Theoretical model of nursing care for children with obesity

Grounded Theory and the theoretical/philosophical framework of Virginia Henderson were used. The research was conducted in Family Basic Health Units and in Specialized Services in the city of Campina Grande, Paraíba, Brazil. A total of 24 participants composed four sample groups. Data were collected through semi-structured interviews, between April and October 2015, and analyzed by the constant comparison method. The analysis occurred by initial coding, construction of diagrams and memos, axial coding, selective coding and reflection on the paradigm and on the emerging theory.

Results:

six categories emerged from the data. Nurses worrying about the care of children with obesity as a neglected area in Primary Health Care was the theoretical model.

Final Considerations:

the phenomenon is related to the individuality of nursing care and the need for shared responsibilities.

Descriptors:
Obesity; Child Care; Nursing Care; Primary Health Care; Grounded Theory

CATEGORIES	SUBCATEGORIES	DISCOURSES
1. Identifying processes that lead to discontinuity of care of children with obesity in health facilities.	Discovering weaknesses in management directed at structuring nursing care for children with obesity in PHC; Limiting nursing care for children with obesity due to insufficient human resources and lack of training; and revealing the organization of the work process based on the biomedical model	"There must be team that makes it work, but in my team, it is still very difficult... because obesity should be treated as hypertension is, we know, we keep records, we understand, we care, we go after people, we are always following-up." (E02); "I am working in FHC for 16 years and I have never heard of a nurse attending healthy older children [...]" (G01)
2. Characterizing the fragility of care shared by parents and health professionals in the care of children with obesity	Receiving influence of cultural, socioeconomic and psychological factors in food choices; Seeing maternal absence as a potentiator of childhood obesity; Reconstructing the vicious circle: parent's habits being reproduced by their children; Facing difficulties to establish partnerships between professionals and family members in the care of children with obesity; and (un)knowing childhood obesity as a disease.	"When I talk about customs, I mean the custom of taking the easy route... It takes time, and nobody has the time to worry about this..." (E02); "[...] When the mother is not home, she takes the opportunity. The father is always there facilitating." (PS04); "[...] Sometimes, the obstacle can be something basic, as when the family does not believe in the process, or gives up on the child... because the mother herself believes that the child will lose weight later." (E04)
3. Interacting with the multi-professional team in care.	Maintaining a relationship with the multi-professional and multidisciplinary work in the care of children with obesity; and having a specialized center for the care of children with obesity	"[...]That's why multi-professional work is important... It's been a long time since we understood that none of us are so good as all of us together[...]" (E08)
4. Glimpsing new possibilities for nursing care	Supporting the UBS as the gateway to the care of children with obesity; Breaking the boundaries of the UBSF to find and follow-up children with obesity; Establishing bonds with families for the care of children with obesity; Thinking of alternatives to take care of children with obesity; and designing the systematized care through intervention projects	"When patients arrive at the unit, they first go through the Nurse[...] initially, when the user arrives, when they look for us, they go directly to the nurse[...]" (PS03) "[...] In order for nurses to look at the entire life cycle of the child, from 0 to 11 years of age, we would need to have a systematization, because if we do not, the child does not go to the nurse[...]" (G01)
5. Moving through nursing care settings	Identifying unsatisfactory resource supplies; Reflecting on childhood obesity in health management; and pointing to the lack of situational planning as a limitation of nursing care	"We sometimes feel powerless, because we can't change things as we would like to, because we do not have the resources... The problem is the management... The politics of a city or a country. [...]" (E07)
6. Addressing the concern for new nursing care processes	Addressing prevention of childhood obesity during pregnancy care; Including the nursing consultation as a principle of care for children with obesity; Using daily care to address childhood obesity through guidance; and instituting systematic monitoring of children with obesity in PHC: the nurse's perspective	"[...] What I see is that orientation should begin in prenatal care. When the baby is born, it should continue and then expand into schools when the child reaches school age..." (G04)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Larissa Soares Mariz Vilar de Miranda. E-mail: larissamariz@gmail.com