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1.
Texto & contexto enferm ; 29: e20180348, Jan.-Dec. 2020. tab
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1059138

RESUMO

ABSTRACT Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.


RESUMEN Objetivo: identificar los factores asociados al deterioro clínico reconocido por una Puntuación Pediátrica de Alerta Temprana. Método: estudio de corte transversal realizado en un hospital público pediátrico terciario con 271 niños de cero a diez años de edad, hospitalizados entre mayo y octubre de 2015. Para identificar a los niños con y sin signos de deterioro clínico, se aplicó la versión traducida, adaptada y validad del Brighton Pediatric Early Warning Score para el contexto brasileño. Se utilizaron el análisis de regresión logística y la relación de prevalencia (RP) para medir la asociación entre las variables estudiadas. Se adoptaron el Intervalo de Confianza (IC) del 95% y el Valor de p como medida de significancia estadística para identificar los potenciales factores asociados. Resultados: los factores asociados al deterioro clínico de los niños estudiados fueron los siguientes: edad ≤ 2 años (p=0,000), internación en la unidad de emergencia (p=0,000), comorbilidad (p=0,020) y diagnóstico clínico de enfermedad respiratoria (p=0,000). Conclusión: los niños con una edad máxima de 2 años, con alguna comorbidad, con diagnóstico de enfermedad respiratoria e internadas en la unidad de emergencia presentaron una mayor probabilidad de deterioro clínico. Identificar factores asociados al deterioro clínico puede servir como alerta y orientar al equipo de salud hacia los niños más susceptibles a este fenómeno.


RESUMO Objetivo: identificar os fatores associados à deterioração clínica reconhecida por um Escore Pediátrico de Alerta Precoce. Método: estudo de corte transversal, realizado num hospital público pediátrico terciário, com 271 crianças de zero a dez anos, hospitalizadas entre maio e outubro de 2015. Para a identificação das crianças com e sem sinais de deterioração clínica, foi aplicada a versão traduzida, adaptada e validada do Brighton Pediatric Early Warning Score para o contexto brasileiro. Foram utilizadas a análise de regressão logística e a razão de prevalência (RP) para medir a associação entre as variáveis estudadas. O Intervalo de Confiança (IC) de 95% e Valor de p foram adotados como medida de significância estatística para a identificação dos potenciais fatores associados. Resultados: os fatores associados à deterioração clínica das crianças estudadas foram idade ≤ 2 anos (p=0,000), internamento na unidade de emergência (p=0,000), comorbidade (p=0,020) e diagnóstico clínico de doença respiratória (p=0,000). Conclusão: crianças ≤ 2 anos, portadoras de comorbidade, com diagnóstico de doença respiratória e internadas na unidade de emergência apresentaram aumento da probabilidade de deterioração clínica. A identificação de fatores associados à deterioração clínica pode alertar e direcionar a equipe de saúde para crianças mais suscetíveis a esse fenômeno.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Enfermagem Pediátrica , Criança Hospitalizada , Saúde , Saúde da Criança , Deterioração Clínica , Alerta , Hospitalização
2.
Medicine (Baltimore) ; 99(45): e22017, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157910

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 viral infection resulting in corona virus disease 2019 (COVID-19) disease has recently been designated by the World Health Organization as a global pandemic. Some doctors are using convalescent plasma (CP) therapies to treat COVID-19 patients. However, whether CP therapy is effective for children with COVID-19 remains controversial. Therefore, this study further explores the effectiveness and safety of human coronavirus immune CP in the treatment of COVID-19 in children. METHODS: Comprehensively search the electronic databases such as the Cochrane Library, PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and WanFang, and collect relevant documents. We will also look for other sources. All document sources will not be restricted by language and publication status. Two researchers will independently conduct research selection, data extraction and research quality assessment. RevMan 5.3 was used for statistical analysis. RESULTS: This study will provide high-quality comprehensive evidence for the effectiveness and safety of human coronavirus immuno CP in the treatment of COVID-19 in children CONCLUSIONS:: The results of this study will provide the basis for the effectiveness and safety of human coronavirus immuno CP treatment of COVID-19 in children. PROSPERO REGISTRATION NUMBER: CRD42020199410.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Betacoronavirus , Criança , Criança Hospitalizada , Humanos , Imunização Passiva , Metanálise como Assunto , Pandemias , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
4.
PLoS Negl Trop Dis ; 14(9): e0008603, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32925941

RESUMO

BACKGROUND: The World Health Organization (WHO) proposed guidelines on dengue clinical classification in 1997 and more recently in 2009 for the clinical management of patients. The WHO 1997 classification defines three categories of dengue infection according to severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Alternative WHO 2009 guidelines provide a cross-sectional classification aiming to discriminate dengue fever from dengue with warning signs (DWWS) and severe dengue (SD). The primary objective of this study was to perform a comparison of two dengue classifications. The secondary objective was to describe the changes of hematological and biochemical parameters occurring in patients presenting with different degrees of severity during the course of the disease, since progression to more severe clinical forms is unpredictable. METHODOLOGY/PRINCIPAL FINDINGS: We performed a prospective, monocentric, cross-sectional study of hospitalized children in Cambodia, aged from 2 to 15 years old with severe and non-severe dengue. We enrolled 243 patients with acute dengue-like illness: 71.2% were dengue infections confirmed using quantitative reverse transcription PCR or NS1 antigen capture ELISA, of which 87.2% and 9.0% of DF cases were respectively classified DWWS and SD, and 35.9% of DHF were designated SD using an adapted WHO 2009 classification for SD case definition. Systematic use of ultrasound at patient admission was crucial for detecting plasma leakage. No difference was observed in the concentration of secreted NS1 protein between different dengue severity groups. Lipid profiles were different between DWWS and SD at admission, characterized by a decrease in total cholesterol, HDL cholesterol, and LDL cholesterol, in SD. CONCLUSIONS/SIGNIFICANCE: Our results show discrepancies between the two classifications, including misclassification of severe dengue cases as mild cases by the WHO 1997 classification. Using an adapted WHO 2009 classification, SD more precisely defines the group of patients requiring careful clinical care at a given time during hospitalization.


Assuntos
Dengue Grave/classificação , Dengue Grave/patologia , Índice de Gravidade de Doença , Adolescente , Camboja , Criança , Criança Hospitalizada , Pré-Escolar , Colesterol/sangue , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Estudos Prospectivos , Dengue Grave/diagnóstico , Triglicerídeos/sangue , Proteínas não Estruturais Virais/metabolismo , Organização Mundial da Saúde
6.
Rech Soins Infirm ; (141): 7-16, 2020 06.
Artigo em Francês | MEDLINE | ID: mdl-32988192

RESUMO

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.


Assuntos
Criança Hospitalizada/educação , Cuidados de Enfermagem/ética , Ensino/ética , Criança , Criança Hospitalizada/psicologia , Humanos , Estudantes/psicologia
8.
PLoS One ; 15(9): e0239258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32961548

RESUMO

BACKGROUND: Viral infections in children and adolescents with malignancy are commonly encountered and have a significant impact on morbidity and mortality. Studies and epidemiological data regarding viral infections in children with cancer in developing countries are lacking. This retrospective cohort study aims to assess the burden of viral infections in children and adolescents with cancer, by assessing prevalence, risk factors, as well as morbidity and mortality of common viruses over a period of 8 years. METHODS AND FINDINGS: Medical records of cancer patients treated at the Children Cancer Center of Lebanon were reviewed and 155 participants under the age of 21 were identified with at least one documented viral infection during the period from July 2009 to November 2017. This subset included 136 participants with active malignancy and 19 participants with a history of cancer who underwent hematopoietic stem cell transplantation [HSCT] and were in remission; the latter group was analyzed separately. Information regarding participant characteristics, hospital course, and complications were obtained. Associations between viral infections and certain factors were assessed. In the cohort, 64% were male, 81% were Lebanese. In participants with active malignancy, 90% received chemotherapy in the 6 months preceding the viral infection episode, 11% received radiotherapy. 51% of participants were neutropenic at the time of viral detection, and 77% were lymphopenic. 17% experienced a bacterial co-infection, and 3 experienced a viral co-infection. Among 162 viral infection episodes, clinically diagnosed skin infections, mainly herpes simplex virus type 1 and varicella-zoster virus, were the most common [44% of cases]. These were followed by laboratory-proven systemic herpes infections: cytomegalovirus [14%] and Epstein-Barr virus [6%]. Respiratory viruses: influenza and respiratory syncytial virus, accounted for 9% and 4%, respectively, whereas rotavirus represented 11% and BK virus represented 3% of cases. Acute lymphocytic leukemia was the most prevalent neoplasia [57%]. Fever was the most common presenting symptom [55%] and febrile neutropenia was the reason for admission in 24% of cases. The mean length of stay was significantly longer in participants with cytomegalovirus infections and significantly lower in rotavirus infection. Admission to the ICU occurred in 9%, complications in 8%, and mortality in 5%. Participants with viral infections post-HSCT were noted to have a significantly longer length of hospital stay compared to non-HSCT participants, with no other significant differences in clinical course and outcome. The study was limited by its retrospective nature and by the late introduction and underuse of multiplex PCR panels, which may have led to underdiagnosis of viral infections. CONCLUSIONS: Viral infections were prevalent in our sample of cancer patients and may have contributed to morbidity and mortality. Newly available viral diagnostics are likely to vastly increase the number and scope of detectable viral infections in this population. Prospective studies using multiplex PCR technology with systematic testing of patients will be more helpful in defining the burden of viral infections. Furthermore, efforts at antimicrobial stewardship would benefit from the identification of viral causes of infection and limit the unnecessary use of antibiotics in the pediatric cancer population.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Influenza Humana/epidemiologia , Neoplasias/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Criança , Criança Hospitalizada , Pré-Escolar , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/virologia , Feminino , Transplante de Células-Tronco Hematopoéticas , Hospitais , Humanos , Lactente , Influenza Humana/complicações , Influenza Humana/diagnóstico , Influenza Humana/virologia , Líbano/epidemiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/virologia , Pediatria , Vírus Sincicial Respiratório Humano/genética , Vírus Sincicial Respiratório Humano/isolamento & purificação , Vírus Sincicial Respiratório Humano/patogenicidade , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Estudos Retrospectivos , Infecções por Rotavirus/complicações , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/patologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-32752251

RESUMO

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.


Assuntos
Transtornos Psicóticos , Ideação Suicida , Tentativa de Suicídio , Adolescente , Adolescente Hospitalizado/psicologia , Ansiedade , Criança , Criança Hospitalizada/psicologia , Feminino , Humanos , Tentativa de Suicídio/psicologia
11.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817268

RESUMO

BACKGROUND: Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients. METHODS: The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure. RESULTS: Interrupted time series analysis of EHR orders (npre = 493; npost = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (+50.7%; 95% confidence interval 41.2% to 60.3%; P < .001) and a subsequent decrease in slope each week (-0.16%; 95% confidence interval -0.32% to -0.01%; P = .037). Statistical process control of surveys (npre = 263; npost = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P < .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported. CONCLUSIONS: A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.


Assuntos
Determinação da Pressão Arterial/normas , Criança Hospitalizada , Pessoal de Saúde/normas , Análise de Séries Temporais Interrompida/normas , Melhoria de Qualidade/normas , Sono/fisiologia , Adolescente , Determinação da Pressão Arterial/psicologia , Determinação da Pressão Arterial/tendências , Cuidadores/educação , Cuidadores/normas , Cuidadores/tendências , Criança , Criança Hospitalizada/psicologia , Pré-Escolar , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/tendências , Feminino , Pessoal de Saúde/educação , Pessoal de Saúde/tendências , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida/tendências , Masculino , Projetos Piloto , Estudos Prospectivos , Melhoria de Qualidade/tendências
12.
Curr Med Sci ; 40(4): 642-645, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32767262

RESUMO

The SARS-CoV-2 infection status of hospitalized children was surveyed in the department of pediatric hematology and oncology in three different hospitals of epidemic areas in Hubei, China. A cross-sectional study was performed to investigate the clinical characteristics, lung CT scan, SARS-CoV-2 nucleic acid test and serum antibodies of hospitalized children with hemato-oncological diseases from January 23 to April 24, 2020. 299 children were enrolled in this study, including 176 males (58.9%) and 123 females (41.1%), aged from 2 months to 16 years. 255 cases (85.3%) received chemotherapy or other immunosuppressive therapies, and there were 44 cases (14.7%) of other benign diseases. Nucleic acid test was performed on 258 children (86.3%) and one case was positive. 163 cases (54.5%) were tested for serum antibodies, and all of them were negative. Lung CT scan was performed on 247 children (82.6%), and 107 of them showed infectious changes. Only one case (0.33%) of COVID-19 was diagnosed in the group. The prevalence rate of COVID-19 in enrolled children with hemato-oncological diseases in Hubei was 0.33%. Immunosuppressed patients are not prone to produce related antibodies. Comprehensive protective measures and ward management can reduce the risk of SARS-CoV-2 infection in the group patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Doenças Hematológicas/epidemiologia , Neoplasias/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Criança , Criança Hospitalizada , Pré-Escolar , China/epidemiologia , Técnicas de Laboratório Clínico/métodos , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Lactente , Controle de Infecções , Masculino , Programas de Rastreamento , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Prevalência , Fatores de Risco , Inquéritos e Questionários
13.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(8): 882-886, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32800036

RESUMO

OBJECTIVE: To investigate the nutritional recovery status of children with moderate or severe malnutrition during hospitalization after discharge. METHODS: The children with moderate or severe malnutrition were given nutrition support during hospitalization. They received a regular follow-up and nutrition guidance after discharge. The weight-for-age and height-for-age Z-scores reaching above -2 SD were considered the nutrition criterion for ending follow-up. RESULTS: Among the 298 children with moderate or severe malnutrition, 174 (58.4%) reached the criterion for ending follow-up, 100 (33.6%) were lost to follow-up, 18 (6.0%) died, and 6 (2.0%) did not reach the criterion for ending follow-up after 18 months of follow-up. The children with malnutrition in the department of surgery had a significantly higher proportion of children reaching the criterion for ending follow-up than those in the department of internal medicine (P<0.05). The children with severe malnutrition had a significantly higher loss to follow-up rate than those with moderate nutrition (P<0.05). The majority of children with emaciation reached the criterion for ending follow-up at month 3 after discharge, while those with growth retardation reached such the criterion at months 3-6 after discharge. Up to 1 year after discharge, more than 80% of the children with different types of malnutrition reached the nutrition criterion for ending follow-up. CONCLUSIONS: Most of the children with malnutrition who adhere to follow-up can reach the expected nutrition criterion within 1 year after discharge. The children with growth retardation have slower nutritional recovery than those with emaciation.


Assuntos
Desnutrição , Alta do Paciente , Criança , Criança Hospitalizada , Hospitalização , Humanos , Estado Nutricional
17.
Mikrobiyol Bul ; 54(2): 318-325, 2020 Apr.
Artigo em Turco | MEDLINE | ID: mdl-32723286

RESUMO

Influenza is an important cause of respiratory illness in children and is still an important cause of morbidity and mortality in children. The influenza virus subtypes determine the prevalence of the epidemic and pandemic influenza, the hospitalization and mortality rates in children each year. Surveillance of the circulation of different influenza virus strains is important in ensuring a good strain con-cordance for the composition of the annual influenza vaccine. The Global Influenza Hospital Surveillance Network® (GIHSN) is an international institution in which tertiary hospitals from many countries participate and where epidemiological surveillance of influenza disease is conducted. Six centers from Turkey participated in the study organized by GIHSN during the influenza season 2016 2017. The aim of this study was to demonstrate the frequency of influenza, virus types, clinical characteristics and vaccination rates in children admitted to our hospital with influenza-like symptoms in the influenza season 2016-2017. Informed consents were obtained from patients. 217 pediatric patients were screened with in the 24th and 48th hours of the hospitalization. Then a nasal/nasopharyngeal swab were collected from 184 patients who met the inclusion criteria. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) was used to obtain laboratory results. Influenza virus, influenza virus subtypes were studied by rRT-PCR. The 83.3% of the patients with positive influenza was under 5 years of age. The rate of influenza positivity was 16.3% (n= 30 patients). Influenza A (H3N2) was the predominant strain in children. The 70% of isolates were influenza A (H3N2) and the 30% were influenza B (Yamagata). There were no case of influenza A (H1N1) or influenza B (Victoria). In 30% of cases with influenza positivity, there was an underlying disease. The most prevalent of them were neuromuscular disease followed by cardiovascular disease and asthma. Tobacco exposure was 86.6% in influenza positive cases. The empirical oseltamivir prescription rate was 28.2%. The vaccination rate of the influenza vaccine was very low (1.6%). The out of 3 patients with influenza positivity were admitted to pediatric intensive care unit, and 2 of them required mechanical ventilation. None of these patients required extracorpereal membrane oxygenation and did not die. Our results highlight the importance of surveillance for influenza and in particular, influenza vaccination rates of groups with risk for morbidity and mortality, such as children, need to be increased.


Assuntos
Vírus da Influenza A Subtipo H3N2 , Vírus da Influenza B , Vacinas contra Influenza , Influenza Humana , Vacinação , Criança , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Humanos , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza B/genética , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Turquia/epidemiologia , Vacinação/estatística & dados numéricos
18.
Enferm. foco (Brasília) ; 11(2): 55-61, jul. 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1104078

RESUMO

Objetivo: conhecer as estratégias defensivas utilizadas por trabalhadores de enfermagem para minimizar o sofrimento advindo da vivência da morte de crianças hospitalizadas em unidade de terapia intensiva pediátrica. Método: estudo descritivo-exploratório de abordagem qualitativa. Em Unidade de Terapia Intensiva Pediátrica de um hospital universitário. A coleta de dados ocorreu entre agosto e setembro de 2016, por meio de entrevista semiestruturada com 15 trabalhadores de enfermagem. Os dados foram submetidos à análise temática de conteúdo. Resultados: os dados apontaram como principais estratégias: negação, afastamento no momento do óbito, tentativa de separação entre as atividades laborais e vida pessoal. A família do trabalhador e os colegas de trabalho constituem-se em suporte para o enfrentamento dessas situações, ainda, a sensação de dever cumprido e busca de apoio em crenças religiosas. Conclusão: os trabalhadores utilizam estratégias defensivas que vão da negação do sofrimento, perpassando por diferentes formas de agir perante as situações de sofrimento. (AU)


Objective: to know the defensive strategies used by nursing workers to minimize the suffering resulting from the experience of the death of children hospitalized in a pediatric intensive care unit. Method: descriptive-exploratory study of a qualitative approach. In Pediatric Intensive Care Unit of a university hospital. Data collection occurred between August and September 2016, through a semi-structured interview with 15 nursing workers. The data were submitted to content thematic analysis. Results: the data indicated as main strategies: denial, withdrawal at the time of death, attempt to separate work activities and personal life. The worker's family and co-workers constitute support for coping with these situations, as well as a feeling of accomplishment and seeking support in religious beliefs. Conclusion: workers use defensive strategies ranging from denial of suffering through different ways of acting in situations of suffering. (AU)


Objetivo: conocer las estrategias defensivas utilizadas por trabajadores de enfermería para minimizar el sufrimiento proveniente de la vivencia de la muerte de niños hospitalizados en unidad de terapia intensiva pediátrica. Método: estudio descriptivo-exploratorio de abordaje cualitativo. En Unidad de Terapia Intensiva Pediátrica de un hospital universitario. La recolección de datos ocurrió entre agosto y septiembre de 2016, por medio de una entrevista semiestructurada con 15 trabajadores de enfermería. Los datos se sometieron al análisis temático de contenido. Resultados: los datos apuntaron como principales estrategias: negación, alejamiento en el momento del óbito, intento de separación entre las actividades laborales y vida personal. La familia del trabajador y los compañeros de trabajo se constituyen en soporte para el enfrentamiento de esas situaciones, aún, la sensación de deber cumplido y búsqueda de apoyo en creencias religiosas. Conclusión: los trabajadores utilizan estrategias defensivas que van desde la negación del sufrimiento, pasando por diferentes formas de actuar ante las situaciones de sufrimiento. (AU)


Assuntos
Criança Hospitalizada , Família , Saúde do Trabalhador , Enfermagem , Unidades de Terapia Intensiva
19.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32680879

RESUMO

OBJECTIVES: Cardiorespiratory and pulse oximetry monitoring in children who are hospitalized should balance benefits of detecting deterioration with potential harms of alarm fatigue. We developed recommendations for monitoring outside the ICU on the basis of available evidence and expert opinion. METHODS: We conducted a comprehensive literature search for studies addressing the utility of cardiorespiratory and pulse oximetry monitoring in common pediatric conditions and drafted candidate monitoring recommendations based on our findings. We convened a panel of nominees from national professional organizations with diverse expertise: nursing, medicine, respiratory therapy, biomedical engineering, and family advocacy. Using the RAND/University of California, Los Angeles Appropriateness Method, panelists rated recommendations for appropriateness and necessity in 3 sequential rating sessions and a moderated meeting. RESULTS: The panel evaluated 56 recommendations for intermittent and continuous monitoring for children hospitalized outside the ICU with 7 common conditions (eg, asthma, croup) and/or receiving common therapies (eg, supplemental oxygen, intravenous opioids). The panel reached agreement on the appropriateness of monitoring recommendations for 55 of 56 indications and on necessity of monitoring for 52. For mild or moderate asthma, croup, pneumonia, and bronchiolitis, the panel recommended intermittent vital sign or oximetry measurement only. The panel recommended continuous monitoring for severe disease in each respiratory condition as well as for a new or increased dose of intravenous opiate or benzodiazepine. CONCLUSIONS: Expert panel members agreed that intermittent vital sign assessment, rather than continuous monitoring, is appropriate management for a set of specific conditions of mild or moderate severity that require hospitalization.


Assuntos
Eletrocardiografia , Monitorização Fisiológica/métodos , Oximetria , Guias de Prática Clínica como Assunto , Transtornos Respiratórios/fisiopatologia , Testes de Função Respiratória , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/farmacologia , Benzodiazepinas/efeitos adversos , Benzodiazepinas/farmacologia , Criança , Criança Hospitalizada , Técnica Delfos , Relação Dose-Resposta a Droga , Humanos , Oxigenoterapia , Respiração/efeitos dos fármacos , Transtornos Respiratórios/etiologia , Sepse/fisiopatologia
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