ISSN: 1981-8963
DOI: 10.5205/reuol.6039-55477-1-ED.0810201425
Pereira PO, Queluci GC, Guimarães TCF et al.
Problem situations and levels of complexity…
ORIGINAL ARTICLE
PROBLEM SITUATIONS AND LEVELS OF COMPLEXITY ON HEALTH CARE
PATIENT PRACTICE WITH CHRONIC ENCEPHALOPATHY
SITUAÇÕES PROBLEMA E OS GRAUS DE COMPLEXIDADE NA PRÁTICA ASSISTENCIAL AO
PACIENTE COM ENCEFALOPATIA CRÔNICA
SITUACIONES PROBLEMÁTICAS Y LOS NIVELES DE COMPLEJIDAD EN LA PRACTICA DE ATENCIÓN
MÉDICA A PACIENTES CON LA ENCEFALOPATÍA CRÓNICA
Patrícia Osório Pereira1, Gisella de Carvalho Queluci2, Tereza Cristina Felippe Guimarães3, Ana Karine Ramos
Brum4
ABSTRACT
Objective: classifying, according to expert nurses, levels of complexity lower, middle and higher of problem
situations of patients with chronic encephalopathy. Method: a descriptive study with a qualitative approach,
case study type. There were used as primary source records of 40 patients with chronic encephalopathy of a
Health Institution of Rio de Janeiro/RJ, specialized in caring for people with special needs. The research
project was approved by the Research Ethics Committee, CAAE 05730012.0.0000.5243. Results: there was a
predominance of patients classified as of higher complexity (55%), middle complexity (25%) and reduced
complexity (20%). Conclusion: in the opinion of expert nurses would be important not only to identifying an
isolated nursing care, but the set of elements/aspects in the context of problem situations. These showed
that the independence, openness, cooperativeness, ability to support the patient during care and family
support also influence the level of complexity. Descriptors: Nursing; Chronic Encephalopathy; People with
Disabilities.
RESUMO
Objetivo: classificar, de acordo com os enfermeiros peritos, os graus de complexidade menor, médio e maior
das situações problema do paciente com encefalopatia crônica. Método: estudo descritivo, com abordagem
qualitativa, do tipo estudo de caso. Foram utilizados como fonte primária 40 prontuários de pacientes com
encefalopatia crônica de uma Instituição de Saúde do Rio de Janeiro/RJ, especializada no atendimento às
pessoas com necessidades especiais. O projeto de pesquisa teve a aprovação do Comitê de Ética em Pesquisa,
CAAE 05730012.0.0000.5243. Resultados: houve predominância de pacientes classificados como de maior
complexidade (55%), de média complexidade (25%) e de menor complexidade (20%). Conclusão: na opinião
dos enfermeiros peritos o importante não seria apenas a identificação de um cuidado de enfermagem isolado,
e sim o conjunto de elementos/aspectos no contexto das situações problema. Estes mostraram que a
independência, receptividade, cooperatividade, capacidade de auxílio do paciente durante os cuidados e o
apoio familiar, também influenciam no grau de complexidade. Descritores: Enfermagem; Encefalopatia
Crônica; Pessoas Com Deficiências.
RESUMEN
Objetivo: clasificar de acuerdo con las enfermeras expertos, los niveles de complejidad inferior, medio y
superior de situaciones problema por los pacientes con encefalopatía crónica. Método: un estudio descriptivo,
con enfoque cualitativo, del tipo de estudio de caso. Fueron utilizados como fuente primaria los registros de
40 pacientes con encefalopatía crónica de una Institución de Salud de Río de Janeiro/RJ, especializada en el
cuidado de personas con necesidades especiales. El proyecto de investigación fue aprobado por el Comité de
Ética en Investigación, CAAE 05730012.0.0000.5243. Resultados: se observó un predominio de pacientes
clasificados como de mayor complejidad (55%), complejidad mediana (25%) y la de menor complejidad (20%).
Conclusión: en la opinión de las enfermeras expertas sería importante no sólo identificar a una atención de
enfermería aislada, sino el conjunto de elementos/aspectos en el contexto de situaciones problemáticas.
Estos mostraron que la independencia, la apertura, cooperación, capacidad de apoyar al paciente durante la
atención y el apoyo familiar también influyen en el grado de complejidad. Descriptores: Enfermería;
Encefalopatía Crónica; Personas con Discapacidad.
1
Nurse, Master’s student, Professional Master’s Degree Program in Healthcare Nursing, School of Nursing Aurora de Afonso
Costa/MPEA/EEAAC/UFF. Rio de Janeiro (RJ), Brazil. Email: [email protected]; 2Nurse, Professor of Nursing,
Department of Nursing Fundamentals and Administration, School of Nursing Aurora de Afonso Costa/EEAAC/UFF. Niterói (RJ), Brazil.
Email: [email protected]; 3Nurse, National Institute of Cardiology Laranjeiras, Doctorate in Nursing, University Estacio de Sa.
Rio de Janeiro (RJ), Brazil. Email: [email protected]; 4Nurse, Professor of Nursing, Department of Nursing Fundamentals and
Administration, School of Nursing Aurora de Afonso Costa/EEAAC/UFF. Email: [email protected]
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INTRODUCTION
Chronic non-progressive encephalopathy of
childhood (EC), also known as Cerebral Palsy,
is a set of motor manifestations resulting from
a brain injury sustained during the maturing
period of the central nervous system, and so
are non-progressive disorders of posture and
movement.1 It is a non-progressive disease;
however, although the neurological lesion is
static, the musculoskeletal complications
change throughout life, resulting in sequelae,
such as orthopedic deformities, changes in
muscle tone, joint degeneration, difficulty to
controlling seizures, spasticity, changes in
postural tone, osteoporosis, fatigue and
pain.2-4
These sequels usually manifest with
specific patterns of posture and movement,
which can compromise the functional
performance and become a major cause of
the affected disabilities causing physical
and/or mental impairment 3,5 resulting in a
problem situation (SP) that will vary the
complexity of the patient in daily care
practice.6,7
Problem situation is conceptualized as a set
of circumstances of spatial and temporal
reality that compromise the health of the
individuals, groups or communities and whose
sphere befalls the meeting of the nurse with
its patient, and that can change the
complexity of the affected individual.7
In the hospital setting, it is observed that
the SP and its level of complexity can be
covered in terms of nurse-client encounter,
since nurses usually providing care, emerge
with difficulty on determining a proper
conduct in relation to the specific conditions
and affected aspects, or opposite to the levels
of complexity: lower, middle and higher - in
situations involving the problems of patients
with special needs.6,7
It is worth noting that situations differ,
sometimes, regarding the level of complexity
not only because they are related to the
symptoms of the patient, but also by the
amount of trouble in the dimension of
elements present in the context of which
occur around this individual, these elements,
perceived practical experience and give
meaning to the situation of problem nursing
covered up, as clinical care situation that
embraces this patient, with a certain degree
of complexity, influencing clinical practice.6
DOI: 10.5205/reuol.6039-55477-1-ED.0810201425
Problem situations and levels of complexity…
It is believed that this study will provide
grants for clinical practice of nurses, due to
the importance of this topic for the daily life
of these professionals once, rethinking leads
to the development of care initiatives for
people with disabilities to be observed in
exercising the profession.
Given the problems exposed, the following
questions were raised:
Which elements or conditions underlie the
situations problem of patients with chronic
encephalopathy in order to determining a
level of lower, middle or higher complexity?
As this complexity is defined by expert
nurses
(EP)
from
problem
situations
described?
To answering these questions, the following
objectives were defined:
● Classifying, according to expert nurses,
lower, medium and higher levels of situations
problem
of
patients
with
chronic
encephalopathy complexity;
● Analyzing the level of complexity of
problem situations and the influence of
nursing care.
METHOD
The present study was extracted from the
dissertation << Manual guidelines and basic
nursing final care from the complexity of
problem situations of patients with chronic
encephalopathy >> School of Nursing Aurora
de Afonso Costa/MPEA/EEAAC/UFF, 20122014.
It was used in the research the
methodology of resolution of problem
situations 6 having as proposal to giving
continuity to the doctoral thesis, presented at
Program of Postgraduate in Nursing Research
of the Anna Nery School of Nursing at the
Federal University of Rio de JaneiroEEAN/UFRJ, based on a study on the
classification of nursing situations by levels of
complexity – lower, middle and higher –
involving hospitalized patients based on the
perspective of the nurses’ diagnostic.7
This is a descriptive study with a
qualitative approach, of case study type,
conducted in a Philanthropic Institution of
Health of Rio de Janeiro/RJ, specialized on
care for people with special needs. The
theoretical framework used was Virginia
Henderson, which discusses the needs of
primary care nursing.8 For data collection it
was used as primary source 40 records.
Inclusion criteria were: the records of
hospitalized clients with confirmed diagnosis
of EC. Charts of patients with CS who came to
death were excluded. The data collection
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period was from September to November
2012.
Four expert nurses participated in the
selection (EP) determining the level of
complexity of SP. The selection criteria of the
expert nurses were: having a master's degree
or doctorate in nursing and articles in the
area of Fundamental Nursing and/or Nursing
Assistance Systematization.
Initially, came into contact with the
director of the institution, whose purpose was
to obtain authorization to accessing the
information contained in the medical records
of patients. Then, the researchers followed
the steps: the first step consisted of an
instrument to be completed by the researcher
through observation in the data collection
scenario. There were first described 40 SP
subtracted from medical records and later
were checked and/or described the nursing
problems of each. This instrument shows the
major nursing problems highlighted by the
author, and was also used as a guide for
observation and field diary.
The second stage included questionnaires
to be delivered to expert nurses to identifying
the level of lower, middle and higher
complexity, from the SP found. For the degree
of agreement between the responses of the
EP, it established the following criteria:
minimum of three experts agreed with the
same degree of complexity of SP. With the
tools (and the notes of the researcher)
triangulation of data was performed.
In a third step, we detailed some specific
factors, the instrument related to nursing
problems with patient conditions, which may
be found as the clinical picture and vary
according to the complexity of the SP. For
example: for hygiene and physical comfort, it
is important to note: related to good or poor
Problem situations and levels of complexity…
hygiene of the patient is bedridden or aspect
is independent of aid for self-care, it performs
the activity and mobility in bed, among other
specific conditions, and which nursing care
they need.
It was maintained the anonymity of the
expert nurses, being identified by the letters
"EP" with the numbering, as for example: EP1,
EP2, etc. Data analysis was used to follow the
content analysis of Bardin.
We emphasize that the construction of
data only started after project approval by
the Research Ethics Committee (CEP) of the
Antonio
Pedro
University
Hospital
(HUAP/UFF), registered under number CAAE:
05730012.0.0000.5243, of the Confidentiality
Agreement and the Term of Consent. Been
complied the criteria laid down by Resolution
No 196/96, of the National Health Council,
insuring the rights and obligations with regard
to the scientific community and the
information of the subjects of research.
RESULTS AND DISCUSSION
Results are shown considering the
characteristics of research participants being
constituted a single category:
Problem situations of lower, middle and
higher complexity in patients with EC and the
influence of nursing care.
In this category, the expert nurses spoke
about the classification of levels of
complexity in hospitalized patients with EC.
Considering the content expressed in their
testimonies, grouping into 3 subcategories, as
shown below:
Figure 1. Percentage of classification of complexity levels.
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Problem situations and levels of complexity…
Regarding the classification of levels of
complexity, figure 1 (one) shows the lower,
middle and higher percentage according to
the analysis of expert nurses. From figure 01
it can be seen that the observed 40 SP, 22
(55%) were classified as higher complexity, 10
(25%) as middle complexity and 08 (20%) as
lower.
● Subcategory 1 - Situations problem of
lower complexity in patients with
Chronic
Encephalopathy
and
the
influence of nursing care
Data presented in Figure 1 integrates
relevant information about the studied
sample, which features on the percentage of
SP of lower complexity with 08 (20%),
constituting the minority, being classified by
the EP as those in which patients are quiet,
lucid and oriented in time and space or
partially oriented; have preserved their
individual needs, are receptive, perform
verbal or non-verbal communication, roam
with or without assistance and/or move
around with wheelchair, may have mobility
limitations, collaborate with the nurses in
their own care, making meals alone and/or
with assistance, bathing with or without
assistance and/or under supervision, have
family support and have conditions to study.
Some
patients
have
seizures
and
hypertension.
Considered of lower complexity, because it
depends minimally of nursing. (EP1)
Patient is quite independent
activities of self-care. (EP2)
in
most
These data are reinforced by the theory of
Henderson that the nurse should stimulate
and encourage the patient so that he acquires
as much independence as possible. Impaired
or absent motor function beyond the
limitation to physical activities should not act
as a useless factor in the life of the person
with EC.
A selection of some activity is important
for self-esteem, for thought and depends in
most cases, the sex of the patient, his age,
intelligence, experience, and predilections
mainly depend on your general condition or
the severity of their disease, as well as the
taste that he feels the exercise and the arts,
the existence of company resources for
recreational activities. 8
Human thought is sometimes very limited,
not because it has insufficient information,
but because it is not able to sort the
information
and
knowledge,
hindering
9
communication.
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The following statement emphasizes not
only the fact that the patient is responsive,
communicative, as well as the importance of
family, aiming at all.
It is responsive, carries out basic activities
without assistance and receives family
assistance (EP4)
Another
important
aspect
to
be
emphasized is that it is the cooperativeness
and communication with the nursing actions
reduced the complexity of the situation. 7 The
patient interacts better and allows you to
understand its needs when you receive
support from family, being of great
importance it to be present.10,11
The nurse also has pedagogical training
that promotes interaction between the
patient and the family. We note that, in the
aid relationship, the nurse uses both nursing
their general knowledge and the specific
situation in question as technical procedures
and especially himself, as a therapeutic tool.
In aid relationship, it is believed that the
nurse manages an environment where
individuals feel peace and confidence to
express themselves, because the goal of the
helping relationship is to give the patient the
ability to identify, feel, and know how to
choose decide whether to change. 12
In turn, the fact that they have to study
clinical conditions was pointed out by one of
the EP for the patient points to be considered
less complex, because to live with other
colleagues, learn to interact and become
more receptive, benefiting the emotional
part.
The patient is quietly studying in
Municipal school in a special class. (EP3)
a
Education is fundamental to the treatment,
as it helps in preserving the social side of
these people.13 Law No. 7.853, of October
24th, 1989, establishes general standards
which ensure the full exercise of individual
and social rights of persons with disabilities,
and their effective social integration, as well
as the inclusion in this education system,
special, private and public schools. 14
Data related to education and formal
insertion in schools for disabled in long-stay
institutions demonstrate a large percentage
(81,3%) were illiterate. Part of this high
percentage is explained by the severity of
cases, the lack of specialized schools or
professional for this type of clientele,
transportation
difficulties
and
a
not
effectively safeguard the inclusion of this
group in the formal school system;13 however,
despite laws further establish the individual
and social rights of people with disabilities,
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impressive considering that education aims to
impart knowledge that is blind as to what is
human knowledge, their devices, diseases,
difficulties, tendencies to error and illusion,
and do not worry to make known what is
known. 16
 Subcategory 2 − Middle complexity
problem situations in patients with
Chronic
Encephalopathy
and
the
influence of nursing care
From Figure 1, we observe that the
percentage of SP middle complexity was 10
(25%), being classified by the EP as those in
which the patients are also quiet, though
alternate with moments of agitation, partially
oriented or disoriented, partly depend on the
effectuation of nursing care, unable to walk
or roam with aid, have abnormal movement
patterns, shortening and/or deformity,
impaired communication and/or do not speak,
hygiene, assistance with bathing and feeding,
have difficulty falling asleep, generally have
poor financial conditions, requiring careful
attention to their basic human needs and
hospitalized client. In addition to presenting
these and other specifics as postoperative use
of cystostomy, a peripheral venipuncture,
have other associated diseases such as:
hydrocephalus, seizures, hypertension, etc.
They need more aid from nursing, clients who
present the most risk to their own condition
and also to effectuation of care.
Considered of middle complexity because it
depends on the Nursing without, however,
being in serious health conditions. (EP1)
Partially dependent patient to perform selfcare activities, because although voice,
need aid to feed and maintain hygiene.
(EP2)
Partially depends on nursing and receives a
supportive family. (EP3)
It was noted, also, that addiction for the
basics of food and hygiene, besides other
associated diseases such as hydrocephalus and
hypertension influenced the patient to be
considered of medium complexity. However,
the EP show that despite needing more help
nursing and expose associated diseases, have
positive points as the ease in communicating
not be serious health conditions, in addition
to family support.
As regards the lack of motor/dependence
coordination and other diseases in general
increase the functional deficiencies are
however while the child care facilities, and
the forms of ergonomic adaptation, such as
seats, bathtubs, are more accessible
However, when adults become heavier and
the difficulties increase. The market adapted
equipment is also limited and when they offer
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Problem situations and levels of complexity…
these equipments having high cost
difficult
accessibility,
increasing
complexity of the patient. 17
and
the
The imperative of complexity is to think
through an organizational form, which was
considered
beyond
the
complications
associated with the patient to understand that
the organization is not just some principles of
order. We observed that the organization of
nursing planning should be carried out from
which emerge the problems related to a given
nursing situation, since there is no way to
establish rules on professional actions of
nursing care according to the well-being of
the patient and family. 9
The family also appeared as one of the
elements that permeate the SP will help to
determine the degree of complexity. The
strong family bond with parents favors the
patient, since it makes it more receptive and
happy. The family is a social force that has
influence in the determination of human
behavior and personality formation. It can be
defined as an insert in the immediate
community and wider society significant social
unit. And interdependent, that is, the
relationships
among
family
consisting
influence each other, and any change in this
direction will play arising influence on each
member individually or the system as a whole.
18
Thus, it is necessary that the family
establishes knowledge about the special needs
of their children, as well as builds coping
patterns of feelings and needs of each
Member and of the group as a whole, in
decision-making and in seeking resources for
their well-being. It is essential that nurses
also
develop
healthy
and
respectful
interpersonal relationships, which will lead to
greater efficiency in achieving their goals. 10
Health professionals, especially nurses,
need to develop the ability to understand the
complexity of being a family of people with
disabilities, seeking to strengthen and
facilitate the emotional bond from birth, as
well as stimulate and empower the family to
enable growth and development of this
family, and assist in the communication
process.19
Somehow,
verbal
or
non-verbal
communication is also an important factor
throughout the process of caring for
hospitalized poor, where there is much
proximity and the "touch." Orientation to the
patient about the whole procedure to be
performed, as well as all is happening around
them (environment and actions involved),
where the nurse often needs to understand
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their expectations and anxieties feelings in
order to identify the needs to be met. 7
The various ways to expressing themselves
by themselves are also scents for the "art of
care" [nursing care] as well as to maintain
good quality care, since they are linked to
ways to show affection, to be present entirely
and appreciate others.20
Nursing requires that the individual is
affected by age, cultural background,
emotional balance, and their physical and
intellectual capacity. This set of factors must
be taken into account when assessing the
nurse about the customer needs help. 8
Through established communication with
the client, the nurse can understand it as
being holistic, and understand their world
view, that is, his way of thinking, feeling and
acting. Thus, you can understand the needs of
the patient and thus provide adequate care to
minimize their suffering. In this process,
communication
occupies
space
and
irreplaceable if it is not effective this
assistance becomes failure. 21
 Subcategory 3 − Problem situations of
greater complexity in patients with
Chronic
Encephalopathy
and
the
influence of nursing care
In this category, it was found that there
was a predominance of patients with CS of
greater complexity
22 (55%) which are
classified by the EP as those in which patients
manifest with various difficulties and
increased risk margin, which requires the
support of specific theoretical knowledge of
the nurse. Features on your medical condition
confusion, disorientation, do not walk, speak,
need help to feed and perform hygiene, have
difficulty falling asleep even with medication,
are emotionally unstable and may become
aggressive, requiring constant surveillance,
and do not have family ties, noting
abandonment. Usually also have visual or
hearing disabilities associated deformity in
upper, lower or both, hypertension, seizures,
obesity, dyspnea, among other members.
These patients require multiple nursing care.
For the EP, besides considering the
dependency to activities of self-care, it has
also expressed concern because they are
emotionally
unstable,
risking
hurting
themselves or someone else, beyond the
compromised sleep and rest.
Of higher complexity because of his clinical
suggests a greater need for nursing care.
(EP1)
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Problem situations and levels of complexity…
Has many needs, has difficulties in
reconciling the sleep, depending totally on
nursing. (EP4)
The individual who is on full health is free
to keep track of the environment in which he
lives or modify it when you feel that there is
some danger, however the disease can
deprive him of that freedom. For the patient
confused, disoriented, delirious or psychotic,
with protection from the dangers that
surround them, can become a very complex
problem, since he has no awareness or control
what you do. 8
Studies say that from the moment in which
people with disabilities were admitted to the
institution, began to experience an emotional
overload that cannot be minimized, because
the two considered very stressful situations:
deprivation of coexistence with their families
and/or caregivers, different environment and
adaptation to the rules governing the
institutional life.14,22
Many are the difficulties experienced by
disabled people in the period of adjustment to
institutional life. Often signs as intense crying
and/or
continuous,
social
withdrawal,
aggression and agitation behaviors occur,
describes how can be multiple and severe
damage to the biopsychosocial development,
especially when the institutionalization occurs
for too long, as is the case most neurologically
considered more complex.22-3
One study showed that there is a delay in
the
development
of
perceptual-motor
institutionalized people with disabilities
compared to non-institutionalized. The
superiority of non-institutionalized could be
related to emotional and material security
resulting from the presence of relatives and a
stimulating environment, which seems to be a
necessary condition for a good perceptualmotor development and learning of these
subjects. 24
Another study shows that although children
are in shelter situations, susceptible to factors
in the social environment and stress, the area
was the social function that had greater
weight in most cases, even in the most severe
cases of EC. 23
The teachings on media safety should also
be part of the curriculum of every nurse. The
better the nursing service offered to the
patient, so the smaller the necessary
measures of physical coercion, causing tension
and stress, and to the extent possible should
be avoided. 8
Nursing-dependent patient to perform selfcare activities and has risk of injury. (EP2)
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Another listed problem is the activity of
sleep and altered sleep. Sleep is one of the
mysteries of life and the individual has the
necessary and right up to the day he is
prevented this natural act of the senses. The
lack of rest and sleep are one of the causes,
as well as a manifestation of disease. The
dependence on sleep medications, it becomes
acceptable to many people who are unable to
do it naturally.8
The rhythm of sleep, when changed, brings
numerous health hazards such as stress,
nervous tension, hypertension, etc. In
Symposia on the subject, has been discussed
as the search for alternatives that do not
require medication; however this issue is still
a challenge for scholars. The nurse, however
you can opt for other methods to induce
patients to sleep and rest, as the reduction of
irritating stimuli such as sounds, smells and
unpleasant scenes, famine relief, soft and
harmonious songs, among others, before
resorting to prescription drugs.8
Another concern of the EP as well as a
greater reliance on nursing, and is familiar
with the financial aspects, as shown in the
statement below:
Total dependency of nursing, financial
hardship and family abandonment. (EP3)
It can be observed that the EC has a dark
prognosis, lead the carrier to limitations in
daily activities and dependence in most cases
and many families show both financial and
psychological difficulties to care for the child
and or family, been seeking admission to
specialized institutions. 17
Another aspect to be considered is that
many families have a situation of particular
vulnerability, for different treatments and
special care they need are expensive.
Moreover, often need to be managed
throughout the life of people with EC. And
national laws and international conventions
are clear: the rights of persons with
disabilities cannot be violated. It is the duty
of the State to assuring them and to
supporting the family that has care conditions
and treatment for their children with
disabilities;13 however, studies show that the
lack of material resources of the family or
guardian appears as an important reason for
demand admission. These same surveys show
that for a third of people with disabilities,
their universe is reduced to the institution.
The poverty of the family, as well as various
other associated factors shall justify
institutionalization and not the temporary
shelter, as established by law. Also denotes
the fate of those clients who lose family ties,
English/Portuguese
J Nurs UFPE on line., Recife, 8(10):3452-60, Oct., 2014
DOI: 10.5205/reuol.6039-55477-1-ED.0810201425
Problem situations and levels of complexity…
and that will be established as a candidate for
the "perennial institutional confinement".13
Faced with so many injuries, leads us to
think that the way the nurse face complexity
in SP is in thinking, reasoning, around
strategies that will advance the nursing
problems. The complexity attracts only
through strategy and the strategy we can
move forward in right and random. Therefore,
the path of complex thinking is fundamental
to understanding the articulation of identified
and
understanding/discernment
of
all
9
situations of nursing needs.
CONCLUSION
There
was
a
predominance
of
institutionalized patients with EC of higher
complexity, due to the dark prognosis, which
leads to limitations in daily activities and
total dependence on care.
The expert nurses also, when classifying
the SP, the conditions that underlie these
hospitalized patients, associated social factors
such as communication, difficulties in family
relationships, swinging visits, abandonment
and the precarious financial situation,
influencing the degree of complexity. Families
showed both financial and psychological
difficulties to care for the child and or family,
come to seek admission in specialized
institutions, often resulting in abandonment,
also raising the level of complexity.
There is the need to seek individuality in
the histories of each patient, aiming to
understand their specific care and, as a
result, able to delineate their actual
demands. Nursing acts directly on patient
care, so the partnership between the
patients, family and nursing are keys to
success in planning a quality care. This means
integrated and responsible commitment
among all stakeholders commitment. Another
aspect to be commended is that even if the
sample is not representative for the whole
population of hospitalized patients with CS,
the results are consistent with the literature
and raises as the need for developments and
strengthening lines of research on this subject
in nursing, since it is still so little attention
graduation.
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Submission: 2014/05/23
Accepted: 2014/08/13
Publishing: 2014/10/01
Corresponding Address
Patrícia Osório Pereira
Avenida Carlos Pontes, 597 / Rua 01 / Casa 10
Bairro Jardim Sulacap
CEP 21741-340  Rio de Janeiro (RJ), Brasil
English/Portuguese
J Nurs UFPE on line., Recife, 8(10):3452-60, Oct., 2014
3460