Promoción de la salud afectiva-sexual en primera infancia, contexto de cuido y educativo en Costa Rica. Una revisión crítica / Affective-sexual health promotion in early childhood: critical review in the context of childcare and education in Costa Rica

Resumen La presente revisión describe investigaciones sobre el desarrollo afectivo-sexual en primera infancia en el ámbito preescolar y de cuido; éstas se analizan desde el marco normativo y operativo en el cual se sustenta la educación sobre este tema en Costa Rica. Dicha revisión se realizó con 4 bases de datos internacionales y se sustentó en estudios empíricos y de revisión. Los estudios hallados apuntan a una diversidad de procesos a tomar en cuenta. Algunos de éstos se relacionan con el desarrollo de vínculos seguros y confiables, el uso de terminología genital desde temprana edad, abordajes asertivos de las manifestaciones afectivas-sexuales de infantes, así como a contemplar los aspectos culturales y socio-históricos. A nivel nacional se encuentra que existe un amplio marco normativo que respalda la comprensión integral del desarrollo afectivo-sexual para su abordaje. Sin embargo, se observa que en el programa nacional de preescolar, se prioriza el riesgo al abuso sexual. Además en este se devela una visión moralista por edades, considerando que los genitales deben nombrarse sólo en los últimos niveles de preescolar y no cuando se conocen las partes del cuerpo en los niveles iniciales. Desde un enfoque de promoción de la salud sexual en el ámbito de cuido y educativo nacional, aquí se propone una visión más amplia que tiene plenamente en cuenta las complejidades en torno a los determinantes sociales del desarrollo afectivo sexual. Por lo que se requiere una actualización del programa de preescolar, acompañado de formación continua para el personal y las familias de infantes.

Abstract This critical review describes research on affective and sexual development in early childhood in preschool and childcare settings. Studies are analyzed from the point of view of the regulatory and operational frameworks on which education on this topic in Costa Rica is based. The review was carried out using 4 international databases, examining empirical studies and review studies. Costa Rica has put in place a broad national-level policy framework that supports a comprehensive understanding of affective-sexual development from infancy. However, implementation of the policy in the national preschool program does not always meet the framework's standards. We find that the risk of sexual abuse tends to be prioritized in early sexual-affective education. Sexual-affective development is often addressed from a moralistic standpoint, advising for instance that the genitals should be named only in the last levels of preschool and not when the other parts of the body are first named. From a health-promotional perspective on national childcare and early education, we here propose a broader view that takes fully into account the complexities around the social determinants of sexual-affective development. We conclude that an update of the preschool program is required, accompanied by continuous training for staff and families of infants.

Visión integradora del pase de visita médico asistencial y docente en hospitales universitarios de Ecuador / Integrated vision of the clinical and educational round at Ecuador university hospitals

Introducción: El pase de visita docente asistencial en las instituciones docentes hospitalarias es complejo y hay que vencer diferentes objetivos en una misma actividad. Objetivo: Proponer un diseño a partir de concepciones pedagógicas actuales del pase de visita médico asistencial y docente en hospitales universitarios ecuatorianos. Material y Métodos: Se realizó una revisión de la bibliografía relacionada con los procesos pedagógicos de la educación en el trabajo en la formación médica. Se utilizaron los buscadores PubMed, Cochrane Library y Google académico, para identificar, seleccionar, estructurar y dar una visión sistémica del pase de visita médico docente-asistencial, proponiendo bases estructurales y metodológicas, partiendo de la experiencia cubana y directivas académicas propias de Ecuador. Desarrollo: El pase de visita docente- asistencial como forma de educación en el trabajo para obtener la excelencia debe de ser más integrador donde no solo se utilice el método clínico, sino el clínico y epidemiológico, y donde estén integrados objetivos gerenciales, se utilicen métodos pedagógicos constructivistas, concepciones del entorno salud-enfermedad del tipo holísticos, a través de estrategias de participación heurísticas. Conclusiones: La utilización de un modelo de actuación con fundamentos científicos, adecuadamente estructurado y basado en transformaciones pedagógicas cualitativas que se interrelacionen con los procesos asistenciales, gerenciales y donde el paciente sea evaluado integralmente, ofrece un enfoque más sistemático de esta actividad(AU)

Introduction: The educational and assistance round in the educational-hospital institutions is complex and it is necessary to overcome different goals in the same activity. Objective: To provide a design from current pedagogical conceptions of educational-medical rounds at Ecuadorian university hospitals. Material and Methods: It carried out review of the related bibliography with the pedagogic processes of education in the work of medical formation. Were used the searchers PubMed, Cochrane Library and Google scholar to know, select, built, analyze and give a systematic view of the educational and assistance round in Ecuador, proposing structural and methodological bases, starting from the Cuban’s experience and the own Ecuadorian academic directives. Development: Educational-medical rounds as educational method of labor to obtain excellence must be more inclusive not using only the clinical method, but also clinical and epidemiological method shall be included and where integrated management objectives must be joined, using pedagogical constructional methods, holistic health-disease environment through heuristic participation strategies. Conclusion: The use of a proceeding model on a scientific basis properly structured and based on qualitative educational transformations that interrelate with medical caretaking and management issues where patients are evaluated integrally, provides a systemic approach process to this activity(AU)

Estratégias de educação em saúde direcionadas a cuidadores durante a internação / Health education strategies directed to caregivers during patient hospitalization

OBJETIVO: Avaliar a repercussão de estratégias de educação em saúde direcionadas aos cuidadores durante a internação. MÉTODOS: Pesquisa qualitativa, realizada com cuidadores principais de sujeitos incluídos em projeto de educação para cuidados domiciliares, por meio de entrevista semiestruturada. Os dados foram analisados de acordo com o conteúdo temático, organizados em categorias. RESULTADOS: Houve predomínio das orientações verbais com demonstração prática dos cuidados e entrega de cartilhas educativas. Identificou-se baixa renda e escolaridade entre os cuidadores, dependência severa dos sujeitos cuidados e dificuldades das equipes de atenção domiciliar para suprimento de recursos materiais. CONCLUSÃO: As estratégias de educação em saúde direcionadas aos cuidadores durante a internação auxiliaram a execução das técnicas de cuidado no domicílio. Ainda assim o cuidado domiciliar apresentou domínios comprometidos pelas condições socioeconômicas.

OBJECTIVE: To evaluate the impact of health education strategies directed to caregivers during patient hospitalization. METHODS: Qualitative research conducted with semi-structured interviews with primary caregivers of patients in a home care education project. Data were analyzed according to thematic content, and organized into categories. RESULTS: There was a predominance of verbal instruction with practical demonstration of care, and delivery of educational booklets. Low income and education among the caregivers, severe dependence of patients, and difficulties of home care teams to supply material resources were identified. CONCLUSION: The health education strategies directed to caregivers during hospitalization helped the implementation of home care techniques.Yet some aspects of home care were compromised by socioeconomic conditions.

O trabalho do cuidado: uma análise psicodinâmica / The work of caretaking: a psychodynamics analysis

O presente estudo analisa as formas de sofrimento e o uso de estratégias defensivas do/a cuidador/a social de abrigo de crianças e adolescentes. Tem como aporte teórico os princípios da Psicodinâmica do Trabalho e do pensamento e pesquisas desenvolvidas por Molinier (2008; 2009). Nesta investigação foi adotado o método proposto pela Psicodinâmica do Trabalho com a realização de discussões grupais com oito cuidadoras responsáveis pelo cuidado de crianças de zero a seis anos de idade do abrigo municipal de Macaé, localizado no Estado do Rio de Janeiro. Os resultados indicam que o trabalho do/a cuidador/a é uma atividade complexa que se constrói na relação com o outro, o que exige forte mobilização subjetiva e contínua necessidade de inventividade. O sentimento de impotência - de dúvida nos modos de fazer -, o medo frente às condições de precariedade e falta de segurança no trabalho e, principalmente, a falta de reconhecimento são as formas de sofrimento evidenciadas entre as cuidadoras pesquisadas. Constatamos que as estratégias defensivas são uma forma coletiva de lidar com as deficiências da organização do trabalho e que tais recursos criam um distanciamento afetivo entre cuidador/a e usuário. Concluímos ainda que nossos achados de pesquisa demonstraram a construção de estratégias defensivas sexuadas já identificadas em outras categorias profissionais do cuidado.

The present study analyzes the suffering and the defense strategies put into play by the social caretaker of a municipal shelter for children and adolescents. Our investigation, relying on the principles of the Psychodynamics of Work, and on the thoughts and research studies developed by Molinier (2008; 2009), adopted the methodology proposed by the Psychodynamics of Work for group discussions with eight caretakers in charge of children, ranging from 0 to 6 years of age, in a municipal shelter in Macaé, Rio de Janeiro state. Our findings show that the work of the caretaker is a complex activity built on the relationship with the other, which demands a strong subjective mobilization and requires continuous inventiveness. The sense of helplessness - doubts concerning the 'means ways of doing' -, the fear generated by precarious working conditions and lack of safety at work, aggravated by the lack of recognition, constitute the suffering evident among these women caretakers.We conclude that the defense strategies are a collective means of dealing with the deficiencies of the work organization and that such resources establish an affective distancing between caretaker and care recipient. We further understand that our findings demonstrate the construction of sexual defense strategies already identified in other professional categories of caretaking.

Comportamento de cuidado entre crianças institucionalizadas: observações nos pátios do abrigo e da escola / Behavior of caretaking among institutionalized children: observations of shelter and school yards

O comportamento de cuidado compreende ações prossociais que sofrem a influência de fatores físicos e sociais do ambiente. Este estudo objetivou investigar aspectos do ambiente que concorrem para a manifestação do comportamento de cuidado entre crianças, de quatro a seis anos de idade, no pátio da escola onde estudam e do abrigo em que estão acolhidas. Foram realizadas dez sessões para observação dos sujeitos focais com duração de 50 minutos em cada ambiente. Ao todo, 43 eventos comportamentais foram registrados e organizados nas seguintes subcategorias: Ajudar, Brincar de cuidar, Estabelecer contato afetuoso e Entreter. Diferentemente da maioria dos estudos, esta pesquisa mostra que não houve diferença significativa na manifestação do comportamento de cuidado associada a aspectos físicos do pátio do abrigo e da escola. Contudo, indicou ser significativa a influência de características pessoais do sujeito focal, como o sexo do receptor, o tempo de permanência e a atividade lúdica, corroborando a literatura.

The behavior of caretaking includes prosocial actions which are influenced by physical and social factors of the environment. This study aimed at investigating aspects of the environment which contribute to the manifestation of the behavior of caretaking among children, from four to six years of age, in the yard of the school where they study and of the shelter in which they live. Ten sessions were conducted for the observation of the focal subjects with a lenghth of time of fifty minutes in each environment. In all, 43 behavioral events were recorded and organized into the following subcategories: helping, caretaking playing, establishing afection, and entertaining. Unlike most studies, this survey shows that there were no significant differences in the manifestation of the behavior of caretaking associated to physical aspects of the shelter and the school yards. However, it suggested that the influence of personal characteristics of the focal subject is significant, such as the gender of the receiver, the period of permanence, and the ludic activity, corroborating the literature.

Bebês: o irresistível poder da graciosidade. Um estudo sobre o significado evolutivo dos traços infantis / Babies: the irresistible power of cuteness. A study concerning the evolutionary function of infantile traits

Os bebês, em geral, despertam ternura e comportamentos de cuidado nas pessoas. O objetivo deste trabalho foi discutir a atração provocada pelos traços infantis, tendo como referencial teórico os quatro níveis de explicação de Tinbergen. Do ponto de vista dos mecanismos que desencadeiam essa atração neonatal, avaliamos a importância da aparência do infante para eliciar as respostas de cuidado parental. Considerando a função adaptativa desta característica, discutimos os processos evolutivos que moldaram as preferências pelos atributos infantis, além da história filogenética do favoritismo pelos sinais morfológicos de filhotes. Apresentamos, ainda, dados sobre o desenvolvimento deste traço comportamental ao longo da vida. Tomadas em conjunto, estas informações provêem uma análise de por que achamos os bebês tão irresistíveis.

Babies generally elicit tenderness and caretaking behaviors on people. The aim of this study is to discuss the attraction towards babyish features, taking Tinbergen's four questions as a theoretical benchmark. Concerning the mechanisms implicated in this neonatal attraction, we evaluated the importance of children´s morphology on eliciting parental responses. Considering the adaptive function of this characteristic, we discuss the evolutionary process that shaped the preferences towards infantile traits as well as the phylogeny of the preference towards infant´s morphological traits. It was also presented data about the development of this behavioral trait across life span. The information provided here suggests a reason why we find babies such irresistible creatures.

Crianças que cuidam de irmãos com necessidades especiais / Children caretaking for siblings with special needs

Este estudo analisou situações em que um irmão/ã ajuda a cuidar de uma criança com necessidades especiais. Foram entrevistadas as mães e as crianças cuidadoras de 10 famílias de baixa renda, em Salvador-Bahia, com filhos portadores de paralisia cerebral. São detalhados os comportamentos de cuidado indicados pelas mães e pelas crianças cuidadoras, a participação das crianças em tarefas domésticas e suas atividades de lazer. Descrevem-se dificuldades e satisfação/insatisfação dos cuidadores com a tarefa, e expectativas de mães e crianças em relação ao futuro. Discute-se o grau de responsabilidade atribuído às crianças. Apontam-se limitações do estudo e algumas direções de intervenção para profissionais de saúde que atendem essas famílias.

This study analyzed situations in which a child shares part of the caretaking tasks required by a brother or sister with special needs. Mothers and child caretakers of 10 low-income families, in Salvador-Bahia, with a cerebral palsy child, were interviewed. Caretaking behaviors indicated by mothers and child caretakers, children's participation in domestic tasks, and their leisure activities are detailed. The caretakers' satisfaction/dissatisfaction and difficulties with their role, and their mother's and their own expectations for the future are described. The degree of responsibility attributed to the children is discussed. Limitations of the study and some possible directions of intervention for health professionals attending families in similar situations are pointed out.

A questão do gênero no ensinar em enfermagem / La cuestión del género en el enseñar en enfermería / Gender issue in nursing teaching

Trata-se de um artigo de pesquisa, que teve como objeto a maneira como enfermeiras ensinam e prestam o cuidar/cuidado a homens e mulheres. Definiu-se como objetivo analisar a questão de gênero no processo de ensino do cuidado na formação da enfermeira. A abordagem metodológica foi a qualitativa. O local foi a Universidade Estadual de Feira de Santana, situada no semiárido baiano. A coleta de material foi realizada com 21 enfermeiras nos meses de janeiro, fevereiro e julho de 2002, tendo como técnica a entrevista. Para análise dos dados, recorreu-se à estratégia do discurso do sujeito coletivo. Analisados os depoimentos, concluiu-se pela necessidade de implementação de maneiras diferentes de ensinar homens e mulheres a cuidar. A sugestão é que seja feita a integração dos saberes de enfermagem e que se discutam as questões de gênero.

This article goes over an aspect of the research in nursing teaching whose object is the way female nurses teach and take care of men and women. The objective defined was the analysis of the gender issue in the process of teaching care in the female nurse’s education. The methodological approach was qualitative. The place was the State University of Feira de Santana, in the semi-arid region of Bahia, Brazil. Collection of material was done with 21 female nurses in January, February, and July, 2002, resorting to the technique of interviews. Data analysis was made with the use of the collective subject speech strategy. After analyzing the speeches, conclusions pointed to the need for implementing different ways of teaching men and women to take care. Integration of the different parts of nursing knowledge and discussion of gender issues come out as suggestions.

Se trata de un artículo de pesquisa que tuvo como objeto la manera como enfermeras enseñan y prestan el cuidar/cuidado a hombres y mujeres. Se definió como objetivo analizar la cuestión de género en el proceso de enseñanza del cuidado en la formación de la enfermera. El abordaje metodológico fue el cualitativo. El sitio fue la Universidad Estatal de Feira de Santana, ubicada en el semiárido baiano-Brasil. La recolección de material fue realizada con 21 enfermeras en los mese de enero, febrero y julio de 2002, teniendo como técnica la entrevista. Para análisis de los datos, se recurrió a la estratégia del discurso del sujeto colectivo. Analisadas las hablas, se concluyó por la necesidad de implementación de maneras diferentes de enseñar a hombres y mujeres a cuidar. La sugestión es que sea hecha la integración de los saberes de enfermería y que se discutan las cuestiones de gênero.

Vivenciando o cuidado perioperatório de Enfermagem / Experiencing perioperative nursing care

Trata-se de estudo qualitativo, tendo como objeto as vivências de cuidar/cuidado perioperatório de pacientes de cirurgias gerais eletivas. Objetivou compreender como os pacientes no perioperatório de cirurgias gerais eletivas vivenciam o cuidar/cuidado de enfermagem. Os sujeitos foram 12 colaboradores em 04 unidades cirúrgicas de um hospital público de Salvador-Bahia em 2005. As informações foram levantadas usando-se a técnica da história oral de vida, seguindo-se um roteiro de entrevista semi-estruturada. O processo de análise utilizado, tendo por referencial o cuidar e o cuidado de enfermagem, foi a análise temática de Minayo. Emergiram duas categorias temáticas: Vivências perioperatórias de cuidados de enfermagem por pacientes submetidos a cirurgias gerais eletivas constituída das seguintes subcategorias: a) Externando sentimentos negativos na experiência cirúrgica geral eletiva; b) Externando o cuidado sistematizado na experiência cirúrgica geral eletiva; Significados de cuidar e de cuidados de enfermagem por pacientes que vivenciaram o perioperatório de cirurgias gerais eletivas com as subcategorias: a) Cuidado é implementação de procedimentos pré-operatórios e cuidados pós-operatórios; b) O cuidar e o cuidado se estabelecem nas relações entre paciente e equipe de enfermagem; c) O cuidar e o cuidado significam comunicar-se; e d) Reconhecendo aspectos éticos do cuidar e do cuidado perioperatório. Os resultados apontam para o reconhecimento de que o processo de cuidar envolve a soma de cuidados técnicos bio-psico-afetivos. Conclui-se que, em relação à SAEP, a admissão está implantada no Centro Cirúrgico; a enfermagem está preocupada com a redefinição de seus papéis no cuidar/cuidado; os colaboradores reconhecem que há necessidade de se perceberem prioridades diante de aspectos negativos do cuidar/cuidado. Para o paciente, estar na condição de perioperatório significa vivenciar sentimentos de medo, apreensão e incertezas. Há valorização da comunicação, relação cuidativa e presença dos componentes da equipe de enfermagem nesse processo. Os princípios de responsabilidade, beneficência, não maleficência, autonomia e liberdade permeiam a vivência do cuidar/cuidado no perioperatório.(AU)

Attachment-Oriented Caretaking Behaviors and Related Factors in Mothers of Breast-feeding Infants / 아동간호학회지

PURPOSE: The purpose of this study was to identify the characteristics and the related factors of attachment-oriented caretaking behavior in mothers who are breast-feeding their infants. METHOD: The subjects were 155 mothers who participated in a healthy breast-feeding contest in the Busan area. The data were collected from September 24, 2003, and were analyzed using SPSS WIN 10.0. RESULTS: The mothers were highly affirmative in their attachment-oriented caretaking behaviors (total mean 2.59+/-.502 of a possible score of 3). Among the attachment-oriented caretaking behaviors (10 items), the scores for 6 items were higher than the average score and 4 items were lower than the average score. There were significant differences in the attachment-oriented caretaking behaviors according to level of education (p<0.05), and planned duration of breast-feeding (p<0.001). Mothers with university education who planned to breast-feed as long as the baby wanted had higher scores. CONCLUSIONS: The above results suggest that nursing interventions which are individualized and practical are needed to encourage the attachment-oriented caretaking behaviors essential to breast-feeding mothers.

A Concept Analysis of the Caretaking Behavior for Children / 아동간호학회지

The purpose of this study is to analyze the concept of caretaking behavior for children. This study adopts the methode of Walker and Avant in analysis. Based on the results of the study, the attributes, precedents, and consequences of caretaking behavior for children are follows ; 1.The affirmative attributes of caretaking behavior are affection binding, nutritional guidance, education, caring, protection moral training and acquisition of parents' role. The negative attributes of caretaking behavior are inconsistent moral training, incapability of affection binding and overprotection. 2. The precedent of caretaking behavior are postpartum contact with their babies, cognizance capacity of child-caretaking, economic support, level of preparation for child-caretaking and self-consciousness as parents. 3. The affirmative consequences of caretaking behavior are promotion of child growth and development, formation of maternal-infantile attachment, development of children sociality, satisfaction of parental role and reinforcement of relationship between the members of family. The negative consequences of caretaking behavior are burden and conflict to parental role, children's illness, role conflict and role stress among the members of the family and family breaking up.

The study on the maternal burden of caretaking, the support and educational need for the caretaking activities of the infants' mother / 아동간호학회지

It is important to asess the risk factors of parenting and provide early intervention for promotion of the maternal caretaking ability. The purpose of the study was to identify the maternal burden of caretaking, the supporting and the educational need for the caretaking activities of the mother of infant. Sixty three mothers of infants who visited the wellbaby clinic of S university hospital and one health center during the period of November 1st, to 30th in 1996 comprised the subjects of this study. Data were gathered through the instruments that were developed by researcher. Statistical analysis of this study was used ANOVA and Pearson correlation. The results were as follows : 1) The mean score of the maternal burden of caretaking was 22.06. The maternal burden of caretaking was significantly high in the mothers who had vaginal delivery compare with the mothers who had caeserean section and in the mothers who gave artificial feeding compare with the group of breast or mixed feeding. 2) The mean score of the support need for the caretaking activities was 30.69. The support need for the caretaking activities was significantly high in the mothers who had the second child, compare with the mothers who had first or third child. And the support need for the caretaking activities was significantly high in the mothers who had caretaking help compare with the mothers who had no caretaking help. The specific subjects of 'mother-infant interaction', 'immunization' and 'prevention of accident' on the support need for the caretaking activities were relatively high. 3) The mean score of the educational need of caretaking activities was 29.3. The educational need of caretaking activities was significantly high in the mother who had the second child compare with the mothers who had first or third child. And the educational need of caretaking activities was significantly high in the mothers who had caretaking help compare with the mothers who had no caretaking help. The specific subjects of 'mother-infant interaction', 'emergency care' and 'prevention of accident' on educational need of caretaking were relatively high. 4) The maternal burden of caretaking was not correlated with the support need or the educational need of caretaking activities. But the support need of caretaking activities was significantly correlated with the educational need of caretaking activities. 5) The support and educational need of caretaking activities were significantly high in the mothers who wanted home care for caretaking their infants. Through the study, it was found that there is considerable maternal burden of caretaking as well as the support and educational need on the caretaking activities in the mothers whose child is young. Therefore developing the systematic and effective program is needed to meet the mother's need. The results of this study will be useful resources to develop the program. On the other hand, it can be recommended that home health care will be one of the approach to support the mothers caretaking activities.