Hospitalized Adolescents' Perspectives on Sexual and Reproductive Health Discussions.

OBJECTIVES: Experts recommend that providers discuss adolescent patients' sexual and reproductive health (SRH) at any health care encounter, including hospitalizations. The purpose of this qualitative study was to gain insight into hospitalized adolescents' experiences and perspectives on SRH discussions (SHDs) to better inform patient-centered care. METHODS: Private semistructured interviews were conducted with hospitalized adolescents aged 13 to 17 years. Interviews were coded and analyzed using thematic analysis. Themes were developed through an iterative process with focus on the primary research aim. RESULTS: Twenty participants were interviewed with a median age of 15.4 years. Adolescents expressed a range of preferences related to SHDs with providers. Themes included (1) experiences discussing SRH with providers, (2) SHDs during hospitalization, (3) communication preferences, and (4) perceptions of why providers initiate SHDs. Viewpoints about SHDs during hospitalizations varied, including that they addressed unmet needs, as well as that they seemed irrelevant to some participants. Aspects that facilitate SHDs include brevity with relevant depth, nonjudgmental provider demeanor, and reassurance of privacy. Some participants believed providers could judge the depth of discussion needed on the basis of the adolescent's age or personality. CONCLUSIONS: This study highlights variation in adolescents' preferences around SHDs with health care providers. Providers should initiate SHDs with statements of purpose and confidentiality. Given the variation in adolescents' perspectives, tools to privately collect self-reported behaviors before an SHD may help providers frame the conversation to the adolescent's specific SRH needs and communication style preferences.

"God gives me hope!": Hospitalized children's perception of the influence of religion in coping with chronic illness.

PURPOSE: The mechanism of the impact of religion on health is still unclear, especially in children and adolescents with chronic illness who live in religious contexts. This study aimed to understand the influence of religion on coping with chronic diseases from the perspective of hospitalized children and adolescents diagnosed with cancer, type 1 diabetes mellitus and cystic fibrosis. DESIGN AND METHODS: Qualitative descriptive research used photo-elicitation interviews with 35 Brazilian children and adolescents with cancer, type 1 diabetes mellitus and cystic fibrosis, aged between 7 and 17 years old. A thematic analysis approach was used to analyze qualitative data. RESULTS: Participants were diagnosed with cystic fibrosis (14.3%), cancer (57.1%), and type 1 diabetes mellitus (28.6%) and 82.9% had a religious affiliation. Three themes were constructed: finding strength and support in the relationship with the divine, religion as an important source of meaning, and religious practice as a promoter of well-being. These themes demonstrate that children and adolescents themselves perceived their illness as a journey through which their faith grew. CONCLUSIONS: This research shows the influence of religion on the positive coping of chronic illness, being a source of strength and support from the relationship with the divine, as well as offering a source of meaning, purpose and well-being based on religious practices. PRACTICE IMPLICATIONS: This study supports clinical practice, based on the recognition of the patient as a religious and spiritualized person who has spiritual beliefs and needs that are capable of influencing treatment.

Comunicação de adolescentes hospitalizados com a equipe de enfermagem: revisão integrativa / Communication between hospitalized adolescents and the nursing team: integrative review / Comunicación de los adolescentes con el equipo de enfermería: una revisión integradora

Objetivo: conhecer as percepções dos adolescentes hospitalizados sobre sua comunicação com a equipe de enfermagem durante a internação. Método: revisão integrativa, incluindo as bases de dados PubMED, BVS, Psycinfo, Scopus e Web of Science. Aplicaram-se os descritores "Adolescent", "Hospitalization", "Nursing Care" e "Qualitative Research". Resultados: selecionaram-se sete artigos. A comunicação empática é interpretada pelo adolescente como uma valorização de sua individualidade, transmitindo maior segurança. A comunicação com a enfermagem foi considerada desagradável em situações em que o profissional se comunicou de forma fria e autoritária. Os adolescentes percebem uma comunicação disciplinadora por parte da equipe de enfermagem; contudo, essa é vista por eles como necessária para o seu cuidado. Considerações finais: os adolescentes percebem nos profissionais de enfermagem uma comunicação individualizada, mas também um excesso de demandas da equipe que torna essa comunicação mais fria e distante. Torna-se fundamental a valorização dessa ferramenta, para se obter um cuidado qualificado(AU)

Objective: to analyze perceptions of hospitalized adolescents about their communication with the nursing team during hospitalization process. Method: integrative review, including PubMED, BVS, Psycinfo, Scopus and Web of Science databases. The descriptors "Adolescent", "Hospitalization", "Nursing Care" and "Qualitative Research" were applied. Results: seven articles were selected. Empathetic communication is interpreted by adolescents as valuing their individuality, conveying greater security. Communication with nursing was considered unpleasant in situations where the professional communicated in a cold and authoritarian way. Adolescents perceive disciplining communication from the nursing team; however, this is seen by them as necessary for their care. Final considerations: adolescents perceive individualized communication in nursing professionals, but also an excess of demands from the team, which makes this communication colder and more distant. It is essential to value this tool in order to obtain qualified care(AU)

Objetivo: conocer las percepciones de adolescentes hospitalizados sobre su comunicación con el equipo de enfermería. Método: revisión integradora, incluyendo las bases de datos PubMED, BVS, Psycinfo, Scopus y Web of Science. Se aplicaron los descriptores "Adolescent", "Hospitalization", "Nursing Care" y "Qualitative Research". Resultados: se seleccionaron siete artículos. El adolescente interpreta la comunicación empática como una valoración de su individualidad, transmitiendo mayor seguridad. La comunicación con el personal de enfermería se consideró desagradable en situaciones en las que el profesional se comunicaba de forma fría y autoritaria. Los adolescentes perciben una comunicación disciplinaria por parte del equipo de enfermería; sin embargo, los jóvenes consideran ese aspecto como siendo necesario para su cuidado. Consideraciones finales: los adolescentes perciben una comunicación individualizada por parte de los profesionales de enfermería, pero también un exceso de exigencias del equipo, lo que vuelve esa comunicación más fría y distante. Es fundamental valorar esta herramienta para obtener una atención cualificada(AU)

Desenhar, escrever e contar: qualidade de vida da criança e adolescente com condição crônica / Draw, write and tell interview: Quality of life of children and adolescents with chronic condition / Dibujar, escribir y contar: calidad de vida de niños y adolescentes con enfermedades crónicas

Objetivo: compreender por meio da técnica Desenhar, escrever e contar como a condição crônica influencia na qualidade de vida infantojuvenil; e analisar o uso da técnica nessa população. Método: estudo qualitativo, descritivo e exploratório. Participaram onze crianças e adolescentes com condição crônica entre sete e dezessete anos. A coleta de dados ocorreu mediante entrevista semiestruturada, com auxílio da técnica Desenhar, escrever e contar, em um Hospital público. Para análise dos dados utilizou-se a análise de conteúdo temática de Bardin. Resultados: emergiram três categorias que evidenciam diversas alterações na qualidade de vida dessa clientela, com destaque para o comprometimento físico, emocional e social que impacta nas de experiências que compõem a infância e a adolescência. A técnica Desenhar, escrever e contar foi um facilitador e enriqueceu a coleta de dados. Considerações finais: a técnica escolhida possibilitou identificar a qualidade de vida prejudicada da criança e adolescente com condição crônica(AU)

Objective: to understand, through the Draw, Write and Tell interview technique how chronic condition influences pediatric quality of life; To analyze the use of the technique in this population. Method: qualitative, descriptive, exploratory study. Eleven children and adolescents with chronic conditions between seven and seventeen years old participated. Data collection took place through semi-structured interviews, with the aid of the Draw, Write and Tell interview technique, in State University Hospital. For data analysis, thematic content analysis according to Bardin was used. Results: three categories emerged that show several changes in the quality of life of this clientele, with emphasis on the physical, emotional and social impairment that impact on the experiences that make up childhood and adolescence. The Draw, Write and Tell interview technique facilitated and enriched data collection. Final considerations: The chosen technique made it possible to identify the impaired quality of life of children and adolescents with chronic conditions(AU)

Objetivo: comprender, a través de la técnica de entrevista Dibujar, Escribir y Contar, cómo la condición crónica influye en la calidad de vida infantojuvenil; y analizar el uso de la técnica en esta población. Método: estudio cualitativo, descriptivo y exploratorio. Participaron once niños y adolescentes, con condiciones crónicas, de siete a diecisiete años. La recolección de datos ocurrió por medio de entrevistas semiestructuradas, con el auxilio de la técnica de entrevista Dibujar, Escribir y Contar, en un hospital público. En cuanto al análisis de datos, se utilizó el análisis de contenido temático de Bardin. Resultados: surgieron tres categorías que muestran varios cambios en la calidad de vida de esta clientela, con énfasis en el deterioro físico, emocional y social que tiene un gran impacto en las experiencias que componen la infancia y la adolescencia. La técnica Dibujar, Escribir y Contar facilitó y enriqueció la recolección de datos. Consideraciones finales: la técnica elegida permitió identificar la calidad de vida deteriorada de niños y adolescentes con condiciones crónicas(AU)

Intervenciones de enfermería promotoras de la adaptación del niño / joven / familia a la hospitalización: una scoping review / Intervenções de enfermagem promotoras da adaptação da criança / jovem / família à hospitalização: uma scoping review / Nursing interventions promoting child /youth /family adaptation to hospitalization: a scoping review

OBJETIVO: Identificar el proceso de adaptación del niño y la familia a la hospitalización y mapear las intervenciones de enfermería que promueven la adaptación a la hospitalización del niño/joven/familia. MÉTODO: Elaboración de Scoping Review basado en Joanna Briggs Institute (2014). Criterios de inclusión para Población: Niño, Joven (0-18 años) y Familia; Concepto: Intervenciones promotoras hacia la adaptación y Contexto: Hospitalización. Los estudios considerados fueron estudios cuantitativos, cualitativos y revisiones sistemáticas. Búsqueda de artículos en tres bases de datos electrónicas - PUBMED, MEDLINE y CINAHL. Criterio de selección: datados entre 2012 y 2019 y en régimen full text. Idiomas: inglés y portugués. RESULTADOS: Se analizaron un total de 14 artículos, destacando que el diseño del estudio incluye 2 revisiones sistemáticas de la literatura, 7 estudios cualitativos y 5 cuantitativos. Los resultados del análisis se organizaron por temas: adaptación del niño a la hospitalización, adaptación de los padres y estrategias que promueven la adaptación a la hospitalización. Las intervenciones dirigidas a los niños se centran en el fortalecimiento de los mecanismos para hacer frente a los problemas y en el aumento de la seguridad, y se han clasificado en estrategias de comunicación; actividades recreativas y de relajación; promoción de la esperanza y estrategias de coping. CONCLUSIÓN: Las intervenciones de enfermería promotoras de la adaptación a la hospitalización mapeadas pretenden disminuir la ansiedad y el estrés del niño / familia, aumentando la capacidad para recibir información, participar en el cuidado y en las decisiones. Se destacan el juego terapéutico, informaciones anticipatorias, técnicas de relajación, distracción, humor, musicoterapia, kits de adaptación, grupos terapéuticos y estrategias promotoras de esperanza

OBJETIVO: Identificar o processo de adaptação da criança e família à hospitalização e mapear as intervenções de enfermagem promotoras da adaptação à hospitalização da criança/jovem/família. MÉTODO: Elaboração de uma Scoping Review com base no Joanna Briggs Institute (2014). Critérios de inclusão - População: Criança, Jovem (0-18 anos); Conceito: Intervenções promotoras da adaptação e Contexto: Hospitalização. Os estudos considerados foram estudos quantitativos, qualitativos e revisões sistemáticas. Pesquisa de artigos em três bases de dados eletrónicas - PUBMED, MEDLINE e CINAHL. Critério de selecção: datados entre 2012 e 2019 e em regime full text. Línguas de inclusão: Português e Inglês. RESULTADOS: Foram analisados 14 artigos, salientando-se que o desenho de estudo incluem 2 revisões sistemáticas da literatura, 7 estudos qualitativos e 5 quantitativos. Os resultados da análise foram organizados por temas: adaptação da criança à hospitalização, adaptação dos pais à hospitalização e estratégias promotoras de adaptação à hospitalização. As intervenções dirigidas à criança centram-se no fortalecimento dos mecanismos de enfrentamento e no aumento da segurança, tendo estas sido categorizadas em estratégias comunicacionais; atividades lúdicas/brincar e atividades de relaxamento; promoção da esperança e estratégias de coping. CONCLUSÃO: As intervenções de Enfermagem promotoras da adaptação à hospitalização mapeadas visam diminuir a ansiedade e stress da criança/família, aumentando a capacidade para receber informação, participar nos cuidados e em decisões. Destacam-se a brincadeira terapêutica, informações antecipatórias, técnicas de relaxamento, distração, humor, musicoterapia, kits de adaptação, grupos terapêuticos e estratégias promotoras de esperança

OBJECTIVE: Identify the adaptation process of the child and family to hospitalization and map the nursing interventions that promote the child/youth/family's adaptation to hospitalization. METHOD: Elaboration of a Scoping Review based on the Joanna Briggs Institute (2014). Inclusion criteria - Population: Child, Young (0-18 years old); Concept: Interventions promoting adaptation and Context: Hospitalization. The studies considered were quantitative, qualitative and systematic reviews. Electronic databases used for article search - PUBMED, MEDLINE and CINAHL. Selection criteria: full text articles dated between 2012 and 2019. Languages of inclusion: Portuguese and English. RESULTS: A total of 14 articles were analyzed, including 2 systematic reviews of the literature, 7 qualitative studies and 5 quantitative studies. The results of the analysis were organized by themes: the child's adaptation to hospitalization, the parent's adaptation to hospitalization and strategies promoting adaptation to hospitalization. The interventions aimed at children are focused on strengthening coping mechanisms and on increasing the sense of security. These have been categorized into communication strategies; playful activities and relaxation activities; and promotion of hope and coping strategies. CONCLUSION: The mapped Nursing interventions that promote adaptation to hospitalization intend to decrease the child / family's anxiety and stress, increasing the ability to receive information and to participate in care and decisions. Intervention such as therapeutic play, anticipatory information, relaxation techniques, distraction, humor, music therapy, adaptation kits, therapeutic groups and hope-promoting strategies are emphasized

Convivendo com múltiplos sintomas: a experiência de crianças e adolescentes com condição crônica / Living with multiple symptoms: the experience of children and adolescents with chronic condition / Vivir con múltiples síntomas: la experiencia de niños y adolescentes con condición crónica

Objetivo: compreender como é a experiência das crianças/adolescentes de conviver com sintomas de uma condição crônica. Método: abordagem qualitativa, utilizando como referencial a Teoria Fundamentada nos Dados. Os participantes foram 11 crianças e adolescentes de seis a 18 anos incompletos hospitalizados em um hospital estadual universitário. Como instrumentos de coleta de dados, utilizou-se a entrevista semiestruturada e a técnica "draw, write and tell". As entrevistas foram audiogravadas e transcritas, e a análise seguiu os passos do referencial. Resultados: apreendeu-se a categoria "Tendo que conviver com os sintomas", que engloba cinco subcategorias que apresentam sintomas físicos, emocionais e gerais, a convivência com a multiplicidade de sintomas simultâneos e as consequências de se conviver com eles. Conclusão: a convivência com diversos sintomas leva a limitações. A enfermagem precisa favorecer a expressão das vivencias das crianças/adolescentes, minimizando situações de estresse e melhorar o gerenciamento dos sintomas, através do planejamento de estratégias individualizadas.

Objective: to comprehend children's or adolescents' experiences of living with symptoms of a chronic condition. Method: on a qualitative approach, taking Grounded Theory as a frame of reference and 11 children and adolescents aged 6 to 18 years hospitalized in a state university hospital as participants, data were collected by semi-structured interview using the "draw, write, and tell" technique. The interviews were recorded and transcribed, and then analyzed following the steps of Grounded Theory. Results: analysis identified the category "Having to live with symptoms", which comprised 5 subcategories featuring physical, emotional and general symptoms, the experience of living with multiple simultaneous symptoms, and the consequences of living with them. Conclusion: living with several symptoms entails limitations. Nursing needs to favor children's and adolescents' expressions of their experiences in order to minimize stressful situations and improve symptom management by planning individualized strategies.

Objetivo: comprender las experiencias de niños o adolescentes de vivir con síntomas de una enfermedad crónica. Método: con un enfoque cualitativo, tomando como marco de referencia la Teoría Fundamentada y como participantes a 11 niños y adolescentes de 6 a 18 años hospitalizados en un hospital universitario estatal, los datos se recolectaron mediante entrevista semiestructurada utilizando el método "dibujar, escribir y decir "técnica. Las entrevistas fueron grabadas y transcritas, y luego analizadas siguiendo los pasos de Grounded Theory. Resultados: el análisis identificó la categoría "Tener que vivir con síntomas", que comprendía 5 subcategorías que presentaban síntomas físicos, emocionales y generales, la experiencia de vivir con múltiples síntomas simultáneos y las consecuencias de vivir con ellos. Conclusión: vivir con varios síntomas conlleva limitaciones. La enfermería debe favorecer la expresión de las experiencias de los niños y adolescentes para minimizar las situaciones estresantes y mejorar el manejo de los síntomas mediante la planificación de estrategias individualizadas

Characterization of adopted suicidal behavior and its main influencing factors: A qualitative study with adolescents.

INTRODUCTION: A better understanding of the meanings that adolescents associate with suicide, contributes to the development of psychotherapeutic intervention programs to be implemented by nurse specialists in mental health and psychiatric nursing. Therefore, adolescents need to characterize their adopted suicidal behaviors and identify the personal characteristics that contribute to this same behavior. METHODOLOGY: A descriptive, exploratory, and qualitative study was conducted with 33 adolescents with suicidal behavior, hospitalized in a child psychiatry unit. Data were collected through a structured interview, and data treatment used the content analysis technique. RESULTS: Suicidal behaviors are characterized according to causality, meaning, and intent. Causality is mostly related to psychological factors (sadness, desperation, mental suffering, internal pain, emptiness, and rejection). As to the meaning, suicidal behavior is understood as an escape but also as a personal choice, sometimes regarded as rational. In what concerns intent, the intent to die is the most frequently reported. The most-reported personal characteristics which contributed to the suicidal behavior are feelings of exclusion, rejection, and humiliation, and also introversion. CONCLUSIONS: The results point to the need to reflect on the perceptions of adolescents with suicidal behavior. The current intervention strategies should be adjusted especially through the identification of the signs associated with mental distress in adolescents and the training of gatekeepers, contributing to productive and congruent suicide prevention in this vulnerable group.

Clinical and Psychosocial Characteristics of Adolescent Pediatric Patients Hospitalized after Different Types of Suicidal Behaviors-A Preliminary Study.

The objective of this study was to examine the clinical characteristics of adolescents hospitalized after a suicide attempt or instrumental suicide-related behavior. Participants included thirty-six adolescents from the pediatric unit of a Polish hospital who made a nonfatal suicide attempt (SAA) or engaged in instrumental suicide-related behavior (IBA), as well as a general population sample (GPS). Psychosocial features were measured using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Suicide Behaviors Questionnaire-Revised (SBQ-R), the Psychache Scale (TPS), the State-Trait Anxiety Inventory (STAI), the Center of Epidemiological Studies Depression Scale for Children (CES-DC), and the Prodromal Questionnaire (PQ-16). The SAA group scored significantly higher than the IBA group and the GPS in modules related to irritability and anhedonia, voice hallucinations and delusions, suicidal acts, thoughts and ideation, and medical lethality. Additionally, the SAA scored higher on the SBQ-R and PQ-16 compared to the IBA group and the GPS. Although anxiety, mental pain, and depressive symptoms could not independently distinguish between the SAA and IBA groups, psychotic symptoms were more frequently present within the SAA group. The above symptoms may be important to consider when screening for suicide risk in the general population.

Youth Self Report Thought Problems and Sleep Difficulties Are Linked to Suicidal Ideation Among Psychiatrically Hospitalized Adolescents.

Objectives: Thought problems, such as hallucinations and delusional or disorganized ideas, have been associated with increased sleep problems and risk for suicidal ideation (SI). Sleep problems have also been linked directly to suicidality in adolescence. The nature of the relationship between these symptoms among adolescents with acute suicidality is not well understood. This study aims to examine the interrelationships between thought problems, sleep difficulties, and SI in adolescents psychiatrically hospitalized for safety concerns, with the goal of informing suicide risk screening and intervention for this population. Methods: Participants included adolescents (n = 690) aged 11-18. A retrospective chart review was used to obtain scores on study measures, including the Suicidal Ideation Questionnaire Junior (SIQ-Jr), the thought problems and sleep disturbance scales on the Youth Self Report (YSR), and mental health diagnoses using the Children's Interview for Psychiatric Syndromes (ChIPS). Results: Findings indicate that SIQ-Jr scores are moderately correlated with both YSR thought problems (r = 0.51, p < 0.001) and YSR sleep disturbance (r = 0.47, p < 0.001). Further, linear regression analyses support the hypotheses that thought problems (ß = 0.28) and sleep difficulties (ß = 0.11) are uniquely associated with SI, beyond the significant effects of depression (ß = 0.36) and female sex (ß = -0.07); R2 = 0.43, F (8, 673) = 62.49, p < 0.001). Conclusions: These results suggest that sleep interventions and treatment of thought problems may be important for reducing SI, within and outside the context of depression. Furthermore, the adolescent version of the YSR may be a useful tool to evaluate these risk factors alongside other psychiatric concerns.

Characteristics of a First Suicide Attempt that Distinguish Between Adolescents Who Make Single Versus Multiple Attempts.

Although a history of a suicide attempt is the strongest predictor of future suicide attempts, not all adolescents who make an attempt engage in repetitive suicidal behavior. The present study sought to determine whether certain characteristics of a first suicide attempt (e.g., age of first attempt, method of attempt used, intent seriousness, medical lethality, and receipt of treatment after attempt) can distinguish between adolescents who make single versus multiple suicide attempts. Adolescents (N = 95) who were psychiatrically hospitalized and their guardian completed a diagnostic interview to gather information on all lifetime suicide attempts. A multivariate hierarchical logistic regression was conducted, predicting single attempt versus multiple attempt status. Of the first-attempt characteristics examined, only age of first attempt, OR = 0.33, 95% CI [0.17-0.63], p = .001, and receipt of treatment following attempt, OR = 0.28, 95% CI [0.09-0.88], p = .028, significantly distinguished SA vs. MA status, even after controlling for current age and depression at the time of first attempt. Female and White participants were overrepresented in this sample, which limits generalization to more heterogenous and diverse samples. The cross-sectional nature of data introduces the potential for retrospective recall bias. Younger age of first attempt and lack of receipt of mental health treatment following a first attempt were associated with multiple attempt status. These findings highlight the importance of early mental health screening, parental psychoeducation, and linkage to mental health care after a suicide attempt.

Using Animation to Self-Report Health: A Randomized Experiment with Children.

BACKGROUND: The Child Health Utility-9D (CHU-9D) is the only generic preference-based measure specifically developed to elicit health-related quality of life directly from children aged 7-11 years. The aim of this study was to investigate whether the use of animation on a touch screen device (tablet) is a better way of collecting health status information from children aged 4-14 years compared to a traditional paper questionnaire. The specific research questions were firstly, do young children (4-7 years) find an animated questionnaire easier to understand; secondly, independent of age, is completion of an animated questionnaire easier for sick children in hospital settings; and thirdly, do children's preferences for the different formats of the questionnaire vary by the age of the child. METHODS: Using a balanced cross-over trial, we administered different formats of the CHU-9D to 221 healthy children in a school setting and 217 children with health problems in a hospital setting. The study tested five versions of the CHU-9D questionnaire: paper text, tablet text, tablet still image, paper image and tablet animation. RESULTS: Our results indicated that the majority of the children aged 4-7 years found the CHU-9D questions easy to answer independent of the format of the questionnaire administered. Amongst children aged 7-14 with health problems, the format of questionnaire influenced understanding. Children aged 7-11 years found the tablet image and animation formats easier compared to text questionnaires, while the oldest children in hospital found text-based questionnaires easier compared to image and animation. CONCLUSION: Children in all three age groups preferred animation on a tablet to other methods of assessment. Our results highlight the potential for using an animated preference-based measure to assess the health of children as young as 4 years.

Experiencia de los adolescentes al ingreso en un hospital de dia de salud mental: descubriendo el estigma internalizado / Adolescent's experiences of the admission to a day hospital program: discovering the internalized stigma

INTRODUCCIÓN: El impacto de la crisis en la enfermedad y la admisión a un hospital de día son acontecimientos de excepcional trascendencia para los adolescentes. Hasta la fecha, la literatura ha prestado poca atención a las experiencias de los adolescentes en esta transición múltiple. OBJETIVO: El objetivo de este estudio fue analizar la experiencia de los adolescentes con una enfermedad mental que requieren de un ingreso en un hospital de día de salud mental. MÉTODO: El estudio utilizó métodos de investigación cualitativos. Un total de 13 adolescentes participó en las entrevistas semiestructuradas. Los datos se transcribieron y analizaron de acuerdo con los métodos establecidos para el análisis de datos temáticos inductivos. RESULTADOS: Se identificaron cinco temas: la lucha contra uno mismo, una montaña que me va aplastando, la presión de la Educación Secundaria Obligatoria, inscrito en una institución psiquiátrica y ser como los otros. DISCUSIÓN: El análisis de los textos de los adolescentes nos reveló un fuerte estigma internalizado, barreras emocionales, psicológicas e interpersonales que se acumularon en forma de experiencias negativas que influyeron y aumentaron su sufrimiento. CONCLUSIONES: Los esfuerzos para reducir el estigma hacia los niños y adolescentes con diagnósticos de enfermedad mental obtienen la capacidad de acumular beneficios a largo plazo. Las intervenciones de enfermería de salud mental en adolescentes deben basarse en la detección de las barreras y la validación de la experiencia de los adolescentes

INTRODUCTION: The crucial moments for adolescents with mental illness are the impact of the crisis and the admission to a day hospital program. Till the date the literature has paid little attention to the experiences of parents in this multiple transition. AIM: The aim of this study was to analyse the experience of adolescents with a mental illness who require admission to a day hospital. METHOD: The study used qualitative research methods. A total of 13 adolescents participated in the semistructured interviews. Data was then transcribed and analysed in accordance with established methods for the analysis of inductive thematic data. RESULTS: Five themes were identified: the fight against oneself, a mountain that is crushing me, the pressure of Compulsory Secondary Education, enrolment in a psychiatric institution and I want to be like the others. DISCUSSION: The analysis of the texts of the adolescents revealed a strong internalized stigma along with emotional, psychological and interpersonal barriers that accumulated in the form of negative experiences, these influenced and increased their suffering. CONCLUSIONS: Efforts to reduce stigma towards children and adolescents with mental illness diagnoses facilitate the accumulation of long-term benefits. Adolescent mental health nursing interventions should be based on detecting barriers and validating the experience of adolescents

Incertidumbre en los cuidadores de niños hospitalizados en unidades de: cuidado intensivo neonatal - cuidado intensivo pediátrico (UCIN-UCIP) / Uncertainty in caregivers of children hospitalized in units of neonatal intensive care -pediatric intensive care (NICU-UCIP) / Incerteza em cuidadores de crianças internadas em unidades de terapia intensiva neonatal - terapia intensiva pediátrica (NICU-UCIP)

OBJETIVO: Determinar el nivel de incertidumbre ante la enfermedad y el significado de los factores que influyen en la experiencia de los cuidadores de niños de0 a14 años hospitalizados en UCI neonatal y pediátrica. MATERIALES Y METODOS: investigación mixta, con integración sistemática de los métodos cuantitativo y cualitativo, mediante triangulación analítica de los resultados, la muestra cuantitativa estuvo conformada por 285 cuidadores de niños internados en las UCI, y 10 informantes claves en el componente cualitativo. RESULTADOS: La incertidumbre global en la población encuestada fue: regular, con un 57%, alto en un 36 %, solo el 7% presento nivel bajo; las categorías cualitativas fueron: experiencia difícil, imprevisibilidad, vínculo parental, apoyo, calidad de la atención, espiritualidad, esperanza y experiencia única. La triangulación analítica evidenció la aplicabilidad de los postulados teóricos en el contexto. CONCLUSIONS: La incertidumbre es una experiencia única, enmarcada por sentimientos y emociones generan una nueva perspectiva, delineada por factores asociados al estado de salud, como: ambigüedad, falta de claridad e información respecto a los hechos experimentados por los niños.comunicarse con el personal de salud es relevante, porque permite al cuidador desarrollar estrategias de afrontamiento eficaces, disminuir sentimientos negativos, promover vínculos, soporte y capacidad para aceptar eventos

OBJECTIVE: To determine the level of uncertainty regarding the disease and the importance of the factors that influence the experience of caregivers of children aged 0 to 14 years hospitalized in neonatal and pediatric ICU. MATERIALS AND METHODS: mixed research, with systematic integration of quantitative and qualitative methods, through the analytical triangulation of the results, the quantitative sample consisted of 285 caregivers of children admitted to the ICU and 10 key informants in the qualitative component. RESULTS: The global uncertainty in the surveyed population was: regular, with 57%, high in 36%, only 7% presented low level; The qualitative categories were: difficult experience, unpredictability, paternal bond, support, quality of attention, spirituality, hope and unique experience. The analytical triangulation showed the applicability of the theoretical postulates in the context. CONCLUSIONS: Uncertainty is a unique experience, framed by feelings and emotions generate a new perspective, delineated by factors associated with the state of health, such as: ambiguity, lack of clarity and information about the facts experienced by children.communication with health personnel is relevant, since it allows the caregiver to develop effective coping strategies, reduce negative feelings, promote links, support and capacity to accept events

OBJETIVO: Para determinar o nível de incerteza na doença ea importância dos fatores que influenciam a experiência de cuidadores de crianças de 0 a 14 anos internados em UTI neonatal e pediátrica. MATERIAIS E MÉTODOS: pesquisa conjunta com a integração sistemática de métodos quantitativos e qualitativos, usando tri angulação analítica dos resultados, amostra quantitativa consistiu de 285 cuidadores de crianças na UTI e 10 informantes-chave no componente qualitativa. RESULTADOS: A incerteza global na população pesquisada foi: regular, com 57%, alta de 36%, apenas 7% apresentaram baixo nível; As categorias qualitativas foram: experiência difícil, imprevisibilidade, vínculo parental, apoio, qualidade do cuidado, espiritualidade, esperança e experiência única. A triangulação analítica mostrou a aplicabilidade dos postulados teóricos no contexto. CONCLUSÃO: A incerteza é uma experiência única, emoldurado por sentimentos e emoções gerar uma nova perspectiva delineada por fatores relacionados à saúde, como a ambigüidade, a falta de clareza e de informação sobre os acontecimentos vividos por crianças. A comunicação com o pessoal de saúde é relevante, pois permite que o cuidador desenvolva estratégias eficazes de enfrentamento, reduza sentimentos negativos, promova vínculos, suporte e capacidade para aceitar eventos

Perfil clínico y Psicosocial de los Adolescentes de 15 a 18 años Intentadores de Suicidio Hospitalizados en la Clínica Psiquiátrica de la Universidad de Chile (CPU) 2009-2011 / Clinical and Psychosocial Profile of 15 to 18-year-old Adolescents with Suicide Attempts Hospitalized in the Universidad de Chile Psychiatric Clinic (CPU) 2009-2011

El fenómeno suicida ha aumentado en la población general y esto cobra especial relevancia en los adolescentes de nuestro país. Si bien se conocen factores de riesgo asociados, existen aún escasos estudios locales respecto a las características de los adolescentes intentadores de suicidio en población consultante. Métodos: Se consideró población estudio a los adolescentes entre 15 y 18 años hospitalizados en la CPU entre 2009 y 2011, se dividieron intentadores (IS) y no intentadores de suicidio (NIS), registrando características clínicas y sociodemográficas, analizadas luego con el software STATA. Resultados: En el grupo de intentadores de suicidio el 68,13% presentaban historia de intento suicida previo, siendo más frecuente en mujeres. Otra característica distintiva de este grupo es la asociación a conducta suicida de familiar de primer grado y el antecedente de abuso sexual infantil. Palabras Clave: comportamiento suicida, intento suicida, adolescentes, perfil psicosocial, abuso sexual.

The suicidal phenomenon has increased in the general population and this is especially relevant in our country's adolescents. Although there are known risk factors for suicide, there are still few local studies regarding the characteristics of adolescents attempting suicide in our consulting population. Methods: The study population was considered to be 15 to 18-year-old adolescents hospitalized in the CPU between 2009 and 2011, they were divided into suicide attempters (SA) and non suicide attempters (NSA); clinical and sociodemographic characteristics were recorded and later analyzed with the software STATA. Results: In the group of suicide attempters 68.13% presented a history of previous suicide attempts, more frequently in women. Another distinctive feature of this group is the association of suicide attempts to suicidal behavior of a first-degree relative and a history of child sexual abuse.Key words: suicidal behaviour, suicidal attempt, adolescent, psychosocial profile, sexual abuse.

Identification of suicidal behavior among psychiatrically hospitalized adolescents using natural language processing and machine learning of electronic health records.

OBJECTIVE: The rapid proliferation of machine learning research using electronic health records to classify healthcare outcomes offers an opportunity to address the pressing public health problem of adolescent suicidal behavior. We describe the development and evaluation of a machine learning algorithm using natural language processing of electronic health records to identify suicidal behavior among psychiatrically hospitalized adolescents. METHODS: Adolescents hospitalized on a psychiatric inpatient unit in a community health system in the northeastern United States were surveyed for history of suicide attempt in the past 12 months. A total of 73 respondents had electronic health records available prior to the index psychiatric admission. Unstructured clinical notes were downloaded from the year preceding the index inpatient admission. Natural language processing identified phrases from the notes associated with the suicide attempt outcome. We enriched this group of phrases with a clinically focused list of terms representing known risk and protective factors for suicide attempt in adolescents. We then applied the random forest machine learning algorithm to develop a classification model. The model performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. RESULTS: The final model had a sensitivity of 0.83, specificity of 0.22, AUC of 0.68, a PPV of 0.42, NPV of 0.67, and an accuracy of 0.47. The terms mostly highly associated with suicide attempt clustered around terms related to suicide, family members, psychiatric disorders, and psychotropic medications. CONCLUSION: This analysis demonstrates modest success of a natural language processing and machine learning approach to identifying suicide attempt among a small sample of hospitalized adolescents in a psychiatric setting.

Hospitalized adolescents' perception of dignity: A qualitative study.

BACKGROUND: Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents' recovery. However, many studies have been conducted on exploring the concept of the patients' dignity from the adult patients and fewer studies still have explored the dignity of young people. OBJECTIVE: This study explores the hospitalized adolescents' perception about dignity. RESEARCH DESIGN: A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents' dignity. PARTICIPANTS AND RESEARCH CONTEXT: Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13). ETHICAL CONSIDERATIONS: Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees. FINDINGS: Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication. DISCUSSION AND CONCLUSION: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent's identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses.

How Do Hospitalized Adolescents Feel Safe? A Qualitative Study.

BACKGROUND: The feeling of safety makes an important contribution to the sense of well-being and quality of care for hospitalized adolescents, who are at a higher risk of feeling unsafe. Feeling unsafe during hospitalization may have a negative impact on recovery. Nurses must be sensitive to the possibility that patients feel unsafe, even in the absence of obvious direct physical threat. PURPOSE: This study explores the experiences of hospitalized adolescents to obtain an understanding of psychological safety. METHODS: A qualitative study using unstructured interviews was conducted to explore the sense of psychological safety of hospitalized adolescents aged 12-18 years and registered in a general medical or surgical pediatric unit. Purposive sampling was used to recruit new qualified participants until data saturation was reached (N = 16). RESULTS: Psychological safety is reflected by the four themes of receiving comprehensive support, protection of human dignity, relaxing environment, and attempts to adapt. CONCLUSIONS: Hospitalized adolescents stated that healthcare services should provide comprehensive support in a relaxing environment that allows them to retain their human dignity and that elicits feelings of psychological safety.

Implementation of a standardized screening program for risk of posttraumatic stress disorder among youth hospitalized with injury.

Children with pediatric injury and their parents are at risk for developing posttraumatic stress disorder (PTSD). Although challenging to implement, standardized screening for risk of developing PTSD can identify families most at risk. The current retrospective, chart review study evaluated the implementation of a clinical program that integrated screening for risk of PTSD into standard care for youth admitted to a Level I pediatric trauma center due to injury. Advanced practice nurses administered the Screening Tool for Early Predictors of PTSD (STEPP), a brief screen that evaluates risk of developing PTSD for injured children (ages 8-17 years) and their parents. Positive parent or child STEPPs prompted a referral to psychology for an inpatient consultation. Data were collected via review of electronic medical records and trauma program registry, including demographic, injury, and admission information, completion of and result on the STEPP, and completion of a psychology consultation. During the 2.5 year study period, 1,153 youth (birth-17 years) were admitted due to injury. Among those eligible for the STEPP (i.e., ≥8 years; N = 562), 67% completed the STEPP. Among those who completed the STEPP, 25% had positive parent or child screens and 68% of these completed an inpatient psychology consultation. Standardized screening was related to significantly higher use of inpatient psychology services compared with a control sample not eligible for screening (i.e., <8 years). STEPP scores varied by demographic, admission and injury factors. Results suggest standardized screening is feasible and improves reach of trauma-informed care. Barriers and facilitators of this screening program are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Feasibility and Perceptions of PICU Diaries.

OBJECTIVES: To determine the feasibility of implementing an ICU diary in the pediatric critical care setting and to understand the perceptions held by family members who receive the diaries after PICU discharge. DESIGN: Observational pilot study. SETTING: PICU in a tertiary academic hospital in the United States. PARTICIPANTS: Critically ill pediatric patients admitted to the PICU and their families. INTERVENTIONS: The addition of a PICU diary to a patient's routine care. MEASUREMENTS AND MAIN RESULTS: Twenty families of critically ill children admitted to the PICU were enrolled in the PICU diary pilot study between May 2017 and March 2018. Patients who had an anticipated length of stay of at least 3 days and whose families were English-speaking were included. The median age of patients was 6 years, ranging from newborns to 18 years old, and the median length of stay was 11.5 days (interquartile range, 8.5-41 d). A total of 453 diary entries were written in 19 diaries over 433 PICU days, the majority of which were composed by bedsides nurses (63%). Follow-up surveys sent to parents 2 weeks after PICU discharge revealed that of the parents who had contributed to the diary, most enjoyed doing so (7/8). Nine of 12 parents had reviewed the diary at least once since discharge, and all parent respondents found the diary to be a beneficial aspect of their experience after PICU discharge. CONCLUSIONS: The use of ICU diaries in the PICU setting is feasible and perceived as beneficial by families of critically ill children. Future studies are needed to better understand if PICU diaries may objectively improve psychologic outcomes of patients and family members after PICU admission.

Psicodiagnóstico na internação psiquiátrica da infância e adolescência: panorama do triênio 2015-2016-2017 / Psychological assessment in a child and adolescent inpatient psychiatric unit: 2015-2016-2017 triennial overview

Introdução: A internação psiquiátrica é um recurso terapêutico utilizado para a estabilização dos sintomas, contenção de riscos, elucidação diagnóstica e planejamento terapêutico. O psicodiagnóstico permite acesso a questões emocionais e cognitivas do indivíduo. Objetiva-se apresentar um panorama referente à realização de psicodiagnósticos em leitos da especialidade da Psiquiatria Infância e Adolescência de um hospital geral nos anos 2015, 2016 e 2017. Métodos: Trata-se de um estudo transversal, em que foram obtidas informações a partir do prontuário eletrônico de pacientes internados em leitos da especialidade. Os dados analisados foram sexo, idade, naturalidade, realização de psicodiagnóstico, motivo e tempo de internação. Resultados: Durante o triênio estudado, houve realização de psicodiagnóstico em 65,1% das internações. Entretanto, constatou-se diminuição estatisticamente significativamente (p = 0,006) no número de psicodiagnósticos em relação ao número de internações: 82% em 2015; 63% em 2016; e 53% em 2017. Conclusão: Esta diminuição no número de psicodiagnósticos realizados durante a internação indica que houve uma mudança nesse processo, onde se passou de um período em que a grande maioria das crianças e adolescentes (82%) realizava a avaliação, para um panorama onde metade dos pacientes (53%) realiza o psicodiagnóstico. Esse resultado sugere que estratégias de psicoeducação, voltadas para equipes assistentes, tendo por objetivo otimizar custo-efetividade e qualidade da assistência, levaram esses profissionais a refletirem sobre relevância, riscos e benefícios da realização do psicodiagnóstico durante a internação psiquiátrica de crianças e adolescentes. (AU)

Introduction: Inpatient psychiatry is a therapeutic resource for symptom stabilization, risk management, diagnostic clarification and/or treatment planning. Psychological assessment provides information on emotional and cognitive functioning. This study aims to provide an overview of psychological assessment in a child and adolescent inpatient psychiatric unit at a general hospital in southern Brazil in 2015, 2016 and 2017. Methods: This cross-sectional retrospective study obtained information from electronic medical records of patients admitted to the hospital psychiatric unit. Data for analysis were sex, age, place of birth, psychological assessment, reason and length of stay. Results: In those three years, psychological assessments were requested in 65.1% of all unit admissions. However, there was a statistically significant decrease (p = 0.006) in the number of psychological assessments in relation to the number of admissions: 82% in 2015; 63% in 2016; and 53% in 2017. Conclusion: The decrease in the number of psychological assessments performed in the inpatient unit indicates that there was some changes in the process, as first most children and adolescents (82%) underwent the assessment and then the rate reduced to half of all patients (53%). This can be explained by the implementation of strategies to educate the health care team about psychological assessment, with the purpose of improving costeffectiveness and quality of care. This led to greater reflection on relevance, risks and benefits of psychological assessment in a child and adolescent inpatient psychiatric unit. (AU)