Repositório RCAAP

ABSTRACT Objective: To analyze the care practices of family members of premature infants admitted to a Neonatal Intensive Care Unit in the light of Leininger’s transcultural theory. Methods: Qualitative, descriptive and exploratory study. Participant observation and semi-structured interviews were conducted with 16 family members of newborns, admitted to the neonatal unit of a public maternity hospital, during the months of May and June 2019. The software called Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® and the Bardin Content Analysis technique. Results: Two thematic categories emerged: Family care in the neonatal unit; (in)effective support for shared care. Conclusion: The participation of families in the care of babies is still unstable, but it must be an inseparable element of culturally congruent care, thus collaborating with the full recovery of the premature.

ABSTRACT Objective: To know the experiences of family members of children with cystic fibrosis under the light of the theory of Callista Roy. Method: Qualitative research that used the adaptation theoretical framework of Callista Roy for inductive content analysis. Fifteen family members, in a university hospital, between 23 and 63 years old, participated in the study, from September to October 2018. Results: Two categories were elaborated: “Evaluation of stimuli” and “Evaluation of behaviors”. The first has three subcategories: “focal”, “contextual” and “residual”. And the second, four subcategories: “physiological domain”, “self-concept”, “role function” and “interdependence”. Final Considerations: During the evaluation of stimuli, work overload and stress were identified as focal stimuli. Regarding contextual stimuli, it was noticed that the social life of caregivers was prejudiced. As for residual stimuli, the fear of loss is constant, and it appears that the emotional aspect of family members is the most affected comparing with physical exhaustion.

ABSTRACT Objective: to evaluate the clinical conditions and the risk classification of children and adolescents treated in a hospital emergency, according to the Pediatric Risk Classification Protocol. Method: cross-sectional study, with 200 participants, using an instrument based on the Pediatric Risk Classification Protocol and using odds ratio for the analysis. Results: most participants were male patients in early childhood and who were or weren’t in daycare. As for clinical conditions, most showed changes in vital (24.5%) and respiratory (20.0%) signs, most patients (57.5%) did not present pain; 35.5% were classified as urgent and 45.0% as non-urgent. There was a greater chance of being classified as very urgent (orange) when compared to non-urgent (blue). Conclusion: the protocol used contributed to an effective classification and was considered a valid and reliable health technology for determining the priority of care.

ABSTRACT Objective: To identify the prevalence of xerostomia in women undergoing chemotherapy for breast cancer. Method: Prospective cohort with 27 women who underwent up to 16 sessions of intravenous chemotherapy. Data collection was performed at the outpatient clinic of a university hospital in the city of São Paulo, where two forms were applied before the start of treatment and the Xerostomia Inventory before and after each chemotherapy session. Results: Complaints of dry mouth were present in 48.1% of women before chemotherapy, and they were approximately 28 times more likely to develop dry mouth during treatment. It was observed that the use of antiemetics contributed to the occurrence of xerostomia, and the anti-ulcerous were presented as a protective factor. Conclusion: The study identified both a high prevalence of xerostomia regardless of the chemotherapy used and the need to create protocols to improve the quality of life of these patients.

ABSTRACT Objective: Identify the level of reproductive autonomy of quilombola women and associate it with sociodemographic characteristics and aspects of sexual and reproductive health. Methods: Cross-sectional census study carried out in quilombola communities in a municipality in Bahia. Data was collected through questionnaires from the National Health Survey and the Reproductive Autonomy Scale, applied to quilombola women who agreed to participate. Descriptive statistics procedures were used and associations were made between reproductive autonomy scores and sociodemographic and reproductive characteristics. Results: The average total score for reproductive autonomy was 2.06. An association was found between the “decision-making” score and marital status. The score for “total reproductive autonomy” was associated with the use of contraceptive method. Conclusion: The reality of the study participants converges with the literature regarding the interference of sociodemographic and reproductive factors in the reproductive autonomy of black women.

ABSTRACT Objectives: to know the nurses’ perception on violence against children by their companion in pediatric ward; describe the nurses’ actions in this situation; analyze these actions in light of government policies; and know the organization and communication of the multidisciplinary team to face this phenomenon. Method: a descriptive qualitative research conducted through semi-structured interviews with nurses. Thematic analysis identified three categories: “A perception of violence”; “Actions and interventions performed by nurses”; and “Multidisciplinary team organization and communication”. Results: nurses recognize the types of violence, but attaches greater severity to physical violence. The reported causes were children with difficult temperaments, transgenerational violence and hospitalization. The actions were dialogue, companion-child separation, registry and notification to the Guardianship Council. Poor communication from the multidisciplinary team and medical-centric organization have been reported.

ABSTRACT Objective: to understand the experience of families of living with children and adolescents with bladder and bowel dysfunction. Methods: a qualitative phenomenological interpretive research carried out through an in-depth open interview with parents of children and adolescents linked to Advanced Practice Nursing clinic in pediatric urology. Results: the following representative categories of the families’ experiences emerged: Knowledge and learning: building family knowledge; Living with the children’s BBD: symbolic representations; Management and adaptation to the children’s BBD: reorganizing family life. Final considerations: the experience of families related to positive and negative meanings, presence or absence of previous experiences, information gaps, learning process and access to specialized professional follow-up. Follow-up by nurses is important in pediatric urology care for the learning and consolidation of specific knowledge about bladder and bowel dysfunction.

ABSTRACT Objective: To evaluate effectiveness of using educational intervention serial album to positioning pregnant women for spinal anesthesia. Method: Randomized clinical trial with 90 women casually assigned to control (CG) and intervention group (IG), in a maternity hospital located in Northeast region of Brazil. The primary endpoint was “achieve correct positioning to perform spinal anesthesia”; and secondary, “how number of spinal cord puncture attempts”. Effectiveness was verified using the chi-square test, Fisher’s exact test and likelihood ratio. Results: The positioning was correct in 37 women in each group. There was an association between women in control group remaining still, relaxing shoulders and flexing the spine; and women in intervention group should remain still and relax the shoulders; furthermore there was a statistical association achieved by correct positioning and the number of attempts to access the lumbar puncture. Conclusion: Educational intervention with serial album was effective and contributed to immobility and positioning of pregnant women. Brazilian Registry of Clinical Trials (RBR-3Z7SRD).

ABSTRACT Objective: To analyze the factors associated with the performance of episiotomy. Methods: Cross-sectional study, developed with data from the research “Born in Belo Horizonte: Labor and birth survey, “conducted with 577 women who had their children via vaginal birth. In order to verify the magnitude of the association between episiotomy and its possible determinants, logistic regression models were constructed to estimate the odds ratio. Results: Episiotomy was performed in 26.34% of women, and 59.21% knew they had been subjected to it. We observed that younger women, primiparous women, women assisted by a professional other than the obstetric nurse and women who had their babies in a private hospital have an increased chance of being submitted to this procedure. Conclusion: Considering the rates of episiotomy, this study highlights the need for the absolute contraindication to indiscriminate performing it.

ABSTRACT Objective: to identify, through the contributions of hospitalized children and adolescents, the characteristics they consider necessary for a hospital that promotes well-being and development. Method: descriptive and exploratory study, with qualitative data analysis, carried out with a total of 30 hospitalized children and adolescents. Data were collected through semi-structured interviews, mediated by drawing, and analyzed by inductive thematic analysis, supported by the theoretical framework of the humanization of health care and the Florence Nightingale’s Environmental Theory. Results: the designed hospital takes up the principles of Florence Nightingale’s Environmental Theory, as well as one of the guidelines of the National Humanization Policy, the environment, from two perspectives: elements and material resources from the physical environment; elements of comfort and well-being environment. Final considerations: hospitals such as the projected institution corroborate what is recommended in public policies, as they qualify health care.

ABSTRACT Objective: To know the beliefs, values and practices of families in the care of hospitalized children. Method: Qualitative study developed at the Pediatrics Unit of a University Hospital in southern Brazil through non-participant observation, participant observation and interview with children’s family members. The methodological framework of Ethnonursing was adopted. Data were coded, classified and scrutinized to identify saturation of similar or different ideas and patterns, and recoded by making theoretical formulations and recommendations. Results: Beliefs, values and practices of families depend on cultural references and are manifested in the care with feeding, clothing and hygiene, maintenance of sleep and rest, presence, care with medication and exercise of religious belief. Conclusion: Family members care for the hospitalized child based on their cultural reference and it is important that nurses take this aspect into consideration during care practice. Cultural care aggregates knowledge and can be considered a new paradigm for nursing care that allows an affective, reflective, human, empathic relationship between nurse/child/family.

ABSTRACT Objective: Analyze the occurrence of dyslipidaemia and associated factors in children aged 2 to 9 years. Method: Cross-sectional study, carried out with 700 children, in a region of Northeast Brazil. For comparison of means, Student’s t test was used; and, for the comparison of medians, the Mann-Whitney test. Results: A prevalence of dyslipidaemia of 68.4% was found. In isolation, the majority had a level of: total desirable cholesterol (386; 55.1%), undesirable lipoprotein cholesterol (376; 53.7%), low density lipoproteins - desirable cholesterol (514; 73.4%) and desirable triglyceride (509; 72.7%). In the final multivariate model, only the variable “preschool age” was significant (prevalence ratio = 1.14), indicating that these children are more likely to have dyslipidaemia than those of school age. Conclusion: An association was found between dyslipidaemia and preschool age. The need for programs and strategies to better understand this problem is indicated, in addition to preventing early coronary diseases.

ABSTRACT Objective: to unveil the interrelation of childhood colic management by mothers and Family Health Strategy professional. Methods: a qualitative, exploratory and descriptive research carried out with 4 Family Health Strategy teams and 31 mothers who experienced childhood colic. Data collection included, respectively, focus group and individual unstructured interview. Symbolic Interactionism was adopted as the theoretical framework, and Narrative Research as methodological. Results: two themes emerged: “Colic approach” and “Social support and care”. Professional childhood colic management is based on diagnosis and drug interventions. For mothers, the child’s suffering and impotence in the face of the disease stand out. Final considerations: childhood colic is socially widespread because it is a physiological and self-limiting event. Mothers felt helpless in the face of childhood colic. Professionals felt the need to expand their care, with a view to achieving maternal suffering and alleviating it.

ABSTRACT Objective: to assess the complications, acceptability and causes of discontinuation of women who inserted copper intrauterine devices at a usual risk maternity for one year. Methods: a longitudinal-prospective study, lasting 12 months. Eighty-three women who received the device by a doctor or nurse in a maternity hospital between September and October 2017 participated. Data were collected at one, six and 12 months after insertion and underwent descriptive analysis. Results: most were inserted by nurses and 71 continued with the device. Women chose IUD use because there is no risk of forgetfulness, it is non-hormonal and effective. The 12 who discontinued use reported dysmenorrhea, menorrhagia, irregular bleeding, fall out, and endometrium perforation. Conclusion: the method was continued by most of participants and the complications found are common to the literature. There is a need to expand nursing training to increase the offer to the population.

ABSTRACT Objective: to understand, through dramatic therapeutic play, children’s experiences during maternal imprisonment. Methods: this is a phenomenological study in the light of Winnicott’s theoretical framework carried out in a philanthropic assistance center in the capital of São Paulo, with eight children aged three to ten who participated in an interview mediated by dramatic therapeutic play session. Results: two categories emerged: Children being without a mother: a storm with lightning and thunder and Children growing up without a mother: drizzle, heavy rain and some rays of sun. Final considerations: children revealed that, even in the absence of their mothers, it is possible to continue being and growing. Therapeutic play allowed children to give voice to their experiences, surrounded by concerns and limitations, in addition to unveiling an unknown social context.

ABSTRACT Objectives: to identify, in the scientific literature, the educational practices performed by nurses with the families of children and adolescents using long-term venous catheters, concerning home care. Methods: integrative review in LILACS, PubMed, SCOPUS, Web of Science and CINAHL databases, from August to September 2018. Results: we analyzed eight articles that met the inclusion criteria. The results showed that all studies are international, mostly North American and with low level of evidence. The educational practices found were home visits, production of printed educational materials, use of mannequins for simulation, creation of an educational video, and combined educational practices. Final Considerations: the care provided by families at home in the countries studied is more complex than in Brazil, and the conclusion is that Brazilian studies need to advance in publications related to this area.

ABSTRACT Objectives: to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics. Methods: integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included. Results: the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information). Conclusions: there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child’s right to know their condition.

ABSTRACT Objective: To stablish a middle range theory for the understanding of the causal mechanisms and clinical consequentes of the nursing diagnosis Excess Fluid Volume (00026) among pregnant women. Method: The Middle Range Theory was constructed in five stages: defining of construction approach, establishing main concepts, elaborating propositions, developing a pictorial diagram, and establishing the causal relationships and evidence for practice of the Middle Range Theory. Results: We identified 14 clinical indicators and 6 causal factors of Excess Fluid Volume. A pictorial diagram was developed and relationships between Excess Fluid Volume elements were established with 6 propositions for them. Conclusion: The Middle Range Theory included both physiological and pathological conditions to explain Excess Fluid Volume. This Middle Range Theory might help in the better understanding of interactions between causal factors and clinical indicators of Excess Fluid Volume.

ABSTRACT Objective: to describe the main evidence available in the literature on safe practices in the prevention and care of skin lesions in newborns admitted to Neonatal Intensive Care Units. Methods: integrative literature review in the PubMed, BDENF, LILACS, MEDLINE, SciELO and Cochrane Library databases between 2013 and 2018. We included primary articles on: lesion prevention and skin care in newborns in Portuguese, English or Spanish and excluded editorials, thesis, dissertations and duplicate articles. For the evidence level, we used the Melnyk and Fineout-Overholt classification, which classifies studies between weak to strong evidence. Results: a total of 10 articles with moderate to weak evidence on thermoregulation, bathing, lesion prevention, use of patches and skin antisepsis. Final considerations: there was a shortage of publications with high evidence, and it is necessary to invest in research that seeks to support safer skin care practices.

ABSTRACT Objective: to analyze the postnatal care practices of newborns in the family context from the scientific literature. Methods: the searches of the integrative literature review were carried out in the Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database (BDENF), Scientific Electronic Library Online (SciELO), and U.S. National Library of Medicine (PubMed) databases. Results: sixteen studies composed the final sample and, from these, two analytical categories emerged: Practices and doubts of families in postnatal care of newborns; and Best practices in postnatal care of newborns. Final considerations: several cultural practices of families differ from scientific recommendations, which can generate risks to the health of newborns. Therefore, it is essential to consolidate educational programs with family members, to improve the quality of care offered and to reduce preventable neonatal deaths in different socio-family contexts.