Background In Nyanza in western Kenya are 30,5% of children estimated as malnourished. It is a family situation that nurses often come in contact with. Therefore it is of interest to know how nurses work with parents of malnourished children when they have a significant role in developing the family's knowledge and child health. Aim. The aim is to investigate how nurses experience that they are working with parents of malnourished children. Method. Semi-structured qualitative interviews with a life-world approach were conducted. All respondents work at St. Joseph Mission Hospital. Results. The study shows the nurses long-term goal was to change parents thought patterns regarding their situation and the role nutrition play in it. To identify each family's uniqueness is crucial to this change, the identification determines the content of the relationship and nurses' attitudes. Providing security, knowledge about nutrition, participation in the caring of the child and a personal relationship with the parents of malnourished children, are important elements in the relationship. The reflection of the nurses also constitute a significant part of the work. Discussion. The nurses work to guide parents to a change in thought patterns and can be viewed as individually foundation stones for how nurses work with parents of malnourished children. The essence is changing the parents thought patterns about their behavior, perception and knowledge regarding nutrition. To achieve optimal results, it requires that the nurse works self-reflectively, with openness and attention and that nurses design education individually. Clinical implications. How the Kenyan nurses works to distinguish empathy and sympathy in practice, can be a useful reflection in health care in Sweden. In the nurses attitudes and actions, they use their emotions to create a personal and professional relationship. The Kenyan nurses' ways of dealing with their emotions, can create new alternative approach among Swedish nurses. / Program: Sjuksköterskeutbildning

Children with complex health problems who are dependent upon medical technology require frequent hospitalizations, during which parents must make difficult decisions regarding their child’s care. Although principles of “family-centred care” have been widely adopted by paediatric hospitals, studies indicate that many parents are dissatisfied with their roles in decisions about their child’s care. Pierre Bourdieu’s Logic of Practice, specifically his concepts of field, capital, and habitus, as they relate to cultural and symbolic capital within the field of pediatric medicine, were used to guide the design of a parent briefing intervention aimed at improving parents’ satisfaction with decision making. Briefings were conducted during daily hospital rounds. Physicians and nurses were asked to sit while using a checklist as a communication guide. A two-part study was conducted to determine feasibility of a randomized controlled trial of a parent briefing. One component was a psychometric evaluation of an instrument to measure parents’ satisfaction with decision making. The other was a phase I single group, post-test study of the parent briefing. Eighty-two parents of children admitted to an in-patient unit in a large metropolitan pediatric health centre, with an expected length of stay ≥ 3 days, completed the Family Satisfaction with Decision Making (FS/DM) subscale and the Decisional Conflict Scale (DCS) prior to discharge. A subgroup of parents participated in the parent briefing study. The Cronbach’s alpha reliability coefficient of the FS/DM was 0.87, and it was inversely correlated with the DCS (r2= -0.635, p<0.0001). Eighteen physicians, 25 nurses, and 31 parents participated in the phase I trial of the briefing intervention. Sixty-eight out of an expected 93 briefings were carried out as per study protocol. Nineteen parents did not receive the required “dose” of the study intervention. Mean time to complete the intervention was 11.9 minutes (SD = 6.9). Parents and nurses rated the acceptability and usefulness of the intervention favourably, whereas physicians’ ratings were mixed. The FS/DM instrument is a suitable primary outcome measure for an RCT. However, more work needs to be done, to ensure the feasibility of the intervention, including more intensive clinician training.

Children with complex health problems who are dependent upon medical technology require frequent hospitalizations, during which parents must make difficult decisions regarding their child’s care. Although principles of “family-centred care” have been widely adopted by paediatric hospitals, studies indicate that many parents are dissatisfied with their roles in decisions about their child’s care. Pierre Bourdieu’s Logic of Practice, specifically his concepts of field, capital, and habitus, as they relate to cultural and symbolic capital within the field of pediatric medicine, were used to guide the design of a parent briefing intervention aimed at improving parents’ satisfaction with decision making. Briefings were conducted during daily hospital rounds. Physicians and nurses were asked to sit while using a checklist as a communication guide. A two-part study was conducted to determine feasibility of a randomized controlled trial of a parent briefing. One component was a psychometric evaluation of an instrument to measure parents’ satisfaction with decision making. The other was a phase I single group, post-test study of the parent briefing. Eighty-two parents of children admitted to an in-patient unit in a large metropolitan pediatric health centre, with an expected length of stay ≥ 3 days, completed the Family Satisfaction with Decision Making (FS/DM) subscale and the Decisional Conflict Scale (DCS) prior to discharge. A subgroup of parents participated in the parent briefing study. The Cronbach’s alpha reliability coefficient of the FS/DM was 0.87, and it was inversely correlated with the DCS (r2= -0.635, p<0.0001). Eighteen physicians, 25 nurses, and 31 parents participated in the phase I trial of the briefing intervention. Sixty-eight out of an expected 93 briefings were carried out as per study protocol. Nineteen parents did not receive the required “dose” of the study intervention. Mean time to complete the intervention was 11.9 minutes (SD = 6.9). Parents and nurses rated the acceptability and usefulness of the intervention favourably, whereas physicians’ ratings were mixed. The FS/DM instrument is a suitable primary outcome measure for an RCT. However, more work needs to be done, to ensure the feasibility of the intervention, including more intensive clinician training.

Sammanfattning: Syfte: Att belysa barnsjuksköterskors erfarenheter av att bedriva relationsbaserad vård för det förtidigt födda barnet och dess föräldrar. Bakgrund: Aktuell kunskapsgrund redovisar vikten av en familjecentrerad, relationsbaserad, neonatalvård i strävan efter tidig anknytning och självständigt föräldraskap. Bakgrunden redovisar även barnsjuksköterkans erfarenheter av den relationsbaserade vården. Design: En intervjustudie utifrån en kvalitativ ansats, med ett vårdarperspektiv som studiens teoretiska referensram. Metod: Data samlas in under 2015 genom öppna och semistrukturerade intervjuer med 10 barnsjuksköterskor verksamma vid neonatalavdelningar. Som stöd för intervjuerna används en intervjuguide, som testas i en pilotintervju. Materialet bearbetas i en kvalitativ innehållsanalys, och resulterar i tre kategorier, 10 subkategorier och ett tema. Resultat: Resultatet redovisas utifrån följande kategorier: att utveckla en vårdande relation, att använda relationsfrämjande arbetssätt på neonatal, att erfara svårigheter att bedriva relationsbaserad vård. Temat för resultatet är; en varsam och utmanande vägledning. Konklusion: Barnsjuksköterskornas erfarenheter av att bedriva relationsbaserad vård på en neonatalavdelning kan förstås som en varsam och samtidigt utmanande vägledning mot föräldraskap. Att bedriva relationsbaserad vård är en viktig del i att skapa föräldrar på neonatalavdelning och det finns all anledning att fortsätta att utveckla ett relationsbaserat vårdande på landets neonatalavdelningar. / Abstract: Aim: To explore pediatric nurses' experiences of practicing relationship-based care for premature infant and their parents. Background: A family centered, relationship-based, care is significant for pursuing early ties and independently parenting in the neonatal care unit. The backround also reports pediatric nurses’ experiences of relationship-based care. Design: An interview study with a qualitative approach, using caring perspective as a theoretical framework. Methods: The data is collected in 2015 through open and semi-structured interviews with 10 children nurses’ working in neonatal units. An interview guide, tested and validated in a pilot interview, is used as guidance for the interviews. The transcribed data is analysed using qualitative content analysis, and resulted in an overarching theme illustrating the latent content including three categories and 10 subcategories. Results: The findings portrayes in the following categories: development of a caring relationship, relationship promotion practices in the neonatal unit, the difficulties with practicing relationship-based care. The theme is a gentle and challenging guidence. Conclusion: Pediatric nurses' experiences in conducting relationship-based care in neonatal units can be understood as a gentle and challenging guidance on parenting. To engage in relationship-based care is an important part of creating parents in the neonatal care unit and there is every reason to continue to develop a relationship based care.