Bakgrund: Sjuksköterskan som arbetar i ambulansen har en varierad patientgrupp, däribland barn. Detta kan i sig vara komplexa och sjuksköterskan kan ibland känna sig osäker och stressad. Därför är det viktigt att sjuksköterskan känner sig trygg och innehar kunskap om vårdandet av barn med andningsbesvär. Barn är känsliga för syrebrist vilket är en vanlig orsak till hjärtstopp. Barn har inte lika lätt att uttrycka sig som vuxna och bedöms inte heller på samma sätt. Barnets föräldrar är oftast närvarande i situationen vilket kan påverka mötet. Metod: En kvalitativ intervjustudie användes med en fenomenografisk ansats. Sex semistrukturerade intervjuer genomfördes på sjuksköterskor på tre olika ambulansstationer i Örebro län samt Värmlands län. Materialet analyserades i sju steg enligt en fenomenografisk analys. Syfte: att belysa sjuksköterskans erfarenhet av att vårda barn med akuta andningsbesvär prehospitalt. Resultat: I resultatet framkom tre beskrivningskategorier som handlade om sjuksköterskans erfarenhet av att vårda barn med akuta andningsbesvär. Föräldrars påverkan, sjuksköterskans förberedelse, att kunna kommunicera. Konklusion: Vårdandet av barn är komplext i sin karaktär inte minst då föräldrars närvaro påverkar situationen, både positivt och negativt. Resultatet visade på kunskapsbrist och oerfarenhet som leder till stress hos sjuksköterskan. Det finns behov av vidare forskning och utbildning inom detta fenomen. Detta för att öka kunskap och erfarenhet hos sjuksköterskan som i sin tur bidrar till en ökad patientsäkerhet. Det kommer även leda till minskad stress och oro hos sjuksköterskan. / Background: The nurse who works in the ambulance has a diverse group of patients, including children. This can be complex and the nurse can sometimes feel insecure and stressed. Therefore, it is important that the nurse feels safe and has knowledge about the care of children with respiratory problems. Children are sensitive to lack of oxygen, which is a common cause of cardiac arrest. Children do not find it as easy to express themselves as adults, nor are they examined in the same way. The child's parents are usually present in the situation, which can affect the meeting. Method: A qualitative interview study was used with a phenomenographic approach. Six semi-structured interviews were conducted on nurses at three different ambulance stations in Örebro County and Värmland County. The material was analyzed in seven steps according to a phenomenographic analysis. Aim: To illustrate the nurse experience of prehospital care of children with acute respiratory problems. Results: The result revealed three categories of descriptions that describes the nurse's experience of caring for children with acute respiratory problems. The influence of parents, the nurse´s preparation, being able to communicate. Conclusion: The care of children is complex in nature, not least because the presence of parents affects the situation, both positively and negatively. The results showed a insufficient of knowledge and inexperience that leads to stress among the nurses. There is a need for further research and education in this phenomenon. This is to increase the knowledge and experience among healthcare professionals but also to increase patient safety. It will also lead to reduced stress and anxiety for the nurse.

Este estudo de abordagem qualitativa, descritivo e de caráter exploratório tem como objetivo investigar a vivência da equipe multiprofissional na assistência ao adulto em situação de parada cardiorrespiratória, numa unidade de suporte avançado de vida de Atendimento Pré-Hospitalar móvel (APH) da Secretaria Municipal de Saúde de Ribeirão Preto-SP. Para a coleta de dados, foi utilizada a entrevista semi-estruturada que compreendeu questões sobre o perfil sociodemográfico, profissional e questões norteadoras sobre o tema. A amostra foi constituída por 16 profissionais, médicos, enfermeiros e condutores de veículo de urgência terrestre integrantes da Unidade de Suporte Avançado (USA). Os dados foram organizados por meio da análise de conteúdo proposta por Bardin (1977), sendo identificados quatro temas: o trabalho no APH móvel avançado, os sentimentos e emoções da equipe multiprofissional de APH móvel avançado frente ao atendimento à Parada Cardiorrespiratória (PCR), identificação dos agentes estressores ao atendimento à PCR e as reações de estresse no atendimento à PCR. Na presente pesquisa, a equipe multiprofissional relata a sua vivência nesse tipo de atividade com a visão de um serviço desafiante e difícil, por vivenciar diariamente situações inesperadas, desconhecidas e angustiantes, mas que, com tudo isso, também são capazes de perceber satisfações pessoais e realização profissional. Na análise, evidenciaram-se também nas demais categorias, as expressões: conhecimento e constante capacitação técnica e tecnológica, habilidade e agilidade, tomada de decisões, trabalho em equipe, a dificuldade de lidar com o sofrimento dos familiares na cena do agravo, envolvimento emocional em situações de grande sofrimento e dor, trabalhar em altas temperaturas, dificuldades em lidar com a morte, principalmente em situações inesperadas e com vítimas jovens, trazendo sentimentos de impotência, frustração e tristeza. Portanto essa equipe multiprofissional vivencia diariamente a real possibilidade de sofrimento psíquico e mostra por meio deste estudo, a necessidade de que a equipe promova momentos para reflexão e discussão acerca dos aspectos técnicos, científicos e éticos referentes ao cuidado dos pacientes críticos, em parada cardiorrespiratória, quanto às diferentes possibilidades de situações que os envolva durante o atendimento, com vistas à melhoria da qualidade do atendimento e do relacionamento interpessoal. Levando em consideração os resultados e conclusões da nossa investigação, é relevante a questão da saúde mental desses profissionais no exercício de suas funções, diante do exposto nos seus próprios relatos, e até que ponto os mecanismos de enfrentamento utilizados pelos mesmos são eficientes, ou seja, são métodos eficazes de elaboração do estresse. Sugerimos como métodos que podem ser eficazes: buscar informações e discutir o assunto em grupos; aceitar os acontecimentos, buscando o lado positivo da situação, buscar auxílio de especialistas, psicólogos ou psiquiatras e seguir suas orientações. Diante da importância desse serviço, vemos a necessidade de propor formas alternativas dentro dessa equipe, para que ela alcance um equilíbrio no estresse individual e coletivo e que efetivamente não atinja os limites de sofrimento psíquico. Assim são necessárias outras investigações, porque as seqüelas advindas podem comprometer a vida social e pessoal do indivíduo. / This study of qualitative boarding and of exploratory character has as objective investigate the experience of the multi-professional team in the assistance for the adults in situations of cardiorespiratory emergency in a unity of advanced support of life and movable pre-hospitalar attendance (APH) of the Municipal Secretary of Health from Ribeirão Preto?SP. To collect the data was utilized a semi-structuralized interview that was included questions about the sociodemographic profile and professional and questions directed to the topics. The sample was constituted of 16 professionals, doctors, nurses and conductors by the way of the USA. Data were organized and analyzed the content proposed by Bardin (1977), identifying four topics: The Work in the APH advanced movable, the feelings and emotions of the multi professional team of APH advanced movable in front of the attendance to PCR, identification of the stresses agents in the attendance to PCR. In the present search the multi-professional team relate their experience in this kind of activities with the vision of a hard and challenger job by experience the daily of non waiting situations, unknown and overwhelming but even with of all of this they are also able to percept personal satisfactions and professional realization. In the analyze evidence too in the others categories the expressions: knowledge and constant technique qualification and technologic, ability and agility, taken decisions, group work, the difficult to deal with the pain of the familiars in the scene of the aggravate, emotional involvement and situations of a lot suffer and pain, work in high temperatures, difficult to deal with the death, principally in unexpected situations and of young victims bringing feelings of incapacitation, frustration and sadness. Therefore this multi-professional team experience daily the real possibility of psychic suffer, and show trough this study the necessity that the team promote moments of reflection and discussion around of the techniques aspects, scientifics and ethical referring to the cautions of the critics patients in cardio respiratory problems and of the different possibilities of situations that involve them during the attendance with vision on better quality of the attendance and the interpersonal relation. Considering the results and conclusions of our investigation is important the aspect of mental healthiness of this professionals in the act of their functions based in their own experiences and the mechanisms of fronting utilized by the team are efficient so are methods of elaboration of stress. So we suggest how methods can be efficient: search for informations and discuss the subject in group; accept the knowledge looking for the good side of the situation, search aid of specialists, psychologist or psychiatrist, and follow their orientations. Once that is necessary this kind of service we see the necessity to propose alternatives ways inside of this team, to got a equilibrium of personal stress and of the group that don?t affect the limits of psychic suffer. So it makes necessary others investigations because the symptoms can interfere in the personal life.

Estudos envolvendo o meio ambiente estão sendo cada vez mais desenvolvidos devido ao fato dos níveis de poluição e das mudanças climáticas estarem causando a degradação da qualidade do ar e dos reservatórios de água de maneira alarmante nos últimos anos, comprometendo sobretudo, a qualidade de vida do ser humano. Dado que estes fatores são preponderantes nos agravos e complicações respiratórias dos indivíduos, buscou-se compreender com este estudo a relação entre as condições atmosféricas e os problemas respiratórios nos residentes do município de Ribeirão Preto, interior de São Paulo, onde há um elevado número de focos de queimadas nos períodos de estiagem e, consequentemente, altas concentrações de poluentes, como o material particulado. Considerando os dados mensais de contagem de inalações/nebulizações, foram assumidos diferentes modelos de regressão de Poisson na presença de um fator aleatório que captura a variabilidade extra-Poisson entre as contagens. A análise dos dados foi feita sob enfoque Bayesiano, utilizando métodos de simulação MCMC (Monte Carlo em Cadeias de Markov) para obter os sumários a posteriori de interesse. / Many studies involving the environment are being developed in the last years due to the fact that the levels of pollution and climate changes are causing the degradation of air quality and water reservoirs at an alarming rate in recent years, with great consequences for the quality of life of the population. Since these factors are prevalent in respiratory disorders and complications of the health for the individuals, we intended to understand from this study the relationship between weather conditions and respiratory problems for the residents of the municipality of Ribeirão Preto, São Paulo, which has a high number of outbreaks of fires in drought periods and, consequently, high concentrations of pollutants such as particulate matter. Considering the monthly count of inhalations / nebulizations, we assumed different Poisson regression models in the presence of a random factor that captures the extra-Poisson variability between the counts. The data analysis was performed under a Bayesian approach using MCMC simulation methods (Markov Chain Monte Carlo) to get the posterior summaries of interest.

Estudos envolvendo o meio ambiente estão sendo cada vez mais desenvolvidos devido ao fato dos níveis de poluição e das mudanças climáticas estarem causando a degradação da qualidade do ar e dos reservatórios de água de maneira alarmante nos últimos anos, comprometendo sobretudo, a qualidade de vida do ser humano. Dado que estes fatores são preponderantes nos agravos e complicações respiratórias dos indivíduos, buscou-se compreender com este estudo a relação entre as condições atmosféricas e os problemas respiratórios nos residentes do município de Ribeirão Preto, interior de São Paulo, onde há um elevado número de focos de queimadas nos períodos de estiagem e, consequentemente, altas concentrações de poluentes, como o material particulado. Considerando os dados mensais de contagem de inalações/nebulizações, foram assumidos diferentes modelos de regressão de Poisson na presença de um fator aleatório que captura a variabilidade extra-Poisson entre as contagens. A análise dos dados foi feita sob enfoque Bayesiano, utilizando métodos de simulação MCMC (Monte Carlo em Cadeias de Markov) para obter os sumários a posteriori de interesse. / Many studies involving the environment are being developed in the last years due to the fact that the levels of pollution and climate changes are causing the degradation of air quality and water reservoirs at an alarming rate in recent years, with great consequences for the quality of life of the population. Since these factors are prevalent in respiratory disorders and complications of the health for the individuals, we intended to understand from this study the relationship between weather conditions and respiratory problems for the residents of the municipality of Ribeirão Preto, São Paulo, which has a high number of outbreaks of fires in drought periods and, consequently, high concentrations of pollutants such as particulate matter. Considering the monthly count of inhalations / nebulizations, we assumed different Poisson regression models in the presence of a random factor that captures the extra-Poisson variability between the counts. The data analysis was performed under a Bayesian approach using MCMC simulation methods (Markov Chain Monte Carlo) to get the posterior summaries of interest.

Este estudo de abordagem qualitativa, descritivo e de caráter exploratório tem como objetivo investigar a vivência da equipe multiprofissional na assistência ao adulto em situação de parada cardiorrespiratória, numa unidade de suporte avançado de vida de Atendimento Pré-Hospitalar móvel (APH) da Secretaria Municipal de Saúde de Ribeirão Preto-SP. Para a coleta de dados, foi utilizada a entrevista semi-estruturada que compreendeu questões sobre o perfil sociodemográfico, profissional e questões norteadoras sobre o tema. A amostra foi constituída por 16 profissionais, médicos, enfermeiros e condutores de veículo de urgência terrestre integrantes da Unidade de Suporte Avançado (USA). Os dados foram organizados por meio da análise de conteúdo proposta por Bardin (1977), sendo identificados quatro temas: o trabalho no APH móvel avançado, os sentimentos e emoções da equipe multiprofissional de APH móvel avançado frente ao atendimento à Parada Cardiorrespiratória (PCR), identificação dos agentes estressores ao atendimento à PCR e as reações de estresse no atendimento à PCR. Na presente pesquisa, a equipe multiprofissional relata a sua vivência nesse tipo de atividade com a visão de um serviço desafiante e difícil, por vivenciar diariamente situações inesperadas, desconhecidas e angustiantes, mas que, com tudo isso, também são capazes de perceber satisfações pessoais e realização profissional. Na análise, evidenciaram-se também nas demais categorias, as expressões: conhecimento e constante capacitação técnica e tecnológica, habilidade e agilidade, tomada de decisões, trabalho em equipe, a dificuldade de lidar com o sofrimento dos familiares na cena do agravo, envolvimento emocional em situações de grande sofrimento e dor, trabalhar em altas temperaturas, dificuldades em lidar com a morte, principalmente em situações inesperadas e com vítimas jovens, trazendo sentimentos de impotência, frustração e tristeza. Portanto essa equipe multiprofissional vivencia diariamente a real possibilidade de sofrimento psíquico e mostra por meio deste estudo, a necessidade de que a equipe promova momentos para reflexão e discussão acerca dos aspectos técnicos, científicos e éticos referentes ao cuidado dos pacientes críticos, em parada cardiorrespiratória, quanto às diferentes possibilidades de situações que os envolva durante o atendimento, com vistas à melhoria da qualidade do atendimento e do relacionamento interpessoal. Levando em consideração os resultados e conclusões da nossa investigação, é relevante a questão da saúde mental desses profissionais no exercício de suas funções, diante do exposto nos seus próprios relatos, e até que ponto os mecanismos de enfrentamento utilizados pelos mesmos são eficientes, ou seja, são métodos eficazes de elaboração do estresse. Sugerimos como métodos que podem ser eficazes: buscar informações e discutir o assunto em grupos; aceitar os acontecimentos, buscando o lado positivo da situação, buscar auxílio de especialistas, psicólogos ou psiquiatras e seguir suas orientações. Diante da importância desse serviço, vemos a necessidade de propor formas alternativas dentro dessa equipe, para que ela alcance um equilíbrio no estresse individual e coletivo e que efetivamente não atinja os limites de sofrimento psíquico. Assim são necessárias outras investigações, porque as seqüelas advindas podem comprometer a vida social e pessoal do indivíduo. / This study of qualitative boarding and of exploratory character has as objective investigate the experience of the multi-professional team in the assistance for the adults in situations of cardiorespiratory emergency in a unity of advanced support of life and movable pre-hospitalar attendance (APH) of the Municipal Secretary of Health from Ribeirão Preto?SP. To collect the data was utilized a semi-structuralized interview that was included questions about the sociodemographic profile and professional and questions directed to the topics. The sample was constituted of 16 professionals, doctors, nurses and conductors by the way of the USA. Data were organized and analyzed the content proposed by Bardin (1977), identifying four topics: The Work in the APH advanced movable, the feelings and emotions of the multi professional team of APH advanced movable in front of the attendance to PCR, identification of the stresses agents in the attendance to PCR. In the present search the multi-professional team relate their experience in this kind of activities with the vision of a hard and challenger job by experience the daily of non waiting situations, unknown and overwhelming but even with of all of this they are also able to percept personal satisfactions and professional realization. In the analyze evidence too in the others categories the expressions: knowledge and constant technique qualification and technologic, ability and agility, taken decisions, group work, the difficult to deal with the pain of the familiars in the scene of the aggravate, emotional involvement and situations of a lot suffer and pain, work in high temperatures, difficult to deal with the death, principally in unexpected situations and of young victims bringing feelings of incapacitation, frustration and sadness. Therefore this multi-professional team experience daily the real possibility of psychic suffer, and show trough this study the necessity that the team promote moments of reflection and discussion around of the techniques aspects, scientifics and ethical referring to the cautions of the critics patients in cardio respiratory problems and of the different possibilities of situations that involve them during the attendance with vision on better quality of the attendance and the interpersonal relation. Considering the results and conclusions of our investigation is important the aspect of mental healthiness of this professionals in the act of their functions based in their own experiences and the mechanisms of fronting utilized by the team are efficient so are methods of elaboration of stress. So we suggest how methods can be efficient: search for informations and discuss the subject in group; accept the knowledge looking for the good side of the situation, search aid of specialists, psychologist or psychiatrist, and follow their orientations. Once that is necessary this kind of service we see the necessity to propose alternatives ways inside of this team, to got a equilibrium of personal stress and of the group that don?t affect the limits of psychic suffer. So it makes necessary others investigations because the symptoms can interfere in the personal life.

Une morbidité et une mortalité néonatales élevées limitent l’efficacité du clonage somatique chez les bovins. Des malformations myoarthrosquelettiques, des anomalies ombilicales, des problèmes respiratoires et de la faiblesse ont été fréquemment observés chez les veaux clonés nouveaux-nés. Cette étude rétrospective porte sur 31 veaux clonés. Ses objectifs étaient de décrire les problèmes respiratoires rencontrés, leur évolution au cours du temps, les traitements instaurés pour soutenir la fonction respiratoire et la réponse aux traitements. Vingt-deux veaux ont souffert de problèmes respiratoires. La tachypnée, l’hypoxémie et l’hypercapnie sont les signes cliniques les plus fréquemment observés. L’analyse des gaz sanguins a été un outil essentiel dans le diagnostic et le suivi de la fonction respiratoire. La radiographie a permis une évaluation globale du poumon. L’oxygénothérapie intranasale et la ventilation mécanique ont permis de limiter la mortalité due à une insuffisance respiratoire à 18% (4/22). Cette étude a permis d’émettre des hypothèses quant à l’origine des problèmes respiratoires chez les veaux clonés. Plus d’une maladie semblent affecter les veaux clonés. La déficience en surfactant, l’hypertension pulmonaire persistante et le retard de résorption du fluide pulmonaire figurent parmi les entités pathologiques les plus probables. / High morbidity and mortality decrease the efficiency of somatic cell nuclear transfer. The main abnormalities observed in neonatal cloned calves are skeletal malformations, enlarged umbilical vessels, respiratory problems and weakness. This retrospective study involved 31 cloned calves. The objectives of this study were to describe the respiratory problems suffered by cloned calves during neonatal period, to assess their evolution, and to determine the possible causes. Secondary objectives were to describe the techniques used to assess and support respiratory function and the calves’ response. Respiratory problems affected 22 calves. Tachypnea, hypoxemia and hypercapnia were the most frequently observed signs. Arterial blood gas analyses and chest radiographs were precious to identify and assess respiratory problems. Intranasal oxygen and mechanical ventilation were efficient to limit mortality due to respiratory failure to 18% (4/22). It is plausible that more than one disease affect cloned calves. Delayed resorption of pulmonary fluid, persistent pulmonary hypertension and surfactant deficiency, or a combination of these factors, are among the most probable pathological entities.

Une morbidité et une mortalité néonatales élevées limitent l’efficacité du clonage somatique chez les bovins. Des malformations myoarthrosquelettiques, des anomalies ombilicales, des problèmes respiratoires et de la faiblesse ont été fréquemment observés chez les veaux clonés nouveaux-nés. Cette étude rétrospective porte sur 31 veaux clonés. Ses objectifs étaient de décrire les problèmes respiratoires rencontrés, leur évolution au cours du temps, les traitements instaurés pour soutenir la fonction respiratoire et la réponse aux traitements. Vingt-deux veaux ont souffert de problèmes respiratoires. La tachypnée, l’hypoxémie et l’hypercapnie sont les signes cliniques les plus fréquemment observés. L’analyse des gaz sanguins a été un outil essentiel dans le diagnostic et le suivi de la fonction respiratoire. La radiographie a permis une évaluation globale du poumon. L’oxygénothérapie intranasale et la ventilation mécanique ont permis de limiter la mortalité due à une insuffisance respiratoire à 18% (4/22). Cette étude a permis d’émettre des hypothèses quant à l’origine des problèmes respiratoires chez les veaux clonés. Plus d’une maladie semblent affecter les veaux clonés. La déficience en surfactant, l’hypertension pulmonaire persistante et le retard de résorption du fluide pulmonaire figurent parmi les entités pathologiques les plus probables. / High morbidity and mortality decrease the efficiency of somatic cell nuclear transfer. The main abnormalities observed in neonatal cloned calves are skeletal malformations, enlarged umbilical vessels, respiratory problems and weakness. This retrospective study involved 31 cloned calves. The objectives of this study were to describe the respiratory problems suffered by cloned calves during neonatal period, to assess their evolution, and to determine the possible causes. Secondary objectives were to describe the techniques used to assess and support respiratory function and the calves’ response. Respiratory problems affected 22 calves. Tachypnea, hypoxemia and hypercapnia were the most frequently observed signs. Arterial blood gas analyses and chest radiographs were precious to identify and assess respiratory problems. Intranasal oxygen and mechanical ventilation were efficient to limit mortality due to respiratory failure to 18% (4/22). It is plausible that more than one disease affect cloned calves. Delayed resorption of pulmonary fluid, persistent pulmonary hypertension and surfactant deficiency, or a combination of these factors, are among the most probable pathological entities.

The main idea was to choose a child as a measure of design. Immerse yourself in his world and his perception of space - keep in mind his needs. What did the place where he would be able to recover from respiratory problems look like? Was she in the hospital? What kind of room was that? What was that for? place? Did nature play any meaning in that? Would you like to go back there? How does she remember him? The aim was to create a place that resembles the hospital environment as little as possible, is in direct contact with nature and attracts to get to know it more. The stay in the hospital should be more reminiscent of spending holidays at school in nature. How to avoid austere hospital premises? Is there such a guide at all? Should I draw inspiration elsewhere? Where do we go to gain strength from everyday worries? In nature, of course. And how does this need translate into architecture? And we have at all such architecture? The answer to the questions I asked was the cottage. House created for a stay in nature. But how to lift it to something richer and more interesting? There was something else that fascinated me as a child spending time in Luhačovice - the spa environment. How these two forms to connect?