Literatura académica sobre el tema "Specialist Nurse in Child and Pediatric Health Nursing"

AimTo determine the impact of replacing a nurse with a ward-based pharmacy technician as the second checker, in the process of administering medicines to children in hospital by exploring the views and experiences of parents and staff involved in the change in practice.MethodHaving undertaken additional in-house training, a pharmacy technician replaced the second nurse on medication ward rounds (second checker) for 10 months over two wards. This took place on a neuro-medical ward and a medical specialty ward. The pharmacy technician undertook roles relating to medicines administration, including: attending day time medicine administration rounds; checking accuracy and appropriateness of prescriptions; preparing/administering prescribed medicines; independently undertaking dosage calculations; recording the administration of medicines. Using their specialist knowledge and skills, the role aimed to improve medicines optimisation for patients and their families during their inpatient stay.Research staff conducted semi-structured qualitative interviews with parents of patients who were administered medicines during the study period (n=12) and with staff involved with the change in practice, as well as an interview with the pharmacy technician themselves after leaving each ward. Families were recruited from the two wards. Semi-structured interviews with staff (n=14) gathered data on the perspectives and experiences of the contribution of the ward-based pharmacy technician across two wards. An exploratory approach was taken using Thematic Analysis.1 Interviews were transcribed verbatim and anonymised. The research team familiarised themselves with transcripts by reading in full and generating initial codes using text from the data. Themes were generated and discussed between the team to produce an overall story of the analysis. Interviews were conducted over a 4 month period.ResultsParents discussed the importance of communication about their child’s medicines in hospital. Some parents were aware of the pharmacy technician’s role as second checker. Parents recognised the benefits of the technician’s background and expertise, and their contribution to the ward team.Fourteen staff interviews were conducted including the ward based pharmacy technician (after leaving each ward), the Chief Pharmacist, the Director of Nursing, a Ward Manager, Nursing and Pharmacy staff. Staff commented how the pharmacy technician provided a link between the Pharmacy and Nursing teams, alleviating nurses of administration duties and allowing them to spend more time with patients. The role was also seen as educational allowing for nurses to refresh their knowledge on medication storage procedures and alternative methods of administration.ConclusionTo the research team’s knowledge, this is the first study of its kind to assess the potential benefits of introducing a ward-based pharmacy technician as a second checker. This novel role extension releases nursing staff time to undertake more patient-centred nursing duties. In addition, the specialist knowledge of the pharmacy technician at the point of medicine administration had a positive impact on medicines optimisation for children in hospital, providing more effective administration of medicines and contributing to wider patient safety in paediatric settings. Although further evaluation is required, our findings indicate that parental and staff support the future development of this service.ReferenceBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3(2):77–101.

OBJECTIVE: To describe the epidemiological characteristics of all exogenic poisoning cases in children assisted in a pediatric emergency unit in Recife, State of Pernambuco, Brazil, from April to September 2006. METHODS: This is a descriptive study of exogenic poisoning in 0-12 aged children treated at Centro de Assistência Toxicológica de Pernambuco (Pernambuco Toxicological Assistance Center). The data were collected through interviews and by consulting patients' records. RESULTS: 26 cases of accidental exogenic poisoning were registered, mainly males (65.4%). Regarding age, children under five years old were the most affected (65.4%). Medication was involved in 50.0% of the cases. CONCLUSION: Accidental exogenic poisoning affecting children younger than five years of age stands out as a significant public health problem. As a member of a multiprofessional health team, the nurse plays an important role in health education and in the measures to prevent child poisoning.

AbstractProcedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space. What is Known:• Effective and prompt analgesia, anxiolysis, and sedation (PSA) outside the operating theatre have become standard in managing pain and anxiety in children undergoing painful or anxiogenic diagnostic and therapeutic procedures.• We searched PubMed up to September 15, 2020, without any date limits or language restrictions, using different combinations of the MeSH terms “pediatrics,” “hypnotics and sedatives,” “conscious sedation,” and “ambulatory surgical procedures” and the non-MeSH term “procedural sedation” and found no reports describing the current practice of pediatric PSA in Europe. What is New:• This study is, to the best of our knowledge, the first to shed light on the pediatric PSA practice in European EDs and uncovers important gaps in several domains, notably availability of sedation medications and topical anesthetics, safety aspects such as PSA provider training, availability of nonpharmacologic support to PSA, and high impact interventions such as nurse-directed triage analgesia.• Other identified barriers to PSA implementation include staff shortage, control of sedation medications by specialists outside the emergency department, and lack of space.

Abstract.NURSES SPECIALIST IN CHILD HEALTH AND PEDIATRICS AND PROMOTION OF BREASTFEEDING AFTER THE RETURN TO WORKBackground: In Portugal, breastfeeding rates are still below those recommended by the World Health Organization, despite the initiatives for its promotion. Most women choose and are favourable to breastfeeding. Working outside the home has become a reality for most women, and reconciling breastfeeding with the professional activity is often difficult. Thus, the return to work is one of the reasons mentioned by mothers for early breastfeeding cessation. The promotion of breastfeeding is a public health priority. Nurses’ attitudes and interventions influence the success of breastfeeding and help overcome some of the difficulties encountered. Objectives: To identify measures developed by primary care nurses specialized in Child Health and Pediatrics to promote breastfeeding and encourage working mothers to continue breastfeeding, as well as identify these nurses’ interventions toward the promotion of breastfeeding in the community, family, workplace, and day-care centers. Participants and Methods: Descriptive, cross-sectional study with a quantitative methodology using a sample of 13 nurses specialized in Child Health and Pediatrics working in Health Care Centers of a Cluster of Health Centers. Data were collected through semi-structured interviews between June and July 2015. Dara were analyzed using Bardin’s content analysis technique. Results: Aware of the need to promote breastfeeding after the mother’s return to work, nurses implement multiple interventions targeted at mothers, fathers, and grandparents (“breastfeeding corners”, phone support services, home visits, training sessions, celebration of the World Breastfeeding Week) in nursing consultations. Conclusions: Nurses only intervene in nursing consultations. However, there are other places where nurses should intervene, namely day-care centers, the workplace, and the community in general, with the purpose of reducing early breastfeeding cessation due to the mothers’ return to workKeywords: Breastfeeding; Women, Working; Pediatric Nursing; Primary Health Care.Resumo. Antecedentes: Em Portugal, apesar das iniciativas desenvolvidas para promover o aleitamento materno, as taxas e suas práticas continuam abaixo do recomendado pela OMS. A generalidade das mulheres decide e é favorável à amamentação. Trabalhar fora de casa tornou-se uma realidade para a maioria das mulheres. Por vezes torna-se difícil conciliar o aleitamento materno com a atividade laboral e o regresso ao trabalho encontra- se entre um dos motivos apontados pelas mães para o abandono precoce da amamentação. Promover a amamentação é uma prioridade de saúde pública. As atitudes e intervenções dos enfermeiros exercem influência no processo/sucesso da amamentação e no ultrapassar de dificuldades que surgem. Objetivos: Conhecer as medidas promotoras da amamentação que os enfermeiros dos cuidados de saúde primários, especialistas em Enfermagem de Saúde Infantil e Pediatria, desenvolvem no sentido de apoiar as mães que trabalham a continuar a amamentar e identificar as intervenções promotoras da amamentação desenvolvidas por estes enfermeiros junto das mães, a nível da comunidade, na família, nos locais de trabalho, nas creches e nos seus próprios locais de trabalho. Participantes e Métodos: Estudo descritivo, transversal, segundo a metodologia qualitativa, junto de 13 enfermeiros Especialistas em Enfermagem de Saúde Infantil e Pediatria que trabalham em Centros de Saúde de um Agrupamento de Centros de Saúde. Colheram-se dados por entrevista semiestruturada entre Junho e Julho de 2015. No tratamento da informação recorreu-se à análise de conteúdo de Laurence Bardin. Resultados: Os Enfermeiros embora despertos para a necessidade de promover a manutenção da amamentação após o regresso das mães ao trabalho desenvolvem, predominantemente no contexto das consultas de enfermagem, várias intervenções (cantinhos da amamentação, apoio telefónico, visita domiciliária, ensinos, comemoração da semana mundial do aleitamento materno) junto das mães, pais e avós. Conclusões: A atuação dos Enfermeiros resume-se ao contexto das consultas de enfermagem. Há contudo, outros locais onde as intervenções de enfermagem devem chegar, nomeadamente, creches, entidades patronais e sociedade em geral, com vista a reduzir o desmame precoce motivado pelo regresso das mães ao trabalho.Palavras-chave: Aleitamento Materno; Mulheres Trabalhadoras; Enfermagem Pediátrica; Cuidados de Saúde Primários.

Abstract.NURSES SPECIALIST IN CHILD HEALTH AND PEDIATRICS AND PROMOTION OF BREASTFEEDING AFTER THE RETURN TO WORKBackground: In Portugal, breastfeeding rates are still below those recommended by the World Health Organization, despite the initiatives for its promotion. Most women choose and are favourable to breastfeeding. Working outside the home has become a reality for most women, and reconciling breastfeeding with the professional activity is often difficult. Thus, the return to work is one of the reasons mentioned by mothers for early breastfeeding cessation. The promotion of breastfeeding is a public health priority. Nurses’ attitudes and interventions influence the success of breastfeeding and help overcome some of the difficulties encountered. Objectives: To identify measures developed by primary care nurses specialized in Child Health and Pediatrics to promote breastfeeding and encourage working mothers to continue breastfeeding, as well as identify these nurses’ interventions toward the promotion of breastfeeding in the community, family, workplace, and day-care centers. Participants and Methods: Descriptive, cross-sectional study with a quantitative methodology using a sample of 13 nurses specialized in Child Health and Pediatrics working in Health Care Centers of a Cluster of Health Centers. Data were collected through semi-structured interviews between June and July 2015. Dara were analyzed using Bardin’s content analysis technique. Results: Aware of the need to promote breastfeeding after the mother’s return to work, nurses implement multiple interventions targeted at mothers, fathers, and grandparents (“breastfeeding corners”, phone support services, home visits, training sessions, celebration of the World Breastfeeding Week) in nursing consultations. Conclusions: Nurses only intervene in nursing consultations. However, there are other places where nurses should intervene, namely day-care centers, the workplace, and the community in general, with the purpose of reducing early breastfeeding cessation due to the mothers’ return to workKeywords: Breastfeeding; Women, Working; Pediatric Nursing; Primary Health Care.Resumo.Antecedentes: Em Portugal, apesar das iniciativas desenvolvidas para promover o aleitamento materno, as taxas e suas práticas continuam abaixo do recomendado pela OMS. A generalidade das mulheres decide e é favorável à amamentação. Trabalhar fora de casa tornou-se uma realidade para a maioria das mulheres. Por vezes torna-se difícil conciliar o aleitamento materno com a atividade laboral e o regresso ao trabalho encontra-se entre um dos motivos apontados pelas mães para o abandono precoce da amamentação. Promover a amamentação é uma prioridade de saúde pública. As atitudes e intervenções dos enfermeiros exercem influência no processo/sucesso da amamentação e no ultrapassar de dificuldades que surgem. Objetivos: Conhecer as medidas promotoras da amamentação que os enfermeiros dos cuidados de saúde primários, especialistas em Enfermagem de Saúde Infantil e Pediatria, desenvolvem no sentido de apoiar as mães que trabalham a continuar a amamentar e identificar as intervenções promotoras da amamentação desenvolvidas por estes enfermeiros junto das mães, a nível da comunidade, na família, nos locais de trabalho, nas creches e nos seus próprios locais de trabalho. Participantes e Métodos: Estudo descritivo, transversal, segundo a metodologia qualitativa, junto de 13 enfermeiros Especialistas em Enfermagem de Saúde Infantil e Pediatria que trabalham em Centros de Saúde de um Agrupamento de Centros de Saúde. Colheram-se dados por entrevista semiestruturada entre Junho e Julho de 2015. No tratamento da informação recorreu-se à análise de conteúdo de Laurence Bardin. Resultados: Os Enfermeiros embora despertos para a necessidade de promover a manutenção da amamentação após o regresso das mães ao trabalho desenvolvem, predominantemente no contexto das consultas de enfermagem, várias intervenções (cantinhos da amamentação, apoio telefónico, visita domiciliária, ensinos, comemoração da semana mundial do aleitamento materno) junto das mães, pais e avós. Conclusões: A atuação dos Enfermeiros resume-se ao contexto das consultas de enfermagem. Há contudo, outros locais onde as intervenções de enfermagem devem chegar, nomeadamente, creches, entidades patronais e sociedade em geral, com vista a reduzir o desmame precoce motivado pelo regresso das mães ao trabalho.Palavras-chave: Aleitamento Materno; Mulheres Trabalhadoras; Enfermagem Pediátrica; Cuidados de Saúde Primários.

BackgroundPressures to open pharmacy services 7 days a week, with no financial input for these extra resources, has knock on effects that may dilute accessibility to clinical pharmacists in specialist areas.AimsThe aim of this survey was to assess opinions of the users of the current pharmacy services to PICU and the planned extended hours provision.MethodAn e-survey was sent to PIC Consultants, Advanced Nurse Practitioners, and Senior Nursing Staff following a six month period of increased clinical pharmacists time allocation to PIC. Free-text area was added to each multiple choice question.ResultsTwenty-four staff responded, 14 prescribers and 10 senior nursesPresence of PICU trained clinical pharmacist on morning ward rounds was considered essential by 19 (79%) respondents and desirable by 4 (17%). Attendance on the afternoon round was deemed essential by 14 (59%) and desirable by 8 (33%) of respondents.Comments on the benefits of pharmacists on ward rounds included:“Enabling a second professional review of the patient overall—it prevents forced direction from the consultant and the pharmacists are empowered to ask us to reconsider. Very useful to have this safety and reality check.”“Essential for the guidance of drug usage and drug chart review which improves safety, benefit of advice for use with specialist patients, best cost approach, multiple benefits.”Roles expected as routine from the clinical pharmacist included patient safety (100%), managing parenteral nutrition (80%), advice on intravenous therapy e.g. compatibility (100%), education of the multidisciplinary team (96%), management of long term medicines e.g. sedation withdrawal (83%), and therapeutic drug monitoring control (83%).Only 6 respondents felt the PICU patient would benefit from extending access to dispensary only over weekends, 11 felt that there was no benefit, and 6 respondent unsure.Provision of the pharmacy on call service which involves both supply and clinical advice, was felt sufficient to the requirements of the PICU patient by less than a third of repondents,56% feeling the current service insufficient. Comments on the on call service included.“difficult to get experienced advice on weekends”“need access to pic pharmacists officially.”“we may direct queries to the on call pharmacy staff but 9 times out of 10 theses queries are redirected to our PICU pharmacists. Our questions are answered at any time of the weekend”Ninety one percent answered positively to the final question asked about extending the current clinical pharmacy service from 5 to 7 days per week. Comments included.“PICU is a 24 hr, 7 day a week service…how we can provide adequate care to children if this valuable service is only provided 5 days a week.”ConclusionPharmacy is a valued service on PICU, where the service users support increased access and attendance on certain ward rounds by specifically PICU trained pharmacist.

IntroductionDemand from local NHS stakeholders identified a gap for a taught education course tailored to the niche requirements of paediatric healthcare staff wishing to become non-medical prescribers. This was seen as an excellent opportunity to review and develop the pharmacology module within the Non-medical Prescribing (NMP) course by giving it a paediatric focus.AimTo develop a pharmacology module with an emphasis on paediatric prescribing that meets the professional requirements of the General Pharmaceutical Council (GPhC), the Nursing and Midwifery Council (NMC) and the Health Care Professions Council (HCPC).MethodKnowledge of curriculum design and structure was utilised in developing the paediatric pharmacology module. This ensured that the underpinning theory of prescribing medicines safely for children was delivered at the right academic level. The content, delivery and learning outcomes were dictated by the Prescribing Competency Framework for All Prescribers (RPS, 2016).1 But the cognitive teaching and learning methods arose from the rigid expectation to meet the regulatory requirements of each professional body. To ensure consistency across the whole NMP programme, the structure of the pharmacology module assessments (both formative and summative) was kept the same. The summative (final) assessments consisted of a multiple choice question (MCQ) paper requiring the students to answer a total of twenty MCQs, with the pass mark set by the regulatory bodies at 80%; a drug calculations paper consisting of five questions with a 100% pass mark; and a 5 minute information giving OSCE (objective structured clinical examination). The whole module was looked at a fresh from a paediatric perspective. The content and timetable were compiled and reviewed jointly by a paediatric pharmacist and a paediatric nurse. Both were experienced academics already teaching on the NMP course. While some of the lectures were delivered by in-house university academic staff, the majority of the sessions were delivered by specialist paediatric guest lecturers who were actively working in their respective clinical fields. This ensured that the knowledge imparted to students was practical, current and relevant to prescribing for children.ResultsAll students had to be practising in paediatrics for a minimum period of two years and have evidence of studying at level 6 (graduate level) or equivalent. The target audience consisted of allied healthcare professionals specialising in paediatrics, including nurses, pharmacists, optometrists, physiotherapists, podiatrists, dieticians and therapeutic radiographers. However, the first cohort of 51 students comprised entirely of paediatric nurses. The majority of students passed each assessment first time. All students passed the 5-minute information giving OSCE, but 25% of the students had to re-sit the pharmacology MCQ paper and 17% had to re-sit the drug calculations paper. Following the resits the remaining students all passed except for one student who failed the course.ConclusionOverall, the course was well received, with positive feedback from most students and stakeholders. Valuable suggestions were also received for further improvements to the course and pharmacology module. These are currently being implemented with intake of students.ReferenceRoyal Pharmaceutical Society ( 2016) A competency framework for all prescribers. Available from: http://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf [Accessed 25/6/19]

Mestrado em Enfermagem, Área de especialização: Saúde Infantil e Pediátrica
Sabe-se que as crianças sentem e guardam memória da dor que, quando não tratada, tem consequências na sua vida a curto e longo prazo. O alívio e controlo da dor deve ser uma prioridade de todos os profissionais de saúde em todos os contextos de prestação de cuidados. Assim, torna-se fundamental reconhecer, avaliar, prevenir e tratar a dor na criança, com recurso a intervenções não farmacológicas e/ou farmacológicas. O enfermeiro, pela sua relação de proximidade com a criança/jovem e família, tem um papel fundamental na gestão de processos dolorosos, nomeadamente o Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica, que presta cuidados diferenciados, avançados e seguros, promotores do mais elevado estado de saúde e alicerçados na prática baseada na evidência. O presente relatório visa a descrição, análise e reflexão do percurso formativo em contexto de Estágio, que conduziu ao desenvolvimento e aquisição de competências comuns e especificas de enfermeiro especialista e de mestre.
It is known that children feel and keep the memory of pain, that when untreated has consequences in their lifes, in short and long term. Pain relief and control should be a priority for all health professionals in all healthcare settings. Thus, it is fundamental to recognize, evaluate, prevent and treat pain in children, using non-pharmacological and/or pharmacological interventions. Nurses have a fundamental role in the management of painful processes, namely the Nursing Specialists in Child and Pediatric Health Nursing, who provide differentiated, advanced and safe care, which are promoters of the highest state of health and are based on evidence-based practice. The aim of this resport is to describ, analyze and discuss the knowledge obtain in the context of internship, which led to the development and acquisition of common and specific competences of specialist and master nurse.

Mestrado em Enfermagem, Área de especialização: Saúde Infantil e Pediátrica
Sabe-se que as crianças sentem e guardam memória da dor que, quando não tratada, tem consequências na sua vida a curto e longo prazo. O alívio e controlo da dor deve ser uma prioridade de todos os profissionais de saúde em todos os contextos de prestação de cuidados. Assim, torna-se fundamental reconhecer, avaliar, prevenir e tratar a dor na criança, com recurso a intervenções não farmacológicas e/ou farmacológicas. O enfermeiro, pela sua relação de proximidade com a criança/jovem e família, tem um papel fundamental na gestão de processos dolorosos, nomeadamente o Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica, que presta cuidados diferenciados, avançados e seguros, promotores do mais elevado estado de saúde e alicerçados na prática baseada na evidência. O presente relatório visa a descrição, análise e reflexão do percurso formativo em contexto de Estágio, que conduziu ao desenvolvimento e aquisição de competências comuns e especificas de enfermeiro especialista e de mestre.
It is known that children feel and keep the memory of pain, that when untreated has consequences in their lifes, in short and long term. Pain relief and control should be a priority for all health professionals in all healthcare settings. Thus, it is fundamental to recognize, evaluate, prevent and treat pain in children, using non-pharmacological and/or pharmacological interventions. Nurses have a fundamental role in the management of painful processes, namely the Nursing Specialists in Child and Pediatric Health Nursing, who provide differentiated, advanced and safe care, which are promoters of the highest state of health and are based on evidence-based practice. The aim of this resport is to describ, analyze and discuss the knowledge obtain in the context of internship, which led to the development and acquisition of common and specific competences of specialist and master nurse.

Background: The child health care in Sweden has a health program for children of various ages. Traditionally, the child health nurse would turn to the parents to talk about the child's health and lifestyle habits. This often results in a communication that does not involve the child. To involve the child more, new routines have been implemented during health care visits. The implementation of artifacts, such as puzzles (Bamsepussel) and cartoons, has given the child health nurses tools to communicate more directly with the child. Aim: To describe the child health nurses' experiences of using the Bamse program when communicating with the child during its four-year checkup at the child health center. Method : Child health nurses (n=8) were interviewed during a semi structured interview used openended questions, recorded as digital audio files. Their answers were transcribed verbatim and then analyzed using qualitative content analysis. Results: The child health nurses describes experiences of the Bamse program as timeconsuming, involvement and interaction and a learning tool. Conclusion: The Bamse program tool is effective, and the joy that Bamse conveys creates an environment that leads to child participation and interaction. Bamse is time consuming as it takes time to communicate with the child. The child health nurses experience a sense of purpose and joy through this method of working. In-service training is requested.

ABSTRACT Background. Childhood sexual abuse (CSA) is a silent, but pervasive concern across the United States, the prevalence of which is often vastly underestimated. Some research indicates that as many as one in four girls and one in six boys become victims of CSA. CSA is classified as an adverse childhood experience (ACE), which has been shown to have serious longstanding negative physical, emotional, and mental health impacts. The pediatric primary healthcare provider is well posed to intervene to detect and prevent the occurrence of CSA. Objective. The overall goal of this study is to gain an understanding of the current state of sexual abuse screening and prevention in pediatric primary care settings in the state of Vermont. Methods. An anonymous, 20-item survey was distributed to Vermont pediatric primary care providers via the electronic mailing lists of three Vermont-based professional organizations for healthcare providers. The online survey was conducted with the Limesurvey software through the secure University of Vermont server. The survey remained active for three weeks, and potential participants received three weekly reminder emails inviting them to complete the survey. As an incentive for volunteer participation in the study, all participants received a list of the available local, statewide, and national resources available to them to assist in sexual abuse detection and prevention following survey completion. Results. There were 37 participants who completed the survey. The groups were divided based on professional title, patient population, years of experience in practice, geographic location, and access to a social worker. Each of these groups was analyzed against the survey data to determine any underlying trends that existed. Conclusions. Nurse practitioners were found to be more likely than physicians to routinely screen every child and their caregivers during health supervision visits. NPs were also more likely to report that the electronic health record prompted these screenings. A positive correlation was found between the likelihood of routinely screening children and increased provider confidence with screening. However, no differences were found between NPs and physicians in confidence with screening, nor were there differences in perceived educational sufficiency between the two groups. Across all professional titles, pediatric providers reported greater confidence in their ability to detect risk factors and red flags than family practice providers. A greater perceived sufficiency of education was positively correlated with provider confidence and comfort with screening. Educational sufficiency was also positively correlated with the perception that area resources are highly available and are effectively used in practice. Time was reported as the greatest barrier to screening and prevention by those who have the highest perceptions of their ability to make an impact on prevention. Also, those who felt that there were highly available and accessible resources at their disposal also reported time as their greatest barrier. Additionally, those who reported greater than 20 years of experience in practice were significantly less likely to view access to the patient as the greatest barrier that providers face in their efforts to detect and prevent sexual abuse. Further study is indicated to confirm these findings.

The complex challenges facing the sexual assault nurse examiners program in a midwest state are underreporting, late reporting, and poor coordination of care for pediatric victims of child maltreatment with sexual abuse. The main objective of this quality improvement project was the identification of necessary practice-related approaches to care to decrease barriers associated with reporting suspicions of abuse or neglect. An evidence-based, multidisciplinary assessment clinical toolkit that followed clinical components of trauma-sensitive, child-centered screenings triggering a coordinated response to conduct a forensic medical exam within 96 hours of the alleged incident was evaluated. During 3 rounds of surveys following the Delphi technique, 10 members of an expert panel agreed upon critical success indicators were used for the review and final decision for adoption of the toolkit. The final consensus obtained, with an intraclass correlation of 0.924 with a 95% confidence interval, supported implementation of this trauma-informed toolkit which would ensure that medical care and throughput through the system of care addressed the physical and mental needs of the patient and caregivers as well as improvement in the forensic investigative data collection. A child-centered, trauma-sensitive approach to screening and evaluation by healthcare professionals will help decrease the delay to evaluation and to curtail long-term adverse impacts on survivors. This family-based primary prevention effort is a framework for healthcare practitioners to use and includes strategies (i.e., health history, mental health evaluation, family dynamics evaluation) that are child and family centered contributing significantly to positive social change.

Övervikt och fetma hos barn är ett världsomfattande folkhälsoproblem. Barnhälsovården har en betydande roll i det hälsofrämjande och förebyggande arbetet mot barnfetma och är en nyckelfaktor i främjandet av barns tillväxt och utveckling. Tidig barndom är en kritisk tid där många riskfaktorer för övervikt och fetma framträder. Syftet var att belysa barnsjuksköterskans hälsofrämjande och förebyggandearbete mot övervikt och fetma inom barnhälsovården. En intervjustudie genomfördes utifrån en kvalitativ ansats. Datainsamlingen utgick från semistrukturerade intervjuer med sjubarnsjuksköterskor inom barnhälsovården. En kvalitativ innehållsanalys användes i analysprocessen. Resultatet presenteras utifrån analysens framkomna fyra kategorier: Bedömning och uppföljning av övervikt och fetma, De goda valen, Faktorer som berör barnsjuksköterskans arbete och Den enskilda barnavårdcentralen. Barnsjuksköterskornas hälsofrämjande och förebyggande arbete mot övervikt och fetma hos barn inom barnhälsovården grundar sig på att främja de goda valen och skapa en tillitsfull relation till familjen. Slutsats:En förhoppning är att föreliggande studie kan bidra till att belysa de faktorer som berör barnsjuksköterskans hälsofrämjande och förebyggande arbete mot övervikt och fetma hos barn, vilketi sig skulle kunnastödja och utveckla barnhälsovården.
Background: Overweight and obesityin children is a global public health problem. The Child Health Care(CHC) havean important role in thepreventionof childhoodobesity and in the promotion ofchildren’s growth and development. The aimof this study was to illustrate thehealth promotion and preventativework of pediatricnurse’s against overweight and obesity in the CHC. Method: An interview study was conductedbased on a qualitative content analysis. The data collection was based on semi structured interviews with seven pediatric nursesworking at CHC:s.A qualitative content analysiswas used in the analysis process. Results: The result is dividedintofour categories based on the analysis: Assessment and follow-up of overweight and obesity, The good choices,Factors that concern the pediatric nurse’s work and The individual Child Care center.The pediatric nurse’shealth promotionand preventative work against overweight and obesity in children in the Child Health Care is based on promoting the good choices and creating a trustful relationship with the family. Conclusion: Hopefully thisstudy canhighlightthe pediatric nurse’shealth promotiveand preventative work against overweight and obesity in children.

Mestrado em Enfermagem, Área de especialização: Enfermagem de Saúde Infantil e Pediátrica
O presente documento, elaborado no âmbito do curso de Mestrado em Enfermagem com especialização em Enfermagem de Saúde Infantil e Pediátrica, tem como objetivo geral descrever e refletir acerca do percurso de aprendizagem realizado, que nos permitiu o desenvolvimento do projeto de intervenção “Continuidade de Cuidados em Pediatria: SER criança com doença crónica no domicílio- Uma Resposta Pediátrica”. A doença crónica tem um enorme impacto na criança/família, tendo que ser assumida como um enorme desafio e responsabilidade para as instituições de saúde, que deverão responder cabalmente às suas necessidades. Neste âmbito, o Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica (EEESIP) ganha um papel de destaque. Percorridos diferentes contextos de cuidados à criança/jovem e família, foram delineados objetivos e desenvolvidas atividades, visando a obtenção de competências de Mestre, bem como competências específicas do EEESIP, seguindo a linha orientadora do projeto, o qual foi desenvolvido sob a metodologia de trabalho de projeto. Das experiências vivenciadas, emergiu um corpo de conhecimentos que contribuiu para a construção do perfil de competências de enfermeiro especialista e de Mestre em Enfermagem. Consideramos, assim, que atingimos os objetivos propostos.
The present document, elaborated in the scope of the Master's degree course in Nursing with specialization in Child and Pediatric Health Nursing, has a general objective to describe and reflect about the learning pathway that has enabled us to develop the intervention project "Continuity of Care in Pediatrics: Being a child with chronic illness at home - the Case Manager ". Chronic illness has a huge impact on the child / family, and must be assumed as a huge challenge and responsibility for health institutions, that must respond to their needs. In this context, nurses specializing in children's and pediatric health (EESIP) gain a prominent role. Through different contexts of child / youth care and family, objectives were defined and activities were developed, aiming at obtaining masters' competences, and also specific competences of EESIP, following the guideline of the project, that was developed under the methodology of the project work. From these experiences, emerged a body of knowledge that contributed to the construction of the skills profile of a specialist and Master nurse. We consider that we have achieved the proposed objectives.

Este relatório tem por base o Estágio de Saúde Infantil e Pediátrica (SIP) realizado no período de 19/04/2010 a 29/01/2011, em diferentes contextos assistenciais à criança e família. Surge com o propósito de evidenciar a aquisição, desenvolvimento e integração de competências diferenciadas conducentes à obtenção do Grau de Mestre em Enfermagem, na especialidade de Enfermagem de Saúde Infantil e Pediátrica, após defesa pública. Assim, enquanto instrumento de partilha e veículo de transmissão, a sua finalidade primordial é fornecer, de forma global e coerente, um relato sintético e objetivo do trabalho/atividades realizadas nos diferentes contextos de estágio, no sentido de alcançar os objetivos gerais e específicos previamente estabelecidos e, desta forma, desenvolver competências científicas, técnicas, culturais e humanas como Enfermeiro Especialista de Saúde Infantil e Pediátrica nos domínios da prestação de cuidados especializados, gestão de cuidados e de serviços, formação e investigação. O estágio decorreu no Centro de Saúde de São Martinho do Bispo (CSSMB) em Coimbra (Módulo I – Saúde Infantil) e no Hospital de Santo André (HSA) em Leiria (Módulo II- Serviço de pediatria (SP) e Módulo III - Serviço de Urgência Pediátrica (SUP) e Unidade de Cuidados Especiais Neonatais e Pediátricos (UCEP)). A metodologia utilizada é descritiva e reflexiva. A componente crítico-reflexiva, que apresentamos, ao longo de todo este documento visa transmitir a intencionalidade das atividades desenvolvidas, o significado das experiencias vividas e o aporte enriquecedor que este período de formação proporcionou como Enfermeiro Especialista em Saúde Infantil e Pediátrica, para a prestação de cuidados de enfermagem avançados e especializados, numa perspetiva holística, à criança, adolescente, família e comunidade. Procuramos evidenciar a aquisição, desenvolvimento e integração de competências / saberes para a assistência de enfermagem avançada ao recém-nascido, criança e adolescente, especialmente direcionadas para a promoção do desenvolvimento e adaptação aos processos de saúde e doença. Elegemos como foco de enfermagem privilegiado, e transversal a todo o estágio, a Promoção da segurança e Prevenção de acidentes na criança, por razões que se prendem com a sua pertinência social e profissional. Social, porque apesar da evolução do conhecimento científicotecnológico e dos avanços da medicina, os acidentes na infância, representam, um importante problema de saúde pública. Cultura de segurança – sempre existiu. Contudo, impõem-se a necessidade de manutenção desta cultura. Parece-nos claro que crescer em segurança passa pelo desenvolvimento e pela consolidação de uma cultura social de segurança. Profissional, porque diariamente, enquanto enfermeiro a exercer num serviço de pediatria, somos confrontados com um número significativo de crianças vítimas de acidentes. Trata-se de um foco emergente e altamente sensível à intervenção do Enfermeiro Especialista em SIP, enquanto profissional detentor de conhecimentos, competências e capacidades que lhe permitem um efetivo entendimento do crescimento e desenvolvimento da criança, do seu ambiente familiar e social. As crianças representam o futuro, e garantir o seu crescimento e desenvolvimento seguro e saudável deverá ser uma preocupação primordial de toda a sociedade em geral e dos profissionais de saúde em particular. Assim, neste percurso de estágio, criamos um projeto multimédia, de carácter transversal, intitulado “Criança + Segura! Sem segurança ?? Sinto muito…
This document is based on a placement of Pediatrics’ health care that took place between 19/04/2010 and 29/01/2011, in different caring contexts for child and family. This becomes with the purpose of showing the acquisition, development and integration of the several skills that will lead to a master’s degree in Nursing, in the main area of infant and child health care. Thus, as knowledge instrument, its primary purpose is to provide, in a global and coherent way, a synthetic and objective description of the work/activities undertaken in the different contexts of the placement. In order to achieve the aim and specific objectives of the placement, scientific, technical, cultural and human skills were developed as Nurse Specialist in Pediatric and Child Health in the areas of specialized care, care management and services, training and research. The placement took place at the Health Center of São Martinho do Bispo in Coimbra (Module I - Child Health) and at Santo André Hospital in Leiria (Module II- pediatric service and Module III - Pediatric Emergency and Unit of Pediatric and Neonatal Special Care. The methodology used was descriptive and reflexive. The critical and reflexive component is present throughout this document and it intends to convey the intent of the activities developed and performed. The meaning of the lived experiences and the enriching contribution has provided advanced and specialized nursing care, in a holistic perspective, to the child, adolescent, family and community. This work presents the acquisition, development and integration of skills/knowledge for advanced nursing care to newborns, children and adolescents, especially aimed at promoting the development and adaptation to health and disease processes. The focus of privileged nursing chosen was the safety promotion and accident prevention in children, transversal to the entire placement, for reasons connected with their social and professional relevance. Social, because childhood accidents, represent an important public health problem, despite of the development of the scientific-technological knowledge and the advances in medicine. Safety culture as it always existed. However, it is necessary to maintain this culture. It seems clear that to grow in safety it requires the development and consolidation of a social culture of security. Professional, because daily as a nurse practicing in a pediatric service, a significant number of children victims of accidents is faced. This is an emerging focus and highly sensitive to the intervention of a Specialist Nurse in Pediatric and Child Health, as a professional with knowledge, skills and abilities to a real understanding of the children´s growth and development, in their familiar and social environment. Children represent the future and ensure their safe growth and healthy development must be a primary concern of society in general and of health professionals in particular. So, at this stage of the placement, a multimedia presentation of transversal character was elaborated, entitled “Criança + Segura! Sem segurança ?? Sinto muito…”

O presente relatório pretende descrever o meu processo de aprendizagem, no âmbito da Unidade Curricular Estágio, que se iniciou com o desenvolvimento de um Projecto Individual de Estágio, subordinado ao tema “A Dor na Criança/Família”, pretendeu-se durante o estágio, contribuir para o desenvolvimento de competências no âmbito da assistência à criança/família com dor, através do alívio e minimização desta, no âmbito das funções atribuídas ao Enfermeiro Especialista em Saúde Infantil e Pediatria. A valorização da dor na criança tem vindo a crescer, reconhecendo-se que a criança aprende, desde cedo, o sentido de dor, no entanto, algumas crenças persistem, influenciando muitas vezes os cuidados à criança. Existe um conjunto de intervenções que desempenhadas por todos os que cuidam da criança, tais como, pais ou profissionais de saúde, contribuem de forma decisiva para a diminuição e alívio da dor face procedimentos invasivos. A teórica que norteou este percurso foi Katharine Kolcaba, e a sua Teoria do Conforto (1994), que se centra nas necessidades de cuidados de saúde como necessidades de conforto ao nível físico, ambiental, psico-espiritual e sociocultural. A escolha desta teórica deriva do facto da dor poder ser interpretada e explicada pela estrutura taxonómica do conforto defendida pela autora. As necessidades da criança/família foram essenciais na avaliação inicial e permitiram-me realizar um diagnóstico de situação, a partir do qual pude planear actividades fundamentadas na experiência de saúde individual e humana do utente pediátrico Destaco o desenvolvimento das seguintes actividades: no âmbito dos cuidados de saúde primários, a implementação de estratégias de alívio da dor perante o diagnóstico precoce e a vacinação; na neonatologia, o “Banho Enrolado” e, em contexto da urgência pediátrica, a implementação da avaliação da dor e a operacionalização de um conjunto de estratégias não farmacológicas de alívio da dor na criança/família. Neste processo formativo desenvolvi competências técnicas, científicas, relacionais e éticomorais que me permitem o cuidado especializado em enfermagem avançada à criança e família, impulsionando o meu crescimento e desenvolvimento, com finalidade de diminuir a dor e ansiedade face aos procedimentos invasivos e assim atingir a excelência do cuidar, sendo isto, que se espera de um Enfermeiro Especialista em Saúde Infantil e Pediatria
This report aims to describe my learning process during the nursing internship course that began with the development of an individual project that aimed to "Pain in Child / Family" and aimed to contribute to the development of skills in scope of advanced nursing in child care / family with pain, through the relief and minimization of pain, within the tasks assigned to the Nurse Specialist in Pediatrics and Child Health. The knowledge concerning pain in children has been receiving more recognition and it is accepted that children learn early on the meaning of pain, however, some beliefs persist, often influencing child care. A number of interventions performed by everyone who cares for the child such as parents or health professionals, contribute decisively to the reduction and pain relief over invasive procedures. The theoretical principles underlying the work presented, was Katharine Kolcaba, and her Theory of Comfort (1994), which focuses on healthcare needs such as physical comfort, environmental, psycho-spiritual and cultural needs. The choice of this theory derives from the fact that pain can be interpreted and explained by the taxonomic structure of comfort defended by Kolcaba. The needs of the child / family, were essential in the initial evaluation, allowing me to diagnose the situation. Thus, planning of activities was defined with a base grounded in the child’s individual experience of health. I will highlight the development of the following activities within the primary health care strategies for pain relief before the early diagnosis and vaccination in the neonatal implementation of the "Wrapped Bath" and in the context of the implementation of emergency pediatric pain assessment and of non-pharmacological strategies for pain relief in children / family. In this formative process, I developed technical, scientific, moral, ethical and relational skills that allow me to care as a specialized advanced nurse for the child and family, contributing to my growth and development, aiming to reduce the pain and anxiety of the child in situations of invasive procedures and thus achieve excellence of care, and this, is what is expected of a Nurse Specialist in Pediatrics and Child Health

Este relatório surge como o resultado de uma reflexão sobre as actividades desenvolvidas e competências adquiridas ao longo da Unidade Curricular Estágio inserida no Mestrado em Enfermagem de Saúde Infantil e Pediatria. O objectivo geral para a Unidade Curricular Estágio foi "Prestar cuidados de enfermagem à criança/família de acordo com a Teoria do Conforto de Katharine Kolcaba, no âmbito das funções atribuídas ao EESIP". O conforto está vinculado à enfermagem desde a sua origem. No contexto pediátrico em Portugal, os enfermeiros têm vindo a desenvolver uma visão mais holística do binómio criança/família. É fundamental abandonar o conceito de que o conforto é apenas uma medida de alívio da dor mas sim algo positivo, dinâmico e complexo. A enfermagem enquanto disciplina do conhecimento e da prática deverá fundamentar as suas intervenções em procedimentos metodológicos. Considerando o conforto como o estado resultante das intervenções de enfermagem, a Teoria do Conforto de Katharine Kolcaba (1994) apresenta uma estrutura taxonómica que permite operacionalizar este conceito. Demonstra-se a aplicabilidade desta teoria, ao longo dos três Módulos de Estágio ocorridos em contexto: comunitário (Centro de Educação para Crianças Deficientes e na Unidade de Cuidados Personalizados de Alcântara); de internamento da criança/família com doença crónica (na Unidade de Cuidados Especiais e Nutricionais do Hospital Dona Estefânia) e de atendimento à criança/família em situação crítica (Serviço de Urgência Pediátrica e Unidade de Cuidados Intensivos Neonatais do Hospital Dona Estefânia). Utilizou-se como metodologia o levantamento das necessidades de conforto da criança/família como um diagnóstico da situação de cada local, para um posterior delinear de estratégias com vista ao conforto. Com base na estrutura taxonómica da Teoria do Conforto de Kolcaba, estes resultados permitiram fomentar mudanças que procuram estabelecer comportamentos promotores de saúde na criança/família. A promoção do conforto aplicada à criança/família é uma atitude altruísta, prática e satisfatória para quem é confortado e para quem conforta, traduzindo-se em ganhos em saúde e contribuindo para a excelência dos cuidados de enfermagem.
This report was the result of a reflection of the activities and skills acquired throughout the Internship Course inserted in Nursing Master of Pediatrics and Child Health. The overall objective for the Internship Course was "to provide nursing care for the child/family according to the Theory of Comfort by Katharine Kolcaba within the functions attributed to EESIP . Comfort is bound to nursing since its inception. In the pediatric context in Portugal, nurses have been developing a more holistic view of the binomial child / family. It is essential to abandon the concept that comfort is only a measure of pain relief but something positive, dynamic and complex. Nursing as a discipline of knowledge and practice, should base their interventions on methodological procedures. Given the comfort and the resulting state of nursing interventions, the Theory of Comfort Katharine Kolcaba (1994) presents a defined taxonomic structure, which allows applying the concept. Over the three modules occurring in the context InteRNhip: Community (Education Center for Disabled Children and Care Unit Custom Alcantara) hospitalization of the child / family with chronic illness (in Unit Special Care and Nutrition, Hospital Dona Estefania) and child care / family emergency (ER Pediatric and Neonatal Intensive Care Unit, Hospital Dona Estefania), was possible to demonstrate the applicability of this theory. Following a methodology, where used Surveys for gathering the needs and comfort of the child / family, along with a diagnosis of the situation of each location, all for shaping strategies in order to reach comfort as defined by Kolcaba. These results led to foster changes that sought to establish health-promoting behaviors in children and their family life. The promotion of comfort applied to child / family is an unselfish attitude, practical and satisfactory for those who are comforted and comfort, resulting in gains in health and contributing to the excellence of nursing care.