Necessidades e papéis parentais em cuidados intensivos neonatais: revisão dos guias portugueses

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Abstract

Resumo Pretende-se analisar as necessidades e os papéis parentais incluídos nos guias sobre Unidades de Terapia Intensiva Neonatal. Realizou-se uma análise de conteúdo temática de 33 guias (28 consensos e 5 documentos dirigidos aos pais) disponíveis em acesso livre no site da Sociedade Portuguesa de Pediatria em agosto de 2014. Estes documentos contemplam, principalmente, necessidades de informação, cuidados a prestar pelos pais e respectivas responsabilidades na tomada de decisões quanto à saúde das crianças. Características parentais e familiares foram mencionadas como fatores de risco para a prematuridade e doenças perinatais. As consequências psicossociais e a adequação das características físicas das Unidades de Terapia Intensiva Neonatal às necessidades parentais emergiram com menos frequência. Raramente se abordaram questões especificamente relacionadas com o conforto, suporte social, segurança e confiança dos pais nos serviços de saúde. Os documentos analisados refletem normas socioculturais associadas à parentalidade intensiva, centrada na criança, orientada por profissionais de saúde e altamente emotiva. Importa disseminar guias que orientem a integração de cuidados de saúde centrados na família nas dinâmicas das Unidades de Terapia Intensiva Neonatal.

Translated abstract

Abstract The scope of this article is to analyze the parental roles and needs included in Neonatal Intensive Care Unit guidelines. Thematic content analysis was conducted of 33 guidelines (28 consensuses and 5 documents directed to parents) freely available on the Portuguese Pediatrics Society website in August 2014. These documents deal mainly with information needs, child care activities performed by the parents and the respective responsibilities in decision making with respect to the health of children. Furthermore, parental and family characteristics were mentioned as risk factors for prematurity and perinatal diseases. The psychosocial consequences of parenthood experienced in Neonatal Intensive Care Units, as well as the adequacy of their environmental characteristics to parental needs, were less frequently touched upon. Issues related to the safety and comfort, confidence of parents in healthcare and social support were rarely touched upon. The results reflect sociocultural norms associated with intensive parenting, which is exclusively child centered, highly emotional and performed under the guidance of health professionals. The important aspect is to issue and disseminate guidelines that foster the integration of family-centered care in the dynamics of Neonatal Intensive Care Units.

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Methods for the thematic synthesis of qualitative research in systematic reviews

James Thomas, Angela Harden (2008)

Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

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The principles for family-centered neonatal care.

Lee Harrison (1993)

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Assessment of family needs in neonatal intensive care units.

Julia Mundy (2010)

Limited research has been conducted to assess family needs in neonatal intensive care units. Health care providers often make assumptions about what families need, but these assumptions are unfounded and can lead to inappropriate conclusions. When assessed appropriately, family needs can be incorporated into individualized plans of care, enhancing family-centered care. To assess the needs of parents in neonatal intensive care units, we asked the following 3 questions: What are the most and least important needs of families in a level III neonatal intensive care unit? Do parents' needs differ at admission and discharge? Do the needs of mothers and fathers differ? Parents were interviewed by using the Neonatal Intensive Care Unit Family Needs Inventory. Participants rated statements as not important (1), slightly important (2), important (3), very important (4), or not applicable (5). Fifty-two (93%) of the 56 items were rated as important or very important, and parents rated assurance-type needs highest. Parents at admission rated support needs higher than parents at discharge rated those needs. Needs of mothers and fathers did not differ significantly. Identifying the needs of parents in neonatal intensive care units can enhance nursing communication and allow nurses to incorporate parents' needs into families' plans of care. The family needs inventory can help identify those needs and allows the integration of individualized nursing care to fulfill those needs, providing a positive family-centered experience in the unit for patients and their families.

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Author and article information

Contributors

Mariana Amorim: Role: ND

Elisabete Alves: Role: ND

Henrique Barros: Role: ND

Susana Silva: Role: ND

Journal

Journal ID (publisher): csc

Title: Ciência & Saúde Coletiva

Abbreviated Title: Ciênc. saúde coletiva

Publisher: ABRASCO - Associação Brasileira de Saúde Coletiva

ISSN: 1678-4561

Publication date (Print): August 2016

Volume: 21

Issue: 8

Pages: 2583-2594

Affiliations

[1 ] Universidade do Porto Portugal

Article

Publisher ID: S1413-81232016000802583

DOI: 10.1590/1413-81232015218.07292015

SO-VID: b629f656-58a7-4da0-ba90-d560fd584a6f

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This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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SciELO Public Health

Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=1413-8123&lng=en

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