Description of the use of integrative mixed method in neonatal nursing.

To describe the application of the integrative mixed method and its steps. Descriptive methodological study. The integrative mixed method approach was exemplified in a study conducted in neonatal nursing on maternal stress throughout the experience of premature newborns' care. Data on maternal stress level (quantitative approach) and maternal perception of care (qualitative approach) were grouped after analyzes made separately according to the analysis technique of each approach. Subsequently, quantitative and qualitative data were integrated, which originated a new set of data to be interpreted, and consequently enabled a greater understanding of the phenomenon under study and emphasized the importance of the integrative mixed method. The integration of the two approaches, qualitative and quantitative, is a denser theoretical framework with strong scientific evidence for a better understanding of the phenomenon under study than the use of a single approach, since, at the same time, it identifies the frequency of the phenomenon and the reason for its occurrence.

Dimensioning of painful procedures and interventions for acute pain relief in premature infants / Dimensionamento dos procedimentos dolorosos e intervenções para alívio da dor aguda em prematuros / Dimensionamiento de los procedimientos dolorosos e intervenciones para alivio del dolor agudo en prematuros

ABSTRACT Objective: to dimension the exposure of premature infants to painful procedures, relating the distribution of the exposure to contextual factors, as well as to describe the pharmacological and non-pharmacological interventions health professionals use during the first two weeks of the infant's hospitalization at two neonatal services. Method: descriptive-exploratory study in which the professionals registered the painful procedures and pain relief interventions on a specific form in the patient file. Results: the daily average of the 89 premature infants was 5.37 painful procedures, corresponding to 6.56 during the first week of hospitalization and 4.18 during the second week (p<0.0001). The most frequent procedures were nasal/oral (35.85%) and tracheal aspirations (17.17%). The children under invasive ventilation were the most exposed to painful procedures (71.2%). Only 44.9% of the painful procedures received some intervention for the purpose of pain relief, the most frequent being sucrose (78.21%) and continuing sedation (19.82%). Conclusion: acute pain was undertreated at these neonatal services, recommending greater sensitization of the team for the effective use of the existing protocol and implementation of other knowledge transfer strategies to improve neonatal pain management.

RESUMO Objetivo: dimensionar a exposição de prematuros a procedimentos dolorosos, relacionando a distribuição da exposição aos fatores contextuais, bem como descrever as intervenções, farmacológicas e não farmacológicas, utilizadas pelos profissionais de saúde durante as primeiras duas semanas de internação do prematuro, em duas unidades neonatais. Método: estudo descritivo-exploratório, no qual foram registrados os procedimentos dolorosos e intervenções para alívio da dor em formulário específico no prontuário, pelos profissionais. Resultados: os 89 prematuros tiveram média diária de 5,37 procedimentos dolorosos, sendo essa média de 6,56 na primeira semana de internação e 4,18 na segunda (p<0,0001). Os procedimentos mais frequentes foram as aspirações nasal/oral (35,85%) e traqueal (17,17%). Aqueles em ventilação invasiva foram os mais expostos a procedimentos dolorosos (71,2%). Apenas 44,9% dos procedimentos dolorosos receberam alguma intervenção para o alívio da dor, sendo as mais utilizadas a sacarose (78,21%) e a analgesia contínua (19,82%). Conclusão: constata-se o subtratamento da dor aguda nessas unidades neonatais, recomendando-se maior sensibilização da equipe para o uso efetivo do protocolo existente e a implantação de outras estratégias de transferências de conhecimento, para aprimorar o manejo da dor neonatal.

RESUMEN Objetivo: dimensionar la exposición de prematuros a procedimientos dolorosos, relacionando la distribución de la exposición de los factores contextuales, y así como describir las intervenciones, farmacológicas y no farmacológicas, utilizadas por los profesionales de salud durante las primeras dos semanas de hospitalización del prematuro en dos unidades neonatales. Método: estudio descriptivo-exploratorio, en el cual los profesionales registraron los procedimientos dolorosos e intervenciones para alivio del dolor en formulario específico en la historia clinica. Resultados: los 89 prematuros recibieron en promedio 5,37 procedimientos dolorosos por día, siendo ese promedio de 6,56 en la primera semana de internación y 4,18 en la segunda (p<0,0001). Los procedimientos más frecuentes fueron las aspiraciones nasal/oral (35,85%) y traqueal (17,17%). Aquellos en ventilación invasiva fueron los más expuestos a procedimientos dolorosos (71,2%). Solamente el 44,9% de los procedimientos dolorosos recibieron alguna intervención para aliviar el dolor, siendolas más utilizadas la sacarosa (78,21%) y la analgesia continua (19,82%). Conclusión: se constata el subtratamiento del dolor agudo en esas unidades neonatales, recomendándose mayor sensibilización del equipo para el uso efectivo del protocolo existente y la implantación de otras estrategias de trasferencia de conocimiento, para perfeccionar el manoseo del dolor neonatal.

Perception of premature infants' mothers on home visits before and after hospital discharge.

OBJECTIVE: To understand the meaning of home visits by neonatal nurses for mothers of premature babies. METHODOLOGY: A qualitative study was conducted with 21 mothers of families participating in a project that supported families of premature infants, born at a university hospital in the city of Londrina, Brazil. Data collection was conducted through semi-structured individual interviews, using a form with the identification data of mothers and an interview script. RESULTS: Three themes were revealed: the home visit as a support to the family, individualized home care, feeling cared for and supported in performing the baby's care. CONCLUSION: The home visit from the perspective of longitudinal care was a powerful resource that promoted the link between families and nurses, decreasing doubts, fears and anxieties of the mother. In addition, home care was provided and adherence to care and treatment was encouraged.

Incidence of nonelective removal of percutaneously inserted central catheters according to tip position in neonates.

OBJECTIVE: To compare the incidence and reasons for nonelective removal of percutaneously inserted central catheters (PICC lines) between centrally and noncentrally placed PICC lines in neonates. DESIGN: Prospective cohort study. SETTING: A 60-bed, tertiary-level neonatal intensive care unit in a private hospital in São Paulo, Brazil. PARTICIPANTS: Neonates who were born at the hospital and underwent successful insertion of 237 PICC lines. They were divided into two groups, central and noncentral, according to tip position. METHODS: Neonates were monitored daily from insertion of the PICC until its removal. Data were collected from medical records. RESULTS: Of the 237 PICCs analyzed, 207 (87.4%) had their tip in a central position and 30 (12.6%) in a noncentral position. The incidence of nonelective PICC removal was similar between the central and noncentral groups (p = .48). The reasons for nonelective removal were significantly different between the groups (p = .007), with a higher incidence of extravasation in the noncentral group. CONCLUSION: Noncentrally placed PICCs can provide vascular access in neonates requiring venous access for the administration of intravenous solutions. Many potential catheter-related complications can be prevented by careful bedside nursing. Frequent monitoring of noncentral PICCs is necessary to detect and prevent extravasation in neonates.

[The working process of a neonatal intensive care unit]. / O processo de trabalho em uma Unidade de Terapia Intensiva Neonatal.

The objective of this study was to analyze the organization of the working process of a Neonatal Intensive Care Unit through the relationships established between the social actors present in the micropolitical space. This study used an unconventional methodology, adapted to a qualitative study. A case series study was adopted, whose trajectory was referred to as sentinel-trajectory, through which it was possible to detect noises that affected the quality of the care provided. The analysis of the flowchart revealed weaknesses of the contract network, problems regarind the registers and documentations, and errors in the health care process.

O processo de trabalho em uma Unidade de Terapia Intensiva Neonatal / The working process of a neonatal intensive care unit / El proceso de trabajo en una unidad de terapia intensiva neonatal

Este estudo teve como objetivo analisar a organização do processo de trabalho em uma Unidade de Terapia Intensiva Neonatal através das relações estabelecidas entre os atores sociais presentes no espaço micropolítico. Trata-se de uma metodologia não-convencional, adaptada a estudo qualitativo. Adotou-se um estudo de série de casos cuja trajetória foi denominada trajetória-sentinela e, através desta foram, detectados ruídos que influenciaram na qualidade da assistência. A análise do fluxograma revelou fragilidades na rede de contratualidade, problemas de registros e arquivamento de documentação e, erros relativos ao processo assistência.

The objective of this study was to analyze the organization of the working process of a Neonatal Intensive Care Unit through the relationships established between the social actors present in the micropolitical space. This study used an unconventional methodology, adapted to a qualitative study. A case series study was adopted, whose trajectory was referred to as sentinel-trajectory, through which it was possible to detect noises that affected the quality of the care provided. The analysis of the flowchart revealed weaknesses of the contract network, problems regarind the registers and documentations, and errors in the health care process.

Este estudio tuvo como objetivo analizar la organización del proceso de trabajo en una Unidad de Terapia Intensiva Neonatal, mediante las relaciones establecidas entre los actores sociales presentes en el espacio micropolítico. Se trata de una metodología no convencional, adaptada al estudio cualitativo. Se adoptó un estudio de serie de casos, cuya trayectoria fue denominada trayectoria-centinela y, a través de ella, se detectaron ruidos que influenciaron en la calidad de la atención. El análisis del flujograma reveló fragilidad en la de de contractualidad, problemas de registro y archivo de documentación, y errores referidos al proceso de atención.

[Assistance to newborns in a family health program]. / Assistência ao recém-nascido em um Programa de Saúde da Família.

This study describes the neonatal health care implemented through the Family Health Program in a unit in Guarapuava, State of Paraná, with the aim of supporting the organization of child health care in a family context. It is a descriptive survey based on data from live birth statements and files of families with babies born between October 1, 2003 and September 30, 2004, totaling 90 infants. The description of how clients were attracted and the verification of care delivery made possible the construction of a newborn health care flow chart. It was found that the flow chart represents a means for identifying the type of demand, the care delivered by each professional, the procedures, the referrals and the returns, as well as the gaps. This made possible for us to visualize the health care schematically, thus contributing to the organization of newborn health care in Family Health Program units.

Assistência ao recém-nascido em um Programa de Saúde da Família / Assistance to newborns in a Family Health Program

Este estudo tem como objetivo descrever o atendimento neonatal implementado pelo PSF de uma unidade do município de Guarapuava-PR, com vistas a subsidiar a organização da atenção à saúde da criança no contexto da família. É um estudo descritivo, com base no levantamento de dados registrados em declarações de nascidos vivos e prontuários de famílias com bebês nascidos no período de 01/10/2003 a 30/09/2004, totalizando 90 recém-nascidos. Considerando a descrição da forma de captação da clientela e da verificação dos atendimentos realizados, foi possível construir um fluxograma de atendimento ao recém-nascido. Depreendeu-se que o fluxograma representa uma forma de identificar o tipo de demanda, o atendimento de cada profissional, os procedimentos, os encaminhamentos, os retornos, assim como as lacunas. Permitiu visualizar o atendimento esquematicamente, possibilitando contribuir para a organização da assistência ao recém-nascido em unidades de Programa de Saúde da Família.

This study describes the neonatal health care implemented through the Family Health Program in a unit in Guarapuava, State of Paraná, with the aim of supporting the organization of child health care in a family context. It is a descriptive survey based on data from live birth statements and files of families with babies born between October 1, 2003 and September 30, 2004, totaling 90 infants. The description of how clients were attracted and the verification of care delivery made possible the construction of a newborn health care flow chart. It was found that the flow chart represents a means for identifying the type of demand, the care delivered by each professional, the procedures, the referrals and the returns, as well as the gaps. This made possible for us to visualize the health care schematically, thus contributing to the organization of newborn health care in Family Health Program units.

Este estudio tiene como objetivo describir la atención al recién nacido en un Programa de Salud a la Familia, realizado en la ciudad de Guarapuava-PR, para subvencionar la organización de la atención a la salud del niño en el contexto de la familia. Es un estudio descriptivo, de datos registrados en declaraciones de nacidos vivos y manuales de las familias de los bebés natos a partir la 01/10/03 a 30/09/04, en la cantidad de 90 recién nacidos. Considerándose la descripción de cómo fue hecha la captación de la clientela y con la verificación realizada en los servicios, fue posible estructurar un organigrama de la atención al recién nacido. Se percibió que el organigrama representa una forma de identificar el tipo de demanda, el servicio de cada profesional, los procedimientos, las orientaciones, los retornos, así como las fallas. Permitió visualizar el servicio esquemáticamente, posibilitando contribuir para la organización de la asistencia al recién nacido en unidades del Programa de Salud de la Familia.

Avaliação da qualidade da assistência de enfermagem ao prematuro em uma unidade de tratamento intensivo em neonatologia

A presente monografia se propõe a avaliar a qualidade da assistência de enfermagem prestada ao recém-nascido. O trabalho analisa a UTIN do Hospital da Criança Conceição, que integra o Grupo Hospitalar Conceição, na cidade de Porto Alegre. Seu foco é o processo de educação continuada. Objetiva identificar as possíveis dúvidas e medos da equipe de enfermagem no manuseio do recém-nascido prematuro. Pretende, igualmente, avaliar o processo de educação continuada na equipe de enfermagem da Unidade de Terapia Intensiva Neonatal do Hospital

Nursing diagnoses identified during parent group meetings in a neonatal intensive care unit.

PURPOSE: To identify nursing diagnoses in the reports of parents obtained during parent support group meetings in a neonatal intensive care unit. METHODS: An explorative descriptive study using records obtained during 29 meetings over a period of 11 months with parents and family members. FINDINGS: Six NANDA-approved nursing diagnoses were identified from parent group data: fear, risk for impaired parent/infant attachment, parental role conflict, risk for ineffective breastfeeding, impaired home maintenance, and risk for caregiver role strain. Diagnoses were not validated with parents. DISCUSSION: Support groups helped the parents express their thoughts and feelings and provided nurses with opportunities to identify nursing diagnoses and interventions. The identification of nursing diagnoses showed that nursing interventions that are focused on improved parent outcomes should be implemented for parents and other family members. IMPLICATIONS: Nursing care in neonatal units should focus on interventions for parents and other family members in addition to providing the necessary care of newborns.

Imposed burdens: a Mexican American mother's experience of family resources in a newborn intensive-care unit.

OBJECTIVE: A case study analysis examines how the availability of resources to ensure family-centered care (FCC) in a newborn intensive-care unit (NICU) affected one Latina mother's NICU experience. DESIGN: Case study analysis. SETTING: An NICU in the western United States. SAMPLE: A mother of Mexican American heritage, bilingual in Spanish and English. MAIN OUTCOME MEASURE: Audiotaped interviews and field notes of the mother's descriptions, actions, and evaluation surrounding family resources in the NICU were analyzed using narrative and content analysis. RESULTS: Inadequate resources to facilitate the provision of FCC in the NICU resulted in a complex set of interrelationships and situations in which providers and other Latina mothers, with varying personal resources, called upon the mother to fill in the resource gaps. Important areas of work of the NICU were shifted to the Latina mothers differentially based on their personal resources. These areas of work included facilitation of families' access to their babies, interpretation, information and emotional support, and elements of discharge planning and teaching. CONCLUSIONS: Adequate resources to ensure FCC in the NICU is highly relevant to the care of all families. Nurses must ground their advocacy in actions that help secure needed resources without shifting responsibility to other NICU families.

[Organization of neonatal nursing in the region of Ribeirão Preto-SP. Brazil-1992]. / A organização do trabalho na assistência ao recém-nascido em berçários da regional de Ribeirão Preto-SP. Brasil-1992.

The present study analyses the organization of newborn care in different nurseries in the region of Ribeirão Preto as well as how nursing participates in this work. Through observation and interviews in 4 nurseries, we found that the work organization varies according to the hospital size and complexity. Action is centred on the child and in more complex cases, priority is given to the pathology and clinical care. We also observe enlarged actions, involving the binomial mother-child and the family. The quality of care is a result of a complex combination of human resources, material and installation. Bigger and more complex institutions present a diversity of personnel, more bureaucracy and hierarchy, information and technology system, routine procedures by written norms and more sophisticated equipment. The object of action is centred on the child, but there are practices in which the object is enlarged to the binomial mother-child and the family.

A organizaçäo do trabalho na assistência ao recém-nascido em bercários da Regional de Ribeiräo Preto-SP-Brasil-1992 / The organization of newborn care in nurseries in the region of Ribeiräo Preto-SP, Brasil-1992

O estudo analisa a organizaçäo da assistência ao recém-nascido em berçários da regional de Ribeiräo Preto e a participaçäo da enfermagem neste trabalho. Através de observaçäo e entrevistas em quatro berçários, constata-se que a organizaçäo do trabalho diferencia-se pelo porte e complexidade do hospital. A açäo está centrada na criança e nos casos mais complexos prioriza-se a apatologia e a assistência clínica. Percebe-se também, algumas açöes mais amplas, apreendendo o binômio mäe-filho e a família. O nível de atençäo é resultado de uma complexa combinaçäo dos recursos humanos, materiais e área física. A instituiçäo de maior porte e complexidade apresenta diversidade de agentes, trabalho mais burocratizado e hierarquizado, sistema de informaçäo e tecnologias complexas, procedimentos rotinizados mediados por normas escritas e aparelhos sofisticados. O objeto de açäo está centrado na criança, mas há práticas cujo objeto é ampliado para o binômio mäe-filho e familiares.