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- Eficácia da intervenção da enfermagem pré-hospitalar na estabilização das vítimas de traumaPublication . Mota, Mauro; Cunha, Madalena; Santos, Eduardo; Figueiredo, Ândrea; Silva, Márcio; Campos, Rui; Reis Santos, MargaridaAbstract Background: Trauma is a public health issue with a significant social and economic impact. However, national data on its characterization and the role of nursing in its management is still scarce. Objective: To assess the effectiveness of prehospital nursing interventions in stabilizing trauma victims provided by nurses of Immediate Life Support Ambulances in Portugal. Methodology: Observational, prospective, and descriptive-correlational study. Data were collected by nurses of the Immediate Life Support Ambulances in mainland Portugal, from 01/03/2019 to 30/04/2020, and the Azores, from 01/10/2019 to 30/04/2020. Trauma severity indices were assessed before and after the nursing interventions. Results: This study included 606 cases (79.4% blunt trauma; 40.8% road accidents) reported by 171 nurses. Nurses performed mostly interventions for hemodynamic support (88.9%) and non-pharmacological pain control (90.6%) of trauma victims. The nursing interventions improved the Revised Trauma Score and the Shock Index (p<0.001). Conclusion: Prehospital nursing interventions improve trauma victims’ clinical status.
- Nurses’ Views on How to Best Design a Program to Prevent Adolescents’ Anxiety in the Perioperative Period. A Qualitative StudyPublication . Pestana-Santos, Marcia; Pestana-Santos, Adriana; Cabral, Ivone Evangelista; Reis Santos, Margarida; Lomba, LurdesPurpose: To describe the nurses' views for consideration when designing a program to prevent adolescents' anxiety in the perioperative period. Design: A qualitative descriptive case study using focus group and thematic analysis was conducted. Methods: Three face-to-face focus group interviews were conducted in October and November 2019 in the pediatric department of a university hospital. A purposive criterion method was applied to achieve a sample of 19 pediatric nurse specialists. Data were organized and systematized in the professional software for qualitative and mixed methods data analysis software (MAXQDA) and treated through the thematic analysis method. The COREQ checklist was used to report data collection, analysis, and results. Findings: Four major themes and 14 subthemes regarding the perioperative period were generated. The first, adolescent evaluation, included the knowledge evaluation about procedures, signs and symptoms, and desire to be engaged in care. The second, caring adolescents and parents, means that nurses must be ready to care for both, use the opportunities to implement the nursing interventions, and manage physical teen space to accommodate adolescents in the ward. The third, nurses' challenges in the perioperative period, comprise the lack of time and trained nurses to work with adolescents, and the absence of prior adolescents' preparation and postoperative feedback. The fourth, nursing consultation, consists in promoting interdisciplinarity, developing the nursing interventions, and the main content to be included in the program's design. Conclusions: Given the challenges experienced by nurses when caring for adolescents in the perioperative period, nurses suggested a systematized assessment of the adolescent at an early stage of the perioperative caring process. Added to this is the nurse’s readiness for the adolescent and parents, as well as the existence of trained nurses to evaluate adolescents and to implement non-pharmacological interventions in the perioperative period. A nursing consultation emerges as the most suitable solution to include in a program to prepare adolescents for the surgical procedure and help them to manage anxiety. This kind of intervention should begin in the preoperative period, preferably after the decision on the need for the procedure.
- Estratégias de supervisão clínica: análise crítico-reflexiva das práticasPublication . Pires, Regina; Reis Santos, Margarida; Pereira, Filipe Miguel Soares; Pires, MargaridaIntrodução: A supervisão clínica em enfermagem é um processo formal de acompanhamento da prática clínica, que visa promover o desenvolvimento profissional, a proteção dos clientes e a segurança dos cuidados, através de processos de reflexão e análise das práticas. Objetivo: Identificar estratégias de supervisão clínica em uso. Métodos: Estudo qualitativo, exploratório. Os participantes foram 42 Enfermeiros de três Centros de Saúde da região norte de Portugal. Recolha dos dados através de entrevista semiestruturada e análise efetuada segundo os princípios do método da grounded theory. Resultados: Da análise emergiu a categoria “Análise crítico-reflexiva das práticas” e respetivas dimensões e subcategorias. As dimensões identificadas foram: “Dimensão intrapessoal”, da qual emergiram duas subcategorias; e a “Dimensão interpessoal”, da qual emergiram dez subcategorias. Conclusão: Concluiu-se que existia um conjunto de estratégias de supervisão em uso, promotoras do desenvolvimento profissional, nomeadamente, a análise crítico-reflexiva das práticas. Contudo, constatou-se que havia um conjunto de constrangimentos de natureza individual e contextual que podiam interferir com a operacionalização desta estratégia, que exige serem refletidos.
- 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.
- Adolescents’ perioperative experiences in relation to inpatient and outpatient elective surgery – a qualitative studyPublication . Pestana‐Santos, Marcia; Pestana‐Santos, Adriana; Reis Santos, Margarida; Lomba, LurdesBackground: Perioperative experience can be very distressing in adolescence if not managed properly by healthcare professionals. In the clinical context, the emotional expression of the adolescent is less spontaneous, which makes the assessment of anxiety, pain or even the desire to be involved in the perioperative process, difficult. Listening to their perioperative experiences will permit an understanding of their difficulties and expectations, regardless of the surgical intervention undergone. Aim: To explore the adolescents’ perioperative experiences in relation to inpatient and outpatient elective surgery. Methods: Qualitative exploratory study, with thematic analysis approach. A purposive sample of 40 adolescents aged 14–18 years and in the perioperative period, from two paediatric surgery settings in a university hospital, was questioned from January to July 2020. Data were collected using a semi-structured interview and analysed inductively with qualitative thematic analysis. Results: The data yielded one major theme, five themes, and 14 sub-themes. The major theme, Adolescent in perioperative period, included the five themes: (1) emotional and psychological aspects; (2) physical aspects; (3) social aspects; (4) organizational aspects; (5) previous surgical experience. Adolescents expressed fear of the unknown, anxiety, difficulty in pain control, and feelings of autonomy loss. Issues related to withdrawal from school and friends is also a focus of adolescent concern during the perioperative period. Despite showing satisfaction with the way they were cared for, they complained about the lack of pre-and post-operative preparation. Conclusion: There are aspects that should be considered when caring for adolescents in perioperative period. As far as possible, programmes to prevent adolescents’ anxiety in perioperative period should be designed in a holistic perspective, with aim at the psychological, physical, sociocultural, and organisational aspects.
- Efectiveness of family-centred educational interventions for anxiety, pain and behaviours of children and adolescents and anxiety of their parents during the perioperative journey: A systematic review and meta-analysisPublication . Esteves, Inês Martins; Coelho, Marcia Silva; Neves, Hugo; Pestana-Santos, Marcia; Reis Santos, MargaridaAim: To evaluate the e,ectiveness of family-centred educational interventions on the anxiety, pain and behaviours of children and adolescents (three to 19 years old) and their parents’ anxiety during the perioperative journey. Design: Systematic review of e,ectiveness and meta-analysis. Data sources: MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, SciELO and Sources of unpublished studies OpenGrey, Open Access Theses and Dissertations, and RCAAP – Portugal were systematically searched from January 2007 to April 2021 for available articles in English, Spanish and Portuguese. Review methods: This review followed the methodology for systematic reviews of e,ectiveness from Joanna Briggs Institute (JBI). Included studies were critically appraised using JBI Critical Appraisal Checklist for Randomised Controlled Trials and JBI Critical Appraisal Checklist for Quasi-Experimental Studies. Data was synthesised through meta-analysis, using a random-e,ects model in the Stata Statistical SoZtware 16.0, and narrative synthesis. Two independent reviewers performed the selection process, critical analysis, and data extraction. Results: Twenty-eight studies (26 randomised controlled trials (RCTs) and two quasi-randomised controlled trials) were included with a total of 2516 families. In a meta-analysis of ten RCTs with 761 participants, pre-operative anxiety management was more e,ective in children and adolescents who received educational interventions (SMD = -1.02; SE = 0.36; 95% CI [-1.73; -0.32]). At the induction of anaesthesia, children and adolescents were significantly less anxious (SMD = -1.54; SE = 0.62; 95% CI [-2.72; -0.36]) and demonstrated better compliance than controls (SMD = -1.40; SE = 0.67; 95% CI [-2.72; -0.09]). Post-operative pain (SMD = -0.43; SE = 0.33; 95% CI [-1.05; 0.19]) and pre-operative parental anxiety (SMD = -0.94; SE = 1.00; 95% CI [-2.87; 0.99]) were reduced in favour of the educational interventions. Conclusion: Family-centred educational interventions probably lead to a considerable reduction of paediatric and parental anxiety and improve paediatric behaviours at induction of anaesthesia. The evidence is very uncertain regarding the e,ectiveness of these interventions on post-operative paediatric maladaptive behaviours and pain intensity or parental anxiety levels at the induction of anaesthesia.
- O enfermeiro no pré-hospitalar: cuidar para a curaPublication . Mota, Mauro; Cunha, Madalena; Reis Santos, MargaridaIntrodução: A presença de enfermeiros no contexto pré-hospitalar português remonta ao ano de 1981. Em 2007, constituíram-se as Ambulâncias Suporte Imediato de Vida do Instituto Nacional de Emergência Médica, onde os enfermeiros assumem a função de team leaders. Esta reflexão tem como objetivo analisar o papel dos enfermeiros no socorro pré-hospitalar. Desenvolvimento: O contexto pré-hospitalar imprime fortes desafios à Enfermagem e à sua identidade profissional. Os enfermeiros conduzem as suas intervenções e tomam as suas decisões de acordo com a melhor evidência científica, seguindo protocolos terapêuticos predefinidos. Enquanto lideres da equipa de socorro, são responsáveis pela gestão dos diferentes intervenientes que prestam assistência no pré-hospitalar, garantindo a segurança dos cuidados de saúde. As pessoas socorridas no pré-hospitalar depositam no enfermeiro as esperanças não só de garantir a sua sobrevivência, como também, de que no decorrer do socorro, o cuidar, intimamente ligado à génese da Enfermagem, seja também salvaguardado. A produção e disseminação de conhecimento científico contribuirá para a otimização de todas as práticas autónomas e interdependentes. Conclusões: O papel do enfermeiro do pré-hospitalar assenta em três pontos fundamentais: administração de cuidados de Enfermagem no processo de cura/saúde; implementação de metodologias de gestão do risco e desenvolvimento de estratégias de gestão para a segurança do socorro; promoção de investigação no âmbito da prestação de cuidados de emergência que contribuam para a melhoria dos cuidados de Enfermagem prestados. A disseminação do conhecimento que corrobora as práticas vigentes no contexto pré-hospitalar contribuirá para que se perceba a importância da participação de enfermeiros no quadro da emergência e para a afirmação da imprescindibilidade e insubstituibilidade da sua intervenção no pré-hospitalar.
- Nurse managers in mental health units: from activities to time managementPublication . Alferes, Luísa Paula da Silva Pires; Martins, MM; Reis Santos, Margarida; Teixeira, Manuela; Poeira, Ana Filipa da Silva; Pires, Regina; Asseiro Alferes, Rui PauloObjective: to understand the use of time by nurse managers in psychiatry and mental health units, as they carry out their daily tasks. Methods: cross-sectional study, carried out by 48 managers from public psychiatric units and from the social sector. Data collection was made through an online questionnaire that is part of the Scale of Perception of Nurse Manager Work, including 43 items separated in five functional domains of nurse managers. The responses were in a Likert scale: does not take time, takes little time, takes some time, takes much time. Results: the activities inherent to ethical and legal professional practices and to the management of care and of human resources required more time from the manager when compared to policy interventions, and consulting and professional development. Conclusion: the managers recognize that managing time implies organization, planning work, and establishing priorities in the tasks to be developed.
- Atitude dos enfermeiros gestores face à morte: repercussões da pandemia por COVID-19Publication . Passos Teixeira Cardoso, Maria Filomena; Martins, MM; Ribeiro, Olga; Sousa Cruz Pereira, Virgínia Lucinda; Pires, Regina; Reis Santos, MargaridaObjetivo: analisar as atitudes dos enfermeiros gestores face à morte, antes e após o período crítico da pandemia por COVID-19. Método: estudo quantitativo, transversal e comparativo, realizado em uma instituição hospitalar do Norte de Portugal. A coleta de dados ocorreu através de questionário, que integrava a Escala de Avaliação do Perfil de Atitudes acerca da Morte, em dois momentos. O primeiro ocorreu em 2018, com participação de 28 enfermeiros gestores, e o segundo, em 2020, com 21 enfermeiros gestores. Resultados: globalmente, os participantes manifestaram maior concordância com as atitudes “aceitação neutral/neutralidade” e “medo”. Embora algumas das cinco dimensões das atitudes não tenham apresentado diferenças significativas entre o primeiro e segundo momento, constatou-se que em relação à “aceitação como aproximação”, a média obtida no momento, após o período crítico da pandemia por COVID-19, foi superior. Conclusão: a partir dos resultados emerge a importância de se investir na preparação dos enfermeiros gestores para lidar com a morte e o processo de morrer, com uma dupla intencionalidade: minimizar o seu sofrimento e assegurar a otimização do acompanhamento e apoio aos enfermeiros da equipe que lidera.