Many parents experience preterm birth as traumatic and develop high levels of emotional stress, anxiety, and depressive symptoms. This can have a negative impact on the bonding process and the development of their parental identity. The emotional support provided by the staff varies between Swedish neonatal intensive care units (NICUs), and little is known about parents´ needs and preferences for emotional support. Further, there are knowledge gaps regarding parental stress in fathers and their needs for emotional support, differences in stress between mothers and fathers, change of parental stress over time and potential predictors for parental stress. The aim of this thesis was to explore the needs and preferences for emotional support in parents of preterm infants during their infant’s hospitalisation in a NICU, and to describe parental stress in mothers and fathers up until the infant’s age of 12 months and predictors for parental stress.  Study I was a qualitative study using semi-structured interviews with 51 parents of preterm infants, which were analysed using qualitative content analysis. The results showed that parents need a sense of coherence during their infant’s stay in a neonatal intensive care unit, and they want to be offered emotional support according to their preferences. Many parents preferred to attend professionally led parental groups as other NICU parents could really understand their situation and feelings. Parents also emphasised the value of combining parental groups with other means of support. Study II was a longitudinal cohort study in which data on self-reported parental stress during the first year were obtained from 493 mothers and 329 fathers of preterm infants and analysed using descriptive statistics, Student’s independent t-tests, linear regression, and linear mixed-effects modelling. The results showed that mothers perceived more role restriction than fathers, and that fathers experienced more social isolation than mothers. Further, parental stress decreased during the first year for mothers but increased for fathers, especially between 6 months and 12 months postpartum. For both mothers and fathers, having twins and a lower perceived general health were associated to higher levels of parental stress. In addition, mothers with infants of lower gestational age experienced significantly higher levels of parental stress.  In conclusion, individualised emotional support is important for parents of preterm infants for them to manage their situation both during their infant’s hospitalisation and during the first year postpartum. Apart from professional support, peer-support in the form of professionally led parental groups are perceived to be potentially valuable emotional support by parents. This peer-support could, preferably, be combined with other means of support during hospitalisation as ‘one size does not fit all’. In a next step, support interventions need to be designed, tested, and evaluated. Antonovsky’s theory of Sense of Coherence can be used to identify emotional needs in NICU parents and how to provide emotional support consistent with the parents’ preferences. After discharge from the NICU, vulnerable groups of parents, including parents of very preterm infants and twins need additional support. Moreover, there is a need in fathers for additional emotional support programmes offered during the first year of infants’ lives.

Introduction. L’exposition à la douleur répétée pendant la période néonatale a des effets nocifs sur le développement neurologique des nouveau-nés prématurés et peut contribuer à une douleur prolongée. Une taxonomie précise de la douleur néonatale est absente due à l’existence d’une terminologie ambigüe qui persiste en néonatologie. Par conséquent, l’évaluation et la gestion de ce type de douleur dans le milieu clinique sont sous-optimales. Objectif. Établir la portée, l'étendue et la nature des écrits scientifiques liées à la douleur prolongée des nouveau-nés prématurés hospitalisés dans l’unité de soins intensifs néonatals (USIN), par le biais d’une revue de la portée. Méthodologie. La revue de la portée suit les lignes directrices du Joanna Briggs Institute (JBI). Une stratégie de recherche a été effectuée dans les bases de données CINAHL, PubMed, Medline, Web of Science, Google Scholar, GeryLit.org et Grey Source Index. Résultats. La revue de la portée a identifié 78 articles pertinents qui abordaient des définitions (n=25), des indicateurs (n=37), des contextes de soins (n=47), des outils d’évaluation (n=49), des conséquences (n=29) et des interventions (n=21) pour soulager la douleur prolongée néonatale. La revue soutien que les contextes de soins des nouveau-nés prématurés devraient toujours être considérés indépendamment de la présence ou non d’indicateurs de la douleur prolongée afin de guider l’évaluation et le soulagement de la douleur prolongée. Conclusion. Ce mémoire a recensé les éléments essentiels de la douleur prolongée et a permis d’émettre des recommandations pour la pratique, la formation, la gestion et le recherche infirmière, guidé par le cadre théorique de Huth et Moore (1998). / Introduction. Exposure to repetitive pain during the neonatal period has been shown to have important long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. Since a uniform taxonomy of neonatal prolonged pain is still lacking to this day in neonatology, prolonged pain management remains suboptimal in neonatal intensive care units (NICU). Aim. This master’s thesis aims to determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalized in the NICU by way of a scoping review. Methodology. An electronic search was conducted in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. This scoping review follows the JBI guidelines for scoping reviews. Results. A total of 78 articles were included in the scoping review which identified key elements of neonatal prolonged pain such as definitions (n=25), indicators (n=37), contexts (n=47), pain scales (n=49), consequences (n=29) and possible interventions (n=21) for prolonged pain management. The contexts of care were identified as being more indicative of prolonged pain and should guide pain evaluation and management. Conclusion. This master’s thesis contributes to the foundation of growing knowledge in neonatal prolonged pain and sheds light on the ambiguity that currently exists on this topic in the scientific literature and informs nursing prolonged pain management in NICU with the ultimate goal of improving developmental outcomes of premature neonates.

Bakgrund: Inom neonatalvård vårdas sjuka och för tidigt födda barn med varierande vårdbehov. För att främja anknytning och välbefinnande är hud-mot-hud och familjecenterad omvårdnad en central del inom neonatalvården. Hud-mot-hud har flera fördelar för barnet och föräldern men respiratorvård kan vara en utmanande faktor för att möjliggöra denna typ av vård på ett tryggt och säkert sätt.  Syfte: Var att beskriva barnsjuksköterskors erfarenheter av att vårda hud-mot-hud vid respiratorvård. Metod: Kvalitativ intervjustudie med induktiv ansats utfördes. Elva barnsjuksköterskor med erfarenhet av neonatal intensivvård och respiratorvård vid fem olika neonatalavdelningar deltog. Semistrukturerade intervjuer genomfördes via videosamtal och granskades enligt kvalitativ manifest innehållsanalys enligt Graneheim och Lundman (2004).  Resultat: Innehållsanalysen resulterade i tre generiska kategorier: Att vårda hud-mot-hud vid respiratorvård och dess positiva effekter, Att vårda hud-mot-hud medför utmaningar, Att använda strategier för att möjliggöra hud-mot-hud. Barnsjuksköterskorna strävade för att vårda hud-mot-hud vid respiratorvård. Deras erfarenhet var att vårdmiljön var av betydelse samt att förflyttningen var en utmanande faktor. Med strategier och erfarenhet upplevde de att de etablerade en säker och trygg vård hud-mot-hud.  Slutsats:  Med vetskap om fördelarna med hud-mot-hud har barnsjuksköterskorna en viktig del i att främja hud-mot-hud i den neonatala intensivvården. Genom inarbetade rutiner för hud-mot-hud som bidrar till en trygg och säker vård är det betydelsefullt att ytterligare neonatalavdelningar tar del av detta för att alla barn ska få lika och rättvis vård i Sverige. / Background: Children who are born prematurely or sick have different needs of care in the neonatal unit. To promote attachment and well-being, skin-to-skin contact as well as family centered care are important. Skin-to-skin contact has several advantages for the newborn and the parents, but respiratory care can be a challenging factor to enable this type of care in a safe and secure way.  Aim: Was to describe pediatric nurses' experiences of providing skin-to-skin care during respiratory care.  Method: Qualitative interview study with an inductive approach. Five neonatal units participated, involving 11 pediatric nurses with experience in neonatal intensive care and respiratory care. Semi-structured interviews were conducted through video calls and analysis using qualitative manifest content according to Graneheim and Lundman (2004).  Result: The content analysis results in three generic categories: Skin-to-skin care with respiratory care and the positive outcomes, Skin-to-skin care involves challengers, Employing strategies to enable skin-to-skin care. The pediatric nurses aimed to provide skin-to-skin care during respiratory care. Their experience was that the environment was significant, and that mobility was a challenging factor. With strategies and experience, they felt that they established a safe and secure skin-to-skin treatment. Conclusion: With an understanding of the benefits of skin-to-skin contact, pediatric nurses have an important part in promoting it in neonatal intensive care. With incorporated routines for skin-to-skin that can contribute to a safe and secure care, it is significant that further neonatal units take part so that all newborns get the same care in Sweden overall.

This dissertation examines how newborn medical care was institutionalized in hospitals across the United States between 1930 and 1980. Over that time, newborn medicine evolved from a relatively neglected domain of pediatrics into one of its most crowded arenas, anchored by new neonatal intensive care units (NICUs) where round-the-clock, high-tech care was provided to critically ill and premature newborns. Rather than focusing on therapeutic developments, “Newborn Country” uses space and place as analytic optics to understand the rise of the NICU. It argues that the course of newborn medicine was set in the process of answering questions about how to construct safe hospital environments for newborns and how to distribute specialized newborn care across a fragmented national landscape of hospital-centric medicine. Specific techniques of governance, from infection control protocols to health planning agendas, as well as their uneven and often unequal application, structured the spaces of promised health and healing that American newborns and their caretakers have moved through. The transition of birth from the home to the hospital demanded new spaces for newborn care, the safety of which were quickly cast into question by epidemics of hospital-associated infections. The organized response to these infections relied on the reallocation of hospital space through a gendered paradigm of aseptic discipline, but this paradigm fell apart in the face of hospital spaces defined by regimes of socioeconomic and racial segregation. In the 1950s, antibiotic-resistant infections in hospital nurseries challenged prevailing infection control strategies, exposing the porous boundaries between hospital environments and their surrounding communities and encouraging institutions to surveil their built and social ecosystems more actively. As antibiotic-resistant nursery infections waned in virulence in the early 1960s, freedom from the threat of infection opened the possibilities for newborn care. It facilitated new arrangements of space, labor, and neonatal patients that challenged norms of hospital safety but held immense promise for saving newborn lives. “Newborn Country” also considers the politics of organizing and distributing specialized newborn care, beginning with systems of emergency transport organized for premature infants in the 1930s and 1940s. Both emergency medical services and specialized newborn care were caught up in a wave of enthusiasm for “regionalizing” medical services within defined geographic areas in the 1960s. Hospitals enacted “perinatal regionalization” by creating hierarchical networks of care connected by a circulatory system of newborn transportation. In the 1970s, perinatal regionalization remade geographies of care under the new banner of perinatal health. As the decade came to a close and NICUs were increasingly identified as a source of institutional profit and prestige, perinatal regionalization became a contested stage for the spatial politics of allocating hospital resources.

La Communauté française décide en concertation avec la Région bruxelloise et la Région wallonne, de financer un Centre d’Epidémiologie Périnatale (CEpiP). Les Communautés et Régions chargent le CEpiP de les assister dans la vérification, le remplissage et la correction des certificats concernant les naissances à partir du 1er janvier 2008. Le CEpiP est également chargé d’encoder les certificats bruxellois, les certificats wallons étant toujours encodés par un sous-traitant.<p>Un problème souvent rencontré dans l’analyse des certificats de naissance est la présence de données manquantes. Des informations manquaient sur 64.0% des certificats bruxellois de janvier 2008 (situation de base). Le renforcement de l’enregistrement par le CEpiP durant l’année 2008 est lié à une diminution des informations manquantes sur les certificats initiaux (à la sortie des maternités et services d’état civil) après la première et la deuxième année d’enregistrement :20,8% et 19,5% des naissances en décembre 2008 et 2009 respectivement. Le taux résiduel de données manquantes après correction grâce aux listes envoyées aux maternités et services d’Etat civil est faible. En particulier, la nationalité d’origine des parents était souvent manquante, jusqu’à 35% à Bruxelles (données non publiées), et ce taux est passé à 2.6% en 2008 et 0.1% en 2009. Certaines données manquantes ne sont pas distribuées de façon équivalente selon la nationalité de la mère, même après correction. Les mères d’origine sub-saharienne ont les taux de remplissage les moins élevés. Enfin, le taux de mort-nés a augmenté par rapport aux données de 2007, au profit des mort-nés avant l’âge de 28 semaines, et suggère une amélioration de l’enregistrement suite au renforcement de l’information.<p>Les données concernant l’indice de masse corporelle des patientes sont donc relevées depuis 2009 pour l’ensemble des mères qui accouchent en Belgique. L’obésité maternelle et l’immigration sont en augmentation en Belgique, et ont été rarement étudiées au travers d’études de population sur les certificats de naissance. Des études ont pourtant montré que ces mères étaient à risque de complications périnatales, comme la césarienne ou la mortalité périnatale. L’obésité et l’immigration ont en commun le fait qu’elles recouvrent des réalités médicales, sociales et relationnelles face au personnel soignant, qui les mettent à risque de complications périnatales.<p>Des différences en termes de complications obstétricales et néonatales entre populations immigrantes et autochtones ont été observées en Belgique et dans d’autres pays, mais elles sont encore mal comprises. <p>Dans un premier travail d’analyse, nous avons évalué les taux de mortalité périnatale chez les mères immigrantes, en fonction du fait qu’elles étaient naturalisées ou non.<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères immigrantes (8.6‰) que non-immigrantes (6.4‰).<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères non naturalisées (10.3‰) que chez les mères naturalisées (6.1‰).<p>Le taux de mortalité périnatale varie selon l’origine des mères, mais dans chaque sous-groupe étudié, les mères non naturalisées ont un taux plus élevé de mortalité périnatale.<p><p>Des études ont successivement montré davantage, ou moins de césariennes chez les mères immigrantes. Peu de facteurs confondants étaient généralement pris en compte. Dans un second travail d’analyse, nous avons comparé les taux de césarienne dans plusieurs sous-groupes de nationalités.<p>Les taux de césarienne varient selon les sous-groupes de nationalités. Les mères originaires d’Afrique sub-saharienne ont un odds ratio ajusté pour la césarienne de 2.06 (1.62-2.63) en comparaison aux mères belges. L’odds ratio ajusté n’est plus statistiquement significatif après introduction des variables anthropométriques dans le modèle multivariable pour les mères d’Europe de l’Est, et après introduction des interventions médicales pour les mères du Maghreb.<p><p>Peu d’études ont analysé la relation entre l’obésité maternelle et les complications néonatales, et la plupart de ces études n’ont pas ajusté leurs résultats pour plusieurs variables confondantes. Nous avons eu pour but dans un troisième travail d’analyse d’étudier la relation entre l’obésité maternelle et les paramètres néonatals, en tenant compte du type de travail (induit ou spontané) et du type d’accouchement (césarienne ou voie basse). Les enfants de mères obèses ont un excès de 38% d’admission en centre néonatal après ajustement pour toutes les caractéristiques du modèle multivariable (intervalle de confiance à 95% :1.22-1.56) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 45% (1.21-1.73) et 34% (1.10-1.63) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 18% (0.86-1.63) et non statistiquement significatif.<p>Les enfants de mères obèses ont un excès de 31% de taux d’Apgar à 1 minute inférieur à 7, après ajustement pour toutes les caractéristiques du modèle mutivariable (1.15-1.49) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 26% (1.04-1.52) et 38% (1.12-1.69) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 50% (0.96-2.36) et non statistiquement significatif.<p><p>In 2008, a Centre for Perinatal Epidemiology was created inter alia to assist the Health Departments of Brussels-Capital City Region and the French Community to check birth certificates. A problem repeatedly reported in birth certificate data is the presence of missing data. The purpose of this study is to assess the changes brought by the Centre in terms of completeness of data registration for the entire population and according to immigration status. Reinforcement of data collection was associated with a decrease of missing information. The residual missing data rate was very low. Education level and employment status were missing more often in immigrant mothers compared to Belgian natives both in 2008 and 2009. Mothers from Sub-Saharan Africa had the highest missing rate of socio-economic data. The stillbirth rate increased from 4.6‰ in 2007 to 8.2‰ in 2009. All twin pairs were identified, but early loss of a co-twin before 22 weeks was rarely reported.<p>Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship status. Perinatal mortality rate varied according to the origin of the mother and her naturalization status: among immigrants, non-naturalized immigrants had a higher incidence of perinatal mortality (10.3‰) than their naturalized counterparts (6.1‰). In a country with a high frequency of naturalization, and universal access to health care, naturalized immigrant mothers experience less perinatal mortality than their not naturalized counterparts. <p>Our second objective was to provide insight into the differential effect of immigration on cesarean section rates, using Robson classification. Cesarean section rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from Sub-Saharan Africa with a term, singleton infant in cephalic position, without previous cesarean section, appear to carry the highest burden.<p>If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the last study, after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis. Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Die doel van hierdie studie is die ontwikkeling van 'n ouerleidingsprogram vir moeders wat hul premature babas in 'n kangaroemoedersorgprogram versorg. Die program het ten doel om die moeders in die onmiddelikke versorging, sowel as die toekomstige begeleiding van hut kinders, toe te rus. 'n Literatuuroorsig word gegee van prematuriteit as fenomeen en van kangaroemoedersorg (KMS) as versorgingswyse, met spesifieke verwysing na die toepassing daarvan in Kalafonghospitaal. Die grondslae van ouerteiding word uit die literatuur opgesom en riglyne word ook gestef vir die samestelling van 'n ouerfeidingprogram. Die kwalitatiewe navorsingsmetode word gebruik om die inhoud van die ouerfeidingsprogram te bepaal en om ondersoek in te stel na die mees geskikte aanbiedingswyses. Die verslag word afgesluit met riglyne vir die samestelling van 'n prakties-toepasbare ouerleidingsprogram waarin inhoudsmoontlikhede, idees vir aanbieding en wyses vir die bepaling van gestelde uitkomste uiteengesit word. / The aim of this study is the development of parental guidance for mothers who take care of their premature babies in a programme of Kangaroo Mother Care. The programme aims to equip mothers for immediate and future care of their children. A literature review of prematurity as phenomenon and of kangaroo mother care as care method is presented with specifK: reference to the way it is applied in Kalafong-hospital. The basics of parental care are summated from literature and guidelines are set to design a parental guidance programme. The qualitative research method is put into operation to determine the content of the parental guidance programme and to investigate the most appropriate method of presentation. The report is concluded with guidelines for setting up a practical and applicable parental guidance programme in which subject possibilities, ideas for presentation and means for determining set outcomes are explained. / Educational Studies / M.Ed.(Spesialisering in voorligting)

The HIV/AIDS pandemic is a crisis for the South African government, society and Church. About sixty percent of the HIV population are in Sub Saharan Africa with women being three times more likely to be infected with HIV than their male counterparts. Governmental, societal and Church responses seem to have had little effect in reducing the pandemic as can be seen from the rising prevalence rates. Responses to the HIV/AIDS pandemic lack a gender focus. Some churches have not responded to the HIV/AIDS pandemic. Other Church-based responses have been isolated and simplistic in that they have concentrated on one aspect of the HIV illness. The HIV/AIDS pandemic is a growing crisis to which the Church should respond. The hermeneutical point of departure in this thesis is to express a preferential option for the poor by standing in solidarity with a group of women living on the margins of society. To this end the perspectives of black people, who are materially poor, HIV positive and part of support groups are articulated in the study. The research project suggests that the preferential option for the poor has the potential to contribute to the personal and social transformation of society. Focussing on the deep-seated longing many desire for fullness of life, this thesis explores and describes a gendered Christian response to the HIV/AIDS pandemic that could contribute to the full humanity of people. Full humanity is understood as transformation to wholeness and incorporates unity with God, others, creation and within oneself. A multifaceted, integrated and gendered response to the HIV/AIDS pandemic is suggested by way of a model of full humanity. The South African context of HIV/AIDS, patriarchy and poverty pose a challenge to the way that Christians develop their spirituality. This thesis aims to explore and describe aspects of a fully human spirituality emerging from the South African situation. The study suggests that a clearly integrative and holistic approach that embodies the gender perspective is necessary for churches to adopt in responding to the HIV/AIDS pandemic. / Christian Spirituality, Church History and Missiology / D.Th.(Christian Spirituality)

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.

A influência das características laborais sobre a saúde mental dos trabalhadores pode decorrer de inúmeros fatores ou formas de organização do trabalho. Na atualidade, verifica-se os crescentes índices de sintomas psíquicos entre determinadas categorias profissionais, com destaque para os trabalhadores de saúde atuantes em ambiente hospitalar Objetivo: Este estudo objetivou identificar a ocorrência de Transtornos Mentais Comuns (TMC), a ocorrência da síndrome de Burnout, e a associação de ambos os transtornos nos trabalhadores de enfermagem, bem como elaborar propostas de intervenção para redução do desgaste psíquico. Metodologia: Trata-se de um estudo exploratório, transversal com abordagem quanti-qualitativa. A pesquisa foi realizada em Hospital Público Universitário especializado em cardiologia, pneumologia e cirurgias cardíacas e torácicas. A amostra foi composta por trabalhadores de enfermagem que atuam em unidades de terapia semi-intensiva e intensiva pediátrica e neonatal, perfazendo um total de 92 participantes. Para a coleta de dados quantitativos foram utilizados: instrumento de caracterização sócio demográfica, Self-Reporting Questionnaire (SRQ-20), e o Maslach Burnout Inventory (MIB). Para os dados qualitativos, optou-se pela técnica de grupo focal, conduzido por questões norteadoras, com uma amostra de 17 trabalhadores de enfermagem. O período de coleta foi nos meses de junho e julho de 2012. Resultados: A análise dos resultados evidenciou a ocorrência de TMC em 44,60%(41) dos trabalhadores e a ocorrência de Burnout em 8,7%(8) trabalhadores. Houve associação estatística entre os TMC e o Burnout p=0,003, considerando nível de significância de 5%. Em relação aos TMC, as respostas dos trabalhadores foram distribuídas de acordo com os quatro grupos de sintomas avaliados pelo SRQ-20: Grupo somático, Decréscimo de energia vital, Humor depressivo-ansioso e Pensamentos depressivos. Em relação à sindrome de Burnout, os trabalhadores foram avaliados considerando-se a ocorrência de escores alto nas três dimensões (Desgaste Emocional, Despersonalização e Reduzida Realização Profissional) ou em uma delas apenas. Não foi constatada associação entre os transtornos e as variáveis sócio-demográficas. Houve associação entre ambos os transtornos. As sessões de grupo focal evidenciaram propostas de intervenção mediante três temas que emergiram das discussões: Aprender a lidar com a criança cardiopata grave, Receber o reconhecimento profissional e Repensar a gestão de pessoas. Conclusão: Os achados, em conjunto, evidenciam necessidade de medidas protetoras à saúde mental do trabalhador que assiste crianças cardiopatas graves. Palavras-chave: Estresse psicológico, Esgotamento profissional, Equipe de enfermagem, Hospitais públicos, Unidades de terapia intensiva pediátrica, Unidade de terapia intensiva neonatal, Saúde do trabalhador. / The influence of work characteristics on mental health workers may be due to numerous factors or forms of work organization. At present, there is the growing rates of psychiatric symptoms among certain professions, especially health workers working in hospitals Objective: This study aimed to identify the occurrence of Common Mental Disorders (CMD), the occurrence of Burnout, and the association of both disorders among nursing staff, as well as elaborate proposals for intervention to reduce wear psychic. Methodology This is an exploratory study, cross-sectional with quantitative and qualitative approach. The research was conducted in a public University Hospital specialized in cardiology, pulmonology, thoracic and cardiac surgery. The sample consisted of nursing workers of care units, semi-intensive and intensive, pediatric and neonatal, making a total of 92 participants. For quantitative data collection was used: instrument of socio demographic, Self-Reporting Questionnaire (SRQ-20), and the Maslach Burnout Inventory (MIB). For qualitative data, we chose the technique of focal group, conducted by leading questions, with a sample of 17 nurse workers. The collection period was between June and July, 2012. Results The result of the analysis revealed the occurrence of CMD in 44.60% (41) of the workers and the occurrence of Burnout in 8.7% (8) of the workers. There was a statistical association between CMD and Burnout p = 0.003, considering level of significance 5%. Regarding CMD, the answer of the workers was distributed according to the four groups of prognostic evaluated by the SRQ-20: Somatic Group, Decrease of vital energy, Anxious-depressive humor and Depressive thoughts. Regarding Burnout syndrome, workers were evaluated considering the occurrence of high scores in all three dimensions (Emotional Exhaustion, Depersonalization, and Reduced Professional Accomplishment) or only in one of them. There was no association between the disorders and sociodemographic variables. There was an association between both disorders. The focal group sessions revealed proposals for intervention through three issues that emerged from the discussions: Learn to deal with severe heart disease children, professional acknowledgment and rethink people management. Conclusion: Findings, during the sessions, highlight the need for protective measures of mental health for workers who assist children with heart disease

OBJETIVO: Identificar o perfil da clientela atendida na Unidade de Cuidados Intensivos Neonatal Externa (UCINE); observar possíveis diferenças entre recém-nascidos e família de mães adolescentes e de mães adultas, e verificar a participação das famílias nos programas de humanização da unidade. MÉTODO: Estudo de coorte transversal prospectivo de 284 recém-nascidos (RN) e seus familiares admitidos na Unidade de Cuidados Intensivos Neonatal do Instituto da Criança de maio de 2005 a dezembro de 2006. Os dados foram coletados com as mães seguindo o conteúdo do formulário construído especificamente para este estudo, que incluía informações socioeconômicas e demográ-ficas, história antenatal, tipo de parto, dados relacionados ao recém-nascido como idade gestacional e cronológica, pesos de nascimento e de admissão, tipo de aleitamento à internação e na alta, doenças que geraram a internação, número de altas, óbitos e transferências, trata-mentos utilizados e participação da família durante a internação. RESULTADOS: Evidenciou-se em relação às condições sociodemográ-ficas que a maioria dos 284 pacientes (66,2%) procedia da cidade de São Paulo, principalmente da Zona Oeste, ou dos municípios. O pré-natal foi realizado por 96,1% das mães, e 59% dos RN nasceram de parto cesa-riano, com peso entre 600 e 4780g, idade gestacional mediana de 37,6 semanas, e na maioria adequados para a idade gestacional (77,5%). A mediana da idade à internação foi de 7 dias de vida, associada princi-palmente a causas infecciosas (32,0%) e respiratórias (25,0%), sendo o peso nesta ocasião de 600 a 5810g. A taxa de mães adolescentes ( 19 anos de idade) foi de 21,0%, e neste grupo observou-se índices inferiores de escolaridade e de número de consultas de pré-natal e, maior inci-dência de prematuridade (47,5%). As mães adultas apresentaram maior número de intercorrências durante a gestação e maior incidência de parto cesariano (63,6%). Em relação às características dos RN, não houve diferenças estatísticas entre mães adolescentes e adultas, entre-tanto observou-se a necessidade de internação mais precoce dos RN de mães adolescentes na unidade, e pesos menores à admissão. A sobre-vida foi de 91,2% e, a evolução dos RN não foi influenciada pela idade materna, quando questionada a participação das famílias nos programas de humanização da unidade, observou-se participação ativa dos fami-liares de ambas as faixas etárias nos cuidados ao RN e aumento da porcentagem de RN em aleitamento na alta (69,3%) comparada à admissão (51,7%). CONCLUSÕES: O perfil da clientela mostra que o atendimento é na sua maior parte regionalizado, e constituído por pacientes com doenças complexas que necessitam de atendimento em Unidade de Cuidados Intensivos Neonatal de nível terciário. As mães adolescentes apresentaram intercorrências durante a gestação como hipertensão arterial e diabetes mellitus que, além da idade, predispõem ao nascimento de recém-nascidos prematuros. A participação das famílias nos cuidados aos seus filhos demonstrou-se relevante, no entanto são necessárias medidas que aumentem a adesão e integração dos familiares nos programas de humanização / OBJECTIVES: Identify the profile of the patients assisted in the Neonatal Intensive Care Unit (NICU); observe the possible differences between the newborns from families of adult mothers and families of teenage mothers, and also verify the participation of the families in the unit humanization programs. METHOD: Prospective transversal cohort of 284 newborns (NB) and their family members, who were admitted in the Neonatal Intensive Care Unit of the Instituto da Criança, between May 2005 and December 2006. The data was collected from the mothers according to the contents of the form that was specifically designed for this study, which included demographic, social and economical information; the antenatal history; type of delivery; data related to the newborn such as gestation age and chronological age; birth and admission weight; type of feeding at the time of admission and at the time of discharge; the diseases that caused the admission; number of discharges, deaths and transfers; the treatments used; and the participation of the family during the stay in the NICU. RESULTS: We found that, as far as the social and demographical conditions are concerned, the majority of the 284 patients (66.2%) were from the city of São Paulo, mainly from its West Part, or from the cities belonging to the greater São Paulo area. The prenatal exam was carried out by 96.1% of the mothers, and 59% of the NB were delivered by cesarean sections, having a body weight varying from 600 to 4780 grams, average gestation age of 37.6 weeks, and the majority were physically adequate for their gestation age (77.5%). Their average age upon admission was of 7 days, being the causes for admission mainly associated with infectious (32%) and respiratory (25%) diseases, and their weight at the time varied from 600 to 5810 grams. The percentage of teenage mothers ( than 19 years old) was 21%, and in this particular group we found inferior schooling levels and inferior prenatal exam figures, and also in this group we found a greater incidence of preterm births (47.5%). The adult mothers presented a greater number of complications during pregnancy and a greater number of surgically assisted deliveries (63.6%). As far as the NB\'s characteristics, there were no statistical differences between teenage and adult mothers, however we found an earlier admission age of the NB from teenage mothers in the Unit, and also less weight upon admission. The survival rate was 91.2% and the evolution of the NB was not influenced by maternal age. When we asked about the families\' participation in Unit humanization programs, we found an active participation of the families of either teenage or adult mothers in the care to the NB and an increase in the percentage of NB being breastfed at the moment of discharge (69.3%) compared to the moment of admission (51.7%). CONCLUSIONS: The profile of the patients show that the assistance is in most part regionalized, being constituted of patients with complex diseases that needed care in a Level III NICU. The teenage mothers presented complications during pregnancy such as high blood pressure and diabetes mellitus, which, along with their age, prearranged the preterm birth of newborns. The participation of the families in the care to their infants has shown to be relevant, however some measures are necessary in order to increase and improve the participation of the family members in the humanization programs