Passamos por um período de grandes descobertas para a ciência, mas o homem ainda continua sem desvendar o processo de morte e morrer. A morte ainda é um grande mistério que o amedronta; é vista como um tabu, tema interditado e fracasso profissional. Partindo do pressuposto de que os profissionais de enfermagem têm preparo insuficiente para lidar com pacientes em iminência de morte, traçamos como objetivo desse estudo: investigar como os profissionais de enfermagem vivenciam o processo de morte e o morrer das crianças/adolescentes hospitalizados, onde buscam preparo e apoio para enfrentar essa perda e identificar que tipo de apoio eles oferecem à família durante o processo de morte e morrer de seus filhos. Pela natureza dos objetivos propostos, este estudo é de natureza qualitativa. Os participantes são enfermeiros, auxiliares e técnicos de enfermagem que trabalham em clínicas com leitos pediátricos de um hospital-escola do interior do estado de São Paulo, que tenham vivenciado o processo de morte e morrer das crianças/adolescentes que estiveram sob seus cuidados. Os dados empíricos foram coletados mediante entrevista e organizados em três temas: enfrentando a morte, estratégias de apoio e luto da equipe. Os resultados indicam que os profissionais de enfermagem negam a morte nos hospitais e acreditam que sua função é salvar vidas; oferecem apoio afetivo e emocional às famílias; buscam apoio principalmente na equipe de trabalho e na família e vivem o luto pela morte de seus pacientes. Concluímos, a partir desses resultados, que os profissionais de enfermagem estão necessitando de suporte emocional e educacional para lidarem com a morte de forma mais harmoniosa e assistirem às reais necessidades das crianças e adolescentes que estão em iminência de morte. Recomendamos que seja incluído nos currículos o tema da morte e que as instituições hospitalares busquem a educação permanente como estratégia para promover mudanças de posturas dos profissionais junto ao paciente que está morrendo. / We are in a period of great advancements in science, but men are still seeking to understand the process of death and dying. Death is a great scary mystery, it is seen as a taboo, a theme that we must no approach and considered a professional failure. Basead on the presupposition that the nursing professional is not well prepared to cope with patients tha are dying, the goals of this study were: to investigate how nursing professionals experience the process of death and dying of hospitalized children and adolescents, to verify where they find preparation and support to face this loss and to identify what kind of support they offer to the families during the process of death and dying of their child/adolescent. Due to the nature of the objectives proposed, this study is considered qualitative. Subjects were nuses, nursing auxiliaries and technicians who work in pediatric wards at a university hospital in the state of São Paulo, Brazil and who had experienced the process of death and dying of children/adolescents that were receiving the care provided by them. Empirical data were collected through interviews and were organized in there themes: facing death, support strategies and team mourning. Results indicated that nursing professionals deny death in the hospitals and believe that their function is to save lives; they offer affective and emotional support to families; they look for support mainly within the working team and family and they experience the mourning due to the death of their patients. Author concluded, based on these results that the nursing professionals need emotional and education support in order to cope with death in a more natural way and to assit the children and adolescents’ real necessities whwn they are dying. The author recommends the inclusion of the theme “death” in the curricula and also that hospitals must for permanent education as a strategy to promote changes in posture of the professionals that provide care to patients who are dying.

O Projeto Biblioteca Viva em Hospitais é uma estratégia adotada por diversas instituições de saúde com o objetivo de levar à criança e ao adolescente hospitalizados a mediação de leitura de histórias infanto-juvenis por intermédio de profissionais e voluntários capacitados para tal função. A leitura terapêutica tem sido amplamente utilizada dentro e fora do hospital, por diversos profissionais, como os bibliotecários, fonoaudiólogos, psicólogos, pedagogos, enfermeiros e terapeutas ocupacionais. O objetivo deste trabalho é apreender em que medida a estratégia da mediação de histórias infanto-juvenis proposta pelo Projeto Biblioteca Viva em Hospitais pode ser um recurso de comunicação com a criança e o adolescente hospitalizados. Para tanto, a coleta de dados empíricos foi realizada mediante a observação de sessões de mediação de leitura e entrevista semi-estruturada com o mediador e as crianças maiores de sete anos. Procedemos à análise qualitativa dos dados os quais foram organizados ao redor dos seguintes temas: aprendendo com as histórias; as histórias e as possibilidades terapêuticas e a comunicação e a contação de histórias. Constatamos que a mediação de leitura facilita os diálogos e o estabelecimento de relacionamentos durante a hospitalização, além de contribuir para o aprendizado de quem ouve e de quem conta as histórias. Os resultados do presente estudo poderão contribuir para a ampliação do processo diagnóstico e terapêutico incorporando intervenções que valorizem o processo de desenvolvimento de crianças, adolescentes, familiares e profissionais de saúde e também para a humanização do cuidado em saúde. / The Biblioteca Viva (Live Library) Project in Hospitals is a strategy adopted by several health institutions aiming to provide the hospitalized child and adolescent the reading mediation of infant-juvenile stories through professionals and volunteers capable of such function. The therapeutic reading has been widely used both in and out of hospitals by several professionals such as librarians, phonoaudiologists, psychologists, pedagogues, nurses and occupational therapists. This study aimed to learn in what extent the reading of infant-juvenile stories strategy proposed by this Project in hospitals can be a communication resource to use with hospitalized children and adolescents. In order to do that, the empirical data collection was carried out through the observation of reading sections and semi structure interviews with the reader and children older than seven years old. The qualitative data analysis was organized on the following themes: learning with stories; the stories and the therapeutic possibilities, and the communication and telling stories. It was verified that the reading mediation favors the dialogs and the establishment of relationships during hospitalization besides contributing for the learning of those who listen and those who tell the stories. This study results can contribute for the expansion of the diagnostic and therapeutic processes incorporating interventions that value the development process of children, adolescents, relatives and health professionals and also for the humanization of the health care.

BACKGROUND: Constipation is highly prevalent in older adults and may be associated with greater frequency of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We investigated the prevalence of lower defecation frequency (DF) and risk factors (including AECOPD) associated with lower DF among hospitalized elderly patients. METHODS: We conducted a retrospective case-control study in a community hospital of Southeast Ohio. Adults aged 65 years or older admitted during 2004 and 2006 were reviewed (N = 1288). Patients were excluded (N = 212) if their length of stay was less than 3 days, discharge diagnosis of Clostridium difficile-associated diarrhea, death or ventilator- dependent respiratory failure during hospitalization. Lower DF was defined as either an average DF of 0.33 or less per day or no defecation in the first three days of hospitalization; cases (N = 406) and controls (N = 670) were included for the final analysis. RESULTS: Approximately 38% had lower DF in this patient population. Fecal soiling/smearing of at least two episodes was documented in 7% of the patients. With the adjustment of confounders, AECOPD (adjusted odds ratio [AOR] =1.47, 95% confidence interval [CI] =1.01-2.13) and muscle relaxant use (AOR =2.94; 95% CI =1.29-6.69) were significantly associated with lower DF. Supplementation of potassium and antibiotic use prior to hospitalization was associated with lower risk of lower DF. CONCLUSIONS: Approximately 38% of hospitalized older adults had lower DF. AECOPD and use of muscle relaxant were significantly associated with lower DF; while supplementation of potassium and antibiotic use were protective for lower DF risk after adjusting for other variables.

The purpose of this study was to investigate the impact of three factors, the expectation of events, situational control and situational anxiety, on the coping effort of parents of acutely ill hospitalized children. A secondary purpose was to determine the influence of the parents' locus of control orientation on the parents' coping effort. Coping effort was defined as the amount of behavior, both action oriented and intrapsychic, employed by parents to master, tolerate, reduce or minimize stressful events encountered during their child's hospitalization. The study utilized a mathematical correlational design with a causal modeling approach to assess a four-stage theory. The convenience sample selected for the study was 45 Anglo mothers of acutely ill hospitalized children between the ages of one and 24 months. A four-scale instrument based on magnitude estimation measurement strategy was constructed to index the theoretical concepts. Reliability, validity and cross modality matching were conducted to estimate the psychometric properties of the instrument. The theory was estimated using correlational and multiple regression statistical techniques. Residual analysis was conducted to estimate violations of the causal model and statistical assumptions. Expectation of events showed a direct effect on situational anxiety (R² = .35) and thus, an indirect impact on parental coping effort. Situational anxiety had a strong, direct, positive influence on coping effort (R² = .97). Situational control did not significantly influence the parents' coping effort directly nor indirectly and was not influenced by the expectation of events. The impact of the parents' locus of control orientation on their coping effort could not be determined since the locus of control index was found to be psychometrically inadequate for this sample. Parents who knew what events to expect experienced less anxiety and, as a result, expended less effort to cope with the stresses of their child's hospital experience. By knowing what factors influence the parents' coping effort, the pediatric nurse is able to manipulate the parents' hospital experience to provide as therapeutic an environment for the child and the parents as possible.

Programa de Doctorado de Enfermería: Práctica y Educación.

When children are hospitalized they are exposed to an unfamiliar and frequently forboding world of an efficiently run institution. They cannot, as adults do, afford to interrupt (Plant, 1962) their normal way of living and exclude the relationships, play and learning that contribute to their overall growth. There is a general tendency for children to be treated much in the same manner that adults are when they are confined in a hospital situation. The adult (Chapman, 1956) is prepared to make this temporary adjustment because he is aware, to some extent, of the need for hospitalization and the positive consequence of necessary painful proceedures to which he is subjected. He is an adult with adults serving him and he is aware of his power to leave or to dismiss individuals in his attendance.

Abstract Objectives: This research project was undertaken to review two commonly used screening instruments for the elderly who attend at hospital emergency departments in Ontario. These instruments were then contrasted with a new potential screening instrument made up of items drawn from the Minimum Data Set-Acute Care instrument (MDS-AC Version 1_CAN). The hypothesized outcome was better specificity and sensitivity utilizing the newly prepared instrument in predicting at an earlier point if an elderly emergency department patient would become an alternate level of care (ALC) patient. The ability of the screener to predict negative outcomes (delirium, longer length of stay) was also analyzed. Methods: One dataset from a previous International Resident Assessment Instrument (interRAI) organization study in southern Ontario completed in 2000 was utilized to inform this research. Each of the commonly used screening instruments was crosswalked to the MDS-AC items, then both univariate and bivariate analyses were completed. Three research questions were then posed. By testing various logistic regression models, the research looked to establish whether the newly developed instrument would be able to perform comparably to the other two currently-used instruments, and whether it would be more effective in predicting ALC status and particular adverse patient outcomes. Results: The newly-developed instrument was found to perform more accurately. While several variables were tested, a core number were found to be more strongly predictive of future need for ALC status. Conclusions: Future research in this area is recommended.

Objectives: Study wanted to explore the factors that will affect the total medical expense in the patients who receive laparoscopic cholecystectomy (LC). We also to confer the influencing factor that will associate with the difference of reports the expense under the case payment system. Methods:Retrospective study . Collected from year 2003 to 2007, received LC in a general teaching hospital in Kaohsiung city. We also adopt the chart review and combined with the health insurance expense data to explore the important factors that were associated with total hospitalized expenses, declaration of expense differences, and profits. The methods of multiple linear and logistic regressions were needed. Results: 1539 subjects, 613 male and 926 female. The average age was 54.4 , and 1313 subjects were hospitalized from outpatient. All subject¡¦s average hospitalized days were 3.79 and medical expenses were 42528.1 dollars. The frequencies of the type of declaration about ¡¥not exceed¡¦, ¡¥exceed but actually¡¦, and ¡¥exceed but no actually¡¦ were 88.8%, 8.6%, and 2.6%, in sequence. The average declaration of expense differences was 14484.1 dollars. The significant factors that were associated with total hospitalized expenses were the age, surgical year, source of hospitalize, major symptom, combine disease, a complication after surgery, hospitalized days, type of declaration. In the other linear regression model, we found the age, surgery year, source of hospitalize, major symptom, high technology examination before surgery, combine disease, a complication after surgery, hospitalized days, and physician¡¦s surgery quantity per year had been statistically significant with the declaration of expense differences. For the odds of hospital¡¦s profits, the significant factors include the surgery year, source of hospitalize, major symptom, high technology examination before surgery, and hospitalized days. Conclusion: We found a few significant factors that were associated with dependent variable in three regression models in this study. The major factor is hospitalized days that were a stronger influence total hospitalized expenses, declaration of expense differences, and hospital¡¦s profits. The hospital¡¦s superintendent can carry on the management through the appropriate method to control the medical resource consumes.

Abstract Objectives: This research project was undertaken to review two commonly used screening instruments for the elderly who attend at hospital emergency departments in Ontario. These instruments were then contrasted with a new potential screening instrument made up of items drawn from the Minimum Data Set-Acute Care instrument (MDS-AC Version 1_CAN). The hypothesized outcome was better specificity and sensitivity utilizing the newly prepared instrument in predicting at an earlier point if an elderly emergency department patient would become an alternate level of care (ALC) patient. The ability of the screener to predict negative outcomes (delirium, longer length of stay) was also analyzed. Methods: One dataset from a previous International Resident Assessment Instrument (interRAI) organization study in southern Ontario completed in 2000 was utilized to inform this research. Each of the commonly used screening instruments was crosswalked to the MDS-AC items, then both univariate and bivariate analyses were completed. Three research questions were then posed. By testing various logistic regression models, the research looked to establish whether the newly developed instrument would be able to perform comparably to the other two currently-used instruments, and whether it would be more effective in predicting ALC status and particular adverse patient outcomes. Results: The newly-developed instrument was found to perform more accurately. While several variables were tested, a core number were found to be more strongly predictive of future need for ALC status. Conclusions: Future research in this area is recommended.

Introduction: Thromboprophylaxis recommendations for hospitalized cancer are based on trials done for the general medically patients, as there are no randomized clinical trials(RCTs) looking at thromboprophylaxis in medically ill patients with cancer. Methods: To determine if thromboprophylaxis is safe and effective to prevent VTE these patients, a Systematic Review(SR) was done. A survey was performed to assess: clinical equipoise, trial design and minimally clinically important difference(MCID) for a potential trial. Lastly, a pilot study for an RCT was designed. Results: The pooled RR of VTE was 0.91 (95%CI:0.21 to 4.0;I2:68%) among hospitalized cancer patients receiving thromboprophylaxis compared to placebo. 63.9% believe there is clinical equipoise and 58.3% would consider participating in a RCT comparing different agents/dosing. The MCID for absolute reduction in symptomatic VTE between two arms was 2% and for “acceptable” increase in major bleeding events was 1%. Conclusion: The risk-benefit ratio of current doses of thromboprophylaxis administered to hospitalized cancer patients is unclear and additional RCTs are necessary.