Scientific production of Adolescent Health Nursing residents at a university hospital in Rio de Janeiro (RJ)

Original Article

Vol. 16 nº 3 - Jul/Sep - 2019
Pages:51-
58

Scientific production of Adolescent Health Nursing residents at a university hospital in Rio de Janeiro (RJ)

Authors: ^¹, ^², ^³, ^⁴, ^⁵

¹Resident in the Adolescent Health Nursing Program at the Pedro Ernesto University Hospital (HUPE – UERJ). Rio de Janeiro, RJ, Brazil

²PhD student in Nursing at the State University of Rio de Janeiro (UERJ). Master’s degree in Nursing from the State University of Rio de Janeiro (UERJ). Professor at the Department of Medical-Surgical Nursing (DEMC) of the School of Nursing at the State University of Rio de Janeiro (ENF/UERJ). Rio de Janeiro, RJ, Brazil

³Nurse at the Center for Adolescent Health Studies (NESA), Coordinator and Tutor of the Adolescent Health Nursing Residency Program at the Pedro Ernesto University Hospital (HUPE – UERJ). Rio de Janeiro, RJ, Brazil

⁴PhD in Community Health from the Abel Salazar Institute of Biomedical Sciences (ICBAS). Porto, Portugal. PhD in Public Health – concentration area Health Policy, Planning and Administration, from the Institute of Social Medicine of the State University of Rio de Janeiro (IMS/UERJ). Professor at the Department of Medical-Surgical Nursing (DEMC) of the School of Nursing of the State University of Rio de Janeiro (ENF/UERJ). Rio de Janeiro, RJ, Brazil

⁵PhD student in Nursing at the State University of Rio de Janeiro (UERJ). Professor at the Department of Medical-Surgical Nursing (DEMC) of the School of Nursing of the State University of Rio de Janeiro (ENF/UERJ). Rio de Janeiro, RJ, Brazil

Correspondence:

Mellina Fernanda Silva dos Santos Gualberto
( mellinafernanda@hotmail.com )
School of Nursing, State University of Rio de Janeiro
Boulevard 28 de Setembro, 157, Vila Isabel
Rio de Janeiro, RJ, Brazil. Zip Code: 20551-030

Submitted on 17/12/2018
Approved on 02/09/2019

Keywords: Nursing, Practical; Adolescent; Monograph.

Abstract

OBJECTIVE: To analyze the scientific production of Adolescent Health Nursing residents between 2007 and 2017.
METHODS: This is a descriptive, quantitative study, carried out through documentary analysis of the Residency Completion Papers (TCR) of the Adolescent Health Nursing Residency Program at Pedro Ernesto University Hospital. Based on inclusion and exclusion criteria, 18 papers were selected for analysis. Data were collected in June and July 2018, through electronic media searches. The data were tabulated and organized using simple descriptive statistics and presented in tables and graphs.
RESULTS: Of the papers analyzed, 44.44% (n = 8) used qualitative research methods. The semi-structured interview technique was used in 39% (n=7) of the studies, with the ward as the setting for 45% (n=8), with chemotherapy 16% (n=3) and teenage pregnancy 16% (n=3) being the most addressed themes.
CONCLUSION: The study allowed characterizing the scientific production of nursing residents in Adolescent Health, serving as subsidies for a new look at the problems arising from care practice. They demonstrate to be in line with public policies aimed at this specific population and with the reality of the service.

INTRODUCTION The objective of this study is to map the scientific production of the Nursing Residency Program in Adolescent Health, of the State University of Rio de Janeiro (UERJ), linked to the School of Nursing (ENF) and the Pedro Ernesto University Hospital (HUPE). It is important to note that scientific production refers to the form of course completion work, adopting, in this research, the term Residency Completion Work (TCR). The Nursing Residency Specialization course is a form of lato sensu postgraduate education aimed at nurses, characterized by in-service teaching with a workload of 60 hours per week and a minimum duration of two years ¹ . Regarding nursing residency and the requirements needed to train specialists in the in-service training modality, Resolution No. 3 of May 4, 2010, establishes the duration and workload of the Multiprofessional Residency in Health and Residency in the Professional Area of Health programs, as well as the need for individual submission of a monograph or scientific article with proof of submission protocol for publication 1 ^. It is worth noting that the Nursing Residency Program in Adolescent Health is part of the clinical area of the School of Nursing (ENF), offering four vacancies annually. The initiation into research occurs in the first months of the first year of residency, when the student and advisor begin to define the theme to be developed and the necessary subsidies to carry out the research. Mendes ² points out that nursing needs the development of research for its growth, as this is a fundamental requirement in the creation and validation of the knowledge necessary for its practice, in addition to ensuring professional status through the awareness that the autonomy of the profession depends on the art of mastering its own knowledge. Furthermore, the production of knowledge is necessary for problem-solving, and nursing must act in teaching, research and extension, socializing knowledge and ensuring research that can intervene in everyday reality ³ . However, the development of the research will involve the organization of stages defined by the researcher together with his/her advisor and will begin with the choice of the topic to be investigated, which sometimes refer to the problems experienced by the researcher in everyday practice ⁴ . Based on these considerations, the authors observed the need to analyze the scientific productions of the Adolescent Health Residency Program, in relation to the main researched themes involving adolescents, nursing care for these subjects, and the relationship with the practical action scenarios experienced by residents during the residency. It is noteworthy that the State of Rio de Janeiro does not have specialized units in Adolescent Health focusing on the different levels of health care, with the Adolescent Health Study Center (NESA) being a reference for this specialty. In addition, the nursing residency program is the only program in the country that offers vacancies for the training of hebiatric nurses. Aquino ⁵ corroborates this statement by pointing out that in Brazil, units dedicated to comprehensive health care for adolescents date back to 1974, but they are few and the exact number of units is unknown. In this sense, it is essential to outline the themes researched by specialist nurses in the scope of comprehensive adolescent health care, evaluating their consonance with the reality of health services and the health-disease process of this population group. In view of the above, the following research problem was defined: What is the scientific production of the Nursing residency in Adolescent Health between 2007 and 2017? The objective was defined: to analyze the scientific production of Nursing residents in Adolescent Health, between 2007 and 2017. METHODS This is a descriptive, quantitative study, carried out through documentary analysis. The TCR of the Adolescent Health Nursing Program of the Pedro Ernesto University Hospital, in Rio de Janeiro, stored as electronic media in the CD drives of the Nursing Training and Assessment Service (STAVE) were analyzed. In June and July 2018, data were collected from TCRs carried out between 2007 and 2017. This time frame was defined after prior consultation with STAVE, as there were no materials available prior to 2007. The sample consisted of 18 works selected based on the following inclusion criteria: Complete Residency Completion Works, available on electronic media – CD units, and with a final approval report. TCRs that did not meet the following criteria were excluded: works whose electronic media – CD units were not openable and viewable, incomplete and unavailable materials. The variables defined by the authors to create the Data Collection Instrument (DCI) were: author, advisor and co-advisor, year, central theme addressed, methodology (type of study, study participants, research scenario) and conclusion. The instrument was previously tested and adjusted in order to meet the objective of the study. The works were manipulated directly by the authors and the scientific initiation scholarship holder, with simultaneous completion of the forms, after prior training. The data were tabulated and organized with the application of descriptive statistics, being grouped into absolute and relative frequencies. To analyze these data, a database was built with Microsoft Excel Office XP . After analysis, the data were presented in tables and graphs. It is important to note that the research does not require registration on the Brasil platform because it deals with access data available from documentary sources. RESULTS It was found that 40 TCR should have been defended between 2007 and 2017, according to the number of annual vacancies opened by the Program. However, over the years, four (4) papers were not defended because the residents did not complete the course; the electronic media – CD of five (5) papers was not found, although the residents successfully completed the course; and thirteen (13) vacancies were left vacant, that is, those approved did not enroll, during the period analyzed. Therefore, the study sample consisted of 18 residency completion papers. Regarding the methodological approach, 44.44% (n=8) of the studies were qualitative, 22.22% (n=4) were quantitative, 22.22% (n=4) were integrative reviews, and only 11.11% (n=2) were quantitative-qualitative, as shown in Table 1.

Regarding the data collection technique, 39% (n=7) used semi-structured interviews, 22% (n=4) carried out an integrative review of the databases, 17% (n=3) structured interviews, 17% (n=3) phenomenological interviews, and only 5% (n=1) documentary analysis, as shown in Table 2.

Regarding the distribution of the studies in relation to the researched scenario, of the 14 articles that were developed in the field, 57% (n=8) were carried out in the ward, 29% (n=4) in the outpatient clinic, and only 14% (n=2) in the Polyclinic. It is worth noting that, during the period outlined in the research, the Center for Studies on Adolescent Health operated at the primary level in a Polyclinic, at the secondary level in an outpatient clinic and at the tertiary level in a ward, all linked to a Public University in the State of Rio de Janeiro, as shown in Table 3.

The thematic areas most addressed by the TCR, when compared to the other themes, were Chemotherapy 16% (n=3) and Teenage Pregnancy 16% (n=3), as observed in figure 1.

Figure 1. The thematic areas most covered in the Residency Conclusion Work analyzed.

DISCUSSION Most studies with adolescents present qualitative research as the preferred methodological approach, and semi-structured interviews as the most widely used data collection technique. One possible inference is that this type of research is more appropriate for understanding the nuances that involve adolescence as an object of scientific investigation. Qualitative research becomes appropriate for several areas of knowledge, themes and problems that are still unknown and require appropriate answers, since the process of this type of research collects, analyzes, and at the same time reformulates new questions, in addition to being effective in analyzing the social processes of human life and the social understanding of the world ⁶ . Regarding the practice settings of residents, there is a predominance of studies in the ward. However, the polyclinic, a primary level unit where residents develop nursing consultation activities, health education through waiting rooms, activities in schools, among others, presented incipient scientific production. The importance of actions focused on the triad of promotion, prevention and care by the entire health team is highlighted, with the first two being of greatest relevance in the work process, in line with the principles and guidelines of the Unified Health System, considered to be of great relevance for co-responsibility and strengthening the bond in the nurse-adolescent relationship. Health promotion permeates all health policies, programs and actions across the board, with the challenge of establishing comprehensiveness and equity ^7,8 . Furthermore, when observing the themes analyzed, some themes that emerge as social processes stand out, such as violence, teenage pregnancy and HIV/AIDS. These themes are in line with what is proposed by the National Guidelines for Comprehensive Health Care for Adolescents and Young People, in the promotion, protection and recovery of health. However, some structural themes for Comprehensive Health Care for Adolescents and Young People still need to be investigated, such as youth participation in society, gender equity, sexual rights, reproductive rights, life projects, ethics and citizenship, racial and ethnic equality, among other themes ⁹ . Teenage pregnancy is considered a high-risk pregnancy due to the complications it can cause to the teenage mother and the newborn. For this reason, it is incorporated into a situation of psychosocial risk, affecting the biography of the youth and the possibility of forming a stable life, being a very traumatic factor, especially in socioeconomically disadvantaged classes, contributing even more to the maintenance of poverty ^10,11 . Teenage pregnancy encompasses several aspects, since adolescents are not prepared to care for another person, in addition to being a population that is exposed to sexually transmitted infections, use of legal and illegal drugs, and various forms of violence, situations of extreme vulnerability ¹² . Therefore, it has a great impact on the lives of adolescents, and research in this area may contribute to the understanding of this phenomenon. In addition, there is a growing concern in various sectors of society regarding teenage pregnancy, understood as a social and public health problem, a concern corroborated by the increasing number of adolescents who have become pregnant in recent years ^13,11 . Added to this is the fact that teenage pregnancy is one of the most worrying issues related to sexuality, due to the implications arising from this event, such as abortion, maternal morbidity and mortality. When pregnancy occurs in the 10 to 14 age group, the problems are even greater, due to lack of planning, and it is often interrupted by abortion performed under poor technical conditions, with the risk of developing serious complications that can lead to the death of the adolescent ¹⁴ . It is also noted that one of the most researched topics was Chemotherapy. The survey of the profile of hospitalizations in tertiary care by the Center for Studies on Adolescent Health points to oncohematological and hematological pathologies as prevalent, such as leukemia, lymphoma, purpura, sickle cell anemia, thalassemia, coagulation disorders, aplastic anemia, among others. The treatment of most of these conditions is based on antineoplastic therapy. Although rare in absolute numbers, compared to the incidence in adults, childhood and adolescent cancer has been showing an increase in incidence rates. Previously, cancer was considered an acute and fatal disease, and today it has characteristics of a chronic disease ¹⁵ . There are several types of treatment, and chemotherapy is the most common among them, whether or not associated with other therapies. The treatment protocol is established according to the type of tumor, its biological behavior, location, extent of the disease, age and general condition of the patient ¹⁵ . In addition, chemotherapy treatment promotes a series of transformations in the lives of those who receive it, altering their body, emotional state and routine, as well as that of their family members. As a result of these factors, issues related to quality of life are seen as priorities; however, despite the adverse effects, chemotherapy is seen as a source of life ¹⁶ . Therefore, chemotherapy has an impact on the lives of adolescents and their families. In this sense, research on this topic is essential in the context of health and care for adolescents. It is worth noting that another topic that has been little developed but has seen significant progress at the hospital and outpatient level is the peripherally inserted central catheter (PICC), a device that allows the administration of fluids and medications that cannot be infused through peripheral access ¹⁷ . This type of catheter is widely used in patients undergoing antineoplastic chemotherapy treatment. As for chronic diseases, these represent a challenge for adolescents, family members and health professionals, as they imply significant changes in the adolescent’s lifestyle and in their family environment. Nursing care should establish care in treatment and routines, and also provide support, relief and encouragement so that the adolescent and their family can live in the best possible way in the face of their chronic disease ¹⁸ . In this sense, there is a need for research involving important themes in nursing, in the context of care for adolescents in the various vulnerabilities involved, such as care, the care process, and the systematization of nursing care. Finally, there is a need to produce care according to the real health needs of these individuals. Care must be appropriate for adolescents, understanding the particularities of this phase of life, with regard to biopsychosocial transformations, since the different ways of thinking and acting of these individuals presuppose different forms of interaction with the world, resulting from actions that are based on subjectivity ¹⁹ . Nursing professionals need to know and understand the reality of adolescents in order to offer care capable of helping them better cope with illness and hospitalization ²⁰ . To this end, it is necessary to deepen the health-disease process of this population group, with emphasis on nursing care through scientific research in the various scenarios of professional practice. CONCLUSION The analysis of the scientific production of the Nursing residency in Adolescent Health, in the period 2007-2017, highlighted the tendency of residents to produce studies with a qualitative methodological approach, using the semi-structured interview technique, with the ward as the setting. The topics related to chemotherapy and teenage pregnancy were the most investigated. However, there is a lack of scientific production focused on topics related to youth participation in society, gender equity, sexual rights, reproductive rights, life projects, ethics and citizenship, racial and ethnic equality, among others. The study allowed us to characterize the scientific production of residents in Adolescent Health Nursing, serving as a basis for a new look at problems arising from care practice that require scientific investigation. Thus, they are in line with public policies aimed at this specific population and with the reality of the service. It is expected that this study can contribute to nurses and nursing residents, signaling the gaps to be addressed in improving nursing care for adolescents in the various scenarios of residency practice, from a perspective of comprehensive care, through quality care. As limitations of the study, it is worth highlighting the absence of residency completion works prior to the year 2007, as well as those that were not available for research in the period outlined in the data collection.

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