Conceituando a negligência no cuidado às crianças obesas na atenção básica de saúde: significados dos enfermeiros
Obesity is a major problem worldwide. In children, its care is a challenge because it requires Nursing care of the obese child is a challenge in Primary Health Care because it requires the active participation of all involved. In parallel to this concern, is the fact that obesity is a major health problem that is growing globally. In this context, the nurse can act in its prevention, identification, assessment, and treatment. Qualified practice in this area, however, requires theoretical investment. The objective of the study was to understand the meanings that nurses in Primary Health Care attribute to the care of obese children and to describe a theoretical model that explains the process. The study used the Grounded Theory method and Virginia Henderson´s theoretical/philosophical perspective. Data were collected in Primary Care Health Units, Family Health Units, and Specialized Health Services in Campina Grande, Paraiba, Brazil, during the months of April to October 2015. A total of 24 participants formed four theoretical sample groups: 11 Primary Health Care nurses, four caretakers, five health professionals, and four health service managers. Data were collected during the months of April to October 2015 by semi-structured interviews and analyzed by the constant comparison method. The analysis consisted of the initial coding, diagram and memorandum construction, axial and selective coding, and reflection of the emerging paradigm and theory. Six categories emerged from the data: Identifying processes that determined the discontinuity of care to the obese child in the health unit – causal condition; Characterizing the fragile parental co-responsibility of care to the obese child – consequence; Interacting with the multi-professional care team – intervening condition; Envisioning new perspectives for the nurse´s care and Attending to the preoccupation for new processes of nursing care – strategic actions/interactions; and Moving within the nursing care scenarios – context. The categories´ interrelations and interactions gave rise to the theoretical explicative model: The nurse worrying about the care of the obese child as a neglected area in Primary Health Care. The theoretical model provides a comprehension of the nursing care of the obese child as a web of complex relations and interactions that is permeated by the concern for the child´s health, but that is devoid of effective and continuous actions. The care surpasses individual attention and needs the shared responsibility of nurses, specialized professionals, health service managers and family. In midst of the Primary Health Care neglected area, the nurse identifies the need for care of a population that does not have priority attention in the health service units with precarious structural and human resources conditions. This reflects on the parents´ and caretakers´ lack of understanding of infantile obesity and on their distancing from the collective responsibility. It is concluded that the nursing care of the obese child configures meanings derived from the lived experience of practice and reflects intrinsic professional principles and pre-established concepts. As a whole, the meanings direct the way that care is provided, of action, and of its behavior with obese children, establishing relationships with the multiple contextual factors and the subjects, and interacting in a complex process.
Obesidade, Saúde da criança, Cuidado da criança, Enfermeiro, Atenção primária à saúde
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