Social support network of family members of abused children and adolescents: Perspectives and possibilities.

AIMS AND OBJECTIVES: To analyse the network of care and social support from the perspectives of family members of children and adolescents who have been abused. BACKGROUND: The theoretical-methodological background of the ecological model for understanding violence and the Paradigm of Complexity provide a broad perspective of violence. The paradigm considers all aspects that constitute a phenomenon as well as particular features. DESIGN: Qualitative research based on the Paradigm of Complexity, developed by Edgar Morin, the primary philosopher. We have adhered to the COREQ Checklist guidelines for qualitative research. METHODS: Data were collected through Minimal Maps of Personal Social Networks, and semi-structured interviews were held with 15 families who were assisted by a nongovernmental organisation in a Brazilian city. The notions of comprehension and contextualisation guided the data analysis. RESULTS: Two categories emerged from the data analyses: "Social isolation" and "Affective relationships needs." The maps revealed a weakened and limited network with low-density, homogeneous bonds and few significant bonds. Therefore, the network provided predominantly instrumental and material social support with few important effective relationships. The participants disclosed some strategies to empower their lives. CONCLUSIONS: We conclude that it is urgent to develop strategies in a broad manner to promote family empowerment, especially on education and employment dimension, and to construct supportive and respectful relationships between services and families as well. RELEVANCE TO CLINICAL PRACTICE: The present study contributes to international clinical nursing, especially in low- and middle-income countries, by discussing (a) looking at and caring for family members of children and adolescents who have been abused in a contextualised manner; (b) family empowerment, which enables them to have access to healthier environments and to educational/employment opportunities; and (c) broad comprehension of health care among the family members, which provides perspectives not only for looking at violence but also for strengthening supportive social relationships.

The care network of the families involved in violence against children and adolescents: the Primary Health Care perspective.

AIMS AND OBJECTIVES: To contribute the understanding of the network care provided to families involved in family violence against children and adolescents (FVACA), from the Primary Health Care (PHC) perspective. BACKGROUND: Children and adolescents figure among the main victims of violence around the world, which occurs predominantly in the family context. PHC-guided network care has emerged as a new process that contrasts with traditional approaches, which rely on fragmented, punctual and compensatory actions and produce simplified and segmented interventions in response to complex phenomena like violence. The Paradigm of Complexity interacts with the network care approach and, by articulating the multiple dimensions of the research phenomenon, contributes to its understanding. DESIGN: Qualitative research, based on the Paradigm of Complexity. METHODS: Data were collected through minimal maps of the external institutional social network, focus groups and semi-structured interviews held with 41 PHC professionals in Brazil. The notions of comprehension and contextualisation as well as dialogical, recursive and holographic principles from complexity theory guided the data analysis. RESULTS: The two thematic categories that emerged revealed reduced institutional networks, with low-density and homogeneous bonds, which resulted in fragmented care in all stages of the care process. CONCLUSIONS: Although the network organisation of care for the families involved in FVACA is fundamental, the construction of these networks still represents a great challenge, as it requires the joint work of a multiprofessional team. RELEVANCE TO CLINICAL PRACTICE: For nursing to respond to the contemporary care demands in a contemplative and pertinent manner, a perspective and a reference framework need to be developed, leading to broader and more contextualised actions, with a multidimensional approach to the families and communities of which child and adolescent victims of violence are a part.

Domestic violence against children and adolescents: social support network perspectives. / Violência doméstica contra crianças e adolescentes: olhares sobre a rede de apoio.

OBJECTIVE: To identify and analyze the social support network of families involved in violence against children and adolescents, from the perspective of health professionals and families in a municipality of the state of São Paulo, Brazil. METHODS: This was a qualitative strategic social study, anchored in the paradigm of complexity. Data were collected from 41 health professionals and 15 families using institutional or personal network maps, and semi-structured interviews. Analysis was conducted by organizing the data, constructing theoretical frameworks, and categorizing resulting information. RESULTS: The category "weaving the network" was unveiled, with family experiences and professionals focused on a logic of fragmentation of care. FINAL CONSIDERATIONS: The creation and implementation of public policy are urgently needed to address the needs of this population, by empowering families and communities and developing research that respects the multidimensional nature of the phenomenon.

Minimum Map of Social Institutional Network: a multidimensional strategy for research in Nursing.

OBJECTIVE: To analyze the use of methodological strategies in qualitative research - Minimum Maps of Social Institutional Network, as proposed to understand the phenomena in the multidimensional perspective. METHOD: Methodological theoretical essay in which we aimed to reflect on the use of innovative methodological strategies in nursing research, supported in Complex Paradigm fundamentals. RESULTS: The minimum map of Social Institutional External Network aims to identify institutional linkages and gaps for the intervention work of the surveyed institutions. The use of these maps provided important advances in know-how qualitative research in Health and Nursing. CONCLUSIONS: In this perspective, the use of minimum Social Intitutional Network maps can be stimulated and enhanced to meet the current demands of the contemporary world, particularly for its flexibility in adapting to various research subjects; breadth and depth of discussion; and possibilities with health services. OBJETIVO: Analisar o uso de estratégias metodológicas em pesquisas qualitativas - Mapa mínimo da Rede Social Institucional, como proposta para compreender os fenômenos na perspectiva multidimensional. MÉTODO: Ensaio teórico metodológico em que buscou-se refletir sobre o uso de estratégias metodológicas inovadoras de pesquisa na enfermagem, sustentada nos fundamentos do Pensamento Complexo. RESULTADOS: O mapa mínimo da Rede Social Institucional Externa tem o objetivo de identificar os vínculos institucionais e lacunas para o trabalho de intervenção das instituições pesquisadas. O uso destes mapas proporcionou avanços importantes no saber-fazer pesquisa qualitativa em Saúde e Enfermagem. CONCLUSÃO: Nessa perspectiva, o uso de mapas mínimos da Rede Social Institucional pode ser estimulado e potencializado para responder às atuais demandas da contemporaneidade, em especial pela sua flexibilidade na adequação a diversos objetos de pesquisa; amplitude e profundidade de discussão; e possibilidades de articulação com a prática dos serviços.

[Social support from the perspective of adolescent victims of domestic violence]. / O apoio social sob a ótica de adolescents vítimas de violência doméstica.

OBJECTIVE: Assess the understanding of adolescents regarding the social support received in situations of domestic violence. METHOD: A qualitative study with data collection carried out through focus groups with 17 adolescent victims of domestic violence, institutionally welcomed in Campinas-SP, and through semi-structured interviews with seven of these adolescents. Information was analyzed by content analysis, thematic modality. RESULTS: Observing the thematic categories it was found that social support for the subjects came from the extended family, the community, the Guardianship Council, the interpersonal relationships established at the user embracement institution and from the religiosity/spirituality. CONCLUSION: The mentioned sources of support deserve to be enhanced and expanded. With the current complexity of the morbidity and mortality profiles, especially in children and adolescents, the (re)signification and the (re)construction of health actions is imperative.

Social network of families involved in child neglect: building a multidimensional perspective. / Rede social de famílias envolvidas na negligência contra crianças e adolescentes: construindo um olhar multidimensional.

Neglect is one of the most frequently reported forms of violence against children and adolescents, although it has rarely been explored in national studies. In this light, the present study aimed to analyze the personal social network of families involved in negligence against children and adolescents. This work takes a qualitative approach, anchored in the Paradigm of Complexity, conducted with twenty families involved in negligence against children and adolescents in a municipality in the countryside of the state of São Paulo, Brazil. Data collection took place through minimal maps of the personal social network and semi-structured interviews in January 2021. The networks were limited, with little to no interaction among the different services and sectors, and were predominantly homogeneous. Because they have many weakened ties, they are relatively unsupportive, pointing out difficulties in access to work, education, and health. Due to the characteristics of the network, the complexity of the phenomenon of neglect was identified, in which elements condition and perpetuate experiences of absence and fragility. Interprofessional and intersectoral views and actions are requested and recommended.

A negligência constitui uma das violências contra crianças e adolescentes mais notificadas, entretanto ainda pouco explorada em estudos nacionais. O objetivo deste estudo foi analisar a rede pessoal social de famílias envolvidas na negligência contra crianças e adolescentes. Estudo qualitativo, ancorado no paradigma da complexidade, realizado junto a 20 familiares envolvidos na negligência contra crianças e adolescentes em município do interior de São Paulo, Brasil. A coleta de dados se deu por mapas mínimos da rede pessoal social e entrevistas semiestruturadas em janeiro de 2021. As redes se apresentaram reduzidas, com pouca ou nenhuma articulação entre os diferentes serviços e setores e predominantemente homogêneas. Por terem muitos vínculos fragilizados, mostrou-se pouco sustentadora, apontando dificuldades no acesso a trabalho, educação e saúde. Pelas características da rede, identificou-se a complexidade do fenômeno da negligência, em que elementos condicionam e perpetuam vivências de ausências e fragilidades. Olhares e ações interprofissionais e intersetoriais são pleiteadas e recomendadas.

Circle of culture in supporting the identity process of adolescents: an action research.

OBJECTIVE: To report and discuss the experience of the Circle of Culture in a school space, with attention to the social identity of adolescents. METHOD: Action research, conducted under the assumptions of the Circle of Culture, from August to December 2019. Participants were 16 adolescents, enrolled in Elementary School, in a state public school, in the rural district of a city of São Paulo. Data collection took place through photographic records, participant observation and field diary. RESULTS: The relations of friendship were the central agenda of the Circles of Culture when dialogues about their structuring and influence on the identity construction were developed. CONCLUSION: Circles of Culture mediated by health professionals in the school setting have the power to problematize the reality of each adolescent's life and, simultaneously, dialogue about the common, an aspect that empowers identity projects.

Meanings of nurses' role in Child and Adolescent Psychosocial Care Centers.

OBJECTIVE: to analyze the meaning attributed to nurses' role in mental health care in Child and Adolescent Psychosocial Care Centers. METHODS: qualitative research, anchored in the paradigm of complexity. Data collection was carried out through online semi-structured interviews with ten nurses from São Paulo, between March and September 2022, being analyzed thematically. RESULTS: the diversity and specificity of a child and adolescent mental health clinic, with the need for expanded, territorial and intersectoral care, were unveiled in addition to a fragmented training in the area. There was a need for a deconstruction of being a nurse to make it possible to produce more inclusive and salutogenic practices. FINAL CONSIDERATIONS: the need for training nurses with adequate knowledge and skills to care for the mental health of children, adolescents and their families is reinforced as well as permanent education of working teams.

Hospital discharge planning in care transition of patients with chronic noncommunicable diseases.

OBJECTIVE: to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases. METHOD: a qualitative study, based on the Care Transitions Intervention theoretical model, with four pillars of intervention, to ensure a safe transition. Twelve professionals participated in a public hospital in the countryside of São Paulo. Data were collected through observation, document analysis and semi-structured interviews. RESULTS: there was a commitment of a multidisciplinary team to comprehensive care and involvement of family members in patient care. The documents facilitated communication between professionals and/or levels of care. However, the lack of time to prepare for discharge can lead to fragmented care, impairing communication and jeopardizing a safe transition. FINAL CONSIDERATIONS: they were shown to be important elements in discharge planning composition, aiming to ensure a safe care transition, team participation with nurses as main actors, early discharge planning and family involvement.

School inclusion of children and adolescents with epidermolysis bullosa: The mothers' perspective.

OBJECTIVE: to understand the school inclusion of children and adolescents with Epidermolysis Bullosa from the mothers' perspective. METHOD: qualitative study, based on Urie Bronfenbrenner's Bioecological Theory of Development, conducted between September and November 2021. Interviews were conducted with six mothers from different Brazilian locations, recording audio and video using the Google Meet® platform. The statements were analyzed using thematic analysis. RESULTS: two categories were identified: i) The school microsystem: challenges and adaptations for inclusion of children and adolescents with Epidermolysis Bullosa; ii) The school-family mesosystem: possibilities to promote better school inclusion. Mothers highlighted the challenges in school inclusion as well as the benefits provided by social interaction. In order to facilitate the inclusion, the school microsystem promoted adaptations in the teaching-learning process, structural changes, hiring of caregivers, and dialogues with family members. CONCLUSION: initially, school inclusion was permeated by feelings such as fear and anguish, but the adaptations contributed to promote well-being, welcoming, and social integration of children and adolescents.

Suffered life, hard life: adverse experiences in childhood of people with chronic musculoskeletal pain.

OBJECTIVE: To analyze the adverse experiences lived in the childhood by people with chronic musculoskeletal pain, based on psychoanalytic psychosomatics. METHODS: Qualitative research, developed with 20 people with chronic musculoskeletal pain and who were receiving physiotherapeutic treatment at a clinic in the countryside of the state of São Paulo. The data were collected during the months of June and July 2018, through semi-structured interviews. This article refers to one of the resulting themes of reflexive thematic analysis: Suffered life, hard life. RESULTS: When talking about their lives, people living with chronic musculoskeletal pain revealed themes associated with some adverse childhood experiences such as parental deaths, neglect, economic hardship, family violence, physical and psychological violence. FINAL CONSIDERATIONS: The analysis of adverse experiences lived in childhood by people with chronic musculoskeletal pain shows presence of intense suffering revealed in people's speech when associated with perceived physical pain.

Attention to women in situation of intrauterine fetal death: experiences of health professionals.

OBJECTIVES: Understand the experiences of health professionals in obstetric care in relation to the situation of intrauterine fetal death. METHOD: Study of a qualitative approach, in which 11 health professionals participated. Data were collected through semi-open interviews and submitted to thematic content analysis. RESULTS: The professionals' difficulty in dealing with the topic and its invisibility during the training proved to be challenging. The lack of ambience and the forms of organization of attention reflected in the care for women and families who are undergoing intrauterine fetal death. The lack of strategies and spaces for sharing among professionals was directly related to the suffering and feeling of helplessness in the cases. FINAL CONSIDERATIONS: There is a need to develop strategies for changes in the model and organization of the service in the face of situations of fetal death, promoting spaces that are welcoming producers.

Dating violence among adolescents from a region of high social vulnerability.

OBJECTIVE: to know and analyze the perceptions of adolescents with high social vulnerability regarding the establishment of dating violence. METHOD: a qualitative research study carried out with 19 adolescents from a central municipality São Paulo, Brazil. Data collection took place by means of focus groups and field diaries, with the data being analyzed thematically. RESULTS: two categories emerged: "A new female posture in a context of traditional gender norms" and "Violence in intimate relationships: the (non)perception of adolescents". Traditional gender norms still occupy a significant place in the design of dating violence among adolescents. Such behaviors are more visible in these relationships, when commitment and exclusivity are seen as the main characteristics, authorizing possession and control. Jealousy emerges as the main trigger for violence and the technologies appear as contemporary resources to reinforce it. CONCLUSION: the need for early interventions with adolescents is reiterated, with a focus on actions that promote gender equality.

"Health does not discuss trans bodies": Oral History of transsexuals and transvestites.

OBJECTIVES: to understand the life stories and itineraries of transvestites and transsexuals in health services. METHODS: study with a qualitative approach, anchored in the methodological framework of Oral History. Interviews were conducted and thematically analyzed. RESULTS: two themes emerged: 1) gender and sexuality in life stories; and 2) the trajectories in health services. These revealed the challenges in the process of recognizing gender identity before the family and society. The reports show the dilemmas that transsexuals and transvestites face in health care, which ends up generating the removal of this population from services. FINAL CONSIDERATIONS: it has been demonstrated that Oral History can increase knowledge, especially about life histories and trajectories in the health services of transvestites and transsexuals; in addition, information was offered that can assist managers and health professionals in making decisions or caring for these people.

The meaning of the social support network for women in situations of violence and breastfeeding.

OBJECTIVE: to understand the meanings attributed to the social support network of women breastfeeding and in situations of violence by an intimate partner. METHOD: a qualitative study, carried out with 21 women, through semi-structured interviews and data analyzed by the Method of Interpretation of the Senses in the light of the conceptual framework of Social Support Network. RESULTS: all women suffered violence by the partner in the puerperium and only one of them maintained exclusive breastfeeding until 180 days postpartum. In the analysis, the category entitled "The action of the social support network in the face of breastfeeding in the context of intimate partner violence" emerged, with two subcategories: "Interpersonal support network" and "Institutional support network". In the interpersonal network, the partner was little mentioned, on the other hand, there was a greater participation of other women. In the institutional network, non-resolution and actions centered on biological character were evident. CONCLUSIONS: the search for help in the interpersonal network stood out in comparison to the institutional network, both with regard to the issue of violence and breastfeeding and the actions related to it, mostly ineffective, characterized by counseling and referrals.

Violence in intimate relationships from the point of view of adolescents: perspectives of the Complexity Paradigm.

OBJECTIVE: To analyze adolescents' perceptions about intimate violence from the perspective of the Complexity Paradigm. METHOD: A qualitative approach configured as strategic social study. The study participants were adolescents between 15 and 18 years old, attending high school in two public schools in a city in the interior of São Paulo State, Brazil. Data collection was performed through a focus group and a semi-structured interview as a complement. Data analysis was based on the dialogical, organizational and holographic principles of the Complex Paradigm. RESULTS: The study included 39 adolescents (14 males and 25 females). Through the emerging categories, it was noticed that intimate violence occurs through dialogical affection-jealousy/control by a naturalization of violent acts which permeates gender, cultural and social issues, and by technology as preponderant for intimate violence among adolescents, denoting new forms of control and coercion. CONCLUSION: The study introduces aspects present in intimate violence among adolescents, presenting them in an articulate and interdependent way. These aspects constitute a relevant contribution to the actions of health professionals.

"I don´t have it, I didn´t have it": experiences of families involved in violence against children and adolescents.

OBJECTIVES: to characterize and analyze the experiences of families involved in domestic violence against children and adolescents, based on the Paradigm of Complexity. METHODS: qualitative research, in which data of 15 families was collected through documentary research, open interviews and field diary. The data were analyzed through thematic analysis. RESULTS: two categories "I don't have it" and "I didn't have it" emerged, revealing the historicity that marks the violence experienced in the present. They include social vulnerability, maternal burden, associated with urban violence to which families are exposed. At the same time, stories of violence by the intimate partner, as well as intergenerational violence and drug abuse have impacted the current moment. Final Considerations: nursing can contribute to attribute new meaning to violent stories woven by families, as well as to the interdisciplinary construction of perspectives and interventions that consider the multiple violence and adversities to which such a population is exposed.

Adolescents' health in times of COVID-19: a scoping review. / A saúde do adolescente em tempos da COVID-19: scoping review.

COVID-19, the disease caused by SARS-CoV-2 (novel coronavirus), emerged in China in December 2019 and spread quickly throughout the world. In this scenario, the current study aimed to identify the impact or effects of the COVID-19 pandemic on adolescents' health. This is a scoping literature review based on the following databases: Web of Science, CINAHL, PsycINFO, SciELO, and PUBCOVID19. The study adopted the stages proposed by the Joanna Briggs Institute for scoping reviews, and the question orienting the procedures consisted of the acronym PCC (population; concept; context). Eleven articles were included in the review. Clinically, adolescents present the same COVID-19 symptoms as adults. The pandemic and the health measures taken to control transmission were found to be associated with mental health problems in adolescents. Specifically, adolescents have a negative experience with social distancing measures and closing of schools. These measures can also favor situations of violence or aggressive behaviors in the home environment. Healthcare services that treat the adolescent population had to reorient their practices, adopting a virtual model to replace face-to-face care, and even research projects involving adolescence had to be rethought. This scoping review addressed an emerging theme in relation to a population that has received little attention in studies on COVID-19. The results suggest that the pandemic can be considered a determinant that affects different dimensions of adolescents' lives.

Protection network in the assistance to children, adolescents and their families in situation of violence.

OBJECTIVE: To understand the performance of the protection network for children, adolescents, and their families in situations of intrafamily violence, from the perspective of professionals of the Specialized Reference Center for Social Assistance. METHOD: A qualitative study conducted with five Specialized Reference Center for Social Assistance professionals in a Pernambucan municipality. Data collection was conducted from October 2017 to January 2018 by means of a semi-structured interview, with data analyzed by the thematic content technique. RESULTS: The professionals know how the protection network works, but they see the deductive logic of the team; the lack of material resources; the difficulty of articulation; and the logistics of care flow as limiting factors for maintaining effective care. CONCLUSION: The performance of the protection network must be able to ensure the rights of children, adolescents, and their families in situations of violence, through articulated and integrated care, aiming at changing attitudes and breaking the cycle of violence.

Inter-sectoral network to face violence against children and adolescents in a rural context.

OBJECTIVE: To analyze the Primary Health Care inter-sectoral network in a rural context to face domestic violence against children and adolescents. METHOD: A qualitative research study, with the Paradigm of Complexity as theoretical and methodological framework. Eighteen health professionals from two rural Family Health Units in a municipality in the state of São Paulo were the participants. Data was collected through minimum maps of the institutional network and focus groups in May and June 2019. Data was analyzed through thematic analysis. RESULTS: Two categories emerged, entitled "It's not nonexistent, but it's complicated" and "We're always on the firing line". The existence of a weakened network; assistance based on biomedical bias; and care fragmentation were characteristics present in the care provided to the families. FINAL CONSIDERATIONS: The absence of network care was evident, with isolation and overload of the Primary Health Care unit that is enhanced by the characteristics of rurality.