Background: One in five households has a child with special health care needs (SHCN). Such parents report poorer mental health, greater depressive symptoms, and more restrictions in instrumental activities of daily living (IADL). The quality of mental and physical health of all family members' continuingly declines. Objectives: To evaluate the effects of the current ITK Healing Retreat Week program on familial well-being via introduction of CAM methods through assessment of 1) mood based on affect 2) self-efficacy 3) changes in coping skills 4) growth over time in parents/caregivers who have children with SHCN. Methods: A secondary analysis of data from sixteen parents/caregivers who participated in the ITK Healing Retreat Week July 13-19, 2014. Scores from Positive and Negative Affect Schedule (PANAS) with Serenity subscale, Post Traumatic Growth Inventory (PTGI), and Self-Efficacy Scale (SES) were analyzed using SPSS. Content analysis was performed on open-ended questions from post, three and six-month post retreat questionnaires. Results: Before to immediately after the retreat week there was a statistically significant decrease in negative emotions and increase in positive mood state, ability to feel calm/at peace, relate to others, see new possibilities, and confidence in ability to perform certain care needs (<.001). From post to three-month post retreat the families' confidence in ability to perform certain care needs did not change (<.001), but declined from three to six month post retreat in a statistically significant manner (.044). Content analysis indicated that the biggest benefit for the families was being in a supportive community and having an increase in positive emotional states. At six-months post retreat an increase in receptivity was additionally reported. Conclusion: The ITK Healing Retreat Week program positively impacted families who have children with SHCN in multiple positive ways: increased mood, more confidence, ability to relate better to others and ability to see new possibilities. In effort to make this program generalizable or even replicable, further research needs to be done on the mechanism of change, the structure that creates this change, and how to make such a change sustainable by investigating a new retreat format and alternative research tools, questions, and scales.

SAMMANFATTNING Syfte: Att studera föräldrars upplevelse av att kunna tolka sitt barns behov och mående samt upplevda kompetens i föräldrarollen efter att barnet har vårdats på neonatalavdelning. Metod: En jämförande kvantitativ studie med deskriptiv explorativ design som är en del av ett större projekt som genomförts vid två neonatalavdelningar i Sverige. En vecka efter barnets utskrivning från neonatalavdelningen samt vid två månaders korrigerad ålder fick barnets mamma och pappa varsin enkät, innehållande bland annat en föräldra-attitydskala, hemskickad. Insamlade data matades in i Statistical Package for the Social Sciences (SPSS) och redovisades med deskriptiv (md; median och range; minimum och maximum) och jämförande statistik (Chi-2-test och Mann-Whitney U-test). Resultat: En enda signifikant skillnad kunde ses mellan de två neonatalavdelningarna och det gällde föräldrarnas upplevelse att barnet tyckte om kontakt från dem i form av deras doft. På neonatalavdelning 2 svarade föräldrarna i högre grad att detta påstående stämde en vecka efter barnets utskrivning från neonatalavdelningen. Inga andra signifikanta skillnader ses vid jämförelsen av föräldrarnas enkätsvar från de två neonatalavdelningarna. Slutsats: Den enda signifikant skillnad som kunde ses anses av flera orsaker inte vara av särskilt hög betydelse. Följaktligen kan inga väsentliga skillnader ses mellan föräldrarnas upplevelse av sitt barns behov och mående samt upplevda kompetens i föräldrarollen beroende på om barnet vårdats på en neonatalavdelning där föräldrarna fick bo med sitt barn under hela vårdtiden och tidigt involveras i sitt barns vård eller om barnets vårdats på en neonatalavdelning med mindre föräldranärvaro. / ABSTRACT Aim: Studying parents' experience of being able to interpret their child's needs and well-being, and perceived competence in parenting after the child has been cared for in the neonatal unit. Method: A comparative quantitative study with a descriptive exploratory design that is part of a larger project conducted at two neonatal units in Sweden. A week after the child's discharge from the neonatal unit and at two months' corrected age, the child’s mother and father received a questionnaire sent to their home, containing among other things a parental attitude scale. Collected data were fed into the Statistical Package for the Social Sciences (SPSS) and presented with descriptive (md; median and range; minimum and maximum) and comparative statistics (Chi-2 test and Mann-Whitney U test). Results: Only one significant difference was seen between the two neonatal wards and it was regarding the parents' experience that the child enjoyed contact from them in terms of their fragrance. In the neonatal unit 2 parents agreed to a greater extent that this claim was true a week after the child's discharge from the neonatal unit. No other significant differences were seen when comparing the parents' questionnaire responses from the two neonatal wards. Conclusion: The only significant difference that was found was for several reasons not considered to be of very high importance. Consequently, no significant differences was found between the parents perception of their child's needs and well-being, and perceived competence in the parental role, depending on whether the child received care in a neonatal unit where the parents were allowed to stay with their child throughout the whole hospital stay and early get involved in their child's care or if the child was admitted to a neonatal unit with less opportunity for parental presence.

Autism spectrum disorders (ASDs) are chronic and pervasive developmental disorders; children with ASDs require more multidisciplinary services than children with other developmental, behavioral, and emotional disorders (Kogan et al., 2008). Little research has been done on the practices and perspectives of the professionals providing services to children with ASDs. Evidence-based practice (combining use of evidence-based interventions [EBIs], family-centered care [FCC] respecting patient/family values, and clinical expertise) leads to the best outcomes for children with ASDs (APA Presidential Task Force on Evidence-Based Practice, 2006). The aim of this study was to assess the extent to which psychological constructs (attitudes, subjective norms, perceived behavioral control) within the Theory of Planned Behavior (Ajzen, 1991) are helpful for understanding the behavior of professionals in regards to two areas of evidence-based practice: recommending and/or providing EBIs and using a FCC approach to care with children with ASDs. Professionals (N=709) providing direct services to children with ASDs were recruited from different disciplines (Education, Medicine/Nursing, Occupational and Physical Therapy, Psychology, Social Work, Speech Language Pathology/Audiology) and were asked to fill out an Internet or paper survey including measures on TPB constructs and EBI and FCC behavior. Participants were recruited from a convenience Internet sample and a stratified random sample of online provider listings (from professional and autism-specific organizations). Professionals’ attitudes and familiarity with EBIs significantly predicted their self-reported recommendation and provision of EBIs in the positive direction. Professionals’ attitudes, perceived-behavioral control, and years in practice significantly predicted self-reported use of an FCC approach with children with ASDs in the positive direction. There was a trend for explicit training on EBI or FCC to predict professionals’ behavior, but these findings did not reach conventional levels of significance. Subjective norms did not significantly predict EBI or FCC behavior. Discipline membership did not moderate the relationship between TPB and EBI and FCC self-reported behavior measures. The TPB is a useful framework for better understanding professionals’ evidence-based practice behavior. This study sheds light on practices and perspectives of professionals working with children with ASDs and highlights areas for future research and training with this population.

O propósito da pesquisa foi desvelar o fenômeno: a enfermeira no cuidado à família da criança hospitalizada. Este estudo de natureza qualitativa teve como objetivos: conhecer a vivência do enfermeiro no cuidado às famílias de crianças hospitalizadas em unidades pediátricas e apreender o típico da vivência dos enfermeiros em ações que envolvem este cuidado. Foi utilizado como referencial teórico filosófico a abordagem da Fenomenologia Social de Alfred Schütz. Foram realizadas entrevistas com 16 enfermeiras que atuavam em unidades de emergência pediátricas, terapia intensiva pediátrica e neonatal, berçário e unidade de internação de um hospital universitário da cidade de São Paulo, tendo como foco sua vivência no cuidado às familias de crianças hospitalizadas. A análise conduzida segundo a teoria motivacional de Schütz, possibilitou identificar o tipo vivido da enfermeira no cuidado à família da criança hospitalizada, que é apresentado em duas condutas motivacionais. Na primeira o cuidado da enfermeira é caracterizado por Incluir a família, pois para ela pensar na família é fundamental. Com isso, sente necessidade de atender às demandas da família durante a hospitalização e de aprimorar seus conhecimentos quanto à abordagem da família. Na segunda conduta, o cuidado da enfermeira se caracteriza por Engajar a família na assistência prestada à criança. Para ela a presença da família é importante, e a necessidade de integrar a família no cuidado e atender às demandas da criança são modos de garantir o cuidado futuro da criança. O estudo revelou que a experiência de cuidado à família da criança hospitalizada prestado pela enfermeira não é uniforme, a motivação ainda se dá como prática individual, conforme a bagagem de conhecimento e os propósitos de cada profissional. A implementação de um modelo de cuidado centrado na família, apresenta desafios que demandam superação, individual e institucional, para que também a família seja considerada como unidade de cuidado durante a hospitalização de um seus membros. / The purpose of this research was to reveal the phenomenon: the nurse in caring for families of hospitalized children. This qualitative study aimed to understand the experiences of nurses in caring for families of hospitalized children and learn the typical experience of nurses\' actions involving such care. It was used as a theoretical philosophical approach the Social Phenomenology of Alfred Schutz. Interviews were conducted with 16 nurses working in pediatric emergency, pediatric intensive care, newborn nursery and pediatric unit at a university hospital in São Paulo city, focusing on their experience in caring for families of hospitalized children. The analysis conducted according to the motivational theory of Schütz, enabled us to identify the experienced type of nurse in caring for families of hospitalized children, which is presented in two motivational behaviors. The first is characterized by Including family in care: the nurse think family as fundamental, needs to meet the demands of the family during hospitalization and improve knowledge to approach the family. The other is characterized by Engaging the family in care: for the nurse, the family presence is important and she needs to integrate the family in care and meet the demands of the child as a way of ensuring the future care of the child . The study revealed that nurses\' experience in caring for families of hospitalized children is not uniform, that motivation has emerged as solo practice, in accordance with the baggage of knowledge and purposes of each professional. The implementation of a family-centered care model, presents challenges to overcome, so that the family is considered as the unit of care during the hospitalization of one its members

Kunskap och förståelse för kommunikation och interaktion mellan sjuksköterskan och barn/föräldrar är nödvändigt för att förbättra patientsäkerheten. Alla har rätt att få information utifrån sina egna förutsättningar, individanpassad information. Litteraturstudiens syfte var att belysa kommunikationens betydelse för föräldrars delaktighet i barnets vård. Både kvantitativa och kvalitativa artiklar hittades vilket matchade syftet. Slutsatserna i artikelresultaten ledde fram till följande kategorier: omgivande faktorer, sjuksköterskans förhållningssätt och kommunikationsstrategier. Faktorer som påverkar kommunikationen och föräldrars delaktighet i barnets vård var: tidspress, bemanning, hjälpmedel i form av informationsblad på olika språk, sagor och tolk. Även förmågan att individanpassa informationen utifrån förälderns kunskapsnivå utifrån deras situation framkom som viktigt. Kommunikationsstrategier som fungerade var att upprepa information på ett enkelt språk och att föräldern återberättade. En öppen och personlig attityd hos sjuksköterskan gjorde att föräldern kände sig delaktig. Användandet av nutidens teknik inom vården bör öka. Forskning kring olika skattningsinstrument av föräldrarnas läs- och skrivförmåga, och deras "health literacy", känns angeläget att fokusera på för att anpassas till svenska förhållanden.

Att drabbas av en plötslig och oväntad död som familj innebär en komplex situation där omvårdnaden fokuserar på den avlidne. Den överlevande familjen och de behov som uppstår för dem efter dödsfallet ignoreras för att istället centreras kring praktiskt omvårdnadsarbete kring den avlidne. Syftet med litteraturöversikten var att beskriva anhörigas behov av stöd vid plötslig och oväntad död av en närstående. Metod för studien var en litteraturöversikt av kvalitativ forskning med en induktiv ansats. I resultatet framkom fyra kategorier som beskriver anhörigas behov av stöd vid plötslig och oväntad död. Kategorierna är: Behov av god information, Behov av gemenskap, Behov av tröst och Behov av gott bemötande. Slutsatsen för litteraturöversikten är att anhöriga har ett stort behov av stöd från både sjuksköterskor och närstående samt att anhöriga blir förbisedda i deras behov av stöd. / Being affected by a sudden and unexpected death as a family means a complex situation. The surviving family and their needs after the death is ignored and the care executed by the personnel is usually focused on the deceased. Little time or none is given to the affected family and the support they need is often overlooked. The aim of this literature review is to describe relative’s need of support in sudden and unexpected death of a relative. A literature review of qualitative studies with an inductive approach was implemented as the chosen method. In the result four categories are presented that describe the relative’s perception of support in sudden and unexpected death. The categories are as follows: Need for valuable information, Need for social network, Need for consolation and Need for positive reception. The conclusion of the literature review suggest that relatives have a great need for support from both healthcare personnel and relatives and that the relatives’ need of support is easily overlooked.

Advances in healthcare and shifts toward patient and family centered care have allowed healthcare professionals to focus on the entirety of a patient and what affects his/her health. In noting such changes, and in consideration of what affects quality of life, findings in the literature address the physiological and physiological differences between those who are caregivers versus those who are not caregivers. This study investigated the relaxation state of those who were considered informal caregivers of hospice and palliative patients in an acute hospitalized setting. A family centered music therapy session was conducted utilizing a music-­‐ assisted relaxation intervention incorporating a loving-­‐kindness meditation. A total of 29 participants, 15 males and 13 females, took part in the study and 28 participants were included in data analysis. Findings from the study suggest an increase in relaxation scores after taking part in the brief intervention. Participant survey responses indicated participants’ agreement with feeling more relaxed and supported as a caregiver after the intervention. Survey results also indicated participants’ willingness to try some relaxation techniques from the study intervention on their own.

Research show evidence for benefits of breastfeeding and that infant-feeding-plans are supportive. Family-centered care is the theoretical framework. Family support is crucial for successful breastfeeding. It is important that society creates opportunities for mothers to breastfeed and contribute information and support by healthcare professionals. The aim of this study was to evaluate how the midwives and child healthcare nurses found that the newest breastfeeding strategy influenced their breastfeeding- and rearing support in the County of Jönköping. The method was a questionnaire with mainly quantitative and partly qualitative approach. The questionnaire consisted of fifteen questions and was distributed to 272 people, response rate was 58 %. The result showed that the professionals were updated with current breastfeeding-strategy and they were using infant-feeding-plans, which were considered positive for the chain of care. Most respondents reckoned that they since 2011 had increased the time allocated, and individual customization of information and support. Breastfeeding-delegate-nurses were familiar, supportive and positive for the chain of care. The document Breastfeeding Plan should not be changed now, but should eventually improve the inclusion of non-Swedish speaking persons, fathers and the mothers who won’t breastfeed. Experience and education were positive factors. The strategy was supported by the healthcare professions. / Tidigare forskning har visat stark evidens för amningens fördelar och att amningsplaner är ett stöd för mödrar. Som teoretisk ram används familjefokuserad omvårdnad, då familjens stöd är centralt för en lyckad amning. Det är viktigt att samhället ger goda förutsättningar samt att vårdpersonal ger stöd och information. Studiens syfte var att utvärdera hur barnmorskor, barnsjuksköterskor och distriktssköterskor bedömde att den nyaste amningsstrategin med amningsplaner och amningsombud påverkat deras amnings- och uppfödningsstödjande arbete i landstinget i Jönköpings län. Metoden var en enkätstudie med huvudsakligen kvantitativ och delvis kvalitativ ansats. Enkäten omfattade femton frågor och distribuerades till 272 personer, svarsfrekvensen var 58 %. Resultatet visade att vårdprofessionerna var uppdaterade med amningsstrategi och använde amningsplaner, vilka ansågs positiva för vårdkedjan. Amningsombuden var välkända, stödjande och positiva för vårdkedjan. Majoriteten av respondenterna bedömde att de sedan 2011 ökat avsatt tid och individanpassningen av information och -stöd, trots att det även tidigare prioriterats. Önskemål fanns att dokumentet Amningsplan inte ska förändras i nuläget, men så småningom bör förbättra inkluderingen av icke-svensktalande, fäderna och de mödrar som inte ska amma sitt barn. Vårdprofessionernas arbets- och livserfarenhet samt amningsutbildning var positiva faktorer. Amningsstrategin hade ett genomgående stöd från yrkesgrupperna från samtliga sjukvårdsområden oavsett ålder och verksamhetsår.

Övervikt och fetma är ett folkhälsoproblem världen över. Effektiv behandling är under utveckling. Tidigare studier undersöker i första hand fetmabehandlingens effekt på barnets BMI. Få studier belyser föräldrars upplevelse av att ingå i fetmabehandling trots att deras delaktighet anses avgörande för lyckade resultat. Syftet var att belysa föräldrars upplevelse av stöd från fetmateamet när barnet behandlas för fetma. Data insamlades genom åtta kvalitativa intervjuer med nio föräldrar vars barn behandlas för fetma. Analysen genomfördes med induktiv innehållsanalys. Resultatet visar att föräldrarna behöver multidimensionellt stöd under behandlingens gång. Fem huvudkategorier framkom: Behov av kunskap för att genomföra en förändring, visar att ny kunskap stöttar familjen i genomförandet av livsstilsförändringar. Behov av individualiserad uppföljning betonar varje familjs unika behov och förutsättningar, samt vikten av att behandlingen formas utifrån det. Behov av teamets samarbete med skolan, beskriver vikten av teamets stöd i samarbetet med skolan.  Behov av ett stöttande förhållningssätt från teamet, belyser hur goda vårdrelationer, hälsofrämjande fokus och gemensam målsättning ingav förtroende. Behov av emotionellt stöd, där föräldrarna lyfter behov av stöd i sitt föräldraskap både professionellt och genom föräldragrupper.  Konklusion: Genom att arbeta med familjecentrerad samskapande omvårdnad kan fetmateamet möta familjernas behov på ett bra sätt. Förbättringspunkter som framkom var behov av anhöriginformation, föräldragrupper samt ökat samarbete med skolan. / Overweight and obesity is an increasing health issue in the world. Effective treatment is under development. Previous research explores the treatments effect on the BMI of the child, but few studies explore parents' experiences of obesity treatment programs even though it is known that parental participation is essential for a successful treatment. The purpose of the study was to illuminate parents' experiences of support from the obesity team when their child is going through obesity Treatment. Eight qualitative interviews of nine parents having children going through obesity treatment where made. Data was analyzed through content analysis with an inductive approach. The results show a parental need of multidimensional support during obesity treatment. Five main categories were found: Needing knowledge to implement change, Needing individually customized follow-ups, Needing the team to cooperate with the school, Needing supporting approaches from the team, describing how good relationships, a health focused atmosphere and shared goals made the family trust the team and the treatment, and Needing emotional support. Conclusion: Using family-centered coproductive care creates a good foundation to meeting the needs of the families going through obesity treatment. Parents need support informing relatives, cooperating with the school and through group sessions with other families.

Bakgrund: De två senaste decennierna har övervikt blivit vanligare hos barn. Övervikt är ett hälsoproblem som barnhälsovården (BHV) försöker förhindra uppkomst och utveckling av. BHV riktar sig till alla barn mellan 0-6 år. Föräldrarna erbjuds bland annat hälsovägledning och föräldrastöd. Studiens syfte: Syftet med denna studie var att beskriva sjuksköterskors erfarenhet av att arbeta med övervikt inom ramen för barnhälsovården. Metod: En kvalitativ intervjustudie genomfördes med tolv sjuksköterskor inom BHV i södra Sverige. Resultatet analyserades sedan med induktiv innehållsanalys enligt en modell av Elo och Kyngäs. Resultat: Sjuksköterskorna strävade efter att uppmärksamma riskfaktorer tidigt och stötta familjerna i att ha en sund inställning till kost och fysisk aktivitet. Sjuksköterskorna hade en viktig roll inom BHV. Motiverande samtal (MI) genomsyrade mycket av sjuksköterskornas arbete och omvårdnaden utformades utifrån de familjer som kom till barnavårdscentralen och deras tankar och behov. Det svåraste för sjuksköterskorna var mötena med de föräldrar som inte förstod eller såg att övervikten var ett problem. Slutsats: Sjuksköterskornas erfarenhet är att de, med tidiga insatser utifrån styrdokument, metoder och hjälpmedel, har goda möjligheter att arbeta med övervikt hos barn inom BHV. / Background: In the last two decades overweight has become more common among children. Overweight is a health problem that child health care attempts to prevent the emergence and development of. The child health care is aimed at all children between 0-6 years. Parents are among other things offered health counseling and parental support. Objective: The purpose of this study was to describe nurses´ experience of working with overweight within the framework of child health care. Methods: A qualitative interview study was conducted with twelve nurses in child health care in southern Sweden. The result was then analyzed by inductive content analysis according to a model by Elo and Kyngäs. Results: The nurses strived to give attention to risk factors early and support families in having a healthy attitude towards food and physical activity. Nurses had an important role in child health care. Motivational interviewing (MI) pervades much of the nurses´ work, and the nursing care was adapted to the thoughts and needs of the families who came to the child health care centers. The hardest part for the nurses was the encounters with parents who did not understand or saw the overweight as a problem. Conclusion: The nurses´ experience is that they, with early efforts based on control documents, methods and tools, have good possibilities to work with overweight in children within child health care.