![](data:image/png;base64,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)
em relação à amamentação foram favoráveis. A opinião
positiva sobre aleitamento materno de uma avó tinha o
potencial de influenciar uma mãe até 12% a iniciar a
amamentação. Por outro lado, uma opinião negativa tem a
capacidade de diminuir a probabilidade de amamentação
até 70%.
17
Neste sentido, torna-se pertinente permitir e
incentivar a presença e participação das avós nos cuidados
de saúde prestados às gestantes e pais, se for o desejo
destes, principalmente no período perinatal.
A ambivalência de sentimentos dos pais em relação aos
avós, foi outro aspeto destacado nesta revisão scoping. Se por
um lado, os pais apreciam e reconhecem a importância do
apoio dos avós na transição para a parentalidade, por outro
lado, quando há visões divergentes em relação a conceitos
e convicções relativas às crianças, através do
questionamento das atitudes e papéis parentais e através do
julgamento critico sobre as suas capacidades, existe uma
ambivalência de sentimentos, que pode conduzir a conflitos
intergeracionais.
12,21
A comunicação clara e direta leva a
uma melhor relação familiar e entendimento mútuo, em
detrimento da crítica.
21
Por outro lado, a forma de
comunicação mais ineficaz traduz-se nos conselhos
indesejados dos avós, podendo estes serem percebidos
como uma critica aos cuidados parentais, afetando a
confiança nas próprias competências parentais.
15
Neste
sentido, os profissionais de saúde, podem assumir um papel
de mediadores dos conflitos, através do esclarecimento de
pontos de vista, baseando-se na mais recente evidência
cientifica. De acordo com um estudo qualitativo
exploratório,
21
todos os participantes do mesmo
manifestaram o desejo de que os profissionais de saúde
pudessem ajudá-los, acreditando que estes estão em melhor
posição para mediar os conflitos familiares.
Vários artigos referem ainda, uma lacuna nos cuidados de
saúde relativamente à inclusão de pessoas significativas no
cuidado à mulher, nomeadamente dos avós, representando,
estes uma fonte de apoio crucial na transição para a
parentalidade.
6,11,21
É importante que os profissionais de
saúde, nomeadamente os que realizam a preparação para o
parto e que promovem a adaptação à parentalidade,
reconheçam o papel dos avós, fazendo uma avaliação
completa, que permitirá prestar cuidados apropriados tanto
para os pais como para os avós, adotando uma abordagem
mais inclusiva.
Conclusão
Os diversos artigos analisados identificaram os vários
papéis que os avós podem ter na transição para a
parentalidade dos seus filhos nos mais distintos locais do
mundo, indo ao encontro do objetivo desta revisão scoping,
bem como respondendo à questão de investigação
formulada. Para além de identificar os papéis dos avós na
transição para a parentalidade dos seus filhos, também
identificou os possíveis sentimentos e conflitos que podem
surgir entre estes e os seus filhos neste período, sugerindo
que é através de uma comunicação clara e assertiva, que
estes se podem resolver. Identificou, igualmente, lacunas
relativamente aos cuidados de saúde e à integração dos avós
nos mesmos, sugerindo que os profissionais de saúde
incluam os avós na sua abordagem de cuidados.
Sendo o enfermeiro, um dos principais prestadores de
cuidados de saúde à mulher e casal na transição para a
parentalidade, torna-se importante incorporar os resultados
desta revisão scoping, com o intuito de perspetivar uma
contínua melhoria nos cuidados prestados por este, nos
diversos contextos. Assim, este, deve envolver as pessoas
significativas no processo de cuidados, integrando-as,
também, como clientes dos cuidados e estabelecendo
parcerias com as mesmas.
Ao percebermos os diferentes papéis que os avós podem
representar na transição para a parentalidade, melhor
entenderemos a importância de os integrar nos cuidados de
saúde à mulher/casal e criança, neste processo. Porém, este
aspeto implica uma avaliação individual e personalizada,
pois cada pessoa é única. Vivemos numa sociedade cada
vez mais multicultural e com necessidades específicas de
cuidados de saúde. Salientamos como ponto forte desta
revisão scoping, a multiculturalidade dos diversos estudos
incluídos, permitindo alargar a visão de cuidados e
alertando para as diferentes perspetivas e especificidades de
cada indivíduo como ser social, cultural e espiritual. Por
outro lado, salientamos como limitações essa mesma
multiculturalidade dos estudos, o que não permite uma
generalização dos resultados; assim como a maioria dos
estudos selecionados focam apenas as mulheres/gestantes
e as avós na transição para a parentalidade. Embora cada
vez mais, se atribui um papel vital também às figuras
masculinas relativamente à parentalidade, ainda hoje, em
muitas culturas esta é vivida, sobretudo no feminino.
Importa, portanto, considerar que por vezes, pode haver
casais que prefiram incluir os pais, nomeadamente as mães,
no seu processo de saúde durante a transição para a
parentalidade.
Considera-se necessário haver mais investigação sobre esta
temática, particularmente em Portugal, com o objetivo de
consciencializar os profissionais de saúde, nomeadamente
os enfermeiros, sobre a importância da integração da
família nos cuidados de saúde. Sugere-se, assim, a realização
de futuros estudos primários, com o intuito de conhecer a
realidade portuguesa sobre o papel dos avós na sociedade
contemporânea.
Contribuições autorais
IS: Conceção e desenho do estudo; Recolha de dados;
Análise e interpretação dos dados e Redação do manuscrito.
HB: Recolha de dados; Análise e interpretação dos dados;
Revisão crítica do manuscrito.