1
Financial suppor t fr om Funpesquisa/ Sant a Cat ar ina Federal Univer sit y. General suppor t fr om t he Nucleus of Resear ch and Ext ension in Popular Educat ion, Nursing and Healt h – NEPEPS; 2 Associat e Professor, e- m ail: ast [email protected]; 3 Adj unct Professor; 4 Nurse, Secret ary of Healt h of t he Florianopolis Municipal
Gover nm ent , Brazil, Mast er st udent . Sant a Cat ar ina Federal Univer sit y, Br azil
D isponible e n ca st e lla no/ D isponíve l e m língua por t ugue sa SciELO Br a sil w w w .scie lo.br / r la e
THE ROUTI NE OF FAMI LI ES W I TH NURSI NG I NFANTS
1Ast r id Egger t Boehs2
Már cia Gr isot t i3
Mar ly Denise Wuer ges de Aquino4
Boehs AE, Gr isot t i M, Aquino MDW. The r out ine of fam ilies w it h nur sing infant s. Rev Lat ino- am Enfer m agem
2 0 0 7 set em br o- ou t u br o; 1 5 ( 5 ) : 9 0 2 - 8 .
This descr ipt ive st udy invest igat es t he r out ine of fam ilies w it h nur sing infant s ages bet w een six m ont hs
and t w o year s old, involving w or king m ot her s user s of a Basic Healt h Unit in a cit y in t he Sout h of Br azil. The
t h eor et ical d iscu ssion is b ased on t h e f am ilies’ r ou t in e ap p r oach . A t ot al of 2 5 m ot h er s w er e in t er v iew ed
t h r ou gh a sem i- st r u ct u r ed qu est ion n air e. Th e qu alit at iv e dat a an aly sis f ollow ed t h e ph ases of or gan izat ion ,
codificat ion, cat egor izat ion and int er pr et at ion. The findings suggest t hat childcar e r out ines v ar y accor ding t o
t he per iodicit y , schedule and occupat ion of t he m ot her . Differ ent alt er nat iv es t o childcar e w er e ident ified, and
alt hough m ost of t he w om en int er v iew ed r epor t ed t o be m ar r ied, t hey alm ost did not m ent ion t he husband’s
par t icipat ion in t he r out ine. The inv est igat ion based on fam ily r out ines allow s t he ident ificat ion of fam ily r oles,
t he social r elat ions and t he healt h car e or ganizat ion.
DESCRI PTORS: infant car e; fam ily healt h, fam ily
RUTI NAS FAMI LI ARES CON LACTANTES
Por m edio de est e est udio descr ipt iv o, con enfoque cualit at iv o se inv est igó las r ut inas de fam ilias con
n iñ os lact an t es en t r e 0 6 m eses a 0 2 añ os de edad, cu y as m adr es t r abaj aban y t en ían com o r ef er en cia u n
Ser v icio Básico de Salu d de u n m u n icipio del su r del Br asil. Com o f u n dam en t o t eór ico f u er on u t ilizadas las
r ut inas fam iliar es. Siendo ent r ev ist adas 25 m adr es, por m edio de un for m ular io sem i est r uct ur ado. El análisis
de los dat os cualit at iv os fue r ealizado por m edio de las fases de or ganización, codificación, cat egor ización e
int er pr et aciòn. I dent ificándose que los cuidados en las r ut inas fam iliar es v ar ían con la per iodicidad, el hor ar io
y el t ipo de ocupación de la m adr e. Se ident ificar on diver sas alt er nat ivas de cuidado br indado al niño y, a pesar
de la gr an m ay or ía de las ent r ev ist adas ser casadas, no fue m encionado el esposo com o coady uv ant e en las
r ut inas. Est a inv est igación per m it ió ident ificar los r oles fam iliar es, las r elaciones sociales y la or ganización de
los cuidados a la salud.
DESCRI PTORES: cuidado del lact ent e; salud de la fam ilia; fam ilia
ROTI NAS DAS FAMÍ LI AS COM CRI ANÇAS LACTENTES
At r av és dest e est u do descr it iv o, de abor dagem qu alit at iv a, in v est igou - se as r ot in as de fam ílias com
filhos lact ent es de 6 m eses a 2 anos, cuj as m ães enfr ent am o m er cado de t r abalho e se ut ilizam de Unidade
Básica de Saúde em um m unicípio do Sul do Brasil. Com o referencial t eórico, ut ilizou- se a abordagem das rot inas
fam iliares. Foram ent revist adas 25 m ães, at ravés de form ulário sem i- est rut urado. A análise dos dados qualit at ivos
segu iu as f ases de or gan ização, codif icação, cat egor ização e in t er pr et ação dos dados. I den t if icou - se qu e as
rot inas fam iliares de cuidado variam com a periodicidade, horário e t ipo de ocupação da m ãe. Foram ident ificadas
dif er en t es alt er n at iv as de cu idado da cr ian ça e, apesar de gr an de par t e das en t r ev ist adas se con sider ar em
casadas, qu ase n ão h ou v e m en ção aos m ar idos n a r ot in a. A in v est igação, baseada n as r ot in as da f am ília,
possibilit a ident ificar os papéis fam iliar es, as r elações sociais e a or ganização de cuidados na saúde.
I NTRODUCTI ON
I
n t h e l a s t f e w d e c a d e s , k n o w l e d g e co n st r u ct i o n i n f am i l y h eal t h h as em p h asi zed t h econcept ion t hat t he fam ily r epr esent s a basic healt h
u n i t ( 1 ). I n t h i s c o n c e p t i o n , t h e f a m i l y h o m e i s
consider ed as a healt h pr oducer because it s int er nal
r e s o u r c e s , s u c h a s t i m e , m a t e r i a l a n d f i n a n c i a l
con d it ion s, in com b in at ion w it h ex t er n al r esou r ces,
s u c h a s f o r m a l h e a l t h s e r v i c e s , a i m t o p r o t e c t ,
m aint ain and r est or e t he fam ily ( 2).
I n t he 1980´ s, som e r esear cher s( 3), depar t ing
f r om t h e p r em ise t h at social su p p or t con st it u t ed a
m ediat or bet w een a st ressful life and suscept ibilit y t o
diseases, appoint ed t he im pr ecise nat ur e and difficult
m easur em ent of t his concept ion. Ack now ledging t hat
hum an beings have an elem ent ar y need for st abilit y,
pr edict abilit y and cont inuit y, t hey decided t o focus on
st udies about dom est ic r out ines and r it uals as a m or e
ob j ect iv e w ay of assessin g f am ilies’ social su p p or t
ans it s relat ion w it h diseases. Aft er a lit erat ure review
and t w o cross- sect ional st udies involving fam ilies from
different social classess and et hnic origins in t he Unit ed
St at es, t hese r esear cher s( 3) at t em pt ed t o under st and
t h e r elat ion b et w een t h e r ou t in es an d t h e d isease,
d e f e n d i n g t h e t h e s i s t h a t f a m i l y r o u t i n e s a r e
o b se r v a b l e a n d r e p e t i t i v e b e h a v i o r s t h a t i n v o l v e
differ ent gr oup m em ber s and occur at a pr edict able
r egular it y. Fam ily r out ines can pr ot ect t he healt h and
w ell- b ein g of t h eir m em ber s, p r ov idin g f or st ab ilit y
a n d co n t i n u i t y d u r i n g st r essf u l p er i o d , p r o m o t i n g
solidar it y an d coh esion .
More recent ly, one aut hor( 4) at t ract s at t ent ion
t o t h e n eed f o r n u r si n g t o l o o k a t f a m i l y h ea l t h ,
r e c o v e r i n g t h e c o n c e p t s o f r o u t i n e s a n d r i t u a l s
p r e v i o u s l y m e n t i o n e d( 3 ) a n d e m p h a s i z e s t h e
im por t ance of t his r efer ence fr am ew or k for car e and
research. I n lat er st udies ( 5- 6), at t em pt s w er e m ade t o
defin e t h e differ en ces bet w een r ou t in es an d r it u als:
r ou t in es ar e r ep et it iv e an d st an d ar d ized act iv it ies,
closely link ed w it h daily and r egular act iv it ies, w hile
r it u als ar e act s or act ion s con du ct ed by a gr ou p of
people, u sin g on e or m or e sy m bols in a r epet it iv e,
f o r m a l a n d p r e c i s e w a y, d e s c r i b e d i n t e r m s o f
celebr at ion, r eligious t r adit ions and sy m bolic ev ent s.
I n Brazil, a m ore specific st udy( 7) about rit uals
inv olv ing fam ilies of new bor n infant s concluded t hat
t h e c a r e g i v e n s i n c e b i r t h a s p a s s a g e r i t e s a r e
im p or t an t asp ect s in t h e n u r sin g con t ex t . An ot h er
r esea r ch( 8 ), a i m e d a t u n d e r st a n d i n g h o w f a m i l i e s
c o n s t r u c t t h e f a m i l y e n v i r o n m e n t , e l a b o r a t e d a
cat egor y called gov er ning daily life. I n t his cat egor y,
t he fam ilies describe daily life rout ines w it hin t he focus
r e l a t e d t o t h e r o l e s a n d t a sk s o f t h e i r d i f f e r e n t
m em b er s. Ho w ev er, t h ese st u d i es d i f f er f r o m t h e
init ially appoint ed appr oach ( 3- 6), despit e show ing t he
im port ance of rout ines and rit uals in nursing research.
Now adays, in t he Brazilian realit y, effort s hav e
been m ade t o consolidat e t he Fam ily Healt h St rat egy
( FHS) . I n t his sense, under st anding fam ilies’ dynam ics
i s e s s e n t i a l t o l o o k a f t e r t h e i r h e a l t h n e e d s ( 9 ).
Mor eov er, r ou t in e act iv it ies of d aily liv in g , su ch as
e a t i n g , sl e e p i n g a n d p r e p a r i n g m e a l s, co n st i t u t e
f u n dam en t al it em s f or t h e f u n ct ion al assessm en t of
t he fam ily ( 10).
Thus, t his st udy aim s t o descr ibe t he r out ines
of fam ilies w it h infant s bet w een six m ont hs and t w o
y ear s old, w hose m ot her goes out t o w or k .
METHOD
Th i s d e scr i p t i v e st u d y u se d a q u a l i t a t i v e
appr oach and w as car r ied out in Flor ianópolis, Sant a
Cat arina, Brazil, am ong fam ilies w ho lived in t he area
at t en d ed b y a Basic Healt h Un it ( BHU) . Th e f am ily
r out ine appr oach w as used as a t heor et ical r efer ence
fr am ew or k ( 3- 6).
Th e BHU is locat ed in a n eig h b or h ood t h at
in clu d es d if f er en t ar eas, m ar k ed b y t h e con f lict in g
r elat ion sh ip bet w een com m u n it ies con sider ed n at iv e
and new. The new im m igrant s com e from ot her regions
in Great er Florianópolis, from t he int erior of t he St at e
of Sant a Cat ar ina and fr om ot her Br azilian st at es( 11).
The Unit at t ends a populat ion of approxim at ely 18,000
inhabit ant s. I t is operat ionally subdivided in four
sub-areas, where four fam ily healt h t eam s are act ive. The
BHU offer s space for t he Mult ipr ofessional Residency
i n Hea l t h a n d f o r cu r r i cu l a r t r a i n i n g a ct i v i t i es f o r
st udent s fr om healt h cour ses.
I n t his st udy, a for m was used t o ident ify t he
m ot h er s w h o w ou ld b e in t er v iew ed . I f t h e m ot h er
at t en d ed t o t h e cr it er ia, h er p er m ission w as ask ed
f or t h e in t er v iew , w h ich w as t h en sch ed u led t o b e
h e l d a t h e r h o m e o r, p r o v i d e d t h e m o t h e r w a s
available, at t he BHU. A sem ist r uct ur ed for m w as used,
w hich consist ed of four par t s: a) ident ificat ion dat a;
b ) g et t in g t o k n ow t h e f am ily, w h ich in clu d ed t h e
i n t e r v i e w e d m o t h e r ’ s p e r c e p t i o n o f w h o m s h e
and dat a about t he m ain car egiv er w hile t he m ot her
goes ou t t o w or k ; c) get t in g t o k n ow t h e m ot h er ’s
daily, w eekly and m ont hly rout ines inv olving t he fam ily
an d t h e in f an t ; d) car e f or t h e in f an t ’s h ealt h . Th e
int er view ees w er e r ecor ded if allow ed and, w hen t his
w as n ot p ossib le, r ecor d s w er e m ad e im m ed iat ely
aft er t he end of t he int er view , at t em pt ing t o m aint ain
t he int er v iew ees’ st at em ent s in full.
Th r ee su b j ect select ion cr it er ia w er e u sed .
Fir st , t h e f am ily sh ou ld in clu de a ch ild bet w een six
m ont hs and t w o year s old. This age r ange w as chosen
in v iew of ex clu siv e br east feedin g r ecom m en dat ion s
unt il t he sixt h m ont h, w hich oft en changes and delays
t he m ot her ’s ent r y or r et ur n t o t he j ob m ar k et . The
second cr it er ia w as t he child’s gr ow t h and developm ent
f ollow - u p at t h e BHU, in accor d an ce w it h t h e car e
pr ot ocol for childr en bet w een 0 and 6 year s old fr om
t he Flor ianópolis Healt h Secr et ar y. The t hir d cr it er ion
w as t hat t he m ot her should w or k r egular ly, at least
t hr ee day s per w eek .
A sim ple classif icat ion w as u sed t o an aly ze
i d e n t i f i c a t i o n d a t a o f t h e i n t e r v i e w e d m o t h e r s ’
char act er ist ics ( 13). I n t he analy sis of t he genogr am ,
fam ily com posit ion and st r uct ur e w er e consider ed and,
in t he ecom ap, t he br oader r elat ionship net w or ks t he
f am ily m em b er s est ab lish ed( 1 0 , 1 2 ). As t o q u alit at iv e
d at a, t h e f ollow in g st ep s of con t en t an aly sis w er e
f ollow ed : d at a or g an izat ion , cod in g , cat eg or izat ion ,
infer ences and int er pr et at ion ( 14). Dat a cat egor izat ion
cor r esponded t o it em s pr ev iously est ablished on t he
f o r m : t h e i n t e r v i e w e e ’s f a m i l y, d a i l y, w e e k l y a n d
m ont hly rout ines and care for t he infant ’s healt h. Dat a
w er e in t er p r et ed in t h e lig h t of t h e f am ily r ou t in e
r efer en ce fr am ew or k ( 3 - 6 ).
Th i s r e s e a r c h w a s a p p r o v e d b y t h e
I nst it ut ional Rev iew Boar d at Sant a Cat ar ina Feder al
Univer sit y, in accor dance w it h Resolut ion 196/ 96 w it h
r esp ect t o secr ecy, a n o n y m i t y, f r ee a n d i n f o r m ed
c o n s e n t a n d t h e p a r t i c i p a n t s ’ f r e e d o m t o s t o p
par t icipat ing in t he st udy at any t im e.
RESULTS
Ch ar act er ist ics of t h e in t er v iew ees
Most ( 6 8 % ) of t h e 2 5 in t er v iew ed m ot h er s’
educat ion lev el is r est r ict ed t o basic educat ion, 44%
of w hom unfinished and 24% finished. The r em ainder
is t aking or has alr eady finished secondar y educat ion.
As t o t h e t y p e o f o ccu p at i o n , 7 2 % o f t h e
i n t er v i ew ees p er f o r m d o m est i c f u n ct i o n s. Fi f t y - si x
per cent of t his gr oup w or ks in fam ilies’ hom es, w hile
16% ar e cleaner s in com m er cial est ablishm ent s. The
r em ainder ( 24% ) m ent ions w or k as kinder gar t en aid,
bak er y aid, healt h agent , t elephone operat or, t rainee
and t y pist . Mor e t han half ( 52% ) hav e a for m al j ob
r eg ist r y.
I t should be highlight ed t hat 60% of t he 25
int er view ed m ot her s live in t heir ow n house and 36%
in a rent ed house, w hile only one m ot her is living in a
bor r ow ed h ou se. Th e n eigh bor h ood is ch ar act er ized
by gr eat m obilit y, as 5 2 % of t h e in t er v iew ees h av e
only liv ed at t heir cur r ent addr ess bet w een one and
six m ont hs. As t o civil st at us, 72% of t he int erview ees
con sid er t h em selv es m ar r ied * .
All of t h e in t er v iew ees in d icat e u sin g t h eir
salar y t o pay f or pr im ar y n eeds: f ood, pay in g bills,
r ent and clot hing. The m ain r eason t hat m ade t hem
go out t o w or k was t he “ financial necessit y ”.
Th e in t er v iew ees’ f am ilies
When analyzing answ er s t o t he quest ion about
“ w hom t hey consider as par t of t he fam ily” and w hen
a n a l y z i n g t h e g e n o g r a m , i t w a s f o u n d t h a t t h e
in t er v iew ees con sider people w h o liv e w it h t h em as
fam ily . Som e of t hem ar e t radit ionally com posed by
fat her, m ot her and childr en or m ot her and childr en,
w h ile ot h er s in clu d e m ot h er, ch ild r en , n ep h ew an d
g r a n d p a r e n t s. W h e n a sk e d a b o u t w h o e l se t h e y
consider as par t of t he fam ily, t hey m ent ioned ot her
r elat iv es w ho liv e in t he sam e or in dist ant cit ies. I n
t his case, t he cr it er ion t hey consider ed w as k inship.
They also m ent ioned r elat ionships based on affect ion
as im por t ant r equisit es t o consider w ho is part of t he
fam ily, including neighbor s, baby sit t er and boy fr iend.
I n t he analy sis of t he ecom ap, t he net w or k
o f s o c i a l r e l a t i o n s h i p s w a s i d e n t i f i e d . Th e w o r k
e n v i r o n m e n t s t a n d s o u t a s t h e m o s t c o n s t a n t
relat ionship of adult s w ho are part of t he fam ily core.
I n som e cases, t h e ch u r ch an d t h e n eig h b or h ood ’s
healt h unit also appear. For t he w om en, t he m ot her
a n d s i s t e r s g e n e r a l l y a p p e a r a s v e r y c l o s e
r el a t i o n sh i p s a n d , i n so m e ca ses, t h ei r ch i l d r en ’ s
car eg iv er s w er e m en t ion ed . For m en , on t h e ot h er
h a n d , i n t h e i n t e r v i e w e e s ’ p e r c e p t i o n , c l o s e
relat ionships are m ore frequent w it h friends fr om w or k
an d/ or soccer.
Th e ch ild’s car egiv er
When t he m ot her goes out t o w or k, she needs
t o find alt ernat ives t o t ake care of t he child. Tw o m odes
appear ed in t he dat a: t he kinder gar t en, w hich can be
public or pr ivat e, and t he pr ivat e car egiver, w hich can
be paid or not .
Only t w o m ot her s use t he public kinder gar t en,
w hich belongs t o t he m unicipal net w ork and is free of
ch ar g e as, accor d in g t o t h e in t er v iew ees, t h er e is
gr eat difficult y t o find a place and, w hen t hey m anage,
t h er e is t h e in con v en ien ce t h at t h e ser v ice is on ly
offer ed half- t im e. The int er v iew ed m ot her s car e in a
public kindergart en as t he ideal solut ion alt hough few
of t hem have t he oppor t unit y t o achieve it , due t o t he
r eason s m en t ion ed abov e.
Th er e ar e t w o pr iv at e k in der gar t en m odes:
f or m al an d d om est ic. Th e f or m al m od e, w h ich is a
privat e, for- profit inst it ut ion, is officially regulat ed. The
t est im onies indicat e t he high m ont hly cost as a lim it ing
fact or for t his m ode. Dom est ic k inder gar t ens ar e not
r egulat ed by official m unicipal ent it ies. The ser v ice is
delivered in a house w here various children are j oined.
I n t h e p r iv at e car eg iv er m od e, t h e m ot h er
select s on e p er son t o t ak e car e ex clu siv ely of t h e
child, w het her at t he caregiver’s house or at t he child’s
ow n house. I n t his m ode, t he cost of care is paid for
t hr ough a for m al paym ent . Som e cases do not involve
paym ent in m oney, but r et r ibut ion of favor s. I n ot her
sit uat ions, eit her ot her sm all childr en, fr om t he age
r ange of eight , or gr andm ot her s t ake car e of t he child.
Th e ch oice of t h e pr iv at e car egiv er at t en ds
t o som e cr it er ia. Som e m ot her s choose gir ls younger
t han 15 t o t ake car e of t he baby, w hile ot her s consider
t he car egiv er ’s ex per ience im por t ant and, t hus, look
for n eigh bor s w h o alr eady h av e gr an dch ildr en .
Daily an d w eek ly r ou t in es
When analy zing t he answ er s about t he daily
r ou t in es of t h e in t er v iew ees an d t h eir f am ilies, t w o
cat eg or ies em er g ed : t h e seq u en ce an d t h e t y p e of
r ou t in e act iv it ies.
The sequence of r out ines is st r ongly r elat ed
w it h t he m ot her ’s t ype of occupat ion, educat ion level,
age, civ il st at us and w or k hour s. Thr ee gr oups w er e
ident ified: t he fir st consist s of t en int er v iew ees w ho
w or k full- t im e, five days per w eek; t he second includes
t en in t er v iew ees w h o w or k h alf - t im e, bet w een f ou r
and fiv e day s per w eek ; and a t hir d gr oup w it h fiv e
in t er v iew ees w h o r an d om ly w or k a cou p le of d ay s
per w eek , depending on w het her cleaning j obs com e
u p .
Of t h e t en in t er v iew ees w h o w or k f u ll- t im e
( fir st gr oup) , only t w o ar e y ounger t han 20, t w o ar e
b et w een 2 1 a n d 2 5 y ea r s, o n e 2 8 y ea r s a n d t h e
r em ainder m or e t han 30 y ear s. Wit h r espect t o civ il
st at u s, 8 0 % con sider t h em selv es m ar r ied an d 2 0 %
sep ar at ed . Th i s g r o u p co n t ai n s w o m en w i t h m o r e
childr en and low er educat ion levels: 70% did not pass
t he fift h year of basic educat ion. Mor eover, 80% w or k
as m aids, t hat is, w or k er s w ho r em ain at t he sam e
house several days per w eek, eit her half or full- t im e.
On ly t w o of t h em h av e per f or m ed t h is f u n ct ion f or
less t han a year, w hile t he r em ainder has w or ked in
t he sam e place longer. Ninet y per cent have a for m al
j ob con t r act .
These w om en’s r out ine can be t r anslat ed by
t he follow ing st at em ent .
( ...) I w ake up ear ly, at 6 a.m ., I change t he baby’s
diaper, I get her ready t o leave, feed her and prepare breakfast for
everyone. I leave, drop t he baby off at t he kindergart en and go t o
w or k. As t he bus t akes a long t im e, I only get t her e at 9 a.m . At
noon, m y older son ( 14 years) , w ho st udies in t he m orning, picks
up t he baby at t he kinder gar t en ( ...) . He t akes car e of her in t he
aft er noon. He alr eady know s w hat t o do and I t r ust him . I get
back in t he lat e aft ernoon and prepare dinner, give her a bat h and
pr epar e food for t he next day.
I n t h e g r o u p w h o co n si d e r e d t h e m se l v e s
m ar r ied ( 8 0 % ) , none of t he m ot her s m ent ioned t he
husband in t his r out ine.
I n t he gr oup of fiv e int er v iew ees w ho “ clean
o cca si o n a l l y ” , co n si d e r e d i n t h i s st u d y a s ca su a l
clean er s ( w or k in dif f er en t h om es du r in g t h e w eek ,
w it hout a for m al cont r act , but r egist er ed) , one is 29
y ea r s o l d a n d t h e r em a i n d er o v er 3 0 ; t h ey h a v e
b et w een on e an d t h r ee ch ild r en ; on ly on e of t h em
finished secondar y educat ion, w hile t he r est did not
get past t he sixt h year of basic educat ion; as t o civil
st at us, one m ent ions being divor ced w hile t he ot her s
con sider t h ey ar e m ar r ied.
Th ese w om en h av e an u n st able r ou t in e, as
t hey w or k accor ding t o t he cleaning oppor t unit ies t hat
em er ge. When t hey know t hat t hey ar e going t o w or k
t he nex t day, t hey pr epar e t heir fam ilies’ m eals and
car egiv er. This per son also has an unst able bond, as
( s ) h e i s r e q u e s t e d o c c a s i o n a l l y. Th i s i n s t a b i l i t y
g en er at es co n st an t ch an g es i n car eg i v er an d al so
m akes it difficult for t he infant t o cr eat e bonding. Only
one of t he int erview ees m ent ioned her husband’s help
in housew or k and car e for t he child.
Th e gr ou p of t en w om en w or k in g h alf - t im e
co n t a i n s t h e y o u n g e st i n t e r v i e w e e s, t h a t i s, si x
m ot h er s y ou n ger t h an 2 5 , t w o b et w een 2 6 an d 3 0
y ear s and t w o ot her s ov er 30. As t o civ il st at us, six
con sid er t h em selv es m ar r ied , t h r ee sep ar at ed an d
one single. This gr oup has a higher educat ion lev el:
only t w o did not finish basic educat ion; t hree finished
it and t he r em aining fiv e ar e t ak ing or hav e alr eady
f in ish ed secon d ar y. Hen ce, t h is g r ou p con t ain s t h e
lar gest num ber of j obs out side t he dom est ic spher e
( 50% ) , in w hich 80% has a for m al j ob cont r act .
I n t h e an aly sis of t h e social n et w or k , u sin g
t he ecom ap, it is obser ved t hat t his gr oup of w om en
r eceiv es m ost h elp f r om f am ily m em b er s, in m ost
c a s e s t h e c h i l d ’ s g r a n d m o t h e r. Th u s , t h e y c a n
conciliat e t heir dom est ic act iv it ies w it h for m al w or k ,
w it h t he possibilit y t o t ake care of t he infant one par t
of t he day. Also, in t his gr oup, t he husband is m or e
pr esent in r epor t s on daily r out ines.
I n t he cat egory of rout ine act ivit ies, act ivit ies
appear ed r elat ed t o food, body hygiene, cleaning t he
h ou se an d t ak in g car e of clot h in g. Th ese n eeds ar e
at t ended t o at m or e or less st r ict t im es, accor ding t o
t h e g r ou p s m en t ion ed ab ov e an d t h e su p p or t f r om
t he social net w ork t he int er view ed m ot her has at her
d isp osal.
We e k e n d r o u t i n e w a s n o t v e r y d i f f e r e n t
am ong t he t hr ee gr oups: in one gr oup, t he m ot her s
“ do not go out because t hey do not hav e t im e” and
u se t h e oppor t u n it y t o clean t h e h ou se. I n an ot h er
g r ou p , t h e m ot h er s m en t ion “ g oin g ou t ” t o f am ily
m em ber s’ hom e or ot her public places lik e t he “ par k
and t he m all”. Anot her opt ion t o go out at w eekends
is chur ch.
Mo n t h l y r o u t i n e s c o u l d n o t b e a n a l y z e d
f u r t h er, as t h e in t er v iew ees, p er h ap s b ecau se t h ey
do n ot con ceiv e t h eir lif e in t h e lon g t er m , alleged
t hat t hey could not r espond.
I nfant healt h car e
Wit h r espect t o decision m ak in g in car e for
t h e in f an t ’s sleep, f ood an d h y gien e n eeds, v ar iou s
su b j ect s w er e m en t i o n ed ( so m e i n d i cat ed v ar i o u s
subj ect s at t he sam e t im e) : m ot her ( 16) , gr andm ot her
( 10) , husband ( 4) , sist er ( 2) , daught er ( 2) , babysit t er
( 2 ) a n d s i s t e r - i n - l a w ( 1 ) . Th e m o t h e r ’ s a n d
grandm ot her’s predom inance in t his role is visible and,
again, lit t le m ent ion w as m ade of t he husband in t he
in t er v iew ees’ r ep or t s.
As t o d a i l y o r i e n t a t i o n , t h e i n t e r v i e w e e s
in dicat ed: gr an dm ot h er ( 1 0 ) , m ot h er ( 8 ) , ph y sician
( 6) , BHU t eam ( 4) , m ot her - in- law ( 1) , sist er ( 1) , aunt
( 1 ) , h u s b a n d ( 1 ) a n d s i s t e r - i n - l a w ( 1 ) . W h e n
r econ sid er in g t h e m ot h er ’s an d t h e g r an d m ot h er ’s
r ole, on t h e on e h an d, an d t h e ph y sician ’s an d t h e
BHU t eam ’s on t he ot her, t he r elat ion bet w een healt h
p r o f e ssi o n a l s’ a n d f a m i l y ca r e g i v e r s’ p r a ct i ce s i s
m ar k ed by com plem ent ar iness. Mor eov er, again, t he
h u sb an d ’s alm ost t ot al lack of p ar t icip at ion in t h is
pr ocess st ands out .
I n case of disease, t he int er view ees answ er ed
t hat it depended on t he “ sever it y”. The cat egories “ m ild
d i se a se s” a n d “ se v e r e d i se a se s” t h e y m e n t i o n e d
im plied differ ent t y pes of t her apeut ic cour ses. I f t he
disease w as consider ed m ild, t he m ot her s t ook car e
at hom e w it h m edicat ion or hom e- m ade t eas, or t ook
t h e ch i l d t o t h e n ei g h b o r h o o d BHU. I f co n si d er ed
sev er e, t hey t ur ned t o t he em er gency sect or of t he
h osp i t al . Th e cat eg or i es m i l d d i seases an d sev er e
diseases w er e ex em plified as follow s.
Mild: flue, look ing dow ncast . Sev er e: t uber culosis,
pneum onia, diseases r equir ing hospit alizat ion. [ ...] I n case of
m ild diseases I t ake him t o t he st at ion; in ot her cases ( high
fever for exam ple) I t ake him st r aight t o t he hospit al.
As t o con f id en ce in in f an t car e ad v ice, t h e
i n t e r v i e w e e s i n d i c a t e d s o m e s u b j e c t s : t h e B H U
physician ( 14) , gr andm ot her ( 9) , m ot her ( 3) , a fam ily
m em ber ( 1) , oldest son ( 1) . Ot her s indicat ed: nobody
( 1) and do not know ( 2) .
DI SCUSSI ON
Th e r esu lt s of t h is st u dy appoin t a r elat ion
bet w een t he sequence and t y pe of r out ine act iv it ies
dev eloped an d t h e f act or s: edu cat ion lev el, t y pe of
occupat ion and suppor t fr om t he social net w or k .
The int erview ees perceive low educat ion level
as a lim it in g fact or in t h eir in ser t ion pr ocess in t h e
j ob m ar ket and in t he choice of t he t ype of occupat ion,
and also j ust ifies t heir expect at ions about t he fut ur e,
as t h ey h ope for t h e possibilit y t o con t in u es st u dy in g,
So ci a l n e t w o r k i s a sy st e m co m p o se d o f
people, funct ions and sit uat ions t hat offer em ot ional
and inst r um ent al suppor t t o people in t heir differ ent
n eed s ( 1 5 - 1 6 ). Mor eov er, it con st it u t es a m ed iat or in
st r essing sit uat ions, favor ing at t endance t o t he hum an
being’s elem ent ar y need for pr edict abilit y, cont inuit y
and st abilit y ( 3- 6) and allow ing for t he m ot her ’s inser t ion
i n t h e j o b m a r k e t . I n t h i s st u d y, t h i s n e t w o r k i s
r ep r esen t ed b y p eop le w h o, w it h in ( g r an d p ar en t s,
au n t s, sist er s an d adolescen t s an d pr e- adolescen t s)
as w ell as out side t he fam ily ( neighbor s, fr iends and
ot her s) , and eit her r em uner at ed or not , per for m t he
f u n ct i o n o f car eg i v er s. Th e d ai l y d y n am i cs of t h i s
n e t w o r k i n f l u e n ce s t h e w o r k i n g m o t h e r ’ s t y p e o f
em ploy m ent cont r act , per iodicit y and w or k hour s.
I t is observed t hat t his net work is fragile, as
t he m ot hers direct ly depend on a caregiver for t he child,
and is predom inant ly fem ale, as t he part ners are hardly
m ent ioned in t he daily rout ine. This finding differs from
an ot h er st u d y( 1 5 ), car r ied ou t in a p op u lat ion w it h
charact erist ics sim ilar t o t his st udy, in which t he m ot her
con sider ed t h e h u sban d’s/ par t n er ’s su ppor t as m or e
im por t an t t h an t h e ot h er s. On t h e ot h er h an d, t h is
n e t w o r k p l a y s a cr u ci a l r o l e i n t h e m o t h e r s’ j o b
m aint enance ( as she cannot count on her part ner’s help)
and allows t hem t o cont ribut e wit h basic m at erial goods,
w hich guarant ee cont inuit y, predict abilit y and st abilit y
by at t ending t o housing, food and clot hing needs.
I n decisions about daily care for infant s, as well
as in disease sit uat ions, t he fem ale net work const it ut es
a bridge t o find resources out side t he fam ily circle, where
t he physician was t he m ost indicat ed professional.
This net work cont ains weaknesses, m ainly for
t hose int erviewees wit h lit t le qualificat ion and wit hout
support from t he ext ended fam ily, such as occasional
cleaners for exam ple, who need t o pay a caregiver from
t h e low am ou n t t h ey r eceiv e. Th u s, t h ey h ir e ot h er
w om en, for an ex t r em ely low am ount , using m er ely
t he following com pet ence param et ers: t he person needs
t o be calm , has som e experience ( in t he case of t he elderly,
because t hey hav e gr andchildr en and, in t he case of
young people, because t hey t ake care of t heir siblings) .
These int er view ees’ unst able r out ine dem ands
c o n s t a n t c h a n g e s i n c a r e g i v e r, w h i c h s h o u l d b e
con sid er ed n eg at iv e as t h ese in f an t s n eed b on d in g
and car e deliver ed by r esponsible and t r ained per sons.
I t is con sider ed t h at h ealt h ser v ices st ill lack m or e
syst em ized dat a about w ho act ually t akes car e of t he
children in neighborhoods w it h poor populat ions w hen
t h e m ot h er n eeds t o w or k an d w h en k in der gar t en s
ar e insufficient . Ther efor e, a pr im ar y t ask in pr om ot ing
t he healt h of children in basic care w ould be t o ident ify
t he caregivers’ sit uat ion w hile t he m ot hers leave t heir
hom es t o w or k .
What t he aspect of caregivers is concerned, a
phenom enon occur s w hich seem s t o be root ed in t he
Br azilian cult ur e, in w hich w om en ar e r esponsible for
t aking care of t he children. I t is perceived as “ nat ural”
t hat , when t he m ot hers go out t o work, t he ot her wom en,
appoint ed in t his st udy, whet her younger or older, and
also following t heir “ nat ural” apt it udes, perform t hese
funct ions, whet her paid or not and qualified or not . I t
should be highlight ed t hat , oft en, t he nat uralizat ion of
socially const ruct ed abilit ies can int ervene in t he direct ion
of public policies ( 17). The result s show t his phenom enon,
as t he fem ale net work, alt hough fragile and overloaded,
p er m i t s t h e m o t h er ’s i n ser t i o n i n t h e j o b m ar k et ,
t r a n sf i g u r i n g t h a t , a p p a r e n t l y, k i n d e r g a r t e n s a r e
su f f i ci en t , ch i l d r en ar e b ei n g car ed f o r an d p u b l i c
aut horit ies are com plying wit h t heir funct ions.
Finally, t his kind of research based on fam ilies’
r out ines is consider ed r elev ant for nur sing as w ell as
f o r o t h e r h e a l t h p r o f e s s i o n a l s , a s i t p e r m i t s
underst anding t he daily fam ily life of m ot hers of infant s
w h o g o ou t t o w or k . Based on t h ese asp ect s, it is
r elat iv ely easy t o iden t ify t h e fam ily r oles, h ow t h e
different m em bers relat e inside and out side t he fam ily,
how t hey get or ganized t o at t end t o basic needs, in
h e a l t h p r o m o t i o n a n d d i se a se si t u a t i o n s, m a i n l y
ch ildh ood diseases, as w ell as h ealt h pr of ession als’
possibilit ies t o st r engt hen or help t he fam ily gr oup.
ACKNOW LEDGEMENTS
We ar e g r at ef u l t o n u r se Dan iela Maf iolet t i
Floriano for her help in planning t he research, as w ell
as in dat a collect ion and r egist r y.
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