1
|
Cunha LDM, Pestana-Santos M, Lomba L, Santos MR. "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. J Perianesth Nurs 2023:S1089-9472(23)00943-7. [PMID: 37978973 DOI: 10.1016/j.jopan.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 11/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- Lara D M Cunha
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.
| | - Márcia Pestana-Santos
- Scientific-Pedagogical Child and Adolescent Health Nursing Department, Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Lurdes Lomba
- Scientific-Pedagogical Child and Adolescent Health Nursing Department, Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Margarida R Santos
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal; Scientific-Pedagogical Child and Adolescent Health Nursing Department, Nursing School of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS@RISE), Porto, Portugal
| |
Collapse
|
2
|
Maria Ferreira I, Soares Gonçalves A, Pestana-Santos M, Margarida Leitão Filipe M, da Costa Teixeira L, de Carvalho Coutinho E. Intrapartum care policies in high-income countries with a universal health system: a scoping review. Sexual & Reproductive Healthcare 2023; 36:100841. [PMID: 37058777 DOI: 10.1016/j.srhc.2023.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 04/05/2023]
Abstract
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.
Collapse
|
3
|
Soares Goncalves A, Maria Ferreira I, Pestana-Santos M, McCourt C, Paula Prata A. Antenatal care policy in high-income countries with a universal health system: A scoping review. Sex Reprod Healthc 2022; 32:100717. [PMID: 35248834 DOI: 10.1016/j.srhc.2022.100717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 12/01/2022]
Abstract
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.
Collapse
Affiliation(s)
- Andreia Soares Goncalves
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal; CINTESIS - Innovation & Development in Nursing: Center for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal.
| | - Isabel Maria Ferreira
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Márcia Pestana-Santos
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal; UICISA:E - Unidade de Investigação em Ciências da Saúde: Enfermagem, Avenida Bissaya Barreto, 3046-851 Coimbra, Portugal.
| | - Christine McCourt
- School of Health Sciences, Division of Midwifery and Radiography, M106,Myddelton Street Building, City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Ana Paula Prata
- CINTESIS - Innovation & Development in Nursing: Center for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal; Escola Superior de Enfermagem do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| |
Collapse
|
4
|
Cunha LDM, Pestana-Santos M, Lomba L, Santos MR. Uncertainty in post-anaesthesia nursing clinical reasoning: An integrative review in the light of the model of uncertainty in complex health care settings. Journal of Perioperative Nursing 2022. [DOI: 10.26550/2209-1092.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
5
|
Vasconcelos J, Lomba M, Pestana-Santos M, SteinBackes D. Atribuições do enfermeiro em serviço de acolhimento institucional de crianças e adolescentes: Um estudo Delphi. Rev Enf Ref 2022. [DOI: 10.12707/rv21014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
6
|
Pestana-Santos M, Pereira MJ, Santos E, Lomba L, Santos MR. Effectiveness of non-pharmacological interventions to manage anxiety in adolescents in the perioperative period: a systematic review protocol. JBI Evid Synth 2021; 19:2863-2869. [PMID: 34645776 DOI: 10.11124/jbies-20-00359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Márcia Pestana-Santos
- Institute of Biomedical Sciences Abel Salazar of Porto University, Porto, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal.,Pediatric Unit, Coimbra University and Hospital Centre, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal.,Nursing School of Coimbra, Coimbra, Portugal
| | | | - Eduardo Santos
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal.,Nursing School of Coimbra, Coimbra, Portugal.,Rheumatology department, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Lurdes Lomba
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal.,Nursing School of Coimbra, Coimbra, Portugal
| | - Margarida Reis Santos
- Nursing School of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| |
Collapse
|
7
|
Pestana-Santos M, Reis Santos M, Lomba L. A scoping review as an exploratory method to inform future research on nonpharmacological interventions to prevent anxiety in adolescents in the perioperative period. JBI Evid Synth 2021; 19:2048-2049. [PMID: 34518502 DOI: 10.11124/jbies-21-00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Márcia Pestana-Santos
- Institute of Biomedical Sciences Abel Salazar of Porto University, Porto, Portugal.,Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.,Coimbra University and Hospital Centre- Pediatric Departement, Coimbra, Portugal
| | - Margarida Reis Santos
- Institute of Biomedical Sciences Abel Salazar of Porto University, Porto, Portugal.,Nursing School of Porto; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Lurdes Lomba
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| |
Collapse
|
8
|
Pestana-Santos M, Pires R, Goncalves A, Parola V, Santos MR, Lomba L. Nonpharmacological interventions used in the perioperative period to prevent anxiety in adolescents: a scoping review. JBI Evid Synth 2021; 19:2155-2187. [PMID: 34038923 DOI: 10.11124/jbies-20-00312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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/.
Collapse
Affiliation(s)
- Márcia Pestana-Santos
- Institute of Biomedical Sciences Abel Salazar of Porto University, Porto, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal.,Pediatric Unit, Coimbra University and Hospital Centre, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal.,Nursing School of Coimbra, Coimbra, Portugal
| | - Rita Pires
- Sao Joao University and Hospital Centre, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Andreia Goncalves
- Institute of Biomedical Sciences Abel Salazar of Porto University, Porto, Portugal.,Maternity Services, Woman's Health Division, University College of London Hospitals, London, UK
| | - Vitor Parola
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal.,Pediatric Unit, Coimbra University and Hospital Centre, Coimbra, Portugal.,Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Margarida Reis Santos
- Nursing School of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Lurdes Lomba
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Coimbra, Portugal.,Nursing School of Coimbra, Coimbra, Portugal
| |
Collapse
|
9
|
Cabral IE, Pestana-Santos M, Ciuffo LL, Nunes YDR, Lomba MDLLDF. Child health vulnerabilities during the COVID-19 pandemic in Brazil and Portugal. Rev Lat Am Enfermagem 2021; 29:e3422. [PMID: 34231787 PMCID: PMC8253372 DOI: 10.1590/1518-8345.4805.3422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ivone Evangelista Cabral
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil.,Universidade do Estado do Rio de Janeiro, Faculdade de Enfermagem. Rio de Janeiro, RJ. Brazil.,Fellowship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Márcia Pestana-Santos
- Escola Superior de Enfermagem de Coimbra, Unidade de Investigação em Ciências da Saúde-Enfermagem, Coimbra, Portugal.,Universidade do Porto, Porto, Portugal
| | - Lia Leão Ciuffo
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil
| | - Yan do Rosario Nunes
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil.,Scholarship holder at the Institutional Program of Scientific Initiation of the Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
10
|
Pestana-Santos M, Santos MDSR, Cabral IE, Sousa PC, Lomba MDLLDF. Neuman Systems Model in perioperative nursing care for adolescents with juvenile idiopathic scoliosis. Rev Esc Enferm USP 2021; 55:e03711. [PMID: 34190880 DOI: 10.1590/s1980-220x2020001703711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/23/2020] [Indexed: 11/22/2022] Open
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.
Collapse
Affiliation(s)
- Márcia Pestana-Santos
- Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | | | | | | | | |
Collapse
|
11
|
Silva C, Oliveira D, Pestana-Santos M, Portugal F, Capelo P. Chronic non-cancer pain in adolescents: a narrative review. Braz J Anesthesiol 2021; 72:648-656. [PMID: 34153363 PMCID: PMC9515673 DOI: 10.1016/j.bjane.2021.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022] Open
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.
Collapse
Affiliation(s)
- Carlos Silva
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Coimbra, Portugal.
| | - Dora Oliveira
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Departamento de Pediatria, Coimbra, Portugal
| | - Márcia Pestana-Santos
- Centro Hospitalar e Universitário de Coimbra, Departamento de Pediatria, Coimbra, Portugal
| | - Francisco Portugal
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Coimbra, Portugal
| | - Paula Capelo
- Centro Hospitalar e Universitário de Coimbra, Serviço de Anestesiologia, Departamento de Pediatria, Coimbra, Portugal
| |
Collapse
|
12
|
Goncalves AS, Ferreira IM, Pestana-Santos M, Prata AP, McCourt C. Antenatal care policies for low-risk pregnant women in high-income countries with a universal health system: a scoping review protocol. JBI Evid Synth 2021; 18:1537-1545. [PMID: 32813393 DOI: 10.11124/jbisrir-d-19-00197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
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.
Collapse
Affiliation(s)
- Andreia Soares Goncalves
- 1Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal 2UICISA:E - Unidade de Investigação em Ciências da Saúde: Enfermagem, Portugal 3Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence 4Escola Superior de Enfermagem do Porto, Porto, Portugal 5CINTESIS - Innovation & Development in Nursing: Center for Health Technology and Services Research, Porto, Portugal 6School of Health Sciences, Division of Midwifery and Radiography, City, University of London, London, United Kingdom
| | | | | | | | | |
Collapse
|