Objetivos: rastrear crianças com necessidades de saúde especiais em um serviço de pronto atendimento pediátrico e analisar suas demandas de cuidado. Método: estudo transversal, desenvolvido de março a junho de 2019, em serviço hospitalar de emergência infantil, no município de Rio das Ostras, Rio de Janeiro, Brasil. Aplicaram-se a versão brasileira do Children with Special Health Care Needs Screener (CSHCN Screener®) e o instrumento caracterizador de demandas com familiares cuidadores de crianças. Utilizou-se a estatística descritiva. Resultados: crianças com necessidades de saúde especiais corresponderam a 5,1%, dentre 235 famílias rastreadas. Os principais domínios de necessidades de saúde foram maior utilização de serviços e dependência de medicamentos. Dentre as demandas de cuidados, destacaram-se os cuidados habituais modificados. Conclusão: as seis demandas de cuidados foram identificadas entre as crianças rastreadas. Recomenda-se a adoção do CSHCN Screener® para ampliar a visibilidade e indicar estratégias assistenciais a esse grupo populacional.

/pdf/criancas-com-necessidades-de-saude-especiais-em-um-servico-1raew25k.pdf

Crianças com necessidades de saúde especiais em um serviço de pronto atendimento pediátrico: estudo transversal

Objective: To analyze, based on scientific evidence, nursing care for children with special health care needs in Primary Health Care. Methods: Integrative literature review, with search and selection in MEDLINE databases via PubMed®, LILACS, Embase, SCOPUS and in the Scielo electronic library. Ten primary studies were included, available in full, published between 2011 and 2021, in English, Portuguese and Spanish. Results: Despite the great need for technical knowledge in assisting CSHCN, it is evident the need for these children and their families to be attended in full, and not just with biomedical approaches that limit nursing care in terms of identifying aspects related to the clinical picture of these children. It was also evidenced that nurses, for the most part, do not feel prepared to provide adequate care due to the complexity of the health conditions, the deficiency in professional training or the lack of periodic and specific training after graduation. Conclusion: Nursing care in the care for CSHCN happens in a fragmented way and with actions based on the biomedical model. The findings showed little access and inclusion, in addition to a shortage in the provision of training for nurses as a frequent problem in primary care.  

/pdf/nursing-care-for-children-with-special-health-care-needs-in-voupdfjt.pdf

Nursing care for children with special health care needs in primary care

ABSTRACT Objectives: to validate and implement a home care flow protocol for children with special healthcare needs. Methods: mixed-method research conducted in home care services in Paraíba, Brazil, with 13 judges for content validity and 11 interviews with healthcare professionals after clinical implementation. Quantitative data were analyzed by calculating the Content Validity Index and Cronbach’s alpha, and qualitative data were analyzed by inductive thematic analysis. Mixed-method analysis was performed by integrating data in a joint display. Results: the instrument was considered substantial and valid, with a Cronbach’s alpha of 0.87. There was a need for adjustments to the protocol flowchart in the “transportation”, “communication with Primary Health Care”, “Singular Therapeutic Project implementation”, “telecare” and “emergency service activation” items. Conclusions: the protocol was considered functional for use by home services after incorporation of the suggested adjustments. 

Implementation of a flow protocol in home care for children with special healthcare needs

RESUMO Objetivo: Apreender a percepção da família acerca dos cuidados prestados pelos serviços de atenção domiciliar a crianças e adolescentes com necessidades de saúde especiais. Método: Estudo qualitativo, exploratório-descritivo, realizado com 15 familiares de crianças e adolescentes com necessidades de saúde especiais atendidos por Serviços de Atenção Domiciliar de sete municípios da Paraíba, Brasil, em 2021, selecionados de nove municípios identificados por estudos prévios. Os dados foram coletados com uso de entrevista semiestruturada realizada remotamente por meio de ligações telefônicas. O material empírico foi submetido à Análise Temática Indutiva e interpretado à luz do conceito de vulnerabilidade em saúde. Resultados: Os Serviços de Atenção Domiciliar minimizam as vulnerabilidades em saúde dessas crianças e adolescentes e seus familiares à medida que facilitam o acesso às ações e serviços da Rede de Atenção à Saúde, prestam um cuidado humanizado e centrado na promoção da saúde e fortalecimento de vínculos, bem como, facilitam a tomada de decisão familiar em domicílio quanto às necessidades de saúde dos usuários. Considerações finais: As ações desses serviços permeiam o cotidiano familiar, possibilitando a ampliação das práticas de cuidados aos familiares/cuidadores considerando suas limitações e melhora da articulação das Redes de Atenção à Saúde para garantir um cuidado integral. 

Cuidados do Serviço de Atenção Domiciliar às crianças/adolescentes com necessidades de saúde especiais: percepção familiar

Objectives: to screen children with special health needs in a pediatric emergency service and analyze their care demands. Method: a cross-sectional study, carried out from March to June 2019, in a children's emergency hospital service, in the municipality of Rio das Ostras, Rio de Janeiro, Brazil. The Brazilian version of the Children with Special Health Care Needs Screener (CSHCN Screener®) and the instrument characterizing demands with family caregivers of children were applied. Descriptive statistics were used. Results: children with special health needs corresponded to 5.1% of the 235 families screened. The main domains of health con necesidades especiales de salud correspondieron al 5,1% de las 235 familias procuradas. Los principales dominios de las necesidades de salud fueron el mayor uso de los servicios y la dependencia de medicamentos. Entre las demandas de cuidado, se destacaron los cuidados habituales alterados. Conclusión: las seis demandas de cuidado fueron identificadas entre los niños evaluados. Se recomienda la adopción del CSHCN Screener® para aumentar la visibilidad e indicar estrategias de atención a este grupo poblacional.

Children with special health care needs in a pediatric emergency service: a cross-sectional study*

Although children with special health care needs (CSHCN) represent a minority of the population, they go through more hospitalizations, more admissions to the Emergency Department (ED), and receive a major number of medical prescriptions, in comparison to general pediatric population. Objectives of the study were to determine the reasons for admission to the ED in Italian CSHCN, and to describe the association between patient’s demographic data, clinical history, and health services requirements. Ad hoc web site was created to collect retrospective data of 3479 visits of CSHCN to the ED in 58 Italian Hospitals. Seventy-two percent of patients admitted to ED were affected by a previously defined medical condition. Most of the ED admissions were children with syndromic conditions (54%). 44.2% of the ED admissions were registered during the night-time and/or at the weekends. The hospitalization rate was of 45.6% among patients admitted to the ED. The most common reason for admission to the ED was the presence of respiratory symptoms (26.6%), followed by gastrointestinal problems (21.3%) and neurological disorders (18.2%). 51.4% of the access were classified as ‘urgent’, with a red/yellow triage code. Considering the type of ED, 61.9% of the visits were conducted at the Pediatric EDs (PedEDs), 33.5% at the Functional EDs (FunEDs) and 4.6% at the Dedicated EDs (DedEDs). Patients with more complex clinical presentation were more likely to be evaluated at the PedEDs. CSHCN underwent to a higher number of medical procedures at the PedEDs, more in comparison to other EDs. Children with medical devices were directed to a PedED quite exclusively when in need for medical attention. Subjects under multiple anti-epileptic drug therapy attended to PedEDs or FunEDs generally. Patients affected by metabolic diseases were more likely to look for medical attention at FunEDs. Syndromic patients mostly required medical attention at the DedEDs. Access of CSHCN to an ED is not infrequent. For this reason, it is fundamental for pediatricians working in any kind of ED to increase their general knowledge about CHSCN and to gain expertise in the management of such patients and their related medical complexity.

/pdf/children-with-special-health-care-needs-attending-emergency-31qcb7s0l6.pdf

Children with special health care needs attending emergency department in Italy: analysis of 3479 cases

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Children with special health care needs attending emergency department in Italy: analysis of 3479 cases