Aplicação do brinquedo terapêutico instrucional sobre o cateterismo vesical em crianças hospitalizadas

Abstract

Among the playful interventions proposed for children undergoing hospitalization, Therapeutic Toys which can be classified in three types: dramatic, physiological and instructional function. The instruction toy aims to clarify and train the child-family about hospitalization and the therapy involved. This is a descriptive and exploratory study with a qualitative approach through multiple case studies, supported by Winnicott contributions, with the aim of understanding the meaning attributed by hospitalized children to participating in preparation for bladder catheterization. Ten children hospitalized in the University Hospital in a northeastern capital from October to November 2023 participated. Data collection occurred in three phases: 1) collection of data from medical record; 2) intervention with instruction toy; 3) semi-structured interview with the child. The second and third phases were recorded in video and audio using electronic media and transcribed at all. The field diary was used to record observations related to non-verbal communication during the use of the therapeutic toy and the interview. The criteria used to interrupt collection was theoretical saturation od the data. The data was analyzed based on inductive thematic analyses with the support of Winnicott theorical framework, resulting in the identification of three themes: control over reality, perceptions related to instruction toy, bladder catheterization from the perspective of hospitalized children. The study follows ethical prerogatives required by resolution number 466-2012, from Nation Health Council and its complements, being approved by sight number 6.417.881 and CAAE 71444523.0.0000.5537, issued by the Ethics and Research Committee of the Federal University of Rio Grande do Norte. For children, Therapeutic toys allow them to have control over reality, decide what to do and want to be. By reliving previous experiences, they had the opportunity to dramatize their experiences related to past and current hospitalizations, with the aim of, through creativity deal with the situation better. It was identified that the children perceive therapeutic toys as a pleasurable activity, as it allows them to enter their imagination and play, but it also awakens paradox or negative feelings by reviving memories of past experiences. For some children, bladder catheterization meant healing and care and, as it was an invasive procedure, it was associated with pain. For others children, when contacting their internal reality, the therapeutic toy caused internal disorders and disturbed feeling, which caused an escape from reality. Although the session was intended to instruct children about bladder catheterization, it became a dramatic therapeutic toy recounting their experience and expressing emotions and perceptions related not only to the catheterization, but also to other procedures experience during hospitalization.