“O hospital daqui e o hospital de lá” : fronteiras simbólicas do lugar, segundo significações de crianças hospitalizadas

Abstract

This study presents the results of a research that aims to understand the experience of being and staying in hospital according to hospitalized children. Therefore, references now taken start from the conformity with the discussions about the humanization of hospital spaces that highlight the triad: patients, employees, managers as individuals who share reflection exercises and joint responsibility, aiming to improve and guarantee the rights of all parties involved in the maintenance of the Unified Health System (SUS).In this sense, this study is justified by the need of reflection on the listening process of the professional of health care and of education regarded to the infant speech in the context of care practices. The study had as theoretical support the cultural-historical theory from the lens of developmental psychology (Vigotski, 2006; 2009), as well as in studies of Tuan (1980) on space. The methodological guidings feature the study as ethnographic, noting the peculiarities of researches with children. The data were collected through observation, semi structured interview and ichnographic record, at the pediatrics of the university hospital, during 2011, and its comprehensive analysis allowed the drawing of the case studies. The observation sessions occurred at the hospital ward and at the playroom in the hospital in question. The interviews were conducted at the room attached to the playroom – hospital class – and lasted about 40 minutes.The criteria used for the selection of the subjects were aged between seven and 13 years old, the child's desire of participating on the study as an informant and the child responsible authorization by signing the consent form. The data discussion was guided by comprehensive perspective into an exercise dedicated to identify the cores of the senses. Thus, from the observations, may initially identity some senses associated to the hospital ward starting from the bath ritual. By this mean, it highlighted that the hospital ward bathroom is associated to the fear of the pain, to the discomfort feelings and to the stressed conditions. Consequently, the bath ritual aims the modus operandi of the institution that institutes a narrowly flexible routine referring the child to experience the tension between its time and the institution time. Furthermore, the playroom distinguished itself because of the playfulness manifested assumes the status of everybody’s place, where adults and children seek for distraction and relaxation. Thereby it can be characterized as a space of everybody socialization. From the categories of analysis, it is possible to identify that the hospital is characterized as an ambivalent place, marked by routine, the procedure, the hierarchy, but also marked by movements in which child, companion and some professionals seek to bring its subjective basing on humanization principles, as the host, active listening and forming bonds. In this sense, the playroom seems to work as support for all its users. In those cases, the first analyzed refers to the significance of the hospital as a place that deprives people of life. Thus, Gabriela, on think of what the hospital could be, relates it to the elements of hers everyday routine linked to pleasure, dedicating to subtract the significance of what seems to bother her when she is hospitalized - the hole – while she transforms the hospital in a place of her desire linked to the idea of being outside. In the second case, to Desli, the hospital is seen as a place that only work to pierce people, but when emergencies happen it can help those who are bad. In the third case, Fabio, also draws attention to the privation that this place brings to people's lives. For him to be with family and friends is a part of life that the hospital cannot play. In the fourth case, Eduardo, calls attention to the discomfort that the nurses cause with their injection pierce and highlights that the grandmother's house - outside the hospital - is an important place in his life. Thus, such cases place the hospital as a place where people lose

the control of their lives and lose social network contact, but at the same time, they recognize that in this place there is a chance of improvement and restoration of health. Therefore, from the point of view of the subjective construction, human development is not disrupted, even in the hospital, whether they are characterized by the paradigm of humanization or not. Those which are observed are shared meanings, historically forged, advertising to children the specific social regulators, influencing their experiences, significant elements within the subjective manifestations. The data presented herein refer to reflections that can be thought like that: in that the experience of hospitalization optimize experiences more active of the subject, and it situates the subject beyond the patient's condition, we can think of the hospital as part of life and not as suspension of life for their return through healing. Although this dichotomy, here analyzed, seems to foster the belief that sick children must be recluse from the public space to reestablish, and only then, return to experience social processes that identify to be its life. In this sense, one should think that there is subjective life while people are hospitalized and this must be respected and considered. From there it is important to consider the potential identifier of hospital space, because some identity references can be advertised to children with chronic diseases, recurrently hospitalized. This way it is possible to consider that learning and development processes occur both in hospitalized children, and in other children, creating positive effects on subjective constitution of children with chronic diseases. Such questions present themselves to health and education professionals, especially within the hospitals that silence open care practices to playful expressivities.