This diploma thesis should sketch quantitative research of early enteral nutrition at newborns with low birth weight under 1500 grams at specialized department - neonatology in České Budějovice. Research in this diploma thesis is focused on evaluating of implemetation level according to current recommendations neonatology for the start of early enteral nutrition at premature babies. In the theoretical part of the diploma thesis we try to describe all things that include the issue of premature babies care. Next chapters deal with differences of premature baby in relation to nutrition. The nutrition of the newborn with very low birth weight is provided immediately after parenteral delivery. Quantitative research definately prefers the start of enteral nutrition in the first few hours after delivery. Goal of this strategy is to completely replace the parenteral nutrition as soon as possible. Goal of this diploma thesis is to descibe quantitative research with implementing of the enteral nutrition at newborns with birth weight under 1500 grams at specialized neonatology departments and to identify the most important differences from current recommendations for this field of care. Considering the set goal there was used the quantitative research for this diploma thesis. To get the data to create the research, secundar analysis of the data from nursing documentation of our research team was used. Through the quantitative research we try to demonstrate lack of starts with early enteral nutrition at premature babies with birth weight under 1500 grams in the 2012 and 2013. Secundar analysis of the date was made during my working experience at neonatology department in České Budějovice. Data needed for this research were systematically written into prepared chart created in Microsoft Excel. After entering all necessary data in the table, they were subsequently created graphs that reflect the real situation examined issues. After identifying the most significant differences from the current recommendations for this area of care deficiencies are subsequently provided to the department of neonatology in the České Budějovice for future improvement strategy early initiation of enteral nutrition in premature infants in this weight category, was written Decalogue of practical recommendations for optimization of enteral nutrition for preterm infants nurses working in the neonatal intensive care. The research file was created by 139 respondents (newborns with low birth weight under 1500 grams). This file is created by newborns born from 1 January 2012 to 31 December 2013 which means during two years.

Submitted by Miriam Lucas (miriam.lucas@unioeste.br) on 2018-04-18T17:23:41Z No. of bitstreams: 2 Rosilene_Berres_2017.pdf: 3247343 bytes, checksum: 97680419cf0c605450559d10c4c7af3b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-04-18T17:23:41Z (GMT). No. of bitstreams: 2 Rosilene_Berres_2017.pdf: 3247343 bytes, checksum: 97680419cf0c605450559d10c4c7af3b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-10-09 / The neonatal component has relevance in infant mortality rates, with prematurity being one of the main causes. Prematurity requires that the care of preterm infants be started in the hospital environment and be continued after leaving the health care environment. It is a qualitative study using the Grounded Theory as a methodological reference and the Complexity Theory as theoretical reference. It was aimed to understand the continuity of care to the preterm newborn in the health care environment in a frontier region in the experience of families and health and nursing professionals. Data collection was done through semi-structured interviews, at the Child Nutrition Center of Foz do Iguaçu, Paraná. The study consisted of seventeen participants, divided into three theoretical samples. The first consisted of eight main caregivers of preterm newborns (mothers), the second consisted of eight health professionals (psychologist, physiotherapist, pediatrician) and nursing professionals (nursing assistants and nurses) and the third had the participation of a manager. Data were collected from July 2016 to March 2017. Data collection and analysis occurred concurrently, according to the method. Having reached the depth of the data, came the understanding of the study. The three interdependent steps of the data analysis were processed: open, axial and selective coding, according to Strauss and Corbin's paradigmatic perspective, which consists of five components (context, causal condition, intervening condition, strategies and consequences), which explain the phenomenon, forming five categories and nine subcategories. The category "Describing the structure and functioning of the Child Nutrition Center of Foz do Iguaçu" forms the context; the category "Preterm birth and the need for care of a preterm newborn" indicates the causal conditions; the category "Identifying conditions that intervene in the process of continuity of care of the preterm newborn" reveals the intervening conditions; the category "Identifying strategies to ensure continuity of care for the preterm newborn" identifies the strategies and the category "Identifying flows of (dis) continuity of care to the preterm newborn in border region" represent the consequences of the phenomenon and also of the central category. It is concluded that the (dis)continuity of care to preterm newborns in the border region presents a disordered and disconnected flow between the care services to the child who was born premature, since hospital discharge. Reference and counter-referral systems seem to be disarticulated, and primary health care has no role in the follow-up of the child and the family at the Child Nutrition Center of Foz do Iguaçu, a reference service for preterm care. Health professionals and managers are required to reflect on the (un)continuity of preterm newborn care, taking into account the multiple social, economic, and health vulnerabilities of individuals in a border region to ensure continued care and interconnected to different health services and meet the multiple needs of the child and his family. / El componente neonatal tiene relevancia en los índices de mortalidad infantil, siendo la prematuridad una de las principales causas. La prematuridad requiere que el cuidado al recién nacido pretérmino sea iniciado en el ambiente hospitalario y tenga continuidad después del alta del hospital, en la red de atención de salud. Se trata de estudio cualitativo con uso de la Teoría Fundamentada en los Datos como referencial metodológico y la Teoría de la Complejidad como referencial teórico. Fue objetivo comprender la continuidad del cuidado al recién nacido pretérmino en la red de atención de salud en una región de frontera en la experiencia de las familias y de los profesionales de salud y de enfermería. La colecta de datos se ha realizado por medio de entrevista semiestructuradas, en el Centro de Nutrición Infantil de Foz de Iguazú, Paraná, Brasil. El estudio ha tenido diecisiete participantes, divididos en tres muestras teóricas. La primera fue formada por ocho cuidadores principales de los recién nacidos pretérminos (madres), la segunda contó con ocho profesionales de salud (psicóloga, fisioterapeuta, médica pediatra) y de enfermería (auxiliares de enfermería y enfermeros) y la tercera tuvo la participación de un gestor. Los dados fueron colectados en el periodo de julio de 2016 a marzo de 2017. La colecta y análisis de datos ocurrieron concomitantemente, conforme previsto en el método. Alcanzado la profundidad de los datos, se ha llegado a la comprensión del estudio. Las tres etapas interdependientes del análisis de los datos fueron procesadas, siendo ellas: codificación abierta, axial y selectiva, según la perspectiva paradigmática, de Strauss y Corbin, que es constituida por cinco componentes (contexto, condición causal, condición interviniente, estrategias y consecuencias), que explican el fenómeno, formando cinco categorías y nueve subcategorías. La categoría “Describiendo la estructura y funcionamiento del Centro de Nutrición Infantil de Foz de Iguazú” forma el contexto; la categoría “Sucediendo el nacimiento pretérmino y la necesidad de cuidado de un recién nacido pretérmino” indica las condiciones causales; la categoría “Identificando condiciones que intervienen en el proceso de continuidad del cuidado del recién nacido prétermino” revela las condiciones intervinientes; la categoría “Identificando estrategias para asegurar la continuidad del cuidado al recién nacido pretérmino” apunta las estrategias y la categoría “Identificando flujos de (des)continuidad del cuidado al recién nacido pretérmino en región de frontera” representan las consecuencias del fenómeno y también de la categoría central. Se concluye que la (des)continuidad del cuidado al recién nacido pretérmino en región de frontera presenta un flujo desordenado y desconectado entre los servicios de atención al niño que nació prematuro, desde el alta del hospital. Los sistemas de referencia y de contra referencia parecen desarticulados y la atención primaria a la salud no tiene participación en el acompañamiento al niño y a la familia junto al Centro de Nutrición Infantil de Foz de Iguazú, servicio de referencia al cuidado del pretérmino. Es requerido a los profesionales y gestores en salud reflexionar sobre la (des)continuidad del cuidado del recién nacido pretérmino, considerando las múltiples vulnerabilidades sociales, económicas y de los agravios a la salud, particulares de una región de frontera, para asegurar un cuidado continuado e interconectado a los diferentes servicios de atención a la salud y atender a las múltiples necesidades del niño y su familia. / O componente neonatal tem relevância nos índices de mortalidade infantil, sendo a prematuridade uma das principais causas. A prematuridade requer que o cuidado ao recém-nascido pré-termo seja iniciado no ambiente hospitalar e tenha continuidade após a alta hospitalar, na rede de atenção à saúde. Trata-se de estudo qualitativo com uso da Teoria Fundamentada nos Dados como referencial metodológico e a Teoria da Complexidade como referencial teórico. Foi objetivo compreender a continuidade do cuidado ao recém-nascido pré-termo na rede de atenção à saúde em uma região de fronteira na experiência das famílias e dos profissionais de saúde e de enfermagem. A coleta dos dados foi realizada por meio de entrevistas semiestruturadas, no Centro de Nutrição Infantil de Foz do Iguaçu, Paraná. O estudo contou com dezessete participantes, divididos em três amostras teóricas. A primeira foi formada por oito cuidadores principais dos recém-nascidos pré-termos (mães), a segunda contou com oito profissionais de saúde (psicóloga, fisioterapeuta, médica pediatra) e de enfermagem (auxiliares de enfermagem e enfermeiros) e a terceira teve a participação de um gestor. Os dados foram coletados no período de julho de 2016 a março de 2017. A coleta e análise de dados aconteceram concomitantemente, conforme prevê o método. Tendo alcançado a profundidade dos dados, chegou-se à compreensão do estudo. As três etapas interdependentes da análise dos dados foram processadas, sendo elas: codificação aberta, axial e seletiva, segundo a perspectiva paradigmática, de Strauss e Corbin, que é constituída por cinco componentes (contexto, condição causal, condição interveniente, estratégias e consequências), que explicam o fenômeno, formando cinco categorias e nove subcategorias. A categoria “Descrevendo a estrutura e funcionamento do Centro de Nutrição Infantil de Foz do Iguaçu” forma o contexto; a categoria “Acontecendo o nascimento pré-termo e a necessidade de cuidado de um recém-nascido pré-termo” indica as condições causais; a categoria “Identificando condições que intervém no processo de continuidade do cuidado do recém-nascido pré-termo” revela as condições intervenientes; a categoria “Identificando estratégias para assegurar continuidade do cuidado ao recém-nascido pré-termo” aponta as estratégias e a categoria “Identificando fluxos de (des)continuidade do cuidado ao recém-nascido pré-termo em região de fronteira” representam as consequências do fenômeno e também da categoria central. Conclui-se que a (des)continuidade do cuidado ao recém-nascido pré-termo em região de fronteira apresenta um fluxo desordenado e desconexo entre os serviços de atenção à criança que nasceu prematura, desde a alta hospitalar. Os sistemas de referência e de contrarreferência parecem desarticulados e a atenção primária à saúde não tem participação no acompanhamento da criança e da família junto ao Centro de Nutrição Infantil de Foz do Iguaçu, serviço de referência ao cuidado do pré-termo. É requerido aos profissionais e gestores em saúde refletir sobre a (des)continuidade do cuidado do recém-nascido pré-termo, considerando as múltiplas vulnerabilidades sociais, econômicas e de agravos a saúde, particulares de uma região de fronteira, para assegurar um cuidado continuado e interligado aos diferentes serviços de atenção à saúde e atender às múltiplas necessidades da criança e sua família.

Cette étude se concentre sur l'administration de sucrose pour soulager la douleur chez les nouveau-nés prématurés en unité de soins intensifs néonatals (USIN). En utilisant la Théorie du Comportement Planifié (TCP) d'Ajzen, les chercheurs ont examiné le comportement, l'intention, les attitudes, les normes subjectives et la perception de contrôle des infirmières travaillant dans une USIN d'un centre hospitalier universitaire de niveau III. Les résultats ont révélé que la majorité des infirmières ont déclaré avoir administré du sucrose aux nouveau-nés prématurés au cours des deux dernières semaines de travail en USIN, et qu'elles avaient l'intention de continuer à le faire lors des prises de sang au talon. De plus, les attitudes, les normes subjectives et la perception de contrôle des participantes étaient favorables à l'utilisation du sucrose pour soulager la douleur des prématurés. Ces résultats soulignent l'importance de sensibiliser et de former les infirmières à l'utilisation appropriée des interventions non pharmacologiques, telles que l'administration de sucrose, pour soulager la douleur chez les nouveau-nés prématurés. Ils mettent en évidence le rôle crucial des infirmières dans la gestion de la douleur chez cette population vulnérable et suggèrent des pistes d'amélioration pour une prise en charge optimale. En conclusion, cette étude met en lumière les facteurs influençant le comportement des infirmières concernant l'administration de sucrose pour soulager la douleur des prématurés en USIN. Elle souligne l'importance de considérer les variables de la TCP dans la planification des stratégies visant à améliorer les soins et à réduire la douleur chez les prématurés en USIN. / This study focuses on the administration of sucrose for pain relief in preterm infants in the neonatal intensive care unit (NICU). Using Ajzen's Theory of Planned Behavior (TPB) as a theoretical framework, the researchers examined the behavior, intention, attitudes, subjective norms, and perceived control of nurses working in a level III university hospital NICU. The results revealed that the majority of nurses reported administering sucrose to preterm infants in the past two weeks of their work in the NICU, and they had the intention to continue doing so during heel-stick procedures. Furthermore, nurses' attitudes, subjective norms, and perceived control were favorable towards the use of sucrose for pain relief in preterm infants. These findings highlight the importance of raising awareness and providing training for nurses regarding the appropriate use of non-pharmacological interventions, such as sucrose administration, for pain relief in preterm infants. They underscore the crucial role of nurses in managing pain in this vulnerable population and suggest avenues for improvement in optimizing care. In conclusion, this study sheds light on the factors influencing nurses' behavior regarding the administration of sucrose for pain relief in preterm infants in the NICU. It underscores the importance of considering the variables of the TPB in planning strategies to enhance care and reduce pain in preterm infants in the NICU.