Promoção da saúde da criança: concepções e experiências de enfermeiros da estratégia saúde da família
Data
2018-02-26
Autores
Alcantara, Aline Biondo
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: o presente estudo apresenta como tema a Promoção da Saúde da Criança, recortando como objeto a inserção de suas premissas nos cuidados realizados por enfermeiros da Estratégia Saúde da Família. Objetivo: analisar as concepções e experiências de enfermeiros da Estratégia Saúde da Família, no que se refere à incorporação das premissas da Promoção da Saúde nos cuidados realizados com crianças e suas famílias. Aspectos metodológicos: pesquisa de abordagem mista, composta por duas etapas. Na primeira, foi realizado estudo qualitativo sobre o objeto em estudo na perspectiva dos enfermeiros da Estratégia da Saúde da Família de um município do interior paulista, com coleta e sistematização dos dados feita por entrevistas semiestruturadas gravadas e por técnicas de análise de conteúdo temática, respectivamente. Na segunda, realizou-se estudo quantitativo transversal e descritivo sobre 626 atendimentos clínicos realizados por enfermeiros a 222 crianças, as quais compuseram amostra probabilística e estratificada calculada a partir do universo de crianças nascidas entre 28 de fevereiro de 2015 a 27 de fevereiro de 2017, que foram atendidas em seus dois primeiros anos de vida nas referidas unidades. Os dados foram coletados dos prontuários das crianças e de suas mães, com enfoque nos tipos de atendimento a elas realizados, nos motivos/queixas, avaliações clínicas e nas propostas de cuidados elaboradas. Foi realizada análise descritiva das variáveis estudadas utilizando o Programa SAS System versão 9.3. A discussão dos resultados obtidos, em ambas as etapas, baseou-se nas premissas da Promoção da Saúde da Criança. O projeto desta pesquisa foi aprovado por Comitê de Ética em Pesquisa local (Parecer nº 1.851.368). Resultados: o grupo dos 11 enfermeiros se caracterizou pela maior parte ser do sexo feminino, estar na faixa etária entre 30 a 50 anos, ter oito a 26 anos de graduação e de um a 15 anos de atuação na Estratégia Saúde da Família. De modo ampliado, os participantes relacionaram a Promoção da Saúde da Criança a ações integrais e intersetoriais, que valorizam a Educação em Saúde, comprometimento e vínculo próximo das equipes com as famílias, para capacitá-las a modificar os determinantes do processo saúde-doença de seus filhos, visando sua melhor qualidade de vida e saúde. As dificuldades associadas às referidas ações foram: baixa participação familiar nas atividades programadas, preferência pelo atendimento médico, condições familiares e sociais adversas, carência de recursos de educação permanente na temática. As crianças se caracterizaram por apresentarem situações favoráveis quanto aos aspectos sociodemográficos, condições obstétricas e de nascimento, com parcelas menores daquelas que apresentaram riscos e vulnerabilidades ao nascer. Dos 626 atendimentos clínicos estudados, 548 (87,6%) ocorreram no primeiro semestre de vida, com 407 (65%) do tipo consulta agendada de rotina e 11 (1,8%) visitas domiciliares. Quanto às queixas/motivos, destacaram-se os sinais, sintomas e outros parâmetros clínicos alterados, com 425 (93,4%) registros, relativos principalmente ao sistema respiratório e ao tegumentar, que somaram 200 (43,7%) dos registros; evidenciando-se a febre como o sinal isolado registrado em 95 (20,9%). Em relação às áreas diagnósticas, sobressaiu-se a de Agravos Físicos com 445 (46,3%) avaliações, seguida pela de Alimentação/Hidratação com 206 (21,4%) avaliações e a do Crescimento e a do Desenvolvimento neuropsicomotor, que juntas somaram 197 (20,5%) das avaliações. Sobre as áreas de intervenção, a maior parte se configurou em Orientação 1200 (55,6%), especialmente sobre Higiene corporal/Higiene bucal com 392 (18,2%) e Alimentação/Hidratação com 288 (13,3%) registros, seguidas pelas condutas de Encaminhamento, Agendamento, Solicitação de exames de rotina, com 905 (41,9%) das propostas de cuidados. Considerando as Necessidades Essenciais da Infância, os resultados anteriores sustentam a ideia de que a mais explorada foi a Necessidade de Proteção Física, Segurança e Regulamentação. Considerações finais: as concepções apreendidas revelaram-se próximas às premissas científicas e políticas atuais sobre Promoção de Saúde da Criança. Por outro lado, as experiências relatadas apresentaram-se permeadas pelo enfrentamento de dificuldades e vulnerabilidades inerentes às crianças, aos seus contextos de vida e ao próprio serviço de saúde. Dentre os cuidados de enfermagem realizados na Estratégia Saúde da Família, verificou-se que nos atendimentos clínicos pediátricos, independentemente do tipo, são desenvolvidas ações de Promoção da Saúde. Entretanto, esses atendimentos ainda são fortemente influenciados pelo modelo biomédico, centrado em doenças e agravos à saúde, refletindo no predomínio de registros nas áreas de avaliações diagnósticas e de intervenção voltadas aos agravos físicos, não contemplando várias necessidades tidas como essenciais da infância. Considera-se que o estudo apresenta subsídios para a reorganização das ações de Promoção da Saúde da Criança, evidenciando potencialidades/desafios a serem considerados/superados pelos enfermeiros no contexto estudado e em outros relacionados.
Introduction: the present study has as its theme the Child’s Health Promotion, outlining as object the insertion of its premises in cares carried out by Family Health Strategy nurses. Objective: analyze Family Health Strategy nurses’ conceptions and experiences concerning to Health Promotion premises incorporation in cares carried out with children and their families. Methodological aspects: mixed approach research, composed of two stages. In the first, it was carried out a qualitative study about the object of attention from the perspectives of Family Health Strategy nurses from an inland São Paulo city, with data collection and systematization made by recorded semi structured interviews and techniques of thematic content analysis, respectively. In the second, there was carried out a quantitative transversal and descriptive study about 62 clinical cares made by nurses to 222 children who composed probabilistic and stratified sample calculated from the universe of children who were born between February 28th, 2015 and February 27th , 2017, who were treated during their first two years of life in the cited health centers. Data was collected from children’s and their mothers’ medical records, focusing on the kinds of cares offered to them, on their reasons/complains, clinical evaluation and on their elaborated cares purposes. It was carried out a descriptive analysis of the studied variables using SAS System Program version 9.3. The discussion about the obtained results, in both stages, was based on Child’s Health Promotion premises. This research project was approved by Ethical Committee in local Research (Opinion nº 1.851.368). Results: the group composed by 11 nurses was characterized as being mostly females, between 30 and 50 years old, eight to 26 years of under graduation and one to fifteen years of Family Health Strategy performance. Broadly, participants related Child’s Health Promotion to integral and intersectional actions which value Health Education, commitment and close bonds from teams towards families in order to enable them to modify determinants of their children’s healthillness process, aiming at their better quality of life and health. Difficulties associated with their stated actions were: poor family participation in programmed activities, medical care preference by this population, adverse family and social conditions, lack of material and organizational resources and permanent education on the subject. The children’s sample was characterized by presenting favorable situations regarding to the social demographic aspects, obstetrical and birth conditions, with smaller sectors of those who presented vulnerabilities as life threatening at birth. The analysis of 626 studied clinical cares revealed a higher frequency of these in the first semester of life 548 (87, 6%), with 407 (65%) routine scheduled visits, being only 11 (1,8%) home visits. As for the complaints/reasons related to these visits, signals, symptoms and other altered clinical parameters were highlighted, with 425 (93,4%) recorded, related mainly to tegumentary and respiratory systems, which summed together 200 (43,7%) of records, evidencing fever as an isolated signal recorded in 95 (20,9%). Relating to the diagnosed areas it was highlighted the Physical Injury one with 445 (46,3%) evaluations, followed by the Feeding/Hydration with 206 (21, 4%) evaluations and neuropsychomotor Growth and Development, which summed together 197 (20,5%) evaluations. Concerning to intervention areas most part of them was related to Orientation 1200 (55,6%), especially about Body Hygiene/Oral Hygiene with 392 (18,2%) records and Feeding/Hydration with 288 (13,3%) records, followed to Referral, Scheduling and Request for routine exams with 905 (41, 9%) of the care proposes. Considering essential childhood needs, the former results support the idea that the most explored one was the Physical Protection, Safety and Regulation Need. Final Considerations: the grasped conceptionswererevealed close to scientific premises and current policies about Child’s Health Promotion. On the other hand, reported experiences were presented permeated with coping difficulties and vulnerabilities inherent in children, in their lives contexts and in health service itself. Among cares carried out in Family Health Strategy it was verified that on pediatric clinical cares, irrespective of the kind, Health Promotion actions are developed. However, these cares are still strongly influenced by biomedical model, centered on illnesses and health problems which reflect on predominance of records in diagnoses evaluation’s areas and interventions based on physical injuries, not contemplating several necessities which are treated as essential during childhood. It is considered that the study presents subsidies to reorganization of Child’s Health Promotion actions putting in evidence potentialities/challenges to be considered/overcome by nurses in the studied context and others related to it.
Introduction: the present study has as its theme the Child’s Health Promotion, outlining as object the insertion of its premises in cares carried out by Family Health Strategy nurses. Objective: analyze Family Health Strategy nurses’ conceptions and experiences concerning to Health Promotion premises incorporation in cares carried out with children and their families. Methodological aspects: mixed approach research, composed of two stages. In the first, it was carried out a qualitative study about the object of attention from the perspectives of Family Health Strategy nurses from an inland São Paulo city, with data collection and systematization made by recorded semi structured interviews and techniques of thematic content analysis, respectively. In the second, there was carried out a quantitative transversal and descriptive study about 62 clinical cares made by nurses to 222 children who composed probabilistic and stratified sample calculated from the universe of children who were born between February 28th, 2015 and February 27th , 2017, who were treated during their first two years of life in the cited health centers. Data was collected from children’s and their mothers’ medical records, focusing on the kinds of cares offered to them, on their reasons/complains, clinical evaluation and on their elaborated cares purposes. It was carried out a descriptive analysis of the studied variables using SAS System Program version 9.3. The discussion about the obtained results, in both stages, was based on Child’s Health Promotion premises. This research project was approved by Ethical Committee in local Research (Opinion nº 1.851.368). Results: the group composed by 11 nurses was characterized as being mostly females, between 30 and 50 years old, eight to 26 years of under graduation and one to fifteen years of Family Health Strategy performance. Broadly, participants related Child’s Health Promotion to integral and intersectional actions which value Health Education, commitment and close bonds from teams towards families in order to enable them to modify determinants of their children’s healthillness process, aiming at their better quality of life and health. Difficulties associated with their stated actions were: poor family participation in programmed activities, medical care preference by this population, adverse family and social conditions, lack of material and organizational resources and permanent education on the subject. The children’s sample was characterized by presenting favorable situations regarding to the social demographic aspects, obstetrical and birth conditions, with smaller sectors of those who presented vulnerabilities as life threatening at birth. The analysis of 626 studied clinical cares revealed a higher frequency of these in the first semester of life 548 (87, 6%), with 407 (65%) routine scheduled visits, being only 11 (1,8%) home visits. As for the complaints/reasons related to these visits, signals, symptoms and other altered clinical parameters were highlighted, with 425 (93,4%) recorded, related mainly to tegumentary and respiratory systems, which summed together 200 (43,7%) of records, evidencing fever as an isolated signal recorded in 95 (20,9%). Relating to the diagnosed areas it was highlighted the Physical Injury one with 445 (46,3%) evaluations, followed by the Feeding/Hydration with 206 (21, 4%) evaluations and neuropsychomotor Growth and Development, which summed together 197 (20,5%) evaluations. Concerning to intervention areas most part of them was related to Orientation 1200 (55,6%), especially about Body Hygiene/Oral Hygiene with 392 (18,2%) records and Feeding/Hydration with 288 (13,3%) records, followed to Referral, Scheduling and Request for routine exams with 905 (41, 9%) of the care proposes. Considering essential childhood needs, the former results support the idea that the most explored one was the Physical Protection, Safety and Regulation Need. Final Considerations: the grasped conceptionswererevealed close to scientific premises and current policies about Child’s Health Promotion. On the other hand, reported experiences were presented permeated with coping difficulties and vulnerabilities inherent in children, in their lives contexts and in health service itself. Among cares carried out in Family Health Strategy it was verified that on pediatric clinical cares, irrespective of the kind, Health Promotion actions are developed. However, these cares are still strongly influenced by biomedical model, centered on illnesses and health problems which reflect on predominance of records in diagnoses evaluation’s areas and interventions based on physical injuries, not contemplating several necessities which are treated as essential during childhood. It is considered that the study presents subsidies to reorganization of Child’s Health Promotion actions putting in evidence potentialities/challenges to be considered/overcome by nurses in the studied context and others related to it.
Descrição
Palavras-chave
Promoção da Saúde, Saúde da Criança, Enfermagem, Estratégia Saúde da Família, Atenção Primária à Saúde, Health Promotion, Child’s Health, Nursing, Family Health Strategy, Primary Health Attention