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1.
Rev. Ciênc. Plur ; 5(2): 1-15, ago. 2019.
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1021742

RESUMO

Introdução: O contexto familiar e social influencia nas situações de saúde durante a infância, sendo a orientação familiar um mediador importante entre a família e os profissionais da saúde.Objetivo: avaliar o atributo da orientação familiar sob a ótica dos familiares de crianças inscritas em serviços de puericultura da cidade de Santa Cruz, Rio Grande doNorte. Metodologia: Trata-se de estudo avaliativo, quantitativo, de caráter descritivo, com amostra composta por 186 pais/responsáveis de crianças de 0 à 2 anos dos serviços de puericultura da cidade de Santa Cruz, Rio Grande do Norte, Brasil, no ano de 2016, utilizando um questionário validado no Brasil denominado PCA Tools, versão para crianças. Resultados: Os resultados mostram que os profissionais não conhecem as famílias (48,9%), incluindo os agravos principais (45,7%), entretanto 79,6% afirmaram que sim a respeito dos antecedentes familiares. Para 63,4% eles não sabem sobre os empregos dos familiares, porém estão cientes sobre a dificuldade para obter recursos financeiros para medicação (47,3%). Referente a conhecerem a ideologia sobre o tratamento e autocuidado, 50,5% acreditam que sim.Conclusão: Embora os serviços de saúde da rede da Atenção Primária à Saúde possibilitem maior aproximação com o usuário dos serviços de saúde, bem como em seu contexto familiar e social e tenham sido responsáveis por grandes avanços na saúde pública, ainda se faz necessário implementação de medidas e estratégias para garantir o cumprimento do atributo orientação familiar (AU).


Introduction: The family and social context influences health situations during childhood, with family orientation being an important mediator between family and health professionals.Objective: to evaluate the presence and extension of the family orientation attribute from the perspective of the relatives of children enrolled in childcare services in the city of Santa Cruz, Rio Grande do Norte. Methodology: This is an evaluative, quantitative, descriptive study with a sample composed of 186 parents / guardians of children aged 0 to 2 years of childcare services in the city of Santa Cruz, Rio Grande do Norte, Brazil, in 2016, using a questionnaire validated in Brazil called PCA Tools, version for children.Results: The results show that the professionalsdo not know the families (48.9%), including the main diseases (45.7%); however, 79.6% said yes about the family history. For 63.4%, they do not know about family jobs, but are aware of the difficulty in obtaining financial resources for medication (47.3%). Concerning the ideology about treatment and self-care, 50.5% believe that it is. Conclusion: Although the health services of the Primary Health Care Network make it possible to bring health services closer to the user, as well as to their family and social context and have been responsible for great advances in public health, it is still necessary to implement measures and strategies to ensure compliance with the family orientation attribute (AU).


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Atenção Primária à Saúde , Família , Criança , Saúde da Criança , Pesquisa sobre Serviços de Saúde , Pais , Brasil , Epidemiologia Descritiva , Inquéritos e Questionários , Interpretação Estatística de Dados
2.
J Clin Ethics ; 30(3): 171-182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573959

RESUMO

Lainie Friedman Ross suggests that clinicians increase our efforts to meet children's most basic needs in several ways. These include prioritizing, to a greater extent, children's present and future feelings; placing greater decisional weight on other family members' needs; spotting earlier threats from surrogate decision makers so that we can better prevent these threatened harms; and finding ways to intervene earlier so that we can allow parental surrogate decision makers to remain in this role. I offer some practical ways in which Ross's ideas might be applied.


Assuntos
Tomada de Decisões , Família , Pais , Criança , Humanos , Procurador
3.
J Clin Ethics ; 30(3): 183-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573960

RESUMO

Healthcare decision making for children has adopted the best interest of the child standard, a principle originally employed by judges to adjudicate child placement in the case of parental death, divorce, or incompetence. Philosophers and medical ethicists have argued whether the best interest principle is a guidance principle (informing parents on how they should make healthcare decisions for their child), an intervention principle (deciding the limits of parental autonomy in healthcare decision making), or both. Those who defend it as only a guidance principle often cite the harm principle as the appropriate intervention principle. In this article, I challenge current use of the best interest principle in pediatric decision making as a guidance principle and as an intervention principle. I propose a model that I call constrained parental autonomy, which focuses on promoting and protecting the child's primary goods or basic needs. I show that constrained parental autonomy can serve as both a guidance principle and an intervention principle in making decisions. I conclude by examining a case study involving bone marrow donation by a young child to her sister.


Assuntos
Tomada de Decisões , Pais , Pediatria , Criança , Humanos , Pediatria/ética
4.
J Clin Ethics ; 30(3): 201-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573962

RESUMO

Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians' and parents' decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child's basic needs or primary goods, and both physicians and parents should be guided by a commitment to protect a child's basic needs and primary goods. In contrast, we argue that no principle-neither Ross's CPA, nor the best interest standard or the harm threshold-can serve as both an intervention principle and a guidance principle. First, there are as many correct intervention principles as there are different kinds of interventions, since different kinds of interventions can be justified under different conditions. Second, physicians and parents have different guidance principles, because the decisions physicians and parents make for a child should be informed by different values and balanced by different (potentially) conflicting commitments.


Assuntos
Tomada de Decisões , Pediatria , Médicos , Criança , Diversidade Cultural , Humanos , Pais
5.
J Clin Ethics ; 30(3): 207-212, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573963

RESUMO

Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance or interference principle for decision making on behalf of children, but that her model of constrained parental autonomy can serve as both. I will argue that Buchanan and Brock were correct that a single model or standard cannot serve as both a guidance and interference principle in pediatrics and that the best interest standard is a sufficient guidance principle. The harm principle fulfills the conditions necessary for an interference principle, at least insofar as deciding when state intervention to interfere with parental decision making is justified.


Assuntos
Tomada de Decisões , Pais , Pediatria , Adulto , Criança , Feminino , Redução do Dano , Humanos , Pediatria/ética
6.
J Clin Ethics ; 30(3): 213-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573964

RESUMO

In this commentary, the author discusses two strengths and two weaknesses of "Better than Best (Interest Standard) in Pediatric Decision-Making," in which Lainie Friedman Ross critiques the best interest standard and proposes her own model of constrained parental autonomy (CPA) as a preferable replacement for both an intervention principle and a guidance principle in pediatric decision making. The CPA's strengths are that it detaches from the language and concept of "best" and that it better respects the family as a distinct and intimate decision-making unit. The first weakness of the framework, as an intervention principle, is that because it imports a Rawlsian understanding of basic interests, it neglects certain populations of children (for example, children with intellectual disabilities). The second weakness is that, as a guidance principle, it is unclear what actual guidance the CPA is positioned to offer and how that guidance would be justified. To conclude, this commentary offers suggestions for what should be required of both an intervention principle and a guidance principle in pediatric decision making.


Assuntos
Tomada de Decisões , Pais , Pediatria , Criança , Humanos , Pediatria/ética
7.
J Clin Ethics ; 30(3): 218-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573965

RESUMO

Children's age and developmental capacity leave them incapable of making medical decisions for themselves. Decisions for children are traditionally made under the best interest standard. Ross calls into question whether the best interest standard can function as both a guidance and intervention principle, able to be applied across the spectrum of pediatric decision making. Ross describes constrained parental autonomy as an alternative model, arguing that it affords parents the ability to make decisions within the context of their family while upholding a child's current and future interests. Although the model provides a robust framework for intrafamilial decision making, I question whether it can be broadly applied to children living in non-intimate families.


Assuntos
Tomada de Decisões , Pais , Autonomia Pessoal , Criança , Saúde da Família , Humanos
8.
J Clin Ethics ; 30(3): 223-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573966

RESUMO

While the best interest standard (BIS) enjoys wide endorsement as ethical and decision-making standard in pediatrics, it has been criticized as vague and indeterminate. Alternate decision-making standards have been proposed to replace or augment the BIS, notably the harm principle (HP) and constrained parental autonomy (CPA) model. In this edition of The Journal of Clinical Ethics, Lainie Friedman Ross argues that CPA is a better standard than the BIS or the HP as both guide and limiter in pediatrics. In response, I review the important work done by the BIS in pediatrics, and argue that neither the HP nor the CPA can take over these functions or replace the BIS. Among other things I argue: (1) The BIS provides more robust protections for the moral claims of children. (2) The CPA model and the HP do not resolve the indeterminacy and vagueness present in complex medical situations, and the BIS is better suited to deal with this vagueness and indeterminacy. (3) The BIS is a general principle of medical ethics with special application in pediatrics; it fits seamlessly into the system of medical ethics and fulfills many functions within pediatrics. The HP and the CPA model do not fit in so readily within medical ethics, and are not equipped to take over the functions of the BIS.


Assuntos
Tomada de Decisões , Redução do Dano , Pais , Pediatria , Autonomia Pessoal , Criança , Ética Clínica , Ética Médica , Humanos , Padrão de Cuidado
9.
J Clin Ethics ; 30(3): 232-239, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573967

RESUMO

In their thoughtful critiques of my article "Better than Best (Interest Standard) in Pediatric Decision Making," my colleagues make clear that there is little consensus on what is (are) the appropriate guidance and intervention principles in pediatric decision making, and disagree about whether one principle can serve both functions. Hester proposes his own unitary principle, the reasonable interest standard, which, like the best interest standard from which it is derived, encourages parents to aim for the great, although Hester tempers it with a pragmatic principle that allows consideration of cultural and family values and practical, financial, social, or psychological circumstances. I reject the aspirational guidance principle because it is too demanding, and I also reject the notion that this pragmatic condition "gives permission for others to extol parents to give reasons" for their decisions, because it allows too much interference into the family and its decision making. Whereas the other respondents and I focus on whether and when third parties should intervene in the doctor-patient (surrogate) relationship, Navin and Wasserman mistakenly redefine intervention to include physicians' behaviors that attempt to influence parents, ignoring the integral role of shared decision making-a bidirectional discussion in which physicians help patients (surrogates) select among reasonable medical options through education, and, when necessary, motivation or persuasion. Diekema and Salter focus on the harm principle for intervention, ignoring other conditions in which intervention may be appropriate and institutions other than the state that may intervene. Paquette's overly narrow interpretation of who has positive obligations to children fails to ensure that a child's basic interests and needs are met. Finally, Bester claims that the "need to choose the available option that best promotes or protects the child's basic interests" is akin to a focus on best interests. But constrained parental autonomy does not require parents to choose the option that best promotes a child's basic interests. Rather, it requires respect for broad parental discretion about how they raise their child unless their decisions fail to promote the child's basic needs and interests.


Assuntos
Tomada de Decisões , Pais , Pediatria , Médicos , Criança , Humanos , Pediatria/ética , Relações Médico-Paciente
10.
J Clin Ethics ; 30(3): 240-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573968

RESUMO

What process ought to guide decision making for pediatric patients? The prevailing view is that decision making should be informed and guided by the best interest of the child. A widely discussed structural model proposed by Buchanan and Brock focuses on parents as surrogate decision makers and examines best interests as guiding and-or intervention principles. Working from two recent articles by Ross on "constrained parental autonomy" in pediatric decision making (which is grounded in the Buchanan and Brock model), I discuss (supportively) features of Ross's effort vis-a-vis the best interest standard. I argue that any pediatric decision-making model that brackets or formally limits an engagement with the child patient assumes too much. Further, any model that under appreciates the place of parents and their autonomy, and the dynamic parent-child relationship, misses an opportunity to broaden the clinical encounter by considering questions of justice for the child (Rawls) and within a family (Ross). In this context, I focus on the child's emerging and ongoing emotional and intellectual development and autonomy¬-their capabilities and identifying primary goods.


Assuntos
Tomada de Decisões , Pais , Pediatria , Criança , Humanos , Pediatria/ética
11.
S D Med ; 72(9): 414-417, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31581376

RESUMO

BACKGROUND: Use of procedural sedation to promote anxiolysis, analgesia, and amnesia enhances both pediatric patient experience and procedural outcomes. Sanford Children's outpatient sedation clinic currently uses oral midazolam for minimal sedation. METHODS: A research survey was designed to evaluate parent/guardian satisfaction with midazolam for pediatric sedation in simple outpatient procedures including, bot linum toxin injections, voiding cystourethrogram (VCUG), and intravenous line placement. Parents'/ guardians' understanding of the sedation and procedural logistics were surveyed and their satisfaction with the child's comfort, recovery time, and overall satisfaction were assessed. Each component was rated on a scale of 1-10, 1 being not satisfied and 10 as extremely satisfied. RESULTS: The study was conducted at a single pediatric outpatient center. Forty-one parents/guardians of patients aged 22 months-17 years were recruited; of these, 41 consented and enrolled in the study. Average age was 6.1 years with 22 females and 19 males. Of the surveys collected, 30 were botulinum toxin injections, eight VCUG, one contrast enema, and two were not recorded. Mean survey results were 8.7 (95 percent CI, 8.2-9.2) for satisfaction of recovery time, 8.0 (95 percent CI, 7.4-8.6) for control of discomfort and 8.4 (95 percent CI, 7.9-8.9) for overall satisfaction. CONCLUSION: When evaluating midazolam as a sedation agent in pediatric procedures, parents/guardians were most satisfied with the duration of recovery and had the lowest satisfaction on control of the patient's discomfort. Overall, it can be concluded that midazolam is a moderately good agent for pediatric patients receiving minimal sedation, with the greatest satisfaction in the duration of recovery.


Assuntos
Sedação Consciente , Midazolam , Criança , Feminino , Humanos , Lactente , Masculino , Midazolam/uso terapêutico , Pais , Satisfação Pessoal , Inquéritos e Questionários
12.
Soins Pediatr Pueric ; 40(310): 14-19, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543229

RESUMO

Hypothermia therapy is a protocol put in place to treat neonatal hypoxic ischemic encephalopathy in the first six hours after birth in order to prevent irreversible brain damage. The parents are therefore immediately separated from the newborn and endure an interminable 72-hour wait before being able to really meet their baby. Psychological support is therefore necessary to be able to think the unthinkable.


Assuntos
Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Pais/psicologia , Humanos , Recém-Nascido
13.
Soins Pediatr Pueric ; 40(310): 20-26, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543230

RESUMO

The feeding of the premature infant, even when this is done by gastric tube, should be a moment of sharing. However, the way care is normally organised and at times the availability of the parents turn the process into something the baby passively endures. But an enteral nutrition by tube feeding in the arms of the parents who push the feeding syringe by hand reveals a benefit for the premature newborn and the parents.


Assuntos
Nutrição Enteral/métodos , Recém-Nascido Prematuro , Intubação Gastrointestinal , Humanos , Recém-Nascido , Pais/psicologia
14.
Soins Pediatr Pueric ; 40(310): 27-30, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543231

RESUMO

Studies and the experience of caregivers in paediatric hospital departments reveal the difficulties encountered by families and children when the treatment of a chronic disease requires injections to be administered by the family at home. Many treatments in paediatrics are administered by subcutaneous injection which means parents need to perform this procedure on their child, often for organisational reasons. However, injecting medication into one's child is not easy for the parent, even when the technique is mastered.


Assuntos
Injeções Subcutâneas/psicologia , Relações Pais-Filho , Pais/psicologia , Criança , Humanos
15.
Soins Pediatr Pueric ; 40(310): 31-33, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543232

RESUMO

The death of a twin hospitalised in neonatal intensive care presents several issues that the children's nurse must take into account. Identifying the elements which characterise the issues around supporting families confronted at the same time with the grieving and bonding processes enables suitable actions to be put in place.


Assuntos
Pesar , Enfermeiras Pediátricas/psicologia , Pais/psicologia , Relações Profissional-Família , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal , Apego ao Objeto , Gêmeos
16.
Soins Pediatr Pueric ; 40(310): 34-38, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543233

RESUMO

Most children adopted in a foreign country present somatic disorders, which can have an impact on the construction of the bond with the adoptive parents. This potential complication must be taken into account in the adoption procedure and during the post-adoption follow-up, taking on board the trauma of everyone involved.


Assuntos
Adoção , Internacionalidade , Pais/psicologia , Transtornos Somatoformes/psicologia , Criança , Humanos , Relações Pais-Filho
17.
Prax Kinderpsychol Kinderpsychiatr ; 68(6): 525-539, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480945

RESUMO

Quality of Life in Children with Down Syndrome from Parental Point of View Parents of 42 children with Down syndrome (mean age 9 years) report on their child's quality of life (physical, emotional and social domain). The KINDL-R was used as a proxy-report measure. Quality of life correlated negatively with behavioral symptoms (SDQ), but did not vary between children in mainstreamed or special schools. Regression analysis identified the child's behavioral symptoms and parental stress - assessed when the children had reached the age of five - as significant predictors of quality of life assessed four years later.


Assuntos
Síndrome de Down/psicologia , Pais/psicologia , Qualidade de Vida , Inquéritos e Questionários , Criança , Pré-Escolar , Humanos , Procurador , Estresse Psicológico
18.
Niger J Clin Pract ; 22(9): 1218-1223, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489857

RESUMO

Aim: This study aimed to determine the sleeping habits and sleeping periods of kindergarten children, in order to analyze the problems related to sleep hygiene and determine the underlying factors. Methods: The sample size of this cross-sectional study consisted of 390 children. A questionnaire filled in by the parents was used as the data collection tool. The data were analyzed with appropriate statistical tests. Results: According to the mothers, 77.2% of the children had their own room at home. Thirty nine percent of children slept with the full light on in their room, 50.3% slept with night light on in their room, 12.3% slept with the radio/television on in their room. Infant sleep practices found in this study are swaddling (18.5%), wrapping of the infant's arms (21.0%), and rocking (58.7%). Conclusions: In terms of sleep hygiene, the vast majority of the children slept in a bright environment, and there were electronic appliances in the room. Common infant-transition-to-sleep practices observed were wrapping their arms and swaddling them. In our point of view, awareness training for parents about the subject will support sleep hygiene practices.


Assuntos
Hábitos , Transtornos do Sono-Vigília/prevenção & controle , Sono/fisiologia , Criança , Saúde da Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Mães , Pais , Instituições Acadêmicas , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários
19.
Zhonghua Shao Shang Za Zhi ; 35(8): 595-598, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474039

RESUMO

Objective: To understand the psychological experience of parents of burned infants during hospitalization, and to provide basis for formulating feasible targeted treatment and nursing programs. Methods: The mother or father of 15 burned infants admitted to the Department of Burns and Plastic Surgery of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from June to October 2017 were interviewed about their psychological experience during hospitalization of their burned infants one day before the children were expected to be discharged, using the phenomenological method of qualitative research. Data were collected through face to face, semi-structured, and in-depth interviews, and the Colaizzi's analysis method was applied to analyze, induce, and refine themes of interview data. Results: During hospitalization, the parents of burned infants experienced five periods: collapse period, self-blame period, worrying period, stable period, and life belief transition period. Conclusions: The psychological experience of parents of burned infants is similar. Beginning with emotional collapse and self-blame, their psychological fluctuations gradually stabilize later. Medical staff should strengthen the psychological assessment and offer timely intervention to parents of burned infants, and it is extremely urgent to popularize knowledge related to burn prevention and first aid for parents of infants.


Assuntos
Queimaduras , Pais/psicologia , Adaptação Psicológica , Criança Hospitalizada , China , Hospitalização , Humanos , Lactente , Pesquisa Qualitativa
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