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Abstract(s)
INTRODUÇÃO: Na transição da infância para a adultez, ocorrem mudanças significativas que se manifestam a nível bio-psico-socio-espiritual. O adolescente, protagonista da sua própria história, no caminho da construção da sua identidade, vai aprendendo a gerir as múltiplas mudanças de que está a ser alvo, desenvolvendo estratégias de coping, umas mais positivas, outras menos. Quando as mudanças inerentes à adolescência confluem com um diagnóstico de diabetes mellitus tipo 1 (DM 1), as exigências aumentam. Consideram-se resilientes os adolescentes que ultrapassam o processo adverso, saindo dele fortalecidos. Com este estudo, pretendemos contribuir para a excelência dos cuidados de enfermagem, sugerindo instrumentos sensíveis e fidedignos que permitam o desenho de intervenções personalizadas, porque direcionadas para os problemas detetados, tendo em vista um melhor controlo da patologia e uma vida com mais qualidade.
OBJETIVO: Perceber se os adolescentes com um nível mais elevado de resiliência evidenciam melhor resultado adaptativo e melhor controlo da DM 1.
MATERIAL E MÉTODOS: Realizámos um estudo de paradigma quantitativo, do tipo correlacional e transversal, desenvolvido em três fases: (i) adaptação e validação da Escala Toulousiana de Coping (ETC), numa amostra de 291 adolescentes portugueses a frequentar o 3º Ciclo dos Ensinos Básico e Secundário; (ii) estudo junto duma amostra de 112 adolescentes com DM 1 em Consultas de Endocrinologia Pediátrica de cinco hospitais, para analisar relações entre as variáveis em estudo, a identificação dos fatores preditores da resiliência e a seleção da amostra, para a 3ª fase, em função dos scores de resiliência; e (iii) colheitas de saliva e estudo das relações entre Cortisol, Dehidroepiandrosterona-sulfato, resiliência e controlo metabólico, numa amostra de 50 adolescentes. Foram respeitados os princípios éticos para a investigação, em grupos vulneráveis.
RESULTADOS: A ETC apresenta características psicométricas adequadas para adolescentes (alfa de Cronbach de .85). A resiliência dos adolescentes, medida pela Healthy Kids Resilience Assessment Module (HKRAM), é influenciada pelo sexo, idade, retenção escolar, situação laboral do pai/padrasto, escolaridade da mãe/madrasta, estratégias de controlo e de suporte social. Globalmente, os Acontecimentos Vitais Stressantes (AVS) interferem negativamente na resiliência. O controlo metabólico apresentou médias mais baixas, nos adolescentes provenientes de famílias tradicionais, nos que não sofreram retenção escolar, nos que identificaram menor numero de AVS e/ou menor impacto emocional. Foram ainda identificados como preditores positivos da resiliência, as estratégias de Controlo e de Suporte Social, e, como preditores negativos, o Retraimento, Conversão e Aditividade; a Recusa, e os AVS Impacto.
Identificaram-se três modelos de perfil de stresse, dois com curvas atípicas de Cortisol. O modelo 2, é o que mais se aproxima dos valores de cortisol de referência, revelando os valores médios, que estes adolescentes apresentam recursos de resiliência intermédios e melhor controlo metabólico.
CONCLUSÕES: A ETC, a AVS e a HKRAM são instrumentos fiáveis e úteis para os enfermeiros, com vista à implementação de cuidados preferencialmente proativos e personalizados. Dos resultados desta investigação, decorre a necessidade do desenvolvimento de estudos longitudinais, no âmbito da resiliência, a fim de perceber a possível transitoriedade das mudanças; de estudos em amostras representativas, com grupo controlo, preferencialmente multinível e desenvolvidos por equipas transprofissionais.
Introduction: In the transition from childhood to adulthood, there are significant changes that manifest themselves at the bio-psycho-socio-spiritual level. The teenager, protagonist of his own history, in the process of building his identity, learns how to manage the multiple changes he has been suffering, developing coping strategies, some more positive, some less. When the changes of adolescence come together with a diagnosis of type 1 diabetes mellitus (DM 1), the requirements increase. Adolescents, who overcome the adverse process, are considered resilient coming out from it stronger. With this study we intend to contribute to the excellence of nursing care, suggesting sensitive and reliable instruments that allow the design of personalized interventions, because they are directed towards the problems detected, in order to better control of the pathology and a life with more quality. Objective: To understand if adolescents with a higher level of resilience show better adaptive outcome and better control of DM 1. Material and methods: We carried out a quantitative, correlational and transverse paradigm study, developed in three phases: (i) adaptation and validation of the Toulousiana Coping Scale (ETC) in a sample of 291 Portuguese adolescents attending the 3rd Cycle of Basic and Secondary Education; (ii) study of a sample of 112 adolescents with DM 1 in Pediatric Endocrinology Consultations from 5 hospitals to analyze the relationships between the variables in study, the identification of the predictive factors of resilience and the selection of the sample for the 3rd phase depending of the scores of the resilience; and (iii) saliva harvests and study of the relationships between cortisol, dehydroepiandrosterone sulphate, resilience and metabolic control in a sample of 50 adolescents. Ethical principles for research in vulnerable groups were respected. Results: ETC presents adequate psychometric characteristics for adolescents (Cronbach's alpha of .85). Adolescent resilience, measured by the Healthy Kids Resilience Assessment Module (HKRAM), is influenced by gender, age, school retention, work status of the father/stepfather, schooling of the mother/step mother, strategies of control and social support. Globally, stressful life events (AVS) negatively affect resilience. Metabolic control presented averages means in adolescents from traditional families, in those who did not have school retention, in those that identified a lower number of AVS and/or less emotional impact. We also identified positive predictors of resilience, Control and Social Support strategies, and, as negative predictors, Retraction, Conversion and Addiction, Refusal, and Impact AVS. Three stress profile models were identified, two with atypical cortisol curves. Model 2, is the closest to the reference cortisol values, revealing the average values that these adolescents present, intermediate resilience resources and better metabolic control. Conclusions: ETC, AVS and HKRAM are reliable and useful tools for nurses to implement preferentially proactive and personalized care. From the results of this investigation, the development of longitudinal studies in the context of resilience is necessary in order to perceive the possible transitoriness of the changes; of studies in representative samples, with a control group, preferably multilevel and developed by cross-professional teams.
Introduction: In the transition from childhood to adulthood, there are significant changes that manifest themselves at the bio-psycho-socio-spiritual level. The teenager, protagonist of his own history, in the process of building his identity, learns how to manage the multiple changes he has been suffering, developing coping strategies, some more positive, some less. When the changes of adolescence come together with a diagnosis of type 1 diabetes mellitus (DM 1), the requirements increase. Adolescents, who overcome the adverse process, are considered resilient coming out from it stronger. With this study we intend to contribute to the excellence of nursing care, suggesting sensitive and reliable instruments that allow the design of personalized interventions, because they are directed towards the problems detected, in order to better control of the pathology and a life with more quality. Objective: To understand if adolescents with a higher level of resilience show better adaptive outcome and better control of DM 1. Material and methods: We carried out a quantitative, correlational and transverse paradigm study, developed in three phases: (i) adaptation and validation of the Toulousiana Coping Scale (ETC) in a sample of 291 Portuguese adolescents attending the 3rd Cycle of Basic and Secondary Education; (ii) study of a sample of 112 adolescents with DM 1 in Pediatric Endocrinology Consultations from 5 hospitals to analyze the relationships between the variables in study, the identification of the predictive factors of resilience and the selection of the sample for the 3rd phase depending of the scores of the resilience; and (iii) saliva harvests and study of the relationships between cortisol, dehydroepiandrosterone sulphate, resilience and metabolic control in a sample of 50 adolescents. Ethical principles for research in vulnerable groups were respected. Results: ETC presents adequate psychometric characteristics for adolescents (Cronbach's alpha of .85). Adolescent resilience, measured by the Healthy Kids Resilience Assessment Module (HKRAM), is influenced by gender, age, school retention, work status of the father/stepfather, schooling of the mother/step mother, strategies of control and social support. Globally, stressful life events (AVS) negatively affect resilience. Metabolic control presented averages means in adolescents from traditional families, in those who did not have school retention, in those that identified a lower number of AVS and/or less emotional impact. We also identified positive predictors of resilience, Control and Social Support strategies, and, as negative predictors, Retraction, Conversion and Addiction, Refusal, and Impact AVS. Three stress profile models were identified, two with atypical cortisol curves. Model 2, is the closest to the reference cortisol values, revealing the average values that these adolescents present, intermediate resilience resources and better metabolic control. Conclusions: ETC, AVS and HKRAM are reliable and useful tools for nurses to implement preferentially proactive and personalized care. From the results of this investigation, the development of longitudinal studies in the context of resilience is necessary in order to perceive the possible transitoriness of the changes; of studies in representative samples, with a control group, preferably multilevel and developed by cross-professional teams.
Description
Keywords
Adolescente Adaptação psicológica Biomarcadores Diabetes Mellitus tipo 1 Enfermagem Resiliência psicológica Adolescent Adaptation Psychological Biomarkers Diabetes Mellitus type 1 Nursing Resilience Psychological