Processo de adaptação do cuidador familiar para o cuidado da criança prematura no domicílio com base na Teoria de Enfermagem de Roy

Abstract

With the premature birth and hospitalization in the Neonatal Intensive Care Unit, the family experiences an unexpected situation, which breaks with the idealization they had in their imagination, generating stress, anxiety and fear, influencing their bond with the baby and, subsequently, in the care of premature children after discharge. The objective of the study was to understand the family's adaptation process to care for premature children after hospital discharge. This is a qualitative research based on the Nursing Theory of Callista Roy's Adaptation Model, developed with 16 family caregivers of premature children discharged from a Neonatal Intensive Care Unit of a Hospital in the South of Rio Grande do Sul. Data collection data was carried out through a semi-structured interview, which was recorded, transcribed in full, double checked and validated by the participants. Field diary, genogram and ecomap were used as complementary instruments. The graphic design of the genogram and ecomap was carried out using the GenoPro 2020 software (version 3.1.0.1) and WebQDA was used to organize and categorize the data. Data were analyzed based on thematic analysis. The data were organized into three main themes: ‘Process of caring for premature children: experiences and feelings of the family caregiver’; ‘The influence of prematurity during home care’; ‘Support systems used by family caregivers for premature babies’. The first theme portrays feelings at the time of hospital discharge and during care, of happiness and joy in having the child at home, but at the same time, fear, anxiety and doubts. Fear was a feeling constantly reported over time when caring for premature babies at home, generating overprotection. The second theme reports the influence of prematurity on child care after hospital discharge, highlighting the concern with developmental milestones, weight, nutrition, vaccination, adoption of differentiated care in order to avoid health problems, especially respiratory problems, including COVID- 19. And the third theme talks about support systems, which are made up of the family, partner and/or father of the child, faith/spirituality and health professionals, in addition to the burden on the family caregiver who does not receive support. Family caregivers are always exposed to focal stimuli (separation between child and family after birth and the experience of hospitalization), contextual (fear, insecurity, anguish due to the experience of hospitalization) and residual (overprotection and adoption of different care). Thus, they present innate resistance mechanisms (helping the child quickly when crying) and acquired (bathing a premature child, performing choking maneuvers, tube feeding). Thus, these caregivers presented effective responses (well-being and relief from overload) and ineffective responses (fear of loss and overload). In this context, it became clear that support systems and nursing can help in the adaptation process in a positive way.