Uncertainty in post-anaesthesia nursing clinical reasoning: An integrative review in the light of the model of uncertainty in complex health care settings

Problem 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Cochrane Library (EBSCO), Medline (PubMed), ProQuest and Google Scholar databases was used to find published and unpublished relevant studies.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.info:eu-repo/semantics/publishedVersio

Perioperative anxiety in adolescents: manifestations and control needs. An integrative review

Background: 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.info:eu-repo/semantics/publishedVersio

Nonpharmacological interventions used in the perioperative period to prevent anxiety in adolescents: a scoping review

Objective: 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.info:eu-repo/semantics/publishedVersio

Affectus & alter-ego - formação em saúde sexual e reprodutiva para jovens adultos

En lo referente a la salud sexual y reproductiva hay varios temas implícitos que van desde el bienestar físico y la ausencia de la enfermedad, a la posibilidad de decidir libremente si se quiere tener o no familia. Pero la salud sexual y reproductiva también se refiere al bienestar emocional que viene de una experiencia sexual segura y placentera. El objetivo de este estudio piloto es evaluar el nivel de conocimientos sobre salud sexual y reproductiva entre los adultos jóvenes matriculados en cursos de Enseñanza Superior en los cursos de Educación y Formación de Adultos. Este estudio piloto se incluye en el Proyecto Affectus &Alter-Ego y contó con la participación de 94 personas de dos instituciones de enseñanza en Coimbra. Los datos se recogieron a lo largo del año académico de 2011- 2012 por medio de un cuestionario con respuestas cerradas (V / F) analizados descriptivamente. Los resultados obtenidos en las cuestiones relacionadas con la sexualidad, la anticoncepción y las ITS, sugieren la existencia de una carencia efectiva en los niveles de información sobre la salud sexual y reproductiva entre los adultos jóvenes. Verificándose que la diferencia de la calidad de la información sobre salud sexual y reproductiva no es significativa en la diversidad de género o niveles de formación / educación.In regards to sexual and reproductive health there are various implicit topics ranging from the physical well-being and the absence of disease to the possibility to freely decide if a family is wanted or not. But sexual and reproductive health also relates to the emotional well-being that comes from a safe and pleasurable sexual experience. The aim of this pilot study is to assess the level of knowledge concerning sexual and reproductive health among young adults enrolled in college and second level Adult Education and Training courses. This pilot study is included in the Affectus Alter-Ego Project, and involved the participation of 94 individuals of two schools in Coimbra. The data was collected throughout the academic year of 2011- 2012 by the means of a questionnaire with closed responses (T/F) and analysed descriptively. The results on issues relating to sexuality, contraception and STI, suggest a lack of effective levels of information about sexual and reproductive health among young adults, and the difference in the quality of the information is not significant in either gender diversity or levels of training/education.Quando se fala em Saúde Sexual e Reprodutiva estão implícitos vários temas, que vão desde o bem-estar físico e a ausência de doenças, à possibilidade de decidir livremente se se quer ter, ou não, uma família. Mas a saúde sexual e reprodutiva também diz respeito ao bem-estar emocional através de uma vivência sexual prazerosa e segura. O objectivo deste estudo piloto é avaliar o nível de conhecimento sobre saúde sexual e reprodutiva dos jovens adultos pertencentes ao Ensino Superior e a cursos de Educação e Formação de Adultos de nível Secundário. Este estudo piloto, inserido no Projecto Affectus & Alter-ego, teve a participação de 94 sujeitos, em duas instituições de ensino em Coimbra. Os dados foram recolhidos no ano lectivo 2011-2012 através de um questionário com questões de resposta fechada (V/F) e analisados de forma descritiva. Os resultados obtidos nas questões relacionadas com sexualidade, contracepção e IST, sugerem a existência de uma carência efectiva aos níveis da informação sobre saúde sexual e reprodutiva junto dos jovens adultos. Verificando-se que a diferença de qualidade da informação que detêm sobre saúde sexual e reprodutiva não é significativa quer na diversidade de género ou níveis de formação/ ensinopeerReviewe

Supervisión de enfermero en la comunidad para promover la calidad del cuidado prestado por el cuidador: protocolo de revisión del alcance

Introdução: 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.Introduction: Caregivers do not usually have the knowledge and skills to provide care. Nurses have a decisive role in the quality of care and people's health outcomes. Clinical supervision of nurses is a strategic and formal process that requires a cohesive supervisory relationship. Objective: To map the supervisory strategies used by nurses in the community to promote the quality of care provided by caregivers. Methods: This review will follow the Joanna Briggs Institute guidelines for scoping reviews and will include studies about nurses who have implemented clinical supervision strategies to promote the quality of care provided by caregivers in the community. Published and unpublished studies written in english, portuguese or spanish since 1993 will be considered. Study selection will be carried out by two independent reviewers, using a third reviewer in case of disagreement. The search results, study selection and inclusion process will be presented in a PRISMA flowchart for Scoping Reviews. Data extraction, analysis of evidence and results about the extent and type of evidence will be presented in a tabular form. Results: The previous bibliographic research allowed the identification of some supervisory strategies implemented by nurses to promote the quality of care provided by the caregiverIntroducción: Los cuidadores generalmente carecen del conocimiento y las habilidades para brindar atención. Enfermeros juegan un papel decisivo en la calidad del cuidado y en los resultados de salud. La supervisión clínica de enfermeros es un proceso estratégico y formal que requiere una relación supervisora cohesionada. Objetivo: Mapear las estrategias de supervisión utilizadas por el enfermero en la comunidad para promover la calidad del cuidado prestado por el cuidador. Métodos: Esta revisión seguirá las pautas del Instituto Joanna Briggs para las revisiones del alcance y incluirá estudios sobre enfermeros que hayan implementado estrategias de supervisión clínica para promover la calidad del cuidado prestado por el cuidador en la comunidad. Se considerarán las fuentes de información publicadas y no publicadas en inglés, portugués o español desde 1993. La selección de estudios será realizada por dos revisores, utilizando un tercer revisor en caso de desacuerdo. Los resultados del proceso de investigación, selección de estudios e inclusión se presentarán en un diagrama PRISMA. La extracción de datos, el análisis y los resultados sobre el alcance y el tipo de evidencia se presentarán en una tabla. Results: La investigación bibliográfica previa permitió identificar algunas estrategias de supervisión implementadas por enfermeros para promover la calidad del cuidado prestado por el cuidador. Conclusión: Esta revisión contribuirá a identificar las estrategias de supervisión usadas por enfermeros para promover la calidad del cuidado prestado por los cuidadores.info:eu-repo/semantics/publishedVersio

Antenatal care policy in high-income countries with a universal health system: A scoping review

The availability, effectiveness, and access to antenatal care are directly linked with good maternal and neonatal outcomes, making antenatal care an important determinant in health. But to be effective, care must always be appropriate, not excessive, not insufficient. Perinatal outcomes vary within and between countries, raising questions about practices, the use of best evidence in clinical decisions and the existence of clear and updated guidance. Through a scoping review methodology, this study aimed to map the available antenatal care policies for lowrisk pregnant women in high-income countries with a universal health system, financed by the government through tax payments. Following searches on the main databases and grey literature, the authors identified and analysed ten antenatal care policies using a previously piloted datachart: Australia, Denmark, Finland, Iceland, Italy, Norway, Portugal, Spain, Sweden and the United Kingdom. Some policies were over 10 years old, some recommendations did not present a rationale or context, others were outdated, or were simply different approaches in the absence of strong evidence. Whilst some recommendations were ubiquitous, others differed either in the recommendation provided, the timing, or the frequency. Similarly, we found wide variation in the methods/strategy used to support the recommendations provided. These results confirm that best evidence is not always assimilated into policies and clinical guidance. Further research crossing these differences with perinatal outcomes and evaluation of cost could be valuable to optimise guidance on antenatal care. Similarly, some aspects of care need further rigorous studies to obtain evidence of higher quality to inform recommendations.info:eu-repo/semantics/publishedVersio

Intrapartum care policies in high-income countries with a universal health system: A scoping review

Evidence-based and sustainable intrapartum care policies are essential for safer, effective, and positive birth experiences. This scoping review aimed to map intrapartum care policies for pregnant women at low-risk of complications, in high-income countries with a universal health system. The study followed Joanna Briggs Institute methodology for scoping reviews and PRISMA-ScR. Search was conducted on CINAHL-EBSCO, Scopus, MEDLINE-Pubmed, Cochrane Central Register of Controlled Trials-EBSCO, and, Academic Search CompleteEBSCO. Grey literature was searched, references screened and experts contacted for additional studies/policies. Data were extracted/analysed by two independent reviewers and results were presented in tabular and narrative format. The concept was governmental intrapartum care policies, the context were OECD high-income countries with a health-financing system founded on the Beveridge Model and the participants were low-risk pregnant women From the 561 records screened, 22 were selected, concerning intrapartum care policies from Australia, Denmark, Spain, Finland, Portugal, and the United Kingdom. All the included records were retrieved in the grey literature. No intrapartum care governmental policies were found for Greece, Iceland, Italy, New Zealand, Norway, and Sweden. Some countries do not refer to all the analysed care aspects and there are differences in detail, depth, range, and scientific. The policies show general similarities but differ in the timing and the content of the recommended intrapartum care. Not all of the analysed countries have intrapartum care policies and those who have shown differences between recommendations. These results can be used to create/ revise intrapartum care policies.info:eu-repo/semantics/publishedVersio

Modelo de Neuman en la atención de enfermería perioperatoria para adolescentes con escoliosis idiopática juvenil

Objective: 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.info:eu-repo/semantics/publishedVersio

Vulnerabilidades em saúde da criança durante a pandemia da COVID-19 no Brasil e em Portugal

Objetivo: : analisar as vulnerabilidades da criança no acesso aos cuidados na atenção primária durante a pandemia da COVID-19 no Brasil e em Portugal. Método: pesquisa documental baseada em diretrizes governamentais brasileiras e portuguesas, expedidas entre março e agosto de 2020, sobre o acesso de crianças à atenção primária. A análise temática fundamentou-se nos preceitos da vulnerabilidade em saúde. Resultados: expediram-se 13 documentos nos dois países sobre acesso à vacinação e à puericultura. A restrição à circulação do SARS-CoV-2 nos ambientes sociais, serviços de saúde e de proteção social reduziu a demanda de atendimento. Mantiveram-se, nos dois países, os programas de promoção da saúde do lactente. O acompanhamento de puericultura presencial, para crianças de baixo risco, foi suspenso nos dois países. Portugal manteve a vacinação rotineira e o Brasil a interrompeu nos primeiros 15 dias da pandemia. Os países adotaram estratégias remotas de atenção - telemonitoramento, teleconsulta e aplicativos móveis - mantendo o vínculo da criança com os serviços de saúde. Conclusão: a longitudinalidade foi afetada pela redução do acesso à promoção da saúde da criança, determinando maior vulnerabilidade programática. As vulnerabilidades individuais relacionaram-se à exposição a doenças evitáveis e sensíveis à atenção primária.Objetivo: analizar las vulnerabilidades del niño en el acceso a los cuidados en la atención primaria, durante la pandemia del COVID-19 en Brasil y Portugal. Método: investigación documental basada en directrices gubernamentales brasileñas y portuguesas, expedidas entre marzo y agosto de 2020, sobre el acceso de niños a la atención primaria. El análisis temático se fundamentó en los preceptos de la vulnerabilidad en la salud. Resultados: fueron encontrados 13 documentos, expedidos en los dos países, sobre el acceso a la vacunación y puericultura. La restricción de circulación del SARS-CoV-2 - en los ambientes sociales, servicios de salud y de protección social - redujo la demanda de la atención. En los dos países se mantuvieron los programas de promoción de la salud del lactante. El acompañamiento de puericultura presencial, para niños de bajo riesgo, fue suspendido en los dos países. Portugal mantuvo la vacunación de rutina y Brasil la interrumpió en los primeros 15 días de la epidemia. Los países adoptaron estrategias de atención a distancia (telemonitoreo, teleconsulta y aplicativos móviles) manteniendo el vínculo del niño con los servicios de la salud. Conclusión: la longitudinalidad fue afectada por la reducción del acceso a la promoción de la salud del niño, determinando mayor vulnerabilidad programática. Las vulnerabilidades individuales se relacionaron a la exposición a enfermedades evitables y sensibles a la atención primaria.Objective: to analyze the vulnerabilities of children in the access to primary health care during the COVID-19 pandemic in Brazil and Portugal. Method: documentary study based on Brazilian and Portuguese governmental guidelines issued between March and August 2020 regarding access of children to primary health care. Thematic analysis was based on the precepts of health vulnerability. Results: 13 documents were issued in both countries addressing access to vaccination and childcare. Due to the SARS-CoV-2, restrictions were imposed on the circulation of people in social environments, health services, and social protection, decreasing the demand for health services. Both countries continued programs to promote the health of breastfeeding infants. In-person childcare consultations were suspended for low-risk children in both countries. Portugal maintained routine vaccination while Brazil interrupted vaccination in the first 15 days of the pandemic. The countries adopted remote care strategies - telemonitoring, teleconsultation, and mobile applications - to maintain the bond between children and health services. Conclusion: longitudinality was affected due to restricted access of children to health promotion actions, determining greater programmatic vulnerability. Individual vulnerabilities are related to exposure to preventable and primary health care-sensitive diseases