Modelo de Neuman en la atención de enfermería perioperatoria para adolescentes con escoliosis idiopática juvenil

Pestana-Santos, Márcia; Santos, Margarida da Silva Reis; Cabral, Ivone Evangelista; Sousa, Paula Cristina; Lomba, Maria de Lurdes Lopes de Freitas

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020001703711 copiar

Modelo de Neuman en la atención de enfermería perioperatoria para adolescentes con escoliosis idiopática juvenil

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Implementar el proceso de enfermería, basado en el Modelo de Sistemas Neuman y la terminología de la Clasificación Internacional de la Práctica de Enfermería, en el cuidado de un adolescente que fue sometido a cirugía correctiva por escoliosis idiopática juvenil.

Método:

Estudio cualitativo del tipo de caso único, con triangulación de técnicas de recolección de datos (entrevista clínica formal, anotaciones en diario de campo e información de historia clínica), desarrollado con una adolescente de 17 años e indicación de cirugía correctiva. Los materiales empíricos generados con las entrevistas realizadas al ingreso y al alta, la observación y la información de la historia clínica fueron tratados con el análisis de contenido categórico.

Resultados:

Las categorías de condición personal, ansiedad, autoconcepto, personas significativas, recursos facilitadores de salud, escuela, tiempo libre y ocio fueron recurrentes. Los diagnósticos se definieron con un enfoque en los problemas Ansiedad, Conocimiento sobre el Manejo del Dolor (control) y Voluntad (o disposición) para Aprender, asociándolos con las respectivas intervenciones de enfermería.

Conclusión:

El Modelo contribuyó a evaluar y reconocer los factores estresantes del evento quirúrgico en el adolescente y a fundamentar teóricamente el proceso de enfermería. La clasificación permitió la sistematización de registros de atención de enfermería, elementos de la práctica clínica, unificación de vocabulario y códigos.

DESCRIPTORES:
Adolescente; Escoliosis; Ansiedad; Periodo Perioperatorio; Clasificación; Terminologia Normalizada de Enfermería

Domain	Category	Subcategory	Units of meaning
Physiological variable	Personal condition	Pain	Everyone says that, after surgery, it hurts a lot. The 2^ndand 3^rddays were more complicated because of the pain (long pause). More than back pain, it was stomachache.
		Availability for learning about [pain]	I want to learn how to use the [PCA -Patient Controlled Analgesia] machine that gives me medication. On the eve of the surgery, they talked about physical therapy. I immediately wanted to learn what breathing movements I would have to do (...) and what I would not have to do.
		Discomfort	[in the preoperative period] When I was sitting, as I had a big rotation, I was never able to be well. I didn't feel comfortable. [in the hospital] I was in no position to be, it was really hard.
Psychological variable	Anxiety	Impaired sleep	There were nights when I had trouble sleeping. I know there were risks (pause) [of neurological injury]
	Anxiety	Fear	I was more nervous on the day of surgery. I remember starting to cry (pause) and feeling cold when I left the ward to go to the [operating] room.
	Self-concept	Self-esteem	I did not feel comfortable with my body (...) people noticed and commented (...) others look and perceive (...) a deformity. Sometimes they speak without malice, but I feel bad about it. Some clothes no longer felt very comfortable to wear because it was more noticeable.
	Self-concept	Self-image	Tm very happy, for example, I bought bikinis and I was trying it on (pause), I liked seeing myself with everyone (pause), Tm really happy (smiles).
Sociocultural variable	Meaningful people	Mother	I know that before surgery my mother was more worried than me. I was with my mother. I knew I was fine. My mother helped me with everything, in the hospital and now at home.
	Meaningful people	Friends	My friends visited me at the hospital. One day they went to visit me before going out for the night (...). They went to show me how cute they were and that was important to me. There were people [friends] who did not come to visit me at the hospital and I felt upset, really sad. [cries when remembering] My friends help me a lot, because they carried my backpack and are always careful. [friends] They ask if I'm fine. I am still upset with the friends who did not visit me (pause) because, before surgery, they were always saying that they would go there but that never happened [with watery eyes].
	Facilitating health resources	Pre-operative visit	Knowing the whole team made me less worried or reticent about the surgery. It was important to be able to meet everyone before surgery.
	Facilitating health resources	Hospital	The day before I visited the Intensive Care Unit and went to the Operating Room with nurses who were going to welcome me. It was very important to visit the hospital before surgery.
	School		I am in 12 grade and will not be able to go to school for three weeks. I am afraid that I will not be able to attend classes because I have to sit for a long time* [classes are divided in periods of 90 minutes each].
	Free time. Leisure		After surgery, I won't be able to play sports or dance for at least six months. As I will not return to practice rhythmic gymnastics, after recovery, I will start ballroom dancing.

Focus	Diagnosis activities	Relevant data for diagnosis	Nursing diagnosis	Goal	Result criteria	Nursing interventions	Nursing outcomes
Anxiety (10002429)	Assessing Anxiety (10041745)	-Difficulty sleeping in the period prior to surgery. -On observation, she seems concerned with the surgery, peripheral tremor, restlessness. -She cried on the surgery day.	Anxiety (10000477)	Reduce the adolescent's anxiety in the perioperative period.	That the adolescent develops appropriate strategies to control anxiety.	-Establishing Trust (10024396) Promoting PositivePsychological Status (10032505) -Assisting (10002850) in Self-Control (10046837) and Anxiety (10000477) -Guiding (10008592) in the Relaxation Technique (10016700) -Implementing Comfort Care (10039705)- Promoting Family Support (10036078)	Reduced Anxiety (10027858)
Knowledge Of Pain Management (10034259)	Assessing Knowledge Of Pain Management (10039041)	She does not know the pharmacological and non-pharmacological strategies for postoperative pain relief.	Knowledge Of Pain Management (10033750) Impaired (10012938)	Improve the adolescent's knowledge on pain management.	That the adolescent improves knowledge about pharmacological and non-pharmacological strategies for pain management in the postoperative period.	-Teaching About Managing Pain (10019489) -Teaching About Pain (10039115) [non-pharmacological strategies] -Teaching About Medication (10019470) -Guiding How To Use Patient Controlled Analgesia (10039073) [How to use PCA] -Collaborating on Pain Management Plan (10039831) [pharmacological and non-pharmacological strategies]	Knowledge Of Pain Management (10033750) Effective (10014956)
Readiness To Learn (10016422) about Pain (10023130)	Assessing Readiness to Learn (10002781)	She questions how pain control will be in the postoperative period. Shows interest in learning about pain control.	Readiness To Learn (10016422) [about pain] Effective (10014956)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Ivone Evangelista Cabral, Rua Afonso Cavalcani, 275, Cidade Nova CEP 20211-110 - Rio de Janeiro, RJ, Brazil icabral44@hotmail.com