REVIEW ARTICLE

Scientific production in nursing on violence in adolescence

Nathália da Silva Pimentel Reis^I; Ellen Marcia Peres^II; Dayana Carvalho Leite^III; Helena Ferraz Gomes^IV; Maria Fabiane Galdino dos Santos^V

^I Nurse. Specialist. Fellow of the Technical Support Program, State University of Rio de Janeiro. Brazil. E-mail: natyspreis@oi.com.br
^II Nurse. PhD. Associate Professor of the Medical-Surgical Department, State University of Rio de Janeiro. Brazil. E-mail: ellenperes@globo.com
^III Nurse. Specialist. Pedro Ernesto University Hospital. Rio de janeiro Brazil. E-mail: dayanaleite@hotmail.com
^IV Nurse. Assistant Professor, PhD student at the Graduate Program in Nursing UERJ, State University of Rio de Janeiro. Brazil. E-mail: helenafg1@yahoo.com.br
^V Nurse. Specialist. Student of the Graduate Course in Nursing, residency modality, Fernandes Figueira Institute. Rio de Janeiro Brazil. E-mail: fabianegaldino92@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2017.26475

ABSTRACT

Objective: to analyze Brazilian scientific production in nursing on violence in adolescence, from 1990 to 2015. Method: this literature review using bibliometric analysis drew on the MEDLINE, LILACS, BDENF and ADOLEC databases, from January to April 2016, applying the combined descriptors: adolescents, nursing, violence, human rights, and defense of children and adolescents. Results: 32 articles published since 2000 were identified, the largest number of which were in the periodical Acta Paulista de Enfermagem. In Brazil, the Northeast region stands out with 11 publications. Strikingly, 31 of the articles came from public institutions and their authors prioritized qualitative methodology with content analysis. Conclusion: production in nursing amounted to an unimpressive total in view of the current situation in which adolescents are the main victims of violence and account for a considerable portion of instances of health care.

Keywords: Adolescents; human rights; nursing; violence.

INTRODUCTION

Violence against adolescents can be considered a serious public health problem nowadays, besides constituting a violation of the Federal Constitution of 1988 that, in its Article 227 established that it is the duty of the family, society and the State to ensure the right to life, health, food, education, leisure, professionalization, culture, dignity, respect, freedom and family and community coexistence to children, and to safeguard them from all forms of neglect, discrimination, exploitation, violence, cruelty and oppression¹.

According to the World Health Organization (WHO), adolescence encompasses the ages from from 10 to 19 years², which is the age range also adopted in Brazil by the Ministry of Health. In turn, youth corresponds to the period from 15 to 24 years old, considering two groups, young adolescents (15 to 19 years) and young adults (20 to 24 years)³. However, the Article 2 of Statute of the Child and Adolescent (SCA) considers adolescents to be those people aged between 12 and 18 years ⁴.

Adolescence is considered to be a period of life with unique characteristics⁵, and it is important to consider it, as well as youth, as a set of complex processes of emancipation, with plastic and mobile borders which are not restricted to the transition from school to work, and involve three interdependent dimensions: the macro-social dimension, in which social inequalities such as class, gender and ethnicity are situated; the dimension of institutional arrangements, which bring together education systems, productive relations and labor market; and finally, the biographical dimension, that is, the particularities of the personal trajectory of each individual⁶.

The analysis of violence against adolescents in Brazil in the last 12 years indicates that aggression is the main cause of death in adolescence. In 2012, all the adolescents who died at 10 to 18 years of age (36.5%) did so as a consequence of aggression. When this percentage is compared with that of the total population (4.8%), a staggering difference that reveals the extent of the vulnerability of in this portion of the population becomes evident⁷. In synthesis, the data show a high degree of vulnerability of this population group, and at the same time confirm the violence as a critical public health problem that needs to be addressed.

In the current context of Brazil, adolescents can be considered victims of violence, and not necessarily causing agents as evidenced by data from the Mortality Information System (MIS): 7,592 adolescents between the ages of 12 and 18 were victims of death by aggression in 2012, which would amount to a rate of 31.3 deaths per aggression for every 100,000 adolescents ⁷.

In view of the above, the following question emerges: What has been the nursing scientific production in Brazil on violence in adolescence from 1990 to 2015?

Based on the premise that nurses are direct actors in the health care able to identify and intervene in cases of adolescent victims of violence, the present study aims to analyze the Brazilian nursing scientific production on violence against adolescents in the period from 1990 to 2015.

Deepening research will also make it possible to detect the knowledge gaps regarding this historical, cultural and social phenomenon, imbued with prejudices and stigmas in contemporary society, which is called violence.

METHODOLOGY

Bibliographical research developed through a review with bibliometric analysis, since it is a study whose theme implies the analysis of publications to recognize its frequency, regularity, types, examined topics, and methods used in texts⁸.

The bibliographic material was sought in the Virtual Health Library (VHL), in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database (BDENF) and Virtual Library in Adolescent Health (ADOLEC). The following descriptors were used in the survey, using the Boolean operator AND: adolescent, nursing, violence, human rights, and defense of children and adolescents.

The inclusion criteria were: articles published between 1990 and 2015 in Portuguese, available electronically in full length and free for download, and that have been published in nursing journals. Literature review articles were excluded, as well as those that did not address violence in adolescence as the main theme, or whose theme was inconsistent with the study topic, and texts found in more than one database where they were counted and analyzed only once in order to avoid repetition.

It should be emphasized that the adoption of the time cut from 1990 to 2015 is directly linked to the promulgation of the main Brazilian legal framework for adolescent health, Law 8.069 of July 13, 1990, known as Statute of the Child and Adolescent) of 1990, a chronologically prior document to the Law 8.090 of the Unified Health System (SUS) of the same year.

The new legal framework incorporated principles of the Convention on the Rights of the Child, adopted by the Resolution L 44 (XLIV) of General Assembly of the United Nations on November 20, 1989, which was ratified by Brazil on September 24, 1990⁹.

The data collection of the present study was carried out through the paired search of articles, that is to say, a search conducted by two researchers, between January and April 2016, and a form called catalog record was prepared by authors for that purpose, to systematize the data collection. This instrument included the following items: title of the article, year of publication, journal title, institution of origin (public or private), Brazilian region where the study was conducted, and methodology/type of study.

Data were analyzed by means of simple statistics and the results were presented in a descriptive way. Contents were discussed in the light of the literature on the subject under study^1-7,9-30.

RESULTS

The potential bibliography consisted of 32 scientific papers that illustrate the data described.

Regarding the year of publication, it should be noted that no publication was found between 1990 and 1999. This fact can be a result from the significant progress of Brazil in the confrontation of violence against children and adolescents that took place only after 2000, with the approval of the National Plan for Combating Sexual Violence against Children and Adolescents by the National Council for the Rights of Children and Adolescents (CONANDA)¹¹.

After the institution of this National Plan, Brazil began to experience a series of important advances in the area of ​​recognition and confrontation of violence, especially sexual violence, against children and adolescents ⁵. We believe that this fact stimulated the start of the nursing publications on the subject from 2000 onwards.

There was an increase in the number of publications in 2009, with a predominance of five articles, followed by a second high concentration in the years of 2010, 2013 and 2014.

Regarding the journals, it was found that the Acta Paulista of Nursing presented the largest number of publications in the study period, with five articles. However, the Latin American Journal of Nursing stands out as a pioneer in this subject, with its first publication in 2000. There is still the Brazilian Nursing Journal and the Nursing Journal of São Paulo, both with four publications; the other journals had less than four publications, as shown in Table 1.

TABLE 1: Distribution of the selected articles according to scientific journals. Brazil, 1990-2015

Public universities (state and federal) predominated in 31 (97%) of the analyzed studies, demonstrating the importance of these institutions as sources of scientific production. In only one article, it was not possible to identify the institution of origin of the study because the available version does not provide this information.

This result portrays a reality: in Brazil, research is highly valued in the academic world, especially in public institutions, since it is a requirement for the practices of professors and students (Master, Doctoral, offend-of-course papers). Furthermore, these units are subject to academic incentives from research promotion agencies, represented by the National Council for Scientific and Technological Development (CNPq) and the Coordination of Improvement of Higher Education Personnel of the Ministry of Education (CAPES MEC)¹⁰.

An analysis was also made of the Brazilian regions where the studies were conducted, as shown in Table 2. It is noteworthy that a high concentration of scientific publications was found in the Northeast - 11 (34.4%) - and South - 9 (28.1%) - regions. The Southeast region had 8 (25%) publications and the Central-West region had 4 (12.5%). No studies on the subject were found in the Northern region.

TABLE 2: Distribution of the selected articles according to Brazilian regions of where the studies were conducted. Brazil, 1990-2015.

The analysis of the studies revealed that the main methodology used in articles had a qualitative approach, which was the case of 21 articles (66%), while the quantitative approach appeared in 11 articles (34%).

Among the studies that had a qualitative approach, most of them (19, 90.5%) employed content analysis for discussion and treatment of the data. Two (9.5%) publications with a qualitative methodology employed the triangulation of data for analysis. Among the studies with a quantitative approach, all used descriptive statistics, organizing numerical data into absolute and relative frequency distribution.

DISCUSSION

Violence is a contemporary social phenomenon characterized as epidemical and intrinsically linked to social and cultural inequalities. It is also determined by behavioral and relational aspects. The magnitude of the injuries, traumas and deaths and the years of life lost due to violence have repercussions in terms of enormous human, financial and social costs. For this reason, the phenomenon of violence is a public health problem^3,11.

In the traditional perspective of public health, adolescents are recognized as capable of assuming three roles in relation to violence - author, victim or witness. However, in Brazil, violence against this population in the last decades has become a subject of reflection on several areas of knowledge due to the high homicide rates in this age group¹². Moreover, the Brazilian press has been given the violence committed by adolescents and young people increasing visibility in society and this fact has mobilized a large part of society to think of adolescents as individuals capable of being held accountable for their actions, just like adults. However, adolescents under 18 years of age are considered not subject to criminal penalties according to the Criminal Statute (1940)¹³.

However, a literature review showed the emergence of nursing publications on violence against adolescents only from the year 2000 onwards, demonstrating, until then, a huge gap of scientific knowledge on the subject.

As for the premise that adolescents are individuals that are in phase of growth and development, marked by great physical, psychic and social transformations, several research studies show that the process of cerebral development occurs in this period. It is in this moment that the control of impulses, and the learning and production of emotions are refined, and only in adulthood reach complete maturation¹⁴. We cannot equate adolescents and adults solely based on the information made available by the press; the entire biopsychosocial context of these individuals must be considered.

When it is said that the theme has been little discussed, this means that throughout history, the phenomenon has always been present and since 1989, it was already introduced in the normative plan: the intrinsic value of children and adolescents as human beings, the need of special respect the recognition of their rights and their absolute priority in public policies, as recommended by the Convention on the Rights of Children created by the General Assembly of the United Nations and ratified by Brazil in 1990⁹.

The vulnerability of this population group to the growing incidence of deaths from violent external causes, in higher proportions than in the rest of the population, is undeniable. It is noteworthy that, in 2012, the Northeast had the highest number of homicides among adolescents in relation to all other regions of the country: after reaching the age of 12, about 5.97 out of 1,000 adolescents would be victims of homicide before reaching the age of 19. It is estimated that in the period from 2013 to 2019, if the current conditions do not change, more than 16,000 northeastern adolescents will die before reaching age 19⁷.

This situation indicates the need to awaken in researchers and scholars from different disciplines and areas of knowledge of public and private institutions the goal to study and publish research on this matter, in order to propose intervention measures to minimize or even eliminate this phenomenon. However, the aim should also be to disseminate knowledge about prevention of violent acts and healthy development⁶.

We observed a predominance of studies with a qualitative approach. We infer that because violence is a multi-causal, historical, social and cultural phenomenon, this type of methodological approach allows a greater understanding of the different aspects associated with violence against adolescents.

Considering the Article 5 of the Federal Constitution (1988), which declares the right to life, liberty, equality, security and property to be inviolable, the extent of the phenomenon of violence against adolescents and the need for studies that address this issue with the intention of producing and disseminating knowledge become clear¹.

As for health professionals, they perceive violence as a multi-causal phenomenon that violates the physical, psychological, social and sexual integrity of children and adolescents, and its repercussions affect families and society. There is a need for effective public policies. These policies must include, besides children and adolescents, the family as the main insertion nucleus¹⁵.

On the other hand, it is essential, in the fight against violence in adolescence, that public policies be intersectoral and involve the society, families, schools, the media, and community movements. Such policies must be based on guidelines that in their structural themes bring up the culture of peace, ethics and citizenship beyond racial and ethnic equality, as well as transversal themes that deepen and enrich health actions for this segment, favoring egalitarian relations and the development of a culture of peace⁵. The fight against violence demands interdisciplinary, interprofessional and multisectoral articulation¹⁶.

There is a need to understand violence in the context of relationships, as a consequence of a complex relational dynamics, being a social problem with serious repercussions on health¹⁷.

It is worth emphasizing that the approach taken in situations of violence against children and adolescents reflects the lack of integration between professionals and the different sectors involved in this problem. A social support network, both inter-institutional and intersectoral, is needed besides the health sector¹⁸.

As violence is a multifaceted social problem, it requires an integrated action from health professionals together with the available services, such as the Guardianship Council and the Public Ministry¹⁹.

It is also important that nursing professionals be able to report cases of violence against children and adolescents, broadening the perception of this phenomenon, not restricting it to strictly biological aspects, but as a social, relational, economic, cultural and historical problem. Notification of cases may contribute to the "denaturalization and social deconstruction of behaviors still accepted within families" ^20:598. Studies have indicated that most acts of sexual violence take place within the domestic context^21-23.

Sexual abuse consists of a political, social and family problem, and it is fundamental that nursing professional be able to diagnose it because this type of violence requires continuous education to identify and treat it at the different levels of health care²⁴.

With regard to cases of child mal-treatment, ignorance and omission of the cases constitute fertile ground for the perpetuation of the occurrences ²⁵.

In this perspective, nurses need to deepen and broaden the discussions about violence, using the scientific knowledge built to detect, notify, provide care, minimize and prevent situations of violence against children and adolescents^26;27.

The perception of nurses of situations of violence against children and adolescents requires the same sensitivity, listening, accessibility, acceptance, empowerment, and deepening of research and studies on violence ²⁸.

In addition, nurses are legally and morally supported to deal with situations of violence, for which they must have the knowledge to adopt measures based on ethics, citizenship and humanization²⁹.

Nursing should act with collective and interdisciplinary actions in the prevention and identification of suspected cases of violence in order to contribute to the reduction of the repercussions resulting from this complex and multi-causal phenomenon³⁰.

CONCLUSION

We conclude that the nursing production on the theme of violence in adolescence in the time cut from 2000 to 2015 totaled 32 publications, a low number in view of the current situation where adolescents are the main victims of violence and represent an important part of assisted cases in the health sector.

Publications were found mostly in the Acta Paulista of Nursing and the majority of the studies were conducted in the Brazilian northeast. Most studies applied a qualitative approach and content analysis and were developed in public institutions.

It is essential that public policies meet the needs of this population, with incentives for health promotion programs that value the empowerment of the individuals with the aim of improving their quality of life, and it is also fundamental that more studies be conducted on violence against adolescents, both nationally and internationally, with emphasis on the health care for this particular public, with a view to contributing to improve the quality of care.

Investing in the health of adolescents and young people is cost-benefit effective because ensuring the quality of life of young people means also ensuring their energy, creativity, and their innovative and constructive spirit, which should be considered as a rich potential capable of influencing in a positive way the development of the country.

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