Maternal mood and concordant maternal and infant salivary cortisol during heel lance while in kangaroo care.

BACKGROUND: Maternal kangaroo care (MKC) is a naturalistic intervention that alleviates neonatal pain, and mothers are assumed to play a stress regulatory role in MKC. Yet, no MKC infant pain study has examined relationship between maternal and infant stress reactivity concurrently, or whether post-partum depression and/or anxiety (PPDA) alters maternal and neonatal stress response and the regulatory effects of MKC. OBJECTIVES: To examine the concordance of salivary cortisol reactivity between 42 mothers and their stable preterm infants during routine infant heel lance (HL) while in MKC and to compare salivary cortisol between groups of mothers with and without PPDA and their infants. METHODS: Maternal and infant salivary cortisol samples were collected pre-HL and 20 min post-HL with two additional maternal samples at night and in the morning. Mothers and infants were allocated to with PPDA versus without PPDA study groups on the basis of maternal post-natal mental health assessment scores. RESULTS: Higher mothers' cortisol pre-HL was weakly associated with higher infants' salivary cortisol in response to the HL procedure. Maternal depression and/or anxiety were not associated with infants' cortisol. During HL, both groups of mothers and infants showed no change in salivary cortisol. CONCLUSIONS: Concordance between mother and infant salivary cortisol supports the maternal stress regulatory role in MKC. MKC may have stress regulatory benefits for mothers and their preterm infants during HL independent of PPDA. Future MKC studies that target mothers with altered mood will help to build on these findings.

[Certificates of live birth: analysis of completion in the city of Ribeirão Preto, São Paulo, Brazil]. / Declaração de nascidos vivos: análise do seu preenchimento no município de Ribeirão Preto, SP.

The study aims to identify the frequency with which certificates of live birth are filled out and to analyze the data they provide. To gather the data, the authors used a model birth certificate filled out by research assistants based on information obtained from the reports on mothers and newborns. This information was then compared to data contained in the official birth certificates available in the Information Technology Division of the Municipal Health Department. The sample consisted of 911 certificates of live birth from July 1996 in the ten maternity wards of the city of Ribeirão Preto. Data analysis showed that frequency of completion of birth certificates differs by hospital, involving both physicians and administrative personnel. The authors identified a high level of agreement in the data, i.e., over 90% in 13 of 18 variables compared in the birth certificates and in half of the hospitals investigated. The disagreement occurred especially with respect to data on the number of children per mother, number of prenatal visits, mother's schooling, and father's name.

Involvement and fragmentation: a study of parental care of hospitalized children in Brazil.

Parental involvement in the care of children who are hospitalized has been encouraged by the government in Brazil, as it has in the United Kingdom (UK). In this paper, key aspects of the UK, North American, and Latin American literature concerning parental participation are discussed, and implications for hospital care of children in Brazil are considered. A study of the division of work between nurses and the mothers (or other relatives) of 10 children hospitalized with chronic illnesses is reported. Data were collected by participant observation of child care in a Brazilian hospital. The results highlight some of the difficulties that arise in the integration of the work of mothers and nurses in hospital care of children and the fragmentation of care into "manual" and "intellectual" work. The results are considered within the theoretical framework of the model of technologic organization of work (Gonçalves, 1979, 1994). Implications for the organization of child care in the hospital are discussed.

[Pediatric nursing knowledge: books edited in Brazil from 1916 to 1988]. / O conhecimento em enfermagem pediátrica: livros editados no Brasil de 1916 a 1988.

From the apprehension of the knowledge in pediatrics nursing in Brazil, a research was done in a Brazilian historical bibliographic work of references. From an historical perspective nursing it is seen as a social articulate practice, as part of a collective process of work. The knowledge in this study is considered as an instrument from which man apprehends his working object. Forty titles were found about how to take care of children, from eight per cent of the a group of five hundred and four. The proportion was considered very small. The production which was found was classified under two aspects: the prescriptive and the analytical. The prescriptive texts are those related to normalize the work in view of the rationality and to the productivity. The analytical opens the possibility and give the means to diversify the nursing assistance particularizing the care and with another aim related to the nursing work.

[Care of hospitalized children: reflexions about the participation of parents]. / Assistência à criança hospitalizada: reflexões acerca da participação dos pais.

The care of a child admitted in the hospital is going through meaningful changes and, in a more actual approach, the main strategy seems to stimulate parents or relatives to stay with their children in the hospital. The purpose of this study is to analyse parents' participation in the process of staying in the hospital with their children. We have chosen the qualitative method and used as a theoretic--methodological reference the Model of Technological Work Organization. Based on the process of work, we have pointed out that bringing mothers to the ward is not so simple as it interferes in the reorganization of the work at the theoretical and practical levels. Concepts such as co-operation and partnership are built, however, sharing knowledge, power and room is not a simple action. It implies in changes of values and postures by parents and professionals.

[Evaluation of a computer system by nursing students]. / Avaliação de uma disciplina de informática por graduandos de enfermagem.

This study was undertaken to investigate the opinion of nursing undergraduate students of the first year about the discipline "Informatic applied to health". Data were collected using a questionnaire with open and closed questions applied through three consecutive years (1989, 1990, 1991). The results showed that undergraduate students considered this course important. Student's expectations were related to the necessity to get familiar with computers. The mentioned critiques were related to the necessity of more time and equipments to support a better learning process.

[Qualitative study on integrated care for children and adolescents]. / Estudo da assistência integral à criança e ao adolescente através da pesquisa qualitativa.

This paper presents the theoretical reference and methodology applied by the Group of Study on Children's and Adolescent's Health of the University of São Paulo at Ribeirão Preto College of Nursing, in their qualitative research aiming at the integral assistance to children's and adolescent's health. The authors describe the health sector in current Brazilian society, where the health actions take place, following with the presentation of the Study Group. After that, they develop the theoretical reference and methodology, defining the analytical--politics and social policies, technological organization of work, health services, child and family. To conclude, the authors present an outline of the results of investigations carried out in the last three years (1995 to 1997).

[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.

[Informatics in nursing practice: a new challenge for the nurse]. / A informática na prática de enfermagem: um novo desafio para o enfermeiro.

The study does a critical analysis about the nurse's insertion and role in the informatic applied to health. It brings up the importance of nurse's envolvement in the implantation projects of the automatized systems information, the necessity of acquiriment knowledge and control about this technology so that it can be used as a useful work instrument, aiding the decision process and rationalizing the work, with the main objective to improve the nursing practice.

[Discourse, institution, power: an analysis of the nurse-patient interaction]. / Discurso, instituição, poder: análise de interação enfermeiro-paciente.

The present investigation is an analysis of nurse patient interaction in a situation of blood collection. The body of this study consists twenty dialogues among five nurses and twenty patients. The "mechanics" of conversation was analyzed using the turn-taking sistem, as well as the formal marks that constitute and individualize the discoursive formation. The results showed an asymmetry in the interaction, a fact that qualifies the nurse-patient interaction as one of control, domination and effacement of individuality. These factors show that ideology of the hospital institution with respect to the patient is characterized by imposition of authority and alienation.

[The computer as a support tool in nursing care and administration]. / O computador como instrumento de apoio na assistência e administração de enfermagem.

The introduction of informatic tools directed to the Assistence and Administration's support will be able to bring important benefits to Brazilian Nursing. Based on American literature the authors expose some specific applications of the computer in the assistence and administration's actives of nursing, demonstrating the various ways to these actives, in order otimize the assistence rended to the patient.

[Nursing care for the mother-child dyad--the attitude of undergraduate nursing students]. / Assistência de enfermagem ao binômio mãe-filho--opinião de alunos de graduação em enfermagem.

This study was carried out to verify the undergraduate students opinion about their experiences in nursing assistance to new born baby and the postpartum woman in separated and integrated ways. The factors investigated were opportunity for education, interation, teaching value in the fifth semester and its contribution to the community.

[Reflections on the introduction of informatics into the nursing profession]. / Reflexões sobre a inserção da informática na profissão de enfermagem.

The paper is an analysis about the impact of introducing informative technology and its consequences in the society, in general professions and mainly, in nursing practice. The authors emphasize the need of major discussions about the insertion of this new technology in nursing profession.

[Care of children with cancer: analysis of the work process]. / Assistência à criança com câncer: alguns elementos para a análise do processo de trabalho.

This study tries to analyse some principle of the working process in the assistance of children with cancer, based on the Model of the Technological Organization of Work. It started from a theoretical principle that nursing is a social practice and so is historically structured, socially articulated, and so nursing is part of the collective process of work. We pointed out toward the fact that the process of the nursing work in assisting a hospitalized child, that it is under a transformation phase, going through the exclusively clinic model to another one, which has some characteristics of amplification to the theoretical reference and a new instrumentalization.

[Nutritional hygiene in the neonatal period: a review of the literature]. / Higiene alimentar no período neonatal: revisão da literatura.

The present study makes a bibliographic review about the alimentary hygiene of children in the neonatal period. It describes the advantages of maternal milk by attending the basic principles that should govern the children's feeding, the importance of free scheme breast-feeding to emotional development, as well as ventral and right side-lying position and belching to the prevention of accidents.

[Technologic features in the working process in nurseries]. / Características tecnológicas do processo de trabalho em berçários.

The relationship established between health professionals and newborns is analysed in this study. The research focuses mainly on the fact that this interaction is mediated by scientific knowledge, technology and the equipment used on the care of babies. This is a exploratory qualitative research. The data was collected in two nurseries in the city of Ribeirão Preto, SP, Brazil. It was verified that the procedures used in these nurseries fulfilled the necessities of newborns regarding the control and maintenance of vital functions (cardio-respiratory, thermoregulation, oxygenation, fluid-electrolyte balance and nutrition), as well as the administration of medicines, and collection of organic material for diagnosis and therapy. It was also observed that nursery professionals prepare, install, control and do the maintenance of the equipment, while doctors are in charge of installing and controlling it in more invasive procedures.

[Using creativeness in health education in neonatal rooming-in: opinion of puerperal women about the use of an educational game]. / Utilizando a criatividade na educação em saúde em alojamento conjunto neonatal: opinião de puérperas sobre o uso de um jogo educativo.

The article presents the experience of nurses in the development and use of an educational game on breastfeeding and basic care with the newborn with a group of puerperae women in a rooming-in unit, the analyzing the opinions of the participants involved in the educational experience. This descriptive study which was carried out at a philanthropic maternity in Ribeirão Preto, São Paulo. The educational activity proposed was a board game, coordinated by a nurse, in which mothers were organized in two groups. One group formulated questions on breastfeeding and basic care of the newborn, while the other group answered the questions. At the end of the game the participants were requested to give their opinion about the activity. The results show that the mothers considered the game entertaining and stimulating. It broke the hospital's routine, kept the "players" attentive and facilitated understanding and learning under discussion of the subject. The authors conclude that the activity proposed was an appropriate strategy to facilitate the exchange and learning under discussing of experiences among mothers, as well as, to develop health education through the use of ludical-educational games.

[Recreational activities for parents of risk babies: experience at the Clinics Hospital of Ribeirao Preto]. / Lazer para pais de bebês de risco: a experiência junto ao Hospital das Clínicas de Ribeirão Preto.

The nursing team at the University of São Paulo Hospital has implemented actions directed to parents, such as support groups, training for hospital discharge and their involvement in the progressive care to their children. Aiming at expanding such care, the authors have implemented a support program involving ludic and recreational activities with the parents of hospitalized preterm babies under risk. The account of this experience is the object of this work. The interventions were performed by a group of nursing students who gather with the parents weekly for a period of two hours and develop group-dynamics techniques; leisure activities; creativity workshops involving manual work and discussions on themes concerning personal and environmental hygiene. Through these new care strategies directed to parents, the authors expect to contribute to the process of construction of more integral and humanized care in the area of neonatology by focusing on the family.

[Assistance to parents of preterm newborns at neonatal units]. / Assistência aos pais de recém-nascidos pré-termo em unidades neonatais.

The purpose of this study is to reflect about the assistance to be given to parents of preterm and low weight babies, born in neonatal units, based on existing literature and the authors' practical experiences. Although mothers right to be close to their babies is assured by law, most of the nurseries still keep strict visit schedules to parents. However, there are some units where mothers' permanency is allowed. The question, in these cases, is if parents effective involvement in the care of the baby should or should not be allowed. For the nursing care unit, the authors suggest some intervention strategies to adapt parents to the new situation, and to strengthen the relationship between them and the baby. The recommendations are as follows: parents free access to the nurseries; motivation of early physical contact between parents and baby; implementation of multi-professional support groups to help parents during the different stages of clinical evolution; incentive for breastfeeding, and direct care of the babies; structuring of formal and informal groups of support for parents during and after hospitalization.