Orientadores: Luciana de Lione Melo, Claudinei José Gomes Campos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-25T10:37:16Z (GMT). No. of bitstreams: 1 Fonseca_MarileiseRobertaAntoneli_M.pdf: 9580080 bytes, checksum: 38e46834760ceafa2fee0718a7ab8fa0 (MD5) Previous issue date: 2014 / Resumo: Com a evolução do tratamento oncológico nas últimas décadas, o câncer infantil passou de uma doença aguda, com morte inevitável, para crônica com possibilidade de cura. Essa mudança de representação do câncer infantil contribuiu para uma ampliação na forma de assistir à criança com câncer para além dos aspectos biológicos e fisiológicos, incluindo as necessidades emocionais e sociais, exigindo assim o uso de técnicas adequadas de comunicação e relacionamento. O brinquedo terapêutico tem sido utilizado na assistência à saúde das crianças como um recurso para propiciar o alívio das tensões e promover a comunicação entre elas e os profissionais de saúde, seja para traçar metas de assistência e cuidado, seja para favorecer a formação de vínculos e, enfim, promover um cuidado integral à criança doente. O presente estudo teve como objetivo compreender o brincar da criança pré-escolar em tratamento oncológico por meio do brinquedo terapêutico dramático. Optou-se pela modalidade de pesquisa qualitativa, na perspectiva da fenomenologia ¿ análise da estrutura do fenômeno situado, para a compreensão do brincar das crianças com câncer. Foram analisadas 26 sessões de brinquedo terapêutico dramático realizadas com cinco crianças com câncer, com idade entre três e seis anos, que estavam em tratamento oncológico, clínico e/ou cirúrgico e que residiam provisoriamente numa casa de apoio localizada no município de Campinas/SP. As sessões de brinquedo terapêutico dramático se iniciaram com a seguinte questão norteadora: "Vamos brincar de uma criança que está com câncer?" A partir das convergências e das divergências das unidades de significados encontradas nos discursos, emergiram duas categorias temáticas: mergulhando no mundo da doença e do tratamento oncológico e relembrando o mundo sem a doença. Na categoria Mergulhando no mundo da doença e do tratamento oncológico foi possível apreender que o adoecer por câncer é um processo gerador de dor e sofrimento para a criança, levando-a sentir-se pequena e frágil frente aos desconfortos dos inúmeros procedimentos a que são submetidas. Os procedimentos terapêuticos estiveram presentes em todas as sessões de brinquedo terapêutico dramático. A categoria relembrando o mundo sem a doença revelou pequenos momentos permeados por situações do cotidiano doméstico. O brinquedo terapêutico por sua vez, contribuiu significativamente para a catarse e alívio da tensão da criança pré-escolar em tratamento oncológico, sendo uma forma eficaz de estimulação, comunicação e de acesso ao seu cotidiano, proporcionando-lhe bem-estar, conforto e distração. Recomenda-se, fortemente, a utilização do brinquedo terapêutico como estratégia de comunicação e cuidado à criança que vivencia o processo de adoecimento / Abstract: With the evolution of oncological treatment in the last decades, cancer in children went from an acute disease, with inevitable death, to a chronic one, with possibility of cure. This change in the representation of cancer in children has contributed to broadening the way children with cancer as cared for beyond the biological and physiological aspects, including social and emotional needs, therefore demanding the use of proper techniques in communication and relationship. Therapeutic plays are being used in caring for children's health as a resource to provide relief from tension and promote communication between them and health professionals, no matter if it is for setting goals for assistance and care or for favoring bonds, but, in the end, for providing full care to the sick child. This study aimed to understand the use of dramatic therapeutic play with pre-school children undergoing oncological treatment. Qualitative research was used, from a phenomenology perspective ¿ analysis of the phenomenon structure in place, in order to understand the play of children with cancer. There were 26 dramatic therapeutic play sessions with 5 children with cancer, ages 3 to 6, that were undergoing oncological, clinical and/or surgical treatment and temporarily resided in a support house located in the municipality of Campinas/SP. The dramatic therapeutic play sessions started based on the following leading question: "What if we play of a child with cancer?" From the convergences and divergences of the units of meanings found in the discourses, two theme categories emerged: entering the disease and oncological treatment world and reminding the world without the disease. The category entering the disease and oncological treatment world was possible to learn that getting sick with cancer is a process that promotes pain and suffering for children, making them feel small and frail compared to the discomforts of the numerous procedures that are submitted. Therapeutic procedures were present at all sessions of dramatic therapeutic play. The category reminding the world without the disease revealed permeated by small moments of everyday household situations. The therapeutic play, in turn, contributed significantly to the catharsis and relief of tension pre-school children undergoing oncological treatment, therefore being an effective way to stimulate, communicate and have access to the everyday life, providing them well-being, comfort and amusement. Strongly, we recommend the use of therapeutic play as a communication strategy and care for the child who experiences the disease process / Mestrado / Enfermagem e Trabalho / Mestra em Ciências da Saúde

Orientador: Eliete Maria Silva / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T17:47:57Z (GMT). No. of bitstreams: 1 Leite_TaniaMariaCoelho_D.pdf: 2134729 bytes, checksum: 912e2da62578cf06fedef1d8b22be9e0 (MD5) Previous issue date: 2012 / Resumo: O brinquedo é reconhecido como facilitador nas relações entre criança e profissional de saúde e, também, como forma de minimizar os efeitos nocivos da hospitalização infantil. Entretanto, percebemos uso restrito deste recurso no cotidiano hospitalar pelo enfermeiro pediatra. Este fato, aliado à convicção de que crianças hospitalizadas necessitam mais do que cuidados físicos relacionados à sua patologia, nos motivaram a desenvolver pesquisa sobre a utilização do brinquedo terapêutico. Assim, este estudo teve como objetivo analisar o processo de trabalho do enfermeiro que atua em unidade de internação pediátrica de um hospital escola do interior de São Paulo/Brasil, com ênfase na utilização do brinquedo terapêutico como instrumento do cuidado. Trata-se de um estudo descritivo, com abordagem qualitativa. Os dados foram coletados por meio de entrevistas semiestruturadas e observação participante, com 17 enfermeiros atuantes nesta unidade e analisados à luz do referencial do processo de trabalho em saúde. Partindo do tema central, compreendendo a utilização do brinquedo terapêutico no trabalho do enfermeiro pediatra, organizamos os dados empíricos em três categorias principais, que foram estabelecidas de modo a contemplar os elementos do processo de trabalho: necessidades da criança, da família e institucionais; práticas e relações presentes no trabalho; prescrições e interações na atenção à saúde da criança. Os resultados apontam para um distanciamento do enfermeiro do objeto em seu processo de trabalho, suas práticas são centradas no modelo biomédico, com predominância de atividades técnicas e subordinadas ao trabalho médico. O Processo de Enfermagem é incompleto, há dificuldade quanto à satisfação das necessidades essenciais da criança e utilização discreta de recursos lúdicos e do brinquedo terapêutico. O processo de trabalho conturbado é uma das dificuldades apontadas pelos enfermeiros para que o brinquedo terapêutico seja operacionalizado. Os resultados deste estudo apontam para a necessidade de mudanças no processo de trabalho do enfermeiro pediatra que valorizem a relação multiprofissional, a comunicação entre a equipe, a criança e o familiar acompanhante, bem como a utilização de estratégias como o brinquedo terapêutico, possibilitando um atendimento mais humanizado e qualificado. Porém, também são necessárias mudanças no paradigma do cuidado, para que a satisfação das necessidades da criança e de sua família passe a ser o foco do processo de trabalho. Torna-se imprescindível sensibilizar e informar enfermeiros, técnicos de enfermagem e gestores sobre a prática do brinquedo terapêutico, garantir educação permanente voltada para o desenvolvimento humano, bem como direcionar a assistência de enfermagem para o desenvolvimento infantil e necessidades da criança, além de mudanças no processo de trabalho. Porém, isto só será possível se houver esforços para reestruturação da rotina institucionalizada por todos os membros da equipe de saúde / Abstract: The play is recognized as a facilitator in relationship between child and health professional and also as a way to minimize harmful effects of infant hospitalization. Nevertheless, there is still limited use of this feature in the daily hospital activities by pediatric nurses. This fact, besides the conviction that hospitalized children need more than physical care related to their disease, motivated me to develop research on use of therapeutic play. Thereby, this study aimed to analyze the working process of nurses who work in a pediatric unit of a teaching hospital in a city of São Paulo State, Brazil, with emphasis on the use of therapeutic play as a tool for caring. It is a descriptive study with qualitative approach. Data were collected using semi-structured interviews and participant observation. Subjects were 17 pediatric nurses of the mentioned unit. Data were analyzed according to the theoretical framework of working process in health. Considering the main theme, the comprehension on use of therapeutic play in the work of pediatric nurses, it was organized empirical data in three main categories, which were established in order to include elements of the working process: institutional, family and child needs; practices and relationships present at work; prescriptions and interactions on child health care. Results have pointed to a detachment from nurses of the object in their working process; their practices are focused on the biomedical model, with predominance of technical activities and subordination to medical job. The Nursing Process is incomplete; there are difficulties on meeting essential needs of children, as well as little use of recreational resources and therapeutic play. The disturbed working process is one of the difficulties pointed out by nurses for using therapeutic play. Results of this study have showed need for changes in the working process of the pediatric nurses: changes that enhance multiprofessional relationship, enhance communication between staff, children and family, and the use of strategies such as therapeutic play, allowing a more humanized and qualified care. However, changes are also required in the caring paradigm for satisfying the child and family needs and its becomes a focus of the working process. It is essential to sensitize and inform nursing staff and managers about the practical therapeutic play, to ensure ongoing education focused on human development, as well as direct nursing care to children's development and needs, besides changes in the nursing working process. However, this is only possible if there are efforts from all members of the healthcare team to restructure institutionalized routine / Doutorado / Enfermagem / Doutora em Enfermagem

Orientador: Edinêis de Brito Guirardello / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T22:05:17Z (GMT). No. of bitstreams: 1 Dini_ArianePolidoro_D.pdf: 2682415 bytes, checksum: 9d3299480d04b448223c89667f0f5d66 (MD5) Previous issue date: 2013 / Resumo: A classificação de pacientes é um método para estimar as demandas de cuidados dos pacientes e promover comunicação efetiva dos enfermeiros para que possam planejar o padrão de cuidado, equalizar o escalonamento da equipe de enfermagem, argumentar e advogar pelos pacientes na gestão de enfermagem. Estudo misto com referencial quantitativo cujo objetivo geral foi validar o instrumento para a classificação de pacientes pediátricos proposto por Dini e os objetivos específicos foram: validar o conteúdo e o construto do instrumento; verificar a associação entre a idade e a classificação de pacientes em categorias de cuidado; e verificar a confiabilidade do instrumento quanto a sua homogeneidade e consistência interna. O estudo foi realizado em três fases: Na primeira fase a validação do conteúdo do instrumento ocorreu concomitantemente à coleta de dados para verificar a validade de construto e confiabilidade do ICPP. A segunda fase contemplou uma nova coleta de dados para monitorar as propriedades de validade de construto e confiabilidade do instrumento após o refinamento de seu conteúdo. Na terceira fase foram coletados e analisados os dados quanto à validade e à confiabilidade do instrumento revisado após o término de sua validação de conteúdo. A coleta de dados ocorreu em hospital universitário no interior do Estado de São Paulo. Os dados foram analisados com auxílio do SPSS®. A confiabilidade foi avaliada quanto à homogeneidade com a aferição do coeficiente Alfa de Cronbach e quanto à consistência interna, por meio da correlação item-total e item item. A validação do conteúdo foi realizada por experts e avaliada pelo índice de validade de conteúdo. A Análise Fatorial Exploratória foi utilizada para avaliar validade de construto. Na primeira fase, foram classificados 227 pacientes pediátricos. A homogeneidade do instrumento foi evidenciada (alfa=0,76) e a avaliação do construto identificou três domínios no instrumento original: Família, Paciente e Procedimentos Terapêuticos; no entanto os valores de comunalidades e carga fatorial indicaram que alguns indicadores apresentavam problemas de clareza, tendo sido conduzido um refinamento em seu conteúdo. Na segunda fase foram classificados 166 pacientes e o instrumento refinado apresentou confiabilidade (alfa=0,775). A análise fatorial identifica apenas dois construtos não suficientemente fundamentados pelo modelo de assistência centrado na família, tendo sido realizada uma nova análise fatorial exploratória com a mesma amostra, com exclusão dos pacientes intensivos. Foram identificados novamente os três domínios que possibilitam a avaliação da assistência centrada na família e os achados permitiram a revisão do conteúdo anteriormente refinado. Na terceira fase o instrumento revisado apresentou confiabilidade (?= 0,77). O processo de validação do Instrumento de Classificação de Pacientes Pediátricos permitiu desenvolver a possibilidade de avaliação dos pacientes pediátricos sob a abordagem do cuidado centrado na família e incorporar com maior clareza algumas necessidades essenciais da infância como brincadeiras, interação e afeto. Recomenda-se a utilização do instrumento validado nesse estudo para avaliação das necessidades do paciente pediátrico enquanto indivíduo de um sistema familiar. Considerando que o processo de validação não é estanque, novos estudos são recomendados para monitorar a validade e a confiabilidade do instrumento em outras realidades / Abstract: Patient classification is a method for estimating the demands of patient care and to promote effective communication of nurses in order to plan the standard of care equalize the staffing and scheduling and to advocate for patients. Multi methods study that aimed to validate Dini's Pediatric Patient Classification Instrument. The specific objectives were to evaluate the content and the construct validity; and to evaluate the instrument's reliability. The study was conducted in three stages. Data collection occurred at a university hospital in the state of São Paulo. Data were analysed by the SPSS®. The reliability was assessed by Cronbach's Alpha coefficient, correlation with item-total-item and item-item. The content validation was done through questionnaires sent to registered nurses, nurse teachers and nurse researches and evaluated by content validity index. Construct validity was assessed using exploratory factor analysis. In the first phase, 227pediatric patients were classified. Data showed that the instrument is reliable (alfa= 0.763). It was identified three constructs: Pediatric patient, Therapeutic procedures, and Familiar participation. However the factor loadings and the communalitties suggested that some indicators had structural problems. In the second stage the content validation consented to the findings of the factor analysis and the content of the instrument was improved. In the third and last stage 166 patients were classified. Data showed that the instrument is still reliable (alfa=0.775). Factor analysis only identified two constructs that couldn't explains the theoretical model of Family-centered-care. It was done a third factor analysis on the same sample excluding intensive care patients that identified three constructs again and the findings allowed the content revision. In the third stage, only 61 patients were classified. The instrument showed reliability (?= 0.77). The validation process of the Pediatric Patient Classification Instrument allowed its development in order to incorporate some children's essential needs into its content, like childhood play, interaction and affection. It is recommended the use of the instrument validated in this study to assess the needs of the pediatric patient in its familiar context. Considering that the validation process is continuous, further studies are recommended to monitor the validity and the reliability in daily practice / Doutorado / Enfermagem / Doutora em Enfermagem

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-19T18:28:46Z No. of bitstreams: 1 Paula Carvalho Barbosa de Oliveira Giolito.pdf: 2833769 bytes, checksum: dfbc06d041c70e63eddc3e2f2db940bb (MD5) / Made available in DSpace on 2016-05-19T18:28:46Z (GMT). No. of bitstreams: 1 Paula Carvalho Barbosa de Oliveira Giolito.pdf: 2833769 bytes, checksum: dfbc06d041c70e63eddc3e2f2db940bb (MD5) Previous issue date: 2015 / Mestrado Profissional em Enfermagem Assistencial / Introdução: Trata-se de um estudo que possui como objeto o registro dos enfermeiros em um setor de pediatria. Objetivos: Elaborar um roteiro para orientação de registros de enfermeiros em pediatria; aplicar a metodologia da problematização para identificar os cuidados e os aspectos relacionados à elaboração dos registros em pediatria; discutir as implicações desses aspectos para o registro de enfermagem em pediatria tendo em vista as situações-problema vivenciadas pelos enfermeiros. Método: Estudo descritivo, com abordagem qualitativa, realizado num hospital pediátrico do município de Duque de Caxias, com a participação de 12 enfermeiros. As informações foram coletadas através de formulários individuais e da abordagem em grupo sobre o tema registro de enfermagem, utilizando a metodologia da problematização. Tais informações foram analisadas utilizando a Análise de Conteúdo, originando duas categorias: 1. As situações-problema que interferem na prática assistencial dos Enfermeiros e 2. Estratégias para otimização do tempo na realização do registro de Enfermagem em Pediatria. Resultados: Os enfermeiros relacionaram as seguintes situações-problema que podem interferir na realização do registro em conformidade com a SAE: situações de caráter institucional e situações de relacionamento interpessoal. Elegeram como problema prioritário o tempo para executar o processo de enfermagem e fazer um bom registro. Dentre as hipóteses de solução para o problema, o grupo elaborou coletivamente o Instrumento para Registro dos Enfermeiros em Pediatria. Considerações Finais: O uso da Metodologia da Problematização em uma pesquisa qualitativa no cenário pediátrico foi bastante produtivo e enriquecedor, pois possibilitou aprofundar o conhecimento na área da Enfermagem Pediátrica, aliando conhecimentos teóricos adquiridos à prática, partindo da reflexão para a ação resolutiva. A construção do Instrumento de forma coletiva evidenciou o que é preconizado na Problematização: a estimulação da relação prática-teoria-prática, com vistas à transformação da realidade vivida. / Introduction: This is a study that has as object the nurse’s record in a pediatric sector. Objectives: Develop a guide to nurses records in pediatrics; apply the methodology of Problematization to identify nursing care and aspects related to the elaboration of the records in pediatrics; discuss the implications of these aspects for nursing record in pediatrics in view of the problem situations experienced by nurses. Methods: A descriptive study with qualitative approach developed in a pediatric hospital in the city of Duque de Caxias, in which participants were 12 nurses. Data were collected through individual forms and group approach about the subject “nursing records”, using the methodology of Problematization. The data were analyzed using content analysis, through which have been defined two categories: 1. The problem situations that interfere in the practice of nurses and 2. Strategies for optimization of time in making the nursing record in Pediatrics. Results: The nurses related the following problem situations experienced in everyday practice that can interfere in making the record in accordance with SAE: institutional situations and interpersonal situations. They elected as main problem the time to run the nursing process and make a good nursing record. Among the hypotheses for solving the problem, the group collectively elaborated the Instrument for Pediatric Nurses’ Record. Conclusion: The use of the Methodology of Problematization in a qualitative research in pediatric setting was very productive and enriching because it allowed to deepen the knowledge in the area of Pediatric Nursing, combining theoretical knowledge into practice, starting from the reflection to the resolutive action. The construction of the Instrument in a coletive way showed what advocates the Problematization: stimulation of practice-theory-practice relationship, with a view to transforming the lived reality.

Bakgrund: Många barn upplever medicinska undersökningar som något obehagligt och smärtsamt. Det första besöket ett barn har med sjukvården kan ha en avgörande betydelse för hur barnet upplever vården i framtiden, ett negativt första besök kan leda till sjukhusrelaterad rädsla även i vuxen ålder. För att undvika detta är det viktigt att barnet får en positiv upplevelse i samband med vistelsen vilket kan åstadkommas med olika distraktionsmetoder som finns för att ändra barnets upplevelse och på så sätt minska obehag och smärta. Syfte: Att undersöka om distraktionsmetoder fungerar vid medicinska undersökningar för att minska lidande och obehag hos barn som vårdas inom pediatrisk sjukvård, primärvård samt inom sluten vård. Metod: En systematisk litteraturöversikt baserad på 10 kvantitativa artiklar ur databaserna PubMed, The Cochrane Library och Cinahl. Resultat: Distraktionsmetoder kan grupperas i olika subgrupper beroende på typen av distraktion: distraktion via handling, distraktion med objekt, distraktion av vuxen samt elektronisk distraktion. Denna studie visar att distraktion generellt är effektivt för reducering av smärta och obehag hos barn under medicinska undersökningar. Beroende på barnets ålder är vissa distraktionsmetoder mer effektiva än vad andra är. Två metoder som visat sig vara effektiva i alla åldrar är distraktion via PlayStation och DITTO. Slutsats: Tillämpning av distraktionsmetoder är ett effektivt sätt att reducera smärta och obehag hos barn som utsätts för medicinska undersökningar. Det finns ett stort antal metoder att välja mellan där många är effektiva. Med fördel används distraktioner med objekt eller elektronisk distraktion och med närvarande förälder. / Background: Many children experience medical procedures as something unpleasant and painful. The first visit a child has with healthcare can be crucial for how the child experiences the healthcare in the future, a negative first visit can lead to hospital-related fear even as an adult. To avoid this it is important that the child get a positive experience in relation to the visit. This can be accomplished with various distraction methods that exist to change the child’s experience and in that way reduce distress and pain.     Aim: To examine if distraction methods works at medical procedures to reduce suffering and distress in children receiving care within pediatric care, primary care and inpatient care. Method: A systematic literature review based on 10 quantitative articles from the databases PubMed, The Cochrane Library and Cinahl. Results: Distraction methods can be grouped into different subgroups based on type of distraction: distraction with action, distraction with object, distraction via adult and electronic distraction. This study shows that distraction generally is effective for reducing pain and distress in children during medical procedures. Depending on the child’s age, some distractions are more effective than others are. Two methods that appear effective in all ages is distraction via PlayStation and DITTO.  Conclusion: Appliance of distraction methods is an effective way to reduce pain and distress in children subjected to medical procedures. There are numerous methods to choose from where many are effective. Distractions with object or electronic distraction are effective as well as have parents presents.

No description available.

Bakgrund: Tillit är en grundläggande faktor inom pediatrisk omvårdnad, trots det finns endast sparsamt med samtida såväl som historisk forskning avseende begreppen tillit och tillitsskapande inom pediatrisk omvårdnad. Den sociala interaktionen, mötet, mellan barn och barnsjuksköterska utgör möjlighet att skapa tillit hos barn. Swanson’s omvårdnadsteori tycks kunna verka som guide i barnsjuksköterskans arbete med att skapa tillit. Syfte: Syftet med examensarbetet var att belysa barnsjuksköterskans erfarenheter av att i mötet med barn skapa en tillitsfull vårdrelation. Metod: För att besvara syftet användes kvalitativ metod med induktiv ansats. Datainsamling skedde genom semistrukturerade intervjuer vilka genomfördes digitalt. Barnsjuksköterskor (n=13), med arbetsplats i Sverige, rekryterades till studien genom bekvämlighetsurval. Data analyserades med hjälp av manifest innehållsanalys. Resultat: Analysen resulterade i skapandet av tre kategorier vilka belyser barnsjuksköterskans erfarenheter av att i mötet med barn skapa en tillitsfull vårdrelation; Barnsjuksköterskans strategier, Förutsättningar och Tillitens betydelse. Slutsats: Ärlighet framkom som en särskilt betydelsefull strategi för skapandet av en tillitsfull vårdrelation barn och barnsjuksköterska emellan. Föräldrarna ansågs vara en betydelsefull faktor för barns tillitsskapande gentemot barnsjuksköterskan och kunde påverka barns tillit både positivt och negativt. En tillitsfull vårdrelation anses kunna bidra till barns ökad hälsa. Vidare forskning av ämnet rekommenderas / Background: Trust is a fundamental factor in pediatric nursing, although it is only sparse with contemporary as well as historical research regarding the concepts of trust and trust building in pediatric nursing. The social interaction, the meeting, between the child and the pediatric nurse is an opportunity to create trust in children. Swanson's nursing theory seems to be able to act as a guide in the pediatric nurse's work to create trust. Aim: The aim of the degree project was to shed light on the pediatric nurse's experiences of creating a trusting care relationship in the meeting with children. Method:To reach the aim of the study, a qualitative method with an inductive approach was used. Data collection took place through semi-structured interviews which were conducted digitally. Pediatric nurses (n = 13), with a workplace in Sweden, were recruited for the study through convenience selection. Data were analyzed using manifest content analysis. Results: The analysis resulted in the creation of three categories which shed light on the pediatric nurse's experiences of creating a trusting care relationship in the meeting with children; The pediatric nurse's strategies, prerequisites and the importance of trust. Conclusion: Honesty emerged as a particularly important strategy for creating a trusting care relationship between child and pediatric nurse. The parents were considered to be an important factor in children's confidence in the pediatric nurse and could affect children's trust both positively and negatively. A trusting care relationship is considered to be able to contribute to chil

Abstract Introduction and Background Many people in the pediatric population are be brushed off and misdiagnosed when it comes to depression. I decided to research into pediatric depression and how the effects of their peers, parents, and exposure to violence correspond with depression and how it effects their daily life. Purpose Statement The purpose of this literature review is to systematically and critically appraise current literature to examine the associations between pediatric depression and sleep issues, exposure to violence, peer relationships, and parental criticism. Literature Review For this literature review I gathered a total of 5 articles which are included in this review. All the 5 articles are academic journals. These articles all come from CINAHL complete from the ETSU library database. Findings When the pediatric population is exposed to emotional abuse, emotional neglect, physical abuse, physical neglect, peer victimization and peer fighting, they were reported to have significantly greater depressive symptoms and hopelessness than the pediatric population who did not experience as much violence and neglect (Benton et al. 2020). Children who had preschool-onset major depressive disorder, after receiving parent-child interactive therapy with a focus on emotional development were found to experience a significant reduction in insomnia, daytime fatigue, and total sleeping problems (Hoyniak et al., 2020). There was also a strong correlation that the more parental criticism an adolescence receives, the higher the risk for major depression there is (Nelemans et al., 2020). The CLPM model indicated that depressive symptoms increased the risk for subsequent peer rejection consistently and peer acceptance mainly before eighth grade (Yang et al., 2020). And in the patients who came to the ER with non-psychiatric complaints, after screening for depression many of their results indicated a moderately-severe depression score which presents a need for additional help from a mental health care provider (Arrojo and Hooshmand, 2021). Conclusions Overall, there is a strong correlation between pediatric depression and sleep issues, exposure to violence, peer relationships, and parental criticism. The studies proved that the more parental criticism a child received, the more depressive symptoms they faced, as well as the more sleeping issues they experienced. The data also proved that in adolescence the influence of peers is strong and peer relationships have heavy influence on the depressive symptoms shown by adolescence. When children are exposed to a ‘web of violence’ they are also more inclined to experience depression and many children try to internalize their mental health issues to please their parents. There needs to be more general education about pediatric depression and more implementations of mandatory screenings added to the EHR. For many of these studies, if they were to be performed again, they would benefit from more diversity as well as larger sample sizes. This would provide a more generalizable set of data that could be applied in more places.

Clinical practice guidelines (CPGs) for Attention Deficit Hyperactivity Disorder (ADHD) recommend documentation of symptom scales and comorbidity screenings at the time of diagnosis and routinely throughout care. Rates of documentation for these tools in pediatric primary care are consistently low, creating a gap in care that impairs diagnosis, management, and patient outcomes. The purpose of this quality improvement project was to implement an online ADHD portal that emails, collects and scores these tools. The aims of the project are to improve utilization of CPGs by increasing documentation rates of symptom scales and comorbidity screenings for pediatric patients with ADHD. One primary care pediatrician located in Middle Tennessee piloted the project, with the goal to expand this practice change to additional partners in the future. Following submission to the IRB, the committee determined this type of quality improvement project to not require their oversight. A six-month retrospective chart review was conducted to determine baseline rates of documentation for the two outcomes. During the ten-week project, the portal was activated and evaluation tools were sent. A second chart review will be conducted at the conclusion of the project to determine if utilization of CPGs for the two outcomes has improved. Limitations included small sample size and accessibility barriers. The expected outcomes of this project include successful implementation of the online portal with improved rates of documentation for symptom scales and comorbidity assessments. This project could potentially improve CPG utilization and ultimately impact the quality of care for pediatric patients with ADHD.

Type 1 diabetes [T1D] is an autoimmune disease that presents in a pathophysiological disorder as insulin deficiency. Managing this illness during childhood is a constant challenge of maintaining blood glucose levels within a healthy range, resulting in increased stress for children and caregivers. School attendance is one factor that may result in increased stress. Studies have highlighted the fact that teachers of students with T1D may receive little education regarding management of the disease and may be required to make accommodations which can result in confusion, miscommunication, and increased psychosocial stress. The goal of this research was to learn about the experiences of teachers of students with T1D, what is expected of them, what resources they have, and factors which they perceive as barriers or facilitators to education for students with T1D. Semi-structured interviews were conducted with two high school teachers in East Tennessee who had experience teaching students with T1D. The results of the interviews showed that teachers receive limited education, that they are expected to make accommodations such as having snacks on hand and allowing extra access to phones, and that there are perceived barriers to education of individuals with T1D due to the possibility of life-threatening events. The teachers reported that school nurses are involved in the care of students with T1D. Limitations include that only two teachers were interviewed, and while the results are important to take into consideration, saturation was not reached. Future research could include more in-depth interviews or surveys with school nurses.