As práticas de cuidados à criança com bexiga urinária neurogênica nos diferentes ambientes sociais: desvelando o discurso dos familiares

Abstract

From the 2nd World War a large number of children had their survival made possible by advances in health care, including in Brazil, known as Children with Special Health Care Needs (CSHCN). These advances allowed a greater chance of these children surviving serious diseases, but in need of special health care temporarily or permanently. The child with neurogenic urinary bladder is included in this group because of the change of entailment in order to care for their families to attend their needs regarding medical care practices and care of urinary elimination. Object of study: the medical care practices and familiar modified habits to children with neurogenic urinary bladder in different social environments. Objectives: to describe the medical care practices and familiar modified habits to children with neurogenic urinary bladder in different social environments; identify the challenges faced by families to make such care in different social environments; analyze the strategies used by family members to the realization of care in these different social environments. Methodology: qualitative research, developed from the sensitive creative method using dynamic body-know and talking map at home of 10 groups of family caregivers, totalizing 29 participants. The period of data generation occurred from November 2015 to January 2016. The data were analyzed from the speech analysis in its French chain, and interpreted in the light of Freire s conception, through the six ideas-forces, especially the concepts of reflexive criticism, awareness process and dialogical education. Results: in the practice of medical care the family revealed the (un) knowledge about the side effects and use of drugs, as well as the use (dis) continuous of medications. About the practice to empty the bladder, family caregivers unveiled the care in the organization of the environment and materials, concern for cleaning the hands of the caregiver and hygiene of the child for care practices with clean intermittent catheterization and vesicostomy in different social environments, also highlighted the practices of care vesicostomy and with the achievement of catheterization. About the challenges and strategies used by the family face to medical care and achievement of catheterization unveiled the difficulties before the preparation and administration of drugs and in respect of potential adverse effects thereof. As for the challenges in performing the catheterization showed the difficulty in introducing the catheter into the urethral meatus and the realization of care in different social environments such as public places and transport. It concludes that family caregivers to overcome the challenges faced reinvent other forms of care, missing and hitting or playing them uncritically. It suggests a teaching practice by health professionals that seeks to contemplate a care that includes overcoming the challenges experienced by families in their different social environments.