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- Ansiedade perioperatória em adolescentes: manifestações e necessidades de controlo. Revisão integrativaPublication . Pestana-Santos, Márcia; Reis Santos, Margarida; Pestana-Santos, Adriana; Pinto, Cláudia; Lomba, LurdesBackground: In a phase of development as complex as adolescence, the surgical experience is a great challenge. While there is some knowledge about manifestations of anxiety in children, less is known about manifestations of anxiety in adolescents. Likewise, the knowledge about adolescents needs for control of anxiety in the perioperative period is missing. Aims: To synthesize the existing research on the manifestations of anxiety in adolescents in the perioperative period and to identify the adolescents needs for control of anxiety in the perioperative period. Methods: An integrative review was conducted using a literature search in five different health databases. Only original studies related to the study topic were included. A six-step method was used to develop the revision and to analyze the results. Results: Of the 251 articles initially selected, only five met the inclusion criteria. A total of 114 adolescents from five different countries were represented. The manifestations of anxiety were grouped in psychological, social and physical. These manifestations were mostly related with fear of surgery, how would they deal with pain, body image change, anxiety itself and the separation from their friends. The needs were ‘to be informed’ and ‘to be involved in the decisions about their own care process’. Conclusions: The adolescents have manifestations of anxiety and specific needs to deal with perioperative anxiety, which need to be taken into account in the planning of perioperative care. Further research is needed to promote the development of an evidence-based program tailored to answer to the adolescent’s needs and to minimize their manifestations of anxiety in the perioperative period.
- Uncertainty in post-anaesthesia nursing clinical reasoning: An integrative review in the light of the model of uncertainty in complex health care settingsPublication . Cunha, Lara Daniela Matos; Pestana-Santos, Márcia; Lomba, Lurdes; Reis Santos, MargaridaProblem identification: Post-anaesthesia nursing plays an important role in the early detection and treatment of clinical deterioration after surgery and/or anaesthesia. Concomitantly, the effectiveness of post-operative care is highly dependent on the accurate analysis, synthesis of patient data and quality of diagnostic decisions through clinical reasoning. Given the dynamic processes required to come to a diagnosis, uncertainty is common in clinical reasoning and expected during practice. Nevertheless, uncertainty may permeate the foundations of clinical reasoning, which can jeopardise diagnostic accuracy and consequently the quality and safety of health care. Literature search: The objectives of this review are to identify available evidence related to uncertainty in post-anaesthesia nursing clinical reasoning and to analyse the results from the perspective of the Model of Uncertainty in Complex Healthcare Settings (MUCH-S). A comprehensive search strategy using CINAHL (EBSCO), Cochrane Library (EBSCO), Medline (PubMed), ProQuest and Google Scholar databases was used to find published and unpublished relevant studies. Studies published in English and Portuguese were included. There was no temporal restriction, nor geographical or cultural limitation for the studies included. Data evaluation synthesis: All papers were reviewed by the authors to extract key information about purpose, sample and setting, research design and method, key findings and limitations. The literature search identified a total of 248 studies, 22 of which were retrieved for full reading. A total of four articles were included in this review. Implications for practice: Three main themes were identified: nurses’ intuition to reason, feelings of uncertainty related to lack of nursing knowledge and clinical (in)experience to deal with uncertainty. These findings are encompassed within the MUCH-S taxonomy: personal, scientific and practical. This review offers post-anaesthesia nurses’ greater levels of understanding of this phenomenon and may support more informed and reflexive clinical reasoning.
- Neuman Systems Model in perioperative nursing care for adolescents with juvenile idiopathic scoliosisPublication . Pestana-Santos, Márcia; Reis Santos, Margarida; Cabral, Ivone Evangelista; Sousa, Paula Cristina; Lomba, Maria de Lurdes Lopes de FreitasObjective: To implement the nursing process, based on the Neuman Systems Model and the International Classification of Nursing Practice terminology, in the care of an adolescent who underwent corrective surgery for juvenile idiopathic scoliosis. Method: This is a qualitative study of the type of single case, with triangulation of data collection techniques (formal clinical interview, notes in a field diary and medical record information), developed with a 17-year-old adolescent and indication for corrective surgery. The empirical materials generated with the interviews carried out at admission and at discharge, observation and medical record information were treated with categorical content analysis. Results: The categories of personal condition, anxiety, selfconcept, meaningful people, facilitating health resources, school, free time and leisure were recurrent. Diagnoses were defined with a focus on Anxiety, Knowledge on pain management (control) and Willingness (or readiness) to learn, associating them with the respective nursing interventions. Conclusion: The Model contributed to assess and recognize surgery stressors for the adolescent and to theoretically base the nursing process. The classification allowed systematizing nursing care records, elements of clinical practice, unifying vocabulary and codes.
- Nonpharmacological interventions used in the perioperative period to prevent anxiety in adolescents: a scoping reviewPublication . Pestana-Santos, Márcia; Pires, Rita; Goncalves, Andreia; Parola, Vitor; Reis Santos, Margarida; Lomba, LurdesObjective: The objective of this scoping review was to examine and map the range of nonpharmacological interventions used in the perioperative period to prevent anxiety in adolescents. Introduction: Undergoing surgery involves experiencing fears and uncertainties that lead to an increase in anxiety levels. The interventions used to prevent anxiety in the perioperative period in adolescents must be appropriate to their developmental stage. Inclusion criteria: Studies involving adolescents (10 to 19 years of age) undergoing any type of surgical procedure and specifying any nonpharmacological interventions administered to prevent anxiety, implemented in the perioperative period, were included in this review. Methods: A comprehensive search strategy using multiple databases was employed to find relevant studies. The databases search included MEDLINE via PubMed; CINAHL Plus with Full Text via EBSCO; Cochrane Central Register of Controlled Trials; LILACS; Scopus; Library, Information Science and Technology Abstracts; PsycINFO; JBI Connectþ; and Cochrane Database of Systematic Reviews. Sources of unpublished studies and gray literature were TDX – Tesis Doctorals en Xarxa (Spain); RCAAP – Reposito´ rio Cientı´fico de Acesso Aberto de Portugal; OpenGrey – System for Information on Grey Literature in Europe; and MedNar. Studies published in English, Spanish, or Portuguese were included. There was no date restriction, or geographical or cultural limitation applied to the search. The relevant studies and their reported outcomes were organized and analyzed. Results: The database search yielded 1438 articles, and three additional records were added after hand searching. Title, abstract, and full-text review identified 11 papers that met the inclusion criteria. The final data set represented 947 participants. The data were analyzed according to the type of nonpharmacological intervention, population, concept (outcome measured and tool used), context (physical location; preoperative vs. postoperative), frequency and duration of the intervention, and which professional team member implemented the intervention. Eight nonpharmacological interventions were identified, applied either in the preoperative or postoperative context. The nurses were the main professionals administering the nonpharmacological interventions to the adolescents. Conclusions: A variety of nonpharmacological interventions were used in the perioperative period to prevent anxiety in adolescents. The most common interventions were music/musicotherapy and hypnosis/guided imagery. However, other interventions such as therapeutic play, preoperative preparation program, mothers’ presence during the anesthesia induction, distraction, relaxation training, massage therapy, and reading were also identified. These interventions were used alone or in a combination of two interventions, either preoperatively or postoperatively. The adolescents in the early stage (10 to 14 years) were the most studied group and the adolescents in the late stage (17 to 19 years) were the least studied. Future research should focus on the implementation of nonpharmacological interventions in the perioperative period involving adolescents, particularly late adolescents. A systematic review on the effect of nonpharmacological interventions for anxiety management in adolescents in the perioperative period should be conducted.
- Supervisão clínica do enfermeiro na comunidade para promover a qualidade do cuidado prestado pelo cuidador: protocolo de revisão de escopoPublication . Coelho, Márcia; Esteves, Inês; Mota, Mauro; Pestana-Santos, Márcia; Reis Santos, Margarida; Pires, ReginaIntrodução: Os cuidadores geralmente não possuem conhecimentos e habilidades para prestar cuidados. Os enfermeiros têm um papel decisivo na qualidade dos cuidados e nos resultados na saúde das pessoas. A supervisão clínica do enfermeiro é um processo estratégico e formal que requer uma relação supervisiva coesa. Objetivo: Mapear as estratégias de supervisão utilizadas pelo enfermeiro na comunidade para promover a qualidade do cuidado prestado pelo cuidador. Métodos: Esta revisão seguirá as diretrizes do Instituto Joanna Briggs para revisões de escopo e incluirá estudos sobre enfermeiros que implementaram estratégias de supervisão clínica para promover a qualidade do cuidado prestado pelo cuidador em contexto comunitário. Estudos publicados e não publicados em inglês, português ou espanhol desde 1993 serão considerados. A seleção dos estudos será realizada por dois revisores independentes, utilizando um terceiro revisor em caso de discordância. Os resultados da pesquisa, seleção de estudos e processo de inclusão serão apresentados num fluxograma PRISMA para revisões de escopo. A extração dos dados, análise de evidências e resultados sobre a extensão e tipo de evidências serão apresentados numa tabela. Resultados: A pesquisa bibliográfica prévia permitiu identificar algumas estratégias supervisivas implementadas por enfermeiros para promover a qualidade dos cuidados prestados pelo cuidador. Conclusão: Esta revisão contribuirá para identificar estratégias de supervisão utilizadas pelos enfermeiros para promover a qualidade dos cuidados prestados pelos cuidadores.