Health care network for children with zika virus from the perspective of professionals

OBJECTIVE

To know the perspective of health professionals working in specialized care regarding the assistance offered to children with Congenital Zika Virus Syndrome in the Health Care Network.

METHOD

Qualitative study carried out in Campo Grande-MS through semi-structured interviews, between September and October 2020, with 12 professionals working in a reference service for people with physical and intellectual disabilities. Minayo's thematic analysis and the theoretical subsidies of the care model for chronic conditions were used for interpretation.

RESULTS

Assistance in the network is weakened by aspects related to access, monitoring and integration between different professionals/services. The potential involves the implementation of the referral and counter-referral system, the communication/integration between these services and the training of professionals.

FINAL CONSIDERATIONS

The participants perceive that assistance is influenced by the availability of trained professionals to work in a network and the optimization of access and follow-up at different points of care.

Quality of life in the voice of children who depend on health technologies: Mixed methods study

OBJECTIVE

To examine the quality of life of children who depend on health technologies as expressed in their own words.

METHODS

A parallel and convergent mixed methods design was employed with 30 aged five to 12 year old children who depend on health technologies. Data collection was done through a characterization form, Pediatric Quality of Life Inventory 4.0 questionnaire with the total sample in quantitative phase; semi-structured interviews with a subset of nine participants in qualitative phase. Quantitative and qualitative data were analyzed using descriptive statistics and deductive thematic content analyses, respectively.

RESULTS

Findings from PedsQL 4.0 showed that quality of life for children who depend on health technologies is average. However, data integration through mixed methods showed that this average goes beyond quantitative data through hearing the children's own voices. The results from data integration pointed out that children recognize their limitations and adapt to them; what most affects their quality of life is the emotional domain; children reported suffering prejudice due to their physical limitations; and that the school positively impacts their quality of life.

CONCLUSIONS

Data integration highlighted that children acknowledge their limitations and pain generated by these devices. Concerns about the future and the ability to do things that other children the same age can do was the most impactful aspect on their quality of life.

IMPLICATIONS FOR PRACTICE

Nursing care plans should consider that what affects most children who depend on health technologies' quality of life is anxiety for the future of being incapacitated or dependent.

Vulnerability in adolescents' daily life during the COVID-19 pandemic

OBJECTIVE

To know the vulnerability in adolescents' daily life during the COVID-19 pandemic.

METHOD

Qualitative research carried out with 25 adolescents from a public school in a municipality in southern Brazil in the second half of 2021 through individual semi-structured interviews. Data were submitted to thematic content analysis and interpreted with the vulnerability theoretical framework.

RESULTS

These adolescents' daily lives during the COVID-19 pandemic presented difficulties in keeping family members working, changing habits and routines, accessing classes, the internet and increasing intra-family violence.

CONCLUSION

Vulnerability in adolescents' daily life during the pandemic can be identified as the absence of interaction in the school context and access to learning resources, reflecting on individual and social vulnerability. Unemployment and possible access to other sources of income have an impact on programmatic vulnerability. Reflection on practices in the context of health and school is suggested, based on the vulnerability identified in adolescents' daily lives during the COVID-19 pandemic.

Focus group in the development of concepts for a Nursing model: experience report

OBJECTIVE

To communicate the experience of developing concepts for the construction of a care model through focus groups.

METHODS

An experience report on the development of concepts through remote focus groups with members of a research group from a public university in southern Brazil.

RESULTS

Focus groups were developed in which homogeneity and heterogeneity criteria were observed among participants. In addition to the concepts of the nursing metaparadigm, the concepts of care and family-centered care were developed, relevant to the nursing care model in question.

FINAL CONSIDERATIONS

Despite the challenges of conducting remote focus groups, they were suitable for the collective construction of concepts for a nursing care model, allowing the interaction of participants from different locations.

Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study

A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.

Crianças e adolescentes com necessidades especiais de saúde: o cuidado nos serviços de atenção domiciliar

RESUMO Objetivo descrever o cuidado prestado às crianças com necessidades especiais de saúde nos Serviços de Atenção Domiciliar do estado de Mato Grosso do Sul. Métodos pesquisa quantitativa, descritiva e exploratória. Os participantes do estudo foram profissionais dos Serviços de Atenção Domiciliar do Mato Grosso do Sul. A coleta de dados se deu com a aplicação de dois formulários on-line, no período de 2019 a 2020. Um dos formulários tinha dados descritivos dos serviços e seus atendimentos; o outro se voltava para a validação de protocolo de fluxo de atenção domiciliar às crianças. Para análise de dados, utilizou-se a estatística descritiva. Resultados houve uma predominância de 25 crianças com paralisia cerebral, sendo que a maioria foi classificada como média complexidade, de acordo com a complexidade e as demandas de cuidados. Os profissionais realizam orientações, procedimentos e avaliação, além de serem responsáveis pelo treinamento da família. Os serviços não possuem protocolo de fluxo para atendimento das crianças. Conclusão Implicações para Prática embora os serviços apresentem capacidade de ampliação do atendimento e utilizem o Plano Terapêutico Singular, avanços na assistência às crianças e famílias ainda se fazem necessários. Recomenda-se a elaboração de protocolos de fluxo e propostas organizativas que auxiliem os profissionais em sua prática.

Children and adolescents with special healthcare needs: care in home care services

ABSTRACT Objective to describe the care provided to children with special health needs in the Home Care Services of the State of Mato Grosso do Sul - Brazil. Methods research, descriptive and exploratory. Study participants were professionals from home care services in Mato Grosso do Sul. Data collection took place through the application of two online forms, from 2019 to 2020, one containing descriptive data of the services and their care and the other for validation of the home care flow protocol for children. It was used for data analysis and descriptive statistics. Results there was a predominance of 25 children with brain flexibility. Most classified as complex average according to the complexity and demands of care. Professionals and guidelines, procedures, assessment are responsible for training the family. The services do not have a flow protocol for the care of children. Conclusion Implications for Practice Services Present ability to deliver care and use the care plan and single use, advances in child care and solutions may still be presented. There is a practice of elaborating flow protocols and organization proposals that help professionals in their.

“Tabela falante” como estratégia de integração de dados em uma pesquisa de métodos mistos

RESUMO Objetivo relatar a utilização da tabela falante como estratégia de integração e análise de dados em estudo de abordagem mista. Método trata-se de um relato de utilização de uma estratégia metodológica de integração e análise dos dados em pesquisa de método misto. São apresentados dados de um estudo longitudinal analítico, que acompanhou 151 lactentes prematuros no primeiro ano de vida. O estudo abordou aspectos das condições de saúde dessa população e integrou dados quantitativos, coletados por meio de instrumento de avaliação de condições de saúde e dados qualitativos oriundos de entrevista semiestruturada. Resultados a integração dos dados em estudos mistos é uma exigência metodológica que requer dos pesquisadores a utilização de estratégias que possibilitem e facilitem esse processo analítico. A tabela falante, por meio da integração visual dos dados quantitativos expressos em tabelas e suas convergências e divergências analíticas com os enunciados qualitativos, favorece a leitura e interpretação integrada. Conclusão e implicações para a prática considera-se a tabela falante uma ferramenta analítica de integração de dados quantitativos e qualitativos que contribui na formulação de metainferências em pesquisas com métodos mistos.

“Talking table” as a data integration strategy in mixed methods research

ABSTRACT Objective to report the use of a talking table as a data analysis and integration strategy in a mixed approach study. Method this is a report on the use of a methodological strategy for data integration and analysis in mixed methods research. Data from an analytical longitudinal study that followed 151 preterm infants in the first year of life are presented. The study addressed aspects of the health conditions of this population and integrated quantitative data, collected through an instrument to assess health conditions and qualitative data from a semi-structured interview. Results data integration in mixed studies is a methodological requirement that requires researchers to use strategies that enable and facilitate this analytical process. A talking table, through the visual integration of quantitative data expressed in tables and their analytical convergences and divergences with qualitative statements, favors integrated reading and interpretation. Conclusion and implications for practice: a talking table is considered an analytical tool for quantitative and qualitative data integration, which contribute to developing meta-inferences in mixed methods research.

Prevalence of children with special healthcare needs: An epidemiological survey in Brazil

PURPOSE

We aimed to estimate the prevalence and delineate the profile of children with special healthcare needs (CSHCN) in the three municipalities of Brazil's southern and southeastern regions from 2015 to 2017.

DESIGN AND METHODS

This cross-sectional study included 6853 children aged 0-11 years. Participants were selected through complex sampling in 32 primary healthcare units. The Brazilian version of the Children with Special Healthcare Needs Screener© and a questionnaire were used to identify sociodemographic and family characteristics, health status, and health services utilization. Simple and multiple logistic regression models were used to evaluate the association between family and child characteristics and prevalence (P < 0.05).

RESULTS

The prevalence of CSHCN was 25.3% (95% confidence interval: 21.0-30.0). Most participants required health services or were on long-term medication for a current chronic condition; approximately 53% of CSHCN had no formally recorded diagnoses. The most frequent health problems were respiratory conditions, asthma, and allergies. Approximately 60% of the CSHCN patients underwent follow-up examinations of the specialties pneumology, pediatrics, otorhinolaryngology, speech therapy, neurology, and psychology. Children of school age, of male sex, with premature birth, with a history of recurrent hospitalization, from non-nuclear families, and from underprivileged social classes were identified as risk factors for classification as CSHCN.

PRACTICE IMPLICATION

These results contribute to the unprecedented mapping of these children in healthcare networks in Brazil.

CONCLUSION

The high prevalence of CSHCN in medium and large municipalities in the southern and southeastern regions was associated with the child's previous health conditions and family structure.

Social and territorial inequalities in the mortality of children and adolescents due to COVID-19 in Brazil

OBJECTIVE

To analyze the mortality rate of COVID-19 among children and adolescents aged 0 to 14 years.

METHODS

Ecological and exploratory study of children's mortality rate by COVID-19 in Brazil, from February to October 2020. The study used the Severe Acute Respiratory Syndrome database to collect the data and made the analysis using descriptive spatial statistics by age and race/color classification.

RESULT

The mortality rate due to COVID-19 represented 1.34 deaths per one hundred thousand in the total group evaluated. The age group with the highest frequency and mortality rate was 1 to 4 years of age. There is a higher frequency of deaths in the brown and Indigenous population.

CONCLUSION

The distribution of deaths due to COVID-19 is unequal in the national territory, and there is a wide variation in the mortality rate by age and race/color groups.

Continuity of care for children with chronic conditions after discharge: a constructivist grounded theory

ABSTRACT Objectives: to understand the meaning of continuity of care for children with chronic conditions through transitional care from hospital to home. Methods: this is a qualitative study, conducted from a Constructivist Grounded Theory perspective. Purposive and theoretical sampling were used to recruit 35 participants, including nurses, professionals from the interprofessional hospital team, and actors responsible for healthcare in the home context. The research was conducted at two large hospitals, between March and September 2019. Semi-structured interviews were conducted. Data analysis was carried out using initial and focused coding, according to constructivist grounded theory. Results: the substantive theory that emerged from this study was named “Postponing the next hospitalization”. Eight categories-concepts and 18 elements were derived from the data to support the substantive theory. Final Considerations: transitional care from hospital to home acts as a reminder for the resumption of continuity of care after discharge.

Desigualdades sociais e territoriais na mortalidade de crianças e adolescentes por COVID-19 no Brasil

RESUMO Objetivo: Analisar a taxa de mortalidade por COVID-19 entre crianças e adolescentes de 0 a 14 anos. Métodos: Estudo ecológico e exploratório da taxa de mortalidade de crianças por COVID 19 no Brasil, no período de fevereiro a outubro de 2020. A coleta foi feita utilizando-se o Banco de Dados de Síndrome Respiratória Aguda Grave, e a análise foi realizada com recurso à estatística espacial descritiva, por classificação etária e de raça/cor. Resultados: A taxa de mortalidade por COVID-19 representou 1,34 mortes a cada 100 mil no grupo total avaliado. A faixa etária com maior frequência e taxa de mortalidade foi de 1 a 4 anos. Há maior frequência de óbitos na população parda e indígena. Conclusão: A distribuição de óbitos por COVID-19 é desigual no território nacional, e há grande variação da taxa de mortalidade por grupos etários e de raça/cor.

Ability of management of families of children with chronic conditions for care at home

ABSTRACT: Objective to analyze the relationship between families' living context and their management skills in caring for children with chronic health conditions. Method a mixed, convergent parallel study, with the Family Management Style as the theoretical framework. Participants were family members of children with chronic conditions egressing from a Neonatal Intensive Care Unit in Southeastern Brazil. For the collection of quantitative data, the instrument Family Management Measure and a questionnaire of socio-demographic characterization were used. Quantitative data were analyzed using the Stata 15 statistical program. Qualitative data were produced by means of semi-structured interviews and submitted to the Directed Content Analysis. Results the families presented a positive average score in the Management Ability scale, having greater ease to meet the care needs of the child with chronic condition at home. Favorable social and economic conditions contributed to the family's ability to care for the child with chronic health condition. Conclusions and implications for practice it was concluded that there is a relationship between the context of life of the families and the ability to manage the child in chronic condition. Being able to count on a partner or other family members can improve the management skills of these families.

An ethical analysis of the impacts of the COVID-19 pandemic on the health of children and adolescents

ABSTRACT The COVID-19 pandemic has impacted the lives of children and adolescents around the world. Hence, this study aimed to examine how the pandemic has impacted children and adolescents in Brazil through an ethical analysis. An interpretive analysis of Brazilian research on child and adolescent health during the pandemic was conducted. Recognizing this ethical dimension is pivotal to shedding more light on how responses to crisis situations, such as the current situation of the COVID-19 pandemic, can be shaped and where the priorities for action are according to all interested parties, situating the child between these parts of interest. Our analysis highlighted both direct and indirect effects surrounding the decision-making processes for children in the COVID-19 pandemic reality. These decisional processes must sustain the child’s right to participation to ascertain that the action taken is in the child’s best interests. Nevertheless, the Brazilian reality has shown a structural exclusion of children’s voices in decisions affecting them, particularly concerning the effects of the pandemic on their lives. Further studies must be conducted to deepen the knowledge about children’s best interests and their participation in the actions planned during the pandemic.

Habilidade de manejo de famílias de crianças com condições crônicas para o cuidado no domicílio

RESUMO: Objetivo analisar a relação entre o contexto de vida das famílias e a sua habilidade de manejo no cuidado às crianças em condições crônicas de saúde. Método estudo misto, do tipo paralelo convergente, tendo o Estilo de Manejo Familiar como quadro teórico. Participaram familiares de crianças com condições crônicas egressas de Unidade de Terapia Intensiva Neonatal do Sudeste do Brasil. Para a coleta de dados quantitativos, foram utilizados o instrumento Medida de Manejo Familiar e um questionário de caracterização sociodemográfica. Os dados quantitativos foram analisados por meio do programa estatístico Stata 15. Os dados qualitativos foram produzidos por meio de entrevista semiestruturada e submetidos à Análise de Conteúdo Dirigida. Resultados as famílias apresentaram um escore médio positivo na escala Habilidade de Manejo, possuindo maior facilidade para atender às necessidades de cuidado do filho com condição crônica no domicílio. Condições sociais e econômicas favoráveis contribuíram para a capacidade da família em cuidar da criança com condição crônica de saúde. Conclusões e implicações para a prática concluiu-se que há relação entre o contexto de vida das famílias e a habilidade de manejo da criança em condição crônica. Poder contar com o companheiro ou com outros membros da família pode melhorar a habilidade de manejo dessas famílias.

Análise ética dos impactos da pandemia de COVID-19 na saúde de crianças e adolescentes

RESUMO A pandemia de COVID-19 trouxe impactos significativos para a vida de crianças e adolescentes em todo o mundo. Considerando esse contexto, o objetivo deste artigo foi examinar como as crianças e os adolescentes no Brasil foram impactados pela pandemia à luz de uma análise ética. Para tanto, uma análise interpretativa de estudos brasileiros sobre a saúde da criança e do adolescente durante a pandemia foi realizada. A tarefa de reconhecer essa dimensão ética é importante para entender como as respostas a situações de crise, tais como a presente situação da pandemia de COVID-19, podem ser moldadas e identificar quais as prioridades de ação de acordo com todas as partes interessadas, situando a criança entre essas partes de interesse. A análise demonstrou que tanto os efeitos diretos quanto os indiretos implicam em processos de tomada de decisão que precisam utilizar e sustentar o direito de participação da criança para que a ação tomada esteja o máximo possível focada nos melhores interesses da criança. Contudo, a realidade brasileira tem demonstrado uma exclusão estrutural das vozes infantis. Recomenda-se que mais estudos sejam conduzidos a fim de aprofundar o conhecimento sobre os melhores interesses das crianças e sua participação nas ações tomadas durante a pandemia.

Continuity of care for children with special healthcare needs during the COVID-19 pandemic

OBJECTIVE

To describe the continuity of care for children with special healthcare needs during the COVID-19 pandemic through the perception of their caregivers in the Northeast of Brazil.

METHODS

Qualitative descriptive-exploratory research carried out between June and September 2020, in a municipality in the Northeast of Brazil. Eleven caregivers participated through semi-structured interviews conducted at home. The data were submitted to thematic content analysis.

RESULTS

The social isolation period and the suspension of health services affected the continuity of care, configuring the category "Implications of the COVID-19 pandemic for the continuity of care". Caregivers expressed fear of children contracting the coronavirus, characterizing the category "Fears and uncertainties of the COVID-19 pandemic in view of the vulnerability of children with special healthcare needs".

FINAL CONSIDERATIONS

Caregivers' reports revealed problems in the continuity of care for the studied cohort. Therefore, health care practices must be rethought in times of pandemic.

Factors associated with the development of skin allergies in premature newborns in the first year of life

OBJECTIVE

To identify the factors associated with the development of skin allergies in the first year of life in moderate and late preterm infants.

METHOD

This is a cross-sectional study with 151 moderate and late preterm infants, born between May 2016 and May 2017. Participants were evaluated in the 3rd, 6th, 9th and 12th months of life, in telephone interviews. Statistical analyzes were performed in the SPSS software with frequency comparison tests and logistic regression.

RESULTS

The prevalence of skin allergy, in the perception of caregivers, among late and moderate preterm infants was 16%. Factors such as being admitted to neonatal intensive care (p = 0.006) and not being breastfed (p = 0.041) showed a significant association with the development of skin allergies in the 3rd and 12th months of life, respectively.

CONCLUSION

Skin allergy, in the perception of caregivers, is more severe in newborn infants who have clinical respiratory and gastrointestinal manifestations, be it conditioning or cause-effect. Breastfeeding proved to be a protective factor in the first year of life.

Health care network (dis)articulation in late and moderate prematurity

OBJECTIVE

to analyze the Health Care Network (dis)articulation of late and moderate premature infants in the first year of life.

METHOD

a qualitative study with semi-structured interview, which addressed the care network constitution in a municipality in southern Brazil. Fifteen mothers of infants participated. Thematic content analysis and flowchart were used to describe networks and services.

RESULTS

first contact in Primary Health Care is a decisive factor for the recognition and articulation of neonates/infants in the network and enables resolution, especially in childcare demands. Secondary and hospital care services support isolated acute events or chronic conditions, without articulation between levels of care and in a uniprofessional way.

FINAL CONSIDERATIONS

attention to health conditions is organized and structured in a uniprofessional, fragmented and disjointed way, which makes it impossible to form a Health Care Network premature infants' perspective.

Hospitalization perceived by children and adolescents undergoing cancer treatment

OBJECTIVE

To know the perception of children and adolescents undergoing cancer treatment about hospitalization.

METHODS

Qualitative research conducted with 13 children and adolescents hospitalized for cancer treatment at a referral hospital in southern Brazil. Semi-structured interviews mediated by the drawing technique were conducted from May to November 2018. Data was submitted to inductive thematic analysis based on the theoretical framework of Brazil's National Humanization Policy.

RESULTS

Disturbances were detected in the professionals' communication with the hospitalized children and adolescents. The participants felt socially isolated and highlighted the importance of recreational activities during hospitalization.

CONCLUSION

Infant cancer is complex and needs multidisciplinary care during the treatment, enabling the organization of healthy and welcoming spaces that favor humanization of care.

CHILDREN AND YOUTH WITH SPECIAL HEALTHCARE NEEDS: (DIS) CONTINUITY OF CARE

ABSTRACT Objective to investigate the follow-up and characteristics of children and youth with special healthcare needs within Primary Health Care services located in a city in the State of São Paulo, Brazil. Method this qualitative study was supported by the Primary Health Care framework, and interviews were held with 37 health workers from the primary health care units located in the interior of São Paulo. Data were collected from May to December 2018 and treated with inductive thematic analysis. Results from the perspective of the health workers, the characteristics of these children and youth are centered on the dependence of specific care such as to promote psychomotor development, and dependence on technology and pharmacological treatments. They reported the difficulty to access health services while the primary health care services do not implement systematic follow-up. Conclusion these children and youth demand continuous and longitudinal care, which, however, is not provided by primary health care services, considering the discontinuity of care and a lack of networked follow-up. Therefore, health services need to be reorganized to keep up with changes in the child and youth morbidity and mortality to ensure continuous, integral, and networked follow-up to this population.

Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials

OBJECTIVE

To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions.

DESIGN

Systematic review of randomised and non-randomised controlled trials.

DATA SOURCES

Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature.

STUDY SELECTION

Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome.

DATA EXTRACTION AND SYNTHESIS

Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials.

RESULTS

24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05).

CONCLUSIONS

These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018107099.

Fertility-Related Concerns and Uncertainties in Adolescent and Young Adult Childhood Cancer Survivors

Purpose: This study aimed to uncover the fertility-related concerns and uncertainties in adolescent and young adult (AYA) childhood cancer survivors. Methods: In this qualitative study, participants were recruited from an oncohematology outpatient clinic at a university hospital in Brazil. Twenty-four AYA cancer survivors, aged 18- 24 years (13 men and 11 women), participated in individual semistructured interviews focusing on two parts-sociodemographic and clinical variables and guiding questions that enabled understanding of the concerns and uncertainties regarding the risks of infertility and their impact on relationships and the need for guidance. Data were analyzed using inductive thematic analysis. Results: Four themes were identified from the data-(1) knowledge about fertility, (2) emotional impact and fertility-related uncertainty, (3) sharing the possible risk of infertility with partners, and (4) need for information on possible loss of fertility. Conclusion: The meanings attributed to the loss of fertility after cancer treatment uncovered the need for health professionals to organize survivor services in line with the survivors' needs, and include reproductive concerns and uncertainties in this planning. The study results provide insights for the development of health care services that meet the real needs of this particular population that has long-term follow-up demands.

(In)visibility of children with special health needs and their families in primary care

OBJECTIVES

to discuss the (in)visibility of children with special healthcare needs and their families in the Primary Health Care scenario.

METHODS

experience report about the difficulties faced by researchers from different regions of Brazil to locate children with special healthcare needs in the scope of primary care.

RESULTS

the main reason for these children and their families to be "unknown" and, therefore, not assisted in PHC, is the fact that they are followed-up by institutions/outpatient clinics and specialized and/or public rehabilitation clinics, or even because they have private health insurance. Final Considerations: transferring care responsibility to the Primary Health Care teams to specialized and rehabilitation institutions may be related to the lack of knowledge of the care demands of this group, as well as to the relevance of care centered on rehabilitation and the specialty instead of the long-term care, one of the features of primary health care.

A Fun Way to Learn About Diabetes: Using Therapeutic Play in a Brazilian Camp

PURPOSE

Understanding disease mechanisms inside the body is crucial to engage youth with type 1 diabetes (T1D) in self-care behaviors. This study describes how Instructional Therapeutic Play (ITP) group sessions held by nurses in a Brazilian camp can enhance youth's understanding about T1D.

DESIGN AND METHODS

Youth with T1D participated in video recorded ITP group sessions guided by the Sensitive Creative Method. First, participants were asked to create an artistic production based upon the query "What happens in the body of a young person who has diabetes?". They described their drawings and shared information, providing opportunities to discuss T1D pathophysiology. Second, campers were told a story about a child who had T1D onset using a rag doll and illustrative figures. Participants were asked to create a second artistic production based upon the same initial query. Finally, campers had another presentation of the drawings, discussion, and sharing through the question "How did the story told help you understand your diabetes?" Transcriptions of ITP sessions were submitted to thematic analysis.

RESULTS

Twenty participants (9-17yo) were assigned to age/gender matched groups. Four themes were built: Designing insulin production; Experiencing the glycemic vigilance in diabetes management; The ITP session as a safe space to share challenges with nurses and peers; and Unraveling the myths of diabetes with the ITP session.

CONCLUSION

Therapeutic play sessions enhanced youth's knowledge and unraveled myths of T1D pathophysiology.

PRACTICE IMPLICATIONS

ITP sessions can be developed by nurses in order to deliver age-appropriate diabetes education to pediatric patients.

Family dynamics and social network of families of children with special needs for complex/continuous cares

OBJECTIVE

To describe the family dynamics and the social support network for families of children with special needs of multiple, complex and continuous care.

METHODS

A descriptive study of a qualitative approach, carried out in Maringá - PR, having as theoretical and methodological reference the Calgary Model of Family Assessment (CMFA). Data was collected through semi-structured audio-video interviews, carried out in the homes, together with 11 family caregivers of 13 children.

RESULTS

Data is presented in the following categories: structural, developmental and functional evaluation, which show the changes in the family routine and the needs for the adjustment of the roles of its members, in order to better implement the care at home.

CONCLUSIONS

Using the CMFA made it possible to identify and understand the composition, fragilities and potentialities of the family, as well as the relationships among its members and rearrangements to better enable care at home. This information favors interventions congruent with the needs of these families.

Accessibility of children with special health needs to the health care network

OBJECTIVE

To know how children with special health needs access the health care network.

METHOD

This is a qualitative research of descriptive-exploratory type, developed using semi-structured interviews mediated by the Talking Map design. Participants were 19 family caregivers of these children in two Brazilian municipalities. Data were submitted to inductive thematic analysis.

RESULTS

Difficulties were mentioned from the diagnosis moment to the specialized follow-up, something represented by the itinerary of the c hild and his/her family in the search for the definition of the medical diagnosis and the access to a specialized professional; a gap between the children's needs and the care offered was observed in primary health care.

CONCLUSION

The access of children with special health needs is filled with obstacles such as slowness in the process of defining the child's diagnosis and referral to a specialist. Primary health care services were replaced by care in emergency care units.

Cotidiano de cuidado de adolescentes com necessidades especiais de atenção à saúde

Resumo Objetivo Compreender o cotidiano de cuidado de adolescentes com necessidades especiais de atenção à saúde. Métodos Pesquisa qualitativa, pautada no referencial crítico-libertador Freireano, realizada no ambulatório pediátrico de um hospital de ensino, no segundo semestre de 2016. Realizou-se a análise de prontuários, entrevista semiestruturada e a construção do genograma e ecomapa de 35 adolescentes com algum tipo de demanda de saúde. Após a dupla transcrição, as entrevistas foram submetidas à análise de discurso Pechetiana. Resultados O cotidiano de cuidado desses adolescentes é traduzido por meio da higiene pessoal, aparência física, uso de medicamentos, nutrição e habituais modificados. O discurso dos adolescentes apresentou diferentes níveis emancipatórios: em alguns momentos a partir da adaptação e alienação, pelo costume e necessidade de ter que desenvolver o cuidado por meio de uma reprodução técnica, o que contribui para a opressão; e em outros momentos pela possibilidade de emancipação, a partir da reflexão sobre sua realidade e posicionar-se sobre ela. Conclusão O cotidiano de cuidado do adolescente é permeado pelas possibilidades e habilidades em diferentes níveis emancipatórios. A ausência de dialogicidade, troca de saberes e reflexão podem contribuir para o processo de opressão. A Enfermagem necessita possibilitar a troca de saberes e a reflexão, para que o adolescente transite de uma consciência ingênua para crítica.

Avaliação das condições da pele do recém-nascido em terapia intensiva neonatal

DOI: http://dx.doi.org/10.31011/1519-339X.2018a18n84.3 Objetiva-se avaliar as condições da pele do recém-nascido internado em unidade de terapia intensiva neonatal,segundo a Escala de Condição da Pele do Recém-nascido. Estudo quantitativo, transversal realizado em uma unidadede terapia intensiva neonatal, com a utilização de um formulário de caracterização clínica e da Escala de Condiçãoda Pele do Recém-nascido, sendo sujeitos 47 recém-nascidos. Foram realizadas associações com as variáveis clínicase os escores da escala de condição da pele do recém-nascido. Os dados foram analisados através do Teste Exato deFischer e o Teste de Qui-quadrado corrigido. Para àqueles que permaneceram por mais de sete dias internados foimais evidente a presença de pele seca. Dentre os que nasceram de bolsa rota, 21,3% apresentaram eritema corporal.Dos que permaneceram até sete dias internados, 55,5% apresentaram ruptura/lesão na pele. Conclui-se que osrecém-nascidos que permaneceram mais de sete dias internados apresentaram a pele mais seca. A ruptura/lesãoocorreu na maior parte dos recém-nascidos prematuros e de baixo peso.Palavras-chave: Recém-Nascido; Pele; Cuidados de Enfermagem; Segurança do Paciente; Unidade de TerapiaIntensiva Neonatal. ABSTRACTThe aim is to evaluate the skin conditions of newborns hospitalized in a neonatal intensive care unit accordingto the Newborn Skin Condition Scale. A quantitative, cross-sectional study conducted in a neonatal intensivecare unit, using a clinical characterization form and the Newborn Skin Condition Scale, with 47 newborns. Theanalysis was performed in the Program Statistical Package for the Social Sciences (SPSS) and the Fischer ExactTests and/or Corrected Chi-Square Test were applied. The presence of dry skin was more evident for those whoremained more than seven days hospitalized. Among those born with a broken amniotic membrane, 21.3% hadbody erythema. Those who remained up to seven days in hospital, 55.5% had rupture / skin lesion. It concludesthat the newborns remained more than seven days hospitalized presented the driest skin. The rupture/injuryoccurred in most of the preterm and low birth weight infants.Keywords: Newborn; Skin; Nursing Care; Patient Safety; Neonatal Intensive Care Unit

The social network of adolescents who need special health care

ABSTRACT Objective: To describe the social network of adolescents who need special health care. Method: A qualitative, descriptive and exploratory study conducted between 2016 and 2017 in the pediatric outpatient clinic of a teaching hospital in southern Brazil. Thirty-five semi-structured interviews were conducted with adolescents between 12 and 18 years of age, followed by the construction of genograms and ecomaps. After transcription, the enunciations were subjected to Pêcheux’s method of discourse analysis. Results: The institutional network consists of health services, schools and religious entities, as well as adolescents’ families and friends. In the family network, women family members—such as mothers, grandmothers and aunts—have a special role. Final Consideration: The adolescents’ social network is composed of institutional and family circles. In the view of adolescents, the tertiary service is more capable of solving their problems, and for this reason used the most. In order to ensure these adolescents access to and continuity of care, the articulation between health policies and health services is suggested.

Systematic review protocol examining the effectiveness of hospital clowns for symptom cluster management in paediatrics

INTRODUCTION

Clown intervention may playing an important complementary role in paediatric care and recovery. However, data on its utility for symptom cluster management of hospitalised children and adolescents in acute and chronic disorders are yet to be critically evaluated. As clinicians strive to minimise the psychological burden during hospitalisation, it is important that they are aware of the scientific evidences available regarding clown intervention for symptom management. We aim to provide quality evidence for the effectiveness of clown intervention on symptom cluster management in paediatric inpatients, both in acute and chronic conditions.

METHODS AND ANALYSIS

A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, Web of Science, Cochrane Library, Science Direct, PsycINFO, CINAHL, LILACS and SciELO databases will be searched from January 2000 to December 2018. Primary outcomes will include measures related with the effect of clown intervention on symptom cluster of paediatric inpatients (anxiety, depression, pain, fatigue, stress and psychological, emotional responses and perceived well-being). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Jadad Scale as well as Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomized Studies Tool for NRCTs. A narrative synthesis will be conducted for all included studies. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges' g score for both fixed and random effect models. I 2 statistics will be used to assess heterogeneity and identify their potential sources.

ETHICS AND DISSEMINATION

As it will be a systematic review, without human beings involvement, there will be no requirement for ethical approval. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia.

TRIAL REGISTRATION NUMBER

CRD42018107099.

Sexuality experiences of hysterectomized women

Abstract Objective: To know the sexuality experiences of hysterectomized women. Method: Qualitative study carried out in Family Health Strategies with 19 hysterectomized women. A semi-structured interview was conducted, combined with the Creativity and Sensitivity Technique called Speaker Map, after approval by the Ethics Committee from January to February 2018. Data were analyzed according to analysis of the thematic content. Results: The participants had different sexuality experiences after the hysterectomy. The procedure was associated with restoration of health, resuming sexual activity, and changes in relationships. It was also related to the onset of dyspareunia and decrease in libido. Conclusion and implications for practice: The changes experienced after surgery led women to build new meanings for sexuality and their relationships. The surgery shows concrete results, such as decreased or increased pain in sexual practice, and subjective results, such as the feeling of freedom and the impact on female identity. These results may contribute to direct educational strategies to approach sexuality with each woman who undergoes hysterectomy.

Stress in Parents of Newborns in a Neonatal Intensive Care Unit

Abstract Objective: To identify the level of stress and the most stressful situations for the parents of newborns hospitalized in a Neonatal Intensive Care Unit. Methods: A descriptive study, with a quantitative approach, performed with parents of newborns admitted to the Neonatal Intensive Care Unit. For the data collection, the Brazilian version of the Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) was used. The analysis was performed using descriptive statistics. Results: The change in the role of mother/father was the subscale in which the highest level of stress was obtained (mean=3.49) and the items considered more stressful in this subscale were "Separated from my baby" (mean=4.00) and "Feeling helpless and unable to protect my baby from pain and painful procedures" (mean=3.78). Conclusion: Hospitalization of a child in a neonatal unit is a stressful experience for parents and there are situations that trigger higher levels of stress.

Development care for children with special health needs in home care at Paraná - Brazil

Abstract Objective: To describe the development of care for children with special health needs in Paraná services of homecare. Method: Quantitative, descriptive, exploratory, and multiple case study was applied. Data were collected by telephone and e-mail, with professionals from the eight services of homecare of Parana, from October 2016 to January 2017. The data was treated with descriptive statistics analysis. Results: Among 35 children in homecare, 25.7% had cerebral palsy, 60% had a tracheostomy. The care provided by the services includes a management of tubes, administration of medication, changing dressings, caregiver guidance for tracheostomy suctioning and a management of diet. Conclusions and implications for practice: Services weaknesses were mainly related to low utilization of the singular therapeutic project and the counter-reference to primary care. The flow of successful practices are developed in the municipality of an isolated manner. Showing positive experiences promotes reflection and improvement of the work process of caring for children with special health needs in homecare.

Challenges of family caregivers of children with special needs of multiple, complex and continuing care at home

ABSTRACT Objective: To describe the challenges of family caregivers of children with special needs of multiple, complex and continuing care at home. Methods: Qualitative study based on the theoretical framework of the Patient and Family-Centerd Care (PFCC). We interviewed eleven family caregivers from 13 children enrolled in a special school in the Brazilian city of Maringá (PR). The data were subject to content analysis, thematic modality. Results: The main challenges identified are the lack of preparation for home care, the difficulty of access and follow-up in Primary Health Care services, and the difficulty of including the child in social interaction. However, caregivers react positively to these adversities. Conclusions and implications for practice: The nurses need the necessary training to transcend hospital technical care and to develop a care practice based on family-centerd care, considering this as a protagonist, including it in the process for the quality of life of these children.

Factors associated with family risk of children with special health care needs

OBJECTIVE

To identify the factors associated with family risk of children with special health care needs.

METHODS

Bicentric study, with a cross-sectional design and a quantitative approach, with family caregivers of children with special health care needs. Instruments were applied to obtain a sociodemographic characterization, and identify and classify the family risk. For analysis between variables, Mann-Whitney and Fisher's exact tests were used and the Spearman's correlation coefficient was calculated.

RESULTS

One hundred and eighteen caregivers participated in the study. The average family risk score was 3.53 (±3.76), with a median of 3.0, and minimum and maximum values of 0 and 16, respectively, with no significant difference between the two studied Brazilian municipalities. In municipality 1, the number of siblings presented a positive correlation with the average family risk score (0.011, p<0.05). Level of education and marital status of the caregiver showed a significant association with the result (0.038 and 0.002, respectively). The social classification variable presented a negative correlation with the outcome in municipalities 1 (0.003, p<0.01) and 2 (0.006, p<0.01).

CONCLUSION

To classify the family risk and recognize associated factors can be taken as a basis for fair home care to children with special health care needs.

Perfil Clínico-epidemiológico de Crianças e Adolescentes com Câncer em um Serviço de Oncologia

Introdução: O progresso no controle do câncer nos últimos 50 anos é inegável; entretanto, no Brasil, ele ainda representa a segunda causa de morte na população infantojuvenil, e estudos não têm evidenciado declínio desses dados. Objetivo: Analisar o perfil clínico--epidemiológico de crianças e adolescentes com câncer em um Serviço de Oncologia. Método: Estudo documental retrospectivo, com busca de dados em prontuários de crianças e adolescentes, com diagnóstico de câncer no período de 2008 a 2014. Os dados foram coletados no período de maio a agosto de 2015, armazenados em banco de dados informatizado e submetidos à análise estatística descritiva. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Tocantins (protocolo 116/2014). Resultados: A idade média ao diagnóstico foi de 8 anos, sendo a maioria do sexo masculino; e os tipos de câncer mais frequentes foram as leucemias, linfomas e os tumores do sistema nervoso central. O uso da quimioterapia predominou entre os tratamentos utilizados. Referente à situação-esfecho, obtiveram alta por cura (11%); em tratamento (14%); acompanhamento pós-tratamento (31%); e foram  a óbito (29%). Conclusão: O perfil de crianças e adolescentes com câncer deste estudo denotou a complexidade e a dimensão biopsicossocial, que envolveram a terapêutica do câncer infantojuvenil, traduzidas pelo número expressivo de internações hospitalares e óbitos em crianças menores de 5 anos. Recomenda-se a capacitação dos profissionais de saúde para a realização do diagnótico precoce e para a excelência do tratamento multiprofissional em busca não só da cura, mas também da qualidade de vida.

GESTAÇÃO, PARTO, NASCIMENTO E INTERNAÇÃO DE RECÉM-NASCIDOS EM TERAPIA INTENSIVA NEONATAL: RELATO DE MÃES

RESUMO Objetivo: descrever a trajetória do parto, nascimento e internação do recém-nascido em unidade de terapia intensiva neonatal. Método: pesquisa qualitativa desenvolvida com 25 mães de recém-nascidos internados na terapia intensiva neonatal. A coleta de dados ocorreu nos meses de agosto a outubro de 2014, por meio de entrevista semiestruturada, abordando questões do pré-natal à internação do bebê. Os dados foram submetidos à análise de conteúdo temática. Resultados: a trajetória apontou complicações na gravidez, gestação não-planejada e a não vinculação com o profissional com quem estava realizando o pré-natal; necessidade de deslocamento para o parto e condições do nascimento revelaram importante impacto na vivencial das mães. Conclusões: Foram características da trajetória destas mulheres o início tardio do pré-natal e a fragilidade de vínculo com o profissional que realizou o pré-natal. Além disso, a dificuldade de acesso aos serviços de saúde para o parto culminou com o impacto de um nascimento de risco e internação na terapia intensiva.

The moral experiences of pediatric nurses in Brazil: Engagement and relationships

BACKGROUND

Pediatric nursing care involves many significant ethical challenges. Although nurses are broadly recognized as professionals with relevant knowledge about children and families, little is known about how nurses experience ethical concerns in their everyday practice.

OBJECTIVE

The objective of this study was to better understand the moral experiences and related moral distress experiences of nurses working in pediatric settings in Brazil.

DESIGN

Interpretative phenomenological study conducted through narrative interviews.

PARTICIPANTS AND RESEARCH CONTEXT

Nine nurses working in three pediatric settings of a teaching hospital in a city of Southern Brazil.

ETHICAL CONSIDERATIONS

The study was approved by the Research Ethics Committee of the research site, and research ethics principles were respected throughout the study.

FINDINGS

This investigation illuminated a broader dimension of nurses' moral distress, which was recognized as moral experience. In advancing our understanding of nurses' moral experiences, engagement was identified as a central phenomenon that is present in the understandings and actions of nurses within their relationships in their daily practice and lived experiences. Three themes were described with regard to nurses' relationships and their moral experiences: (a) relationship with the healthcare team; (b) relationship with the family; and (c) relationship with the child.

DISCUSSION

The findings of this study are congruent with emerging health literature that demonstrated the focus on moral distress as limiting for bioethical inquiry. Moreover, it is important to better understand and recognize nurses' relational environment and engagements to advance understandings of the ethical dimensions of pediatric nursing practice.

CONCLUSION

This study provides a better understanding on how engagement affects moral experiences, demonstrating how nurses can experience distress but also satisfaction, gratification, rewarding feelings, and a sense of responsibility for the care they provide.

TEORIA DO APEGO, INTERACIONISMO SIMBÓLICO E TEORIA FUNDAMENTADA NOS DADOS: ARTICULANDO REFERENCIAIS PARA A PESQUISA

RESUMO Objetivo: apresentar e refletir sobre a articulação entre a Teoria do Apego, o Interacionismo Simbólico e a Teoria Fundamentada nos Dados no estudo da formação de vínculos e interação entre cuidadores e crianças institucionalizadas. Método: os dados foram coletados de abril a julho de 2015, por meio de entrevista intensiva, observação estruturada e diário de campo, em um abrigo institucional que acolhe crianças de zero a oito anos, em um município do Sul do Brasil. Participaram da pesquisa 15 cuidadores e seis crianças. Resultados: a Teoria do Apego e o Interacionismo Simbólico possibilitaram compreender as implicações da formação e quebra de vínculos e as estratégias utilizadas pelos cuidadores nesta interação. A Teoria Fundamentada nos Dados conduziu a elaboração do modelo teórico "Percebendo o trabalho/cuidado com crianças institucionalizadas". Conclusão: a articulação entre a Teoria do Apego, o Interacionismo Simbólico e a Teoria Fundamentada mostrou-se consistente para o estudo desenvolvido, contribuindo para o cuidado no contexto do abrigamento infantil.

[Translation and adaptation of the Children with Special Health Care Needs Screener to Brazilian Portuguese]

This study aimed to elaborate the Brazilian version of the Children with Special Health Care Needs Screener to assess internal consistency and inter-observer agreement. The stages included translation, back-translation, expert committee review, and pretest. Participation included 140 family members of children 0-12 years of age at health services in southern Brazil. Reliability was assessed with kappa statistic and Cronbach's alpha. In the assessment of clarity with health professionals, 80% rated the questions very clear. Prevalence of children with special health needs was 36%. Mean time for applying the instrument was 3.5 minutes. The process identified difficulties in understanding question number two. The instrument showed satisfactory internal consistency and perfect agreement. Future research should add to the psychometric analyses of the instrument's adequacy for the Brazilian context, thereby contributing to a standardized definition of this young age group's epidemiological profile within the public health scenario in Brazil.

Focus group on qualitative research: experience report

ABSTRACT Objective: to report the experience of applying the focus group technique for production of data in qualitative research. Method: four group sessions were held from May to June 2015, with the participation of professionals from the public sector of PHC and from specialized service. Results: the way focus group was developed is described in steps: planning, recruitment, ambience, group sessions, and evaluation. Conclusion: we highlight that the focus group, as a technique to produce data in collective space, can contribute not only to the construction of knowledge in Nursing, but also to the research approach with the assistance practice.

Challenges in the coordination of children's healthcare

This is a qualitative survey with a hermeneutic-dialectic frame of reference, designed to identify how parents and caregivers see the attribute 'coordination' in children's healthcare, in terms of resolving problems in children's health. The interview was held with 16 people responsible for care of children under one year of age, served in Emergency Care Units of a municipality in the south of Brazil, in 2010. With the thematic analysis, the central category was identified as: Effects and results of fragile coordination in Children's Primary Health Care, with the following themes: Divergences between different health units in the organization of care; functional barriers and delays obstructing access to technologies; absence of effective communication; absence of medical transport; need for healthcare on an individual basis; and coordination involving management of healthcare. It was concluded that the absence of coordination results in the absence of a solution-based approach in healthcare for children under one year old, showing gaps in the organization of the services and in health management, since communication, access to technologies, referral and counter-referral systems, and secure transport become essential for organizing primary care services and offering fully rounded care to the child.

Criança dependente de tecnologia e a demanda de cuidado medicamentoso

RESUMO Objetivo: compreender a vivência de mães de crianças dependentes de tecnologia em relação ao cuidado medicamentoso. Método: pesquisa qualitativa do tipo descritivo-exploratória, desenvolvida por meio de entrevistas abertas e aplicação de instrumento estruturado para caracterização, com 12 mães cuidadoras de crianças dependentes de tecnologia durante visita domiciliar. Os dados foram submetidos à análise de conteúdo indutiva. Resultados: organizados em dois temas: a sobrecarga materna diante do cuidado medicamentoso, que revelou a necessidade da administração de medicamentos de forma contínua e as repercussões desse cuidado exaustivo para as cuidadoras; e as dificuldades e facilidades no acesso aos medicamentos, apontando as estratégias informais e redes de apoio. Conclusão: o cuidado medicamentoso configura-se um desafio diário expresso pela sobrecarga materna e dificuldade de acesso aos medicamentos, potencializado por falhas na constituição da rede de atenção e coordenação do cuidado.

Metodologias qualitativas em pesquisa na saúde: referencial interpretativo de Patricia Benner

RESUMO Objetivo: este artigo relata a experiência de utilização do referencial fenomenológico interpretativo de Patricia Benner em uma pesquisa de dissertação de mestrado. A fenomenologia interpretativa, pautada em referenciais filosóficos existenciais e de interpretação, possui como objetivo compreender as experiências humanas nos diversos mundos dos participantes da pesquisa. Os dados foram coletados por meio de entrevistas com nove enfermeiros, nos meses de novembro e dezembro de 2014. Resultados: o processo de análise dos dados, de acordo com o referencial de Benner, segue os passos: transcrição, codificação, análise temática e busca por casos paradigmáticos e exemplares. Para tanto, os conhecimentos prévios dos pesquisadores fazem parte da estrutura do projeto interpretativo, constituindo as vias de condução do estudo. Conclusão: o uso desse referencial teórico e metodológico constituiu-se em um desafio para a pesquisadora, porém demonstrou potencial ímpar para o desvelamento de fenômenos existenciais relacionados ao cotidiano dos participantes.

FAMILY PERCEPTION ABOUT THEIR PRESENCE OR NOT IN A PEDIATRIC EMERGENCY SITUATION

ABSTRACT The objective was to understand the perception of family members who experienced an emergency situation in relation to their presence or not during the child's treatment in the Pediatric Emergency Department. A qualitative study developed in a Pediatric Emergency Department. The study subjects consisted of ten relatives who had experienced an emergency situation. Data collection was through semi-structured interviews and data were submitted for thematic content analysis. The results showed that among the ten relatives interviewed only one said that they preferred not to remain with the child during the emergency situation. Regarding the clinical condition of the children, five of them had special health care needs. Previous negative situations had influenced the family member's choice of staying during the assistance. Considering the benefits of family presence, it is recommended that nursing teams develop strategies which can facilitate the inclusion of the family in child care in any situation, while respecting the uniqueness of each person.