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- Funkquist, Eva-Lotta, 1965-
(författare)
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Policies and Practice in Neonatal Nursing Related to Nutrition
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of these studies was to increase knowledge about hospital feeding routines in high-risk neonates. A retrospective medical chart review procedure was used to study routines at the neonatal units of two Swedish hospitals. In Papers I and II, the sample (Uppsala n=21 and Umeå n=21) comprised of small for gestational age (SGA) infants, in Papers III (Uppsala n=64 and Umeå n=59) and IV (n=127), the samples comprised of appropriate for gestational age (AGA) infants. Paper I indicated large enteral/oral milk volumes rendered i.v. administration of glucose unnecessary, reduced weight loss and helped SGA infants regain birth weight earlier. More rapid postnatal growth did not remain up to 18 months with corrected age in any growth variable (Paper II). In Paper III, effects were compared whether the infants’ volume of breast milk intake in hospital was estimated by “clinical indices” or determined by test-weighing. Infants treated in hospitals where test-weighing was practised attained exclusive breastfeeding at an earlier postmenstrual age (PMA), and they were discharged at an earlier PMA. However, the two study units were similar regarding the proportion of infants attaining exclusive breastfeeding. Paper IV revealed preterm AGA infants with higher standard deviation scores (SDS) at birth had more negative changes from birth to discharge for all growth variables. Conclusions: Papers I and II indicated that early initiation of enteral/oral feeding with proactive increases in milk volume was beneficial short term. No evidence was found for a proactive nutrition regimen with initial large volumes of milk resulting in a different pattern of growth up to the corrected age of 18 months. Test-weighing before and after breastfeeding might help infants to attain exclusive breastfeeding at an earlier PMA (study III). Finally, preterm AGA infants with higher SDS at birth are at higher risk of inadequate growth during their hospital stay (study IV).
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| 2. |
- Almblad, Ann-Charlotte, 1965-
(författare)
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Early Detection and Treatment for Children : Experiences and outcome of implementation at a pediatric hospital
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early recognition of severely ill children is necessary to prevent serious adverse events and unexpected death. To promote patient safety the Early Detection and Treatment Program for Children (EDT-C) was developed at a University Children’s Hospital in Sweden. This program consists of validated tools for communication and teamwork combined with the Pediatric Early Warning Score (PEWS) and guidelines for recommended actions. Ward specific guidelines were developed and EDT-C instructors were trained. The aims were to describe healthcare professionals’ experience of caring for acutely, severely ill children (Study I) and to evaluate the implementation of EDT-C (Study II, III, IV). The Promoting Action on Research Implementation in Health Services (PARiHS) framework guided both implementation and the research study.Before introducing the EDT-C, focus group interviews were performed to explore healthcare professionals’ experience of caring for acutely, severely ill children. A context assessment, using the Alberta Context Tool (ACT) was also conducted. After implementation, a retrospective review of the electronic patient records (EPR) to assess adherence to guidelines were carried out. Instructors’ and healthcare professionals’ experiences from the implementation of EDT-C were gathered through individual interviews. To evaluate the introduction of EDT-C in relation to admission and stay at intensive care a retrospective before-after study using EPR data was performed. Interviews were analyzed using qualitative content analysis and descriptive statistical methods were utilized for quantitative data.The caring for acutely severely ill children was described as being in a multifaceted area of tension with paradoxical elements where contradictory emotions emerged. According to documentation, children at a very high risk of clinical deterioration according to PEWS were identified. Adherence to actions prescribed in guidelines varied. Healthcare professionals and instructors described EDT-C as suitable for clinical practice and that it created a more structured way of working. It was furthermore described that PEWS measurement had become routine practice at the hospital.EDT-C can lead to increased knowledge about early detection of deterioration, strengthen the healthcare in their profession, optimize treatment and teamwork and thereby has potential to increase patient safety for children treated in hospitals.
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