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.

Family Presence During Resuscitation (FPDR) remains controversial and is not consistently implemented during resuscitation events or invasive procedures. Evidence has demonstrated positive outcomes produced by implementation of FPDR; such as, decreased rates of post-traumatic stress symptoms, decreased symptoms of anxiety, and depressive symptoms were not significantly different. Unfortunately, use of FPDR in the acute care setting is not widely accepted or readily implemented. The primary purpose of this integrative literature review is to evaluate the use of FPDR in the acute care setting. The secondary purpose is to evaluate the health care professional's level of perceived value associated with the outcome of having family present during resuscitation. A systematic literature search was conducted using multiple databases for relevant articles in the English language between 2006 to 2017, including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Elton B. Stephens Co. Host (Ebsco Host), Medical Literature On-line (Medline), Psychological Information Database (PsychINFO), and PubMed. Search terms included 'family presence during resuscitation', 'family presence', 'pediatrics', 'nurse perceptions', and 'perceptions'. Ten of the nineteen articles suggest the use of FPDR leads to positive outcomes such as decreased post-traumatic symptoms, and decreased anxiety for family members. The use of FPDR can enhance family members' understanding of resuscitation efforts and involves them in their loved one's care. This integrative review indicates the implementation of FPDR can provide benefits for family members of those undergoing CPR and invasive procedures; although the perceptions of the healthcare team remain the barrier to its use.

The Rural Expansion Program for At-risk Communities to Promote Health Outcomes through the Integration of Mental health and Enabling services in an Existing Primary Care School-Based Setting (REACH ME) program was established to increase access to mental health services at two existing school-based health centers (SBHC) in rural Hancock County, TN. These SBHCs are among the most unique in the nation, holding designations as federally funded qualified health centers - proving primary care services in a geographically isolated, rural, and medically underserved area. The aim of the project is increasing the number of patients receiving mental health and enabling services for not only the children and adolescents of Hancock County, but also adults who use the clinic for primary care services. This project employs a secondary data analysis to determine if there is an increase in the use of mental health services by patients using a school-based health center for care. Variables include number of visits, screening employed, and mental health diagnosis. Data gathered by health center staff and input into Excel will be used. Data collection is ongoing and is expected to be completed in February 2024. Early results indicate an increase in mental health and enabling services from initiation of the project. There were identified facilitators and barriers that impacted the project. Significance for this project is two-fold, identified facilitators and barriers to initiating integrated mental health services in the SBHC setting and increasing early screening, identification, referral and treatment of rural populations with mental health problems.

Bakgrund: Preoperativ oro förekommer hos över hälften av alla barn som ska genomgå kirurgiska ingrepp. Oron inför den kommande operationen orsakar ett stort lidande för barnet. Detta kan orsaka både fysiologiska och psykologiska symtom till följd av oron. Dessutom får dessa barn en ökad risk för postoperativa komplikationer, vilket innebär fortsatt lidande för barnen men även en ökad belastning för sjukvården. Lekterapi har visat ha en lindrande effekt på känslor hos barn och därför syftar denna studie på att undersöka om lekterapin även kan lindra den preoperativa oron.  Syfte: Detta arbetets syfte var att undersöka om lekterapi har effekt på preoperativ oro hos barn i åldrarna 0-18 som ska genomgå kirurgiska ingrepp.  Metod: En litteraturstudie gjordes med en deskriptiv design med en kvantitativ ansats. Denna studie baserades på 11 experimentella kvantitativa studier som undersökte lekterapins effekt på preoperativ oro. Artiklarna kvalitetsgranskades utifrån Fribergs granskningsmall.  Resultat: Studien använde Popenoe et al.s guide för dataanalys och resultatet delades in i tre kategorier: terapeutisk lek, teknologisk lek och strukturerad lek. Gemensamt för alla tre kategorier var att de visade på en reducerande effekt på preoperativ oro hos barn.  Slutsats: Lekterapi verkar ha en reducerande effekt på den preoperativa oron hos barn. Vilken typ av lek som lekterapin baseras på tycks inte påverka effekten av interventionen. Lekterapi bör därmed kunna användas som preoperativ förberedelse av barn i kombination med den rutinmässiga förberedelsen. / Background: Preoperative anxiety is prevalent in over half of all children undergoing invasive procedures. This may cause great suffering for the child which can lead to both physiological and psychological symptoms. Additionally these children face an increased risk of postoperative complications, which only leads to more suffering for the children but also an additional burden on the healthcare system. Studies have shown that play therapy has an alleviating effect on emotions in children, therefore this study aims to explore if play therapy also could have an alleviating effect on preoperative anxiety. Aim: To examine play therapy’s effect on preoperative anxiety in children undergoing invasive procedures.  Method: A literature review using a descriptive design with a quantitative approach. This study was based on 11 experimental quantitative studies examining the effect of play therapy on preoperative anxiety. The articles were reviewed based on Friberg’s quality review template. Results: This study used Popenoe et al.’s guide for data analysis and the results were categorized into three groups: therapeutic play, technological play and structured play. Common across all three categories was that they showed a reduction in preoperative anxiety in children.  Conclusion: Play therapy appears to have an alleviating effect on preoperative anxiety in children. What type of play that was carried out in play therapy does not seem to matter. Therefore, play therapy should be considered as part of the preoperative preparation for children, in conjunction with general surgery preparation.

Sammanfattning Bakgrund: Omvårdnadens ansvarsområden är att främja hälsa och förebygga sjukdom. Trots att barn med intellektuella funktionsnedsättningar har likvärdiga rättigheter till vård visar internationella studier på brister i anpassad vård. Sjuksköterskor tycker ofta att det är svårt, utmanande och tidskrävande att ta hand om dessa barn. God omvårdnad bygger på att främja goda relationer mellan barnen, deras föräldrar och vårdpersonal. Syfte: Att beskriva specialistsjuksköterskors erfarenheter av att möta barn med intellektuell funktionsnedsättning på barnklinik.  Metod: En kvalitativ intervjustudie med induktiv ansats genomfördes med 14 specialistsjuksköterskor från två barnkliniker omfattande både slutenvårdsavdelningar och öppenvårdsmottagningar. Analysen genomfördes utifrån kvalitativ manifest innehållsanalys enligt Graneheim & Lundman. Resultat: Datainsamlingen resulterade i två kategorier, med tillhörande underkategorier. Den första kategorin beskriver att det krävs en individanpassning för att mötet ska bli bra, där relationsskapande och anpassning av kommunikation har stor betydelse. Den andra kategorin beskriver att omgivningsfaktorer har betydelse för mötet, där förberedelser och föräldramedverkan är viktiga komponenter för barnets trygghet. Även kunskap och erfarenhet hos specialistsjuksköterskan är av betydelse.  Slutsats: Studien visar vikten av att specialistsjuksköterskan individanpassar mötet med barn med intellektuell funktionsnedsättning. Med hjälp av en personcentrerad omvårdnad kan barnets individuella behov tillgodoses. Nyckelord: Intellektuell funktionsnedsättning, pediatrisk omvårdnad, personcentrerad omvårdnad, specialistsjuksköterska. / Summary Background: Nursing's responsibilities encompass promoting health and preventing disease. Despite children with intellectual disabilities having equivalent rights to care, international studies reveal care adaptation shortcomings. Nurses often find providing care for these children difficult, challenging, and time-consuming. Effective nursing relies on fostering good relationships between the children, their parents, and nursing staff. Purpose: To describe specialist nurses experiences of meeting children with intellectual disabilities at a child´s clinic.  Method: A qualitative interview study with an inductive approach was conducted, with 14 specialist nurses from two children´s clinics covering both inpatient and outpatient care. The analysis was conducted using qualitative manifest content analysis, according to Graneheim & Lundman.  Results: The data collection resulted in two categories, with associated subcategories. The first category describes that individual adaption is required for the meeting to be good, where relationship building, and adaption of communication are of great importance. The second category describes that environmental factors are important for the meeting, where preparations and parental involvement are important components for the child´s safety. The specialist nurse´s knowledge and experience are also important.  Conclusion: The study shows the importance of the specialist nurse individually adapting the meeting with children with intellectual disabilities. With the help of person-centred care, the child's individual needs can be met.    Key words: Intellectual disability, pediatric nursing, person-centered care, specialist nurse

Bakgrund: Enligt familjemedlemmars erfarenheter upplevs det som en svårare situation när ett barn i familjen är i behov av palliativ vård jämfört med en vuxen person. Ett barn som är i ett livshotande tillstånd kan medföra stora förändringar i relationerna i familjen, då rollerna i familjen ändras och konflikter i familjen kan uppstå.  Syfte: Syftet var att beskriva familjers erfarenheter av att ett barn i familjen får palliativ vård.  Metod: En litteraturstudie där kvalitativ metod använts och åtta artiklar har analyserats. Resultat: Analysen av de åtta artiklarna resulterade i tre huvudkategorier och nio underkategorier. Huvudkategorierna var: Att hantera liv och död, familjens upplevelse av utsatthet och förändringar i familjens dynamik.  Konklusion: Resultatet i denna litteraturstudie visar att när ett barn i familjen får palliativ vård påverkas hela familjen. Familjen utsätts för många negativa situationer och känslor som sorg och rädsla över att förlora barnet. Resultatet visar också att familjemedlemmarna använder sig av olika strategier för att orka med och klara av den svåra situationen de befinner sig i. / Background: According to family members experience it is harder when a child inthe family is in need of palliative care compared to an adult. A child with a lifethreateningcondition can bring big changes within the family relationships since theroles in the family changes and conflicts appear. Aim: The aim of the study was to describe families’ experience of having a child inthe family who is in need of palliative care. Methods: A qualitative literature study was used, and eight qualitative articles werereviewed and analysed. Results: The analysis of the eight articles resulted in three main categories and ninesubcategories. The main categories were: To handle life and death, the family'sexperience of exposure and changes in the family dynamics. Conclusion: The results in this literature study shows that when a child in thefamily is in need of palliative care the entire family is affected. The families areexposed to many difficult situations and feelings like grief and fear of losing the child.The result also shows that the family members use different kinds of strategies tocope with the difficult situation they are living in.Keywords: Families

Malaria is endemic in Uganda. The study attempted to determine how Ugandan caregivers managed home-based care of fever. Structured interviews were conducted with sixty caregivers of children under five. In 15 (25.0%) out of the 60 interviewed households, at least one child had reportedly died from malaria. Caregivers’ decisions were influenced by health education, family members, community leaders and other caregivers. Most caregivers knew about malaria, but lacked knowledge about its danger signs, and about the services of village drug distributors. Most caregivers initiated treatment for fever at home before taking the children to health units. Mosquito nets, indoor residual spraying and other malaria preventive measures were rarely used due to lack of funds. The recommendations include that anti-malaria drugs should always be available and accessible, the services of village drug distributors should be improved, health education should be enhanced, malaria preventive measures should be implemented and sustained. / Health Studies / M.A. (Public Health)