ESSENTIAL ELEMENTS OF THE CHILD AND ADOLESCENT NURSING CONSULTATION ELEMENTOS ESSENCIAIS DA CONSULTA DE ENFERMAGEM À CRIANÇA E AO ADOLESCENTE ELEMENTOS ESENCIALES DE LA CONSULTA DE ENFERMERÍA AL NIÑO Y AL ADOLESCENTE

Objective: to identify the essential elements of the Nursing consultation in the care of the child and the adolescent. Method: this is a descriptive, descriptive, integrative review, conducted in the period of December 2016 and January 2017, in the LILACS and BDENF databases and in the SCIELO library. After applying the search equation in each of the bases, a total of 533 articles were found, and only 12 met the inclusion and exclusion criteria corresponding to the final sample of the study. The studies were evaluated by the Critical Appraisal Skills Program (CASP) and the synthesis was done according to the instrument of data collection and the level of evidence. Results: in the articles, the nursing consultation was explored in different situations, which were related to the scope of collective health, mainly in its epidemiological aspects. Conclusion: the child care was approached in the Nursing consultation having, as main scenario, the primary care. Thus, there is a gap in the literature regarding consultation in specialized care. Descriptors: Child; Adolescent; Office Nursing; Child Care; Nursing Care; Primary Health Care. RESUMO Objetivo: identificar os elementos essenciais da consulta de Enfermagem na atenção à criança e ao adolescente. Método: trata-se de estudo bibliográfico, descritivo, tipo revisão integrativa, realizado no período de dezembro de 2016 e janeiro de 2017, nas bases de dados LILACS e BDENF e na biblioteca SCIELO. Encontrou-se, após a aplicação da equação de busca em cada uma das bases, um total de 533 artigos, e apenas 12 atenderam aos critérios de inclusão e exclusão correspondendo à amostra final do estudo. Avaliaram-se os estudos pelo Critical Appraisal Skills Programme (CASP) e a síntese se deu conforme o instrumento de coleta de dados e o nível de evidência. Resultados: explorou-se, nos artigos, a consulta de enfermagem em diferentes situações, as quais foram relacionadas ao âmbito da saúde coletiva, principalmente em seus aspectos epidemiológicos. Conclusão: abordou-se a puericultura na consulta de Enfermagem tendo, como principal cenário, a atenção primária. Assim, verifica-se uma lacuna na literatura no que diz respeito à consulta na atenção especializada. Descritores: Criança; Adolescente; Consulta de Enfermagem; Cuidado da Criança; Cuidados de Enfermagem; Atenção Primária à Saúde. RESUMEN Objetivo: identificar los elementos esenciales de la consulta de Enfermería en la atención al niño y al adolescente. Método: se trata de estudio bibliográfico, descriptivo, tipo revisión integrativa, realizado en el período de diciembre de 2016 y enero de 2017, en las bases de datos LILACS y BDENF y en la biblioteca SCIELO. Se encontró, después de la aplicación de la ecuación de búsqueda en cada una de las bases, un total de 533 artículos, y sólo 12 atendieron a los criterios de inclusión y exclusión correspondientes a la muestra final del estudio. Se evaluaron los estudios por el Critical Appraisal Skills Programme (CASP) y la síntesis se dio según el instrumento de recolección de datos y el nivel de evidencia. Resultados: se exploró, en los artículos, la consulta de enfermería en diferentes situaciones, las cuales fueron relacionadas al ámbito de la salud colectiva, principalmente en sus aspectos epidemiológicos. Conclusión: se abordó la puericultura en la consulta de Enfermería teniendo como principal escenario la atención primaria. Así, se verifica una laguna en la literatura en lo que se refiere a la consulta en la atención especializada. Descriptores: Niño; Adolescente; Enfermería de Consulta; Cuidado del Niño; Atención de Enfermería; Atención Primaria de Salud. Master, Hospital of Messejana Dr. Carlos Alberto Studart Gomes, Heart Failure Transplant Unit/UTIC. Fortaleza (CE) Brazil. E-mail: gyslanevasconcelos@hotmail.com ORCID iD: http://orcid.org/0000-0003-1754-1009; Pos-doctor, State University of Ceará. Fortaleza, Brazil. E-mail: pessoa_vera@hotmail.com ORCID iD: http://orcid.org/0000-0002-5441-5311; PhD, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Heart Failure Transplant Unit/UTIC. Fortaleza, Brazil. E-mail: raquelsampy@hotmail.com ORCID iD: http://orcid.org/0000-0003-3119-7187; Master, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Heart Failure Transplant Unit/UTIC. Fortaleza, Brazil. E-mail: niniabraga@yahoo.com.br ORCID iD: http://orcid.org/0000-0002-6479-0502; Specialists, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Unit of Heart Failure Transplant/UTIC. Fortaleza, Brazil. E-mail: nilberick@gmail.com ORCID iD: http://orcid.org/0000-0002-8246-2588; E-mail: liaricarte@hotmail.com ORCID iD: http://orcid.org/0000-0003-0321-148X; Master, State University of Ceará. Fortaleza, Brazil. E-mail: virna.ribeiro@hotmail.com ORCID iD: http://orcid.org/0000-0002-7955-0894 INTEGRATIVE LITERATURE REVIEW

English/Portuguese J Nurs UFPE online., Recife, 12 (12):3464-75, Dec., 2018  3465  It is understood that children and adolescents undergo psychological and physiological changes constantly that need to be monitored systematically by nurses.These issues are involved in a range of actions and care that need to be implemented, thus ensuring overall well-being and adequate growth and development.
Several aspects, such as food, social support, health responsibility, life enhancement, physical exercise, stress management and overall health, hygiene and dental hygiene behavior, are essential elements that should be part of the daily work process of the nurse 1 whether in the hospital or outpatient setting.
The latter is done in the Nursing (NC) consultation, defined as a modality of light technology used by nurses to guide and express their work on scientific bases in work environments and in specialized care. 2 The NC is characterized as a technology formed by a combination of human, scientific and empirical knowledge, which systematizes what is done in order to provide a better quality care and that is effective in the care of the individual/family/community, besides the the fact that it is permeated by ethical issues and a reflexive process. 3e essential elements of the Nursing consultation can be deferred from the scenario where they are developed, being necessary to know the actions and processes involved to identify possible gaps.
• To identify the essential elements of the Nursing consultation in the care of the child and the adolescent.This is a bibliographic, descriptive study, integrative review type (IR), whose objective is to give theoretical support to the construction of protocol for the Nursing consultation to the transplanted child and adolescent cardiac.There has been a notable penetration of the integrative review in the area of Nursing in the last decade.It is shown that this condition seems to be associated with the tendency to understand health care, both individually and collectively, as a complex work that requires the collaboration and integration of knowledge from different disciplines. 4e IR was developed here in six stages based on Evidence Based Practice: 1) identification of the theme and selection of the research question; 2) establishment of inclusion and exclusion criteria; [7] During the first stage, the PICO strategy was used, which means: (P) to consider the target population; (I) consider the interest of the intervention or the area of interest; (C) compare the types of intervention or groups; (O) obtain results and consider the effects to be achieved with the intervention; (T) consider the time required to obtain the result.Figure 1 described the acronym PICO used in this IR. 8he following descriptors were listed to answer the questioning in this IR: "Pediatric Nursing"; "Health Care"; "Kid"; "Health services"; "Nursing"; and "Nursing Care", in Portuguese and English.The grouping

OBJECTIVE METHOD INTRODUCTION
English/Portuguese J Nurs UFPE online., Recife, 12 (12):3464-75, Dec., 2018 3466 For the selection of articles, inclusion criteria were defined as: (1) original text; (2) published in the range of 2011 to 2016; (3) complete and available in a free online format; (4) national or foreign article.Thus, all those duplicate studies, letters, editorials and integrative or systematic reviews were excluded.
After the initial selection of the articles, the inclusion and exclusion criteria were applied to the evaluation of the methodological quality through specific protocols and subsequent evaluation of the level of evidence. 8, TheCritical Appraisal Skills Program (CASP) was used as a tool for quality evaluation, classifying the articles into two categories: six to ten points (good methodological quality and reduced bias) and a minimum of five points (satisfactory methodological quality, however, with a risk of increased bias).
The articles were numbered according to the order of location and the data were analyzed according to their contents, using the categorization of the data found after the application of an instrument constructed by the author, as well as the descriptive statistics.It is perceived that this is a great challenge for the researcher, since the analysis and the synthesis of several sources are complex and diverse procedures as to the type of qualitative or quantitative methodological approach. 12sults were compared and consensus disagreements were resolved.The PRISMA recommendations, shown in figure 2 Discussion of the results in the evidence was based.The analysis and interpretation of the results were carried out at this stage.The findings were integrated and, with this, it was possible to raise existing knowledge gaps and to suggest guidelines for future research. 5,11,13he IR presentation was presented, with a detailed description of all the phases and the presentation of the main results obtained. 5It is reported that this stage is a work of extreme importance, since it has an impact due to the accumulation of existing knowledge about the researched topic. 13total of 533 articles were identified and, initially, the selective reading was made for the recognition of the studies through the titles, abstracts and introduction.A table with the following data of each article was generated: year, title, author, source and abstract.The text was searched for those works that initially showed adherence to the proposed objectives.In this way, the final sample was composed by 12 scientific articles published in national and international territory and characterized according to figure 3. To analyze the conceptions and experiences of nurses on Pediatric Nursing consultations and their systematization in the context of FHS.

Qualitative
Ten nurses who worked for at least six months in the FHU, in the municipalities of Serra Negra, Lindoia, Águas de Lindoia and Socorro.

Qualitative
The nurse, the patient, the family/caregiver of the children.

A5 18
Research Journal: Care is Fundamental online /2013

Nurse
Perception of nurses in the Family Health Strategy about childcare.
Understanding the nurses' perception of the Family Health Strategy about childcare describing the actions implemented during the Nursing consultation.

Qualitative
Nurses who make up the FHS.

Nurse
Experience of collective elaboration of a protocol.
To report the experience of collective elaboration of a protocol of childcare for the nurses of the Primary Health Care.

Experience report
Nurses of Primary Health Care.

Nurse
Factors that influence the day to day conduct of the Nursing consultation.
To describe the daily routine of nurses in the child care consultation and to identify the factors that influence the day to day performance of this consultation.

Qualitative
Set of 11 nurses who worked in child care in a health district of the municipality of Salvador/BA.
To construct and validate the contents referring to a Nursing consultation instrument for patients in the pre and post-transplant of abdominal organs in the specialized care service in Rio Branco, Acre.

Methodological study
Specialist nurses A10 23  To know the mothers' perception of the main care to be performed after the son's transplantation, as well as the difficulties they experienced after the procedure.

Qualitative
Mothers of children undergoing heart transplantation who were in follow-up with outpatient staff.
A12 25  To analyze the perceptions of nurses and transplant patients about the pre-transplant Nursing visit of the renal transplant.

Qualitative
Ten nurses who worked with people on renal replacement therapy before and/or after kidney transplantation and 20 post-transplant recipients with coherent verbalization conditions of both genders, over 18 years of age Figure 3. List of selected studies to compose the corpus of IR that will give subsidy to the construction of the protocol.Fortaleza (CE), Brazil, 2018.
English/Portuguese J Nurs UFPE online., Recife, 13(1):3464-75, Jan., 2019 3470 It was verified, with regard to the year of publication of the articles selected in this integrative review, a greater predominance in the year of 2013, with four articles.In the other years of the established temporal cut, there was a certain regularity in the number of articles, with two articles published each year.
It can be noticed that the journal with the greatest number of publications with the theme of this study was the Journal of Nursing Network of the Northeast (REV RENE), with a total of three publications and Qualis B1.The Care Journal is fundamental online, with Qualis B2, comes next, with two articles published.The journals Science, care and health, whose Qualis is B2; the Journal of Nursing UFPE, with Qualis B2; the Nursing Journal of the Anna Nery School and the Journal of Nursing UERJ, with Qualis B1; the Cuidart Nursing, with Qualis B5; the Journal of the Nursing School of the USP, as well as the Acta Paulista magazine, both as Qualis A2, each published an article of the sample analyzed.It is observed, therefore, that a predominant choice occurred by periodicals located in the Northeast region.
It is justified the fact that the articles are written predominantly by nurses because it is a search directed by the Nursing consultation.
Another aspect was considered: the predominance of the primary care environment as a space for the production of articles dealing with Nursing consultation, totaling nine articles.It should be noted that only three articles of the theoretical corpus had a relationship with tertiary care.
The following distribution is verified in relation to the object of study addressed by the material analyzed: six articles report exclusively on the Nursing consultation; a research deals with the Nursing consultation in the scope of collective health; three papers discuss the use of protocols or instruments for conducting the Nursing consultation; another reports the epidemiological aspects of the children who perform the nursing consultation in basic care and an article discusses the perception of the mothers in relation to the Nursing consultation.
The agreement between the objective of the study and the methodological design was developed in all the selected papers.It turns out that two papers were methodological studies, two were quantitative, seven were qualitative, and one was an experience report.In this sense, we evaluated the level of evidence of the methodological articles, quantitative and qualitative as four and the experience report as six, showing a low level of evidence.However, it is important to clarify that the review in question is not focused on an intervention, and therefore this result is acceptable.It was also evaluated the methodological quality of the articles by the CASP instrument, where 11 publications with good methodological quality are considered and only one as satisfactory quality, but with risk of increased bias related to the experience report. 10 should be noted that, of the articles that were part of this review, six were exclusively nurses; one study had, as a sample, a group of nurses and patients; another study dealt with the epidemiology of the children attending the Nursing visit; one research worked with the mothers of transplanted children and the others were methodological studies.Therefore, information was not obtained directly with a set of participants.
It is reported that, of the research that compose the corpus of this IR, five approach what should be contemplated during the Nursing consultation.It is noticed that, in the analyzed material, all the articles mention, as content, only questions directed to the development and the growth of the attended child.It should be emphasized that there is no reference to holistic and clear care within the family environment, but the importance of such care is described, as well as the need for a systematic consultation and better physical facilities for care.
It is known that the Nursing consultation (NC) is a light-hard technology that favors self-care insofar as it allows the patient to develop their own abilities to improve their quality of life.It is shown that it is the instrument in which the nursing professional has complete autonomy to develop comprehensive care strategies for the promotion of patient, family or community health.
The Nursing consultation is based on scientific knowledge, based on a theoretical model of Nursing with a view to determining the needs and degree of dependence of individuals, family and/or community.26 It is emphasized that it should be a systematized practice , scientifically structured and using a unified Nursing language, as well as providing communication and documentation of its practice favoring the promotion, protection and maintenance of life, as well as improving the quality of care provided to the person, family and the community.

DISCUSSION
English/Portuguese J Nurs UFPE online., Recife, 13(1):3464-75, Jan., 2019 3471 It was found, according to this study, that 2013 was the year when there were more publications on the NC and that, in subsequent years, there was a decline in the production of these surveys.It is noteworthy that the number of studies on the NC has been increasing since nurses are seeking to consolidate their profession as a science. 27It is evidenced that additional research is necessary to prove its effectiveness and produce evidence that the Nursing consultation, although regulated, is not fully established at all levels of care.It is known that in Primary Care (PC), this activity is widely used, since it is already defined as a specific attribution of the nurse through ordinance number 2,488, dated October 21, 2011.The same does not occur at Secondary Attention levels and Tertiary. 28e research that composed this IR in different States of the national territory was developed, but during the evaluation of the articles that compose this work, it was verified that 60% of these studies had been carried out in the Northeast region.An exceptional character is demonstrated in the scenario of Brazilian research, since the central axis for the scientific production is limited, almost in its entirety, to the South and Southeast regions of Brazil.
It should be noted that these findings are in agreement with the perception of another author, 29 which reports that in Brazil there is also a huge spatial heterogeneity of scientific research activities, where the regional pattern of distribution of publications and researchers is highly concentrated in the Southeast, with emphasis on the state capitals.As an example, the city of São Paulo concentrates around 20% of Brazilian scientific production and has grown 21 places in the list of cities with the greatest knowledge generation in the world during the last decade.
PC studies are predominant in this research, and this fact corroborates the findings of another recent study, 30 which reports the great relevance of nurses' role in child health surveillance, especially in Primary Health Care (PHC) services.It is reported that such actions have the purpose of enabling the best monitoring of growth and development since this is a prerogative of Brazilian MS. 31 It is reported that the actions carried out at this level of attention to the child are fundamental to prevention activities and intervention because of the potential to detect possible diseases early and reduce the risks of morbidity and mortality.
The Brazilian proposal for the National Primary Care Policy is followed by the Nursing consultation on child care in Primary Care.It is also worth mentioning the nurse's role in this context, which contributes to the children's quality of life by articulating knowledge and practices in the daily routine of Primary Care, which ensures healthier conditions for these children.In primary care, Nursing is considered as a reference profession in relation to child care, as well as health promotion and disease prevention. 32 this context, Nursing is fundamental in the Brazilian health care policy, and consultation with the nursing professional is an extremely effective and decisive instrument in primary health care and in disease prevention.It should be emphasized that, for such a report, it does not justify the absence of its performance in the other levels of attention.Possibly, this action is not visualized due to the deficient disclosure in the scientific environment with a reduced number of publications on the subject. 33e can, however, reflect that there is no absolute NC to the child in specific situations of illness in the hospital space such as outpatient follow-up.
It is explained that health care is everything that involves care for the health of the human being including the actions and services of promotion, prevention, rehabilitation and treatment of diseases.It is reported that in the organization of the actions of the Unified Health System (UHS), health care is ordered at levels of attention, namely BP, secondary care and tertiary care.It is stated that this structure aims at the best programming and planning of the actions and services of the system.It should be noted that one should not consider one of these levels of attention more relevant than the other because health care must be integral. 34 is composed of the assistance in the medium and high ambulatory complexity by actions and services that aim to attend to the main problems and health problems of the population whose complexity of the assistance in clinical practice demands the availability of specialized professionals and the use of technological resources for the support diagnosis, treatment and follow-up.It was observed that, despite the few studies published in relation to the Nursing consultation in this area, nurses' performance is extremely relevant for outpatient followup.
It was found that the focus of interest in 50% of the studies is restricted to the description of contents explored in the NC, English/Portuguese J Nurs UFPE online., Recife, 13(1):3464-75, Jan., 2019  3472  considering the importance of the NC and after the analysis of the selected articles.It is pointed out that others emphasize the construction and implementation of protocols for the NC, while the others turn to the discussion of the posture and the perception of the Nursing professionals regarding this procedure.
It is necessary, for the realization of the NC in an integral way with the purpose of consolidating the protagonism of the nurse, the creation of tools that qualify the practice of care as the protocols.It should be pointed out that they must contain techniques for guiding and normalizing the care provided by the nurse to the child35 so that placement in journals sharing the experience of building protocols for NC standardization becomes more than necessary.It should be emphasized that this does not mean that the discussion regarding the posture and the perception of this professional is not relevant, since the use of this technology and the ability to understand, operate and pay for it is what will guarantee the quality of the work of a health team through the use of protocols. 34 is out that nurses recognize the need for elaboration and implementation of assistance protocols that help in the organization of actions in the work process.It is considered that the implementation of such technologies means a strategic decision to strengthen welfare practices.It is reported that this initiative, led by the nurse, represents an institutional effort that values and encourages the use of the same by the Nursing teams. 36 is inferred that the experience in the use of the instruments in the Nursing consultation is efficient in form and content, since these allow an extended view of the health-disease process, besides facilitating the nurses' performance in the integral approach of the patient. 37is paper describes two articles, A3 16 and A7 20 , which report on the construction and validation of protocols developed for NC and a research is directed to the application of these in the NC, the A9 22 .Citou-se a não fragmentação da assistência aos pacientes como a principal característica pelos profissionais que tiveram a aplicação dos protocolos nos seus atendimentos.
It involves the NC not only the growth and development, but also include actions of health promotion, comprised by the evaluation of hygiene and food, the encouragement of vaccination, as well as preventive actions of injuries, such as care with accidents and domestic violence, with early treatment of children's health problems, being a powerful strategic tool for healthy development. 38 ordinance was signed in 2015 by the Brazilian MS, during the meeting of the National Health Council, in Brasilia, number 1,130, which creates the National Policy for Integral Care to Children's Health (NPICCH).It is known that the goal is to promote breastfeeding and the health of the child, from the gestation to the nine years of life, with special attention to infancy (zero to five years) and to populations of greater vulnerability, such as children with indigenous people, quilombolas, riverside and in street situation.The seven strategic axes of politics are shown: humanized and qualified attention to gestation, birth, birth and newborn; breastfeeding and healthy complementary feeding; the promotion and monitoring of growth and integral development; attention to children with diseases that are prevalent in childhood and with chronic diseases; attention to children in situations of violence, prevention of accidents and promotion of a culture of peace; the health care of children with disabilities or in specific situations and vulnerability; surveillance and prevention of infant, fetal and maternal death. 39 can be observed that the scientific production that composes the corpus of this work demonstrates that nurses, when conducting the child care consultation, tend to value the specific aspects such as growth and development, that is, child care, which departs from that determined by the Ministry of Health, which standardizes an integral and holistic care for this population.
It was found as the main difficulty in this IR, for the accomplishment of the NC in accordance with the guidelines established by the Brazilian MH, the work overload that the professionals have in the BP.It is noted that another aspect mentioned, which impedes the development of NC, refers to the lack of structure in the environment in which this service is performed, which influences the application of systematized care.
A strong physical, mental and psychic exhaustion is caused by the excess demand for care to health professionals, since the care needs to respect the singularities and be effective.It is reported that childcare requires time, as it needs to investigate the problems mentioned by the family and examine the child giving him all the individualized attention he needs.It becomes a complex action, when carried out in an integral and resolutive way, since it requires, English/Portuguese J Nurs UFPE online., Recife, 13(1):3464-75, Jan., 2019 3473 from the professionals, a set of attributes and technological resources quite diversified. 40 is concluded that the essential element of the NC is childcare, however, in the specialized services and other specific aspects for each clinical condition should also be assessed.The assessment of growth and development in all NCs should be addressed at all levels of health care, as it occurs primarily in Primary Health Care.It should be noted that this does not mean that NC is not carried out at the secondary and tertiary levels of attention, but it shows that, possibly, professionals working in this context are not divulging their productions in order to allow a better visibility of this area in the scientific environment.
This study is confirmed by the importance of childcare in the NC and leads to the reflection that other contexts and evaluations need to be carried out for the contribution of promoting the well-being of children and adolescents, since an evaluation performed by the nurse, who contemplates aspects, tends to identify early health problems in the group in question.
Description of the acronym PICO.Fortaleza (CE), Brazil, 2018.The search was guided, according to the figure, by the following guiding question: What are the essential elements of the Nursing consultation in the attention to the child and the adolescent?
according to the search equations was performed: (1) Pediatric Nursing AND Health Care; (2) Pediatric Nursing AND Child; (3) Pediatric Nursing AND Health Services; (4) Pediatric Nursing AND Nursing Care; (5) Health Care AND Child; (6) Health Care AND Nursing; (7) Child AND Health Services; (8) Child AND Nursing Care; (9) Health Care AND Nursing versus Child Care.
1. Frota MA, Andrade IS, Santos ZMSA, Silva CAB, Fernandes AFC.Sociodemographic and clinical profile of children with congenital heart disease assisted at a hospital institution.