Using appreciative inquiry to enhance family centred care in the neonatal intensive care unit

A preterm or complicated birth and the subsequent hospitalisation of the neonate can be a traumatic and stressful experience for both parents and neonates. Parents often encounter challenges to the development of their parenting roles while in the neonatal intensive care unit (NICU), potentially resulting in immediate and long-term impacts on the neonate and overall family functioning. To support and meet the needs of parents experiencing a NICU admission, family centred care (FCC) has been developed and acknowledged as the ‘best way’ of caring for hospitalised children. The philosophy of FCC focuses on the health and wellbeing of the newborn and their family, through the development of respectful partnerships between health care professionals and parents. A general consensus exists in the literature regarding the value and importance of FCC. However, published research identifies major barriers in the implementation of this philosophy into clinical practice. An appreciative inquiry (AI) approach was used in this study to bring neonatal nurses and parents together to examine their perceptions and experiences of FCC and to collaboratively develop innovative strategies to improve care for the neonate and family. AI is a theoretical research perspective, an emerging research methodology and a world-view that builds on action research, organisational learning and organisational change. AI offers a unique, positive participatory strength-based approach to promoting organisational learning, facilitating change and building effective partnerships. AI consists of four phases known as the 4D cycle (discovery, dream, design and destiny). The discovery phase of the study set out to explore neonatal nurses’ and parents’ perceptions of FCC. This phase consisted of four focus groups and five face-to-face interviews with 33 neonatal nurses and one focus group with six parents (total n=39). Data were analysed using inductive thematic analysis and four dominant themes emerged ‘Getting to know parents and their wishes’, ‘Involving family in the day to day care’, ‘Finding a happy medium’ and ‘transitioning across the continuum’. The dream and design phases consisted of one full day workshop that brought neonatal nurses and parents together to collectively explore FCC in the neonatal intensive care unit (NICU). The workshop consisted of nine neonatal nurses and six graduate NICU parents (total n=15). During this phase parents and nurses developed collaborative insights about optimal FCC that could be built upon to support neonates and families. Data were analysed using inductive thematic analysis. One overarching theme emerged ‘sharing experiences and stories’ that comprised four sub themes: ‘discovering what works well’; ‘dreaming of the ideal’; ‘fixing things’; and, ‘destiny, projections for the future’. As a result of the workshop a FCC working party was formed where parents and nurses agreed to meet on a monthly basis to develop and implement strategies to enhance FCC in the NICU. Researcher reflective field notes were thematically analysed and the following themes emerged ‘great expectations’; ‘negotiations around role boundaries’; ‘progressing the agenda’; and ‘ongoing challenges for nurse led initiatives’. The destiny phase of the study reports on the progress and experiences of the FCC working party two years from when the working party was formed. Two focus groups and four individual face-to-face interviews were held (n=12 participants). Data were analysed using thematic analysis. Four dominant themes emerged ‘creating a physical and mental space’; ‘building and maintaining momentum’; ‘ongoing organisational support’; and, ‘continuing collaborations’. This is the first known study that has used an AI approach to bring neonatal nurses and parents together to collaboratively develop strategies to strengthen FCC in the NICU. This original research aimed to improve neonatal outcomes and contribute to a body of knowledge surrounding FCC in the NICU. The findings of this study revealed that while neonatal nurses report a commitment to FCC, there continues to be incomplete or inconsistent applications of FCC principles in neonatal care. While nurses report the need to deliver FCC, the study revealed that successful implementation of FCC in the NICU is difficult and requires time, education, resources and ongoing organisational commitment and support. This study highlighted the importance of developing social networks and the need for interdisciplinary collaborations that includes both health professionals and families. AI provided a useful framework for this study and created opportunities for the exchange of information, networking and developing partnerships and collaborations

Residential House

Bakalářská práce „Rodinný dům“je zpracována ve formě projektové dokumentace, řešící výstavbu jednobytového, samostatně stojícího, rodinného domu. Jedná se o dům dvoupodlažní, částečně podsklepený, s plochou střechou, umístěný v mírně svažitém terénu. Dům je navržen tak, že první nadzemní podlaží je denní část a druhé je noční klidová část. Svislé konstrukce jsou navrženy z keramických tvárnic POROTHERM. Vodorovné konstrukce budou keramické, z nosníku POT a vložek MIAKO. Základové pásy jsou z prostého betonu.The bachelor thesis “A Residential House” has been worked out as a project documentation which comes up with a solution of designing a single-apartment detached residential house. It is a double floor house with a partial cellar and a flat roof and it is situated in a gently sloped terrain. The first floor above the earth level is meant to be a “day” section while the second one should be a night quiet section. The vertical constructions are suggested to be made of ceramic breeze blocks “Porotherm”. The horizontal constructions will be ceramic, composed of the joists “Pot” and inserts “Miako”. The foundation stripes are made of plain concrete.

Awareness towards fertigation system at Polytechnic Jeli Kelantan (PJK) / Suza Hamira Suhaimin

This study investigated the awareness towards fertigation system among 102 respondents from Polytechnic Jeli Kelantan (PJK). There are 39 female and 63 male. Three variables involved in this study are understanding, perception and attitude for this study. This study is cross-sectional design. Cluster sampling method was used in this study and the questionnaire was distributed with self-administrative. The study was analyzed using SPSS 18.0 for descriptive analysis while Amos 18.0 was used for Structural Equation Modeling (SEM). The result shows that all of test on demographic variable (age, gender, level qualification and types of category occupation) is no significant influence to the respondent’s awareness. It explains that, that the respondents come from difference gender, age level qualification and types of category occupation they will have same awareness towards fertigation system. On the main hypothesis testing the results showed that perception and understanding has significant influence on awareness towards fertigation system. Recommendation on this study, PJK should do the program workshop on fertigation system for students and staffs. With this program, it may be able to open the minds of students and staff about the benefits of fertigation system and also can provide an attractive income to staff and studen

PENGARUH LUAS LAHAN TEH DAN PRODUKTIFITAS TEH TERHADAP EKPORTEH DI INDONESIA TAHUN 1985 SAMPAI 2019

This study aims to analyze the effect of tea area and tea productivity on tea exports in Indonesia in the 1985-2019 period. The data used in this study are secondary data for the 1985-2019 period. This research model uses multiple linear regression. Research Results Partially the area of tea land has an effect on tea exports in Indonesia. Partially tea productivity has no effect on tea exports in Indonesia. Simultaneously, land area and tea productivity have a positive effect on tea exports in Indonesi

Optimization of Women's Reproductive Health as Victims of Domestic Abbusive Through Android Application in Medan City

The increasing number of domestic violence cases so far, especially during COVID-19 in Medan City, makes there no longer a safe zone for children and women, especially housewives. Based on LBH APIK data that Medan City is in the red zone for domestic violence cases. With these economic difficulties, it is very risky for domestic violence, especially in the Covid-19 pandemic period which is recommended by the Government to stay at home or reduce employees in complying with Prokes, so that many companies or other businesses experience a major slump or loss. From the observation of the team also get many housewives who are just silent and do not report cases of domestic violence this is due to fear, shame and lack of knowledge. The methods used in this devotion are: 1. Health education with reproductive health materials of domestic violence victims; 2. PKPA staff training; 3. Assistance of PKPA staff in conducting reproductive health counseling to domestic violence victims; 4. Evaluation of program success: pre test and post test of PKPA staff and domestic violence victims of extension participants; 5. Socialization and training in application use Android-based prototype. The external target of this community service program activity is the formation of a group of women who become educators of Reproductive Health of women victims of domestic violence; Reproductive health module of KDRT victims, publication in issn-based journal, Video activities (youtube) and Harian Waspada Medan, Android Prototype Application, UU PKDRT

Role of public health nurses in prevention, early detection, and treatment of diabetes mellitus

Šećerna bolest postala je tiha epidemija današnjeg društva. Osnovna namjera ovog rada je prikazati razmjere i ulogu tog oboljenja u društvu, načine prevencije i liječenja te ulogu patronažne sestre i široku lepezu njeznog rada u borbi protiv ove bolesti. Patronažne sestre gotovo cijelo stoljeće provode preventivne i edukativne aktivnosti u zajednici. Djelokrug i kompetencije rada mijenjale su se kroz destljeća, ali možda ne dovoljnom brzinom kako bi u potpunosti odgovarale potrebama modernog društva. Danas je njezin rad polivalentan i usmjeren na sve osobe unutar zajednice. Takav način rada pruža joj uvid i dobro poznavanje cjelokupnih potreba pojedinca i obitelji. Njegovanje suradnje s brojnim timovima prvenstveno u primarnoj zdravstvenoj zaštiti, horizontalnoj i vertikalnoj strukturi zdravstva omogućava aktivno zauzimanje za pacijenta i promjenu kvalitete života. Cjelokupna obiteljska anamneza s osvrtom na socioekonomsko stanje omogućuje joj lakšu procjenu potreba pojedinca i obitelji te zdravstveno preventivan rad u pogledu primarne, sekundarne i tercijarne prevencije šećerne bolesti. Problemi s kojima se patronažna sestra susreće unutar zdravstvenog sustava su brojni, a rezultat su nerazvijanja radne structure unutar djelatnosti patronažne službe, neunošenja promjena u djelokruga rada te neuočavanja potrebe za visokim obrazovanjem unutar patronažne službe. Razvijanje postojećih potencijala, osmišljavanje razgranatije strukture, osmišljavanje novih projekata i programa, koji će bolje odgovarati potrebama modernog društva pri susretu s kroničnim bolestima velik su zadatak za zdravstveni sustav. Težnja uvođenju visoko obrazovanih sestara u rad patronažne službe po ugledu na razvijene zemlje svijeta jedina može podići razinu edukacije, potaknuti istraživački rad u sestrinstvu te doprinijeti razvijanju pokazatelja kvalitete u radu patronažne sestre.Diabetes mellitus has become a silent epidemic of today's society. The main purpose of this paper was to present the scale and role of the disease in society, the ways of prevention and treatment. It emphasizes the role of a community nurses and wide range of nursing interventions in the fight against this disease. Community nurses have been conducting community-based preventive and educational activities for almost a century. The scope and competencies of the work were changed through the fall, but perhaps not at sufficient speed to fully meet the needs of modern society. Today, her work is multi-valued and oriented on all age structures within the community. Such a way of working gives her an insight and a good understanding of the overall needs of the individual and family. Co-operation with a number of teams, primarily in primary health care and in the horizontal and vertical healthcare structure, provides an active occupation for the patient and a direct impact on the quality of life. A comprehensive family history with an overview of the socioeconomic condition makes it easier to assess the needs of the individual and family and prevent healthcare in terms of primary, secondary and tertiary prevention of diabetes. The problems faced by the community nurses within the health system are numerous and result from the lack of work structure, the lack of change in the scope of work, and the lack of need for higher education within the patronage service. Developing existing potentials, designing a broader structure, designing new projects and programs that will better meet the needs of modern society in meeting chronic diseases are a major task for the health care system. The effort to introduce highly educated nurses to the work of community service in the eyes of developed countries of the world alone can raise the level of education, stimulate research work in nursing and contribute to the development of quality indicators in the work of the community nurse

Latihan Berjalan dengan Kontrol Pernapasan pada Penderita Penyakit Paru Obstruktif Kronik (PPOK): Studi Fenomenologi

This study aims to explore the experience of walking exercise with breathing control in COPD patients. The method used is qualitative with a descriptive phenomenological approach. Participants in this study amounted to 15 people with COPD. Data obtained from in-depth interviews, then analyzed using the Colaizzi method. The results showed that five themes were identified, namely: 1) the implementation of walking exercises with breathing control; 2) increased physical activity and quality of life; 3) increase oxygen demand and reduce shortness of breath; 4) reduce anxiety and improve sleep quality; and 5) family support. In conclusion, walking and breathing exercises are good exercise choices for COPD because they can meet oxygen needs, reduce shortness of breath, reduce anxiety and stress in COPD. Keywords: Breathing Control, Walking Exercise, COP

Physical Activities and Incidence of Obesity among Adolescent in Medan, Indonesia

BACKGROUND: Obesity is a common problem among adolescents. The incidence of obesity is related to daily living activities. AIM: The aim of this study was to determine the correlation between physical activity and obesity among adolescents. METHODS: This research was a cross-sectional study. The study was conducted in September 2017 until June 2018 at Junior High School in Medan, Indonesia. The sample of this study consisted of 114 adolescents with consecutive sampling. The study instruments measured four things in obesity indicators that are: Weight scales, microtoise for body height, body mass index, and physical activity questionnaire for older children. The value validity test value of content validity index 1. Cronbach’s alpha reliability tested to value 0.88. The data areanalyzed using the Chi-square statistical test. RESULTS: The result showed that the adolescents whodid a moderate physical activity as many as 71 respondents (62.30%), mild physical activity as many as 35 respondents (30.70%), and heavy physical activity as many as eightrespondents (7.00%). The incidence of obesity in this study showed that 80 (70.20%) of respondents were not qualified as obese and 34 (29.80%) respondents were obese. There was a correlation between physical activity and obesity among adolescents withp = 0.00 (p <0.05). CONCLUSION: It is concluded that the importanceof physical activityassessmentsby the students for the early detection of obesity risk in the future. In addition, it is need to provide health education to adolescents about the importance of daily physical activity with routine activities, such as exercises and sports

Risk Factors Analysis for Catheter-Associated Urinary Tract Infection in Medan, Indonesia

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) are one of the most common infections in health care caused by several risk factors. AIM: This study aims at analysing the risky factors triggering CAUTI. METHODS: This research was designed by applying prospective study. It was conducted from July to November 2018 by involving 82 patients attached to the catheter and treated in the General Hospital of Medan as the sample. The study instrument used observational sheets by measuring the occurrence of urinary tract infection using urine culture analysis ≥ 105 CFU/ml. RESULTS: The results showed that there was a relationship (p < 0.05) amongs age (p = 0.01; RR = 0.51), diabetes mellitus (p = 0.00; RR = 7.61), duration of catheterization (p = 0.00; RR = 0.01), indications for catheter use (p = 0.00; RR = 0.34) with CAUTI, and there were not significant relationship (p > 0.05) amongs genre (p = 0.06; RR = 1.72), drainage system (p = 0.43; RR = 0.43) and catheter care (p = 0.08; RR = 0.50) with CAUTI. Diabetes mellitus (p = 0.00; OR = 8.92 95% CI = 1.02-11.83) and duration of catheterization (p = 0, 00; OR = 32.84 95% CI = 3.81-322.74) were the most significant factor related to CAUTI. CONCLUSION: CAUTI is influenced by various factors, and it can be controlled by understanding those factors so that the right interventions to prevent the infections can be taken and the quality of nursing care can be increased as well

Pengalaman Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis dalam Mengikuti Asupan Diet dan Cairan: Studi Fenomenologi

This study aims to gather information about the life experiences of patients with chronic kidney disease undergoing hemodialysis in adhering to their diet and fluid intake. The method used is a phenomenological approach involving 15 patients undergoing hemodialysis at the H. Adam Malik General Hospital Medan selected by purposive sampling technique. Data collection was carried out using a qualitative approach in the form of in-depth interviews. Data were analyzed using the Colaizzi method. The results showed that there were seven themes regarding patient experience, namely; 1) changes in the patient's physiological condition; 2) expression of the patient's feelings regarding changes in health conditions; 3) the need to obtain support; 4) changes in meeting the nutritional needs of patients; 5) changes in fulfilling the patient's fluid needs; 6) the need to obtain information about treatment; and 7) patient's obstacles in following diet and fluid rules. In conclusion, each patient's experience in following diet and fluid intake is different.  Keywords: Fluid Intake, Diet Intake, Hemodialysi