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Bakgrund På en neonatalvårdsavdelning tar man hand om för tidigt födda barn eller barn som kräver extra vård på grund av komplikationer och tiden där kan vara omvälvande för föräldrarna. Familjecentrerad omvårdnad handlar om att involvera hela familjen för att kunna erbjuda en högkvalitativ samt säker vård där värdighet, respekt, information, delaktighet och samarbete är grundläggande beståndsdelar. Föräldrars delaktighet inom neonatal vård har visat ge många positiva effekter som exempelvis tidigare anknytning mellan barn och förälder, snabbare viktökning hos barnet, minskade stressnivåer hos föräldrarna och bättre förutsättningar inför hemgång. Syfte Syftet med litteraturöversikten var att beskriva vilka faktorer som påverkar föräldrars delaktighet i omvårdnaden av sitt barn på neonatalvårdsavdelning. Metod Litteraturöversikt valdes som metod och 15 artiklar framtagna genom databassökningar i PubMed och Cinahl inkluderades för att besvara syftet. Resultat I resultatet utgör miljöns betydelse, sjuksköterskans roll och föräldrarollen tre huvudfaktorer som beskriver vad som inverkar på föräldrars delaktighet och på vilket sätt den påverkas. Slutsats Föräldrarnas delaktighet är något som inte bara är till gagn för barnet utan påverkar också föräldrarnas identitet och psykiska hälsa. Sjuksköterskan har en viktig uppgift i att ge föräldrarna adekvat information samt att stötta och involvera dem i omvårdnaden av barnet.

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Each year in Canada there are nearly 13,000 infants born to women under the age of 20 years (Statistics Canada, 2016). Infants born to adolescent mothers are at an increased risk for preterm birth, low birth weight, and congenital anomalies, making these infants more likely to require hospitalization in a neonatal intensive care unit (NICU) shortly after birth (DeMarco et al., 2021; Fleming et al., 2013; Shrim et al., 2011). Admission of their infant to the NICU creates an increasingly complex situation, as adolescent mothers and their children often already experience multiple social, psychological, and economic difficulties (Fleming et al., 2015). Additionally, adolescents are still developing important cognitive functions, such as advanced reasoning and decision-making, thus making their ability to navigate complex systems such as the NICU particularly challenging (Blakemore & Choudhury, 2006). However, the unique experience of the adolescent mother within the context of the NICU and their transition-home following discharge is poorly understood. Therefore, the overall purpose of this thesis was to explore the issue of transition-home from NICU for adolescent mothers with infants admitted to the NICU. Three overarching goals guided this thesis work, these goals were to: (a) understand the transition experiences of adolescent mothers with infants in the NICU from a theoretical perspective; (b) understand how to best collect rich qualitative data among study participants experiencing marginalization or stigma; and (c) conduct research to further understand the phenomena and how to begin to address transition-related issues. Findings related to each of these goals are presented in four manuscripts that make up this sandwich thesis, including a critical review of theory, an exploration of methods, and an interpretive description study exploring NICU-to-Home transitions. The work presented in this thesis emphasizes the complexity of the NICU-to-home transition for adolescent mothers. Findings highlight the need for strategies within the NICU to mitigate the negative influence of this experience and opportunities for more integrated models of care within the NICU and extending into the community. Implications for research, policy, and nursing education and practice are discussed. / Thesis / Doctor of Philosophy (PhD) / Pregnancy and parenting during adolescence and care transitions from neonatal intensive care unit (NICU) to home are relatively complex experiences. While each have been explored separately, very little is known about when these experiences intersect. This thesis examines theory and methods related to this complex intersection and describes findings of research exploring NICU-to-home care transitions for adolescent parents.

Objectives: The quality of securement directly impacts the functionality, duration of patency and likelihood of a complication for a given peripheral intravenous catheter. The objective of the study was to determine which method of peripheral intravenous catheter securement, StatLock or Tegabear dressing was more effective by comparing duration of catheter patency and complication rates. Study Design & Method: A quasi-experimental study using the Model for Improvement was conducted in a neonatal intensive care unit of a tertiary care hospital. Infants requiring insertion of a peripheral intravenous catheter for parenteral nutrition or administration of medications were eligible to participate. The study was conducted over a 4-month period and was divided into two phases, with each phase lasting two months. Results: A total of 363 peripheral intravenous catheters were inserted in 175 infants. There were 211 catheters secured with StatLock and 108 secured with Tegabear dressing. There were 42 catheters which were unable to use StatLock or Tegabear dressing and were secured with a combination of transparent dressing/ tape. There were two peripheral intravenous catheters inserted where the method of securement was not indicated. The groups were similar with regards to all demographic variables except postmenstrual age, where the Tegabear group consisted of a larger proportion of older infants (p=<0.001). There was no significant difference in the mean duration of catheter patency between the StatLock and Tegabear group (46.04 hours versus 45.33 hours respectively), p=0.84. Complication rates and reasons for catheter removal did not significantly differ between the two groups (p=0.78 and p=0.93 respectively). The proportion of catheters that used an arm board was significantly greater with the Tegabear dressing (23.8%) compared to 10.5% with StatLock (p=0.002). Twenty one percent (n=23/108) of the catheters secured with the Tegabear dressing required reinforcement with tape or transparent dressing whereas no catheters in the StatLock group needed to be reinforced (p<0.001). Conclusion: Catheter dwell time and complication rates did not differ significantly between StatLock and Tegabear dressing. However, when evaluating a new product, it is important to consider that there is often a learning curve that must be overcome. A larger study with a more rigorous design such as a randomized controlled trial is needed to validate or dispute the study findings. In the meantime, nurses must exercise individual and independent judgment when selecting a securement method most appropriate for their patient. / Thesis / Master of Science in Nursing (MSN)

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24500号 / 医博第4942号 / 新制||医||1064(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 生田 宏一, 教授 萩原 正敏, 教授 渡邊 直樹 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Book Summary: This is the only advanced practice guide to provide an overview of the major DSM-IV-TR disorders across the lifespan and complete clinical guidelines for their psychopharmacologic management. It has been compiled by expert practitioners in psychiatric care and is designed for use by nurse practitioners and other primary caregivers in clinical practice. The guide is organized in an easy-to-access format with disorders for which drugs can play a significant therapeutic role. The listing for each disorder includes clinical features and symptoms, as well as information about the most current and effective drugs for management. A clearly formatted table identifies the first and second lines of drug therapy along with adjunctive therapies for each disorder. Drugs are organized according to classification, and each listing provides the essential information needed to safely prescribe and monitor a patient's response to a particular drug. This includes brand and generic names, drug class, customary dosage, side effects, drug interactions, pharmacokinetics, precautions, and management of special populations. Convenient, practical, and portable, this guide will be a welcome and frequently used resource.

Book Summary: This quick reference serves as an authoritative clinical guide to diagnostic treatment and monitoring recommendations for patients with mental disorders in the primary care setting. It offers fast and efficient access to evidence-based diagnostic and therapeutic guidelines for managing psychiatric and mental health conditions. The book guides family and adult advanced practice nurses in making clinical decisions that are supported by the best available evidence, reflecting current research and expert consensus. Additionally, researchers may use this book to identify important clinical questions where more research could be conducted to improve treatment decision making. This comprehensive text is organized by major diagnostic categories, such as anxiety disorders, with specific diagnoses organized alphabetically within each category. It supports informed practice, which increases confidence in differential diagnosis, safe and effective treatment decision making, reliable treatment monitoring and, ultimately, improved patient outcomes. Additionally, DSM-IV-TR diagnostic standard summaries and ICD-9 codes are incorporated for use in the clinical setting. It is an essential resource in everyday practice for all health care providers.

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