Introduction: Adolescent Mental health is a growing topic of concern for pediatric nurse practitioners. Adolescents are known for risky behaviors that can lead to poor health habits, unintentional and intentional injuries. There are recommendations from the US Preventive Services Task Force (USPSTF), the American Academy of Pediatrics (AAP), and the National Prevention Council (NPC) to screen adolescents for mental health concerns including depression and suicide. There are established guidelines and evidenced based screening tools to assist practitioners in screening for at risk adolescents. Yet many practitioners are unaware of these screening tools or do not feel comfortable discussing these difficult topics with adolescent. Objective: The purpose of this study was to assess Arizona’s Pediatric Nurse Practitioners' attitude, knowledge, and practice behaviors towards adolescent mental health screenings. The Theory of Planned Behavior was used to address the relationship between the practitioner’s perceived predictive behaviors and actual behaviors. By assessing practitioners’ experience with adolescence mental health screening, barriers were identified for planned future implementation studies. Methods: From this DNP project, a survey was created and electronically distributed to members of the Arizona Chapter of NAPNAP. There were 23 participants who completed the survey. A Likert-scale was used to allow the participants to express their experiences and concerns. Results: The survey showed that most pediatric nurse practitioners strongly agreed about the importance of screening adolescent for mental health concerns such as depression and suicide. The survey also found that although the PNPs felt willing to discuss the topics, their lack of knowledge about the recommendations resulted in them not screening every adolescent every time. Conclusion: The survey showed that PNPs identified adolescent with mental health concerns including depression and suicide in their practice. The results of the survey showed the PNPs are willing to discuss these topics, but need more knowledge and training regarding screening tools. In addition, the survey identified the barriers in screening of adolescents' mental health which include financial reimbursement and time management. Future studies should focus on improving mental health education for pediatric practitioners and resources to assist them in screening their adolescent patients.

År 2015 sökte 70 384 barn asyl i Sverige. Flyktingbarn löper större risk att drabbas av ohälsa än andra. Idag träffar skolsköterskor i Sverige dessa barn allt oftare. Syftet med denna studie var att belysa skolsköterskors upplevelse av att möta nyanlända flyktingbarn. Semistrukturerade intervjuer genomfördes med 11 skolsköterskor och analyserades med hjälp av kvalitativ innehållsanalys. Resultatet redovisas i fyra kategorier: språket, ett hinder för att kommunicera; där skolsköterskorna tar upp vikten och svårigheten av att ha en fungerande dialog. Påfrestande att stödja barnen; där skolsköterskorna beskrev det som betungande att höra barnens historier och att de upplevde en känsla av otillräcklighet. Att känna tillfredsställelse i mötet; skolsköterskorna beskrev sig vara fascinerade över barnens mentala styrka och deras positivitet. Svårighet att anpassa sig till olika kulturer; där skolsköterskorna beskrev att hälsoformulären inte var anpassade till barnens olika kulturer och skolsköterskorna upplevde själva en bristfällig kunskap om de olika kulturerna. Konklusionen av studien var att skolsköterskors möten med nyanlända flyktingbarn kan effektiviseras om skolsköterskor får ökad kunskap om olika kulturer och flyktingbarns psykiska, fysiska och emotionella hälsoproblem samt genom att optimera kommunikationen.

SAMMANFATTNING Bakgrund. I Sverige insjuknar årligen drygt 300 barn i cancer. Det saknas empiriska studier som beskriver de små barnens upplevelser av barnsjuksköterskans bemötande vid insjuknandet av cancer. Föräldrar till små barn med cancer har en avgörande roll i barnets liv och det är därför viktigt att belysa även deras upplevelser för att utveckla den barnonkologiska verksamheten samt öka familjens välbefinnande vid insjuknandet. Syfte. Syftet med studien var att beskriva barn och föräldrars upplevelse av barnsjuksköterskans bemötande inom barnonkologisk verksamhet. Metod. Studiens design var kvalitativ där data inhämtades 3-9 veckor efter diagnostillfället. Deltagarna som inkluderades var barn i åldern 1-5 år. Totalt deltog 13 barn samt 23 föräldrar i studien. Intervjuerna analyserades genom en deduktiv innehållsanalys utifrån Swansons caringteori. Resultat. I resultatet framkom vikten av att barnsjuksköterskan visade tilltro till barnet och föräldrarnas förmågor vid insjuknandet. Föräldrarna önskade att barnsjuksköterskan bibehöll en hoppfull attityd i bemötandet. Föräldrarna ville inge trygghet och inte hålla fast sitt sjuka barn vid svåra omvårdnadshandlingar. När familjerna upplevde barnsjuksköterskans närvaro och fokus på individen ökade välbefinnandet hos barnet och föräldrarna. Konklusion. Barnsjuksköterskans bemötande kan både främja eller hindra hälsa och välbefinnande. Barnsjuksköterskor måste visa tilltro till barnet och föräldrars förmåga genom att tillämpa barnets perspektiv samt ett barnperspektiv. Inom den barnonkologiska verksamheten krävs det vidareutbildade barnsjuksköterskor för att säkerställa god omvårdnad då ett litet barn insjuknat i cancer. / ABSTRACT Background. Each year approximately 300 children fall ill with cancer in Sweden. There is a lack of empirical studies describing the younger children's experiences of the pediatric nurse approach during cancer diagnosis. Parents of young children with cancer have a crucial role in the child's life and it is important to shed light on their experiences to develop the pediatric oncology and increase family well-being during the time of diagnosis. Aim. The aim of the study was to describe children and parents' perception of the pediatric nurse approach in pediatric oncology. Method. The study design was qualitative and the data were collected 3-9 weeks after diagnosis. Included participants were children aged 1-5. A total of 13 children and 23 parents took part in the study. The interviews were analyzed through a deductive content analysis based on Swanson’s caring theory. Results. The importance of the pediatric nurse believing the child and the parents' abilities during diagnosis. Parents of the children wished for the pediatric nurse to maintain a hopeful attitude in her approach. The parents felt a need to contribute the child with security and not hold the child during difficult caring actions. When families experienced the pediatric nurse’s presence and focus on the individual, it increased the well-being of the child and the parents. Conclusion. The pediatric nurse’s approach can either promote or prevent health and well-being. Pediatric nurses must maintain belief in the child and the parents' ability by applying the child's perspective as well as a children's perspective. Within the pediatric oncology, further trained pediatric nurses are required to ensure high quality care for a young child newly diagnosed with cancer.

Objetivos: Verificar eficácia da cetamina intranasal na sedação de crianças para punção venosa. Métodos: Estudo randomizado, duplo-cego, placebo controlado realizado no Hospital de Clínicas de Porto Alegre entre janeiro e agosto de 2016. Estudo aprovado pela comissão de ética em pesquisa da instituição. Incluídas crianças que necessitasse de punção venosa, sendo randomizadas a receber cetamina IN 4mg/Kg ou solução fisiológica no grupo Placebo. Os grupos foram comparados quanto: tempo de punção, facilidade do Enfermeiro para realizar o procedimento, eventos adversos, alterações dos sinais vitais e percepção do acompanhante. Resultados: Foram incluídas 39 crianças (21 Intervenção vs 18 Placebo) sem diferenças quanto à idade, sexo, peso, motivo da internação e experiência profissional. A mediana da idade foi 19,8 vs 15,8 meses (Intervenção vs. Placebo) e a do peso foi 10 vs. 11,3Kg. A Cetamina reduziu o tempo de punção (23,0 vs 67,5 segundos; p=0,01), deu maior facilidade ao Enfermeiro para realizar o procedimento (p=0,00009). A cetamina induziu uma maior sonolência 15 minutos após (p=0,003) e reduziu o número de pessoas para contenção da criança (p=0,025). Sem diferença entre os grupos nas alterações dos sinais vitais e eventos adversos. Evento adverso observou-se em 29% das crianças do grupo cetamina e 17% do grupo placebo, sendo irritabilidade o mais comum em ambos. Em 81% do grupo Intervenção, o acompanhante afirmou que a criança ficou mais calma (p=0,0003). Conclusões: Cetamina intranasal (4mg/Kg) reduz o tempo de punção venosa, facilitando o procedimento para o enfermeiro, diminuindo o número de pessoas envolvidas e permitindo um ambiente tranquilo. / Objectives: To verify the efficacy of intranasal ketamine as sedative agent for venous access in children. Method: Randomized, double blind, placebo controlled study conducted at Hospital de Clínicas de Porto Alegre (Brazil) between January and August 2016. Children needing venous access were randomized to receive intranasal ketamine (4mg/Kg) or normal saline solution (Placebo group). Groups were compared regarding the time for venous access, facility for performing the procedure, adverse events, disturbances in vital signs and perception of the accompanying adult. The study was approved by the Local Ethics Committee. Results: 39 children (21 Ketamine; 18 Placebo) were included without differences regarding to age, sex, weight, reason for hospitalization and professional experience. The median age was similar (19.8 vs 15.8 months), as well as the median weight (10.0 vs 11.3Kg). Ketamine reduced the length for venous access (23.0 vs 67.5 seconds; p=0.01), and facilitated the procedure (p=0.00009). Ketamine induced sleepiness 15 minutes after its administration (p=0.003) and reduced the number of people for the child’s restraint (p=0.025). No difference was verified between groups regarding adverse effects or vital signs disturbance´s. Side effects were observed in 29% of the children in the Ketamine group and 17% in the Placebo group, irritability being the most common for both. The accompanying adult reported that 81% of children in ketamine group were calm and quiet (p=0.0003). Conclusions: Intranasal ketamine (4mg/Kg) reduces the time for venous puncture, facilitates the procedure to the nurse, decreases the number of people involved and provides a tranquil environment.

Bakgrund: Barn som besöker vården upplever rädsla och oro inför att vårdåtgärder kan tänkas göra ont. Adekvat smärtlindring är viktig för att lindra barns fysiska och psykiska smärta samt främja god hälsa.  Det finns olika sätt att lindra barns smärta, en metod är lustgasbehandling. Syfte: Syftet var att i form av ett förbättringsarbete utvärdera lustgasbehandling i samband med att barn genomgår en smärtsam procedur på en barn- och ungdomsmedicinsk klinik på ett medelstort sjukhus i södra Sverige. Metod: Förbättringsarbetet genomfördes med en kvantitativ design. Deskriptiv statistik har använts för att utvärdera lustgasens effekter och bieffekter, vidare har andra faktorer som kan påverka behandlingen utvärderats. Resultat: Lustgas har varit användbart i samband med smärtsamma procedurer, behandlingen har fungerat smärtlindrande samt varit till hjälp för barn som varit rädda. Lustgasbehandling uppskattas av både barn och deras vårdnadshavare. Slutsatser: För att lindra barns lidande och utföra god omvårdnad måste barnsjuksköterskan ha kunskap om hur barn upplever smärtsamma situationer samt hur smärta bäst lindras. Det aktuella förbättringsarbetet har bekräftat att lustgas är en metod som kan hjälpa barn i samband med flera typer av smärtsamma procedurer. Genom att kunna välja lustgas som smärtlindrande och lugnande metod kan barnets delaktighet och hälsa främjas. / Background: Children receiving health care experience fear and anxiety related to possible painful procedures. Adequate pain relief is important to ease children’s physical and psychological pain and further to promote good health. There are various ways of relieving children’s pain, one method is nitrous oxide. Aim: The aim was to through an improvement work evaluate the usage of nitrous oxide in connection to children undergoing a painful procedure on a children’s and youth’s medicine ward at a medium sized hospital in south of Sweden. Method: The improvement work was conducted through a quantitative design. Descriptive statistics was used to evaluate the effects and adverse events of nitrous oxide, furthermore has other variables that may affect the treatment been evaluated. Results: Nitrous oxide has been useful when utilized in painful procedures, the treatment has served pain relieving and eased children who experienced fear. Both children and legal guardians appreciated the usage of nitrous oxide. Conclusion: A children’s nurse must possess knowledge related to children’s experience of pain and adequate pain relief in order to ease children’s suffering and administer good care. The current improvement work has confirmed nitrous oxide to be a tool that might help children in connection to several painful procedures. Through the choice of using nitrous oxide as a pain relieving and sedative method the child’s empowerment and health can be improved.

This diploma thesis examines the role of paediatric nurses caring for newborns in the community. It aims to determine if and how newborn care in the home environment takes place and the role of the paediatric nurse. The research is based on one of the primary objectives set out by the member states of the WHO to improve the health of the entire population in the twenty-first century with the focus on community care and its development. The theoretical part is dedicated to the definition of community care and its history in the Czech Republic. We initially focus on how childcare at home was provided in the past. This is followed by a description of the current situation regarding care of a newborn and the mother during the first weeks following birth, both here and abroad. We evaluate the role of the paediatric nurse in terms of nursing care for newborns and research the duties that the nurse carries out within the clinic, family, and community.We have set out two objectives and five research questions. The first objective was to identify nursing care problems encountered by mothers at home and how they solve these problems. The second objective was set out in order to explore how nurses become involved in the community care of a newborn. We have chosen a qualitative method for the research part of the thesis. Data was collected through semi-structured interviews. Subsequently, a qualitative analysis and categorization of collected data was conducted. Two research sample groups were created in the first phase. The first consisted of mothers with newborns, i.e. children from birth to 28 days. The second group consisted of paediatric nurses who work in outpatient care with children and adolescents. The second phase of the research addressed paediatric nurses working in the neonatal clinic, which is run by the hospital's paediatric department. The result of our thesis is the finding that community care provided by the paediatric nurse in the field, in a natural environment and with the cooperation of the entire family and community, as defined, is almost nonexistent. The long-established system of primary care directs all nursing work into the surgeries of the paediatric practitioner, and only the first visit to the newborn, but not in all cases, is conducted at home. This system is insufficient to cover all the specifics of childcare. The needs of the newborns and their parents are becoming more urgent and in the first weeks following the birth the mothers only very slowly begin to gain healthy self-esteem and confidence in their maternal abilities, hence the need for an individual approach and help in the proper care of their baby. They feel there is a lack of information and they do not know how to deal with the needs of their newborn. The most problematic issue described is breastfeeding. The addressed nurses are of the same opinion and also consider breastfeeding as the most common focus of their intervention, and therefore, the most important part of their work.We have discovered that the skills and competencies of the paediatric nurses are sufficient to enable them to become a relevant element in the comprehensive care of newborns within the community. The interventions delivered by the nurse are fully integrated into paediatric nursing.The parents of newborns would, according to our survey, prefer a home visit from health professionals, particularly if it concerns the first contact with the baby and family. The out-patient care does not provide enough time and space to pursue common nursing issues, therefore, home visits are an essential part of the care that should be offered to the mother and baby. Community nurses would help to coordinate the services provided to families as well as help solve the nursing issues that mothers encounter in the first weeks of their child's life. A paediatric nurse would, therefore, become a partner to the parents in a joint effort to ensure the healthy development of their child.

Objetivos: Verificar eficácia da cetamina intranasal na sedação de crianças para punção venosa. Métodos: Estudo randomizado, duplo-cego, placebo controlado realizado no Hospital de Clínicas de Porto Alegre entre janeiro e agosto de 2016. Estudo aprovado pela comissão de ética em pesquisa da instituição. Incluídas crianças que necessitasse de punção venosa, sendo randomizadas a receber cetamina IN 4mg/Kg ou solução fisiológica no grupo Placebo. Os grupos foram comparados quanto: tempo de punção, facilidade do Enfermeiro para realizar o procedimento, eventos adversos, alterações dos sinais vitais e percepção do acompanhante. Resultados: Foram incluídas 39 crianças (21 Intervenção vs 18 Placebo) sem diferenças quanto à idade, sexo, peso, motivo da internação e experiência profissional. A mediana da idade foi 19,8 vs 15,8 meses (Intervenção vs. Placebo) e a do peso foi 10 vs. 11,3Kg. A Cetamina reduziu o tempo de punção (23,0 vs 67,5 segundos; p=0,01), deu maior facilidade ao Enfermeiro para realizar o procedimento (p=0,00009). A cetamina induziu uma maior sonolência 15 minutos após (p=0,003) e reduziu o número de pessoas para contenção da criança (p=0,025). Sem diferença entre os grupos nas alterações dos sinais vitais e eventos adversos. Evento adverso observou-se em 29% das crianças do grupo cetamina e 17% do grupo placebo, sendo irritabilidade o mais comum em ambos. Em 81% do grupo Intervenção, o acompanhante afirmou que a criança ficou mais calma (p=0,0003). Conclusões: Cetamina intranasal (4mg/Kg) reduz o tempo de punção venosa, facilitando o procedimento para o enfermeiro, diminuindo o número de pessoas envolvidas e permitindo um ambiente tranquilo. / Objectives: To verify the efficacy of intranasal ketamine as sedative agent for venous access in children. Method: Randomized, double blind, placebo controlled study conducted at Hospital de Clínicas de Porto Alegre (Brazil) between January and August 2016. Children needing venous access were randomized to receive intranasal ketamine (4mg/Kg) or normal saline solution (Placebo group). Groups were compared regarding the time for venous access, facility for performing the procedure, adverse events, disturbances in vital signs and perception of the accompanying adult. The study was approved by the Local Ethics Committee. Results: 39 children (21 Ketamine; 18 Placebo) were included without differences regarding to age, sex, weight, reason for hospitalization and professional experience. The median age was similar (19.8 vs 15.8 months), as well as the median weight (10.0 vs 11.3Kg). Ketamine reduced the length for venous access (23.0 vs 67.5 seconds; p=0.01), and facilitated the procedure (p=0.00009). Ketamine induced sleepiness 15 minutes after its administration (p=0.003) and reduced the number of people for the child’s restraint (p=0.025). No difference was verified between groups regarding adverse effects or vital signs disturbance´s. Side effects were observed in 29% of the children in the Ketamine group and 17% in the Placebo group, irritability being the most common for both. The accompanying adult reported that 81% of children in ketamine group were calm and quiet (p=0.0003). Conclusions: Intranasal ketamine (4mg/Kg) reduces the time for venous puncture, facilitates the procedure to the nurse, decreases the number of people involved and provides a tranquil environment.

This thesis deals with not only a question of competence of nurses and their children's development, but also in terms of preparation of professional nurses. The nursing skills are necessary competence to perform the nursing profession. Represent this area of knowledge, skills and attitudes that are acquired through education. One of the ways to qualify nurses to the profession, is today a university course. The second method is a specialized education, provided that the candidate meets the conditions for admission and received his professional competence to practice nurses. Determination of the competencies of nurses in the Czech Republic is governed by Law No. 96/2004 Coll. Acquisition and recognition of eligibility for non-medical professions and for activities related to providing health care and amending certain related acts, the last decree on the activities of health workers and other professionals, No. 55/2011 Coll. The thesis is divided into theoretical and practical part. The theoretical cross section contains the history of pediatrics and nursing, selected chapters from health legislation and development of children's ward in České Budějovice Hospital. For the practical part, I chose a qualitative research method of interviewing and pediatric nurses. The research sample consisted of 10 nurses who work or have worked on the inpatient pediatric ward. There were set three goals in this work. The first task was to determine the development of competencies nurses. The second objective was to determine the extent of the authority nurses at present. In the last part of my job I surveyed whether nurses are aware of their general competence. The research showed that their competencies developed. A large share of this development has the technological development in medicine, new insights in treatment and use of modern diagnostic methods and increasing nursing education. Results of this research can serve for professionals in pediatric congresses and publication in professional journals.

Objetivos: Verificar eficácia da cetamina intranasal na sedação de crianças para punção venosa. Métodos: Estudo randomizado, duplo-cego, placebo controlado realizado no Hospital de Clínicas de Porto Alegre entre janeiro e agosto de 2016. Estudo aprovado pela comissão de ética em pesquisa da instituição. Incluídas crianças que necessitasse de punção venosa, sendo randomizadas a receber cetamina IN 4mg/Kg ou solução fisiológica no grupo Placebo. Os grupos foram comparados quanto: tempo de punção, facilidade do Enfermeiro para realizar o procedimento, eventos adversos, alterações dos sinais vitais e percepção do acompanhante. Resultados: Foram incluídas 39 crianças (21 Intervenção vs 18 Placebo) sem diferenças quanto à idade, sexo, peso, motivo da internação e experiência profissional. A mediana da idade foi 19,8 vs 15,8 meses (Intervenção vs. Placebo) e a do peso foi 10 vs. 11,3Kg. A Cetamina reduziu o tempo de punção (23,0 vs 67,5 segundos; p=0,01), deu maior facilidade ao Enfermeiro para realizar o procedimento (p=0,00009). A cetamina induziu uma maior sonolência 15 minutos após (p=0,003) e reduziu o número de pessoas para contenção da criança (p=0,025). Sem diferença entre os grupos nas alterações dos sinais vitais e eventos adversos. Evento adverso observou-se em 29% das crianças do grupo cetamina e 17% do grupo placebo, sendo irritabilidade o mais comum em ambos. Em 81% do grupo Intervenção, o acompanhante afirmou que a criança ficou mais calma (p=0,0003). Conclusões: Cetamina intranasal (4mg/Kg) reduz o tempo de punção venosa, facilitando o procedimento para o enfermeiro, diminuindo o número de pessoas envolvidas e permitindo um ambiente tranquilo. / Objectives: To verify the efficacy of intranasal ketamine as sedative agent for venous access in children. Method: Randomized, double blind, placebo controlled study conducted at Hospital de Clínicas de Porto Alegre (Brazil) between January and August 2016. Children needing venous access were randomized to receive intranasal ketamine (4mg/Kg) or normal saline solution (Placebo group). Groups were compared regarding the time for venous access, facility for performing the procedure, adverse events, disturbances in vital signs and perception of the accompanying adult. The study was approved by the Local Ethics Committee. Results: 39 children (21 Ketamine; 18 Placebo) were included without differences regarding to age, sex, weight, reason for hospitalization and professional experience. The median age was similar (19.8 vs 15.8 months), as well as the median weight (10.0 vs 11.3Kg). Ketamine reduced the length for venous access (23.0 vs 67.5 seconds; p=0.01), and facilitated the procedure (p=0.00009). Ketamine induced sleepiness 15 minutes after its administration (p=0.003) and reduced the number of people for the child’s restraint (p=0.025). No difference was verified between groups regarding adverse effects or vital signs disturbance´s. Side effects were observed in 29% of the children in the Ketamine group and 17% in the Placebo group, irritability being the most common for both. The accompanying adult reported that 81% of children in ketamine group were calm and quiet (p=0.0003). Conclusions: Intranasal ketamine (4mg/Kg) reduces the time for venous puncture, facilitates the procedure to the nurse, decreases the number of people involved and provides a tranquil environment.

The dissertation objective on the theme {\clqq}Interpersonal relationship development between children's nurse and mother in the neonatology department by means of the H. E. Peplau model`` is to chart individual phases utilization in the process, professional relationship development between children´s nurse and mother according to the H. E. Peplau model. Further through created documentation to find out differences at the approaches during professional relationship connecting between children´s nurse and mother in the neonatology department in the Hospital JSC in České Budějovice. To meet these objectives the dissertation is divided into theoretical part which focuses on differences at the care of developed and underdeveloped infant, nursing model H. Peplau including its application into practice. The second, practical part is divided into quantitative and qualitative parts. The quantitative part concentrates on factors finding out which influence professional relationship between children´s nurse and mother in compliance with the H. E. Peplau model and concurrently specifies individual nurse roles changing during professional relationship children´s nurse and mother. The data of the quantitative research part have been learned by means of questionnaire disquisition. By the dissertation results summarizing I found out facts regarding H. E. Peplau model individual phases utilization at the children nurse {--} mother relationship establishing in neonatology. Hypothesis 1 {\clqq}Children nurses with own children establish faster the professional relationship with mother`` {--} has come true. Hypothesis 2 {\clqq}Children nurse practice length influences the ability to establish the professional relationship with mother`` {--} has come true. Hypothesis 3 {\clqq}Children nurses undertake the role of the mentor in most cases`` {--} hasn´t come true. The data of the qualitative research part were identified by observation, conversation with children nurse, creating of the documentation own proposal at the mothers of prematured children hospitalized by ROOM IN system and its application in practice. Mothers were divided into two groups, the common way of the interpersonal relationship establishing with mother was used in the first group, the way of the interpersonal relationship establishing with mother according to the H. E. Peplau model was applied in the second one. At the quasiexperiment it has been identified the interpersonal relationship establishing with mother proceeds better at the nursing H. E. Peplau model utilisation. The dissertation knowledge can be partly utilised by neonatology department of the Hospital JSC in České Budějovice, in particular by children nurses to master the abilities for professional relationship establishing with mother and to provide subsequently mother and child with the complex nursing care. Further to students and other interested people in this issue.