RESEARCH ARTICLES

Health care intersections at child day care centers: perceptions of mothers

Bruna Caroline Rodrigues^I; Eloana Ferreira D’Artibale^II; Mayara Caroline Barbieri^III; Luciana Olga Bercini^IV; Ieda Harumi Higarashi^V
INurse. Specialist in Occupational Nursing. Master Student from the Post-Graduation Program in Nursing at the State University of Maringá. Paraná, Brazil. E-mail: bruninhaamd@hotmail.com.
^IINurse. Master Student from the Post-Graduation Program in Nursing at the State University of Maringá. Paraná, Brazil. E-mail: eloana_dartibale@hotmail.com.
^IIINurse. Resident from the Nursing Course in Children’s Health at the State University of Londrina. Paraná, Brazil. E-mail: may_barbieri@hotmail.com.
^IVNurse. PHD in Environmental Sciences at the State University of Maringá. Associated Professor from the Nursing Department at the State University of Maringá. Paraná, Brazil. E-mail: lobercini@uem.br.
^VNurse. PHD in Education at the Federal University of São Carlos. Adjunct Professor from the Nursing Department at the State University of Maringá. Adjunct Coordinator the Post-Graduation Program in Nursing at the State University of Maringá. Paraná, Brazil. E-mail: ieda1618@gmail.com.

ABSTRACT: This research aimed at analyzing business-family relations and learning needs about child healthcare within a Center for Early Childhood Education (CEI), from the mothers’ standpoint. It is a descriptive study with a qualitative approach, conducted through semi structured interviews with 13 mothers of children enrolled in a CEI located upstate West Paraná, Brazil, in August, 2011. Content analysis was used for data analysis, which gave rise to three categories as follows: the need for learning about the children’s health from the mother’s stand; communication as an essential tool between education professionals and children’s family; and perception and knowledge about healthcare mechanism at the CEI. The study unveiled that mothers regard learning about contents of child’s health a duty for childcare professionals in daily contact with that clientele as well as an essential need for the family for effective sharing of care.

Keywords: Child day care centers; nursing; mothers; child health.

INTRODUCTION

Changes in family patterns have inserted women into the labor market, which requires them, besides the maternal role, other obligations of professional nature, which reverberate in the need for services that may assist them in the process of caring and educating their children. This support has been attributed to the children’s educational centers (CEI), which emerge with the aim at meeting these requirements¹.

In this context, the professional who works with children’s education is an agent of utmost importance, as an essential element to the promotion of children’s health, given the length and quality of contact between them and the educator in this context of care. This factor, coupled with the proximity of this professional with the family environment of the served children, make it the most suitable social agent to provide guidance in relation to risks and preventions of hazards typical of this age group².

To that end, the health team arises to add and enhance this relationship and the care by performing the task of providing information to preschool teachers and families, through health education. Such an approach is justified as a strategy for the building of foundations for a comprehensive and qualified care³.

Thus, taking into account the importance of CEI and the integration of the actors involved in this universe, this study aimed at analyzing the professional/family relationships and the needs for learning about the children’s health in the context of a CEI, under the viewpoint of mothers.

THEORETICAL BENCHMARK

Although some authors show differences between the words nursery and CEI, whether in terms of age range of coverage of their care (from 3 months to 3 years for nursery and from zero to six years for CEI), or by the emphasis of provided care ( nursery with focus on maternality care and CEI with focus on didactic-pedagogical care), there seems to be currently a consensus that, in the case of children’s education, there is no way to dichotomize the educational and training process of health care and overall well-being of children. This notion became even more apparent with the enactment of the Statute of the Child and the Adolescent, in 1990, and with the Law of Guidelines and Bases of National Education, in 1996. Thus, according to the Ministry of Education, the treatment of various aspects as dimensions of development, and not more as separate areas was essential, since “[...] it emphasizes the need to consider the child in its entirety, with a view to promoting its full development and its insertion into the public sphere” ^4:10.

Under this perspective, nursery is conceived and valued because of its role in training children as historical and cultural subjects in the contemporary model of children’s education. This model gains strength when teachers start to be considered as an important affective and emotional support, and as mediators of growth of consciousness⁵.

The importance of involvement of parents in the phase of development of the child is self-explanatory, because family and nursery together may promote complementary and promote meaningful situations of learning and conviviality. This family involvement is a social, psychological and educational measure that informs, articulates and stimulates the integrated participation of the nursery-family spheres⁶.

In addition to parents, the community involvement is considered as an essential component of a school that plays its job successfully. A successful educational institution puts parent involvement, curriculum, instructional processes and knowledge acquisition, evaluation and social aspects in the same degree of importance⁷.

Regarding the studies performed within this theme, authors report that the researches in Brazil have indicated that the involvement of parents in schools and nurseries is still basic and inconsistent⁶.

By seeking to change this reality, it becomes increasingly evident the consensus that integration between parents and professionals is crucial in these contexts in such a way that the school environment, at any level of education, but primarily in children’s education, take into consideration the pedagogical principles without never forgetting the importance of health care, as a way of seeking to promote the integral development of children.

Thus, health and education emerge as essential elements of the formation of human beings, thereby influencing the future and present quality of life of children in an important way, and making essential the collaborative work between the family and the educational institutions.

METHODOLOGY

This is a descriptive study, with qualitative approach, conducted in the CEI at the State University of Maringá (known as UEM). This institution has a current working capacity to care for approximately 100 children, belonging to the age group between 6 months and 4 years old, divided into seven stimulation rooms, offering care actions from Monday to Friday, from 6:30 A.M. to 7:30 P.M.

The study universe was composed of women, servants of UEM, whose children were enrolled in the CEI.

The members of the research were selected according to the following inclusion criteria: being a mother of child enrolled and attending the CEI for at least a month. The approach of survey participants was held on random days, when children were entering or exiting the CEI. At that time, mothers were instructed with regard to the research and invited to participate. The result of this process was a set composed by 13 mothers. The final number of subjects was defined to the extent that the data were being analyzed, thereby obtaining their saturation and the elucidation of the previously proposed objectives.

The data were collected in August 2011 through the conduction of individualized interviews, by following a semi-structured script ​​specifically prepared for this study. The instrument was consisted of closed questions, addressing the characterization of participants, and open questions, targeted to the development of reports pertaining to the central issue of research.

The interviews were conducted in the premises of the CEI, in a specific room, as the acceptance and availability of interviewees. In order to obtain a more trustworthy record of testimonies, we made use of the cursive annotation of objective data (characterization/identification of subjects) and, as an additional resource, the digital record of reports, for later transcription and analysis. With sights to maintain confidentiality, the interviewees were nominated by the letter “E”, followed by a number corresponding to the sequence of the interviews.

The treatment of the obtained data was performed by using the methodological benchmark of content analysis, in the modality of thematic analysis, which consists in three steps: pre-analysis, material exploration and, lastly, treatment of the obtained results and interpretation.

The accomplishment of this study took place with the permission of the CEI and approval of the project by the Standing Committee on Ethics in Research involving Human Beings (COPEP) from the UEM, under the Opinion nº 108/2011.

RESULTS AND DISCUSSION

The studied group showed people aged between 31 and 45 years, with an average of 36,5 years. As for the schooling level, except for one participant, all had completed higher education. Regarding the amount of children, there was a variation from 1 to 3; however, all had only one child enrolled in the CEI at the time of the interview.

The main reasons that encouraged mothers to opt for the CEI in relation to the permanence of their children during the working hours were: proximity to the workplace, practicality, quality, good recommendations, and due to it is a benefit provided to workers of UEM. It is worth highlighting that only one mother mentioned the fact of needing to work outside, although her preference was to care of the child at home.

With regard to the role of CEI, under the maternal perspective, there were mentions of items like the conduction of activities that promote the education, the care and the suitable development of the child; opportunity for social conviviality and interaction among children; care in relation to feeding and hygiene, in addition to encouragement to breastfeeding because of the ease of access, being that all these expectations were fulfilled. With sights to achieve the proposed goal, the results were analyzed and discussed from three categories resulting from the obtained testimonies: Need for learning about the children’s health according to the maternal perspective, Communication as an essential element between professionals and families in child care and Perception and knowledge of the systematic of health care in the CEI. The process of content analysis, from these thematic categories, is outlined hereinafter.

Need for learning about the children’s health according to the maternal perspective

The need for learning about themes related to children’s health was present in the majority of the testimonies (10). This perception was justified by mothers in stating the need to always be updated in relation to issues related to childish health, as a way of providing a better care for the child at home. Furthermore, one can observe a concern in the sense of receiving such information, from trained professionals, thereby complementing or correcting previous concepts and knowledge of the family:

[...] This gaze of health is one of the aspects of the children’s development, I think we really have to be updated, learn more and more. (E2)

[...] I think health education is important, and even for us too, things are updated so fast, and it is nice that we keep informed about our children. (E9)

Despite the importance attributed to the construction of knowledge and need for updates, three mothers were confident, by considering the learning in relation to childish health as something expendable and stating that they did not feel difficulty about that, due to having already worked in the area or even because they consider that the parents have more details to convey for the teachers than the inverse ratio.

Particularly, for me, I think it doesn’t work, due to the fact of working in the area and such. But, I think, for parents, in general, it works. (E1)

[...] I think parents have more to tell to the teacher than the teacher to tell to parents about the children’s health. (E10)

When questioning the need for learning on the part of professionals working in the CEI, the mothers claim that it is essential that they have knowledge in relation to children’s health, mainly due to the fact these professionals remain most of the day together with the children and know them deeply. These findings were congruent with other researches^2,3,6,7,9,10.
 
I think it’s essential. [...] Because they (preschool teachers) spend more time with them (children) than with us, if you see well, then I think they know the children better than us; they know when the day is good, when it is not. (E6)

[...] She (daughter) stays a reasonable amount of time here in the center, anything that happens to her, that is realized, that there may require a care share, or let me aware as early as possible, I think it’s much better. She will have greater access to care than if the nursery does not have this knowledge [...]. (E2)

[...] I think that acquiring a better knowledge of the field of health is easier.(E12)

In a study conducted in Brasilia, DF, parents with children in educational centers revealed believing that, in addition to teaching the pragmatic content, the teacher has the responsibility to safeguard the well-being of children, including emotional, social and physical aspects⁹.

Similarly, in the present study, the interviewees mentioned the importance of preschool teachers are properly updated and able to act in any intercurrence or health problem that may happen with the children, given the closer relationship in the continuous monitoring of these little ones within the classroom, as noted in the testimony of one of the mothers:

[...] The health professional is here, but he doesn’t remain all the time in each one of the rooms, the educators are the ones who stay in direct contact with the children, and when they are well trained with respect to ‘n’ things that may be happening with the child, observe and realize [...]. (E11)

In this research, when questioning in relation to the themes that mothers would like to see approached in updating courses and lectures promoted by the CEI, the common diseases of childhood and the childish development were the most frequent, followed by issues of accident prevention and infant feeding and, lastly, first aid instructions, breastfeeding and vaccination. Furthermore, and, in relation to the frequency of these educational interventions, mothers felt these could be performed every six months.

The good quality of activities and structure of CEI has positive consequences on the childish development, thereby generating a substantial impact on the social and mental development of children. Thus, the search for empowerment and qualification for dealing with occurrences meets the quality care, by allowing us to contemplate expectations exposed by mothers in relation the school institution, which reinforces the feeling of confidence in the prospect of a proper development of their children¹⁰.

Thus, the most suitable approach in the context of children’s education reinforces the indissociability among the didactic-pedagogical aspects, the health care and overall development of the child, and the interactions among the various social actors involved in this training context¹¹.

Communication as an essential element between professionals and families in child care

From the maternal reports, it was possible to infer that there is a very effective process of communication between the CEI and the parents, which contributes to the establishment of a relationship of greater confidence between the parts, and to the feeling of tranquility of parents to leave their children under the care of such an institution. The aforementioned relationship provides, additionally, spaces for the occurrence of mutual exchange of information and knowledge, which results in a type of child care with continuous sharing.

Whenever there is an assessment, we come here, if the educators observe any problem, they tell us. So they focus attention on things that we, sometimes, end up not realizing, they always transmit the information, so I think it’s pretty cool. (E7)

  [...] The staff is always there when we arrive and the child had or went through some kind of problem, they come to talk, explain what has happened [...]. (E5)

The actions developed by the multiprofessional team allow integration between health team and teachers of the institution at stake, besides cooperation, which results in the approximation of society towards the group, thereby easing a joint work with parents^{2,3,6,7,9,10,12}.

One of the testimonies highlights the importance of the family also share external happenings and experiences of the institution, which may interfere or reflect, in some way, in the care and education provided to the child.

[...] I think it's very important that the mother let the professionals of the nursery abreast of what is happening, if the child is undergoing treatment, if it is taking medications, if it is allergic to any kind of food, these issues of development, if something happens at home, if it requires medical treatment, I think these things have to be really told. (E11)

Such integration extends and qualifies the care, by emphasizing that the basis of a good relationship between the family and the educational institution is started with the effective sharing of information, as an essential foundation to the paternal participation in this process. This exchange keeps parents informed of the content and the effective possibilities of support and participation¹³.

The data found in this research corroborate with a study in which parents stated that cultural events and meetings allow the joint perception and the exchange of experiences between them and teachers in relation to the children’s development, besides promoting closer relationships among family, children and school, with consequences efficient towards the teaching-learning process⁹.

The integration of information in this process of continuous communication emerges as a reflection of family and institutional interests, as well as of needs of children, which, consequently, aims at developing a holistic care, with quality and able to meet the child in its entirety, by providing a suitable biological, social, psychic and motor development to each individual, as a result of this care /education binomial.

In my way of understanding, these things are inseparable, I cannot separate, I care while I’m educating and I educate while I’m caring, then I realize that this occurs during this month of attendance of my daughter, she has all this attention available.(E2)

This speech confirms the results of another study that highlighted the importance of this entanglement, when concluding that act of educating includes the scope of care, so that the physical, emotional, social, cognitive care actions are present in the educational context¹⁴. These findings reiterate the recommendations of the Law of Guidelines and Bases of National Education, in section II, article 29, when it establishes that the children’s education aims at stimulating the integral development of children up to 6 years old, in their physical, psychological, intellectual and social aspects, thereby complementing the action of the family and of the community¹⁵.

Perception and knowledge of the systematic of health care in the CEI

The perception and knowledge of systematic the health care in the CEI on the part of mothers was presented by the interviewees in a fragmented manner, which denotes the lack of a more complete comprehension of the health care process, mainly with regard to a complete view of the systematic used by the institution in the face of cases of damages, accidents or diseases that, perchance, may occur with their children. Such results were confirmed in other studies^2,3,6,9,14.

I just know in relation to getting sick. They warn, for example, if one has a prior fever, they ask to go to nursery, then you cannot go now, you got to take it to the doctor [...] I know about these things [...] but not in relation to hurt. (E13)

What I remember, if the child is not well, the first contact is with the mother, that is why there is the update of the phone extension, so that we can be communicated [...] But, in relation to some accident, something like that, I don’t have it in memory, I’d have to ask again.(E2)

Accordingly, one should perceive the flaws in the transfer of more complete information related to the routine of health care for children in the institution at stake. Under this perspective, one can highlight that it is essential to promote the integration between the CEI and the family, in such a way that there is a better knowledge of the realities of children and development of an educational work suitable to needs of families^12,16.

Another weakness of the communicational process found in the statements is depicted by the lack of basic knowledge of the routine of health care, which is described in a fragmented manner by the interviewees.

If I'm not deceived too, if one starts a treatment with antibiotics, one has to wait a few days, I don’t know if it requires two or three days to bring the child again. (E11)

Before bringing the child, we go through one week of adaptation, and they tell the standards. (E10)

Thus, it appears that there are contradictory situations in which sometimes the attendances take place without the proper process of clarification regarding the conducts and indications for each case, sometimes they are performed through specific and standardized advices, as in the case of the time of enrollment of children in the CEI.

One should note, in the expression of one of the subjects, that the questioning about knowledge of the systematic of care of children’s health in the institution leads it to a moment of silence and reflection, which denotes the lack of a deeper knowledge and appropriate about routine of care.

I just know about the moments I needed, I don’t know if it has a routine [...] it’s really our mistake, because we don’t seek to find out about it.(E9)

Although there is, on the part of mothers, an acknowledgment of their co-responsibility concerning the described informational failures, it becomes necessary to emphasize the importance of the institution to establish an educational and health care work in a continuous way, by fostering the sense of safety and confidence of parents regarding the provided care and ensuring the strengthening of partnerships in decisions relating to the health of the served children.

Such development may be achieved by the adoption of a care-related protocol, which establishes routines and procedures of care and that envisages situations for the consolidation of health education, thereby involving children, families and workers of CEI.

CONCLUSION

By considering the findings of the study, it can be noted that there is the acknowledgment of the personal needs for learning about health care as the more effective ways for developing a comprehensive child care. Mothers assign a great importance to such learning, which should be also extended to the professionals working in the CEI, as actors who coexist daily with their children, in the sense of subsidizing a service that includes actions to educate and care.

This sharing of responsibilities in the process of childish education and development is eased by means of a good relationship and communication between professionals and relatives of children, thereby reverberating in a holistic care, when it integrates intra and extra-institutional facts. Accordingly, the care adds social and cultural factors of family, thereby giving continuity to the training started in the family scope.

Despite the good interaction between professionals and mothers, the maternal perception and knowledge in relation to the systematic of care of health problems or incidents or, even, intercurrences adopted by the CEI, proved to be precarious. The results depict the need for searching for more consistent and continuous educational and health care systematic, capable of generating the family interest in participating, thereby strengthening the integration and interaction of both.

In light of the findings, it becomes possible to rethink the health care and integrative measures, with a view to improving the interaction among parents, health professionals and preschool teachers, thereby enabling the exchange of knowledge about the issue of children’s health in the context of CEIs.

Despite the quantitative limitation of the surveyed universe, which prevents the generalization of findings to other health care realities, the study allows the exercise of a reflection on the crucial role of CEIs in the process of childish training and development. This institution, in its intimate participation in the lives of the served children, represents an agent of health education of paramount relevance, whose action extends to its direct (children) and indirect users (parents and team).

REFERENCES

1. Cordeiro M. Mulher, mãe e trabalhadora: breve balanço de recentes políticas de conciliação trabalho e vida familiar no Brasil. Ser soc.2008; 10(23):71-99.

2. Vieira LJES, Carneiro RCMM, Frota MA, Gomes ALA, Ximenes LB. Ações e possibilidades de prevenção de acidentes com crianças em creches de Fortaleza, Ceará. Cienc saúde coletiva. 2009; 14(5):1687-97.

3. Sousa LB, Torres CA, Pinheiro PNC, Pinheiro AKB. Práticas de educação em saúde no brasil: a atuação da enfermagem. Rev enferm UERJ. 2010; 18: 55-60.

4. Ministério da Educação e do Desporto (Br). Secretaria de Educação Básica. Política nacional de educação infantil. Brasília (DF): MEC/SEB; 2006.

5. Ministério da Educação (Br). Secretaria de Educação a Distância. Salto para o futuro. Educação de crianças em creches. Brasília (DF): Secretaria de Educação à Distãncia; 2009.

6. Bhering E, De Nez TG. Desenvolvimento de pais em creche: possibilidades e dificuldades de parceria. Rev Psic: Teor e Pesq. 2002; 18(1):63-73.

7. Bhering E, Von Oudenhoven N, Wazir R. Acesso à educação infantil: uma estratégia para promover a integração social. Rev Alcance. 2000; 2 (2):11-8.

8. Bardin L. Análise de conteúdo. Tradução de Luis Antero Reto e Augusto Pinheiro. São Paulo: Edições 70; 2011.

9. Iunes SMS, Silva AL, Montenegro ME, Salviano ARM, Batista MM, Pinto CBGC, Melo MDG. Os pais e suas expectativas em relação à educação infantil da escola particular.Psicol educ. 2010; 30:113-26.

10. Barros RP, Carvalho M, Franco R, Mendonça S, Rosalém A. Uma avaliação do impacto da qualidade da creche no desenvolvimento infantil. Pesqui planej econ. 2011; 41(2):213-32.

11. Assunção MLV. Creche: assistencialização ou educação? Um estudo de caso em Pires do Rio - GO.  Rev Poiésis. 2003; 1(1):78-92.

12. Santos IG, Penna CL, Moriyama FM, Leão FV, Souza MPD, Aguiar ZN. Percepção dos educadores e coordenadores de uma creche sobre processo educativo em saúde desenvolvido com abordagem multiprofissional. Rev APS. 2009; 12:409-19.

13. Ferreira SLG, Triches MA. Envolvimento parental nas instituições de educação infantil. Ver pedagog. 2009; 1(22):39-55.

14. Ribeiro AP, Oliveira JP, Simões LR, Côco V. A infância no contexto da educação infantil. Rev FACEVV. 2010; 4:4-11.

15. Senado Federal (Br). Lei de diretrizes e bases da educação nacional: nº 9394/96. Brasília (DF): Gráfica do Senado; 1996.

16. Roecker S, Marcon SS, Decesaro MN, Waidman MAP. Binômio mãe-filho sustentado na teoria do apego: significados e percepções sobre centro de educação infantil. Rev enferm UERJ. 2012; 20: 27-32.