Implementing palliative care, based on family-centered care, in a highly complex neonatal unit

Abstract Objective: To describe the causes and circumstances of neonatal mortality and determine whether the implementation of a palliative care protocol has improved the quality of end-of-life care. Methods: A retrospective observational study including all patient mortalities between January 2009 and December 2019. Cause of death and characteristics of support during the dying process were collected. Two periods, before and after the implementation of a palliative care protocol, were compared. Results: There were 344 deaths. Congenital malformations were the most frequent cause of death (45.6 %). Most patients died after the transition to palliative care (74.4 %). The most frequently cited criteria for initiating transition of care was poor neurocognitive prognosis (47.2 %). Parents accompanied their children in the dying process in 72 % of cases. Twenty-three percent of patients died outside the Neonatal Intensive Care Unit after being transferred to a private room to enhance family intimacy. After the addition of the palliative care protocol, statistically significant differences were observed in the support and patient experience during the dying process. Conclusions: The most frequent causes of death were severe congenital malformations. Most patients died accompanied by their parents after the transition to palliative care. The implementation of a palliative care protocol helped to improve the family-centered end-of-life care.

Development of Discharge Planning Instruments Based on Patient Family-Centered Care in the COVID-19 Inpatient Room, Universitas Airlangga Hospital, Surabaya

@#Introduction: The current era of the COVID-19 pandemic requires innovation in the provision of discharge planning by involving family members through the media safely and effectively. This study aimed to develop a discharge planning instrument based on patient family-centered care. Method: Research design Research and Development. The sampling technique used purposive sampling with a total sample of 110 medical record documents, 23 focus group discussion participants, and 2 experts (expert consultation). Data were collected through observation sheets, focus group discussions, and expert consultations. Data analysis using descriptive analysis, and validity test using I-CVI. Results: Development of a patient family centered care-based discharge planning instrument at the beginning of the patient’s admission (admission), namely sorting and adding assessment items to the level of knowledge of the disease, information and education needs, values, and beliefs, cultural background as well as physical and psychological. During treatment, namely arranging and sorting discharge planning items, providing information and education according to the assessment results using a media approach and the method according to the COVID-19 pandemic protocol. Towards home that is adding items; readiness or environmental conditions (environment), referral plans (Outpatient referral), and continued treatment while at home (Medication). Conclusion: The developed instrument tested is valid. As a result of this development, the new instrument can be tested and applied, and researched in the next stage on the outcomes of patient family-centered care.

Development and validation of a questionnaire regarding knowledge, attitude and practice of the ICU nurses′ family-centered sensory stimulation / 中国实用护理杂志

Objective:To establish a questionnaire regarding knowledge, attitude and practice on family-centered sensory stimulation among ICU nurses and examine its reliability and validity, so as to provide basis for subsequent nursing training targeted sensory stimulation.Methods:Based on the theory of knowledge, attitude and practice, the questionnaire of family-centered sensory stimulation for ICU nurses was constructed by literature review, semi-structured interview, expert consultation and questionnaire survey. From March to April 2022, convenience sampling was used to investigate 253 ICU nurses from 8 general hospitals in four provinces and cities to test the reliability and validity of the questionnaire.Results:The final questionnaire included 33 items in 3 dimensions, and the cumulative variance contribution rate was 76.248%. The average content validity index of the total questionnaire was 0.970, and the content validity index of each item ranged from 0.894 to 1.000. The Cronbach′s α coefficient of the questionnaire was 0.965, the split-half reliability was 0.799, and the retest reliability was 0.818 after 2 weeks.Conclusions:It has good validity and reliability in this questionnaire and can be used as a preliminary assessment tool to understand the status quo of family-centered sensory stimulation in ICU nurses.

A qualitative study of the family-centred care needs of neonatal parents in the post-pandemic era / 中国实用护理杂志

Objective:To explore the needs of parents of hospitalized neonates with the challenges of implementing family-centered care during the Covid-19 pandemic.Methods:Using a method of phenomenological interviewing and Colaizzi′s method of data analysis, the information of 18 parents of admitted infants of Children′s Hospital of Fudan University from January 1 to 20, 2022 were collected and analyzed.Results:In the post-epidemic era, 5 themes of needs for parents of hospitalized neonates during family-centered care were identified: closeness to babies; emotional support; training about feeding; accommodation services; financial support.Conclusions:In the post-epidemic era, experiencing worry, anxiety, uncertainty, helplessness, loss and other negative psychological experience, the parents of hospitalized neonates have many unsatisfied needs. Hospital administrators need to focus on the needs of parents for family-centered nursing care, and actively explore effective coping strategies.

Cuidado centrado na família na unidade de terapia intensiva neonatal (UTIN): experiências de enfermeiras / Cuidado centrado en la familia en la unidad de terapia intensiva neonatal (UTIN): experiencias de enfermeras / Family centered-care at the neonatal intensive care unit (NICU): nurses' experiences

Resumo: Introdução: o Cuidado Centrado na Família na Unidade de Terapia Intensiva Neonatal é uma prática baseada em evidências científicas com o objetivo de proporcionar alívio do sofrimento e bem-estar. Essa prática deve ser constante em cenários, onde familiares acompanham seus recém-nascidos prematuros ou de risco e a enfermeira, pela forte relação de proximidade com estes, assume, na maioria das vezes, a função de assistir as famílias. Objetivo geral: compreender a experiência das enfermeiras no desenvolvimento do cuidado centrado na família de neonatos hospitalizados na unidade de cuidados intensivos neonatais. Objetivos específicos: descrever o cuidado de enfermagem ofertado à família durante a hospitalização do neonato na unidade de cuidados intensivos; descrever a percepção das enfermeiras sobre o cuidado desenvolvido com a família durante a hospitalização do neonato na unidade de cuidados intensivos. Métodos: pesquisa transversal de abordagem qualitativa e interpretativa. Participaram dez enfermeiras que atuam na unidade de cuidados intensivos neonatais. Foram realizadas entrevistas abertas em profundidade. A análise dos dados seguiu os passos do método de Pesquisa de Narrativas e teve como referencial teórico o Interaccionismo Simbólico. Resultados: foram identificadas nas narrativas categorias temáticas referentes aos antecedentes, às condições, às ações e aos resultados percebidos no processo de cuidado ao RN e sua família. Conclusão: as enfermeiras entendem a importância da presença familiar para a recuperação do neonato e para o desenvolvimento da parentalidade, entretanto ainda existem limitações conceituais quanto à compreensão do significado de cuidado centrado na família e para consolidação dessa abordagem na prática.

Resumen: Introducción: la atención centrada en la familia en la Unidad de Cuidados Intensivos Neonatales es una práctica basada en evidencia científica para aliviar el sufrimiento y el bienestar. Esta práctica científica debe ser constante en un entorno como la UCIN donde los miembros de la familia acompañan a sus recién nacidos prematuros o riesgosos, y la enfermería, debido a la fuerte relación de proximidad con los usuarios, asume el rol de ayudar a estas familias en la mayoría de los casos. Objetivo general: comprender la experiencia de las enfermeras en el desarrollo de la atención centrada en la familia de neonatos hospitalizados en la Unidad de Cuidados Intensivos Neonatales. Objetivos específicos: describir la atención de enfermería ofrecida a la familia durante la hospitalización del neonato en la Unidad de Cuidados Intensivos Neonatales; describir la percepción de las enfermeras sobre el cuidado que se toma con la familia durante la hospitalización del neonato en la Unidad de Cuidados Intensivos Neonatales. Métodos: investigación transversal con enfoque cualitativo e interpretativo. Participaron diez enfermeras que trabajan en la UCIN. Se realizaron entrevistas en profundidad. El análisis de los datos siguió los pasos del método de Investigación Narrativa y tuvo como referencia teórica el Interaccionismo Simbólico. Resultados: las categorías temáticas relacionadas con los antecedentes, las condiciones, las acciones y los resultados percibidos en el proceso de atención para el neonato y su familia se identificaron en las narraciones. Conclusión: las enfermeras entienden la importancia de la presencia familiar para la recuperación del recién nacido y para el desarrollo de la paternidad. Sin embargo, todavía existen limitaciones conceptuales con respecto a la comprensión del significado de Unidad de Cuidados Intensivos Neonatales y para consolidar este enfoque en la práctica.

Abstract: Introduction: Family-Centered Care in the Neonatal Intensive Care Unit is a practice based on scientific evidence to provide wellness and relief from suffering. This practice must be constant in an environment where family members accompany their preterm or risky newborns; and the nurse, due to a strong relationship of proximity with the patients, assumes the role of assisting these families in most cases. Main objective: to understand the experience of nurses in the development of the family-centered care of hospitalized newborns in the Neonatal Intensive Care Unit. Specific objectives: to describe the Nursing care offered to families during the hospitalization of newborns in the Neonatal Intensive Care Unit; and to describe the nurses' perception about the care taken with families during the hospitalization of neonates in the Neonatal Intensive Care Unit. Methods: a cross-sectional research study with a qualitative and interpretive approach. Ten nurses working in the NICU participated. In-depth interviews were conducted. Data analysis followed the steps of the Narrative Research method and had Symbolic Interactionism as its theoretical reference. Results: the categories referring to the background, conditions, actions and outcomes perceived in the care process for newborns and their families were identified in the narratives. Conclusion: the nurses understand the importance of family presence for the recovery of newborns and for the development of parenthood; however, there are still some conceptual limitations regarding the understanding of the meaning of family-centered care and to consolidate this approach in the practice.

A percepção da equipe de enfermagem de um hospital universitário quanto às prioridades para a implantação do cuidado centrado no paciente e na família em unidades pediátricas / The nursing team s perception of a university hospital regarding the priorities for the implementation of the patient-and family-centered care in pediatric units

Introdução: O Cuidado Centrado no Paciente e Família (CCPF) tem sido considerada uma abordagem inovadora para o planejamento, a prestação e a avaliação do cuidado em saúde, pois baseia-se em uma parceria mutuamente benéfica entre pacientes, famílias e provedores de cuidados, reconhecendo a importância da família na vida do paciente. A maioria dos profissionais de saúde pediátrica acredita que o CCPF é a melhor maneira de fornecer atendimento de qualidade às crianças e suas famílias nos serviços de saúde. Porém, as ações do CCPF ficam restritas a alguns membros da equipe. Objetivos: Compreender a percepção da equipe de enfermagem sobre a implantação do CCPF nas unidades pediátricas de um hospital universitário; identificar a percepção da equipe de enfermagem quanto às prioridades para a implantação do CCPF nas unidades pediátricas de um hospital universitário. Metodologia: Estudo qualitativo realizado em um hospital universitário na cidade de São Paulo. Grupos focais foram realizados com 14 membros da equipe de enfermagem, que atuam nas áreas pediátricas. As sessões foram gravadas e depois transcritas, para serem submetidas à análise de conteúdo. Resultados: A análise possibilitou o desenvolvimento de três temas: 1) A família nos cenários de assistência pediátrica; 2) Desafios para implantação do CCPF nos cenários de atenção pediátrica; e 3) Prioridades para implantação efetiva do CCPF nas unidades de atendimento pediátrico. Conclusão: O CCPF vem sendo praticado por alguns membros da equipe de enfermagem, os quais consideram a participação da família essencial, no processo de cuidado à criança hospitalizada, e identificam barreiras nos profissionais e nas políticas institucionais para sua implementação. Há necessidade de ações que levem à mudança das atitudes dos profissionais e de revisão das políticas relacionadas às famílias, para superação das dificuldades para implantação do CCPF.

Introduction: The patient-and family-centered care (PFCC)) has been considered an innovative approach to health care planning, delivery and evaluation because it is based on a mutually beneficial partnership between patients, families and caregivers, recognizing the importance of the family in the patient's life. Most pediatric health professionals believe that PFCC is the best way to provide quality care to children and their families in health services. However, the actions of PFCC are restricted to some members of the team. Objectives: To understand the nursing team's perception about the implementation of the PFCC in the pediatric units of a university hospital; to identify the nursing team's perception about the priorities for the implementation of the PFCC in the pediatric units of a university hospital. Methodology: Qualitative study conducted in a university hospital in the city of São Paulo. Focal groups were conducted with 14 members of the nursing team, who work in pediatric areas. The sessions were recorded and the information transcribed, to be submitted to content analysis. Results: The analysis allowed the development of three themes: 1) The family in the pediatric care scenarios; 2) Challenges for the implementation of PFCC in the pediatric care scenarios; and 3) Priorities for the effective implementation of PFCC in the pediatric care units. Conclusion: PFCC has been practiced by some members of the nursing team who consider the participation of the family essential in the care process of hospitalized children, and identify barriers in the professionals and in the institutional policies for its implementation; there is a need for actions that lead to a change in the attitudes of the professionals and the review of policies related to families, in order to overcome difficulties in the implementation of PFCC.

The application effect of family-centered care mode in children′s health care / 中国实用护理杂志

Objective@#To study the application effect of family-centered care (FCC) model in children′s health care.@*Methods@#The data of 200 children who came to the hospital for outpatient care in our hospital were analyzed. They were divided into two groups according to the principle of random number. 100 cases in the control group were given traditional child health care, and 100 cases in the observation group were treated with FCC. Service care, comparing the implementation of child care services under different care modes.@*Results@#After the FCC model was used in the observation group, parents′ knowledge of children′s health knowledge (79.0±6.6), child care compliance 98.0% (98/100), health service effect 95.0% (95/100), nursing satisfaction 96.0% (96/100), the control group was (65.0±5.8), 88.0% (88/100), 80.0% (80/100), and 80.0% (80/100), respectively. There was statistical significance (t value was 15.934, χ2 value was 7.68, 16.50, 12.12, P<0.05). The neuropsychological development scores were evaluated in the two groups. The observation group had a large exercise score (90.9±6.2) and a fine action score (86.8±7.2), adaptability score (96.5±6.5), language score (89.2±2.5), and social development score (88.3±2.5). The control group was (88.2±6.0), (84.0±6.0), (94.0±4.8), (87.9±3.0), (87.0±2.5), and there were statistics between the two groups. Academic significance (t value was 2.253-3.329, P<0.05).@*Conclusion@#The implementation of the FCC model in children′s health care can improve children′s understanding of disease knowledge and child care compliance.

Cuidado centrado na família: elaboração e implementação de consenso das melhores práticas em unidades neonatais e pediátricas / Family-Centered Care: development and implementing of consensus of best practices in neonatal and pediatric units

Introdução: O Cuidado Centrado na Família surgiu do entendimento de que a família é fundamental no cuidado dos seus integrantes, assim a família deve ser considerada objeto do cuidado. A inexistência de consenso sobre a forma de envolvê-las no cuidado permite diferentes abordagens dos profissionais frente à participação da família, contribuindo para o aumento da angústia, medo e insegurança, possibilitando a ocorrência de experiência traumática para a criança e sua família. Objetivos: Analisar a percepção da equipe de enfermagem e da família acerca do Cuidado Centrado na Família (CCF), antes e após a implementação de um consenso para sistematizar a participação da família na assistência. Métodos: Estudo quase-experimental, realizado em 4 etapas metodológicas: Construção do consenso; Avaliação diagnóstica; Implementação do consenso e Avaliação final. O estudo foi realizado no Hospital Universitário da USP (HU-USP). A população consistiu em 79 profissionais da equipe de enfermagem e residentes de enfermagem e 122 familiares presentes na Clínica Pediátrica e Terapia Intensiva Pediátrica e Neonatal. Os dados foram coletados mediante a aplicação dos instrumentos Percepção do Cuidado Centrado na Família-Pais Versão Brasileira; Percepção do Cuidado Centrado na Família-Equipe - Versão Brasileira e do Guia para Atendimento das Famílias na Prática Clínica de Enfermagem. O consenso das especialistas sobre as práticas foi obtido pela Técnica de Grupo Nominal. As variáveis foram analisadas por frequência absoluta e relativa, associação estatística e aplicação dos testes: t pareado e teste t de Welch. Resultados: A percepção dos profissionais e da família respondeu positivamente na maioria das perguntas, apresentando discreto aumento da média dos escores na etapa pós-intervenção, com as médias dos profissionais de 1,86 pré- intervenção x 1,91 pós-intervenção e as médias das famílias de 2,26 pré-intervenção x 2,28 pós-intervenção. As famílias apresentaram maior percepção positiva sobre o CCF do que a equipe de enfermagem; houve aumento significativo da presença da família nos procedimentos invasivos após a implementação do consenso; as famílias participaram com maior frequência na realização dos cuidados de alimentação, higiene, conforto, oferecendo carinho e apoio à criança, inclusive em procedimentos invasivos; as famílias consideraram receber colaboração, apoio e suporte da equipe para a participação. Conclusão: A construção de um consenso fundamentado nas melhores evidências do CCF e o treinamento reflexivo para despertar a consciência da necessidade de avanços, foram fundamentais para os resultados deste estudo. Concluiu-se ser possível o envolvimento e participação das famílias nos ambientes de Clínica Pediátrica e Unidade de Terapia Intensiva Pediátrica e Neonatal. As recomendações enfatizaram a maneira da enfermeira relacionar-se com a família, compreender suas necessidades, estabelecer parcerias e dar autonomia para que a família decida, como e quando deseja participar da assistência, possibilitando que a mesma se torne mais segura e forte, minimizando o seu sofrimento e o da criança.

Introduction: Family-Centered Care emerged from the understanding that the family is fundamental in the care of its members, therefore the family should be considered the object of care, especially in neonatal and pediatric units. The lack of consensus on how to involve families in care, allows different approaches of professionals regarding family participation, contributing to the increase of distress, fear and insecurity, enabling the occurrence of traumatic experience for the child and his family. Objectives: The aim of this study is analyze the perception of nursing staff and family about family-centered care, before and after the implementation of a consensus to systematize family involvement in care. Methods: almost- experimental, carried out in 4 methodological steps: Consensus elaboration; Diagnostic evaluation; Consensus Implementation and Final Evaluation. The study was conducted at the University Hospital of USP (HU USP). The population consisted of 79 nursing staff professionals and nursing residents and 122 family members present at the Pediatric Clinic and Pediatric and Neonatal Intensive Care. The data were collected through the application of the instruments Perception of Family-Centered Care Parents - Brazilian Version; Perception of Family-Centered Care Staff - Brazilian Version of the Family Care Guide in Clinical Nursing Practice. The experts consensus on the practices was obtained by the Nominal Group Technique. The variables were analyzed by absolute and relative frequency, statistical association and tests application: paired t and Welch t test. Results: The perception of professionals and family answered positively on most questions, showed a slight increase in the mean scores in the post-intervention stage 1.86 pre-intervention x 1.91 post- intervention and the average of families 2.26 pre-intervention x 2.28 post-intervention. The data showed that the families had a higher perception of CCF than the nursing staff, and had a significant increase in the presence of family in invasive procedures after consensus implementation, and that families participated more frequently in the provision of food, hygiene, comfort care, providing high care and support to the child even in invasive procedures; families reported having obtained collaboration and support from professional team. Conclusion: The elaboration of consensus based on the best evidence of CCF and reflective training to raise awareness about the need to progress, were fundamental to the results of this study. It is concluded that it is possible for families to be involved in the pediatric clinic and neonatal and pediatric intensive care settings. The recommendations emphasized the nurse\'s way of relating to the family, understanding their needs, establishing partnerships and give autonomy for the family to decide how and when they want to participate in the care, enabling them to become safer and stronger, minimizing your suffering and the child.

Promoting patient- and family-centered care services in intensive care unit / 中华危重病急救医学

In recent years, more and more people have recognized the importance of patients' family in the intensive care unit (ICU) in medical care, and advocated the use of patient- and family-centered care (PFCC) in the ICU. This article explains the content (family presence, family support, communication with family members, consultations and ICU team members, environmental issues) and significance of PFCC in the ICU, and provides guidance for the practice of PFCC in China.

Application of quality control circle with project achievement style in the construction of family-centered care for premature infants / 中国实用护理杂志

Objective To discuss the application of quality control circle with project achievement style in the construction of family-centered care for premature infants. Provide theoretical support for family-centered care model. Methods Set up quality control circle group, select the topic as"construct a family-centered care for premature infants". Carry out activities according to the activity steps of the quality control circle with project achievement style. Advance activities by looking at the support of health care workers, family needs, carrying on the training and the examination to the family member, using the Failure Mode and Effect Analysis (FMEA) to prevent hospital infection and developing discharge plan by trinity model. Then evaluation of tangible and intangible results before and after the activity. Results The growth rate of body mass, breast-feeding rate, length of stay, family satisfaction and family care ability of premature infants after the quality control circle activities were respectively as follow (18.92±0.66) g/kg/d, 47.25％, (23.28 ± 1.39) d, 96.58％, (98.10 ± 12.57) points;before the quality control circle activities all the scores were respectively as follow (17.26 ± 0.38) g/kg/d, 13.45％, (26.40 ± 1.098)d, 80.67％, (61.45 ± 15.07) points. The difference between the two groups was statistically significant(t=7.31, 5.89, 7.52,χ2=34.41, 17.55, P<0.01). The incidence of hospital infection before and after quality control circle activities were respectively (6.11 ± 3.59)％, (5.61 ± 2.19)％,the difference was not statistically significant (χ2=0.262, P>0.05).In addition, we also gained economic and social benefits and many hospitals came to visit and study family-centered care model. Conclusion The family-centered care model is beneficial to the improvement of the nursing quality of premature infants. The activities of the Quality Control Circle with project achievement style can help to improve the participation and acceptance of all medical staff in this model and provide a foundation for the implementation of family-centered care model.

Mother-Neonatal Intensive Care Unit (M-NICU): A Novel Concept in Newborn Care

Health facilities in India are faced with the challenge of providing quality newborn care in the face of major skilled human resourceshortage. A possible solution is the concept of Mother-Neonatal ICU (M-NICU), where the mother has her bed inside the neonatalintensive care unit (NICU) by the side of baby’s warmer. Our observations in M-NICU of a public sector hospital in New Delhi, India,indicate that mothers can be easily trained to follow asepsis routines and monitor the neonates, and are better prepared for their post-discharge care. Incorporating space for both mothers and their newborns in level-II NICUs may provide quality and developmentallysupportive newborn care in coming years.

Atitudes de enfermeiros nos cuidados com famílias no contexto do parto e puerpério imediato / Nurses' attitudes toward the families caring process regarding the childbirth and the immediate postpartum period / Las actitudes en las enfermeras de atención con las familias en el contexto del trabajo y el puerperio inmediata

Objetivo: Identificar las actitudes de las enfermeras acerca de la importancia de las familias en el proceso de atención en el contexto del parto y post-parto de acuerdo a las dimensiones de IFCE Escala - AE; Describir las actitudes que contribuyen y / o dar a entender a la apreciación de las familias en las prácticas de atención de enfermería. Métodos: Estudio transversal, descriptivo realizado con 76 enfermeros de Servicios de Alojamiento Conjunto y obstétrica Centro de dos instituciones de salud. Resultados: Las enfermeras en poder actitudes de apoyo hacia las familias, con amplitud media total de 78,4 puntos y dimensiones Familia: compañero de conversación y de recursos de afrontamiento (35,6 puntos), Familia: uso en el cuidado de enfermería (30 , 8 puntos), Familia: Armadura (11,9 puntos). Conclusión: La mayoría de las enfermeras no tienen el curso de enfermería y las familias, haciendo hincapié en la necesidad de invertir en la formación continua dirigida a las familias encargadas de las prácticas y los cambios en las estructuras curriculares de las universidades

Objetivo: Identificar atitudes de enfermeiros sobre a importância das famílias no processo de cuidado no contexto do parto e puerpério segundo as dimensões da Escala IFCE ­ AE; Descrever as atitudes que contribuem e/ou implicam para a valorização das famílias nas práticas de cuidados dos enfermeiros. Métodos: Estudo transversal, descritivo realizado com 76 enfermeiros dos Serviços de Alojamento Conjunto e Centro Obstétrico de duas instituições de saúde. Resultados: Os enfermeiros detinham atitudes de suporte para com as famílias, com média da escala total de 78,4 pontos e nas dimensões Família: parceiro dialogante e recurso de coping (35,6 pontos), Família: recurso nos cuidados de enfermagem (30,8 pontos), Família: Fardo (11,9 pontos). Conclusão: A maior parte dos enfermeiros não tem o curso de enfermagem e famílias, evidenciando a necessidade de investimento em formação continuada voltadas para as práticas de cuidado de famílias e em mudanças nas estruturas curriculares das universidades

Objective: Herein, our goal has been to identify the nurses' attitudes about the importance of families in the care process in the context of childbirth and puerperium according to the dimensions of the IFCE - AE scale (derived from the original scale: Families' Importance in Nursing Care ­ Nurses' Attitudes). It is also aimed to describe the attitudes that contribute and/or imply for the valorization of the families in the practices of nursing care. Methods: It is a descriptive and cohort study that was performed with 76 nurses from the Shared Housing Services and Obstetric Center of two health institutions. Results: Nurses have had supportive attitudes toward the families, having an average of 78.4 points and in the dimensions as follows, Family: dialoguing partner and coping resource (35.6 points), Family: nursing care resource (30.8 points), Family: burden (11.9 points). Conclusion: The nursing professional's majority do not have the nursing and families course, which evidences the need for investment in continuing education programs focused on family care practices and changes in the university curricular structures

Presença da família no atendimento de emergência pediátrica hospitalar: elaboração e aplicação de um protocolo / Presence of the family in pediatric emergency hospital care: elaboration and application of a protocol

Introdução: Partindo-se do pressuposto que o Cuidado Centrado no Paciente e na Família é o modo mais humanizado de prestar cuidado em saúde, faz-se necessário refletir sobre a aplicabilidade dessa abordagem em unidades de emergência pediátrica. Uma possibilidade é o favorecimento da presença da família no atendimento de emergência. O uso de protocolo e o treinamento de profissionais de saúde são ferramentas que fortalecem a prática. Objetivos: elaborar e aplicar na prática clínica um protocolo brasileiro que inclui a família no atendimento de emergência pediátrica. Método: estudo piloto do tipo descritivo observacional, realizado em três etapas: 1) elaboração do protocolo; 2) treinamento de profissionais para a aplicação do protocolo. O treinamento foi realizado com 26 profissionais de enfermagem atuantes em uma unidade de emergência pediátrica de um hospital de ensino, localizado na cidade de São Paulo e 3) análise da aplicação do protocolo na prática assistencial. Para essa análise, foi investigada a dinâmica do atendimento de emergência focando os aspectos relacionados à presença da família; as perspectivas de profissionais de saúde em relação ao conteúdo do protocolo e as anotações de enfermagem no que tange a aplicação do protocolo. Resultados: Foram analisados 65 atendimentos de emergência com a aplicação do protocolo. Em 65,6% dos atendimentos, foi designado um profissional de suporte; 93.4% das famílias aceitaram o convite para presenciar o atendimento e não ocorreu interrupção do atendimento ao paciente em consequência da presença desta. Ao avaliar o protocolo, 85,7% dos profissionais referiram confiança em aplicá lo em sua prática profissional. As principais dificuldades percebidas pelos profissionais para aplicar o protocolo incluíram a falta de recursos humanos, a falta de treinamento de todos os profissionais e a falta de estrutura fisica para o acolhimento familiar. Em relação às facilidades, foram elencadas equipe sensibilizada à prática, suporte familiar, o CCPF como alicerce teórico e membros na equipe experientes sobre o tema. Em relação ao conteúdo, os profissionais consideraram o protocolo fácil e rápido de ser aplicado. Apenas em 50% das anotações de enfermagem foi registrado que a familia estava presente no atendimento. Conclusões: As ações promotoras para a adoção institucional do protocolo incluem a sensibilização dos profissionais para acolher as famílias no atendimento de emergência e treinamento para a aplicação do protocolo na prática assistencial. Além disso, as ações que facilitam a implantação do protocolo na prática assistencial incluem respaldo teórico na abordagem do CCPF, profissionais que atuem como referência sobre o tema para os demais membros da equipe e designação de um profissional de suporte.

Introduction: Based on the assumption that Patient and Family Centered Care (PFCC) is the most humanized way of providing health care, it is necessary to reflect on the applicability of this approach in pediatric emergency units. One possibility is to favor the presence of the family in emergency care. The use of protocol and the training of health professionals are tools that strengthen the practice. Objectives: To elaborate and apply in clinical practice a Brazilian protocol that includes the family in pediatric emergency care. Method: pilot study of descriptive observational type, carried out in three stages: 1) elaboration of the protocol; 2) professional training for the application of the protocol. The training was performed with 26 nursing professionals working in a pediatric emergency unit of a teaching hospital, located in the city of São Paulo; and 3) analysis of the application of the protocol in the practice of care. For this analysis, it was investigated the dynamics of emergency care focusing on the aspects related to family presence; the perspectives of health professionals regarding the content of the protocol and the nursing notes regarding the application of the protocol. Results: A total of 65 emergencies were analyzed using the protocol. In 65.6% of the attendances a support professional was assigned: 93.4% of the families accepted the invitation to attend the service and there was no interruption of the patient care due to the presence of the family. When evaluating the protocol, 85.7% of the professionals reported confidence in applying it to their professional practice. The main difficulties perceived by professionals to apply the protocol included lack of human resources, lack of training of all professionals and lack of physical structure for the family. Regarding the facilities, the team was sensitized to practice, family support, the PFCC as a theoretical foundation and have experienced team members on the topic. Regarding content, professionals considered the protocol easy and quick to apply. Only 50% of the nursing notes recorded that the family was present in the care. Conclusions: The actions promoting the institutional adoption of the protocol include raising the awareness of professionals to receive families in emergency care and training for the application of the protocol in the practice of care. In addition, actions that facilitate the implementation of the protocol in the practice of care include theoretical support in the approach of the PFCC, professionals who serve as reference on the theme for the other members of the team and appointment of a support professional.

Study on the application of the family centered escort system in neurosurgical intensive care units / 中华医院管理杂志

Objective To study the application of the family centered escort system in neurosurgical intensive care units (NICU). Methods 416 cases of NICU patients from January 2015 to December 2016 were selected, 197 cases of the patients from January to December 2015 serving as the control group subject to a restrictive visit system. 219 cases of patients from January to December 2016 were used as the study group subject to the family centered escort system. The two groups were compared as to the anxiety state and satisfaction of the family members, the job satisfaction of nurses, the duration and cost of the patients in NICU, the ratio of the patients subject to sedation and restraint bands, and the incidences of adverse events of patients during NICU. Results Scores of anxiety state of the family members showed that the control group (52. 76 ± 5. 21) was significantly higher than that of the study group (34. 61 ± 5. 98). The dimensions of " information acquisition" and " access to patients" as found in the satisfaction survey of the family members showed the study group as higher than the control group, a difference of statistical significance between two groups (both P＜0. 01). The dimensions of " state at work" and " interpersonal relationship at work" showed the study group as higher than the control group, a difference of statistical significance between two groups ( P ＜ 0. 05 ) as found in the job satisfaction survey of nurses. The comparison between the two groups in NICU duration and expenses showed no significant statistical difference (P＞0. 05). The ratio of sedation treatment and restraint band usage of control group was significantly higher than that of the study group, a difference of statistical significance (P＜0. 01). The incidence ratio of lower extremity venous thrombosis showed that the control group (13. 7%, 27/197) was higher than that of the study group (6. 8%, 15/219), a difference of statistical significance (P ＜0. 01). There was no significant difference as to the incidences of other adverse events of the two groups ( P ＞ 0. 05 ). Conclusions Compared with the restricted visiting system, the family centered escort system in NICU is beneficial to both the nurses and patients, justifying the humanity of the latter system.

Application of Family- centered Care in Children with Spastic Cerebral Palsy Wearing Ankle-foot Orthosis / 中国康复理论与实践

@#Objective To investigate the effect of family-centered care on wearing ankle-foot orthosis (AFO) in children with spas-tic cerebral palsy. Methods From July to December, 2016, 65 children with spastic cerebral palsy were divided into control group (n=32) and observation group (n=33). The control group accepted routine nursing, while the observation group accepted family-centered care. The children were assessed with modified Ashworth Scale (MAS), and the incidence of skin and soft tissue problems, the compliance for wearing AFO and the satisfaction for nursing service were re-corded. Results The score of MAS decreased in the observation group compared with that in the control group (t=3.298, P=0.002), and the incidence of skin and soft tissue problems was less (χ2=7.386, P=0.007). The compliance of pa-tients wearing AFO for rehabilitation, the rate that family performed the rehabilitation, the satisfaction for nurs-ing service were all more in the observation group than in the control group (χ2>5.346, P<0.05). Conclusion The application of family-centered care can improve the compliance for wearing AFO in the children with spastic cerebral palsy, to improve the rehabilitation effect, reduce the incidence of complications, and promote the satisfaction for nursing service.

Effects of family-centered educational intervention on fall prevention knowledge, attitudes, compliance and the incidence of falls of elderly inpatients / 现代临床护理

Objective To evaluate the effectiveness of family-centered educational intervention on fall prevention knowledge and attitude,compliance and fall incidence of elderly inpatients. Methods A total of 300 elderly inpatients were selected in a first-class grade A hospital in Beijing and divided into the experiment group and the control group equally.The intervention group was given family-centered educational intervention for 6 months,while the control group was given conventional treatment and care in ward.The knowledge and attitude,compliance and the incidence of falls of elderly inpatients were evaluated at discharge and 3 months,6 months after discharge. Results The knowledge and attitude, compliance of elderly inpatients in the intervention group were significantly better than that in the control group (P<0.05).The incidence of falls in the intervention group was significantly lower than that in the control group at discharge and 3 months,6 months after discharge (P<0.05). Conclusions The family-centered educational intervention can enhance the fall prevention knowledge, attitude and compliance of elderly inpatients effectively and reduce the incidence rate of falls.The long-term effect is relatively obvious.

Health Care Providers' Perceptions of Family-centered Care in Pediatrics

PURPOSE: The purpose of this study was to identify and describe health care providers' perceptions of family-centered care in pediatrics. METHODS: A qualitative descriptive study was designed. Data were collected from individual interviews using open-ended questions. Fifty-six pediatric health care providers participated in the study from January to April 2015. Data were analyzed using qualitative content analysis to identify the major perceptions of pediatric health care providers. RESULTS: The providers perceived that the concept of family-centered care has been incompletely implemented. Five themes (respecting a child's family, taking care of a child with the child's family, sharing information about children, supporting a child's family, a child's family participating in child care) with 11 sub-themes were identified in the providers' experiences with families. To achieve the goal of family-centered care in pediatrics, medical and nursing conditions must be improved, education about family-centered care must be provided, and improvements should be made in the mindset of health care providers regarding patients and in families' willingness to participate in care. CONCLUSION: The findings from this study provide insight into pediatric health care providers' perceptions of family-centered care. It will contribute to the establishment of a foundation for implementing family-centered care in pediatric nursing.

Intervención en el lenguaje con niños bilingües y sus familias: una revisión / Language intervention with bilingual children and their families: a review

La atención clínica y educativa que se ofrece a niños bilingües es actualmente un reto para los profesionales. Es necesario investigar sobre la conceptualización del bilingüismo, su naturaleza y su relación con los diferentes entornos de aprendizaje. El objetivo del presente trabajo es revisar la literatura científica con el fin de explorar el papel del entorno familiar y las competencias del fonoaudiólogo/logopeda para garantizar una intervención fonoaudiológica/logopédica funcional en población bilingüe. Para ello, se ha estudiado la información más representativa disponible sobre el enfoque naturalista de intervención en multilingüismo. Así, se pretende reflexionar sobre los modelos de intervención que mejor se adecúan a las necesidades específicas de los niños bilingües y el papel que puede adoptar la familia para contribuir al desarrollo comunicativo de los niños en contacto con varias lenguas.En primer lugar, se ofrece una aclaración terminológica, así como una visión del marco naturalista de intervención. A continuación, se presentan la metodología y los resultados de la revisión efectuada para niños bilingües con diversidad funcional y alteraciones del lenguaje oral. Se incluyen también recomendaciones en relación a las competencias del fonoaudiólogo que trabaje con población bilingüe. Finalmente, se concluye con una propuesta de futuras líneas de investigación aplicada en este campo considerando los modelos naturalistas centrados en la familia para proponer su adaptación a las intervenciones realizadas con niños bilingües

The clinical and educative response required for bilingual children continues to be a challenge for professionals. It is necessary to research the conceptualization of bilingualism, its nature, and its relationship with different learning environments. The purpose of this paper is to review the literature to explore the role of the family environment and the speech & language therapist's (SLT) competence in guaranteeing a functional language intervention in the bilingual population. To this end, the most significant information available about multilingualism and the naturalistic intervention approach has been reviewed. With this evidence, the best models of bilingual intervention are presented, as well as a reflection on how families can contribute to improve the language development of children speaking different languages.In the first section, a terminological clarification of bilingualism is given, alongside the naturalistic frame of intervention, followed by research developed with bilingual children with functional diversity and oral language disorders. In that sense, recommendations about competence of the Speech and Language Therapist working with bilingual special needs children are also included. Finally, this paper provides a suggestion of future applied research in this field on naturalistic family-centered approaches used in language intervention with bilingual children

Experience of Patients and Families about Flexible Visiting / 중환자간호학회지

PURPOSE: This study aimed to understand the essence of experiences of patients and family members during flexible visiting in an intensive care unit (ICU).METHODS: This is a qualitative study using interviews with open ended questions. We used Colaizzi's method of phenomenological interpretation.RESULTS: Flexible visiting in the ICU impacted the patients and their families in various ways. The following categories were extracted from the patients' experiences with flexible visiting: 1) the opportunity to feel the presence of the family and 2) the burden of unrestricted visiting. The following categories were extracted from the families' experiences with flexible visiting: 1) psychological comfort by convenience 2) being aware of health care professionals and critical care nursing in the intensive care unit, and 3) double trouble.CONCLUSIONS: These results showed that flexible visiting in the ICU affected the patients and their families positively and negatively. Therefore, nursing staff need to design psychological and social interventions that address the needs of patients and their families.

Advances in transporting critical ill neonates / 中国小儿急救医学

In order to understand the status of neonatal transport research at home and abroad,we summarized and analyzed the research progress of neonatal transport through the literature search.Thus we evaluated the current application of a variety of transport critical rating system.Intrauterine transport is considered the safest mode of transport,and promote intrauterine transport of high-risk mothers.It is suggested that the parents participate in the transshipment process and return the stable children to the local hospital for further treatment and promote the family-centered treatment mode.In transit,mobile ECMO,hypothermia and other advanced equipment in foreign countries have been applied.It is recommended to use the respiratory function monitor to monitor the respiration during transit.It can provide the parameters of respiratory wave,identify air leak,accidental release,spontaneous breathing.