HEALTH EDUCATI ON: A STRATEGY OF CARE FOR THE LAY CAREGI VER
Luccas Melo de Souza1 Wiliam Wegner2 Mar ia I sabel Pint o Coelho Gor ini3
Souza LM, Wegner W, Gorini MI PC. Healt h educat ion: a st rat egy of care for t he lay caregiver. Rev Lat ino- am Enferm agem 2007 m arço- abril; 15( 2) : 337- 43.
This ar t icle aim ed t o r eflect about t he im por t ance of t he r ole nur ses per for m in st r at egies of healt h educat ion t o lay caregivers, who are im port ant act ors in t he healt h/ disease process. I t is a t hem at ic reflect ion, built t hrough bibliographic review, which discusses t he role of lay caregivers in different st ages of t he life cycle. Consider ing t he par t icipat ion of lay car egiv er s in t he Br azilian r ealit y , st r at egies hav e been sought t o include t hem in t he healt h care, given t he lit t le at t ent ion Public Policies have given t o t hem . Therefore, t he nurses as healt h educat ors, m ust offer support t o t he lay caregivers helping t hem t o choose am ong available alt ernat ives, while delivering care, t o not harm t heir own healt h. Concluding, healt h educat ion can be an alt ernat ive t o offer at t ent ion t o t he lay car egiver s, w hile t he nur se has im por t ant r ole in t he developm ent of alt er nat ives.
DESCRI PTORS: nur sing; healt h educat ion; car egiv er s; pat ient escor t ser v ice
EDUCACI ÓN EN SALUD: UNA ESTRATEGI A DE CUI DADO AL CUI DADOR LEGO
Est e art ículo t iene por obj et ivo reflexionar acerca de la im port ancia de la int ervención de enferm ería a t r av és de est r at egias de educación en salud, par a los cuidador es legos, act or es fundam ent ales en el pr oceso salud/ enferm edad. Se t rat a de una reflexión t em át ica, const ruida por m edio de la búsqueda bibliográfica, a t ravés de la cual se discut e el rol de los cuidadores en las diferent es et apas del ciclo vit al. Tom ando com o base la act ual part icipación de los cuidadores legos en el escenario brasileño, se buscan est rat egias para incluirlos en la asist encia de salud t eniendo en vist a la poca relevancia que las Polít icas Públicas les han dem ost rado. Así, el enferm ero, com o educador en salud, debe ofrecer subsidios a los cuidadores legos para que sean capaces de escoger ent re las alt ernat ivas disponibles para el cuidado de los enferm os, de form a t al que est a función no perj udique la salud del pacient e. Se concluye que la educación en salud puede ser una form a alt ernat iva para ofrecer at ención de salud a los cuidadores legos, siendo el rol del enferm ero indispensable para el desarrollo de est rat egias.
DESCRI PTORES: enfer m er ía; educación en salud; cuidador es; acom pañant es de pacient es
EDUCAÇÃO EM SAÚDE: UMA ESTRATÉGI A DE CUI DADO AO CUI DADOR LEI GO
Obj et iv a- se, com est e ar t igo, t ecer r ef lex ões acer ca da im por t ân cia da at u ação do en f er m eir o por m eio de est r at égias de edu cação em saú de aos cu idador es leigos, at or es fu n dam en t ais n o pr ocesso saú de/ doença. Tr at a- se de r eflexão t em át ica, const r uída a par t ir de busca bibliogr áfica, at r avés da qual se discut e o papel desses cuidador es nas difer ent es et apas do ciclo v it al. Tom ando com o base sua at ual par t icipação no cen ár io b r asileir o, b u scam - se est r at égias p ar a in clu í- los n a assist ên cia d e saú d e, t en d o em v ist a a p ou ca r elev ância que as Polít icas Públicas t êm dem onst r ado a eles. Assim , o enfer m eir o, com o educador em saúde, dev e buscar ofer ecer subsídios aos cuidador es leigos par a que escolham as alt er nat iv as disponív eis, dur ant e a fase em qu e cu idam dos doen t es, sem qu e essa fu n ção acar r et e pr ej u ízo à su a saú de. Con clu i- se qu e a edu cação em saú de pode ser alt er n at iv a par a of er ecer at en ção aos cu idador es leigos, t en do o en f er m eir o papel indispensáv el no desenv olv im ent o de suas est r at égias.
DESCRI TORES: en fer m agem ; edu cação em saú de; cu idador es; acom pan h an t es de pacien t es
1 RN, Nursing Master student, e-mail: [email protected]; 2 RN, Children Hospital Santo Antônio, Nursing Master student, e-mail: [email protected]; 3 RN, PhD in Education, Adjunct Professor, e-m ail: [email protected] .br. Federal University of Rio Grande do Sul College of Nursing
I NTRODUCTI ON
N
u r sin g is a k n ow ledge ar ea t h at cov er s act i v i t i es l i k e car e, m an ag em en t an d ed u cat i on , am ong ot her s. I n t he differ ent scenar ios w her e it s professional pract ice is exercised – hospit als, healt h u n i t s, o u t p at i en t cl i n i cs, sch o o l s, k i n d er g ar t en s, com panies and hom es –, the horizon of nursing does not rem ain restricted to people in disease situations( 1).Am on g n u r ses’ dif f er en t act iv it y f or m s in m oder n society, education practice appears as the m ain health pr om ot ion st rat egy.
According t o lit erat ure, healt h educat ion is a t eaching- learning process aim ed at healt h prom ot ion, and professionals in this area are the m ain m ediators for t his t o occur. These pr ofessionals ar e educat or s prepared to propose strategies, with a view to offering ways t hat m ake possible t ransform at ions in people/ com m u n it ies( 2 ). Wit h r espect t o car e st r at egies, it
should be highlight ed t hat nursing, as an art , allows nurses t o perform t heir funct ions creat ively and wit h m ultiple alternatives, not generalizing their actions to a com m on group, but m aintaining each hum an being’s inherent peculiarit ies.
Th er e ar e t w o w ay s of focu sin g on h ealt h education: the first refers to the ‘old’ Public Health, in which educat ion pract ices are part icularly direct ed at d i se a se p r e v e n t i o n . Th e se co n d , ‘ n e w ’ h e a l t h education hopes to m ove beyond the biom edical m odel and expand to broad obj ectives that aim for a healthy life( 3). I n t his st udy, t he perspect ive of radical healt h
educat ion is em phasized, a newly proposed m odel – based on t he ‘new’ Public Healt h – t hat at t em pt s t o pr om ot e a social t r ansfor m at ion by fight ing against em erging social inequalit ies in healt h syst em s( 3- 5).
Radical healt h educat ion w orks w it h groups an d h i g h l i g h t s t h at t h i s i s t h e w ay t o ex ch an g e ex p er ien ces an d con cep t ion s in a cer t ain g r ou p / r ealit y. This w ould m ak e it possible t o const r uct a cr it ical collect iv e conscience and t hen sur pass it t o t he part icipant s’ individual level: t hus, each person’s aut onom y would be prom ot ed t hrough educat ion( 4).
Now ad ay s, it is em p ir ically ob ser v ed t h at educat ion pract ice focuses on sick people or people su scep t i b l e t o ch an g es i n t h ei r h eal t h st at e, as professionals direct their actions at persons who attend h e a l t h se r v i ce s b e ca u se o f a p o ssi b l e d i se a se . However, there is little concern about people who take car e of t he ill but do not per for m any paid and/ or p r o f essi o n al w o r k i n t h i s sen se: l ay car eg i v er s.
Som etim es, it is forgotten that these can also present healt h unbalance. One ex planat ion for t his lack of at t ent ion t o lay caregivers can be at t ribut ed t o t he hist orical root s of t he profession.
As a j ob, nursing appeared with an em phasis on care for sick people, and it was through this practice t h a t i t s co n so l i d a t i o n a s a p r o f essi o n o ccu r r ed . How ev er, ov er t im e an d as a r esu lt of scien t if ic progress, new spaces have been conquered and t his paradigm – cent ered on t he ill only – was gradually changed. Due to different reasons, the fam ily and lay caregivers becam e significant in t he nursing t eam ’s d ai l y r eal i t y, w h en acco m p an y i n g t h e p at i en t i n hospit al, as well as when t hey part icipat e ( in) direct ly in care in hospital and/ or at hom e. Thus, the elem ent o f t h e l a y ca r e g i v e r e m e r g e d i n n u r se / p a t i e n t int er act ion.
Despit e t his significance, scient ific lit erat ure and professional practice reveal the need for research and reflect ions on lay caregivers, m ainly in t erm s of h eal t h ed u cat i o n f o r t h i s p u b l i c. Th ese p er so n s’ ph y sical, em ot ion al an d social h ealt h t en ds t o be st rained, m ainly due t o t he burden im posed by t he car e t ask , w h ich can t r an sf or m t h em in t o a n ew dem and for healt h services( 6). I t is highlight ed t hat ,
besides car e deliv er y t o sick / hospit alized per sons, support to inform al ( lay) caregivers represents a new challenge t o t he Brazilian healt h syst em , which also j ust ifies t he need for st udies about t his t hem e( 7).
This reflection is also j ustified by the relevance of lay caregivers as, in m any cases, t hey st ay wit h the patient full- tim e and can provide the health team w it h fundam ent al infor m at ion about t heir r elat iv e’s sit uat ion. These caregivers receive at t ent ion and are researched on abroad, but are often ignored in Brazil: by the governm ent ( due to the lack of resources and political structure to help caregivers) ; by fam ilies and com m unities ( due to the low valuation of this function, gener ally cent er ed in one single per son, in v iew of d i f f i cu l t i e s t o d i v e r si f y ca r e g i v e r s) a n d a l so b y researchers, part ially due t o t he lack or absence of resources t o conduct st udies or due t o difficult ies t o m ake out perspect ives for using t he result s( 8). Thus,
a m a cr o - st r u ct u r a l p r o b l e m i s i d e n t i f i e d , w h i ch in v olv es dif f er en t social segm en t s an d act or s an d rem ains st at ic t owards t he present ed difficult ies.
To ca r r y o u t t h i s r e f l e ct i o n , w e so u g h t t h e o r e t i ca l f o u n d a t i o n s f r o m b o o k s, t h e se s, dissertations and j ournal articles, through a review in the database LI LACS, in the SCI ELO electronic library and in t he Library Aut om at ion Syst em at Rio Grande do Sul Federal Universit y. The descript ors used were ‘cu id ad or es ( pat ient car egiv er s) or acom p an h an t es de pacien t es ( pat ient com panions) or edu cação em saú de ( healt h educat ion) , associat ed w it h t he w or d
enfer m agem ( nursing)’. The result s were select ed by reading the abstracts and, if they dealt with the study o b j e ct , t h e t e x t s w e r e a n a l y ze d f o r p o ssi b l e applicat ion. On t he whole, 25 references were used to support this article. These were organized according t o t h e i n t e r e st s o f t h e i n t e n d e d a r g u m e n t s, i n co m b i n a t i o n w i t h q u e st i o n s f r o m t h e a u t h o r s’ pr ofessional pr act ice and ex per ience, t hus allow ing for reflect ions about t he t hem e.
LAY CAREGI V ERS I N TH E BRAZI LI AN
SCENARI O
Car e is a scien ce especially per f or m ed by nur sing pr ofessionals in hospit als and healt h unit s. However, it is known t hat , hist orically and cult urally, care is also delivered by people wit hout professional training, in the fam ily/ com m unity context and in health institutions( 10). The expression ‘lay caregivers’ is used
t o indicat e t hese per sons. I n v iew of difficult ies t o find a definition of the term in scientific literature, the aut hors of t his st udy consider it as t hat person who delivers care t o t he pat ient – in t he inst it ut ional and f am i l y en v i r o n m en t s - , w i t h o u t p ay m en t an d / o r specialized professional t raining.
Accor ding t o lit er at ur e, lay car egiver s have always exist ed. Care pract ice t radit ionally st art ed in t h e pr iv at e h om e sph er e, as t h e f am ily st r u ct u r e i n cl u d ed m u l t i p l e g en er at i o n s, t h u s m ak i n g t h i s pr act ice possible. Relat iv es w er e ack now ledged as t he sour ce of car e for dependent per sons, and t he fem ale figure was chosen t o be responsible for t his care( 10).
How ev er, t he I ndust r ial Rev olut ion ent ailed t he populat ion’s urbanizat ion, increased dem ands for w or k for ce and w om en’s ent r y int o t he j ob m ar k et . This was reflected in changes in the fam ily structure, which becam e predom inant ly one- generat ional. Thus, t h e St at e, in or d er t o k eep u p social p r od u ct ion , st ar t ed t o deliv er car e t o t h e w or k in g popu lat ion .
Hospit als, asylum s, m ent al hospit als and care hom es w e r e cr e a t e d . Th e se p l a ce s w e r e a i m e d a t concent rat ing hum an and t echnological resources t o deliver care t o t he sick populat ion. Hence, t he St at e assu m es t h e r ole of car e d eliv er y t o it s cit izen s, m ov ing t he bur den of car e fr om t he fam ily t o t he St at e( 10).
Nowadays, professional pract ice allows us t o affirm t hat , oft en, t he ill faces t his phase in life wit h the presence of a relative who, out of need and even wit hout specialized t raining, becom es a caregiver. On the counterpart, established health program s in Brazil i g n o r e l a y ca r e g i v e r s, w h o a r e f u n d a m e n t a l co m p o n en t s f o r si ck p er so n s’ r eh a b i l i t a t i o n a n d r ecov er y.
This ‘disregard’ of lay caregivers is a source of concern as, nowadays, est ablished healt h syst em s in Brazil t end t o indicat e t hat people should st ay at t heir hom es – bot h pat ient s whose disease is under control ( especially chronic- degenerative diseases) and those in palliative care situations – under the care of t heir fam ily. This is part ially due t o inst it ut ions’ and t he St at e’s concern t o reduce hospit al care cost s, as well as to the im portance of stim ulating bonds between pat ient s and r elat iv es in t he hom e env ir onm ent( 10).
Thus, the State divides the responsibility to take care of t h e ill w it h t h e f am ily, m ak in g t h e f am ily an d com m unity spaces be revalued as care environm ents. I n Brazil, like in the rest of the world, in m ost sit uat ions, wom en wit h som e degree of relat ionship and physically and/ or affect ively close t o t he pat ient deliver lay care. More specifically, it can be inferred t h at w iv es, m ot h er s or d au g h t er s r ef lect t h e lay caregiver’s profile( 7,11- 16), as it is com m only affirm ed
that wom en are responsible to take care of the house, children or elderly, since they are destined by com m on sense t o be m ot hers and t ake care of t he fam ily( 17).
Moreover, as wom en live longer, t hey are responsible t o t ake care of t heir husbands, as m en t heoret ically get ill and die earlier( 7).
Besides being delivered m ainly by people with som e degree of relationship with the patient, lay care also cent er s in one single fam ily car egiver, w ho is oft en overloaded wit h t his responsibilit y( 15,18- 19).
I n pr ofessional pr act ice, par ent s t ak e car e of t heir ill children/ adolescent s, w hile adult s/ elderly ar e m ainly at t ended by t heir husband/ w ife or son/ d a u g h t e r( 1 1 - 1 4 ). I n m o st si t u a t i o n s, ca r e g i v e r s
that, during the lay caregiver’s stay with the patient, it is not uncom m on for changes in the form er’s health state to occur( 6) . However, m ost health institutions are
not structured to attend them . This disregard and lack of planning can affect t he car e t hey deliv er t o t he p at ien t . Th is ch ar act er izes t h e h eg em on ic m od el ( t r adit ional, only dir ect ed at indiv idualism and t he est ablished disease) , w hich has not been overcom e y et , t o b e r ep laced b y t h e h olist ic m od el, w h ich considers t he int egralit y of t he hum an being and t he a cco m p a n y i n g f a m i l y( 2 0 ), t h u s i n cl u d i n g t h e l a y
caregiver as a person who needs care.
The fam ily receives the responsibility to take car e of it s m em ber s. Th is t ask is r elat ed t o each p e r so n ’ s so ci a l r e sp o n si b i l i t y t o w a r d s h i s/ h e r relatives( 21). However, this relative should be in healthy
condit ions t o deliver care act ions t o people t hey are cl o se w i t h . Fr o m t h e r a d i ca l h e a l t h e d u ca t i o n perspect ive( 3- 5), lay caregivers are expect ed t o have
a cq u i r e d su f f i ci e n t a u t o n o m y t o t a k e ca r e o f t hem selves and t he person t hey are accom panying. However, for this to occur, a m ediator is needed. I t is believed that nurses can play t his facilitating role, as t hese professionals deliver care close t o t he pat ient / lay car egiv er dy ad an d ar e dir ect ly in v olv ed w it h educat ional issues relat ed t o healt h care.
I t should be highlighted that the fam ily is not only t he care unit , but should also be considered as the unit that needs care(22). The m aintenance of fam ilies’
and ov er loaded, st r essed or ex haust ed car egiv er s’ health or quality of life is threatened due to their care responsibility. I n m any situations, they present feelings of im potence, concern, tiredness and irritability( 15,19).
However, health professionals do not yet give due em phasis to the care the relatives deliver, in view o f t h e l i t t l e r e l e v a n ce p u b l i c p o l i ci e s h a v e d em on st r at ed t ow ar d s t h e t h em e, as m en t i on ed before. Moreover, healt h professionals are especially pr epar ed for car e deliv er y t o sick per sons, w it h a disease- orient ed focus. Thus, t hey forget about t he people related with the patients, who need inform ation and support in t heir difficult ies, which oft en affect or will affect their own health( 23).
To accom plish this approach, which considers the integrality of groups, the focus should be expanded t o m ult iple sect or s, inv olv ing not only t he per sons responsible for changes, but including public policies, econom y and cult ure as essent ial variant s t o achieve m odification in the m acro- structure that influences the healt h area( 20).
HEALTH EDUCATI ON FOR LAY CAREGI VERS
Nowadays, t heir are different approaches t o health education. However, in view of their sim ilarities, t h ey can be gr ou ped in t w o pr oposals: t r adit ion al healt h educat ion and radical healt h educat ion, which have recent ly been discussed in Brazil( 3- 5,24).
The t radit ional approach is based on disease p r ev en t i o n , ex p r essi n g t h e h eg em o n i c m o d el o f biom edical care. I n t his approach, act ion focuses on t he disease and on changing individual behavior, and is generated and im posed by health professionals( 3- 4).
I n an ot h er per spect iv e, t h e r adical h ealt h ed u cat ion m od el in t en d s t o w or k w it h a m od er n educat ion per spect iv e, ar ousing people’s and social g r ou p s’ cr it ical aw ar en ess an d in v olv in g t h em in healt h- relat ed aspect s. This proposal aim s t o achieve its goals through group work, with a view to arousing co l l e ct i v e a w a r e n e ss, w h i ch w i l l su p p o r t so ci a l t ransform at ion( 3- 4,24).
I n t he radical m odel, t he role of t he healt h e d u c a t o r i s t h a t o f f a c i l i t a t i n g t h e s u b j e c t s ’ d i s c o v e r i e s a n d r e f l e c t i o n s a b o u t r e a l i t y, a n d i n d i v i d u a l s a r e e m p o w e r e d a n d a u t o n o m o u s t o choose alt er nat iv es( 3- 4).
I n line wit h radical healt h educat ion( 3- 5), it is
ex pect ed t hat cr it ical aw ar eness w ill be ar oused in lay car egiv er s, w hich w ill allow t hem a bet t er life, based on t heir preparat ion t o choose possible ways, wit h a view t o expanding t heir own capacit y t o t ake care of people as well.
Pr of ession al ex p er ien ce con f ir m s t h at lay caregivers are im port ant act ors in care delivery from childhood to old age, independently of the ill person’s healt h st at e. I t is em phasized t hat , t o deliv er car e ex pr essiv ely, it is fundam ent al t o cr eat e condit ions for t he lay car egiv er s t o feel pr epar ed t o per for m t hese funct ions, giving t hem a crit ical view of what t hey are doing. This awareness is needed t o expand t he car e act ion bey ond t he sick per son, ex t ending care t o t he caregivers t hem selves.
Literature highlights that health professionals active in education should expand their praxis beyond t he sim ple t r ansfer ence of infor m at ion, w or k ing t o stim ulate people’s/ groups’ senses, that is: to perceive t he user, t o est ablish relat ions and t o solve com m on problem s( 25). I n t his sense, radical healt h educat ion
The lay caregiver is a new actor to be taken int o account in discussions on healt h educat ion. I t is t hrough healt h educat ion, in com binat ion wit h ot her m easur es, t hat one can m ake out t ools t o par t ially transform the health area. I n m any situations, people affect ed by som e change in t heir healt h st at e have som eone to take care of them during this period. Thus, it should be asked: is t his person t aking care of t he pat ient also t aking care of him - / herself ? I t is known t hat all hum an beings have fragile point s, which can com e t o t he surface any t im e. Hence, when support from lay caregivers is required, these m ay be equally incapable of delivering care t o t he pat ient , because t hey need healt h care t hem selves.
Thus, healt h educat ion em erges as a way t o im plant health care program s for lay caregivers. Even if initially based on disease prevention, they can then m ove on t o t he radical m odel, w hich adapt s t o t he r ealit y of gr oups. I t is believe t hat t hese pr ogr am s can evolve t o t he holist ic paradigm , which considers t he hum an being as a whole and highlight s t hat , in t h is w h ole, t h e lay car egiv er s w ill also h av e t h eir space, as t hey are insert ed in t his care cont ext .
An a n a l y si s o f t h e h o sp i t a l en v i r o n m en t reveals that relatives who take care of and accom pany people w ho ar e consider ed ill som et im es ar e in no appr opr iat e liv ing and healt h condit ions t o per for m t his act ivit y. This represent s a severe and alarm ing Public Healt h problem which, at t he m om ent , is not being included in healt h professionals’ and especially n u r ses’ car e p lan n in g . Mor eov er, n u r ses n eed t o prepare lay caregivers t o carry out int egral inst ead of fragm ent ed care act ions, which norm ally happen. Lit erat ure highlight s t hat t he m ult iple aspect s of t he h e a l t h - d i se a se p r o ce ss sh o u l d b e i n t e g r a t e d , considering prevent ion and prom ot ion t oget her wit h st rict ly curat ive care( 20).
Care is not restricted to the act of delivering som e action to som ebody, but happens based on the existence itself as a hum an being, and it is based on this awareness that one has the opportunity to get to know one’s own possibilities, within the life context( 25).
I t is reaffirm ed t hat healt h educat ion t o lay caregivers is an appropriat e st rat egy t o achieve t he holist ic healt h care paradigm . I n t his art icle, nurses are indicat ed as key pieces t o develop t his process w it h lay car eg iv er s as, d u r in g t h eir p r of ession al t r aining, t hey hav e accum ulat ed ( ev en if par t ially ) , elem ents that can allow them to em erge in this context, besides t he fact t hat t hey work near t he caregiver/
patient groups. I n this sense, the authors agree with ot her r esear cher s’ asser t ion( 24) t hat nur ses, as w ell
as other health professionals, can prom ote individuals’ aw ar en ess of asp ect s in t h eir r ealit y t h at can b e t ransform ed t o facilit at e healt hy choices, using group w or k .
Ba se d o n t h i s a ck n o w l e d g e m e n t o f l a y car eg iv er s’ sig n if ican ce, it is im p or t an t t o cr eat e cont ext ualized m et hods for learning and direct care t o t his part of t he populat ion, encouraging work and research as early as in health professionals’ academ ic educat ion.
FI NAL CONSI DERATI ONS
I t i s v i t a l t h a t p u b l i c p o l i ci e s a n d ca r e st r at eg ies d o n ot ex clu siv ely con cen t r at e on sick p e r so n s w h i l e i g n o r i n g t h e i m p o r t a n ce o f l a y car egiv er s.
Fr om t he per spect iv e of t he holist ic healt h car e p ar ad ig m , t h e im p or t an ce of lay car eg iv er s cannot be disr egar ded. These per sons ar e believ ed t o ( in ) dir ect ly in f lu en ce t h e pat ien t ’s h ealt h car e, whet her by delivering direct care ( such as personal hygiene care) or indirect support ( sim ply by serving as a com panion) . I t is highlighted that ‘taking care of t he car egiv er ’ r eflect s t he concer n t o ex pr essiv ely wat ch over t he hum an being as a whole, considering a m ult i- axis and holist ic approach.
Healt h educat ion pract ice is an im port ant t ool t o st im ulat e t he principles guiding t he not ion of self-car e, t hat is, it is t hr ough healt h educat ion t hat a h e a l t h y l i f e i s a i m e d f o r. Be s i d e s p r o p o s i n g alt ernat ive ways t o lay caregivers, healt h educat ion also deser v es em ph asis becau se it pr epar es t h em t o acq u ir e a cr it ical self - aw ar en ess t o r econ sid er concept s and v alues.
Mor eover, t hr ough radical healt h educat ion, h u m an g r ou p s ar e ‘em p ow er ed ’ b y m ean s of t h e aut onom y t hey r eceiv e t o choose t he best w ay t o follow, but it is known t hat t he alt ernat ives found t o live bet t er are problem at ized collect ively.
I n preventing com plications, nurses can work in act iv it ies dir ect ed at all lay car egiv er s, adv ising t h em t o d el i v er car e t o t h e p at i en t an d eq u al l y st rengt hening self- care. One of t hese care st rat egies can b e d ev elop ed t h r ou g h lay car eg iv er g r ou p s, allowing for j oint experience exchange and stim ulating t h e m t o t a k e r e sp o n si b i l i t y f o r t h e i r h e a l t h , i n accordance wit h t heir possibilit ies.
Nursing professionals should also ident ify lay caregivers who are vulnerable to suffering som e health problem , wit h a view t o decreasing t he chance t hat acute or chronic diseases will occur. I n this perspective, t heir at t ent ion should individually focus on each lay caregiver, w it h a view t o discussing alt ernat ive and specific ways for each situation. The relevance of health ser v ices’ su p p or t p r og r am s is em p h asized , w h ich should provide lay caregivers wit h m echanism s t hat facilit at e m ult iprofessional support , including m edical, p h y siot h er ap eu t ic an d p sy ch olog ical car e, am on g ot hers. Thus, ‘pract icing healt h’ is considered as t he opportunity to offer people access to health services. I n situations when the lay caregivers present som e disease, nur ses act w hen t he healt h pr oblem has alr eady occur r ed. Ther efor e, besides adequat e t r ea t m en t , o n e o f t h e o b j ect i v es sh o u l d b e t h e prevention of relapse. When the problem is identified, nurses need t o inst ruct t he lay caregivers about t he im portance of seeking specialized care. Moreover, they should inform or refer them to som e health institution t o seek t reat m ent . Hence, t he need is reaffirm ed t o cr eat e facilit at ing m echanism s for lay car egiv er s t o achieve care for t heir own healt h.
I t is b eliev ed t h at n u r ses’ p r ax is act u ally depends on healt h educat ion as a way of achieving t he independence and aut onom y of t he person who receives care. The lay caregiver is a part t hat is not attended by the established health system , which does not adequately visualize its im portance in the recovery and r ehabilit at ion of sick per sons’ healt h. How ev er, to avoid this from happening, first, there is a need to take care of the caregivers and prepare them for this a ct i v i t y. He a l t h e d u ca t i o n o f f e r s w a y s f o r l a y caregivers t o t ake care of t hem selves and, from t his p o i n t o n w a r d s, t a k e ca r e o f o t h e r p e o p l e , i n accor dance w it h each cult ur e and values. How ever, in m ost cases, t he lay caregivers only priorit ize care for the persons needing their help, ignoring them selves as beings and solely dedicat ing t hem selv es t o t he per sons r eceiv ing car e.
Therefore, healt h educat ion is im port ant for care to lay caregivers, as it prepares them to preserve t heir healt h and liv e a healt hy life, w it h a v iew t o taking expressive care of persons they are close with. I t is also highlighted that public policies should present proposals t o help t his part of t he populat ion, which cu r r en t h eal t h p r o g r am s st i l l i g n o r e. Th u s, i t i s em phasized t hat care delivery does not only involve t he pat ient , but also t he whole surrounding cont ext , i n w h i ch t h e l a y ca r e g i v e r e m e r g e s a s a ca r e i n st r u m en t . As h ea l t h p r o f essi o n a l s, n u r ses a r e responsible for insert ing t hese subj ect s as a focus in their daily praxis and for involving them as a part of t heir care act ivit ies, using healt h educat ion for t his goal.
REFERENCES
1. Caldas CP. Cuidando do idoso que vivencia um a síndrom e dem encial: a fam ília com o cliente da enferm agem . Rev Texto e Cont ext o Enferm agem 2001 m aio; 10( 2) : 68- 93. 2 . Pe d r o ENR. Vi v ê n ci a s e ( co n ) v i v ê n ci a s d e cr i a n ça s p or t ad or as d e HI V/ AI DS e seu s f am ili ar es: im p l icações ed u ca ci o n a i s. [ t ese] . Po r t o Al eg r e ( RS) : Fa cu l d a d e d e Ed u cação/ PUC- RS; 2 0 0 0 .
3. Oliv eir a DLLC. A ‘nov a’ saúde pública e a pr om oção da saúde via educação: ent re a t radição e a inovação. Rev Lat ino-am Enferm agem 2005 m aio; 13( 3) : 423- 31.
4. Oliveira DLLC. Brazilian adolescent wom en t alk about HI V/ AI DS risk: reconcept ualizing risk sex - what im plicat ions for healt h prom ot ion? [ t hesis] . London ( UK) : Universit y of London; 2 0 0 1 .
5 . Ga st a l d o D . É a e d u ca çã o e m sa ú d e “ sa u d á v e l ” ? r epensando a educação em saúde at r av és do conceit o de bio- poder. Rev Edu cação e Realidade 1 9 9 7 j an eir o- j u lh o; 2 2 ( 1 ) : 1 4 7 - 6 8 .
6. Benj um ea CC. Cuidado fam iliar en condiciones crónicas: u n a ap r ox im ación a la lit er at u r a. Rev Tex t o e Con t ex t o Enfer m agem 2004 j aneir o- m ar ço; 13( 1) : 137- 46.
7 . Kar sch UMS. I dosos dependent es: fam ílias cuidador as. Cad Saúde Pública 2003 m aio; 19( 3) : 861- 6.
8. Karsch UMS, Leal MGS. Pesquisando cuidadores: visit a a um a pr át ica m et odológica. I n: Kar sch UMS, or ganizador a. Envelhecim ent o com dependência: revelando cuidadores. São Paulo ( SP) : EDUC; 1998. p. 21- 45.
9. Karsch UMS. I nt rodução. I n: Karsch UMS, organizadora. Envelhecim ent o com dependência: revelando cuidadores. São Paulo ( SP) : EDUC; 1998. p. 13- 9.
10. Wat anabe HAW, Dernil AM. Cuidadores de idosos: um a ex p er iên cia em u m a u n id ad e b ásica d e saú d e - p r oj et o CapacI DADE. O Mundo da Saúde 2005 dezem br o- out ubr o; 2 9 ( 4 ) : 6 3 9 - 4 4 .
12. Garrido R, Menezes PR. I m pacto em cuidadores de idosos com dem ência at endidos em um serviço psicogeriát rico. Rev Saúde Pública 2004 dezem br o; 38( 6) : 835- 41.
13. Rodr igues MR, Alm eida RT. Papel do r esponsável pelos cuidados à saúde do pacient e no dom icílio - um est udo de caso. Act a Paul Enferm agem 2005 j aneiro; 18( 1) : 20- 4. 1 4 . Pazin at t o MC. Car act er íst icas clín icas e fu n cion ais do paciente idoso que recebe alt a hospit alar e suas necessidades de cuidados após alt a. [ dissert ação] . Port o Alegre ( RS) PUC-RS; 2 0 0 3 .
15. Garcia MAM, Frigerio RM, Miyam ot o DA, Merlin SS. I dosos e cuidadores fragilizados? O Mundo da Saúde 2005 dezem bro-out ubr o; 29( 4) : 645- 52.
16. Tobias MA, Lem os NFD. A percepção do envelhecim ent o do cuidador idoso diant e do cuidado. O Mundo da Saúde 2005 dezem br o- out ubr o; 29( 4) : 653- 61.
17. Silva I P. As relações de poder no cot idiano das m ulheres cuidador as [ disser t ação] . São Paulo ( SP) : PUC- SP; 1995 1 8 . Cer q u eir a ATAR, Oliv eir a NI L. Pr og r am a d e ap oio a cuidadores: um a noção t erapêut ica e prevent iva na at enção à saúde dos idosos. Psicol USP 2002 j aneir o; 13( 1) : 133-5 0 .
19. Gonçalves LHT, Alvarez AM, Sant os SMA. Os cuidadores l ei g o s d e p esso as i d o sas. I n : D u ar t e YAO, D i o g o MJD . At endim ent o dom iciliar: um enfoque geront ológico. São Paulo ( SP) : At heneu; 2000. p. 101- 10.
20. Briceño- León R. Bienest ar, salud pública y cam bio social. I n: Briceño- Leon R, Minayo MCS, Coim bra Jr. CEA. Salud y equidad: una m ir ada desde las ciencias socieales. Rio de Janeiro ( RJ) : Fiocruz; 2000. p. 15- 24.
2 1 . Ma r co n SS, An d r a d e OG, Si l v a D MP. Per cep çã o d e cuidadores- fam iliares sobre o cuidado no dom icílio. Rev Text o e Cont ext o Enferm agem 1998 m aio; 7( 2) : 289- 307. 22. Souza AI J. Cuidando de fam ílias: ident ificando ações de cuidado e não cuidado nos fam iliares. I n: Elsen I , Marcon SS, Sant os MR, organizadoras. O viver em fam ília e sua int erface com a saúde e a doença. Mar ingá ( PR) : Eduem ; 2002. p. 3 6 3 - 8 0 .
2 3 . Hen ck em aier L. Dif icu ldades ao cu idar da f am ília n o hospit al. I n: Elsen I , Marcon SS, Sant os MR, organizadoras. O viver em fam ília e sua interface com a saúde e a doença. Maringá ( PR) : Eduem ; 2002. p. 403- 19.
24. Souza ACS, Colom é I CS, Cost a LED, Olliv eir a DLLC. A e d u ca çã o e m sa ú d e n a co m u n i d a d e : u m a e st r a t é g i a facilit adora da prom oção da saúde. Rev Gaúch Enferm agem 2005 agost o; 26( 2) : 147- 3.
25. Pedroso M. O significado do cuidar de si m esm o para os ed u cad or es em saú d e. [ d isser t ação] . Por t o Aleg r e ( RS) : Escola de Enfer m agem / UFRGS; 2000.
