[Teaching at hospitals: Between educational and nursing care activities]. / L'enseignement en milieu hospitalier : entre éducation et soins infirmiers.

This article aims to reveal the ethical framework surrounding hospitalized school students, showing that, in the context of disease, traditional ethics do not work. From a philosophical perspective, the target audience are teachers and volunteers who teach at hospitals, but also nurses and other professionals who work with sick children. The development of an ethical framework based on the ethics of care (EoC) will enable teachers to guide their activity in hospitals, highlighting the need for another ethical framework in order to achieve a teaching practice that is fully responsible and compassionate. In an ethical framework centered on the sick child, concepts such as "care" and "well-being" are mobilized by understanding how they relate to the psychological well-being of hospitalized students. I propose that an educational attitude rooted in admiration, respect and love can be a good guide for teaching practices in hospitals, offering an alternative to the ethical limitations of codes based on a universal conception of justice.

Percepção de crianças hospitalizadas acerca do tratamento oncológico / The viewpoint of hospitalized children with regards to oncological treatment / La percepción de los niños hospitalizados sobre el tratamiento del cáncer

Objetivo: compreender a percepção de crianças, na faixa etária de seis a doze anos, acerca do tratamento em uma unidade oncológica pediátrica de Petrolina/Pernambuco. Método: pesquisa descritiva, com abordagem qualitativa, realizada em um hospital público, localizado no interior do estado de Pernambuco. Participaram cinco (05) crianças, na faixa etária de seis a doze anos, por meio da entrevista semiestruturada. A análise ocorreu tendo como referência a análise temática de conteúdo proposta por Bardin. Resultados: emergiram categorias que revelam a necessidade do processo terapêutico, as alterações da autoimagem e os procedimentos invasivos como importantes fontes de sofrimento para a criança e o familiar acompanhante; os aspectos negativos e positivos da experiência hospitalar; e os motivos pelos quais as crianças aderiam à terapêutica e enfrentavam a doença. Conclusão: estratégias devem ser priorizadas no sentido de estabelecer comunicação com a criança e a família, incluindo aspectos como o protocolo terapêutico, a rotina da unidade, os procedimentos invasivos, as modificações estéticas, dentre outros; organizar a unidade, considerando a rotina da criança e do familiar acompanhante; e os incentivar para a superação de dificuldades e para a adesão ao tratamento

Objective: To understand the perception of children, aged six to twelve, about the treatment in a pediatric oncology unit of Petrolina/ Pernambuco. Method: descriptive research with qualitative approach, performed in a public hospital, located in the state of Pernambuco. Attended by five (05) children, aged six to twelve years, through semi-structured interviews. The analysis took place with reference to the thematic content analysis proposed by Bardin. Results: categories emerged which show the need of the therapeutic process, changes in self-image and invasive procedures as important sources of suffering for the child and the accompanying family member; the negative and positive aspects of hospital experience; and the reasons why children adhere to therapy and faced the disease. Conclusion: strategies should be prioritized in order to establish communication with the child and family, including aspects such as the therapeutic protocol, unit routine, invasive procedures, a esthetic changes, among others; organize the unit, considering the routine of children and accompanying family member; and encourage them to overcome difficulties and adherence to treatment

Objetivo: Conocer la percepción de los niños, de seis a doce años de edad, sobre el tratamiento en una unidad de oncología pediátrica de Petrolina/Pernambuco. Método: estudio descriptivo con enfoque cualitativo, realizado en un hospital público, situado en el estado de Pernambuco. Con la asistencia de cinco (05) niños, de seis a doce años, a través de entrevistas semi-estructuradas. El análisis se llevó a cabo en relación con el análisis de contenido temático propuesto por Bardin. Resultados: categorías emergieron que muestran la necesidad Del proceso terapéutico, los cambios en la autoimagen y procedimientos invasivos como una importante fuente de sufrimiento para el niño y el miembro de La familia que acompaña; los aspectos negativos y positivos de la experiencia em el hospital; y las razones por las cuales los niños se adhieren a la terapia y se enfrentaron a la enfermedad. Conclusión: Las estrategias deben ser priorizadas para establecer la comunicación con el niño y su familia, incluyendo aspectos tales como el protocolo terapéutico, rutina unidad, procedimientos invasivos, los cambios estéticos, entre otros; organizar la unidad, teniendo en cuenta La rutina de los niños y miembro de la familia que acompaña; y alentarlos a superar las dificultades y la adherencia AL tratamiento

Mobile Robotic Telepresence Solutions for the Education of Hospitalized Children.

Hospitalization affects children's school attendance, resulting in poor academic and sociodevelopmental outcomes. The increasing ubiquity of mobile and tablet technology in educational and healthcare environments, and the growth of the mobile robotic telepresence (MRT) industry, offer opportunities for the use of MRT to connect hospitalized children to their school environments. This article describes an approach at one rural healthcare center in collaboration with local school districts with the aim of describing strategies and limitations of MRT use. Future research is needed on MRT implementation, from user experiences to operational strategies, and outcome metrics need to be developed to measure academic and socioemotional outcomes. By partnering with educational systems and using this technology, hospital information technology personnel can help hospitalized children engage with their school environments to maintain connections with peers and access academic instruction.

Melhores práticas de enfermagem em educação em diabetes à criança hospitalizada: uma revisão integrativa / Best nursing practices in diabetes education for the hospitalized child: an integrative review

A incidência do Diabetes Mellitus tipo 1 (DM1) tem aumentado nos últimos anos, com consequente incremento de hospitalizações de crianças por primodescompensação diabética, com crescente necessidade de processo educativo. Diante desta realidade, objetivou-se identificar na literatura as melhores práticas de enfermagem em educação em diabetes para crianças com DM1 hospitalizadas e sua família. Foi realizada uma revisão integrativa, com os descritores: Diabetic Ketoacidosis, Diabetes Education, Nursing e Child, Hospitalized, e busca livre em revistas de referência e artigos similares. Foram selecionados quatro estudos, e identificadas três categorias: Envolvimento e Empoderamento da Família no Processo Educativo em Diabetes; Atuação da Equipe Multiprofissional; Definição e Conteúdo do Processo Educativo, concluindo que o processo educativo deve incluir a família, ser realizado por uma equipe multiprofissional e fundamentado em evidências científicas. Poucos estudos foram encontrados, evidenciando necessidade de mais pesquisas na área.

The incidence of Diabetes Mellitus type 1 (DM1) has increased in the last years, with a consequent growth of child hospitalizations due to diabetic prime decompensation, with growing need of an educational process. Thus, our objective was to identify in the literature the best nursing practices in diabetes education for hospitalized children with DM1 and their families. We conducted an integrative review with the descriptors: Diabetic Ketoacidosis, Diabetes Education, Nursing and Child, Hospitalized, and the free search in reference journals and similar articles. We selected four studies, and we identified three categories: Family Involvement and Empowerment in the Diabetes Educational Process; Performance of the Multi-professional Team; Definition and Content of the Educational Process. We concluded that the educational process should include the family, it should be conducted by a multi-professional team and based on scientific evidence. We identified few studies, showing the need for more studies in the field.

Intersubjetividade no cuidado com a criança hospitalizada pelo discente de enfermagem: método fenomenológico / Intersubjectivity in nursing students care of hospitalised infants: a phenomenological study / Intersubjetividad en el cuidado con el niño hospitalizado por el estudiante de enfermería: método fenomenológico

OBJETIVO: compreender as experiências do discente de Enfermagem vivenciadas no ensino teórico-prático em saúde da criança. MÉTODO: estudo fenomenológico, fundamentado em Merleau-Ponty, com abordagem qualitativa. Participaram 30 discentes do oitavo período do curso de enfermagem de uma instituição de ensino superior. RESULTADO: é no cotidiano, com os familiares, e em vários ambientes, que se encontram e, uma vez capturados pelas crianças, passam a estar sob o olhar delas e da família, emergindo, assim, a essência do fenômeno, o que aponta para as seguintes categorias: intersubjetividade como envolvimento entre o discente e a criança e intersubjetividade e empatia no cuidado com a criança. IMPLICAÇÕES PRÁTICAS: a aplicação dos conhecimentos teóricos implicará o fortalecimento de estratégias como a empatia e o envolvimento intersubjetivo no cuidado com a criança. CONCLUSÃO: a relação de intersubjetividade se estabelece por meio de um envolvimento entre o discente e a criança, numa imbricação com o mundo da criança.

AIM: to understand what the nursing student participants experienced when taking part in a theoretical-practical course focused on the subject of infant health. METHOD: this was a phenomenological study, based on the theoretical framework of Maurice Merleau-Ponty. This study was carried out using a qualitative approach. The participants were 30 undergraduate nursing students who were, at the time, in the eighth semester of the course. RESULTS: students can be found everyday in different environments and with the children's family members. Once they allow themselves to be dazzled by the children, they are under their watching eyes and of their family members. Then, the phenomenon occurs, creating the following categories: intersubjectivity as a relationship between students and infants and the intersubjectivity and empathy experienced while caring for children. PRACTICAL IMPLICATIONS: the implementation of theoretical knowledge in practice will strengthen strategies such as empathy, leading to the establishment of an intersubjective involvement for those caring for infants. CONCLUSION: the relation of intersubjectivity is established between students and infants due to the student entering the child version of reality

OBJETIVO: comprender las experiencias del estudiante de Enfermería experimentadas en la enseñanza teorica-práctica en la salud del niño. MÉTODO: estudio fenomenológico, fundamentado en Merleau-Ponty, con enfoque cualitativo. Participaron 30 estudiantes del octavo periodo del curso de enfermería de una institución de ensenãnza superior. RESULTADO: en el cotidiano, con los familiares, y en varios ambientes, que se encuentran y, una vez capturados por los niños, pasan a estar sobre la mirada de las y de la familia, surgiendo, así, la esencia del fenómeno, lo que apunta para las siguientes categorías: intersubjetividad como envolvimiento entre el discente y el niño y intersubjetividad y empatía en el cuidado con el niño. IMPLICACIONES PRÁCTICAS: la aplicación de los conocimientos teóricos implicará el fortalecimiento de estrategias como la empatía y el involucramiento intersubjetivo no cuidado con el niño. CONCLUSIÓN: la relación de intersubjetividad se establece por medio de un involucramientoentre lo discente y el niño, en uma superposición con el mundo del niño.

Empowering Our Youth: Initiating Sexual Health Education on the Inpatient Unit for the Chronically Ill Pediatric Patient.

Chronicaly ill pre-teens and adolescents often spend months as inpatients while undergoing treatment. This population includes but is not limited to oncology, transplant, physically disabled, and medically fragile pediatric patients. Sexual health education is often considered less important than the complex disease states and medical issues faced by pediatric inpatients. Many clinicians fail to realize the value of providing this guidance as a necessary part of the physical and psychosocial health of these young patients. Chronically ill youth lack normal social interactions while hospitalized and may have body image issues related to physical disabilities. A need for sexual health education stems from the high sexually transmitted disease prevalence in this population. Lack of formal provider education on sexual health, provider discomfort in discussing sexual health topics, and overlooking the importance of adolescent sexual health have delayed integration of sexual education into inpatient teaching, discharge planning, and outpatient follow up. With few guidelines and minimal published research on this topic, clinicians and parents often have no experience, education, or guidance to provide this specific knowledge effectively. The goal of this discussion of sexual health education for chronically ill adolescents is to highlight the need for additional research, improved training for healthcare providers, and development of evidence-based guidelines in the inpatient and outpatient settings.

El mejor interés del niño en neonatología: ¿es lo mejor para el niño? / The best interest of the child in neonatology: Is it best for the child?

Desde sus inicios, el estándar del mejor interés del niño estuvo unido a las decisiones de suspensión de tratamientos de soporte vital en unidades de neonatología y a la evaluación de los tratamientos aplicados al niño en función de su calidad de vida. Éste origen ha condicionado la interpretación del estándar desde dos extremos: uno vitalista y uno no vitalista que ha triunfado en la bioética occidental y ha llevado a la consagración del estándar del mejor interés del niño en la Convención de Derechos del Niño de Naciones Unidas. Un análisis detallado nos descubre un estándar simplista, utilitarista y proporcionalista, que ha cambiado el fundamento de la paternidad. Por ello creemos que el estándar del mejor interés del niño no es lo mejor para el niño en las unidades de neonatología y especialmente en los procesos de decisión sobre mantener o suspender los tratamientos de soporte vital

Since its inceptions, the standard of best interest of the child was linked to decisions about suspend life-sustaining treatments in neonatal units and evaluation of treatments applied to children in terms of their quality of life. This origin has conditioned the interpretation of the standard from two extremes: a vitalistic one, and a non vitalistic interpretation that triumphed in Western bioethics and has led to the consecration of the standard of best interest of the child in the Convention on the Rights of the Child of United Nations. A detailed analysis reveals a simplistic, utilitarian and proportionalist standard, which change the basis of parenthood. We therefore believe that the standard of the best interest of the child is not the best for the child in neonatal intensive care units and especially not in the process of withhold or withdrawal life-sustaining treatments

Improving oral hygiene skills among children undergoing treatment at the haemato-oncology department - an interventional programme.

OBJECTIVES: The aim of this interventional programme was to educate children undergoing treatment at the haemato-oncology department in how to improve their oral hygiene skills. METHODS: Children (and their parents) treated at the haemato-oncology department for haematological malignancies and disorders were educated and instructed in how to improve their dental oral hygiene skills. Instructions, demonstration and practice of toothbrushing techniques, as well as interproximal cleaning, were carried out in three separate sessions. In each session, toothbrushing skills were evaluated using the Ashkenazi index to assess improvement in oral hygiene skills over time. Four assessments were performed and recorded for each participant: before the initial explanation; immediately following the explanation; and 3 and 6 weeks following the first visit. RESULTS: Overall, 52 children were enrolled in the programme. The first toothbrushing performance skill evaluation revealed a low score of 10.44 out of a total of 40; this was significantly increased, following the instruction session, to 33.02 (P < 0.001). This improvement was maintained at the follow-up visits at 3 weeks (35.09 ± 6.3) and 6 weeks (36.34 ± 8.3). Following the instructions, a significant increase was accomplished in both 'reach' and 'stay' components of the score, to 18.44 out of 20 for 'reach' and 17.9 out of 20 for 'stay' at the last visit (P < 0.01). CONCLUSIONS: Individual supervised toothbrushing education, including a methodological toothbrushing technique, appears to be very effective. Educating medically compromised high-risk patients, such as hospitalised children, might be a good way to improve oral health and prevent future disease in this population.

Estrategia para el bienestar emocional en niños escolares hospitalizados Villa Clara 2013 / Strategy for the emotional well-being in hospitalized school children Villa Clara 2013

Fundamento: Los niños hospitalizados sufren un cambio abrupto, desaparece el hogar, la escuela, el barrio, los hermanos, amigos, las actividades que solía desarrollar y aparece aburrimiento por pobre estimulación y monotonía de las rutinas, condiciones pésimas para la recuperación. La atención sicológica a estos niños enfermos ingresados es insuficiente, por lo que es necesario resolver la situación emocional negativa que genera la hospitalización, la enfermedad y los tratamientos, y así restablecer su salud y su bienestar sicológico. Objetivo: Evaluar el diseño de una estrategia con enfoque intersectorial para mejorar el bienestar emocional en niños hospitalizados. Metodología: Matriz DAFO, método Delphy, criterio de especialistas, encuestas. Intervinieron en el diseño cinco prestadores; muestra para la evaluación, 15 especialistas, seleccionados en “Bola de nieve”. Resultados: Se describió la estrategia diseñada, conformada por cinco dimensiones, nueve programas, veintisiete subprogramas y más de ochenta acciones y se obtuvo un criterio positivo de especialistas sobre el diseño. Conclusiones: Se diseñó una estrategia para mejorar el bienestar emocional en niños escolares hospitalizados con enfoque salubrista. A juicio de especialistas la estrategia es pertinente y apropiada, es factible su aplicación y puede ser eficaz para mejorar el bienestar emocional en niños hospitalizados.

Background: Hospitalized children suffer an abrupt change. Home, school, neighborhood, siblings, friends and usual activities disappear besides boredom due to poor stimulation and monotony of the routines and all of these make recovery very poor. Objective: To assess the design of a strategy with an intersectorial approach to enhance emotional well-being in hospitalized children. Methodology: Delphy method, SWOT matrix, specialists criteria and interviews. Five providers intervened in the design and 15 specialists were taken as samples for evaluation by using the Snow Ball method. Results: The designed strategy was described, consisting of five dimensions, nine programs, 27 subprograms and more than eighty actions and a positive criterion of experts is taken. Conclusions: A strategy was designed to improve the emotional well-being in hospitalized school children with a health approach. The strategy is relevant and appropriate, feasible to be applied and can be very effective to improve the emotional well-being in hospitalized school children.

Hospital-based school for children with chronic illness in Taiwan.

BACKGROUND/PURPOSE: To provide educational support and avoid unwanted damage that may impede learning for children with chronic illness, the learning environment should be friendly and safe. There is a need to establish schools inside hospitals, however, which may be neglected in a highly efficient health care system. A study was conducted to identify hospital-based schools for sick children in Taiwan, and to explore the barriers for implementation. METHODS: The data were collected by structured telephone interview and retrieval of hospital web information. The study targeted social workers and nurses in the pediatric wards of 29 hospitals, plus officials from the Education Bureau in Taiwan. The interviewers inquired about the availability of a formal educational program inside hospitals and the barriers (if any) in providing educational supports. RESULTS: Taiwan has only one hospital-based informal school and eight hospitals with rotating bedside teachers. Education inside hospitals occurs mostly through voluntary teaching in informal education models. Information about special educational resources has not been widely distributed to patients and health care providers. Professional personnel in Taiwan are not well aware of the needs to establish a hospital-based school. CONCLUSION: The educational needs of children with chronic illness can be easily neglected even in an industrialized country. The establishment of policy and the enrichment of professional education on advocacy are necessary to eliminate educational inequities and benefit sick children.

Addressing the effects of missing school for children with medical needs.

Children missing school due to medical treatment is not a new concern. Over one million children 5 through 17 years of age are hospitalized in the U.S. each year (Elixhauser, 2008). Illness severe enough to require hospitalization is often preceded by missed days of school; thus, it will also entail additional days missed as children recover after discharge. Even a brief hospitalization can be disruptive to a child's education. In response to learning that many patients were concerned about falling behind in their education, Cardon Children's Medical Center developed and launched Cardon Children's School: A Bridge to Academic Excellence for Children with Medical Needs. Steps taken to identify the problem, convene a task force, reach out to the community, fund and recruit teachers, and document the unique academic assistance provided to patients are described in detail. Cardon Children's Medical Center has demonstrated that medical and educational institutions must collaborate together with our communities to raise awareness and provide continued assistance and support to children facing this issue.

[The difficulties of educating children with chronic illness in the hospital context]. / As dificuldades da escolarização da criança com doença crônica no contexto hospitalar.

The objective of this qualitative study was to understand the perception that families of hospitalized children with chronic illness about their being away from the process of education. The empirical material was produced by means of interviews performed with families of hospitalized children with chronic illness. The data was analyzed based on the principles of thematic analysis. Among other aspects, the data showed the lack of systematized pedagogical actions in the studied hospital, in a way that the educational activities that were developed were seen as a moment of leisure. We understand that the hospital class is becoming an important health care technology for hospitalized children. Therefore, it requires support, especially from the Departments of Education, in terms of providing the necessary human resources, funding and materials. This is a pioneer study, capable of helping improve the quality of life of children with chronic illness.

As dificuldades da escolarização da criança com doença crônica no contexto hospitalar / The difficulties of educating children with chronic illness in the hospital context / Las dificultades de la escolarización del niño con efermedad crónica en el contexto hospitalario

Pesquisa qualitativa que objetivou compreender a percepção da família de crianças hospitalizadas com doença crônica acerca do afastamento do processo de escolarização. O material empírico foi produzido por meio de entrevistas com famílias de crianças hospitalizadas com doença crônica. Os dados foram analisados a partir dos princípios da análise temática. Dentre outros aspectos, revelaram a ausência de ações pedagógicas sistematizadas, no hospital em estudo, de modo que as atividades educacionais desenvolvidas eram compreendidas como um momento de recreação. Consideramos que a classe hospitalar vem se constituindo em uma importante tecnologia de cuidado na assistência às crianças hospitalizadas. Para tanto, precisa de apoio, principalmente, das Secretarias de Educação, no que concerne à provisão de recursos humanos, financeiros e materiais. Esse é um trabalho pioneiro, capaz de auxiliar a criança com doença crônica a ter uma melhor qualidade de vida.

The objective of this qualitative study was to understand the perception that families of hospitalized children with chronic illness about their being away from the process of education. The empirical material was produced by means of interviews performed with families of hospitalized children with chronic illness. The data was analyzed based on the principles of thematic analysis. Among other aspects, the data showed the lack of systematized pedagogical actions in the studied hospital, in a way that the educational activities that were developed were seen as a moment of leisure. We understand that the hospital class is becoming an important health care technology for hospitalized children. Therefore, it requires support, especially from the Departments of Education, in terms of providing the necessary human resources, funding and materials. This is a pioneer study, capable of helping improve the quality of life of children with chronic illness.

Investigación cualitativa que objetivó comprender la percepción de la familia de niños hospitalizados con enfermedad crónica respecto al alejamiento del proceso de escolarización. El material empírico se produjo mediante entrevistas con familias de niños hospitalizados con enfermedad crónica. Los datos fueron analizados a partir de los principios del análisis temático. Entre los aspectos, se reveló la ausencia de acciones pedagógicas sistematizadas en el hospital estudiado, de modo que las actividades educativas desarrolladas eran entendidas como momentos recreativos. Consideramos que las clases hospitalarias están constituyéndose en una importante tecnología de cuidado en la tecnología de cuidado en la atención de los niños hospitalizados. En consecuencia, la misma necesita de apoyo, principalmente por parte de las Secretarías de Educación, en lo concerniente a la provisión de recursos humanos, financieros y materiales. Este es un trabajo pionero, capaz de ayudar al niño con enfermedad crónica a tener una mejor calidad de vida.