Nursing strategies for child health surveillance 1

ABSTRACT Objective: to appreciate the strategies promoted by nurses in the context of child health surveillance relevant to early childhood development. Method: this is a qualitative study with an inductive thematic analysis of the data, based on the conceptual principles of child health surveillance, and developed through semi-structured interviews with Brazilian nurses working with families in primary health care. Results: the nurses’ strategies in favor of child health surveillance focus on actions that anticipate harm with continuous follow-up and monitoring of health indicators. The process of child growth and development is the basis for responses and benefits to health, connection with the daily lives of families, active search, articulations between professionals and services, access to comprehensive care, and intrinsic actions between promotion, prevention and health follow-up. Conclusion: child health surveillance actions developed by nurses with families involve knowledge sharing, favor the resolution of problems, increase child health indicators, and strengthen the relationship between health and children’s rights, which support the promotion of development in early childhood.


Method
This is a qualitative study with thematic analysis of the data, based on the conceptual principles of child health surveillance (1,8) , focusing on actions that anticipate damages or injuries and interventions for promotion, prevention and continuous monitoring in search for integral health care. Form. There were 3 nurses who refused to participate, and one was on sick leave during the data collection.
After accepting to participate, and after signing the Informed Consent Form, the participants received a copy with the researcher's signature. Thus, 21 nurses who met the inclusion criteria participated in the study.
Data collection was terminated based on exhaustion, after approaching all eligible subjects.
Data collection was performed through semistructured interviews, using the following questions: Additional questions were asked to the nurses to clarify doubts and to deepen their professional experiences.
The interviews were carried out from January to April 2014, in a private room in the work environment, and lasted from one to one and a half hours. Interviews were previously scheduled with the nurses, recorded in MP3 format, and transcribed verbatim. After transcription and analysis, they were deleted.
In this study, data were treated in a qualitative way, with the investigation of relevant aspects of the strategies Yakuwa MS, Neill S, Mello DF. used by the nurses to provide care for children, in the context of the FHS, based on the premises of health surveillance under PHC. In the analysis of the qualitative data, we used thematic inductive content analysis (14) . In the inductive model, the identified themes are extracted from the data, in which the inductive analysis represents a process of coding of the data, which are not fixed a priori, that is, the coding is directed and based on the data itself (14) . In this research, the elements of the practices of nurses were identified, analyzed and reported from the collected data, culminating in themes that translate significant parts and are based on the data set.

Results
The characteristics of the 21 participating nurses who work in family health units are initially presented.
All participants were female and the age ranged from In the analysis of qualitative data, the significant dimensions were grouped into four thematic units, which were built from interviews reports, according to     In the thematic unit of Building trust, bonding and intersectoral work, the strategy to establish a bond between professionals and families were highlighted.  investigations (2)(3)(4)(5)9,(11)(12)(13) . Since the year 2000, the term 'child health surveillance program' has been expanded to 'child health promotion program' (1) , with greater emphasis on early detection of harms and vulnerabilities. It is therefore necessary to ensure the survival of children, but also to offer the conditions to live with quality, to grow, to develop and to reach its full development potential (3,15) .
In this focus, the present study points out that nurses A study (16)  to care, reduced costs and salutogenic characteristics of empowerment for social changes (16) .
Childcare consultations were highlighted as part of the practice of child health surveillance, considering socioeconomic, environmental and cultural aspects, and provision of guidelines for mothers on breastfeeding, vaccination, hygiene, among others. The education of mothers/caregivers has been emphasized to give families subsidies for protective care to children's health (2)(3)(4)(10)(11) . Home visits and the active home search were also emphasized in child health surveillance, in line with other international investigations that address these practices as relevant to evaluate the mother-child interaction and the attention to the child (17) , and to allow a closer understanding of health-disease determinants and contribute to the improvement of the trajectories of children, women and families (13,18) . surveillance (9) . A study (20) showed that nurses who work in primary health care print a practice that provides safe and effective primary care.
In the present research, the interviewed nurses did