das vulnerabilidades das CRIANES para o cuidado profissional a criança e sua família na perspectiva da educação em saúde para manutenção da vida no cotidiano. Para a produção dos dados optou-se pelo Método Criativo Sensível (MCS) mediado pelas Dinâmicas de Criatividade e Sensibilidade (DCS). As DCSs conjugam técnicas consolidadas de pesquisa qualitativa tais como: entrevista coletiva, observação participante e discussão grupal. As DCSs desenvolvidas foram a Corpo Saber e a dinâmica Costurando Estórias. A primeira objetiva dimensionar o processo de cuidar no espaço domiciliar e a segunda visa explicitar problemas e dificuldades individuais que possam ter raízes sociais coletivas. Os sujeitos do estudo foram dez familiares/cuidadores de CRIANES internadas na Unidade de Internação Pediátrica (UIP) do Hospital Universitário de Santa Maria (HUSM) na época da produção dos dados. Os dados foram submetidos à Análise de Discurso (AD) em sua corrente Francesa. Na condução do estudo seguiu-se a Resolução 196/96, que regulamenta a realização de pesquisa envolvendo seres humanos. Os resultados apontaram duas dimensões do processo de cuidado de CRIANES: na primeira, os familiares/cuidadores desenvolvem um cuidado de preservação da vida dessas crianças, pautado na (pré)ocupação. Por meio da (super)proteção da CRIANES, os familiares acreditam que podem reduzir os agravos à saúde da criança. Nessa dimensão, o cuidado (sobre)natural provém do somatório de esforços desses familiares, que realizam cuidados de natureza contínua e complexa para a manutenção da vida da criança, abdicando das atividades profissionais e dos desejos pessoais. A espiritualidade emergiu como um suporte para amenizar o sofrimento. Na segunda dimensão, tem-se que a rede familial da CRIANES é restrita aos familiares mais próximos, como os pais, avós, tias e madrinhas; e que as demandas de educação em saúde para o cuidar partem da experiência, o saber da experiência feita; e a rede de atenção básica à saúde encontra-se desarticulada, não conseguindo atender à demanda desta clientela. Conclui-se que para os familiares/cuidadores de CRIANES a dimensão subjetiva do processo de cuidado sobrepõe-se aos saberes técnicos. Para eles, mais do que realizar um procedimento, o importante está em aprender a conviver com a nova situação e na manutenção da vida da criança. Recomenda-se a reestruturação do sistema de referência e contrarreferência e que os profissionais de enfermagem reconheçam a dimensão subjetiva do processo de cuidado de CRIANES pelos familiares/cuidadores no contexto do domicílio, possibilitando a estas crianças uma vida com mais qualidade.

Domestic violence against children represents an important issue in public health due to its higher taxes of morbidity and mortality. At the same time it constitutes a social and professional challenge. Familiar violence that is continuous throughout the generation, reinforcing it in the culture as a normal thing. Thus, we aimed understand how the institutionalized children experience the domestic violence in order to reach subsides to face it and prevent it. It is a qualitative research with a descriptive-exploratory approach which applied the Creative and Sensitive Method. The study was carried out in two institutions where living children and adolescents that suffered domestic violence in the southern Brazil. The study participants were 4 children, 2 girls and 2 boys between 8-11 years-old. 2 dynamics of creativity and sensibility were conducted with 4 participants each one: Playing in Act and Body Knowledge. In the first one aimed know how was the children s life in the familiar home environment that they came from. In the second one, the objective was known how the children s bodies were cared in the familiar home environment under their perspective. The institution ethical committee approved this study. In order to understand the abused children s language the analytical tools of the French Discourse Analysis were applied to the data. The findings pointed at several motives to children s institutionalization such as: mother s mental disorders, alcohol abuse and physical aggression. Mothers were the main aggressor. The types of violence founded the physical, sexual and negligence. The head, arms, legs and buttock were indicated by children as main points to physical violence. The boys discourses revealed feelings as love and affection by relative that take care of them. At the same time, they revealed the disregard by relative that practiced violence against them. The girls discourses pointed out the hygiene care as the unique kind of care that they received in their family. We recommend that the domestic violence are emphasized in the teaching, clarifying it causes, consequences and recognize it as a public health issue. The professionals must to know how to direct victims and aggressors. We believe in a preventive work developed together families since the reproductive plan, pre-natal care and delivery. We suggest a humanizing policy centered in actions that are possible the bond between mother-child and the familial relationships in the daily life. So, this study intends to contribute to minimize the domestic violence occurrences. / A violência intrafamiliar contra crianças, além de representar uma importante questão de saúde pública devido a seu alto índice de morbimortalidade, também se constitui em desafio social e profissional. A violência que se apresenta nas relações familiares, perpassa os tempos, reforçando uma cultura que a mostra como algo normal, perpetuando-se através das gerações. Dessa forma, objetivou-se compreender como as crianças abrigadas vivenciam a violência intrafamiliar a fim de buscar subsídios para o seu enfrentamento e prevenção. Trata-se de uma pesquisa qualitativa do tipo descritivo-exploratória, utilizando-se o Método Criativo Sensível. A pesquisa foi desenvolvida em duas instituições que abrigam crianças e adolescentes vítimas de violência familiar, que não podem permanecer com as suas famílias, localizadas em município do Estado do Rio Grande do Sul. Os participantes do estudo foram 4 crianças, dois meninos e duas meninas, com idade entre 8 e 11 anos. Como técnica de coleta de dados, utilizou-se as dinâmicas de criatividade e sensibilidade (DCS) que constituem o eixo central do Método Criativo Sensível. As DCSs desenvolvidas nesse estudo foram: O Brincar em cena e Corpo Saber. Na DCS O Brincar em cena, buscou-se conhecer como era a vida das crianças no ambiente da família de origem. Na DCS Corpo Saber buscou-se, conhecer de que forma o corpo das crianças era cuidado/tratado no ambiente da família de origem sob a perspectiva das mesmas. Todos os preceitos éticos foram mantidos, e o protocolo de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da instituição. Para compreender a linguagem utilizada pelas crianças vitimizadas e significar seu discurso foram aplicadas as ferramentas da análise de discurso francesa. Os resultados apontaram como motivos para a institucionalização problemas mentais da mãe, uso abusivo de álcool e a agressão. A mãe foi identificada como principal agressora. Os principais tipos de violência encontrados foram: físicas, sexuais e de negligência. A identificação da violência no corpo indicou a cabeça, os membros superiores e inferiores e nádegas como locais mais atingidos. Os discursos dos meninos revelaram o sentimento de amor e carinho pelo familiar que prestava o cuidado e o sentimento de desprezo pelo familiar que agredia. O discurso das meninas apontou os cuidados básicos de higiene, como a única forma de cuidado que elas referem ter recebido em sua família. Recomenda-se que, a violência intrafamiliar contra crianças seja abordada enfaticamente no ensino, explicitando causas, conseqüências e reconhecimento dessa, a fim de fornecer subsídios para os futuros profissionais no encaminhamento de vítimas e agressores. Acredita-se em um trabalho preventivo, realizado junto às famílias desde o planejamento reprodutivo, cuidados no pré-natal e parto. Sugere-se uma política de humanização que tenha seu foco em ações que propiciem o apego, o fortalecimento do vínculo mãe-filho e das relações familiares no cotidiano da convivência. Tudo isso com vistas a possibilidade de contribuir para minimizar a ocorrência da violência intrafamiliar.

Adolescent athletes with type 1 diabetes (T1DM) face unique challenges when compared to peers with and without diabetes. Continuous subcutaneous insulin infusion (CSII) provides a method of insulin delivery that can enhance flexibility in insulin regimens and lifestyle that may be especially appealing to the adolescent athlete. No studies have explored the impact of athletics in this population. This descriptive qualitative study explored and described the experiences of adolescent athletes using CSII as their primary insulin delivery method, with a focus on athletic participation and performance. The purposeful sample consisted of four adolescent athletes, ages 13 to 15 years with T1DM, using CSII, in excellent diabetes control, and recently participated in organized sports activities. After written informed consent, data were collected through a semi-structured interview with the adolescent and parent. Results were transcribed verbatim and analyzed for emerging themes. Four themes emerged from the transcripts along with multiple subcategories. The main themes included: protecting the pump and infusion site; dealing with highs and lows; maximizing participation and performance; and keeping watch. Information gathered from this study will prepare healthcare professionals to anticipate the needs of adolescent athletes using CSII when prescribing a diabetes management regimen.

The purpose of this study was to determine if a relationship existed between body mass index and school absence. The research was a retrospective study of school nurse height and weight reports and attendance reports for 2nd grade Hispanic students at an elementary school in Riverside, California.

Introduction and Background: Today, in 2022, there is a community that receives discrimination, lack of acceptance, and lack of equality. This is the LGBTQ community. They suffer from the indifferences of the way they express themselves resulting in a rise of mental health issues and overall health disparities. Purpose Statement: The purpose of this review is to explore the disparities in mental health for the LGBT community including young adolescents and older adults. The question that drives this review is how does being a member of the LGBT community effect mental health. Literature Review: This literature review utilized search engines such as PubMed, ETSU One Search, and Google Scholar. Articles were chosen from within the past five years and corresponded with disparities in mental health for the LGBT community and the effects of acceptance from others. Key words used during the search of articles included “LGBT”, “mental health”, “suicide”, and “nursing”. A total of four articles and one systematic review were selected. Findings: Adolescents who didn’t have acceptance from others had a higher risk of suicide. Many mental health and substance abuse facilities didn’t have LGBT-specific programs. Healthcare professionals expressed the lack of training with LGBT clients but were willing to learn as it is relevant to their practice. Conclusions: The United States is under pressure as we watch the LGBT community become victims of inequality and health disparities. There is a need for more training and cultural competency, and implications of programs and resources specifically for the LGBT community.

Little is known about what variables affect self-management practices of adolescents with T1D. Few studies have examined differences in self-management behaviors by stage of adolescence. Similarly, no studies have examined all of the attributes of self-management, including Collaboration with Parents and Goals. In order to fill the gaps in the literature, a secondary data analysis with a descriptive correlation design was conducted to describe T1D self-management behaviors (Collaboration with Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication and Goals) during early, middle and late stages of adolescence. This study also examined whether the roles of covariates (regimen, duration of illness (DOI), gender) in self-management behaviors vary by stage of adolescence. Data from 504 subjects aged 13 – 21 years were analyzed and the age variable was transformed into three adolescent stages early (13-14) (n=163), middle (15-16) (n=159) and late (17-21) (n=182). The findings revealed significant differences between adolescent stages on Collaboration with Parents and the Diabetes Problem Solving subscale. The covariate analysis showed no significant effect modification for the covariates and stage on any of the subscales so the results did not differ from the ANOVA model. Covariate analysis showed significant associations between regimen and Collaboration with Parents, Diabetes Care Activities and Diabetes Problem Solving. DOI showed significant associations only with Diabetes Problem solving and gender had significant associations with Diabetes Care Activities and Diabetes Communication. The mean scores on Collaboration with Parents show an incremental decline in collaboration with parents as adolescents move through stages. The higher mean Diabetes Problem Solving scores found in the late adolescent group compared correlated with a higher degree of problem solving in this group when compared to those in the early or middle adolescent stage group. Regimen had significant associations with three of the five subscales suggesting this is an important variable for future study. DOI did not have a significant impact on self-management whereas gender related differences in the areas of Diabetes Activities and Diabetes communication warrant further investigation.

The purpose of this qualitative study was to explore school nurses’ (SN) perceptions of factors influencing their ability to identify, refer, and provide mental health services to students with early signs of mental, emotional, and behavioral (MEB) needs. The National Research Council and Institute of Medicine have urged a preventive public health approach to decrease adverse outcomes of unidentified and untreated MEB needs among children (O’Connell, 2009). Historically and theoretically based in public health, SN have daily contact with students and are in an optimal location for early identification, referral and provision of services, yet little empirical research describing their role is available. Five focus groups with 29 SN were conducted and four themes emerged through analysis of data: Frequent flyers : student visits to SN offices, the observations that alert SN to potential MEB needs; Digging to get the whole picture : the process SN frequently used to collect information necessary to confirm MEB needs; Road to referral : the resources used and barriers encountered within the referral process; and, Safety zone : the important role SN play in the provision of services to students with early signs of MEB needs. Within the provision of services was a collective subtheme across all five focus groups: What we need to better help our kids. In this category SN identified their educational limitations and learning needs, as well as potential strategies to improve provision of services for students with MEB needs. The findings of this study provide a lens into the complex and little explored are of early identification, referral and intervention processes used by SN to care for students with MEB needs. Understanding the role of the SN is a critical first step towards improving outcomes.

Purpose: Assess the effectiveness of an online intervention to encourage self-management in adolescents with cerebral palsy (CP). Specific Aims: (a) assess effectiveness of an online intervention to promote readiness for self-management in adolescents with CP, (b) describe health literacy and associations with readiness to assume self-management, and (c) evaluate adolescents’ exposure to the online intervention. Hypotheses: (a) intervention subjects would demonstrate improvement in self-management, and (b) subjects with higher health literacy would demonstrate higher self-management capabilities. Framework: Transtheoretical Model of Health Behavior Change Design: Randomized control trial, performed in a multidisciplinary CP clinic at a university based children’s hospital. Instruments used: (a) Transition Readiness Assessment Questionnaire (TRAQ) and (b) the Health Literacy Skills Instrument-SF (HLSI). Due to low engagement, the study terminated early. Intervention subjects were interviewed to assess their limited engagement. Results: Seventy-five percent of subjects demonstrated inadequate HL. Mean baseline TRAQ score (n=24) was 2.71 (SE = .24). Positive associations were found between TRAQ and age (.47, p = .00) and TRAQ and HL (.48, p = .00). Conclusion: Failure to engage with the intervention appeared to be related to: (a) low HL, (b) low TRAQ scores (indicating subjects in contemplation stage) (c) inconsistency between subjects’ preference for learning and delivery of information, and (d) low motivation for self directed learning. Online interventions should be easy to use and include learning preferences. Lessons learned will inform future development of interventions for this population.