Participación de la madre y la familia en la atención del niño hospitalizado: Análisis histórico y visión de futuro

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Abstract

Introducción: Se ha insistido que el mejor pediatra de un niño es su propia madre, sin embargo, es excluida cuando su hijo se hospitaliza. Desde 1925, inicialmente en Europa y luego en otros continentes, se han hecho esfuerzos para que la madre pueda acompañar a su hijo hospitalizado. Se ha observado efectos beneficiosos en la calidad de la atención médica, mantención del rol afectivo y estado nutricional, disminución de la infección nosocomial, mejoría de la reacción de duelo y menor costo por hospitalización y, aunque se han presentado dificultades, éstas son menores y solucionables, relacionadas con trastornos de la dinámica familiar, angustia y ansiedad materna, alteraciones de convivencia y comunicación. Objetivo: Revisar el desarrollo de la participación familiar en la hospitalización infantil en el mundo, con énfasis en el ámbito nacional y nuestro servicio en particular e identificar aquellos aspectos que constituyen fortalezas y los que se proyectan como obstáculo a esta modalidad de atención. Experiencia Clínica: Desde 1989 en el Servicio de Pediatría del Complejo Hospitalario San Borja Arriarán de Santiago de Chile, se ha llevado a cabo un cambio en la modalidad de atención, desde incorporar a la madre acompañando a su hijo hasta la integración de su actividad en el equipo de salud, participando en los cuidados de su hijo hospitalizado, con claros beneficios para el niño, su familia y el Complejo Hospitalario. Hoy día se reconoce que la integración de la madre y la familia en la atención médica del niño hospitalizado y ambulatorio, se traduce en claros y concretos beneficios, optimizando la calidad de vida del niño y su familia e introduciendo un menor costo en la atención médica. Conclusiones: Para que esta ventajosa modalidad de atención funcione adecuadamente, se requiere de intervención en la madre trabajadora cuyo ingreso económico es un aporte significativo al grupo familiar, apoyo psicológico a la familia en hospitalizaciones prolongadas, modificaciones estructurales en futuros establecimientos y adecuación del modelo de atención del Equipo de salud tal que favorezca la integración de la madre en forma más permanente

Translated abstract

Background: Although it is believed that the best kid pediatrician is his own mother, she is excluded in his attention when hospitalized. Since 1925, changes allow the mother accompany her hospitalized child, initially in Europe and soon after in other countries. Beneficial effects in mothers participation include: manteinance of affective and nutritional status, decrease in nosocomial infections, improvement of duel reaction and minor cost hospitalization. Few difficulties appear related to disturbances of family dynamics, maternal anxiety and alterations in communication. Objective: To review the development of family participation in infant hospitalization worldwide, with emphasis in our hospital. Identify those aspects that strengthen and those that interfere with this modality of attention. Experience: In the Pediatrics Service from Complejo Hospitalario San Borja-Arriarán at Santiago of Chile, a change in attention modality began in 1989, integrating the mother to the activities of the health team in charge of the attention of her hospitalized son, with clear benefits for the child, its family and the hospital care, in terms of life-quality and less cost in medical attention. Conclusions: For making suitable this modality of hospitalization, the mother who works requires support when its economic entrance is a significant contribution to the family group, psychological assistance to the family in prolonged hospitalizations, structural modifications when building future hospitals and adjustment to the model of attention by the health team, in order to integrate the mother in a more permanent way

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Epidemiologic aspects of overweight and obesity in the United States.

Katherine Flegal (2005)

National survey data from the U.S. show that the prevalence of overweight and obesity among adults remained relatively constant over the 20-year period from 1960 to 1980, began to increase around the mid-1980s and has continued to increase. Data for children and adolescents, based on different definitions, show the same pattern. It can sometimes be more useful to look at the whole distribution of body mass index, rather than on prevalence estimates based on pre-defined cutoffs. Data from several countries suggest that for both adults and children, the distribution of BMI has become more skewed over time. Although many hypotheses have been put forward about the causes of the increases, data to address these issues are sparse. Obesity is a well-known risk factor for numerous health conditions. Nonetheless, the health consequences of the increases in obesity have not been fully delineated. Increases in diabetes have been noted in conjunction with the rise in obesity. On the other hand, declines in some other cardiovascular risk factors have been seen at all BMI levels. Rising life expectancy and decreasing heart disease mortality rates seem to confound some of the expectations about the effects of increasing obesity on mortality. The effects of obesity on morbidity may be greater than its effects on mortality. The increasing prevalence of obesity poses challenges for researchers and for policy makers.

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Child in hospital: family experiences and expectations of how nurses can promote family health.

Hanna Hopia, Eija Paavilainen, Päivi Åstedt-Kurki … (2005)

This study set out to explore, from the family's point of view, ways in which nursing staff can promote family health during the child's hospital stay. Having a child in hospital is a major source of stress and anxiety for the whole family. Earlier studies have described parental coping strategies, ways to strengthen those strategies and to support parental participation in child care, but no one has studied the promotion of family health during the child's hospitalization from the family's point of view. Interviews were conducted in 2002 with 29 families who had a child with a chronic illness which were receiving or had received treatment on the paediatric wards of two Finnish hospitals. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data collection and analysis phases proceeded simultaneously. Five domains were distinguished in the promotion of family health: (1) reinforcing parenthood, (2) looking after the child's welfare, (3) sharing the emotional burden, (4) supporting everyday coping and (5) creating a confidential care relationship. The results strengthen the knowledge base of family nursing by showing how nursing staff can promote family health during the child's hospital stay. The results have a number of practical applications for nursing, both for clinical practice and research. The results can be used in paediatric hospital wards caring for chronically ill children and their families. The five domains of family health promotion described here should be tested in other paediatric wards and in other geographical locations.