"A Certainty for you Does Not Mean That it is a Certainty for Science": A Phenomenological Analysis of Experiences of Uncertainty in Clinical Reasoning of Nurses in the Postanesthesia Care Unit.

PURPOSE: To explore the experiences of uncertainty in the clinical reasoning of nurses in the postanesthesia care unit (PACU). DESIGN: A phenomenological descriptive design, following Colaizzi's analysis. METHODS: Semistructured interviews were conducted with 14 nurses from a PACU on their experience of uncertainty in clinical reasoning. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed seven phases: (re)reading the transcripts, extracting significant statements, formulating meanings from significant statements, aggregating formulated meanings into themes, developing a description of the phenomenon's essential structure, generating of the fundamental structure of the phenomenon, validating of the findings through participant feedback. The process employed MAXQDA analytics Pro 2022 software. Consolidated Criteria for Reporting A Qualitative Research checklist was used for reporting. FINDINGS: From uncertainty experiences in nurses' clinical reasoning, 10 themes emerged: ambiguity and decision latitude, communication, work ethic, difficulty interpreting and predicting outcomes, cognitive performance impairment, incivility, core competence vagueness of postanesthesia nurses, high-tech care, (in)security and risk, and occupational stress. CONCLUSIONS: The experiences of uncertainty in clinical reasoning of nurses in postanesthesia care units are highly focused on patient safety. Exploring these experiences has made uncertainty more tangible and explicit, which will enable nurses in postanesthesia care units to prepare for adaptive responses to deal with uncertainty when it occurs in clinical practice.

Effectiveness of perioperative family-centered educational interventions in the anxiety, pain and behaviors of children/adolescents and their parents: Systematic Review Protocol / Eficacia de las intervenciones educativas perioperatorias familiares centradas en la ansiedad, el dolor y las conductas de las personas menores y adolescentes y de sus progenitores: protocolo de revisión sistemática

Introduction: Every year, millions of children and adolescents undergo surgery, 50%-75% of them experience fear and anxiety. Children are particularly susceptible to stress and anxiety surrounding surgery as a result of their cognitive development, previous experiences, and knowledge about healthcare; this leads to additional interventions to prevent and reduce these symptoms. Objective: To evaluate the effectiveness of family-centered educational interventions in the children's and adolescents' anxiety, pain, and behaviors and their parents' anxiety during the perioperative period. Methods: This review will follow the Joanna Briggs Institute guidelines for systematic reviews of effectiveness and will consider those studies (experimental and quasi-experimental) in which perioperative educational interventions have been applied to children and adolescents and their parents; these studies measured children and adolescents' pain, anxiety, and behaviors, as well as their parent's anxiety. An initial search of MEDLINE and CINAHL will be followed by a second search for published and unpublished studies from January 2007 on, available in English, Spanish and Portuguese. After all full texts are retrieved, the methodological quality assessment and data extraction will be independently and critically evaluated by two reviewers, and the data will then be presented in a tabular format. An explanatory synthesis will accompany the results. Whenever possible, a meta-analysis will be performed, and a Grading of Recommendations, Assessment, Development, and Evaluation Summary of Findings will be presented. Expected Results: This review will provide guidance on how family-centred educational interventions can be used as a resource to manage anxiety, pain, and behavior in children, adolescents and their relatives during the perioperative processes.

Introducción: Cada año, millones de personas menores y adolescentes se someten a cirugía, de las cuales entre el 50-75 % experimenta miedo y ansiedad. Las niñas y los niños son particularmente susceptibles al estrés y la ansiedad que rodea a la cirugía, como resultado de su desarrollo cognitivo, experiencias previas y conocimiento de la salud, lo que requiere intervenciones para prevenir y reducir estos síntomas. Objetivo: Esta revisión tiene como objetivo evaluar la efectividad de las intervenciones educativas familiares centradas en la ansiedad, el dolor y los comportamientos de las personas menores y adolescentes y de sus progenitores en el período perioperatorio. Métodos: Esta revisión seguirá las pautas del Instituto Joanna Briggs para revisiones sistemáticas de efectividad y considerará estudios experimentales y cuasiexperimentales en los que las intervenciones educativas perioperatorias para medir el dolor, la ansiedad y los comportamientos en niñas, niños y adolescentes y la ansiedad de sus progenitores. Se ha realizado una búsqueda inicial limitada de MEDLINE y CINAHL. Además, una segunda búsqueda de estudios publicados y no publicados de enero de 2007 disponibles en inglés, español y portugués. Una vez recuperados los textos completos, dos revisores evaluarán críticamente, de forma independiente, la calidad metodológica y la extracción de datos y se presentarán en forma de tabla. Una síntesis narrativa acompañará a los resultados y, si es posible, se realizará un metanálisis y se presentará un Grading of Recommendations, Assessment, Development and Evaluation. Resultados esperados: Esta revisión brindará orientación sobre cómo las intervenciones educativas centradas en la familia pueden usarse como un recurso para controlar la ansiedad, el dolor y el comportamiento en niñas, niños, adolescentes y sus familias en el contexto perioperatorio.

Introdução: Todos os anos, milhões de crianças e adolescentes são submetidos a cirurgias e 50-75% apresentam medo e ansiedade. Crianças/adolescentes são particularmente suscetíveis ao stress e ansiedade em torno da cirurgia devido ao seu desenvolvimento cognitivo, experiências anteriores e conhecimento que possuem sobre os cuidados de saúde, necessitando de intervenções para a prevenção/redução destes sintomas. Objetivo: Avaliar a eficácia de intervenções educacionais centradas na família na ansiedade, dor e comportamentos de crianças/adolescentes e ansiedade dos pais no período perioperatório. Métodos: Esta revisão seguirá a metodologia do Instituto Joanna Briggs para revisões sistemáticas de eficácia e considerará estudos (experimentais e quase-experimentais) em que as intervenções educacionais perioperatórias tenham sido aplicadas a crianças/ adolescentes e seus pais e avaliadas a dor, ansiedade e comportamento em crianças/adolescentes e ansiedade dos pais como resultados. Uma pesquisa inicial limitada de MEDLINE e CINAHL foi realizada. Será seguida por uma segunda busca por estudos publicados e não publicados de janeiro de 2007 disponíveis em inglês, espanhol e português. Após a recuperação dos textos completos, a avaliação da qualidade metodológica e a extração de dados serão avaliadas de forma crítica e independente por dois revisores e apresentadas em forma de tabela. Uma síntese narrativa acompanhará os resultados e, se possível, uma meta-análise será realizada e um resumo das Grading of Recommendations, Assessment, Development and Evaluation apresentado. Resultados esperados: Esta revisão fornecerá orientações sobre como as intervenções educativas centradas na família podem ser utilizadas como um recurso para gestão da ansiedade, dor e comportamento em crianças, adolescentes e suas famílias no contexto perioperatório.

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 Complete-EBSCO. 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.

Atribuições do enfermeiro em serviço de acolhimento institucional de crianças e adolescentes: Um estudo Delphi / Nurses' responsibilities in institutional foster care settings for children and adolescents: A Delphi study / Atribuciones del enfermero en los servicios de acogimiento institucional a niños y adolescentes: Un estudio Delphi

Resumo Enquadramento: O acolhimento institucional é uma estratégia protetora para crianças/adolescentes em situação de risco na qual a educação, promoção e cuidados de saúde são da responsabilidade do enfermeiro. Objetivo: Validar um protocolo de atribuições do enfermeiro em serviço de acolhimento institucional de crianças e adolescentes. Metodologia: Estudo de Delphi com duas rondas para validação de protocolo construído após revisão de literatura e pesquisa de campo. Utilizou-se um inquérito Delphi para validar o protocolo, por 12 peritos internacionais, com experiência assistencial, na docência e investigação. Considerou-se o índice de concordância mínimo de 80%. Foi utilizada a recomendação modificada para a condução e elaboração de relatórios dos estudos Delphi (CREDES). Resultados: O protocolo foi validado com um índice de concordância de 90% na segunda ronda, após convergencia entre os peritos quanto aos itens que constituem as atribuições dos enfermeiros categorizadas em "gerenciais", "assistenciais", "educativas" e "socio-políticas". Conclusão: O protocolo foi considerado válido em conteúdo e aparência, e servirá para subsidiar as atribuições do(a) enfermeiro(a) em serviços de acolhimento institucional de crianças/adolescentes.

Abstract Background: Institutional foster care is a protective strategy for children/adolescents at risk in which nurses are responsible for health education, health promotion, and health care. Objective: To validate a protocol of nurses' responsibilities in institutional foster care settings for children and adolescents. Methodology: Delphi study with two rounds for validation of the protocol that was built after a literature review and field research. A Delphi survey was used to validate the protocol by 12 international experts with experience in clinical practice, teaching, and research. The minimum agreement rate of 80% was considered. The modified Guidance on Conducting and REporting DElphi studies (CREDES) was used. Results: The protocol was validated, with an agreement rate of 90% in the second round, after expert consensus on the items related to the managerial, care, educational, and sociopolitical categories of nurses' responsibilities. Conclusion: The protocol had content and face validity and will be used to define nurses' responsibilities in institutional foster care settings for children/adolescents.

Resumen Marco contextual: El acogimiento institucional es una estrategia de protección para los niños/adolescentes en situación de riesgo en la que la educación, la promoción y el cuidado de la salud son responsabilidad del enfermero. Objetivo: Validar un protocolo de atribuciones del enfermero en el servicio de acogimiento institucional a niños y adolescentes. Metodología: Estudio Delphi con dos rondas para la validación de un protocolo construido tras la revisión de la literatura y la investigación de campo. Se utilizó una encuesta Delphi para validar el protocolo por parte de 12 expertos internacionales con experiencia en asistencia, docencia e investigación. Se consideró el índice de concordancia mínimo de 80%. Se utilizó la recomendación modificada para conducir y elaborar informes de los estudios Delphi (CREDES). Resultados: El protocolo fue validado con un índice de concordancia del 90% en la segunda ronda, tras la convergencia entre los expertos en cuanto a los ítems que constituyen las atribuciones de los enfermeros categorizadas en "directivas", "asistenciales", "educativas" y "sociopolíticas". Conclusión: El protocolo se consideró válido en cuanto a su contenido y apariencia, y servirá para subsidiar las atribuciones de los enfermeros en los servicios de acogimiento institucional de niños y adolescentes.

Chronic non-cancer pain in adolescents: a narrative review

Abstract Introduction Chronic pain is defined as a pain lasting more than 3-6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context. Adolescence, corresponding to a particular period of development, seems to present the ideal territory for the appearance of maladaptive mechanisms that can trigger episodes of persistent or recurrent pain. Methods A narrative review, in the PubMed/Medline database, in order to synthetize the available evidence in the approach to chronic pain in adolescents, highlighting its etiology, pathophysiology, diagnosis, and treatment. Results Pain is seen as a result from the interaction of biological, psychological, individual, social, and environmental factors. Headache, abdominal pain, and musculoskeletal pain are frequent causes of chronic pain in adolescents. Pain not only has implications on adolescents, but also on family, society, and how they interact. It has implications on daily activities, physical capacity, school performance, and sleep, and is associated with psychiatric comorbidities, such as anxiety and depression. The therapeutic approach of pain must be multimodal and multidisciplinary, involving adolescents, their families, and environment, using pharmacological and non-pharmacological strategies. Discussion and conclusion The acknowledgment, prevention, diagnosis, and treatment of chronic pain in adolescent patients seem not to be ideal. The development of evidence-based forms of treatment, and the training of health professionals at all levels of care are essential for the diagnosis, treatment, and early referral of these patients.

Nurses' Views on How to Best Design a Program to Prevent Adolescents' Anxiety in the Perioperative Period. A Qualitative Study.

PURPOSE: 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.

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 low-risk 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.

Adolescents' perioperative experiences in relation to inpatient and outpatient elective surgery - a qualitative study.

BACKGROUND: 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.

Chronic non-cancer pain in adolescents: a narrative review.

INTRODUCTION: Chronic pain is defined as a pain lasting more than 3-6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context. Adolescence, corresponding to a particular period of development, seems to present the ideal territory for the appearance of maladaptive mechanisms that can trigger episodes of persistent or recurrent pain. METHODS: A narrative review, in the PubMed/Medline database, in order to synthetize the available evidence in the approach to chronic pain in adolescents, highlighting its etiology, pathophysiology, diagnosis, and treatment. RESULTS: Pain is seen as a result from the interaction of biological, psychological, individual, social, and environmental factors. Headache, abdominal pain, and musculoskeletal pain are frequent causes of chronic pain in adolescents. Pain not only has implications on adolescents, but also on family, society, and how they interact. It has implications on daily activities, physical capacity, school performance, and sleep, and is associated with psychiatric comorbidities, such as anxiety and depression. The therapeutic approach of pain must be multimodal and multidisciplinary, involving adolescents, their families, and environment, using pharmacological and non-pharmacological strategies. DISCUSSION AND CONCLUSION: The acknowledgment, prevention, diagnosis, and treatment of chronic pain in adolescent patients seem not to be ideal. The development of evidence-based forms of treatment, and the training of health professionals at all levels of care are essential for the diagnosis, treatment, and early referral of these patients.

Effectiveness of non-pharmacological interventions to manage anxiety in adolescents in the perioperative period: a systematic review protocol.

OBJECTIVE: This review aims to evaluate the effectiveness of non-pharmacological interventions to manage anxiety in adolescents in the perioperative period. INTRODUCTION: Adolescents undergoing surgery suffer considerable levels of anxiety and distress before surgery, which are maintained beyond the procedure. Although the benefit of non-pharmacological interventions in this area is significant, their efficacy is still under-studied. INCLUSION CRITERIA: This review will consider studies that focus on adolescents aged 10 to 19 years, who have undergone a surgical procedure. All studies that focus on non-pharmacological interventions occurring in the perioperative period designed to reduce anxiety without restrictions on comparators, geography, or culture will be included. METHODS: An initial limited search of PubMed and CINAHL has been undertaken and will be followed by a second search for published and unpublished studies, without limitations of publication date, in major health care-related electronic databases. Studies in English, Spanish, and Portuguese will be included. After full-text studies are retrieved, methodological quality assessment and data extraction will be performed independently by two reviewers. A narrative synthesis will accompany the results and, if possible, a meta-analysis will be performed and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020184386.

Child health vulnerabilities during the COVID-19 pandemic in Brazil and Portugal.

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.

Neuman Systems Model in perioperative nursing care for adolescents with juvenile idiopathic scoliosis.

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.

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 Connect+; and Cochrane Database of Systematic Reviews. Sources of unpublished studies and gray literature were TDX - Tesis Doctorals en Xarxa (Spain); RCAAP - Repositório Científico 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. SCOPING REVIEW REGISTRATION: Open Science Framework: https://osf.io/jhwca/.

Child health vulnerabilities during the COVID-19 pandemic in Brazil and Portugal / Vulnerabilidades em saúde da criança durante a pandemia da COVID-19 no Brasil e em Portugal / Vulnerabilidades en la salud de niños durante la pandemia del COVID-19 en Brasil y Portugal

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.

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.

Neuman Systems Model in perioperative nursing care for adolescents with juvenile idiopathic scoliosis / Modelo de Neuman en la atención de enfermería perioperatoria para adolescentes con escoliosis idiopática juvenil / Modelo de Neuman no cuidado de enfermagem perioperatório de adolescente com escoliose idiopática juvenil

ABSTRACT 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.

RESUMEN Objetivo: Implementar el proceso de enfermería, basado en el Modelo de Sistemas Neuman y la terminología de la Clasificación Internacional de la Práctica de Enfermería, en el cuidado de un adolescente que fue sometido a cirugía correctiva por escoliosis idiopática juvenil. Método: Estudio cualitativo del tipo de caso único, con triangulación de técnicas de recolección de datos (entrevista clínica formal, anotaciones en diario de campo e información de historia clínica), desarrollado con una adolescente de 17 años e indicación de cirugía correctiva. Los materiales empíricos generados con las entrevistas realizadas al ingreso y al alta, la observación y la información de la historia clínica fueron tratados con el análisis de contenido categórico. Resultados: Las categorías de condición personal, ansiedad, autoconcepto, personas significativas, recursos facilitadores de salud, escuela, tiempo libre y ocio fueron recurrentes. Los diagnósticos se definieron con un enfoque en los problemas Ansiedad, Conocimiento sobre el Manejo del Dolor (control) y Voluntad (o disposición) para Aprender, asociándolos con las respectivas intervenciones de enfermería. Conclusión: El Modelo contribuyó a evaluar y reconocer los factores estresantes del evento quirúrgico en el adolescente y a fundamentar teóricamente el proceso de enfermería. La clasificación permitió la sistematización de registros de atención de enfermería, elementos de la práctica clínica, unificación de vocabulario y códigos.

RESUMO Objetivo: Implementar o processo de enfermagem, fundamentado no Modelo de Sistemas de Neuman e terminologia da Classificação Internacional da Prática de Enfermagem, no cuidado de uma adolescente submetida a cirurgia corretiva de escoliose idiopática juvenil. Método: Estudo qualitativo do tipo de caso único, com triangulação de técnicas de coleta de dados (entrevista clínica formal, notas em diário de campo e informações de prontuário), desenvolvido com uma adolescente de 17 anos de idade e indicação de cirurgia corretiva. Os materiais empíricos gerados com as entrevistas realizadas na admissão e na alta, a observação e informações de prontuário foram tratados com a análise de conteúdo categorial. Resultados: Foram recorrentes as categorias condição pessoal, ansiedade, autoconceito, pessoas significativas, recursos de saúde facilitadores, escola, tempos livres e lazer. Definiram-se diagnósticos com foco nos problemas Ansiedade, Conhecimento sobre manejo (controle) de dor e Disposição (ou prontidão) para aprender, associando-os às respectivas intervenções de enfermagem. Conclusão: O Modelo contribuiu para avaliar e reconhecer fatores estressores do evento cirúrgico na adolescente e fundamentar teoricamente o processo de enfermagem. A classificação permitiu a sistematização de registos dos cuidados de enfermagem, dos elementos da prática clínica, unificação de vocabulário e de códigos.

Antenatal care policies for low-risk pregnant women in high-income countries with a universal health system: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to map the available evidence on the nature, extent, and range of antenatal care policies for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model. INTRODUCTION: Low-risk women in high-income countries have good evolutionary perinatal outcomes but high intervention rates in pregnancy and childbirth, which ultimately leads to high morbidity. This has implications at all levels including families, the health care system, and society. This review aims to inform future policy and identify the viability of the adoption of alternative models to the Portuguese context that can reduce unnecessary interventions. INCLUSION CRITERIA: Studies, protocols, guidelines, and policies that provide guidance on antenatal care for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model (universal health care) will be considered. Documents from 2005 to present will be included, and no language restrictions will be imposed. METHODS: An initial search will be conducted in databases including MEDLINE (via PubMed) and CINAHL (via EBSCOhost), followed by a manual search of the reference lists from the documents accepted for inclusion, and a hand search of gray literature. For the countries whose policies are not available through the earlier steps, key persons from health ministries and academia will be contacted. Search results will be exported and data extracted using charting forms. Data will be synthesized using narrative description.

Ansiedade perioperatória em adolescentes: manifestações e necessidades de controlo. Revisão integrativa / 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 manifes-tations of anxiety were grouped in psychological, social and physical. These manifes-tations 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

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Non-pharmacological interventions used during the perioperative period to prevent anxiety in adolescents: a scoping review protocol.

OBJECTIVE: The objective of this review is to map the range of non-pharmacological interventions used during the perioperative period to prevent anxiety in adolescents. INTRODUCTION: Evidence shows that 80% of adolescents report having experienced significant anxiety in the perioperative period. Non-pharmacological interventions implemented in the perioperative period are recommended as a resource to help to control anticipatory, separation and perioperative anxiety and fear related to surgical procedures in adolescents. INCLUSION CRITERIA: This review will consider studies that focus on adolescents aged 10 to 19 who have undergone a surgical procedure, regardless of the type of surgery, and participated in non-pharmacological interventions aimed to prevent anxiety in the perioperative period. The intervention may be provided by any healthcare professional. Studies related to non-pharmacological interventions associated with hospitalization in a non-surgical context will be excluded. METHODS: The methodology will follow the JBI recommendations for scoping reviews. Any published and unpublished sources of information will be considered. Studies published in English, Spanish and Portuguese will be included, with no geographical or cultural limitations. Duplicates will be removed and two independent reviewers will screen the abstracts and assess the full text of selected studies, based on the inclusion criteria. The results of study selection will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for scoping reviews. Data synthesis will be presented in a narrative summary to provide a description of the existing evidence.