A presença do familiar acompanhante durante os procedimentos invasivos realizados na criança em unidade de terapia intensiva: contribuição para a enfermagem

Abstract

Thinking about the child in intensive care is reflecting beyond the context of clinical severity, the invasive procedures performed routinely and the intermittent verification of vital signs. It is worth valuing the importance of the family member always accompanying the child, understanding the family as an inseparable structure. Thus, the child needs significant people at his side, however, it is common to request the accompanying family member to leave the room during the execution of some technical procedure performed by health professionals. Taking these matters in consideration, the objectives of this study were: to know the nurse's action regarding the presence of the family member accompanying the child during the performance of invasive procedures in the intensive care unit (ICU); and to interpret the role of the nurse and the power relations involved in decision making regarding the presence of the accompanying family member with the child during the performance of invasive procedures in the ICU. Method: Exploratory-Descriptive Qualitative research with 19 nurses from two pediatric intensive care units (PICUs) located in the city of Rio de Janeiro. Data collection was carried out through semi-structured interviews from May to July 2019. The research was approved by the ethics committees under the respective opinions n. 3,383,388 and n. 3371,533. Results: the analysis of the empirical material was performed using the Iramuteq software. The textual corpus was processed by the software that organized the Descending Hierarchical Classification (DHC) into 5 classes. In the lexical analysis, classes 2, 4 and 5 refer to the wishes of the nurse and the accompanying family member in the PICU, the statements that support the decision for the absence of the family member during the performance of invasive procedures and the removal of the accompanying family member as a strategy for power. Classes 3 and 1 deal with the relationship between the nurse and the accompanying family member as well as guidance as a strategy to clarify doubts. There were many reasons listed by nurses to justify the non-presence of the family member with the child during the performance of any invasive procedure, such as: the behavioral characteristics of the family member/child; norms and rules based on the scenario institutions of this study; and the interviewed nurses' unwillingness. It is concluded that nurses, in the PICU context, still do not institute the presence of a family member accompanying the child during the performance of invasive procedures as part of their care practice. In the justifications, the nurse/family accompanying power relations and power as a need for control are represented, thus configuring the daily routine regarding the presence of the family member with the child when performing invasive PICU procedures. Therefore, the nurse builds an exercised power, either by interdicting or excluding the family member during an invasive PICU procedure.