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Advisor(s)
Abstract(s)
Parentalidade pode ser entendida como o assumir das responsabilidades de ser pai de uma
criança durante o seu desenvolvimento. Isso implica um papel ativo e eficaz em que os pais se
sentem ligados à criança e possuem o conhecimento e as habilidades para desempenhar o
papel de ser um pai ou uma mãe.
Por vezes, a condição de saúde da criança requer um episódio de hospitalização. Viver a
experiência de ter um filho internado muitas vezes é difícil e complexo. A atitude dos pais ao
lidar com o internamento do seu filho depende das características pessoais dos pais, dos
enfermeiros, bem como das características pessoais da própria criança. Nesta situação, a
atitude dos pais depende também do tipo de assistência de enfermagem que recebem e da
própria condição de saúde da criança. Estabelecer uma parceria de cuidados, entre
enfermeiros e pais em unidades pediátricas hospitalares é visto como o melhor caminho para
alcançar os melhores resultados. Assim, nos dias de hoje, a parceria de cuidados é exigida por
pais e por enfermeiros, dado que muitos benefícios foram já identificados.
A capacidade dos enfermeiros para trabalhar em parceria com os pais é uma competência
essencial para alcançar melhores padrões de qualidade dos cuidados de enfermagem. Os pais
devem ser vistos pelos enfermeiros como parceiros no cuidar da criança. No entanto, o nível e
tipo de participação devem ser orientados para os objetivos terapêuticos. Neste contexto, a
parceria de cuidados deve ser orientada pelos objetivos terapêuticos e para o alcançar dos
resultados desejados estabelecidos no planeamento de enfermagem. Apesar da relevância da
parceria de cuidados, não foram encontradas pesquisas sobre como esta pode influenciar os
resultados de saúde relacionados com o desempenho dos pais. Assim, a pesquisa em
enfermagem é desafiada a desvendar a intencionalidade terapêutica do envolvimento dos pais
no cuidado da criança hospitalizada.
Com o projeto atual pretendemos responder, principalmente, à questão: quais são as
intencionalidades terapêuticas dos enfermeiros quando promovem a parceria de cuidados com
os pais durante a hospitalização da criança? Para empiricamente respondermos a esta
questão, um projeto de investigação-ação foi concebido envolvendo enfermeiros de uma
unidade pediátrica hospitalar da área de Matosinhos (Portugal).
Um processo de hospitalização de uma criança representa um evento crítico na transição
parental que pode dificultar a experiência dos indivíduos enquanto pais. Pode também desafiar
o decurso do exercício parental. Os pais precisam compreender o estado de saúde da criança
e o processo de hospitalização. Têm também de aprender a gerir incertezas, a adquirir novos
conhecimentos e habilidades e, em alguns casos, a construir novos significados sobre as suas vidas e dos seus filhos. A deslocalização da criança de casa para o hospital pode influenciar a
sensação de bem-estar, as expetativas e o padrão de relacionamento entre os pais. Em
algumas situações, ter o filho hospitalizado exige que os pais alterarem alguns
comportamentos, sendo que, por vezes, eles vivem também um período de reformulação em
alguns aspetos da sua identidade. Isto acontece quando a condição de saúde da criança
determina a necessidade permanente de cuidados complexos que devem ser realizados pelos
pais após o momento da alta hospitalar.
Os relatos das mães sobre as experiências relacionadas com a hospitalização do filho
enfatizaram a ideia de que a hospitalização do filho é um evento na vida pessoal relacionado
com o papel parental. As experiências das mães podem ser vistas em duas perspetivas
diferentes: algumas mães destacaram que a hospitalização gera a interrupção no padrão
habitual de desempenho do papel maternal; outras enfatizaram a autoconsciência sobre as
mudanças e diferenças que precisam introduzir no exercício do papel maternal habitualmente
realizado até agora, devido ao estado de saúde do filho (muitas vezes uma doença crónica
diagnosticada pela primeira vez). Nesta segunda situação, as mães perceberam a necessidade
de reorientar seu projeto de vida e, portanto, elas vivem uma experiência de transição que
começa com a perceção de uma crise relacionada com as mudanças no seu papel maternal.
A fim de evoluir na profissionalização do envolvimento dos pais pelos enfermeiros ao construir
a parceria de cuidados, em primeiro lugar, focámos a análise dos dados recolhidos a partir da
observação das interações entre enfermeiros, pais e crianças, tendo em vista produzir uma
síntese teórica acerca dos padrões de parceria de cuidados. Após, foram analisados dados de
entrevistas e questionários dirigidos a pais e enfermeiros, a fim de responder à questão de
pesquisa: quais as intencionalidades terapêuticas principais dos enfermeiros quando
promovem a parceria de cuidados com os pais durante a hospitalização da criança?
Desta investigação emergiram sete tipos de objetivos embebidos nas intenções dos
enfermeiros: (1) Promoção da participação dos pais nos cuidados do tipo desenvolvimental
(cuidados habituais); (2) Promoção de competências parentais para prestar cuidados
complexos; (3) Promoção de participação dos pais nos cuidados complexos quando as
competências parentais foram avaliadas como eficazes; (4) Melhoria no desempenho dos pais
para realizar os cuidados complexos quando um potencial de valorização de competências dos
pais para realizar os cuidados complexos foi identificado; (5) Redução do nível stress
associado ao papel parental em pais de crianças com necessidades especiais permanentes,
facilitando, durante a hospitalização, o descanso no exercício do papel; (6) Preparação dos
pais para prestar cuidados complexos; (7) Preparação dos pais para promover a autonomia da
criança.
Parenting can be understood as taking on responsibilities of being parent of a child throughout their development. It implies an active and effective role in which parents feel connected to the child and have the knowledge and skills to perform the role of being a father or a mother. Sometimes, the health's condition of the child requires an hospitalization's episode. To live the experience of having a son hospitalized is often very difficult and complex. The parents' attitude when dealing with the hospitalization of their son depends on the personal characteristics of the parents, nurses, as well on the personal characteristics of the child itself. In that situation, parents' attitude also depends on the kind of assistance that parents receive from nursing, and of the child's health condition. Establish a care's partnership between nurses and parents in hospital's pediatric units is seen as the best pathway for achieve better outcomes. Thus, in nowadays, care's partnership is required by parents and by nurses because many benefits were identified. Nurses' ability to work in partnership with parents is an essential competence to achieve better standards of nursing care quality. Parents must be seen by nurses as partners in child's care. However, the level and type of participation should be oriented toward the therapeutic goals. In this context, the care's partnership must be oriented by the therapeutic goals, and in order to achieve the desired outcomes established when planning nursing care. Despite the relevance of the care's partnership, no research was found on how it can influences health results related with the parental performance. So, nursing research is challenged to unveil the therapeutic intentionality of the parental involvement in the hospitalized child's care. With the actual research project we pretend to answer mainly to the question: what are the major therapeutics’ intentionalities of nurses when promote the care partnership with parents during the child's hospitalization? To empirically answer to this research question an actionresearch project was designed involving nurses from one hospital pediatric unit of the Matosinhos area (Portugal). This thesis reports the results of the research done. A child's hospitalization process represents a critical event on the parental transition that can disrupt the experience of the individuals as parents. It can also challenge the course of parenting. Parents need to understand about child's health condition and about the process of hospitalization. They must also learn about how to manage uncertainties, acquire new knowledge and skills and, in some cases, build new meanings for their lives and about their children. The child's relocation from home can influence the sense of well-being, the expectations, and the pattern of relationships between parents. In some situations, to have the son hospitalized require that parents change some behaviors and sometimes they are also to reformulate some aspects of their identity. This is necessary when child's health condition determines the permanent need of complex care that must be performed by its parents after the moment of the hospital discharge. Mothers' reports about their experiences related with his son's hospitalization emphasized the idea in which his son's hospitalization is a personal life's event related with his parental role. Mothers' experiences can be seen in two different perspectives: Some of them highlighted that the hospitalization of his son interrupts their usual pattern of maternal role performance; other ones emphasized the self-awareness about changes and major's differences they need to introduce in the maternal role regularly performed so far due to the actual's son health condition (often a chronic disease diagnosed for the first time). In this second situation, mothers perceived the need of reorient his life's project and so, they should live a transition's experience that starts as a crisis related with the changes in his maternal role. In order to evolve on the professionalization of parents' involvement by nurses when they are building the care partnership, firstly we focused the data analysis collected from the observation of interactions between nurses, parents, and child, on the theoretical synthesis of patterns of care partnership. After that we analyzed data from interviews and questionnaires directed toward parents and nurses in order to answer to the research question: what are the major therapeutics’ intentionalities of nurses when promote the care partnership with parents during the child's hospitalization? From this research emerged seven types of nursing goals embebed in nurses' intentions: (1) Promotion of parent's participation in care of the developmental type (habitual care); (2) Promotion of parental competences to perform complex care; (3) Promotion of parent's participation in complex care when parental competences was assessed as effective; (4) Improvement on the performance of parent to perform complex care when a potential for enhancement of parents competencies to perform complex care was identified; (5) Reduction in parental role strain level of parents of children with permanent special needs by facilitating, during hospitalization, a period of rest; (6) Preparation of the parents to perform complex care; (7) Preparation of the parents to promote child's autonomy.
Parenting can be understood as taking on responsibilities of being parent of a child throughout their development. It implies an active and effective role in which parents feel connected to the child and have the knowledge and skills to perform the role of being a father or a mother. Sometimes, the health's condition of the child requires an hospitalization's episode. To live the experience of having a son hospitalized is often very difficult and complex. The parents' attitude when dealing with the hospitalization of their son depends on the personal characteristics of the parents, nurses, as well on the personal characteristics of the child itself. In that situation, parents' attitude also depends on the kind of assistance that parents receive from nursing, and of the child's health condition. Establish a care's partnership between nurses and parents in hospital's pediatric units is seen as the best pathway for achieve better outcomes. Thus, in nowadays, care's partnership is required by parents and by nurses because many benefits were identified. Nurses' ability to work in partnership with parents is an essential competence to achieve better standards of nursing care quality. Parents must be seen by nurses as partners in child's care. However, the level and type of participation should be oriented toward the therapeutic goals. In this context, the care's partnership must be oriented by the therapeutic goals, and in order to achieve the desired outcomes established when planning nursing care. Despite the relevance of the care's partnership, no research was found on how it can influences health results related with the parental performance. So, nursing research is challenged to unveil the therapeutic intentionality of the parental involvement in the hospitalized child's care. With the actual research project we pretend to answer mainly to the question: what are the major therapeutics’ intentionalities of nurses when promote the care partnership with parents during the child's hospitalization? To empirically answer to this research question an actionresearch project was designed involving nurses from one hospital pediatric unit of the Matosinhos area (Portugal). This thesis reports the results of the research done. A child's hospitalization process represents a critical event on the parental transition that can disrupt the experience of the individuals as parents. It can also challenge the course of parenting. Parents need to understand about child's health condition and about the process of hospitalization. They must also learn about how to manage uncertainties, acquire new knowledge and skills and, in some cases, build new meanings for their lives and about their children. The child's relocation from home can influence the sense of well-being, the expectations, and the pattern of relationships between parents. In some situations, to have the son hospitalized require that parents change some behaviors and sometimes they are also to reformulate some aspects of their identity. This is necessary when child's health condition determines the permanent need of complex care that must be performed by its parents after the moment of the hospital discharge. Mothers' reports about their experiences related with his son's hospitalization emphasized the idea in which his son's hospitalization is a personal life's event related with his parental role. Mothers' experiences can be seen in two different perspectives: Some of them highlighted that the hospitalization of his son interrupts their usual pattern of maternal role performance; other ones emphasized the self-awareness about changes and major's differences they need to introduce in the maternal role regularly performed so far due to the actual's son health condition (often a chronic disease diagnosed for the first time). In this second situation, mothers perceived the need of reorient his life's project and so, they should live a transition's experience that starts as a crisis related with the changes in his maternal role. In order to evolve on the professionalization of parents' involvement by nurses when they are building the care partnership, firstly we focused the data analysis collected from the observation of interactions between nurses, parents, and child, on the theoretical synthesis of patterns of care partnership. After that we analyzed data from interviews and questionnaires directed toward parents and nurses in order to answer to the research question: what are the major therapeutics’ intentionalities of nurses when promote the care partnership with parents during the child's hospitalization? From this research emerged seven types of nursing goals embebed in nurses' intentions: (1) Promotion of parent's participation in care of the developmental type (habitual care); (2) Promotion of parental competences to perform complex care; (3) Promotion of parent's participation in complex care when parental competences was assessed as effective; (4) Improvement on the performance of parent to perform complex care when a potential for enhancement of parents competencies to perform complex care was identified; (5) Reduction in parental role strain level of parents of children with permanent special needs by facilitating, during hospitalization, a period of rest; (6) Preparation of the parents to perform complex care; (7) Preparation of the parents to promote child's autonomy.
Description
Keywords
Parentalidade Hospitalização da criança Parceria de cuidados Intencionalidade terapêutica Parenting Hospitalization Care partnership Therapeutic intentionality