Yes / . Kangaroo care (KC) has been used widely in neonatal care to promote bonding/attachment and neurodevelopment for preterm and term infants. However, current literature suggests that research mainly focuses on infants' and mothers' experiences. The role of fathers in caring for their infant/child is changing and evolving in many countries around the globe. Yet little is known about fathers' experiences of KC in neonatal units. This review, therefore, aims to scope the current evidence of Father-infant KC (Father KC) in Neonatal Intensive Care Units (NICUs). Research question. What impact does KC have upon fathers when their baby is cared for in NIUCs? Search method. A scoping review was conducted and guided by the framework of Arksey and O'Malley (2005). The data sources consisted of Medline, Embase, America Psychological Association (APA) PsycInfo, Emcare, Cochrane Central, Web of Science, Google Scholar and ProQuest. The study inclusion criteria were: (1) studies involving fathers who had experience of KC with their baby whilst in Neonatal Intensive Care Units (NICUs), and other neonatal care settings, such as Special Care Baby Nursery (SCBU), delivery/labour room and postnatal ward; (2) literature published from 2000 to 2020; (3) primary studies including qualitative, quantitative, and mixed methods studies; (4) studies published in English. Results. The total number of studies identified were 13. Seven studies were qualitative and six were quantitative. None were mixed methods. Studies reported several positive KC benefits on fathers, such as reduced stress, promotion of paternal role and enhanced father-infant bond. It was highlighted that KC could be time-consuming for fathers and challenging to practise when balancing work and family life commitments. Conclusion. This review provides evidence that KC practice has health and wellbeing benefits for fathers and infants in NICUs and other relevant neonatal care settings, The findings of this review support the justification to promote Father KC in NICU environments, and guide policies to include father involvement. Implementing Father KC in NICU settings will assist fathers to care and connect with their baby. Further research is needed to explore how to facilitate and evaluate KC education for fathers from diverse s and cultures.

Background: NICU experiences pose significant challenges for parents, especially immigrants, necessitating comprehensive support. South Asian immigrants, comprising 25% of Canada's visible minority population, face unique adversities related to gender roles, hindering access to essential health services and integration. Coupled with unfavourable social determinants of health (SDoH), these challenges worsen issues like inadequate prenatal care, education, and nutrition, predictors of adverse maternal and neonatal health outcomes. Existing studies lack insight into the specific experiences of South Asian immigrant mothers in the NICU. This study investigates these experiences. Methods: Using a qualitative descriptive approach, we recruited four participants for semi-structured interviews, supplemented by a demographic questionnaire and participant observation. Qualitative content analysis was employed for data analysis. Findings: Four key themes were identified from the interviews: (1) Seeking Understanding, (2) Cultural Influence on NICU Experience, (3) Motherhood Journey, and (4) Circle of Care. Implications: This study fills a gap in NICU research for South Asian immigrant women, providing a foundation for future nursing research and practice. It underscores the importance of communication and preparation for discharge delays to ease parental concerns. Additionally, it emphasizes culturally sensitive care practices and encourages further exploration of cultural influences on hospital experiences. Insights from this study can benefit other ethno-racial immigrant groups. / Thesis / Master of Science in Nursing (MSN) / Existing research offers insights into the general challenges and distress often associated with mothers' experiences in the NICU. However, there is little evidence to understand the specific experiences of South Asian immigrant mothers within this context. The objective of this thesis is to describe and understand the experiences in the NICU reported by this population. Employing a qualitative description methodology, this study engaged four eligible participants. Data collection entailed semi-structured interviews alongside a demographic questionnaire. Employing qualitative content analysis, four overarching themes were identified: (1) Seeking to Understand, (2) The Impact of South Asian Culture on the NICU Experience, (3) Becoming a Mother One Step at a Time, and (4) Circle of Care.

Sammanfattning Bakgrund: Miljön på intensivvårdsavdelningar (IVA) är högteknologisk. Patienter som vårdas inom intensivvården övervakas ständigt av personal och medicinteknisk utrustning. Omvårdnadsåtgärder och undersökningar behöver utföras oavsett tid på dygnet. Personalens närvaro påverkade patienternas sömn och apparatur låter dygnet runt. Vid utebliven sömn och minskad REM-sömn ökar riskerna för negativa effekter som nedsatt immunförsvar och delirium. Det behövs ökad kunskap för hur patienterna upplever sin sömn på IVA för att kunna främja förutsättningarna för sömn, hälsa och välbefinnande.  Syfte: Syftet med studien var att belysa hur patienter som vårdats på intensivvårdsavdelning upplever sin sömn under vårdtiden.  Metod: En kvalitativ systematisk litteraturstudie baserad på 11 vetenskapliga artiklar. Analysen genomfördes med Bettany-Saltikov och McSherry (2016) analysmetod.  Resultat: I resultatet framkom det att patienterna upplevde att sömnen påverkades av IVA-miljön. Många upplevde svårigheter att somna, men också att de väcktes flera gånger. Patienterna kände sig fast mellan sömn och vakenhet, vilket skapade mycket ångest och oro. De upplevde vårdmiljön som skrämmande och kunde känna sig ensamma och övergivna vilket försämrade sömnkvaliteten ytterligare. För att känna trygghet behövde patienterna kontinuerligt kommunicera med vårdpersonal och känna deras närvaro. Det skapade förutsättningar för god sömn.  Slutsats: Aspekter i den fysiska och psykiska miljön spelade stor roll för att intensivvårds patienterna skulle få goda förutsättningar för tillräcklig sömn. Intensivvårdssjuksköterskan kan genom lyhördhet och ökad kunskap uppmärksamma hur viktig den yttre miljön samt existentiella faktorer är för att patienten ska kunna uppnå god sömn på IVA.

Immobility in an Intensive Care Unit (ICU) patient can be extremely detrimental and life-threatening to a person who suffers from a plethora of acute and chronic morbidities. Nurses in the ICU care a great deal about the~ patients, but may not always have the time, the knowledge, or the staffing to mobilize their patients as they should be mobilized. This literature review discusses the importance of mobilizing the ICU patient, what hazards of immobility could occur due to the lack of mobilization and different mobility interventions which are utilized in the ICU. The significance of this is to improve patient outcomes and limit the deconditioning caused by immobility. The writing of this review is an effort to encourage nurses to integrate mobility interventions into their plan of care. Understanding how to use this basic skill in a complex - environment will improve patient putcomes.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25157号 / 医博第5043号 / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 西浦 博, 教授 江木 盛時 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Unplanned extubation is premature removal of endotracheal tube, is an adverse event; which can either, be accidental during a nursing procedure or self deliberate by the patient. The AACN Synergy Model for Patient Care was used as conceptual model for this study. A retrospective descriptive design revealed that over a period of two years, 327 patients admitted to the intensive care unit require intubation of which 40.4% were self-deliberate extubation and 59.4% accidental extubation. Of the accidental extubated patients, 29.8% had physical restrains, 57.6% received sedation, 43.9% had analgesic infusion and 38.9% were on neuromuscular blockade. A means Glasco Coma Scale was 9.4 and 56% of the patients were reported as being. Most patients (89.9%) required re-intubation. The findings also revealed that 49.1% of the nurses who cared for the patients when the extubation occured had one patient at the time. Also, 84.2% of nurses had 0-6 years of nursing experience and 74% of nurses had less than five years of ICU experience. / Health Studies / M.A. (Health Studies)

The aim: was to describe and compare a group of experts and critical care nurses' agreement in detecting delirium in intubated, ventilator treated patients with sedation / analgesia, before and after an in house training intervention with the instrument Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Method: A quasi-experimental study, one group pretest - posttest design. A convenience sample of 17 critical care nurses in a general intensive care unit included. To detect delirium the instrument CAM-ICU was used, 21 paired tests before and 22 after an educational intervention. Main Results: The results showed that after an in house training intervention sensitivity and kappa coefficient improved of the characteristic 1 "acute onset and fluctuating course," an improvement that was significant. In other features, and overall values were signs of numerical improvement and deterioration in sensitivity, specificity and kappa coefficient but no significant change. Conclusion: Implementing a new instrument for detecting delirium in clinical practice requires education and follow-up. A small sample of critical care nurses with varying ability to use the new instrument and the fact that patients' status may change rapidly making it difficult to draw any conclusions from this study. It is clear, however, that education and follow-up is needed when new care routines are introduced, and that further studies are needed to clarify whether the CAM-ICU is a valit and reliable instrument to use in clinical practice. / Syftet var att beskriva och jämföra en expertgrupp och intensivvårdssjuksköterskors överensstämmelse i att detektera delirium hos intuberade, respiratorbehandlade patienter med sedering/analgesi, före och efter en utbildningsintervention med instrumentet Confusion assessment method for the intensive care unit (CAM-ICU). Metod: En kvasiexperimentell studie, en grupps pretest – posttest design. Ett bekvämlighetsurval på en allmän intensivvårdsavdelning där inkluderades 17 intensivvårdssjuksköterskor. För att detektera delirium användes instrumentet CAM-ICU, 21 parmätningarna före och 22 efter en utbildningsintervention. Huvudresultat: Resultatet visade att efter utbildningsinterventionen förbättrades sensitiviteten och kappa koefficienten i kännetecken 1 ”akut insättande eller fluktuerande förlopp”, en förbättring som var signifikant. I övriga kännetecken och totalvärden fanns tecken på numerär förbättring och försämring i sensitivitet, specificitet och kappakoefficient men ingen signifikant förändring. Slutsats: Att implementera ett nytt instrument för att detektera delirium i klinisk verksamhet kräver utbildning och uppföljning. Ett litet sample av intensivvårdssjuksköterskor med varierad förmåga att använda det nya instrumentet samt det faktum att patienters status hastigt kan förändras gör det svårt att dra några slutsatser av denna studie. Klart är dock att utbildning och uppföljning behövs när nya vårdrutiner införs, och att ytterligare studier behövs för att klargöra om CAM-ICU är ett valit och reliabelt instrument att använda i klinisk verksamhet.

Unplanned extubation is premature removal of endotracheal tube, is an adverse event; which can either, be accidental during a nursing procedure or self deliberate by the patient. The AACN Synergy Model for Patient Care was used as conceptual model for this study. A retrospective descriptive design revealed that over a period of two years, 327 patients admitted to the intensive care unit require intubation of which 40.4% were self-deliberate extubation and 59.4% accidental extubation. Of the accidental extubated patients, 29.8% had physical restrains, 57.6% received sedation, 43.9% had analgesic infusion and 38.9% were on neuromuscular blockade. A means Glasco Coma Scale was 9.4 and 56% of the patients were reported as being. Most patients (89.9%) required re-intubation. The findings also revealed that 49.1% of the nurses who cared for the patients when the extubation occured had one patient at the time. Also, 84.2% of nurses had 0-6 years of nursing experience and 74% of nurses had less than five years of ICU experience. / Health Studies / M.A. (Health Studies)

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T13:33:08Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_LarissaGressDeLima.pdf: 1774220 bytes, checksum: 17fe91b0a702bc2ee02fbd5ac1949377 (MD5) / Made available in DSpace on 2018-08-22T13:33:08Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_LarissaGressDeLima.pdf: 1774220 bytes, checksum: 17fe91b0a702bc2ee02fbd5ac1949377 (MD5) Previous issue date: 2017-06-29 / The experience of hospitalizing a baby in the Intensive Care Unit for mothers and their families is a difficult time. There are families that can overcome the difficulties of hospitalization, however, others are unstructured, since the hospitalization of the child can have repercussions throughout the family system. This is why, during the hospitalization of a baby, the support of the social network becomes essential for the mother and for the other relatives. There are several support networks that can be detected during the hospitalization of a baby: a network of relatives, friends, professionals and internal networks. Thus, the present study aimed to elaborate a graphical representation of the results of the social support network of mothers who had their babies hospitalized in a Pediatric or Neonatal Intensive Care Unit. As specific objectives, this study considered: elucidate the feelings of mothers regarding the experience of child care in a Pediatric or Neonatal Intensive Care Unit; to know the factors that favor or hinder the experience of mothers during the period of hospitalization of their baby; and, to know the relationships established by the mothers in the hospital environment. A qualitative research was conducted through a semi-structured interview and through the application of an adaptation of Sluzki's Minimal Relations Map (1997), with the participation of nine mothers of infants who were admitted to six different Pediatric and Neonatal ICUs. Data collection was performed from June to September 2016, and originated two articles. In the first article. Data resulting from the interview were coded by content analysis and resulted in three categories: When the real does not correspond to the expected: the mother facing the need for hospitalization of the baby in the ICU; The exchange of a lullaby pack by a roller coaster of emotions; and, What can mitigate the strong emotions of the roller coaster?: the importance of support. In the second article, already from the analysis of the map, which was given by incidence, it was highlighted in the family quadrant, that the husband was the most cited as being the closest relative and that most supported the mother; in the friends' quadrant, some participants mentioned having close friends and receiving support from them during the baby's hospitalization; in the family quadrant of other patients: some participants mentioned that they had a close relationship with the other mothers and that they supported her during ICU stay; And in the ICU team quadrant, among the professionals, the nurse perceived the closest one perceived by the mothers. It was concluded that it is difficult for mothers not to be able to take their babies home after birth. They revealed feelings such as fear, insecurity, fear of the baby's death, impotence and guilt. The mothers experienced a sense of loss of control of the situation, concern for other children and need for support. It was possible to elucidate that the husband, in most cases, plays the most important role of support, both socially and emotionally, and failing him, the second person closest is the maternal grandmother of the baby, but the other family and friends also play the role of social support and material aid. Proximity to other mothers is greater when hospitalization is long or occurs outside the home city, and the team also exerts important support for mothers. Professionals can minimize the suffering of mothers and their families through simple initiatives, with a view to greater reception, always prioritizing clear and welcoming communication. As a way to broaden the reflections, according to the objective, a graphic representation of the results of the Minimum Adapted Relationship Map was prepared, which was presented to the students of the health area and will be exposed in the halls of the Teaching Institution Centro Universitário Franciscano. Descriptors: Pediatric Intensive Care Unit; Neonatal Intensive Care Unit; Hospitalized Child; Social network; Social support; Maternity / A experiência da hospitalização de um bebê em Unidade de Terapia Intensiva, para as mães e suas famílias, é um momento difícil. Existem famílias que conseguem superar as dificuldades da hospitalização, porém, outras se desestruturam, pois a internação do filho pode repercutir em todo o sistema familiar. Motivo pelo qual, durante a hospitalização de um bebê o apoio da rede social se torna essencial para a mãe e para os demais familiares. São várias as redes de apoio que podem ser detectadas durante a internação de um bebê: rede de familiares, de amigos, de profissionais e redes internas. Assim, o presente estudo teve como objetivo geral elaborar uma representação gráfica dos resultados da rede de apoio social de mães que tiveram seus bebês hospitalizados em uma Unidade de Terapia Intensiva Pediátrica ou Neonatal Como objetivos específicos, este estudo considerou: elucidar os sentimentos das mães em relação à vivência de cuidado do filho em uma Unidade de Terapia Intensiva Pediátrica ou Neonatal; conhecer os fatores que favorecem ou dificultam a experiência das mães no período de internação do seu bebê; e, conhecer as relações estabelecidas pelas mães no ambiente hospitalar. Foi realizada uma pesquisa qualitativa, por meio de entrevista semiestruturada e através da aplicação de uma adaptação do Mapa Mínimo de Relações de Sluzki (1997), com a participação de nove mães de bebês que foram internados em seis diferentes UTIs, Pediátricas e Neonatais. A coleta dos dados foi realizada no período de junho a setembro de 2016, e originou dois artigos. No primeiro artigo, os dados resultantes da entrevista foram codificados pela análise de conteúdo e resultaram em três categorias: Quando o real não corresponde ao esperado: a mãe diante da necessidade de internação do bebê na UTI; A troca do embalo do ninar por uma montanha russa de emoções; e, O que pode atenuar as fortes emoções da montanha russa?: a importância do apoio. Já no segundo artigo, a partir da análise do mapa, que se deu por incidência, destacou-se no quadrante dos familiares, que o esposo foi o mais citado como sendo o familiar mais próximo e que mais apoiou a mãe; no quadrante dos amigos, algumas participantes citaram ter amigos bem próximos e terem recebido apoio deles durante a internação do bebê; no quadrante de familiares de outros pacientes: algumas participantes citaram que tiveram uma relação bem próxima com as outras mães e que estas lhe apoiaram bastante durante a internação na UTI; e, no quadrante equipe da UTI, entre os profissionais, o mais próximo percebido pelas mães foi o enfermeiro. Concluiu-se que é difícil para as mães não poder levar os seus bebês para casa após o nascimento. Elas revelaram sentimentos como medo, insegurança, temor da morte do bebê, impotência e culpa. As mães vivenciaram a sensação de perda de controle da situação, preocupação com os outros filhos e necessidade de apoio. Foi possível elucidar que o marido, na maioria dos casos, desempenha a função mais importante de apoio, tanto social quanto emocional, e na falta dele, a segunda pessoa mais próxima é a avó materna do bebê, porém, os demais familiares e amigos também desempenham a função de apoio social e ajuda material. A proximidade com as outras mães é maior quando a hospitalização é longa ou se dá fora da cidade de origem, e a equipe também exerce um importante apoio às mães. Os profissionais podem minimizar o sofrimento das mães e de seus familiares por meio de iniciativas simples, com vistas a um maior acolhimento, priorizando sempre por uma comunicação clara e acolhedora. Como forma de ampliar as reflexões, de acordo com o objetivo, foi confeccionado uma representação gráfica dos resultados do Mapa Mínimo de Relações Adaptado, o qual foi apresentado aos estudantes da área da saúde e ficará exposto nos corredores da Instituição de Ensino Centro Universitário Franciscano.

Bakgrund: Specialistsjuksköterskor med inriktning mot intensivvård har ansvar för omvårdnaden av de svårast sjuka patienterna samt kommunicerar med deras närstående. Coronaviruset (SARS-CoV-2) även kallad för Covid-19, leder till en atypisk form av akut andningsbesvär som i vissa fall kräver ventilatorbehandling. Dessa patienter kommer alla att behöva urträning ur respiratorn inför extubation. Urträning initieras oftast på intensivvårdsavdelningen och tillhör intensivvårdssjuksköterskans arbete. En förkortad ventilatorbehandling kan minska patientens lidande, mortaliteten och sänka samhällskostnader. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors framgångsfaktorer för ventilatorurträning av patienter med Covid-19. Metod: Vi har använt oss av kvalitativ metod och intervjuat åtta intensivvårdssjuksköterskor i Västra Sverige. Intervjuerna analyserades kvalitativ innehållsanalys med manifest ansats som resulterade i tre kategorier. Resultat: Denna kvalitativa intervjustudie visade att en längre och svårare urträningsprocess kräver tålamod och försiktighet. Samtliga intensivvårdssjuksköterskor beskrev urträningsprocessen för patienter med Covid-19 som både längre och svårare i jämförelse med patienter som ventilatorbehandlats av andra orsaker. Tidiga insatser kan lindra sjukdomsförlopp och underlätta urträningen. Intensivvårdssjuksköterskorna beskrev att de under pandemin lärt sig använda både medicinska och omvårdnadsmässiga insatser tidigt för att bromsa, lindra eller förhindra ett progrederande sjukdomsförlopp. Mobilisering, teamsamverkan och kontinuitet var viktigt vid urträning och framgångsfaktorer som påverkades av personalens kompetens, stressnivå och andraorganisatoriska faktorer. Slutsats: Denna kvalitativa intervjustudie visade att intensivvårdssjuksköterskor upplever att erfarenhet under pandemins gång har förbättrat förutsättningarna för patienter med Covid-19 i behovav urträning från ventilatorbehandling. Och dessa lärdomar ligger till grund för de faktorer som i dagsläget ofta ligger till grund för en framgångsrik ventilatorurträning. Deras erfarenhet och kunskaper skiljer sig åt och resultatet tyder på att mer utbildning och kontinuitet krävs för att kunna ge en säkrare vård.