ABSTRACT
BACKGROUND: Children with Special Health Care Needs (CSHCN) require greater attention from family caregivers as they present temporary or permanent physical, developmental, behavioral, or emotional issues. This demand for care generates overload and stress among family caregivers. So far, there is no study that gathers the available literature regarding the use of biomarkers to assess stress among caregivers of CSHCN. Hence, we aimed to synthetize and to assess the scientific evidence on biomarkers associated with stress in caregivers of CSHCN. METHODS: This systematic review and meta-analysis protocol was elaborated following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The search strategy will be undertaken through 7 electronic bibliographic databases: Embase, MEDLINE/PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, and PsycINFO. In addition, secondary searches in other sources, such as Clinical trials.gov-NIH, The British Library, Pro Quest Dissertations Database, Google Scholar, and medRXiv will be also carried out. The reference section of the included studies will be hand searched for additional relevant studies. There will be no restriction regarding the publication dates or languages for this systematic review. Moreover, in an independently manner, 2 investigators will select studies, perform data extraction, as well as perform a critical appraisal of the risk of bias and overall quality of the selected studies, based on their designs. The heterogeneity among the studies will be assessed using the I2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the SPSS version 23.0. RESULTS: This systematic review and meta-analysis will provide better insights regarding the biomarkers associated with stress in caregivers of CSHCN. Hence, consistent data and robust evidence will be provided to help practitioners and decision-makers in this area. CONCLUSIONS: To the best of our knowledge this study, will be the first to synthetize and critically evaluate the scientific evidence on biomarkers associated with stress in caregivers of CSHCN.
Subject(s)
Caregivers , Delivery of Health Care , Child , Humans , Caregivers/psychology , Systematic Reviews as Topic , Meta-Analysis as Topic , BiomarkersABSTRACT
INTRODUCTION: Outpatient care for children and adolescents with chronic conditions needs to be continuous and programmed, encompassing comprehensive care, with periodically scheduled consultations, exams, and procedures, to promote quality of life and reduce mortality. In the context of the new coronavirus pandemic, however, outpatient care for children and adolescents with chronic conditions, in person, was hampered in favor of social isolation, a necessary sanitary measure to reduce and prevent the spread of Coronavirus Disease 2019. In response to this need, studies suggest telehealth in pediatrics as a fertile and expanding field especially in times of pandemics. Here, we aimed to map the evidence related to telehealth in outpatient care for children and adolescents with chronic conditions during the COVID-19 pandemic, to identify which strategies were implemented and their impacts on the continuity of care. METHODS: A scoping review protocol is reported and guided by the Scoping Reviews Manual of the Joanna Briggs Institute. The search for evidence will cover the following databases: MEDLINE/PubMed, Cochrane Libary; Embase; Web of Science; Scopus; Cinahl and PsycINFO, plus additional sources, such as The British Library, Google Scholar, and Preprints [medRXiv]. No date or language restrictions will be employed in this scoping review. Two independent researchers will conduct the search strategy, study selection, data charting, and data synthesis. RESULTS: The findings will be presented through tables, charts, narrative summaries, and assessed based on the type of data charted as well as outcomes. Additionally, the meaning of these findings will be considered as they relate to the guiding question, the characterization and measurement of the impact of different telehealth modalities used in outpatient care for children and adolescents with chronic conditions during the COVID-19 pandemic, and the implications for practice and further research. DISCUSSION: To the best of our knowledge, this will be the first scoping review to look specifically at the telehealth modalities to be used in outpatient care for children and adolescents with chronic conditions during the COVID-19 pandemic. We expect that our results will be of interest to practitioners as well as researchers concerned with this particular emerging issue in the pandemic context. Also, the plans for the dissemination of this study comprise peer-reviewed publication and conference presentations. TRIAL REGISTRATION: Open Science Framework Registration: osf.io/5pqgu.
Subject(s)
COVID-19 , Telemedicine , Adolescent , Ambulatory Care , COVID-19/epidemiology , Child , Chronic Disease , Humans , Pandemics , Quality of Life , Research Design , Review Literature as TopicABSTRACT
ABSTRACT Objective: to understand how nurses assess the implementation of therapeutic play by the nursing staff in the care provided to children. Method: qualitative study addressing nurses providing pediatric care in hospitals located in five Brazilian regions. Face-to-face meetings were held with nine focal groups between January and August 2018. The sessions lasted two hours on average and were audio-recorded and transcribed verbatim. Data were analyzed through inductive thematic analysis. Results: 52 nurses reported their perspectives regarding play and therapeutic play implemented in the care provided to children, which revealed The power of Play-Care implemented in nursing care: advancements and challenges and its subthemes: using puppets/dolls and dramatizing procedures; using distraction strategies to perform the procedures; wearing colorful and fun uniforms; recognizing the power of play in nursing care; and barriers challenging the connection between play and care in nursing practice. Conclusion: the power of Play-Care is manifested in the routine of nursing care through playful attitudes; however, these attitudes appear to be individual initiatives rather than systematized in the nursing process. Hence, there is a need to expand the possibilities of teaching this topic by promoting training programs, including practical activities and virtual learning environments.
RESUMEN Objetivo: comprender cómo los enfermeros evalúan la utilización del jugar e del juguete terapéutico, en el equipo de enfermería en el cuidado a niños. Método: estudio cualitativo con enfermeros actuantes en el cuidado pediátrico hospitalario de las cinco regiones de Brasil. Nueve grupos de enfoque presenciales fueron realizados entre enero y agosto de 2018. Las sesiones tuvieron duración media de dos horas, que fueron grabadas en audio, transcritas y analizadas según el análisis temático inductivo. Resultados: 52 enfermeros relataron sus perspectivas sobre el jugar y el juguete terapéutico en el cuidado a niños, revelando La fuerza del Jugar-Cuidar en el cuidado de enfermería: avances y desafíos y, sus subtemas: uso de muñecos y la dramatización de procedimientos; uso de la distracción para realización de procedimientos; uso de uniformes coloridos y divertidos; reconocimiento de la potencia del jugar en el cuidado de enfermería y barreras desafiadoras de la conexión jugar-cuidar en enfermería. Conclusión: la fuerza del jugar-cuidar se revela en lo cotidiano del cuidar de la enfermería, por medio de actitudes lúdicas; sin embargo, fueron identificadas como individuales y no sistematizadas en el proceso de enfermería. Se revela la necesidad de ampliar las posibilidades de la enseñanza de la temática, en la forma de capacitaciones, incluyendo actividades prácticas o además, que se hagan disponibles cursos en ambientes virtuales de aprendizaje.
RESUMO Objetivo: compreender como os enfermeiros avaliam a utilização do brincar e do brinquedo terapêutico pela equipe de enfermagem no cuidado à criança. Método: estudo qualitativo com enfermeiros atuantes no cuidado pediátrico hospitalar das cinco regiões do Brasil. O total de nove grupos focais presenciais foi realizado entre janeiro e agosto de 2018. As sessões tiveram duração média de duas horas, foram audiogravadas, transcritas e analisadas segundo a análise temática indutiva. Resultados: 52 enfermeiros relataram suas perspectivas sobre o brincar e o brinquedo terapêutico no cuidado à criança, revelando A força do Brincar-Cuidar no cuidado de enfermagem: avanços e desafios e, seus subtemas: uso de bonecos e a dramatização de procedimentos; uso da distração para realização de procedimentos; uso de uniformes coloridos e divertidos; reconhecendo a potência do brincar no cuidado de enfermagem e barreiras desafiadoras da conexão brincar-cuidar em enfermagem. Conclusão: a força do brincar-cuidar se revela no cotidiano do cuidado de enfermagem por meio de atitudes lúdicas, no entanto, são identificadas como individuais e não sistematizadas no processo de enfermagem. Revela-se a necessidade de ampliação das possibilidades de ensino da temática na forma de capacitações, incluindo atividades práticas ou ainda, que sejam disponibilizados cursos em ambientes virtuais de aprendizagem.
Subject(s)
Humans , Male , Female , Pediatric Nursing , Play and Playthings , Child, Hospitalized , Professional Competence , Focus Groups , Qualitative Research , Humanization of Assistance , Nurses, Male , Nursing Care , Nursing, TeamABSTRACT
PURPOSE: The main stage of developing an educational health technology is meeting the expectations of users. Nurses in Brazil can benefit from online training about therapeutic play interventions. This study identified the learning demands of nurses for acquiring competence in the use of therapeutic play to build an online course. DESIGN AND METHODS: Focus groups study, guided by the COREQ guidelines. Nurses experienced in pediatric care participated in eight groups held in hospitals across all Brazilian regions in 2018. The focus group interviews had a mean duration of two hours and were moderated by the main researcher and an observer, both of whom were nurses experienced in qualitative research. All interviews were audio recorded. The transcripts of the audios were coded, from which the themes were developed, and thematic analysis performed. RESULTS: Nurses (N = 53, 8.5 ± 6.3 years of experience in pediatric care) reported their learning demands in three themes: "Learning theoretical concepts", "Developing therapeutic play skills", and "Learning the therapeutic play in a fun, interactive and motivational online environment". CONCLUSION: Nurses learning demands involve theoretical concepts and skills to implement therapeutic play through an interesting online course. PRACTICE IMPLICATIONS: By developing play-based competence through an online learning environment nurses can feel confident in implementing therapeutic play into their pediatric practice, setting the stage for a future of positive interaction between nurses and children in pediatric health care.
Subject(s)
Education, Distance , Brazil , Child , Clinical Competence , Focus Groups , Humans , Learning , Qualitative ResearchABSTRACT
ABSTRACT Objective to investigate the follow-up and characteristics of children and youth with special healthcare needs within Primary Health Care services located in a city in the State of São Paulo, Brazil. Method this qualitative study was supported by the Primary Health Care framework, and interviews were held with 37 health workers from the primary health care units located in the interior of São Paulo. Data were collected from May to December 2018 and treated with inductive thematic analysis. Results from the perspective of the health workers, the characteristics of these children and youth are centered on the dependence of specific care such as to promote psychomotor development, and dependence on technology and pharmacological treatments. They reported the difficulty to access health services while the primary health care services do not implement systematic follow-up. Conclusion these children and youth demand continuous and longitudinal care, which, however, is not provided by primary health care services, considering the discontinuity of care and a lack of networked follow-up. Therefore, health services need to be reorganized to keep up with changes in the child and youth morbidity and mortality to ensure continuous, integral, and networked follow-up to this population.
RESUMEN Objetivo investigar el acompañamiento y las características de niños y adolescentes con necesidades especiales de salud, en los servicios de Atención Primaria a la Salud, en un municipio del Estado de Sao Paulo. Método estudio de abordaje cualitativo, apoyado en el cuadro teórico de la Atención Primaria a la Salud, desarrollado por medio de entrevistas con 37 profesionales de la salud, de unidades de atención primaria, de un municipio del interior del estado de Sao Paulo. Los datos recogidos, entre los meses de mayo y diciembre de 2018, fueron sometidos al análisis temático inductivo. Resultados para los profesionales de la salud, las características de esos niños y adolescentes se enfocaron en la dependencia de cuidados específicos, como los cuidados para el desarrollo psicomotor, tecnológico y medicamentoso. Ellos relataron la dificultad de acceso a esa clientela a los servicios de salud y la falta de acompañamiento sistemático por los servicios de atención primaria. Conclusión esos niños y adolescentes demandan un cuidado continuo y longitudinal, el cual no fue sustentado por los servicios de atención primaria, teniendo en consideración la discontinuidad del cuidado y la ausencia del cuidado en red. De esa forma, es necesario reorganizar los servicios de salud para acompañar los cambios en el perfil de morbilidad y mortalidad infantojuvenil, de modo a asegurar el acompañamiento continuo, integral y en red de esta población.
RESUMO Objetivo investigar o acompanhamento e as características de crianças e adolescentes com necessidades especiais de saúde nos serviços de Atenção Primária à Saúde em um município do Estado de São Paulo. Método estudo de abordagem qualitativa, apoiado no quadro teórico da Atenção Primária à Saúde, desenvolvido por meio de entrevista com 37 profissionais de saúde de unidades de atenção primária de um município do interior do Estado de São Paulo. Os dados coletados entre os meses de maio e dezembro de 2018 foram submetidos à análise temática indutiva. Resultados para os profissionais de saúde, as características dessas crianças e adolescentes centraram-se na dependência de cuidados específicos como cuidados para o desenvolvimento psicomotor, tecnológico e medicamentoso. Eles relataram a dificuldade de acesso aos serviços de saúde e a falta de acompanhamento sistemático pelos serviços de atenção primária. Conclusão essas crianças e adolescentes demandam um cuidado contínuo e longitudinal, o qual não foi sustentado pelos serviços de atenção primária, tendo em vista a descontinuidade do cuidado e a ausência do cuidado em rede. Dessa forma, faz-se necessário reorganizar os serviços de saúde para acompanhar as mudanças no perfil de morbimortalidade infantojuvenil, de modo a assegurar o acompanhamento contínuo, integral e em rede desta população.
Subject(s)
Humans , Child , Adolescent , Pediatric Nursing , Primary Health Care , Child Health , Chronic Disease , Health PersonnelABSTRACT
Crianças e adolescentes com demandas de cuidados complexos, contínuos e de longa duração nos setores saúde, educação e/ou social, que ultrapassam aqueles cuidados exigidos por outras crianças e adolescentes, são classificados como Crianças e Adolescentes com Necessidades Especiais de Saúde. Por essas características, são acompanhados com mais frequência nos serviços de saúde secundários e terciários. A Atenção Primária à Saúde, no entanto, representa uma importante aliada no cuidado prestado a essas crianças e adolescentes, dada sua potencialidade de ampliar a resolutividade e o impacto no processo saúde-doença. Nesse sentido, os profissionais da Atenção Primária à Saúde necessitam conhecer tal clientela para direcionar seus saberes e práticas. Assim, o presente estudo teve como objetivo geral descrever os saberes e as práticas dos profissionais nos serviços de Atenção Primária à Saúde relacionados às demandas de crianças e adolescentes com necessidades especiais de saúde. Estudo de abordagem qualitativa, apoiado no quadro teórico da Atenção Primária à Saúde, com análise de dados do tipo temática indutiva, realizado com profissionais de saúde da rede básica de um município do estado de São Paulo. A coleta de dados ocorreu por meio de entrevistas semiestruturadas abordando questões relacionadas ao acompanhamento de crianças e adolescentes com necessidades especiais de saúde nas unidades de saúde. Participaram do estudo 37 membros de equipes de saúde: agente comunitário da saúde (13), auxiliar de enfermagem (6), clínico geral (1), dentista (3), enfermeiro (6), farmacêutico (1), médico de família (3), nutricionista (1) e pediatra (3), sendo 25 profissionais (67,6%) de Unidades Saúde da Família e 12 profissionais (32,4%) de Unidades Básicas de Saúde. O material empírico foi organizado ao redor de três unidades de sentido: características de crianças e adolescentes com necessidades especiais de saúde, identificados mediante a presença de deficiência física ou cognitiva, dependentes de outra pessoa para o seu cuidado ou que necessitavam de atenção diferenciada da equipe de saúde; o cuidado de crianças e adolescentes com necessidades especiais de saúde na Atenção Primária à Saúde, com destaque para a infraestrutura inadequada das unidades; dificuldade de se trabalhar em rede e a descontinuidade do cuidado de crianças e adolescentes com necessidades especiais de saúde pelos serviços e lacunas na formação dos profissionais da Atenção Primária à Saúde, abordando o conhecimento insuficiente para o cuidado desta clientela. Também foram identificados os atributos da Atenção Primária à Saúde, sendo que a falta de coordenação das redes de saúde prejudicou o acompanhamento dessas crianças e adolescentes pelos serviços de atenção primária, levando-os ao atendimento desnecessário nos outros níveis de atenção. Os resultados do estudo podem contribuir para construção de novos conhecimentos no planejamento de estratégias e ações voltadas para crianças e adolescentes com necessidades especiais de saúde no âmbito da atenção primária, a fim de qualificar a assistência prestada
Children and teenagers with complex, continuous and long-during care demands, in the health, educational and/or social sectors, the surpass the care needed for other children and teenagers, are classified as Children and Teenagers with Special Health Needs. For those characteristics, they are more frequently cared by the secondary and tertiary health services. The Primary Health Care, though, represents an important ally on the care to these children and teenagers, given its potentiality of improvement on the solvability and its impact on the health-disease process. In that perspective, the Primary Health Care professionals need to recognize such clients in order to direct their knowledges and practices. Therefore, the present study aimed to describe the Primary Health Care professional's knowledges and practices related to the demands of children and teenagers with special health needs. Study with a qualitative approach, based on the theoretical framework of the Primary Health Care, with inductive theme type data analysis, realized with health professionals of the basic service on a county in the state of São Paulo. The gathering of data happened through semi structured interviews approaching questions related to the medical monitoring of children and teenagers with special health needs in the health units. 37 health team members participated of the study: community health agents (13), nursing assistant (6), general practitioner (1), dentists (3), nurses (6), pharmacist (1), family physicians (3), nutritionist (1) and pediatricians (3), of which 25 (67,6%) are Family Health Units professionals and 12 (32,4%) are Basic Health Units professionals. The empirical material was organized around three sense units: children and teenagers with special health needs characteristics, identified upon the presence of physical or cognitive deficiency, depending on someone else for their care or needing special attention of the health team; the care of children and teenagers with special health needs on the Primary Health Care, highlighting the inadequate infrastructure of the units; the difficulty of working in network and the discontinuity of care to children and teenagers with special health needs and the gaps in the education of the Primary Health Care professionals, approaching the insufficient knowledge to the care of these clients. The attributes of the Primary Health Care were also identified, being that the lack of coordination of the health networks harmed the medical monitoring of these children and teenagers by the services of primary care, taking them to the unnecessary treatment on other attention levels. The results of the study may contribute to the construction of new knowledges on the planning of strategies and actions turned to children and teenagers with special health needs in the context of Primary Care, in order to qualify the provided assistance
