RESEARCH ARTICLES
Nursing care to adolescents at school: a documentary research
Patrícia Naiara de Oliveira MoreiraI; Kálya Yasmine Nunes de LimaII; Francis Solange Vieira TourinhoIII; Viviane Euzébia Pereira SantosIV
INurse. Member of the Group of Research Laboratory for Care Research, Safety, Health and Nursing Technologies of the Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil. Email: patricianaiara9@hotmail.com.ABSTRACT: The objective was to characterize the dissertations and theses available on Theses Database Coordination of Improvement of Higher Education Personnel that deal with nursing care in front of adolescent health in schools. Documentary research conducted at the Thesis Database. The study sample consisted of 12 works: 2 (16.6%) doctoral and 10 (83.3%) masters. There was a higher number of studies in the Southeast Region, with 5 (41.7%) studies, followed by the Northeast Region with 4 (33.2%), and South Region, with 3 (25.1%). The qualitative study predominated with a phenomenological approach with 4 (33.2%) surveys, followed for descriptive exploratory, 3 (25.3%), with all research in nursing. 7 studies (58.3%) are emphasized about promotion and/or health prevention and 5 (41.7%) concerning epidemiological aspects. The little quantitative work has shown that there is a need for more studies focused on adolescents.
Keywords: Nursing; school health; adolescent; adolescent health.
INTRODUCTION
Adolescence, comprising the transition from infant stage to adulthood, is bounded under two classifications: by the Statute of the Child and Adolescent corresponds to individuals aged 12 to 18 years; and by the World Health Organization (WHO) as the period covering the second decade of life, 10 to 19 years, including biological and sociocultural aspects experienced in this age group1.
The biological aspect is observed by the physiological and anatomical changes, including hormonal interaction and sexual maturation. The psychological aspect is characterized by the adaptation that the body undergoes to new relationships with family, search for itself and constant changes of mood. The sociocultural covers the self-assertion of this young man in society, their independence and increasing freedom1,2.
Despite reaching 21% of the Brazilian population, many young people do not have access to information and basic care services3. Furthermore, they show resistance to health care institutions approach, resulting in low demand for these services.
The various changes that are related to this population and self-affirmation in society end up leaving it more vulnerable to existing risk factors4. The adolescent is an idealist, curious and protester, and those feelings awakened in him a need to challenge that, associated with the lack of experience and previous existences, may lead him to risk behaviors such as the use of alcohol, drugs, cigarettes, unhealthy food and early sexual activity, that most often occurs without protection4.
With this, thinking on this group implies to reevaluate policies for health promotion requiring the use of more effective strategies for youth participation. However, oftentimes, the health practice developed for adolescents is more curative than preventive, getting deficient the prevent actions in this group.
Therefore, to know how adolescents live and behave, enables measuring the distribution of risk and protective factors for current and future health, essential components to guide policies for young5.
In this sense, to promote health is to look at the teenage guy and his social context, providing access to information about the dangers of alcohol and drugs, encouraging adequate nutrient intake, offer of contraceptive methods, guidance about sexuality, the practice of physical activities and recreation for healthy physical, emotional, intellectual and social development. These actions include a differentiated and focused listening of problems in this group, thus directing a grounded assistance in the promotion and prevention of disease3,6.
Therefore, we highlight the role of the nurse in the development of actions directed to this audience. This becomes clear when analyzing the foundations that support the action of this professional, whose work is guided in the monitoring of health conditions; in the survey of problems and the exercise of a communicative practice of nursing7.
It is indispensable, therefore, that this attention be consolidated through actions that take into account the actual care and educational needs in health, which makes it vital that the professionals who will develop them further improve their knowledge of this age group, so that are capable of dealing with the issues that involves it7,8.
Then, realizing the vulnerability of young schoolchildren to aforementioned factors and the importance of nursing care to this population, and the role of researches in reporting the reality and propose strategies for intervention, the following research questions emerged: What are the characteristics of dissertations and theses available in Theses Database Coordination of Improvement of Higher Education Personnel (CAPES) that deal with nursing care in front of the health of adolescents in schools? What issues related to nursing care to adolescent health in schools are being addressed?
Thus, the study aimed to characterize the theses and dissertations available in the Theses Databases of CAPES that deal with nursing care in front of the health of adolescents in the school environment.
THEORETICAL-METHODOLOGICAL REFERENTIAL
This is a documentary research, performed at the Theses Database of CAPES of Journal Portal of CAPES. In this database, you can have access to information of dissertations and theses defended in the whole country since the year 19879.
The documental research involved the following stages: the choice of the topic, definition of objectives, preparation of work plan, identification and location of sources to search, obtaining and reading the identified material, pointing this material through records, analysis, interpretation of data and final essay of the study. These phases occurred in a natural sequence and in an articulate manner10.
The choice for these types of scientific monographs was given by theses and dissertations characterized by originality, high-level research and the possibility of progress in scientific area10.
Initially, a structured protocol was elaborated, which was composed of the following steps: delimitation of the subject; objective; guiding questions; search strategies (database and controlled descriptors); study selection (inclusion and exclusion criteria); strategy for data collection; strategy for critical review of the studies; and synthesis of data.
For collecting data, held in July 2012, we used the nursing descriptors, school and adolescent health, controlled by Descriptors of Health Sciences Subject Headings (MeSH) in the search field issue, by the option all words.
The selection of studies was based on previously established criteria, being including dissertations and theses, electronically available in full text, which spoke about the nursing care in front of the health of adolescents in the school environment (epidemiological aspects; promotion and/or prevention in health; and education and research). And the dissertations and theses that did not address the relevant issue to the scope of the survey were excluded; studies not available electronically in full; surveys that were not conducted with adolescents; and studies outside the school environment.
After the selection of studies, the search was conducted in virtual libraries of the universities of origin to find them in full, as the Thesis Database CAPES, provides only the titles and abstracts of scientific works.
The systematic review of each selected study was performed according to the following indicators of data collection: academic level (Masters or PhD); development local of the study; year of publication; area of knowledge; methodological design; level of evidence; and theme.
The referential was based on the quality of the level of scientific evidence from studies, from the methodological designs. The quality of this evidence was evaluated, classified into six levels: Level 1: evidence resulting from the meta-analysis of multiple clinical studies controlled and randomized; Level 2: evidence obtained on individual studies with experimental design; Level 3: evidence from almost-experimental studies; Level 4: evidence of descriptive studies (non-experimental) or qualitative approach; Level 5: evidence from case reports or experience; and Level 6: evidence based on expert opinions11.
RESULTS
Based on the preset protocol and the selected descriptors, the search resulted in 85 theses and dissertations. Of these, 14 works were elected, but two were not available in full text online, with this, according to the inclusion criteria, only 12 investigations entered the sample for analysis.
With regard to the academic level of the selected studies, 10 (83.3%) corresponded to the academic Masters and 2 (16.6%) to the doctorate. The universities that focused more studies with the theme were the Federal University of Minas Gerais with 3 (25.1%) surveys, and the University of Rio Grande do Sul with 2 (16.7%). The rest of the universities developed only 1 (8.3%) research, namely: University of Santa Catarina, Federal University of Paraíba, University of São Paulo, the Federal University of Rio de Janeiro, Federal University of Ceará, Federal University of Rio Grande do Norte and Federal University of Piauí, as shown in Figure 1.
Thus, we observed a higher quantitative of works in the Southeast Region with 5 (41.7%) studies, followed by the Northeast Region with 4 (33.2%) and South Region with less quantitative, 3 (25.1% ), as can be seen in Figure 2.
It was observed in the methodological design, the prevalence of qualitative studies with a phenomenological approach, with 4 (33.2%) investigations, followed by 3 (25.3%) descriptive and exploratory research, with all research in nursing area. The studies were about health promotion and/or prevention of diseases, theme of 7 (58, 3%) works; and epidemiological aspects, which accounted for 5 (41, 7%) searches. The characterization of the analyzed studies is described in Figure 3.
DISCUSSION
It is realized an increase in the development of work about the nursing care to adolescents in schools in recent years, especially since 2000. It is denoted the importance increasing that is being directed at this audience, constituted in the central axis that guides the actions of Adolescent Health Program (PROSAD) of the Ministry of Health12.
It is evident, that the physical-biological and emotional changes bring several implications, especially to health care of adolescents13. Therefore, it is understood that the population in question should be the subject of specific actions that meet their needs. In this context, the school emerges as a fundamental social equipment for performance of health professionals, especially nurses, through actions of disease prevention and health promotion.
The academic level of the studies covered in this research is suitable with the reality of Brazilian postgraduate programs, where the academic master, is the type of postgraduate course that more titles and grows more in the country14.
It is noticed that the production about the topic is more incipient in the South Region, with only three developed works, all at Masters level. The remaining studies were developed in the Southeast and Northeast Regions of Brazil. What shows greater concern in these regions to work adolescence and aspects that involve, apart from the need to develop more studies in other regions.
The researches has as one of its functions to contribute to the knowledge and base the professional practice so that it is more knowledgable and guided by scientific knowledge. Faced with theses and dissertations found, prevailed exploratory descriptive and phenomenological studies, qualitative approach, followed by transversal quantitative studies.
The phenomenological approach was used in 4 (33.2%) works, which can be explained by the need to understand the phenomenon of adolescence with health, showing a time of physical, psychological and social transition, surrounding this period.
Still about the researches relevance, we note that knowledge is in constant growth and improvement in society, it is possible to come across, commonly, with health practices that are not corresponding to current produced knowledge15. Given this, to minimize the gap between the science produced, through scientific studies, and practiced knowledge arose the evidence-based practice (EBP).
In this perspective, the EBP focuses classification systems of evidence characterized hierarchically depending on the adopted methodological approach10.
Thus, before the found works, the level of evidence which prevailed in the studies was 4, which corresponds to descriptive studies or qualitative approach, featuring researches that, although equally important, do not show the maximum rigor for the EBP.
Regarding the theme of the studies, it was noted the complexion of a preventive nature and health promotion of work, followed by epidemiological surveys. What demonstrates the importance of prevention actions and health promotion in front of adolescent health, as the importance of epidemiological studies that aim at detecting and reporting the health condition of the same and the risk factors that permeate this population, in perspective to point out areas that need to be worked by health staff and other researchers.
For being a transition phase, adolescence has aroused the interest of health professionals, especially about aspects of their development and the many factors that contribute to personal and social conflicts.
Many adolescents need attention in relation to socioeconomic, sexuality and the use and abuse of psychoactive substances questions16. Amidst this, there is still the reality of scarce initiatives of attention to adolescent health in the primary care level, and the low demand of this group for health services. Thus, it is recognized that nurses should act with actions for health promotion and disease prevention, whereas adolescents may face problems from different sources17.
Understanding, then, that nurses should act mainly on generating questions of conflicts and doubts during adolescence, studies about sexuality, contraception and sexually transmitted diseases (STDs) correspond to 8 (66.6%) works.
This result demonstrates a growing concern with the current reality, in that rise cases of young people who acquire STDs in the beginning of sexual life, besides the large number of pregnant teenagers16.
Study performed with adolescents shows that they have little knowledge about the transmission of STDs and contraception methods, although consider informed about the issues. However, it was detected a high number of sexual partners among research participants which, associated with the early initiation of sexual activity and negligence in the use of contraception, infer the occurrence of high prevalence of unsafe sexual behaviors and risk unwanted pregnancy18.
The issues relating to overweight were addressed in only one study. Despite little promotion and only one thesis have developed this theme, much has been discussed about risk factors for the development of obesity and its implications for the teen's life. And this is not by chance that the current lifestyle of children and adolescents, especially the most economically advantaged, has caused a reduction in physical activity and stimulation to a less healthy diet, culminating in overweight18,19.
The literature suggests that the increase in the prevalence of overweight and obesity has occurred in several parts of the world, including Brazil, and has direct impact on the quality of life and health status of adolescents. It is observed also that the overweight rates are higher in adolescents from private schools and greater purchasing power20. Accordingly, it is inferred the need for research and actions on the part of health teams, especially nurses, aimed at property of actions, also in private schools, in an attempt to educate adolescents about the risks they are exposed to and encourage them to change their life styles.
With respect to the use and abuse of alcohol in adolescence, we identified only one study about the subject.
Alcohol use by students in Latin America reaches alarming prevalence, with an age at which occurs the first contact with the drink and the frequency influenced by social, economic and environmental factors21,22. Importantly, alcohol consumption is closely linked to cases of violence among adolescents.
In this sense, public health interventions that discourage alcohol consumption could be better employed, mainly addressing the risks to which this population is exposed, since often, adolescents adopt certain behaviors by not knowing or not consider the important problems that may arise due to the use and abuse of alcohol.
Thus, overweight and excess weight, as well as the use and abuse of alcohol are existing problems in this population, still lacking studies about the subject that support the implementation of skilled interventions by nurses and other health professionals.
In general, all the analyzed studies, regardless of the theme, aimed to know, understand or evaluate teenagers' knowledge about a particular subject. None of them brought some form of intervention that had as objective the continued action after the end of the study, which should be viewed with concern, since studies are not going beyond a punctual action and with this, it is hard to take changes in practice.
CONCLUSION
The research allowed to identify a limited quantity of works developed about the nursing care of adolescents in the school environment, although over the years it has seen a gradual increase in theses and dissertations produced about the theme. What makes clear the increasing importance that is being given to this audience, but that is still not enough.
It was observed a need for studies that address intervention models, with performed and evaluated experiences, so that the work provides knowledge to more satisfactory levels of evidence and can be applied in other settings.
The analysis showed how theses and dissertations are being addressed to school young people in our country, the types of performed studies, the main demands of research and possible interventions that can be performed by professional nurses. Thus, the search is shown as an essential event for the knowledge of reality, providing subsidies to nursing to rethink and resize their practice against this population.
Due to the lack of standardization of the abstracts presented at the Portal of CAPES, many studies were excluded since there was no explicit important information about the work. Nevertheless, the search in the libraries of universities noted that it is not always possible to find the studies in their entirety, which interfered directly in the sample of this study. Thus, it is believed that these limitations were crucial to the findings of this research, instigating to reflection of how these barriers can be overcome to new studies with this approach.
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