PERIOPERATIVE NURSING CARE FOR ADOLESCENTS: A SCOPING REVIEWABSTRACT
Objective: To map the scientific production of perioperative nursing aimed at adolescents.
Method: A scoping review based on JBI guidelines and recommendations from the Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping Reviews. The search took place between February and March 2023 in 05 databases and in gray literature.
Results: Nineteen studies were included, 13 articles and 6 works from gray literature. The results demonstrated the importance of systematizing nursing care for adolescents with actions that aim to include them in care and prepare them for their surgical trajectory with a view to reducing anxiety and respecting individualities. Actions such as the use of integrative and complementary therapies, insertion of educational technologies and adaptation of the environment for neuroatypical adolescents were also identified. As a gap, there is a lack of studies specifically aimed at adolescents, encompassing their care for the pediatric population.
Conclusion: The scoping review mapped studies produced by nursing on perioperative care for adolescents and indicated the use of strategies to individualize care, reduce perioperative anxiety and promote engagement and involvement of surgical patients. It is necessary to expand the number of studies and interventions that are specific to adolescents.
DESCRIPTORS: Adolescent health; Perioperative care; Medical-surgical nursing; Constitutional diagnosis; Surgicenters
RESUMEN
Objetivo: Mapear la producción científica de enfermería perioperatoria dirigida a adolescentes.
Método: Revisión de alcance basada en las pautas y recomendaciones del JBI de los Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping Reviews. La búsqueda se realizó entre los meses de febrero y marzo de 2023 en 05 bases de datos y en literatura gris.
Resultados: Se incluyeron 19 estudios, 13 artículos y 6 trabajos de literatura gris. Los resultados demostraron la importancia de sistematizar los cuidados de enfermería a los adolescentes con acciones encaminadas a incluirlos en el cuidado y prepararlos para su trayectoria quirúrgica, con miras a reducir la ansiedad y respetar las individualidades. También se identificaron acciones como el uso de terapias integradoras y complementarias, inserción de tecnologías educativas y adaptación del entorno para adolescentes neuroatípicos. Como brecha, faltan estudios dirigidos específicamente a adolescentes, abarcando la atención a la población pediátrica.
Conclusión: La revisión del alcance mapeó los estudios producidos por enfermería sobre los cuidados perioperatorios para adolescentes e indicó el uso de estrategias para individualizar los cuidados, reducir la ansiedad perioperatoria y favorecer el compromiso y la implicación de los pacientes quirúrgicos. Es necesario ampliar la realización de estudios e intervenciones específicas para el público adolescente.
DESCRIPTORES: Salud de los adolescentes; Atención perioperativa; Enfermería médico-quirúrgica; Diagnóstico constitucional; Centros quirúrgicos
RESUMO
Objetivo: mapear a produção científica da enfermagem perioperatória voltada para o adolescente.
Método: revisão de escopo baseada nas orientações do JBI e recomendações do Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping Reviews. A busca ocorreu entre os meses de fevereiro e março de 2023 em 05 bases de dados e na literatura cinzenta.
Resultados: foram incluídos 19 estudos, sendo 13 artigos e 6 trabalhos da literatura cinzenta. Os resultados demonstraram a importância de sistematizar a assistência de enfermagem ao adolescente com ações que visem incluí-los no cuidado e prepará-los para sua trajetória cirúrgica com vistas à redução da ansiedade e respeito às individualidades. Ações como uso de terapias integrativas e complementares, inserção de tecnologias educativas e adequação do ambiente para adolescentes neuroatípicos também foram identificadas. Como lacuna observa-se a escassez de estudos voltados especificamente para o público adolescente, englobando o cuidado deste à população pediátrica.
Conclusão: a revisão de escopo mapeou os estudos produzidos pela enfermagem acerca da assistência perioperatória ao adolescente, e indicou uso de estratégias para individualizar o cuidado, reduzir a ansiedade perioperatória e favorecer o engajamento e envolvimento do paciente cirúrgico. Faz-se necessário ampliar a realização de estudos e intervenções que sejam específicas ao público adolescente.
DESCRITORES: Saúde do adolescente; Assistência perioperatória; Enfermagem médico cirúrgica; Individualização do paciente; Centro cirúrgico
INTRODUCTION
Adolescents represent a large portion of the world’s population. In Europe, despite the growing decline in the percentage of people in this age group, they still represent an important part of the population structure. In the Americas, it is estimated that by 2030 there will be around 230 million adolescents1-2.
Approximately 5 to 20% of the world’s pediatric population will undergo surgery before becoming an adult3. Adolescents who undergo surgery mostly have chronic health conditions or have suffered accidental or induced injuries4. There has also been an increase in cosmetic surgical procedures in this population5.
Adolescence is a phase in which physical, cognitive and social changes occur that correlate with the consolidation of notions of self-care and the search for identity6. During the surgical process, adolescents temporarily lose self-control and autonomy, since they will depend on the help of others to carry out activities of daily living, such as hygiene, eating and movement7. This situation is a source of stress and concern for these patients, who feel compelled to give up the independence they so desire. Moreover, it is worth noting that 80% of adolescent patients who will undergo surgery experience anxiety, which further impacts their recovery and experience of care8.
Adolescents want to be involved in their treatment, receive information about their surgery, anesthesia, benefits and possible complications; however, they are not always included in this perspective. Because they are in the transition between childhood and adulthood, their desires and need for autonomy are often disregarded by healthcare professionals, including nurses3.
Perioperative nursing is one of the areas responsible for preparing and assisting these patients, and, in this context, it is necessary to consider that risk behaviors are part of this phase, which adds greater complexity to the care provided6. It is important to highlight the increase in adolescents with mental disorders who use psychotropic drugs, neuroatypical patients, in addition to the risk of pregnancy, sexually transmitted diseases and dependence on illicit drugs6.
The care provided by perioperative nurses in general is widely discussed in national and international journals. However, it is important to identify how surgical care is provided to adolescents, given the different needs of adult patients. Therefore, it is important to map the scientific production of perioperative nursing aimed at adolescents, as it is believed that gathering this information will indicate the path taken in caring for this population and will make it possible to identify existing challenges and potentialities to be developed to assist this population.
No published studies or protocols similar to this review were found in a search carried out in the Virtual Health Library (VHL), MEDLINE via PubMed, Cochrane, Scopus, Web of Science databases.
Therefore, this study aimed to map scientific production regarding perioperative nursing care for adolescents.
METHOD
This is a scoping review study, based on the JBI and Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping Reviews8-9 recommendations, with a protocol registered in the Open Science Framework (https://osf.io/vgjbd). The study followed five stages: research question identification; relevant study identification; study selection; data analysis; grouping, synthesis and presentation of findings9.
The research question was outlined based on the PCC strategy, where “P” refers to Participants (adolescents aged 10 to 19 years); “C” refers to Concept (perioperative nursing care for adolescents); and “C” refers to Context (perioperative period). Thus, the question to be answered by this review was: What is the scientific nursing production on perioperative care for adolescents aged 10 to 19 years? Age range was delimited based on the concept of adolescence defined by the World Health Organization1.
Original studies and gray literature that address perioperative nursing care for adolescents, in any language, produced since 1990, were included. Time frame was proposed based on the publication date of the “Convention on the Rights of the Child”, adopted by the UN General Assembly on November 20, 1989. This is an international agreement that aims to protect the rights of children and adolescents10.
Studies such as editorials, annals, narrative reviews, interviews or studies that did not directly address the research topic were excluded, since editorials and interviews represent opinions of experts or not on a given topic, narrative reviews can offer a biased view of the literature produced and annals are not peer-reviewed, which can also generate a biased view. Moreover, studies that did not address the role of nursing in specific care for adolescents and that presented a general assessment through an approach in conjunction with the adult population were excluded.
The searches were carried out between February and March 2023, and took place in the VHL, MEDLINE via PubMed, Cochrane, Scopus, Web of Science databases. The search in gray literature included the following repositories of theses and dissertations: Biblioteca Digital Brasileira de Teses e Dissertações (BDTD); CAPES Catalog of Theses and Dissertations; Networked Digital Library of Theses and Dissertations (NDLTD); E-Theses Online Services (Ethos); Latin American Repository Network; Repositórios Científicos de Acesso Aberto de Portugal (RCAAP); and Google Scholar. In the latter, the first hundred works made available were visited.
In the first stage, keywords and descriptors that covered the topic were identified by searching indexed databases. A library consultation was then carried out to define the search strategies and databases that would compose the review.
Chart 1 presents the search strategies in the databases.
The descriptors used in gray literature were “Adolescence” AND “Surgery”.
The data selection, extraction and review process was carried out by two researchers independently. The following information was extracted from the manuscripts: article title, year of publication, country, study design, surgical specialty and main outcomes. A pilot test was carried out on five articles to verify instrument adequacy, maintaining the version initially designed.
The search and extraction of data from studies included in the review was carried out by two reviewers independently, and disagreements were resolved by a third reviewer.
Rayyan from the Qatar Computing Research Institute was used for duplicate management.
The results were grouped according to the information extracted from the studies and presented descriptively through charts.
Furthermore, an analysis based on the PAGER strategy was used: Patterns, Advances, Gaps, Evidence for practice and Research recommendations. The PAGER framework provides a consistent approach to the analysis and reporting of review findings11.
RESULTS
A total of 350 studies were found in the assessed databases. After review and detection of duplicates, 260 manuscripts remained for title and abstract assessment. After reading the title and abstract, 47 studies were read in full. In the end, 19 studies were included in this review: 13 articles and 6 works from gray literature as shown in Figure 1.
The main reasons for exclusion were: not directly addressing the research topic (1); not fitting into the established age range (15); annals and interviews (2); publication time (3); or articles that were lost even after attempting to access them (5). Regarding gray literature, 165 works that did not address the research topic were excluded, including BDTD (69), CAPES Catalog of Theses and Dissertations (18), Latin American Repository Network (6), RCAAP (42) and Google Scholar (30), as presented below.
Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) flowchart of the study inclusion process
The countries with the highest number of publications were Portugal12,24,26-29,30 (7; 33.3%), Brazil13,17,22-25 (6; 28.5%) and USA19-20,31 (3; 14.3%). The most frequent surgical specialties were general surgery15-18,21,23 (6; 28.6%), neurosurgery29,32(2; 9.5%) and plastic surgery25,27 (2; 9.5%), and nine14,19,20,22,24,26,28,30,31 (47.3%) did not specify the surgical specialty. Most studies were published in the last five years14-18,20,23-25 (9; 42.8%); six19-21,26,29,32 (31.57%), more than a decade ago, and four22,27-28,30 (9.5%), from five to ten years ago. The majority covered the entire perioperative period14-15,18,21,23-24,26-27,29-32 (12; 57.14%), in which for the preoperative17,19-20 (3; 14.28%) and postoperative16,25,28 (3; 14.28%), one22 (5.26%) did not define the period.
Most studies address interventions that encompass, in addition to adolescence, the pediatric age range from 1 to 18 years14-27 and only six (28.6%) addressed care only for the adolescent public28-33.
The main findings will be presented descriptively, as shown in Chart 2.
Summary chart of the main results and indications of articles analyzed, study design and age group (Divinópolis, MG, Brazil, 2024).
Advances, gaps in the literature, evidence for practice and research recommendations were presented according to the PAGER strategy (Chart 3).
DISCUSSION
Adolescents who undergo surgery experience an impact in all areas of their lives, which generates anxiety, fear and stress. They find themselves outside their family and social environment, in addition to being dependent on care, which can mean a setback in their autonomy32.
One way to reduce this impact is by offering individualized care that can be achieved by applying the Nursing Process, identified in medical-surgical nursing as Systematization of Perioperative Nursing Care (SPNC), a methodological tool provided by regulatory bodies of the profession in Brazil33. This was the object of study of the references assessed, and its incorporation is shown to be fundamental to carry out an adequate intervention, with a scientific basis that meets the needs of each patient and that allows assessing the results of the care provided34.
Within this tool, the preoperative visit stands out, a care that emerged in this review as fundamental for adolescents’ surgical preparation. During the preoperative visit, a clinical patient assessment is performed, considering physical aspects, previous surgical experiences and emotional issues that may impact the surgical anesthetic procedure. The care that will be provided during the intra- and postoperative period is then planned on an individual basis. Information about the surgical trajectory is then provided and doubts are clarified35. Therefore, it is also a time to create and strengthen bonds with the family and the adolescent. The preoperative visit can reduce anxiety and complications in individuals undergoing different surgeries36. Anxious patients are more likely to present agitation, reduced cooperation, postoperative delirium, slow recovery and sleep disorders37.
The studies assessed in this review demonstrated the importance of perioperative preparation and the desire of adolescents and their families to receive it. Both value information related to pre- and post-operative care and understand that it is up to healthcare professionals to explain the interventions that will be performed on their bodies. Despite being in a moment of denial of parents and formation of identity, adolescents expect their parents to be involved in surgical care, which brings more peace of mind and security3. Therefore, including them in the adolescent’s perioperative care plan and recognizing the legitimacy of their presence and involvement is a specific nursing action for this population, which, as demonstrated in this review, allows reducing the impacts of surgical fear and anxiety.
Technology has emerged as an ally in the perioperative preparation of adolescents. Nurses can use teaching materials and educational technologies during care, making this moment more attractive and allowing the information provided to be consulted without time and space limits. Possible interventions include the use of serious games, which are games with human-technology interaction for educational and training purposes, ensuring fun, motivation and educational value38. Its incorporation allows the consolidation of knowledge, increased safety and ease of care, generating a positive impact on patient care39.
Such evidence indicates that healthcare professionals, including nurses, can explore the construction of innovative educational technologies and encourage adolescents to take an active role in perioperative preparation40-41.
The use of complementary and integrative therapies, such as aromatherapy, art therapy, acupuncture and meditation, and music therapy, emerged as nursing care in this review. Such approaches are promising for managing perioperative symptoms, and are capable of minimizing adverse effects associated with drug interventions, anxiety, preoperative stress, and reducing blood pressure and heart rate42-43. A study using aromatherapy in patients undergoing breast surgery was able to reduce participants’ anxiety levels44.
Individualized care, recognizing the diversity of development of the population, has emerged as a care to be observed in perioperative care. Currently, approximately one in every 36 children is diagnosed with Autism Spectrum Disorder (ASD)45. It is important to understand that these children will become adolescents and that it will be necessary to personalize healthcare for this population, because when patients with ASD are hospitalized, communication, socialization and behavior barriers can be exacerbated. People with ASD present behaviors that can become difficult in the perioperative period, such as avoiding eye contact when talking, stress due to changes in routine, difficulty understanding questions or instructions and insistence on routines and rituals, causing agitation and anxiety46.
To create a safe and individualized environment, forms of care are presented in the literature, such as avoiding the use of white coats, limiting the number of people in the room, providing information about each procedure before performing it, using concrete words and distractions, such as music, games, electronic devices, and reducing noise in the environment46. The use of preoperative anxiolytic medication, the presence of parents at the time of anesthetic induction, and the use of a quiet room are also beneficial ways of providing care to patients with ASD47.
Research found that only 35% of professionals had adequate management strategies for caring for a child with ASD. Therefore, this is a challenge and an advancement to be incorporated by nursing48.
In addition to patients with ASD, other specificities related to adolescents must also be taken into consideration, such as the risk of suicide, as the surgical process can have an impact on mental health. Therefore, it is necessary that each adolescent be examined for this risk during consultations prior to surgery to better assess the care to be offered49.
In addition to the interventions mentioned so far, the adoption of abbreviated fasting and early feeding has emerged as a tool to improve the perioperative process. Abbreviating fasting by offering clear liquids preoperatively can provide metabolic stability and reduce hunger and thirst50. Early refeeding after surgery accelerates recovery, avoids complications, reduces hospital stay and the need for fluid infusion51.
This review contributed to reflecting on the care process for adolescents who will undergo surgery. It pointed out strategies to be used with the target audience, in addition to nursing actions and conducts to be adopted to individualize care and reduce the impacts of the surgical period on adolescents’ lives. It is worth noting that there are few studies specifically aimed at adolescents, including them together with pediatric populations. Adolescence has different complexities than those found in childhood; therefore, its approach should be individualized. Thus, the present study demonstrates the need to conduct care and research directed at this clientele, which has an identity, but is most often placed by healthcare professionals between the limbo of childhood and adulthood.
Among the limitations, the loss and impossibility of accessing articles that could add more data to the review stands out.
CONCLUSION
The scoping review mapped scientific publications on perioperative nursing aimed at adolescents and identified strategies that can personalize care for this population, such as conducting a preoperative visit, using a systematized instrument to perform care, involving parents and guardians in perioperative care, using non-pharmacological therapies to reduce fear and anxiety, incorporating educational technologies in information provision, and the need to adapt the care plan for neurotypical adolescents and those with challenging behavior.
The use of tools aimed at adolescents can be an ally in the care of surgical patients, by enabling more dynamic interaction with the surgical team, contributing to perioperative education and involving patients in their self-care.
Care and research specifically aimed at this population need to be developed, without incorporating them into the pediatric population.
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Edited by
Publication Dates
-
Publication in this collection
02 Dec 2024 -
Date of issue
2024
History
-
Received
05 July 2024 -
Accepted
01 Oct 2024
