The experiences of relatives of children hospitalized in an Emergency Care Service VIVÊNCIAS DE FAMILIARES DE CRIANÇAS INTERNADAS EM UM SERVIÇO DE PRONTO-SOCORRO EXPERIENCIAS DE FAMILIARES DE NIÑOS INTERNADOS EN UN SERVICIO DE URGENCIAS

Childhood is a phase that requires much attention from the family and the health service, because family members, besides depending on relatives, are vulnerable to the environment. The objective of this study was to describe the experiences of relatives of children hospitalized in an emergency care service, discuss on how those experiences affect the everyday life of the family and report the aspects that interfere in the nursing care. This descriptive study was performed using a qualitative approach, and was developed in a private emergency hospital. Interviews were performed with ten family members to obtain the data. The data was submitted to thematic analysis, and three categories were elaborated: experiences of the family member, changes in the everyday life of the family, the faith of the family and their closeness as facilitating agents. In conclusion, the person accompanying the patient goes thorough adaptations, whilst experiencing hospitalization, with changes to the routine of the family. However, because of the conflicts experienced by the family member, nursing should see them as a subject of the extended care. DESCRIPTORS Child, hospitalized Family Child care Pediatric nursing Emergency medical services RESUMEN La infancia se presenta como una fase que exige bastante atención familiar y del servicio sanitario, toda vez que sus integrantes, además de depender de familiares, son vulnerables al ambiente. Se objetivó describir las experiencias de familiares de niños internados en servicio de Urgencias, discutir cómo esas vivencias influencian el cotidiano familiar y relatar los aspectos que interfieren en el cuidado de enfermería. Estudio descriptivo, de abordaje cualitativo, desarrollado en un hospital de Urgencias privado. Utilizó técnica de entrevista con diez familiares para obtener los datos. Estas fueron sometidos al análisis temático, elaborándose tres categorías: vivencias del familiar, alteraciones del cotidiano familiar, la fe y aproximación familiar actuando como agentes facilitadores. Se concluyó en que el acompañante pasa por adaptaciones al vivir la hospitalización, existiendo alteraciones en la rutina familiar. Sin embargo, debido a los conflictos enfrentados por el familiar, la enfermería debe comprenderlo como sujeto de cuidado ampliado. DESCRIPTORES Niño hospitalizado Familia Cuidado del niño Enfermería pediátrica Servicios médicos de emergencia Received: 05/28/2009 Approved: 08/17/2010 Portuguese / English: www.scielo.b /re usp 464 Rev Esc Enferm USP 2011; 45(2):463-8 www.ee.usp.br/reeusp/ The experiences of relatives of children hospitalized in an Emergency Care Service Santos AMR, Amorim NMA, Braga CH, Lima FDM, Macedo EMA, Lima CF INTRODUCTION The Brazilian Federal Constitution from 1988 ensures universal, equal and integral rights to the population, establishing various doorways to the health system. Depending on the complexity of their clinical condition, the system’s users should seek a unit capable of resolving their health problems. Health problems are characterized according to their severity: elective cases are those that do not require urgent care and treatment can be postponed without harming the patient’s health; urgent conditions correspond to the occurrence of unexpected illness, with or without a potential risk of death, and that require immediate medical care; emergencies require medical evidence that there is a condition involving imminent risk of death or intense suffering, thereby requiring immediate medical care. The context of an emergency department, the unit that takes care of these cases, is different from other hospital units because it offers unrestricted access to the population and receives an excessive number of patients with the most varied levels of severity. In this context, work overload, irregular physical structure and the scarce availability of human and material resources are currently inherent to the conditions of emergency departments in Brazilian hospitals. These units receive a large number of cases, which harms the care provided to severe and acute cases since it leads to accumulated tasks, contributes to increased costs and generates a burden for the health team’s professionals. Coupled with these problems, these professionals also care for situations of extreme severity that go beyond the services’ problem-solving capacity and face counter-referral problems. The observation rooms, which should temporarily serve patients, become hospitalization areas without offering appropriate infrastructure and personnel to provide continuous care. In the context of caring for children in the emergency department, various factors contributing to the vulnerability of these patients are observed such as the constant risk of children getting involved in accidents such as: mimicking their parents’ routine, curiosity, and lack of judgment. There are also diseases prevalent in childhood that can manifest due to the children’s fragile immunity, poor hygiene knowledge and actions, or intense contact with other children. Whatever the case, in the presence of such occurrences and depending on the child’s general condition, children are taken to emergency departments seeking rapid care and effective solutions. Given the disease and hospitalization, some factors may psychologically affect children and be determinant of children’s emotional discomfort such as: not being familiar with the hospital environment; a large number of non-familiar people in this environment with similar needs; being separated from family; the child’s age and personality before being hospitalized related to her/ his level of maturity. A hospitalization is a stressful and conflictive situation, which can be alleviated in the presence of someone the child trusts. Therefore, the figure of a companion emerges, a person who represents the patient’s social network and who accompanies the child during her/ his entire stay in the facility. The presence of a companion is a right acknowledged in the Statute of the Child and Adolescent that establishes in its article 12 that “health care facilities must provide conditions for the full time stay of one of the parents or legal guardian in the case of hospitalization of children or adolescents”. According to the Ministry of Health, the presence of a relative in the hospital facility is necessary to enable better understanding of the guidance and instructions provided concerning the patient and to help the child in her/his existential moment; to provide the professionals information concerning the child’s main problems and needs; to encourage the child’s social inclusion in a hostile environment as well as in the community; and to facilitate, from the beginning, the changes triggered by the hospitalization. Hence, having a relative present during hospitalization is a way to ensure the child keeps her/his personal records and those of her/his social life, which makes the patient feel safer and cooperate with the health team, developing improved communication channels and cooperation with the treatment. The individual accompanying the child during hospitalization also experiences a period in which s/he feels uncomfortable in the environment. The child’s condition itself can determine behaviors and attitudes of companions. Children with acute diseases, such as selflimiting diseases and even accidents, go through a relatively short, though intense, experience in which the disease/trauma has a poignant effect on their lives. Hence, the family should abandon its daily activities and make itself fully available. However, when the occurrence involves chronic diseases or the condition demands a more prolonged time for the patient’s effective recovery, both the patient and his/her significant people attempt to adapt to a new socio-cultural world, with life styles that fit within the limits imposed by the situation. Because the hospitalization is an unexpected and unpredictable event, it may trigger vulnerability in companions, who are, in most of the cases, family members. The meaning of this event may be defined and related to factors capable of reinforcing them, such as: previous experiences, excessive demands, and lack of preparedness to act. ...having a relative present during hospitalization is a way to ensure the child keeps her/his personal records and those of her/his social life, which makes the patient feel safer and cooperate with the health team, developing improved communication channels and cooperation with the treatment.