Рекомендації П’ятої Всеукраїнської науково-практичної конференції пам’яті почесного професора ТНТУ імені Івана Пулюя, академіка НАН України Чумаченка Миколи Григоровича: «Інноваційні засади управління підприємствами в умовах сталого розвитку»

The life of a preterm infant admitted to a neonatal intensive care unit may be stressful from the moment of birth. Ever since Hans Selye’s initial characterisation of the biological stress response, cortisol has been frequently measured as an indicator of stress responsivity. However, research of the stress response and cortisol in infants, especially those who are preterm and/or ill, has been scarce basically because of methodological issues. The first aim with this thesis was to investigate the acute stress response, as measured by salivary cortisol and behaviour, for preterm infants, healthy infants, and infants at high psychosocial risk in response to certain defined handling procedures. The second aim was to investigate the stress response, as measured by salivary cortisol and psychometric measures, for parents present during the handling procedure of their infants. The intention was to perform all investigations in an as naturally occurring situation as possible, which means that the studied procedures would have been performed irrespectively of the research. The present thesis includes six original articles. The results of the first study demonstrate that it is feasible to collect sufficient amounts of saliva and to analyse salivary cortisol in neonates using the presented method of collection and analysis. The second study shows that preterm infants, usually cared for in incubators, show no signs of discomfort and have variable cortisol responses during skin-to-skin care with their mothers. The mothers, however, experience stress and low control before their first skin-to-skin care with their preterm infant and do not relax completely until after the session. In the third study we found that preterm infants have higher baseline salivary cortisol as compared to healthy full-term infants. Moreover, preterm infants have higher and sustained pain response during a nappy change as compared to healthy full-term infants. The results of the fourth study shows that infants younger than three months, living in psychosocial high-risk families, have increased cortisol responses during a nappy change, performed by the mother. However, support with the aim of improving mother-infant interaction, dampens the stress response. The results of the fifth study show that oral sweet-tasting solution in combination with a pacifier dampen the levels of the stress hormone cortisol in three months old infants during routine immunisation. Moreover, parents experience more self-rated emotional stress before immunisation if it is their first child who is being immunised. The sixth paper shows that the material used for saliva collection (cotton buds with wooden or plastic sticks) is of importance when saliva is collected but for practical reasons not centrifuged within 24 hours prior to cortisol analyse. The present thesis shows that it is practically feasible to collect saliva and to analyse the stress hormone cortisol in infants. The interpretation of infants’ and parents’ salivary cortisol responses to different handling procedures are discussed in relation to shortand long-term consequences, neonatal intensive care, preterm birth, attachment, mood, and pain

A Swedish translation and validation of the mother-to-infant bonding scale

© Author(s) 2020. Aim: This study aimed to test initial validity, reliability, and feasibility of the Mother-to-Infant Bonding Scale in a sample of Swedish mothers. Methods: A translation was performed through 11 steps using a forward–backward bilingual technique. For criterion validity, the Swedish translation of the Mother-to-Infant Bonding Scale (S-MIBS) was compared with the Postpartum Bonding Questionnaire, sub-scale 1 (PBQ1) and 2 (PBQ2) and Edinburgh Postnatal Depression Scale (EPDS) in a sample of 63 Swedish mothers. Internal consistency was calculated with Cronbach’s alpha. For feasibility testing, the mothers were asked to grade their experience of S-MIBS and PBQ on a four-point scale. Results: The results show a correlation between S-MIBS and PBQ1 (r=0.80, p\u3c0.001), PBQ2 (r=0.69, p\u3c0.001) and EPDS (r=0.44, p\u3c0.001). Internal consistency was α=0.68. Most mothers (93.1%) found S-MIBS to be easy or very easy to complete compared with PBQ (88.7%). Conclusions: The initial testing of the Swedish translation of the Mother-to-Infant Bonding Scale shows usability to measure the mother’s emotions towards her healthy full-term infant

Everyday life with childhood functional constipation: A qualitative phenomenological study of parents\u27 experiences

Childhood functional constipation (FC) is a worldwide problem with treatment regiments affecting everyday life. Aim: To explore parents´ experiences of living with a child with FC and its impact on everyday family life. Method: A qualitative phenomenological interview study using a reflective lifeworld research approach. Interviews with 15 parents of otherwise healthy children aged 1–14 years affected by FC. Findings: Shame is the driving force making parents put everyday life on hold. The quest for control, self-imposed loneliness, guilt, inadequacy, and frustrating battles become essential parts of everyday life to protect it from FC-related shame. Conclusion: FC has as great an impact on everyday life as any childhood illness. Every part of family life is affected by FC. Continuously family support and guidance are needed. Practice implications: Healthcare professionals need to take FC more seriously, listen to the parents and try to understand their experiences of everyday life to enable custom made care plans with the family-unit in focus. Care with clinical sensitivity might help parents deal with the attendant shame and stigmatization that stem from illness beliefs about FC

A scoping review of non-pharmacological health education provided to families of children with idiopathic childhood constipation within primary health care

Objectives: Idiopathic childhood constipation is a prevalent condition that initially brings the child under the care of the primary health care team. Although it is acknowledged that health education is crucial to reducing chronicity, the range of evidenced-based non-pharmacological health education provided to families has not previously been reviewed. For this scoping review, 4 research questions sought to identify papers that provide information on the utilization of guidelines, the range of health education, who provides it, and whether any gaps exist. Methods: Following a registered protocol and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, searches of 10 online databases, reference lists, Google Scholar, and book chapter references were made. Eligible papers were original research published in English between January 2000 and December 2022. Results: Twelve worldwide studies (2 qualitative and 10 quantitative) reported that: evidence-based guidelines are not consistently used by primary care providers; the range of non-pharmacological health education provided is inconsistent; the non-pharmacological health education is provided by doctors, nurses, and pharmacists; and that gaps exist in non-pharmacological health education provision. Conclusion: This review demonstrates that rather than a lack of guideline-awareness, decreased specific idiopathic childhood constipation knowledge (and possibly time) may be responsible for inconsistent non-pharmacological health education. Inappropriate treatment and management of some children escalates risk for chronicity. Improving health education provision however, may be achieved through: increased collaboration; better utilization of nurses; and through developing the child’s health literacy by involving both child and family in all aspects of health education and decision-making

Струменеві захоплюючо-орієнтуючі пристрої

Introduction. Nurses often experience work-related stress. High stress can negatively affect job satisfaction and lead to emotional exhaustion with risk of burnout. Aim. To analyse possible differences in biological stress markers, psychosocial working conditions, health, and well-being between nurses working in two different departments. Methods. Stress was evaluated in nurses working in a neonatal intensive care unit (NICU) (n=33) and nurses working in a child and adolescent psychiatry inpatient ward (CAP) (n=14) using salivary cortisol and HbA1c. Salivary cortisol was measured three times a day on two consecutive days during two one-week periods, seven weeks apart (= 12 samples/person). Psychosocial working conditions, health, and well-being were measured once. Results. NICU nurses had better social support and more self-determination. CAP nurses had a lower salivary cortisol quotient, poorer general health, and higher client-related burnout scores. Conclusion. When comparing these nurses with existing norm data for Sweden, as a group their scores reflect less work-related stress than Swedes overall. However, the comparison between NICU and CAP nurses indicates a less healthy work situation for CAP nurses. Relevance to Clinical Practice. Healthcare managers need to acknowledge the less healthy work situation CAP nurses experience in order to provide optimal support and promote good health

A Swedish translation and validation of the mother-to-infant bonding scale

© Author(s) 2020. Aim: This study aimed to test initial validity, reliability, and feasibility of the Mother-to-Infant Bonding Scale in a sample of Swedish mothers. Methods: A translation was performed through 11 steps using a forward–backward bilingual technique. For criterion validity, the Swedish translation of the Mother-to-Infant Bonding Scale (S-MIBS) was compared with the Postpartum Bonding Questionnaire, sub-scale 1 (PBQ1) and 2 (PBQ2) and Edinburgh Postnatal Depression Scale (EPDS) in a sample of 63 Swedish mothers. Internal consistency was calculated with Cronbach’s alpha. For feasibility testing, the mothers were asked to grade their experience of S-MIBS and PBQ on a four-point scale. Results: The results show a correlation between S-MIBS and PBQ1 (r=0.80, p\u3c0.001), PBQ2 (r=0.69, p\u3c0.001) and EPDS (r=0.44, p\u3c0.001). Internal consistency was α=0.68. Most mothers (93.1%) found S-MIBS to be easy or very easy to complete compared with PBQ (88.7%). Conclusions: The initial testing of the Swedish translation of the Mother-to-Infant Bonding Scale shows usability to measure the mother’s emotions towards her healthy full-term infant

Should the PBL tutor be present? A cross-sectional study of group effectiveness in synchronous and asynchronous settings

Background: The tutorial group and its dynamics are a cornerstone of problem-based learning (PBL). The tutor\u27s support varies according to the setting, and it is pertinent to explore group effectiveness in relation to different settings, for example online or campus-based. The PBL groups\u27 effectiveness can partly be assessed in terms of cognitive and motivational aspects, using a self-report tool to measure PBL group effectiveness, the Tutorial Group Effectiveness Instrument (TGEI). This study\u27s aim was to explore tutor participation in variations of online and campus-based tutorial groups in relation to group effectiveness. A secondary aim was to validate a tool for assessing tutorial group effectiveness in a Swedish context. Methods: A cross-sectional study was conducted with advanced-level nursing students studying to become specialised nurses or midwives at a Swedish university. The TGEI was used to measure motivational and cognitive aspects in addition to overall group effectiveness. The instrument\u27s items were translated into Swedish and refined with an expert group and students. The responses were calculated descriptively and compared between groups using the Mann-Whitney U and Kruskal-Wallis tests. A psychometric evaluation was performed using the Mokken scale analysis. The subscale scores were compared between three different tutor settings: the tutor present face-to-face in the room, the tutor present online and the consultant tutor not present in the room and giving support asynchronously. Results: All the invited students (n = 221) participated in the study. There were no differences in motivational or cognitive aspects between students with or without prior PBL experience, nor between men and women. Higher scores were identified on cognitive aspects (22.6, 24.6 and 21.3; p \u3c 0.001), motivational aspects (26.3, 27 and 24.5; p = 002) and group effectiveness (4.1, 4.3, 3.8, p = 0.02) for the two synchronously tutored groups compared to the asynchronously tutored group. The TGEI subscales showed adequate homogeneity. Conclusions: The tutor\u27s presence is productive for PBL group effectiveness. However, the tutor need not be in the actual room but can provide support in online settings as long as the tutoring is synchronous. © 2020 The Author(s)

“A source of empowerment and well-being”: Experiences of a dance and yoga intervention for young girls with functional abdominal pain disorders

Background: Functional abdominal pain disorders are common among children and adolescents worldwide and effective treatments are needed to alleviate suffering for these children and their families. This study aimed to explore the experience of participating in a combined dance and yoga intervention from the perspectives of girls aged 9–13 years with functional abdominal pain disorders. Materials and Methods: A randomized controlled trial called Just in TIME (Try, Identify, Move and Enjoy) recruited 121 girls aged 9–13 years with functional abdominal pain disorders. The eight-month intervention combined dance and yoga twice a week, focusing on enjoyment, socialization and playful creativity in an undemanding and non-judgemental environment. The intervention group comprised 64 girls, of whom 25 were purposefully selected for this qualitative interview study. Semi-structured interviews were conducted and analysed using qualitative content analysis with an inductive approach. Results: The girls\u27 experiences of the Just in TIME intervention can be described as “A source of empowerment and well-being which facilitated personal growth and new ways of engaging in life”. The main category was derived from six generic categories: “A sense of belonging”, “Joy and emotional expression through movement”, “Relief from pain”, “More self-confident”, “More active in daily life” and “A sense of calm.” Conclusions: Regular participation in an eight-month intervention with combined dance and yoga in a supportive and non-judgemental atmosphere can ease pain and strengthen inner resources, resulting in empowerment, well-being and a more active life for girls with functional abdominal pain disorders. Trial registration: The Just in TIME study is available online at clinicaltrials.gov, ID: NCT02920268

Experiences of parents who give pharmacological treatment to children with functional constipation at home

© 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd Aim: The aim was to explore the lived experiences of parents who give oral and rectal pharmacological treatment to their children with functional constipation at home. Design: A phenomenological design with a reflective lifeworld research approach that describes phenomena as they are experienced by individuals. Methods: From January–May 2019, 15 interviews were conducted with parents of children with functional constipation with home-based oral and rectal treatment. Parents were recruited from three different healthcare levels. Open-ended questions were used starting from the description of a normal day with constipation treatment. Analyses were made with an open and reflective ‘bridling’ attitude. Findings: Constipation treatment causes parents to question their parental identity and what it means to be a good parent. Forced treatment makes them feel abusive and acting against their will as parents. There is a conflict between doubt and second thoughts about the treatment, the urge to treat based on the child\u27s needs and encouragement from healthcare professionals to give treatment. Conclusion: As pharmacological constipation treatment can be experienced as challenging, it is important to help parents make an informed decision about how such treatment should be carried out at home. The findings reveal a medical treatment situation where parents hesitate and children resist, resulting in insecure parents who question their parental identity. Impact: The findings point to the importance of supporting parents in treatment situations. Healthcare providers need to treat children with constipation with greater focus and more prompt management to prevent these families from lingering longer than necessary in the healthcare system

Supporting premature infants’ oral feeding in the NICU—a qualitative study of nurses’ perspectives

One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU