STARTING POINT: The presence of ADHD symptoms is one of the possible causes of risky behavior. Adolescent risk behaviors bring many challenges that can affect the quality of future life. One of the consequences of risky behavior may be to place a teenager in institutional care. OBJECTIVES: The aim of this diploma thesis is to describe in detail the occurrence of risk behavior in the children's home with the school and then to look into the possible occurrence of symptoms of ADHD. Consequently, we will attempt to characterize the risk behavior of children in institutional care by gender, age and educational program. METHODS: The data were obtained using questionnaire methods, for the presence of the ADHD symptoms the BRIEF questionnaire was used (Gioia et al., 2011). The VRCHA questionnaire the occurrence of risk behavior in adolescents (Dolejš & Skopal, 2015) was used to map the occurrence of risk behavior. The data was also obtained with the study of the documentation, when we worked with existing documents, the subject of the examination was the report of the respondents. RESULTS: The most common risk behavior in children's homes with the school is delinquency and abuse of addictive substances. Risky behavior is more common among girls than among boys in a children's home with a school....

This diploma thesis deals with the possibilities of further education in the agencies of domiciliary care. This is a very current topic. Like any other profession, the nursing profession requires a particular education. The development of the new methods in the medical treatment and home care demands more thorough and specialised education of the nurses employed by the domiciliary-care agencies. The aim of the thesis was to find out the present situation of the nurses´ education in the domiciliary-care agencies, the professional specialisation of nurses, the possibilities of education, the nurses´ need of further education and the employers´ willingness to enable the nurses of the agencies to take part in the further education in their field. It can be said that the aims of the research have been fulfilled.

Congestive heart failure (CHF) is a disease with increasing incidence, which requires an adequate and costly management. Repeated hospitalisations due to decompensated CHF contribute to disease progression and herald dismal prognosis. An important goal of heart failure clinics is reduction in number of hospitalizations due to decompensated CHF. The main approaches to reach this aim seem to be effective diagnostics and treatment of CHF, and importantly, education of patients and their families. We aimed to evaluate knowledge of CHF patients regarding self-care in secondary prevention of CHF. We constructed three hypotheses and three research questions to reach the goal of the project. The theoretical part described recommended life-style interventions, pharmacologic and non-pharmacologic CHF management, and specifically, the role of nurses in education of patients with CHF. The practical part described the methods of analysis, the study group and the process of evaluation. To fulfil the study goal, we performed collection of data using qualitative and quantitative methods of research. The qualitative part of the research project included a non-standardized questionnaire for patients with CHF. A total of 260 questionnaires were distributed in six heart failure clinics. 183 completed questionnaires were returned and analysed. The obtained data were evaluated using descriptive statistical methods. Pearson´s chi-test and Student´s t-test were applied to test the hypotheses. Collection of qualitative data was performed using the technique of a semi-structured interview based on pre-prepared questions. The study respondents included general nurses from out-patient heart failure clinics. Six of nine contacted nurse respondents agreed to participate. Answers were recorded on Dictaphone. Data were analysed using the method of "card display". The quantitative part tested the following hypotheses: 1. CHF patients know symptoms and signs of decompensated CHF. 2. CHF patients follow the life-style recommendations. 3. CHF patients perform daily self-monitoring of their weight, blood pressure and pulse. Our study revealed insufficient knowledge of patients regarding symptoms of possible CHF decompensation. This finding was alarming because suboptimal knowledge of symptoms of decompensated CHF may cause inadequate response of the patient and may delay initiation of treatment. Assessment of compliance with life-style measures revealed that most patients did not use tobacco products and had a limited alcohol consumption. Most individuals reported a regular use of heart failure medication and knew the timing of the next follow-up in their heart failure clinic. Life-style measures included also some dietary restrictions modified by the current nutritional status. Respondents preferred recommended food over inappropriate foodstuffs, however, they did not follow neither the salt restriction nor the optimal frequency of meals. Most respondents did not report a regular exercise A significant ignorance was found in the process of self-monitoring. Most respondents did not monitor their body weight, blood pressure and pulse. The qualitative assessment evaluated the following questions: 1. Do we educate the CHF patients appropriately? 2. Are we able as nurses to pass correct information to CHF patients? 3. How is the process of education implemented in practice? Based on the above mentioned methods, we found that the process of education is a domain of doctors. Nurses have only a limited role in education of CHF patients...

The topic of the thesis Nursing Care of Newborns in the Process of Perioperative Care deals with specific and distinct features of such care from the viewpoint of nursing. The main objective was to specify all tasks of nurses in the process of perioperative care and the procedures they use. Last but not least, we focused on how the nursing care differs with regard to the age of newborns. The selected research method was qualitative research using semi-structured interviews with nurses from perinatology centers. The research covered 10 respondents with various levels of education and lengths of practical experience. Nurses most frequently understand the term of perioperative care as the care provided before, during and after a surgery. Most of them actually perform preparation of the child before the surgery and then they provide postoperative care. Only 2 out of the 10 respondents are directly involved in the surgery procedure and thus accompany the newborns throughout the entire process of perioperative care. The care provided before the surgery most often includes identification of the child, checking of its vital functions, involvement in blood collection, including intravenous cannulation, administration of prescribed medication, preparation of the surgical site and communication with the parents. Children are most frequently accompanied by their mothers and nurses need to communicate with them. Nurses transport the child to the operating room, hand the child over and subsequently take it back after the surgery. They also record all those activities in the medical files and in some cases they check signed informed consents. Intraoperative care consists mainly of monitoring of the newborn, assisting to the physician in airway management - intubation and during the entire surgery procedure. The most common surgical procedures performed in children are hernia, bowel and heart surgeries. The nurses also generally mentioned surgeries of developmental disorders. After the surgery nurses usually move the child to the neonatology intensive care unit which is equipped with a ventilator, incubator and all types of medication. They regularly check and record child´s vital functions, monitor the surgical wound and its proximity, intake and excretion, they provide nutrition etc. Nurses also assess the pain, most frequently using the NIPS scale, and they educate the parents. Post-surgery complications occur only sporadically and they include infections, bleeding or abstinence syndrome after administration of opiates. The collected data have shown only one difference relating to the age of newborns who underwent a surgery. Specifically, certain surgeries, e.g. of necrotic enterocolitis, are performed more frequently on less mature newborns. In general, most of the surgeries are performed on prematurely born neonates and extremely immature neonates. When asked what they would like to change or improve in the perioperative care from the nursing point of view the nurses primarily mentioned more contacts between the mother and child and consistent compliance with aseptic procedures. The responding nurses were mostly content, they praised the highly specialized care and the good cooperation between the nursing team and the medical team which consists of pediatricians and specialists. Results of those teams thus contribute to continually decreasing mortality rate of high-risk and pathological newborns and to better quality of life of those children after the surgery.

The aim of the study is to gain insight into Swedish preschool pedagogues’ conceptualization who work with a special outdoor learning concept, of including children with special needs within their groups. Sweden is a country which is famous for its “education for all” policy, however there is a little to know about the presence of children with special needs in the preschool setting. Children with special needs often risk being isolated as a result of limitations in the number of activities available for them in school. Although various studies examined both the effect of time spent outdoors, both inclusion’s positive effect on children with special needs. Interviews were conducted with four preschool pedagogues who work in the i Ur och Skur preschool, the outdoor education approach popular in Scandinavia. Sociocultural theory was applied as a conceptual framework for analysis of the interview transcripts. The pedagogues demonstrated to support inclusion of children with special needs in preschool activities. The pedagogues showed more willingness to include children with cognitive impairment or neurodevelopmental disorders, than with physical disabilities. Among their concerns, issues of safety, weather and the outdoor activities potential for highlighting differences in skills and abilities (mostly physical) were mentioned. In order to adapt the settings and practices to be more inclusive for children with special needs, pedagogues proposed including extra personnel to provide assistance.

Trata-se de um estudo de abordagem qualitativa, que teve como objetivos descrever as características socioculturais, familiares, domiciliares e capacidade para o autocuidado de estomizados cadastrados na Secretaria de Saúde de uma cidade do interior paulista; avaliar a condição clínica do estomizado em relação à estomia e os equipamentos utilizados; e planejar, implementar e avaliar a educação em saúde sobre o autocuidado de estomizados intestinais, com a estratégia do Método do Arco, fundamentado na Pedagogia da Problematização. Utilizou-se o referencial teórico da Pedagogia da Problematização e o método etnográfico para o desenvolvimento do estudo com pacientes cadastrados na Secretaria de Saúde para aquisição de equipamentos coletores para estomia intestinal e urinária, em uma cidade paulista, com participação em três etapas distintas do estudo. Na primeira etapa do estudo foi realizada a avaliação domiciliária, o uso de equipamentos coletores e a capacidade para o autocuidado, cujos dados foram coletados no domicílio com instrumento de avaliação do domicílio e observação participante, com participação de 52 pessoas com estomia intestinal e urinária, durante os meses de setembro e outubro de 2012. Nesta etapa, a média de idade foi de 37 anos, houve predomínio da casa própria, com saneamento básico, uso do convênio de saúde público, a maioria realiza o autocuidado com estomia e equipamentos, mudanças na alimentação e vestuário. Na segunda etapa participaram 19 estomizados intestinais e urinários, que foram avaliados com utilização de um instrumento de avaliação clínica contemplando dados sociodemográficos, clínicos e terapêuticos; curativo e ferida cirúrgica, autocuidado com a estomia e equipamentos; e capacidade para o autocuidado e com a observação participante das pesquisadoras, no período de 30 de outubro a 01 de novembro de 2012. Nesta etapa, participaram 10 homens e 9 mulheres, com média de idade de 54 anos, predominando aposentados, até oito anos de estudos, renda até dois salários mínimos, responsáveis pela manutenção financeira da família. Na terceira etapa, foi desenvolvida a atividade educativa com 10 estomizados intestinais no domicílio, com a estratégia do Método do Arco para o ensino do autocuidado com estomia intestinal e equipamentos, observação participante, diário de campo e gravação em áudio das entrevistas semiestruturadas com os participantes sobre o aprendizado alcançado por cada um destes, no período de novembro de 1012 a fevereiro de 2013. A atividade educativa foi com duas visitas domiciliares para sete participantes e de quatro a nove visitas para os outros participantes, todos passaram a realizar o autocuidado da estomia e do equipamento coletor e foram unânimes em relação aos benefícios desta aprendizagem na melhoria da autoestima e autonomia, com retomada das atividades cotidianas. Acreditamos que os resultados deste estudo contribuirão na melhoria do ensino de autocuidado de estomizados intestinais / This is a qualitative study that aimed to describe the socio-cultural characteristics, family, household and capacity for self-care of ostomy patients registered at the Secretariat of Health of a city in the state of São Paulo; assess the clinical condition of the ostomy patients in relation to the ostomy and the equipment used, and plan, implement and evaluate health education on self-care of intestinal ostomy patientes, with the strategy of the Arc Method, based on problem-solving pedagogy. The theoretical framework of the Curriculum and Pedagogy ethnographic method were used for the development of the study of patients enrolled in the Health Department to purchase equipment for collectors and urinary ostomy in a city in the satate of São Paulo, with participation in three distinct stages of the study. In the first stage of the study the home care was evaluated, the use of collection equipment and the ability for the self-care, data were collected at home with the resident assessment instrument and participant observation, with the participation of 52 people with urinary and intestinal ostomy during the months of September and October 2012. At this stage, the average age of the patients was 37 years old, there was a predominance of home ownership, with sanitation, use of public health plan, the majority performs self-care with ostomy equipment and reported changes in food and clothing. In the second stage 19 intestinal and urinary ostomy patients were involved, they were evaluated with the use of a clinical assessment instrument covering socio- demographic, clinical and therapeutic, curative and surgical wound, ostomy and self- care with the equipment, and capacity for self-care and observation participant of the researchers in the period from October 30 to November 1, 2012. At this stage, 10 men and 9 women were attended, with the average age of 54 years old, especially retired patients, to eight years of study, receiving up to two minimum wages, responsible for the maintenance of the family. In the third stage, the educational activity was developed with 10 intestinal ostomy patients at home, with the strategy of the Arc Method to teach the self-care and ostomy equipment, participant observation, field diary and audio recording of the semi-structured interviews about the learning achieved by each one of them, from November 2012 to February 2013. Educational activity was done with two visits to seven patients and four to nine visits to other patients, all of them began to perform self-care and ostomy equipment collector and were unanimous regarding the benefits of this learning to improve self- esteem and autonomy, with resumption of daily activities. We believe that the results of this study will contribute to the improvement of the teaching self-care of intestinal ostomy

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T14:30:30Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_ElisianeQuatrinBeck.pdf: 5667398 bytes, checksum: 447ec5f8c89daab9aa4d0fe864873044 (MD5) / Made available in DSpace on 2018-08-22T14:30:30Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_ElisianeQuatrinBeck.pdf: 5667398 bytes, checksum: 447ec5f8c89daab9aa4d0fe864873044 (MD5) Previous issue date: 2017-12-04 / Introduction: Syphilis remains a serious public health problem, with increasing numbers of cases in pregnant women and their partners, which favors the increase of congenital syphilis. This fact demonstrates the need for more effective prevention strategies. Congenital syphilis generates a high financial cost for the health system, besides a great social impact related to the sequels of the disease. Besides these factors, they cause emotional shock to the mothers of newborns with congenital syphilis, justifying the research in this area. Goals: Understanding maternal perceptions of congenital syphilis and the health care of these newborns. As specific objectives: To identify the knowledge of the mothers of newborns with congenital syphilis about the disease; To know the care of the mothers of newborns with congenital syphilis in relation to treatment and monitoring; Creating informational material on congenital syphilis and other Sexually Transmitted Infections, as well as health problems and care of these newborns. Meth-odology: This is a qualitative research of a descriptive nature, developed in a medium-sized hospital in the city of Paranoa / DF, in the period from March to August 2017. Fifteen women, mothers of newborns with congenital syphilis who were in the treatment phase of their children in the hospital's maternity ward participated of the research. Results: The data showed that the interviewees had unfavorable social conditions. Although it is not a disease restricted to the less favored layers, these results indicate a higher social and reproductive vulnerability of these women. The participants of the study reported the performance of prenatal care in the appro-priate period, that is, in the first trimester. Although the data points to an adequate prenatal search, a favorable outcome of syphilis treatment was not assured, generating the diagnosis of Congenital Syphilis in the baby. The complexity of the treatment for congenital syphilis, added to the lack of knowledge about the disease, may explain the limitation of who have recently given birth regarding comprehension and feelings. Product: Booklet with information on Con-genital Syphilis and other Sexually Transmitted Infections to support mothers and their part-ners as well as sexually active adults with the aim of reducing new cases of congenital syphilis and other Sexually Transmitted Infections. Final considerations: With the accomplishment of this work, it was realized that for a better understanding of the measures to prevent the conse-quences of Congenital Syphilis, changes in attitude are necessary in health services. Initially it is suggested that the changes involve proactive actions by the public health system and health professionals. The context of the Network of Health Care can broaden its vision regarding social, economic and health education actions. In this way we can contribute more effectively to achieve better results in the index of cases of congenital syphilis in Brazil. / Introdução: A sífilis permanece como um sério problema de saúde pública, com números crescentes de casos em gestantes e seus parceiros, o que favorece o aumento da sífilis congênita. Esse fato demonstra a necessidade de estratégias de prevenção mais efetivas. A sífilis congênita gera um alto custo financeiro para o sistema de saúde, além de um grande impacto social relacionado às sequelas da doença. Além desses fatores, acarreta abalo emocional às mães de recém-nascidos com sífilis congênita, o que justifica a realização da pesquisa nessa área. Objetivo geral: Compreender as percepções maternas sobre sífilis congênita e os cuidados de saúde dos recém-nascidos com a doença. Como objetivos específicos: Identificar o conhecimento das mães de recém-nascidos portadores de sífilis congênita acerca da doença; Conhecer o cuidado das mães de recém-nascido portador de sífilis congênita em relação ao tratamento e acompanhamento; Criar material informativo sobre sífilis congênita e outras Infecções Sexualmente Transmissíveis, bem como agravos e cuidados à saúde dos recém-nascidos com a doença. Metodologia: Trata-se de pesquisa qualitativa de caráter descritivo, desenvolvida em Hospital de médio porte da cidade satélite Paranoá/DF, no período compreendido entre os meses de março a agosto de 2017. Fizeram parte da pesquisa 15 mulheres, mães de recém-nascidos com sífilis congênita, que estavam em fase de tratamento de seus filhos na maternidade do referido hospital. Resultados: Os dados evidenciaram que as entrevistadas possuíam condições sociais desfavoráveis. Embora não seja uma doença restrita às camadas menos favorecidas, esses resultados sinalizam maior vulnerabilidade social e reprodutiva dessas mulheres. As participantes da pesquisa relataram a realização de pré-natal no período adequado, ou seja, no primeiro trimestre. Embora os dados apontem para uma busca adequada pelo pré-natal, não foi assegurado um desfecho favorável do tratamento da sífilis, gerando o diagnóstico de Sífilis Congênita no bebê. A complexidade do tratamento para sífilis congênita, somada ao desconhecimento sobre a doença, podem explicar a limitação das puérperas quanto à compreensão e sentimentos. Produto: Cartilha com informações sobre Sífilis Congênita e outras Infecções Sexualmente Transmissíveis, visando servir de apoio para orientação das mães e seus parceiros, bem como adultos sexualmente ativos, com o intuito de reduzir novos casos de sífilis congênita e outras Infecções Sexualmente Transmissíveis. Considerações finais: Com a realização deste trabalho, percebeu-se que, para uma melhor compreensão das medidas de prevenção das consequências da Sífilis Congênita, são necessárias mudanças de atitude nos serviços de saúde. Inicialmente, sugere-se que as alterações envolvam ações proativas por parte do sistema de saúde pública e dos profissionais de saúde. O contexto de Rede de Atenção à Saúde pode ampliar sua visão quanto aos aspectos sociais, econômicos e nas ações de educação em saúde. Dessa forma, será possível contribuir mais efetivamente para alcançar melhores resultados no índice de casos de sífilis congênita no Brasil.

O atendimento á infância na maioria dos países ocidentais encontra-se ainda em estágio crítico. Os serviços oferecidos são fragmentados, inflexíveis, incoerentes e segregados, refletindo cisão entre as ações de cuidar e educar a criança pequena. Essa tese é o resultado de um longo percurso em busca de possíveis determinantes desse quadro e de elementos que pudessem conformar um modelo de atendimento unificado e responsivo às necessidades, interesses e potencialidades das crianças e suas famílias. Assim, um modelo de sistema unificado de cuidado e educação infantil foi sendo construído a partir de premissas lançadas em estudo anterior (Haddad, 1991) e ampliado com visitas de estudo a países da Europa ocidental, o contato com o trabalho desenvolvido pela Rede Européia de Atendimento Infantil e, mais especificamente, o conhecimento dos sistemas de atendimento infantil dos países escandinavos. Partindo do pressuposto de que um sistema unificado de atendimento infantil deve apoiar-se numa perspectiva de desenvolvimento humano, suficientemente ampla para incluir as forças provenientes dos ambientes sociais, econômicos e culturais que afetam o desenvolvimento, a teoria ecológica do desenvolvimento humano de Urie Bronfenbrenner (1996) passou a constituir-se a referência básica desse estudo. As informações reunidas nesse trabalho assinalam a coerência entre os aspectos filosóficos, políticos e práticos, a responsabilidade partilhada entre família e poder público, unidade de objetivos e funções, profissionalização, universalização do atendimento, diversidade, continuidade e flexibilidade nos serviços oferecidos como as principais características que compõem um sistema unificado de cuidado e educação infantil. / In most Western countries, the public child care is still in a critical stage. The services offered are fragmented, inflexible, incoherent and segregated, reflecting the division between care and education of young children. This thesis is the result of a long search for possible determinants of this picture and for elements that could comply with a unified model for child care and early childhood education that would meet the needs, interests and potentialities of children and their families. Hence, a model for unified system of care and education has been constructed from the premises launched in previous study (Haddad, 1991) and has been enlarged by study visits to Western European countries, the contact with the work developed by the European Childcare Network, and more specifically, by learning about the Scandinavian child care systems. Starting from the presupposition that an integrated system of care and education must be supported by a broad perspective of human development which includes the strengths forthcoming from social, economic and cultural environments that affect the development, the ecology of human development of Urie Bronfenbrenner (1996) became the basic reference to this study. The data gathered in this work signalizes the main characteristics of a unified system of care and education for young children: the coherence between philosophical, political and practical aspects; the shared responsibility between family and public power; the unity of objectives and functions; professionalism; universal aims, diversity, continuity and flexibility in the services offered.

This diploma thesis deals with the analysis of parental competence of mothers with psychiatric disorder, with an emphasis on the difficulties such diagnosis can have on the family's functionality. The most severe, in practice, seems to be the necessity to place the children in institutions, away from their families, in cases where no other family member can take care of these children during the mother's absence as a result of the attack. Due to the nature of the disorder, periodicity can be expected, which significantly disturbs the child's development and relationships within the family. The real impact was observed in the empirical part via a case study focusing on six families that have a mother diagnosed with a psychiatric disorder. The needs of these families were mapped through interviews and were later compared to the current offer of non-profit organizations. The results were used to find out, which services are offered and in which areas do these families require support. Due to the nature of this problem and the necessity for systematic solution when it comes down to the provided psychiatric care, I reached out to the current Minister of Health, who commented on the present situation. The presumption that the biggest impact is observed in families with single mothers proved to be right,...

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