ISSN: 1981-8963
DOI: 10.5205/reuol.2265-25464-1-LE.0612201201
Brasil EGM, Brito MEM de, Pinheiro PNC.
Characterization of families of children…
ORIGINAL ARTICLE
CHARACTERIZATION OF FAMILIES OF CHILDREN ADMITTED IN A BURNING
TREATMENT CENTER
CARACTERIZAÇÃO DE FAMÍLIAS DE CRIANÇAS INTERNADAS EM UM CENTRO DE
TRATAMENTO DE QUEIMADURAS
CARACTERIZACIÓN DE LAS FAMILIAS DE LOS NIÑOS HOSPITALIZADOS EN UN CENTRO DE
TRATAMIENTO DE QUEMADURAS
Eysler Gonçalves Maia Brasil1, Maria Eliane Maciel de Brito2, Patrícia Neyva da Costa Pinheiro3
ABSTRACT
Objective: to describe the characteristics of the family nucleus of children hospitalized for burnings. Method:
exploratory and descriptive study, with qualitative approach, with 16 families of children who were victims of
burnings and admitted in the Burning Treatment Center. Data were presented in figures and discussed in
accordance with the literature. The study had its research project approved by the Ethics Research
Committee of the institution with the Opinion number 03884/08. Results: families came from the countryside
of state (Ceará), they are characterized as extensive nuclear family; its members had little schooling. The
accident happened within the home, in the kitchen; the age group affected was 1-5 years and, as the causal
agent, we found the super-heated liquid. Conclusion: there is a vulnerability to accidents within the own
residence of the child, showing the need to use strategies of Health Education, for that the families can
reflect on the occurrence of burnings in children. Descriptors: Child; Family; Burnings; Anthropology.
RESUMO
Objetivo: descrever as características do núcleo familiar de crianças internadas por queimaduras. Método:
estudo exploratório e descritivo, de abordagem qualitativa, com 16 famílias de crianças vítimas de
queimadura e internadas no Centro de Tratamento de Queimados. Os dados foram apresentados em figuras e
discutidos com a literatura. O estudo teve o projeto de pesquisa aprovado pelo Comitê de Ética e Pesquisa da
instituição, parecer de número 03884/08. Resultados: as famílias vinham do interior do estado (Ceará),
caracterizaram-se como família nuclear extensa; seus membros possuíam baixa escolaridade. O acidente
aconteceu dentro do lar, na cozinha; a faixa etária atingida foi de 1 a 5 anos e, como agente causal,
encontra-se o liquido superaquecido. Conclusão: existe uma situação de vulnerabilidade para acidentes
dentro da própria residência da criança, mostrando a necessidade de utilização de estratégias de Educação
em Saúde, para que as famílias possam refletir sobre a ocorrência das queimaduras em crianças. Descritores:
Criança; Família; Queimaduras; Antropologia.
RESUMEN
Objetivos: describir las características del núcleo familiar de los niños hospitalizados por quemaduras.
Método: estudio descriptivo y exploratorio de enfoque cualitativo, con 16 familias de los niños hospitalizados
en el tratamiento de las víctimas del Centro de Tratamiento de Quemaduras. Análisis de datos se realizó
cualitativamente. Los datos fueron presentados en las figuras discutidas en la literatura. El estudio fue
aprobado por el Comité de Ética e Investigación, con el dictamen del número 03884/08. Resultados: las
familias que vinieron del estado, que se caracteriza como familia nuclear extensa, sus miembros tenían
educación. El accidente ocurrió en el hogar, la cocina, el grupo de edad afectado fue el de 1-5 años y como el
agente causal es el líquido sobrecalentado. Conclusión: existe una vulnerabilidad a los accidentes dentro de
la residencia del niño, mostrando la necesidad de utilizar estrategias de educación para la salud, para que las
familias reflexionen sobre la incidencia de las quemaduras en los niños. Descriptores: Niño; Familia; Las
quemaduras; La antropología.
1
Nurse, Master in Public Health from Universidade Estadual do Ceará/UECE. Fortaleza (CE), Brazil. E-mail: [email protected]; 2Nurse.
Master in Public Health from Universidade Federal do Ceará/UFC. Fortaleza (CE), Brazil. E-mail: [email protected]; 3Nurse. P.h.D.
in Nursing. Adjunct Professor of the Nursing Department from Universidade Federal do Ceará/UFC. Fortaleza (CE), Brazil. E-mail:
[email protected]
Article designed from the dissertation << The influence of culture family on the care for the child who was victim of burning >> presented to
the Post-Graduation Program of the Nursing Department, of the Center for Health Sciences from Universidade Federal do Ceará-UFC. Fortaleza-CE,
Brazil. 2009
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J Nurs UFPE on line. 2012 Dec;6(12):2867-73
2867
ISSN: 1981-8963
DOI: 10.5205/reuol.2265-25464-1-LE.0612201201
Brasil EGM, Brito MEM de, Pinheiro PNC.
Characterization of families of children…
INTRODUCTION
Burns are serious injuries that have
contributed, in a marking form, with the
growth of statistics of accidents involving
children, due to the immaturity of infants to
evaluate the danger in their daily lives.
Studies performed in Brazil have showed that
50% of accidents involving children under 7
years occur within their own home, of which
48.9% are in the kitchen.1 In Latin America,
epidemiological
studies
conducted
in
Argentina, Chile, Colombia, Cuba, Dominican
Republic and Venezuela highlight the
accidents with children in the home
environment, and the super-heated liquids are
the most common causal agents.2-3
At the moment of attendance of the
burned children, the professionals who
receive them are focused on the care of the
injury, ease the pain and the physiological
changes existing due to the burning; realizing
an assistance aimed at healing, forgetting the
importance of family adherence in the
treatment and recovery of the child.
Everyday life in the service of burned
shows the fragility of the team for leading
situations that involve family conflicts, and
cultural values of those families or taboos
regarding burning and, especially, the
creation of strategies to reintegrate the
victims to their families and the community
are not being discussed.
During the hospitalizations it should be
realized that the family nucleus is targeted
abruptly, needing support and guidance from
professionals, in order to try to minimize the
limitations imposed by the socioeconomic and
cultural conditions of the families. The
nursing staff, to be closer to the children and
their families during hospitalization, "feel the
weight" of the changes through which they
these people pass for, and in these routine,
identifies the suffering, the anguish of the
fathers, mothers and relatives by seeing their
children connected to devices and undergo
treatments
such
as
dressings
under
anesthesia, surgeries, frequent venipunctures
and repeated polls.
Considered as the basic unit for the health,
family assumes responsibilities for the health
of its members, bringing their beliefs, values,
vulnerabilities and habits, particularly in
relation to the children, to the hospital
environment, where the nursing care must
valorize the knowledge acquired through
culture and interactions with social support
networks.4 Reinforcing this assertion some
studies on burnings argue that admissions for
burnings in children cause family alterations
English/Portuguese
J Nurs UFPE on line. 2012 Dec;6(12):2867-73
from the time of the accident until the return
to home.5-6
The importance of family along with the
sick child, which increasingly takes on the
responsibility of caring for its members, is
unquestionable, highlighting the need for
professionals who care for this child be
prepared for: guide, supervise, facilitate and
provide such cares; and the nurse is the main
responsible
in
this
process
of
coresponsibilities.7
The family members of burned children
show stress situations which are characterized
by three phases: indecision, intensification of
pre-existing conflicts and feeling of guilt,
which may influence the clinical evolution of
the victim, requiring the integration of the
professionals, the child and its family to the
successful of treatment.8
Accordingly, the nursing has features
capable of performing the integral promotion
of the health of families; because it is directly
involved in the process of caring for
individuals and this permeates the levels of
complexity, whether in primary, secondary or
tertiary care.9
By exercising care for middle and / or high
complexity, the nurse must understand the
importance of dialoguing on strategies and
possibilities of prevention of accidents
involving children, also valorizing the hospital
environment.
The need of the family members
participate in the care of children hospitalized
for burnings is always a challenge for the
nursing staff and family, because it is a time
of grief and guilt, however at this point, it
opens up a range of opportunities for the
teaching-learning process, in the sense of
sensitize the caregiver to develop the care in
a different manner, and further make it a
multiplying agent in the prevention of future
accidents with burnings.
This study was part of a wider research
that studied how the family culture intervenes
in the care for children who were victims of
burnings. Considering the above mentioned,
the objective is:
● Describe the characteristics of the family
nucleus of children hospitalized for burnings.
● Characterize the types of burnings
suffered by the hospitalized children.
METHOD
This is an exploratory and descriptive
study, with qualitative approach. It is
characterized as ethnographic research10
carried out in a Hospital of Urgency and
Emergency of the Municipality of Fortaleza2868
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Brasil EGM, Brito MEM de, Pinheiro PNC.
Characterization of families of children…
CE, Brazil, which receives patients from all
over the state, with different traumas and
situations that require attendance with
urgency and emergency, such as: multiple
trauma, traumatic brain injury, exogenous
poisoning, burnings, among others; it is a
reference to care for burnings, equipped with
a Burning Treatment Center - Centro de
Tratamento de Queimados / CTQ as well as
field of research to students of graduation,
post-graduation and health professionals of
the State.
The study participants were 16 families of
children, who were victims of burnings,
admitted to the Burning Treatment Center, in
the months of April and May 2008. They
agreed to participate and signed a Free and
Informed Consent Form.11
Data collection was like investigation line
the ethno-nursing, using as a guide a field
diary and the ethnographic interview, which
was comprised by the following guiding
questions: how the child got burned? How
many people live with the child? Would you
like to talk about your family?
Before starting the interview, one of the
authors maintained previous contacts with the
family at the hospital environment, aiming to
build bonds with these families, focusing on
child and caregiver; the interviews were
recorded, transcribed, and performed before
the hospital discharge of the child. For
preserving the identity of these families, we
allocated to them the letter F, followed by
numbers according to the chronological order
of hospitalization during the period of the
research.
Data analysis was performed in a
qualitative manner, as required by ethnonursing, following these steps below:
collection of records and documents; grouping
of data stored in a field diary; contextual
analysis or standard; and identification of
main themes, research findings, theoretical
formulations and recommendations.12 The
data were presented in figures and discussed
regarding the literature pertinent to the study
object.
We followed the ethical standards in
research with human beings at all stages of the
study, grounded by Resolution nº 196/96.11The
project was approved by the Ethics Research
Committee of the institution where the study
was performed, with the Opinion of the
number 03884/08.
RESULTS
To facilitate the visualization
understanding, two pictures were built;
first
shows
the
socioeconomic
demographic characteristics of families
the second characterizes accidents
burnings.
Family
Members*
Origin(city)
Family Income (MW)**
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
08
06
04
06
03
08
04
10
06
03
12
04
06
05
05
03
Pentecoste
Maracanaú
Fortaleza
Fortaleza
Maranguape
Fortaleza
Fortaleza
Acarape
Cascavel
Fortaleza
Acaraú
Caucaia
Caucaia
Horizonte
Fortaleza
Sobral
Unanswered
Unanswered
Two
One and a half
One
Unanswered
Two
One
One and a half
Three
One
Unanswered
Two
Two
Five
Three
and
the
and
and
by
Occupation of the head of the
family
Grower
Retired
Vigilant
Doorkepper
Caretaker(housekeeper)
Cleaning lady
Mason
Pedlar
Mason
Trader
Grower
Unemployed
Mason (grandfather)
Machine Worker
Trader
Mechanic technician
Figure 1. Ratio of families of children hospitalized in the CTQ with the number of members, origin, family income
and occupation of the head of the family. Fortaleza, April-May 2008. (*) In number of people. (**) MW = Minimum
Wage (value at the time of the study - R$ 465.00).
The Figure 1 shows that from the families
of children admitted to the Burning Treatment
Center during the study period, eight had
more than four members, two with ten (F8)
and twelve (F11) people. The demographic
density per household is equal or higher than
six people, in eight (50%) of these families.
The origin of the families was: from the
Capital, metropolitan region and from the
countryside of state of Ceará.
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With regard to the family income, the
interviewees could not inform the value in
Reais(R$) and just said:
This is value of the “Bolsa Escola” of my
boys. (F1, F2, F6 e F12)
It is noteworthy to note that most of them
reported about a family income of up to two
minimum wages. These values can be
associated with the professions of the heads
of the families, whose predominance was
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Brasil EGM, Brito MEM de, Pinheiro PNC.
Characterization of families of children…
informal work or even the unemployment. Of
these families, only three (F10, F15 and F16)
had income higher than two minimum wages.
In this research, the occupations of the
heads of the families are jobs that require
little schooling; it is proven in some speeches:
food or coffee with the kids right next to the
stove.
Some mothers perceived the risks only
after the accident and considered the kitchen
as a place of danger to their children.
He pulled the pot of coffee that was on the
table. (F3).
I do not know read, nor write. (F1)
When I'm cooking on the stove, he cannot go
because it's dangerous. (F6)
I studied only the primary. (F8)
I never studied, simply not. (F10)
The male figure is highlighted as the head
of the family, being the father or grandfather
the only ones providers of the family. In
Figure 2, we can see that the accident with
burnings prevailed in the child's residence in
15 of the 16 occurrences; inside the
residence, the kitchen was the locus of all
burnings, with only one case occurred in the
backyard of the residence (F11). The age
group of the children admitted, in months,
was between 9 and 108 months, children with
an average age of 30 months and a half, , i.e.,
three years were predominant.
The kids were in the kitchen, often, near
the stove and, at the time of the accident,
always had a family member on the place; it
is revealed in the following speeches:
He came running – kidding - then he hit the
table and hit his head on the pot that was
on the fire, so tipped it over him. (F1)
He went up in the cabinet next to the stove,
hit and tipped over the pot of hot water on
him, I got desperate. (F6)
I did not see, I cannot explain it very well,
but I think that this table is with its top
lost. (F9)
In this study, the kitchen was identified as
the place where children are more exposed to
the burnings. Families reported that they had
no idea of the accidents for which the small
children are exposed and they used to make
Families
Location of
Ocorrence
Accidents by hot liquids were the most
common, being characterized as scalding;
water is the main heat agent, followed by the
foods, especially the coffee that is culturally
very consumed by the population in all regions
of the State of Ceará.
In this type of accident various parts of the
body are affected, the liquid flows often in
the direction cephalous-caudal and as the
smaller the infant the greater will be the
severity of the accident, due the smaller
surface of the body.
As for the extent, the burned body area of
the children were more than 15%, the most
common lesions were those of second degree;
leading to an hospitalization average of 10
days of and a half.
The Figure 2 also shows the role of the
mother in the provision of child care. In the
most of cases, they were the caregivers of the
children;
remained
in
the
entire
hospitalization period, with the exception of
two families: one mother showed disturbs of
behavior and, the grandmother had to care for
the child (F1); on the other case, the mother
got sick and the stepfather replaced her (F9).
Age
(months)
Causal Agent
BBS
(%)
Severity
(degree)
Tempo of
admission
(in days)
Key Informant
1
Kitchen
72
Bean Soup
26
2°
32
2
3
4
5
6
7
Kitchen
Kitchen
Kitchen
Kitchen
Kitchen
Kitchen
24
12
12
24
72
12
Hot* Liquid
Hot Coffee
Hot Liquid
Hot Coffee
Hot Liquid
Hot Liquid
26
11
14
12
12
10
1° e 2°
2°
2°
2°
2° e 3°
2°
07
08
07
20
26
05
8
Kitchen
12
Hot Liquid
34
2°
28
9
10
11
12
13
14
15
Kitchen
Kitchen
Kitchen
Kitchen
Kitchen
Kitchen
Kitchen
Kitchen (told
by
grandmother)
108
24
60
12
11
12
12
Hot Coffee
Hot Liquid
Fire
Hot Coffee
Porridge
Hot Liquid
Hot Cooking Óil
15
27
10
12
16
18
15
2°
2°
3°
2°
2°
2°
2°
21
25
25
20
22
23
12
Mother and
Granmother
Mother
Mother
Mother
Mother
Mother
Mother
Mother and
Stepfather
Mother and Sister
Mother
Mother
Mother
Mother
Mother
Mother
9
Hot Coffee
26
2°
33
Mother
16
Figure 2. Characterization of the accident in children who were victims of burnings, considering the location, age,
causal agent, burned body surface (BBS), severity, time of admission and key informant. Fortaleza, April-August 2008. (*)
= Hot Liquid = Water.
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Brasil EGM, Brito MEM de, Pinheiro PNC.
Characterization of families of children…
The male presence as caregiver of the child
occurred in only one family (F9); the
stepfather was for some days like an escort
for his stepdaughter. Parents of other children
just came in the visitation time with other
family members such as: uncles, aunts and
grandparents.
The decrease in contact with friends is
caused by the fact that the families,
especially the maternal figure, get engaged
with more intensity to the child cares, leaving
a little aside their friendship relations. These
mothers start to have a greater coexistence
with the health professionals that are directly
related to the child cares.13
DISCUSSION
With regard to the ethnographic study
performed with families of children admitted
in a Burning Treatment Center, the findings
related to the number of family members go
against the trends of reduction in family size,
because according to the Social Indicators of
the Nucleus of Studies and Surveys on
Demographic and Socioeconomic Information IBGE, the Brazilian family organizations are
changing, mainly due to the cultural changes
that have occurred in recent years, new types
of family arrangements are among them and,
especially, they are reducing their sizes.14
There was a cluster of people, especially of
children, in the families studied, leading to a
greater risk of accidents with burnings,
because it becomes difficult for the caregiver
for observing these infants and, often, the
responsible for them ends up allowing children
to get into the kitchen.2
The lack of a Specialized Center in Burnings
and lack of qualified professionals favor the
transference of the child and his nearest
relative to the Capital. Data from the Institute
Pro-burned (Instituto Pró-queimados), (2010)
highlight only seven Specialized Centres in
burnings in the Northeast Region of Brazil,
where all meet in the capitals of these states,
leading to a large number of attendances,
mostly in victims from the countryside.15
Study evaluating social indicators showed
that family units who perceive insufficient
income to meet their needs (health,
education, housing, etc.) live in a vulnerable
situation with regard to the welfare of its
members, which reaffirms the idea that the
social determinants influence the distribution
of health and disease in a society.16
The inequality of family income remains in
the Brazilian society, especially in the
Northeast region, and the children are the
most affected. Data from IBGE show that, in
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J Nurs UFPE on line. 2012 Dec;6(12):2867-73
this region, 44.1% of children live in families
with very low income.17
The effects of schooling level are
manifested in many different forms and they
are related to disease prevention and health
promotion. According to the report of the
National Commission on determinants in
health, income and schooling are strongly
associated with health outcomes and life
expectancy.18
The type of family arrangement identified
in the study can be named of secondary
extensive nuclear family, in which we find the
main family (father / mother) and another
comprised by son / son in law / daughter /
grandchild.14 It is believed that this contingent
is the result of aggregations; some children
get married or have children and continue
residing in the same house, characterizing
new families.
The data shown (Figure 2) confirm the
execution of epidemiological studies on
burnings in children, which show that
accidents in the range of 1 to 5 years occur in
the kitchen and in the presence of an adult,
the super-heated liquid is the primary causal
agent.2,3 Studies reaffirm that the kitchen is
one of the most dangerous places for this age
group because these children do not know
how to distinguish the risk of pulling the pot
or even from the stove.18-9
Researches on etiology of burnings show
that 70% of burnings in children are caused by
scalding. These types of burnings, usually,
have a good prognosis and, even that in some
cases the time of admission is extended, the
sequels are
more
psychological than
20
physical, meeting the literature.
It is consensus in studies on burned child
that those younger than 10 years and which
present more than 10% of their body burned;
or with deep burns on more than 5% of burned
body surface; or burnings in special areas
(face, hands, feet and genitalia), or burnings
associated to pathologies of basis and
inhalation injury should be treated in
specialized centers for burnings.21
The need for hospitalization is clear by the
characteristics of burnings of the children
attended during the study period. The family
of the child must have understanding of the
severity of the accident and the clinical
changes that are common to the thermal
trauma, so you can comfort and help in
performance of the treatment. Thus, the
nurse must use the listening of the doubts,
concerns and aspirations as a strategy for that
the family become an ally in the process of
victim care.
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Characterization of families of children…
It can be seen that even with the inclusion
of females in the labor market, nowadays, the
woman is still the greater caregiver of the
family, whether in playing the role of mother,
sister or grandmother, reinforcing the
historical and cultural perpetuation of
attribution of this responsibility to this genre.
Thus, society places the female gender as
responsible for raising their children and that
the mother-woman must always remain close
to their children, taking care of their
children.22 The participation of the father in
the process of child hospitalization is little
common among families, due to the fact that
quality of financial provider of families was
given to the men.23
CONCLUSIONS
The research allowed for characterizing the
families and children treated at a center of
references in burnings. It was also possible to
identify the economic, social and family
situation of the children, in which, we viewed
a situation of vulnerability to accidents inside
their own residences, showing the need for
use of the Health Education, in the sense that
people can reflect on their own behavior that
favors the occurrence of burnings in children
who are totally dependent on the care of a
responsible adult.
Most children are from rural areas,
necessitating transference to the city of
Fortaleza, revealing the need of health
professionals receiving not only the victim,
but the family that brings with itself habits,
doubts and fears related to the care of their
children.
In the study, we still visualized the woman
as caregiver of these children, reinforcing the
role of mother and grandmother in the family
care, demonstrating that the father is still the
financial provider of families.
In conclusion, it is important to mention
about the urgency of inserting the families in
discussions about the risks in the home
environment, whereas this locus is where the
majority of these accidents occur. Call upon
the family, community, school, government
agencies / NGOs and society, in general, to
rethink about the mechanisms that favor the
occurrence and recurrence of these damages
in the children, simply, means, fulfill what is
put into statutes, laws, health care plans,
among other documents and official speeches.
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Sources of funding: No
Conflict of interest: No
Date of first submission: 2012/04/12
Last received: 2012/11/11
Accepted: 2012/11/12
Publishing: 2012/12/01
Corresponding Address
Eysler Gonçalves Maia Brasil
Rua Eliseu Uchoa Becco, 600
Bairro Água Fria
CEP: 60810-270  Fortaleza (CE), Brazil
English/Portuguese
J Nurs UFPE on line. 2012 Dec;6(12):2867-73
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