Prioridades de pesquisa em enfermagem neonatal e pediátrica

Abstract

In Brazil, Nursing accounts for approximately 60% (R$ 1.3 million) of the human resources of the Unified Health System (the national public health system, SUS by its acronym in Portuguese), thus making a significant contribution to health care. There is an utmost need to accelerate the process of implementing research into practice. In this setting, nursing has the potential to improve the quality of health research findings and, therefore, improve innovative health care technologies. In Brazil, the production of nursing knowledge is in sheer development, along with the growth of nursing graduate programs, thus increasing its visibility both national and internationally. In 2012 we ranked 6th place on SCImago Journal & Country Rank (SCImago). The field has also increased its participation in the development of scientific production in Brazil, as it went from a 0.2% of publications in 2005 to 1.9% in 2012, on the referred database. Therefore, there was a relative growth of 713%, which is far superior to that of other more established health fields, as Medicine (6.2%) and Dentistry (53%). Considering that the major part of this production is the result of nursing graduate programs, and in view of the theme proposed for this editorial, we were encouraged towards investigating the contribution that theses and dissertations have made to the production of knowledge in Neonatal and Pediatric Nursing. Thus, aiming to characterize the research on newborn, children, adolescent and family health care, we performed a search for the abstracts of theses and dissertations presented in the 2010-2012 triennium, registered with the Coordination for the Improvement of Higher Education Personnel (Capes, by its acronym in Portuguese), according to the three major fields and lines of Nursing research proposed by CAPES, The National Council for Scientific and Technological Development (CNPq, by its acronym in Portuguese) and the Brazilian Nursing Association (ABEn, by its acronym in Portuguese) in 2001 during the 11th National Seminar on Nursing Research(1), themes and approaches. Abstracts were included if the study addressed the referred theme and/or included newborns, children, adolescents and their families as subjects. Of the 2,860 analyzed abstracts (502 theses and 2,178 dissertations), 343 (12.7%) met the inclusion criteria. The Pediatric Nursing descriptor appeared in only eight abstracts (as the keyword in four), whereas the descriptor Neonatal Nursing appeared in two abstracts, as keywords in both. Regarding the major research fields, the care field was the most common, with 209 (61%) theses and dissertations, followed by the organizational field with 103 (30%) and professional field with 31 (9%). In the care field, the line of research with most publications was The Process of Care in Health and Nursing (174 theses and dissertations); in the organizational field, two fields were highlighted: Health Policies and Practices in Nursing (39) and Education and Nursing (36); and in the professional field the most common research line was Technology in Health and Nursing (19). The most commonly themes addressed were: family, child with cancer, breastfeeding, violence, pain, health care technology (health education, nursing care systematization) and the health-disease process (perception and education in health). Regarding the process of care, the most common themes, according to the different age groups, were: newborn – breastfeeding and pain; child – hospitalization and chronic conditions (cancer, HIV and diabetes mellitus); school age – hospitalization and health education; adolescent – pregnancy and sexuality. As to the family theme, most studies addressed the family’s perception and experience of caring for a child during hospitalization and with a disease (such as the therapeutic schedule and mental health), as well as the health care professional’s perspective regarding family care. We noticed that the themes addressed by theses and dissertations in Pediatric and Neonatal Nursing are in line with the health needs of this particular segment of the population(2) and with the public health care policies for children and adolescents(3-4). Most of the reviewed studies were descriptive, which was also the most prevalent among the Nursing theses and dissertations presented between 2010 and 2012(5). Only 23 (6.7%) of the abstracts were from intervention studies, most in health education for children/adolescent or families; 14 (4%) clinical or quasi-experimental trials; 14 (4%) methodological studies that developed and validated measurement tools, and 3.5% (12) addressed the development of products and processes for health care and/or teaching (software, virtual learning objects, handbooks, protocols, scale, nursing care systematization). Most theses and dissertations (195) used a qualitative approach, 49% of which stated the chosen theoretical framework (Social Representations – 12, Dialectics – 11 and Symbolic Interactionism - 6), and 35% used the content analysis method. The limitation of this study was the time window and the data source used, highlighting the fact that the abstracts did not present information regarding the study design and results. Nevertheless, the current setting of knowledge production in Pediatric and Neonatal Nursing in Brazil generated some concerns regarding the impact of our research in professional practice and if the research is actually evidence-based, thus arising the following questions: Are the undergoing studies answering the needs from Pediatric and Neonatal Nursing practice?Is the knowledge that we produced answering the health and quality of life needs of newborn, children, adolescents and their families? Are they in line with health research priorities?Have the study findings been incorporated to health care practice and teaching?How have researchers and institutions worked towards knowledge transference in Neonatal and Pediatric Nursing practice? Below we present some of the challenges that must be overcome to strengthen the impact of research on professional practice in Neonatal and Pediatric Nursing: Improve nurses’ preparation towards developing a profile that is more proactive, creative and of strong leadership in using evidence and the scientific methods when making decisions.Encourage nurses to participate in research-practice committees and in health care and research networks/groups aimed at care and working to promote quality of life, comfort, and empowerment for individuals and the community within the context of child and adolescent health care.Generate and disseminate innovative knowledge, increasing the development of technology and bolder projects, clinical trials, consistent qualitative approaches and others that include changing the practice in the investigation process, with knowledge transference, and showing the cost-effectiveness of implementing health care and management practices in Pediatric and Neonatal Nursing.Improve the latu sensu graduate program (specialization, residence) in line with child and adolescent health needs, health care policies, and the work market. In stricto sensu graduate programs, improve the professional masters modality, reducing the gap between knowledge and practice, and, in academic masters and doctoral programs, strengthen the education for research, and the research lines and groups that have research and outreach projects on nursing care to newborns, children, adolescents and their families.Implement the participation of Brazilian scientific societies in establishing health care policies, guidelines and protocols, creating consensus committees. Furthermore, it is important to highlight the ABEn recommendations presented during the 65th Brazilian Nursing Congress, which took place in October of 2013 in Rio de Janeiro, particularly regarding the development of strategies to meet the National Curriculum Guidelines for Nursing Undergraduate Courses, especially concerning the development, participation and application of research and other types of knowledge production that aim at improving the quality of professional practice. Therefore, this number of the Revista Eletrônica de Enfermagem has five original articles that are relevant for Pediatric and Neonatal Nursing. The studies address themes such as nursing diagnosis in children with respiratory infections, child immunization, childhood vulnerability, factors related to peripheral vascular trauma in children, and using case studies to teach diagnostic thinking. 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