Living the birth process in a humanized assistance model

That was a qualitative study with phenomenological approach that aimed at understanding women's post-partum experiences in a humanized assistance. Data were collected in a hospital from S?o Paulo, SP, Brazil. Eight women in post-partum period were interviewed. From data analysis two themes were extracted: Bearing the labor and Having the opportunity rescuing autonomy, being disclosed the phenomenon: "Living the ambiguity on the birth process in a humanized assistance model". The reports show feelings like pain, fear and anxiety, however, it allowed a participation and rescuing autonomy. Although the study have been realized in a humanized assistance, the women's experiences reveals that they are far from an effective humanization, according to its principles. This study can be used to guide educative actions target to humanization and to generate managerial changes.     

Humanized care in the teaching of nursing

This 'teaching experience' report addresses contents related to the humanized care given to children/adolescents and to their family. It was made in collaboration with students of the Undergraduate Course in Nursing. The Creativity and Awareness workshops proposed by Cabra I (1999) have been used as methodology because they proved adequate to approaching complex themes such as prevention of violence against children/adolescents and assistance to families that experience child sickness. During the workshops, the aim is to create an environment for reflection on humanized care on the basis of students' experiences. We found out that it is important to introduce alternative methodologies into the teaching/learning process of students, seeking the construction of knowledge and giving priority to their experiences.     

Perception of clients when receiving home care

This qualitative and exploratory study analyzed the perception of users of the Home Care Program (SSS-GHC) in Porto Alegre, Rio Grande do Sul state regarding the assistance provided by its interdisciplinary team and caretakers. Among the 17 clients interviewed, there was a prevalence of women, elderly people and chronic degenerative disease patients. As a result of the analysis it was possible to identify five categories which were related to family, professional care and experiences of the subjects in relation to life circumstances. Results showed that, according to the client's point of view, the care received was viewed as humanized and favorable to the evaluative strategy of the Program.     

Cultural meaning of humanized care at intensive care units: "lots of words,little action"

This work consists in an ethnographic study which aimed at understanding the cultural meaning attributed by nursing teams to humanized care in Intensive Care Units of the University Hospital of Goiás Federal University. Participant observations and semi-structured interviews were used for data collection with nursing teams at their workplace. Three main categories emerged from the data: humanized care--"love the other as you love yourself"; humanized care--"it's not present as it should be"; stress and suffering--"the ones who care need to be looked after". The cultural theme that emerged from the data was: the humanized care--"a lot is said about it, but little is experienced". This theme emphasize the reality of the care at the ICU that involves a nursing team with the humanization concept synthesized on the expression: "love the other as you love yourself"; but in a practical way, the caring process does not reveal this deep thought.     

Nursing and caring for in the area of mental health

This study describes the sociopolitical aspects that involved the psychiatric assistance reform, focusing the deinstitutionalization process and the importance of nursing beyond a component of the interdisciplinary team. It aims to analyze the process of nursing assistance to the mentally sick in services outside the hospital. It is a bibliographical review of national periodicals from 1999 to 2001. The authors discuss workers' engagement in the area of mental health, with the "deconstruction"/construction about care, making necessary a humanized approach by way of the interpersonal relationship of patients, nurses and the teams responsible for giving assistance to the mentally sick.     

Discourse and practice of care to newborns at risk: reflecting about humanized care

This study identifies nurses' opinions on humanized care for newborn at risk and their families, using Paterson and Zderad's theory (1976) as a theoretical-methodological reference framework. It was carried out at the Neonatal Intensive Care Unit of a maternity in Fortaleza-CE, between April and July 2003. Data were collected through interviews with 6 nurses. They approached the following themes: humanization, sensitiveness, conscience and care. There is a need to unite discourse with practice in humanized care for newborns at risk.     

RSV outbreak in a paediatric intensive care unit

The Royal Liverpool Children's Hospital-Alder Hey paediatric intensive care unit (PICU) usually has a low rate of nosocomial respiratory syncytial virus (RSV) infection. We report and analyse a major outbreak of nosocomial (acquired) RSV infection on the PICU during a RSV season. All children admitted to the PICU were studied during the six-month winter period 1 October 2002 to 31 March 2002. Nasopharyngeal aspirates were tested using an in vitro enzyme-linked immunoassay (ELISA) membrane test for RSV antigen. PICU-acquired RSV infection was considered to have occurred when a child admitted to the PICU was RSV negative, or from whom no samples were taken as they did not exhibit signs of bronchiolitis, but was RSV positive five or more days after the admission. Fifty-four patients tested RSV positive using the ELISA on the PICU. All the patients were ventilated. Thirty-nine children were RSV positive using the ELISA on admission to the PICU ('imported' cases) and 15 became RSV positive whilst on the PICU ('acquired' cases). The source of the acquired RSV infection accounting for the first peak/outbreak in nosocomial cases were RSV-positive children in isolation cubicles. Acquired cases of RSV infection subsided with reinforcement of traditional methods of barrier precautions. The source of the second peak in nosocomial cases were persistent shedders of RSV. Seventy-three percent (11/15) of the acquired RSV cases had one or more of the following co-morbidities: congenital heart disease, chronic lung disease, airways abnormalities or immunosuppression. Droplet precautions (strict handwashing, use of gloves if handling body fluids, single-use aprons, education) rather than the physical barrier of the cubicle itself played a more important role in curtailing nosocomial spread. Persistent shedders of RSV are an important potential source of nosocomial RSV infection within a PICU. Patients with co-morbidities are at increased risk of nosocomial RSV infection.     

儿童重症监护病房与普通病房病原菌分布 及耐药现状探讨

摘要:目的　了解儿童重症监护病房（Pediatric Intensive Care Unit,PICU）与普通儿科病房（非PICU）患儿医院感染病原菌分布和耐药现状,为临床合理使用抗菌药物进行抗感染治疗提供依据。方法　采用法国生物梅里埃VITEK-2全自动细菌鉴定分析仪进行鉴定和药敏试验,采用WHONET5.6软件进行数据统计分析。结果　2011年1 月-2013年12月某院儿科病房临床分离株共2850株,革兰阴性菌1840株占64.56%,居前4位的是肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌和铜绿假单胞菌;革兰阳性菌636株占22.31%,居前4位的是金黄色葡萄球菌、屎肠球菌、凝固酶阴性葡萄球菌和粪肠球菌;真菌374株占13.12%,以白色假丝酵母菌为主;PICU肺炎克雷伯菌对一、二、三代头孢菌素、头霉素和氨曲南耐药率＞50%;PICU鲍曼不动杆菌对头孢他啶、头孢吡肟耐药率＞50%,对亚胺培南、美罗培南耐药率＞30%;PICU耐甲氧西林金黄色葡萄球菌（MRSA）占25.00%。结论　PICU与非PICU患儿医院感染病原菌均以革兰阴性杆菌为主,PICU的耐药率明显高于非PICU,对常用抗菌药物呈多重耐药,应重视及加强对PICU患者的病原学检查及耐药性监测。     

Puerperal infection from the perspective of humanized delivery care at a public maternity hospital

This is an epidemiological, prospective and non-concurrent study of the cohort type about puerperal infection from the perspective of humanized delivery care, based on information from 5,178 records of patients who went through the experience of humanized delivery. The study aimed at describing the women who underwent humanized delivery, determining the incidence and time for manifestation of puerperal infections and investigating the association between the infection and the risk factors. An accumulated puerperal infection rate of 2.92% was found. The risk factors associated to puerperal infection in Cesarean delivery were the duration of labor and the number of digital examinations. No variable behaved as a risk factor for infection in normal delivery. Cesarean delivery was an important risk factor for puerperal infection. The results reinforce the need to develop alternative forms of delivery care that provides effective conditions for normal delivery, in order to reduce the number of Cesarean sections.     

Home pediatric compassionate extubation: bridging intensive and palliative care

Compassionate home extubation for pediatric patients is a topic that seldom appears in the literature and is of unknown clinical importance. However, standards in pediatric intensive care unit (PICU) and among pediatric critical care physicians regarding end-of-life decisions are changing, including where and when patient extubation occurs. The authors' hospice recently consulted on an infant with spinal muscular atrophy in the PICU requiring mechanical ventilation, for whom further life-sustaining care was deemed futile. In consultation with the family, nursing staff, physicians, and the ethics committee, and following protocol guidelines, arrangements were made for this infant and his parents to be transported home. Once comfortable with his family, a small amount of lorazepam was given and the endotracheal tube removed. The infant died quietly about 20 minutes later. This case prompted the authors to review the current state of published articles covering this topic, suggest a protocol for implementing home extubation, realize imposed barriers, and discuss potential solutions. A well-developed plan for home extubation procedures may improve interactions with PICU and hospice services and at the same time provide additional choices for parents and patients wishing to maximize end-of-life quality outside the hospital setting.     

Etiology of fever and opportunities for reduction of antibiotic use in a pediatric intensive care unit.

OBJECTIVE: To determine the cause of fever in critically ill children and to identify opportunities for reducing antibiotic use in this population. DESIGN: Prospective case series. SETTING: A tertiary-care medical-surgical pediatric intensive care unit (PICU). PATlENTS: Children admitted to the PICU who experienced fever (axillary temperature >38.3 degrees C). MEASUREMENTS: Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups. RESULTS: Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of fever in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards. CONCLUSIONS: Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.     

Epidemiologic investigation of Burkholderia cepacia acquisition in two pediatric intensive care units.

OBJECTIVES: To investigate and describe an outbreak of Burkholderia cepacia in a neonatal intensive care unit (NICU) and a pediatric intensive care unit (PICU), and to report the interventions leading to the cessation of the outbreak. DESIGN: We conducted an epidemiologic investigation of an outbreak of B. cepacia colonization or infection in two clinical wards during a 35-month period (December 1998 to October 2001). SETTING: A 500-bed, university hospital-affiliated, tertiary-care pediatric institution in Paris, France, with a 22-bed PICU and 31-bed NICU. METHODS: Ribotyping was used to determine the genotypes of B. cepacia isolates. Procedures for the maintenance and disinfection of respiratory therapy devices were reviewed. RESULTS: Thirty-two children were colonized (n = 14) or infected (n = 18) by B. cepacia in 2 wards (28 in the PICU and 4 in the NICU). In the PICU, a single ribotype was found among the isolates obtained from all of the patients except 1, and from the 6 isolates obtained from respiratory therapy devices (ie, heated humidifier water). In the NICU, the isolates obtained from the patients harbored a single ribotype unrelated to that of the epidemic strain isolated in the PICU; no environmental source of infection was found. CONCLUSION: Two different outbreaks appeared to be associated with 2 ribotypes, 1 of which was linked to patient-to-patient transmission via respiratory therapy devices. Complete elimination of the outbreak was achieved only when disposable, sterilizable, or easy-to-disinfect materials were used in the PICU. The source of infection in the NICU was not found.     

Nursing assistance and home care in antineoplastic chemotherapy

This paper is the result of our experience in clinical oncology in which we verified the lack of systematization in the nursing assistance offered to oncological patients. Thus, the objectives of this study are to analyze the problems of patients undergoing antineoplasic chemotherapy; identify the need for home nursing care; implement a systematic home assistance in order to continue the post-chemotherapy care and analyze the proposal of a systematic assistance. It was concluded that a specialized, systematic, whole, continuous and holistic assistance, extended to the patients' homes, minimizes complications associated to the side effects of antineoplasic chemotherapy.     

Nosocomial Branhamella catarrhalis in a paediatric intensive care unit: risk factors for disease

There have been few reports on Branhamella catarrhalis as a nosocomial pathogen, and no risk factors for nosocomial infection have been identified. We report 11 cases (mean age 22 months) of nosocomial Branhamella catarrhalis respiratory tract infection in a paediatric intensive care unit (PICU) over a two-year period. There were 2 cases of pneumonia and 9 cases of bronchitis. Branhamella catarrhalis was the sole isolate recovered in 6 cases and was associated with other respiratory pathogens in 5 cases. A case-control study with two age-matched controls per patient (mean age 24.1 months) was undertaken to identify potential risk factors for infection; risk factors identified were the presence of an endotracheal tube (p less than 0.02) and frequent endotracheal tube suction (p less than 0.05). Five of 6 tested strains from PICU patients produced beta-lactamase. DNA preparations of 4 B. catarrhalis isolates from PICU patients revealed no plasmids. B. catarrhalis should be considered a potential nosocomial pathogen.     

Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia

The aim of this study was to determine the rate, risk factors and outcomes of catheter-related bloodstream infections (CRBSIs) in patients in a paediatric intensive care unit (PICU). A prospective cohort study was performed in King Abdulaziz Medical City, Riyadh, Saudi Arabia; a 650-bed academic/tertiary care centre with a combined 10-bed medical and surgical PICU. All patients admitted to the PICU from July 2000 to February 2003 who had a central line placed were monitored for the development of bloodstream infection (BSI) from insertion until 48 h after removal. Four hundred and forty-six patients with 2493 central-line-days were documented; 273 (55%) were male and the mean age was 2.6 years. Of the 446 patients, 278 (56%) had congenital heart disease, 108 (22%) had genetic disorders and/or congenital malformations, 55 (11%) had respiratory disease, and 42 (8%) had trauma. There were 50 episodes of CRBSI in 46 patients with a rate of 20.06 per 1,000 central-line-days and a device-utilization rate of 57%. Of these 50 episodes, 24 (48%) were polymicrobial, 16 (32%) were due to Gram-negative organisms, five (10%) were due to Gram-positive organisms, and five (10%) were fungal. The most common organisms isolated were Klebsiella pneumoniae (N=12, 16%), coagulase-negative staphylococci (N=10, 14%) and Pseudomonas aeruginosa (N=8, 11%). The mean duration of line insertion was 11.8 days for CRBSI patients and 4.22 days for non-BSI patients (P<0.0001). The mean PICU stay was 30.20 days for CRBSI patients and 6.35 days for non-BSI patients (P<0.0001). BSI occurred more often in catheters inserted in the PICU compared with the operating room, and in the femoral site compared with jugular or subclavian sites (P<0.001). In multiple logistic regression analysis of the risk factors, CRBSI patients were more likely to have multiple central lines [odds ratio (OR) 9.19; 95% confidence intervals (CI): 3.76-22.43), the line was more likely to be used for total parenteral nutrition (OR: 8.69; 95% CI: 3.5-21.4), and guidewire exchange was more likely to be performed on the line. CRBSI was not associated with a higher mortality rate. The CRBSI rate in our hospital is high compared with that reported by the National Nosocomial Infection Surveillance system. This study has established a benchmark for future comparisons. Additional studies from Saudi Arabia are necessary for national comparison and development of preventive measures.     

PICU鲍氏不动杆菌临床感染趋势及护理干预

目的 探讨儿童重症监护病房(PICU)鲍氏不动杆菌(ABA)临床感染趋势、耐药性和护理干预措施.方法 回顾性分析2007年1月-2009年12月武汉市儿童医院PICU确诊的ABA感染患儿各类临床标本ABA分离率及其耐药性.结果 3年确诊ABA感染患儿212例,共检出ABA 329株,药敏结果显示,对阿米卡星、左氧氟沙星、环丙沙星耐药率最低＜3.0％,对青霉素类、头孢菌素类等抗菌药物耐药率均＞70.0％,并呈逐年上升趋势.结论 ABA感染在PICU不断增加,常用抗菌药物表现严重耐药和多药耐药,且呈逐年上升趋势.依据细菌培养和药敏结果,合理科学用药,同时加强医院环境和人员消毒管理,进行有效的护理干预措施能积极控制ABA在PICU的定植与播散.     

全方位关怀在儿科重症监护室的应用效果

目的探析全方位关怀式护理在儿科重症监护室(PICU)中的应用效果。方法选取2018年1月-2019年12月广东省中山市人民医院PICU收治的100例患儿,随机分为对照组和观察组各50例,对照组患儿给予常规护理干预,观察组在对照组基础上给予全方位关怀式护理,收集两组的并发症发生率、家属对护理满意率和患儿的治疗配合度。结果观察组患儿并发症发生率为6.0%,低于对照组的22.0%,差异有统计学意义(P<0.05)。观察组患儿家属对护理满意率和患儿配合度均高于对照组,差异均有统计学意义(P<0.05)。结论全方位关怀式护理的实施有助于促进PICU患儿配合治疗,构建和谐护患关系,从而促进患儿早日康复,值得临床推广应用。