Interventions of the Nurse Specialist in Rehabilitation for Children with Acute Bronchiolitis and Their Parents: A Scoping Review Protocol

1. Introduction

Acute bronchiolitis is an acute lower respiratory tract infection and is the most common cause of paediatric emergency department visits (Vieira & Sousa, 2016). It primarily affects children aged between 1 and 23 months and is predominantly of viral origin, with Respiratory Syncytial Virus (RSV) being the leading causative agent (Directorate-General of Health (Direção-Geral da Saúde, DGS), 2015; Jerath, 2021). However, other respiratory viruses have also been identified, including rhinovirus, enterovirus, parainfluenza viruses types 1, 2 and 3, influenza A and B viruses, coronaviruses, human metapneumovirus, and adenovirus (Jerath, 2021). The clinical manifestations result from inflammation of the bronchial mucosa associated with mucus accumulation, leading to obstruction of the small airways and impaired pulmonary ventilation (Jerath, 2021).

This obstruction is particularly significant in infants because of their anatomical and physiological characteristics, especially their predominantly nasal breathing pattern (Jartti et al., 2019). Consequently, when a mechanical, physical (e.g., nasogastric tubes), or physiological (e.g., secretions) obstruction occurs, infants rapidly expend excessive energy to overcome the airway obstruction, which may ultimately lead to respiratory failure (Jartti et al., 2019). Their narrow airways and relatively compliant bronchial structures increase susceptibility to oedema and airway collapse, resulting in greater resistance to airflow (Jartti et al., 2019). For this reason, airway clearance constitutes a fundamental component of paediatric respiratory rehabilitation programmes (Cordeiro & Menoita, 2012) and represents a frequent focus of nursing care aimed at maintaining airway patency and promoting secretion clearance (Roqué-Figuls et al., 2023). Within this context, the phenomenon under study was framed under the Airway Clearance focus of the International Classification for Nursing Practice (ICNP).

The relevance of this nursing focus becomes evident when considering the clinical manifestations of acute bronchiolitis, which include seromucous rhinorrhoea, nasal obstruction, cough, fever, and reduced oral intake (Virgili et al., 2024). In more severe cases, children may present with tachypnoea, chest retractions, nasal flaring, tachycardia, wheezing, and hypoxaemia (Vieira & Sousa, 2016).

In most cases, clinical improvement occurs within two to four days with outpatient supportive management alone (Willer et al., 2025). The median duration of illness is approximately 15 days but may extend up to 30 days (Directorate-General of Health (Direção-Geral da Saúde, DGS), 2015). The average hospital length of stay, in uncomplicated cases, ranges from three to five days (Justice & Le, 2024). Nevertheless, approximately 10% of children develop severe disease requiring prolonged hospitalisation (Justice & Le, 2024). Potential complications include secondary bacterial infection, pneumonia, and atelectasis (Justice & Le, 2024). Children with underlying comorbidities or clinical deterioration may require prolonged admission to paediatric intensive care units (Directorate-General of Health (Direção-Geral da Saúde, DGS), 2015; Justice & Le, 2024).

To reduce symptoms and prevent complications, paediatric respiratory rehabilitation programmes primarily aim to prevent or minimise the mechanical consequences of airway obstruction caused by retained secretions (Andersson-Marforio et al., 2020). According to the Quality Standards for Rehabilitation Nursing, rehabilitation nursing care should promote preventive interventions, prevent complications, and minimise or reduce the impact of impairments affecting physiological functions, including respiratory function (The Portuguese Nurses Order, 2011).

Overall, the techniques and objectives of paediatric respiratory rehabilitation are broadly comparable to those applied in adults (Cordeiro & Menoita, 2012). Nevertheless, important differences arise from the unique anatomical and physiological characteristics of the paediatric population (Cordeiro & Menoita, 2012; Andersson-Marforio et al., 2020).

The principal objectives of paediatric respiratory rehabilitation include facilitating bronchial secretion mobilisation and clearance, preventing and correcting ventilation abnormalities, optimising oxygenation and gas exchange, and preventing pulmonary complications and structural lung damage (Cordeiro & Menoita, 2012; Andersson-Marforio et al., 2020). Overall, respiratory rehabilitation interventions contribute to lung re-expansion, reduced work of breathing, and lower oxygen consumption (Andersson-Marforio et al., 2020). In addition, they improve thoracic mobility and respiratory muscle strength while promoting the child’s overall well-being (Cordeiro & Menoita, 2012; Andersson-Marforio et al., 2020).

Following a comprehensive assessment of the child, the Rehabilitation Nursing Specialist is responsible for selecting the most appropriate respiratory physiotherapy techniques (Cordeiro & Menoita, 2012; Andersson-Marforio et al., 2020). These interventions include the forced expiration technique, increased expiratory flow technique, assisted coughing, airway suctioning, nasal irrigation, nebulisation, postural drainage, chest vibrations, and chest percussion, among others (Cordeiro & Menoita, 2012; Andersson-Marforio et al., 2020).

However, within paediatric practice, it is not possible to care for the child without simultaneously addressing the needs of the parents or caregivers (Freeman et al., 2023). Consequently, successful rehabilitation programmes require the active involvement of the child’s caregivers (Cordeiro & Menoita, 2012). Parents experience their child’s respiratory distress and reduced oral intake, both of which are characteristic features of the illness and its management (Freeman et al., 2023). Persistent coughing, worsening respiratory distress, crying, irritability, and occasionally lethargy are experienced by parents as highly stressful events, frequently accompanied by anxiety and feelings of helplessness during the illness transition process (Ribeiro et al., 2015).

Accordingly, the Rehabilitation Nursing Specialist should be regarded as an agent of change who equips families with the knowledge, skills, available options, and behavioural planning required to achieve optimal health outcomes (França et al., 2021). By facilitating the situational transition process, as described in Meleis’ Transitions Theory, and fostering collaboration with families according to Casey’s Partnership Model of Care, the Rehabilitation Nursing Specialist plays a pivotal role in delivering high-quality, family-centred preventive and therapeutic care that is meaningful to both parents and their children.

Despite its importance, caring for children with bronchiolitis and supporting their parents remains a significant challenge in clinical practice. The literature describes a broad range of interventions aimed at secretion management, maintenance of airway patency, and family support; however, these interventions are frequently reported in a fragmented manner, with varying conceptual frameworks and levels of detail. Consequently, this diversity limits a comprehensive understanding of how these interventions are conceptualised and implemented within paediatric rehabilitation nursing practice and hinders the identification of the strategies most frequently described to support both the child and their caregivers throughout the disease process.

Given the relevance of this topic to rehabilitation nursing practice, a preliminary search for secondary studies was conducted in MEDLINE (via PubMed), CINAHL (via EBSCO), Scopus, PEDro and the Cochrane Database of Systematic Reviews. This preliminary search did not identify any reviews that systematically synthesised the evidence regarding Rehabilitation Nursing Specialist interventions targeting both children with bronchiolitis and their parents. Therefore, undertaking a scoping review is warranted to map the available evidence on these interventions, organise the existing knowledge in a structured manner, and identify the conceptual foundations underpinning their implementation. Ultimately, this review is expected to contribute to a clearer understanding of the scope of Rehabilitation Nursing Specialist practice in this clinical context while identifying knowledge gaps to guide future research in this field.

2. Materials and Methods

This scoping review will be conducted in accordance with the methodology proposed by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.

The primary aim of this scoping review is to identify the interventions implemented by Rehabilitation Nursing Specialists for children aged 1 to 23 months with acute bronchiolitis, as well as the interventions provided to their parents. Specifically, this review seeks to answer the following research questions:

What interventions are implemented by Rehabilitation Nursing Specialists for children aged 1 to 23 months in the management of acute bronchiolitis? (e.g., airway clearance techniques appropriate for infants with bronchiolitis, such as nasal saline instillation, postural drainage, chest vibrations, chest percussion, etc.);

What interventions are implemented by Rehabilitation Nursing Specialists to support the parents of children aged 1 to 23 months with acute bronchiolitis? (e.g., education and training aimed at empowering parents to recognise and manage signs and symptoms).

2.1. Inclusion Criteria

2.1.1. Participants

This review will consider studies including children aged 1 to 23 months diagnosed with acute bronchiolitis and/or their parents or caregivers.

Children must have a diagnosis of acute bronchiolitis based on recognised clinical definitions and be between 1 and 23 months of age, in accordance with the Portuguese Directorate-General of Health guidelines (Directorate-General of Health (Direção-Geral da Saúde, DGS), 2015).

Studies involving the parents or caregivers of these children will also be included, as family-centred care requires their active participation in care delivery in partnership with healthcare professionals.

2.1.2. Concept

This review will consider studies exploring interventions delivered by Rehabilitation Nursing Specialists in the care of children with acute bronchiolitis, particularly those related to respiratory rehabilitation techniques and parental empowerment.

Studies describing interventions aimed at promoting bronchial secretion clearance and optimising the child’s physiological responses will be included.

Studies describing interventions directed at parents or caregivers, specifically those focused on enhancing caregiving competencies and supporting the management of children with acute bronchiolitis, will also be considered.

2.1.3. Context

This review will consider studies addressing the interventions of Rehabilitation Nursing Specialists for children with acute bronchiolitis across different healthcare settings, including both hospital and community care.

No restrictions will be placed on geographical location or cultural context.

2.1.4. Types of Sources

This scoping review will consider quantitative, qualitative, and mixed-methods study designs, including experimental, quasi-experimental, observational, and descriptive studies.

Qualitative studies, systematic reviews meeting the inclusion criteria, as well as text and opinion papers, will also be considered for inclusion.

2.1.5. Search Strategy

The search strategy will aim to identify both published and unpublished primary studies, reviews, and clinical guidelines.

In accordance with the JBI methodology, a three-step search strategy will be employed.

First, an initial limited search will be undertaken in MEDLINE (via PubMed) and CINAHL Complete (via EBSCOhost) to identify articles relevant to the review questions. The text words contained in the titles and abstracts of relevant articles, together with the associated index terms, will be analysed to develop the full search strategy for MEDLINE (via PubMed) (Table 1). The search strategy, including all identified keywords and index terms, will subsequently be adapted for each information source included in the review, as each database uses its own controlled vocabulary. Controlled vocabulary terms will be combined with free-text search terms to maximise retrieval. Finally, the reference lists of all included publications will be screened to identify additional relevant studies.

For this scoping review, both published and unpublished literature will be considered according to the following inclusion criteria: rehabilitation nursing interventions (Concept) delivered to children with bronchiolitis and their parents (Population) across healthcare settings (Context).

Studies published in any language and without restrictions regarding publication type will be eligible for inclusion.

No date restrictions will be applied to the database searches.

The following electronic databases will be searched: MEDLINE (via PubMed), CINAHL (via EBSCOhost), PEDro, Scopus, and the Cochrane Database of Systematic Reviews.

Grey literature sources will also be searched, including DART-Europe E-theses Portal and the Portuguese Open Access Scientific Repository (RCAAP).

This scoping review will consider quantitative, qualitative, and mixed-methods study designs for inclusion. In addition, systematic reviews and text and opinion papers will also be considered for inclusion in the proposed review.

2.1.6. Study Selection

All records identified through the database searches will be imported into Mendeley Desktop (Version 1.19.8), where duplicate records will be identified and removed. Before title and abstract screening, and again before full-text assessment, a pilot test will be conducted by the review team. For the first stage, 5% of the total search results will be screened to achieve approximately 75% agreement between reviewers. For the second stage, 2% of the full-text articles will be assessed to reach the same level of agreement.

In the first stage, two independent reviewers will screen the titles and abstracts of all identified records against the inclusion criteria using Rayyan (Qatar Computing Research Institute – Rayyan QCRI). In the second stage, the full texts of potentially relevant studies will be retrieved and independently assessed in detail by the same reviewers against the predefined inclusion criteria. Studies that do not meet the inclusion criteria at the full-text stage will be excluded.

The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology, using the Participants–Concept–Context (PCC) framework to establish the eligibility criteria according to the review questions.

This review will include studies involving children aged between 1 and 23 months with acute bronchiolitis and/or their parents or caregivers. The selected age range is based on the recommendations of the Portuguese Directorate-General of Health (Directorate-General of Health (Direção-Geral da Saúde, DGS), 2015).

Regarding the concept, this review will consider studies exploring the interventions implemented by Rehabilitation Nursing Specialists for children with bronchiolitis and their parents, acknowledging that paediatric care inherently considers the child–family dyad as the unit of care.

Rehabilitation Nursing Specialist interventions for children with bronchiolitis may play a pivotal role, particularly through the implementation of respiratory rehabilitation techniques. Accordingly, studies describing non-invasive interventions aimed at promoting the mobilisation and clearance of bronchial secretions, maintaining the child’s normal physiological responses, and preventing complications and progression to more severe disease will be included.

Given the high transmissibility and recurrence of bronchiolitis, the role of the Rehabilitation Nursing Specialist extends beyond the child alone. The active involvement of parents is essential, not only as immediate caregivers but also as key partners in ensuring continuity of care and preventing complications. Therefore, studies exploring interventions directed at parental empowerment will also be included, encompassing health education strategies and training in specific caregiving skills to support the effective management of children with acute bronchiolitis.

Accordingly, this review is justified by the need to integrate both the clinical and family dimensions of care, recognising that the effectiveness of paediatric respiratory rehabilitation depends not only on the application of specialised interventions for the child but also on the active and informed participation of parents, without which sustainable outcomes are unlikely to be achieved.

Studies addressing Rehabilitation Nursing Specialist interventions for children aged 1 to 23 months with acute bronchiolitis and/or their parents in hospital or community healthcare settings will be included.

Reasons for excluding full-text articles will be documented. Any disagreements between reviewers at any stage of the selection process will be resolved through discussion or, when necessary, by consultation with a third reviewer.

The results of the search and study selection process will be reported in full in the final scoping review and presented using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow diagram.

As this is a scoping review, the methodological quality of the included studies will not be appraised, in accordance with JBI guidance (Peters et al., 2020).

2.1.7. Data Extraction

Data extraction at the full-text stage will be undertaken using a data extraction instrument developed by the author and aligned with the objectives of the review and the research questions.

The extracted data will include specific information relating to the participants, concept, context, and other relevant variables necessary to address the review question, as presented in Table 2.

Reasons for the exclusion of articles at the full-text screening stage will be documented to ensure transparency in the study selection process (Table 3).

3. Discussion

The data extracted from the included studies will be presented in tabular format and accompanied by a narrative synthesis, allowing the mapping of available evidence regarding Rehabilitation Nursing Specialist interventions for children with acute bronchiolitis and the contribution of these interventions to parental empowerment.

Initially, a table characterising the included studies will be presented, containing information on authors, year of publication, country, study aim, methodological design, clinical setting, and population characteristics. This table will allow the description of the distribution of available evidence and the identification of the contexts in which these interventions have been investigated.

Subsequently, data will be organised into intervention mapping tables, including the type of rehabilitation nursing intervention, associated objectives, target population, reported outcomes, and any educational components directed towards parents or caregivers. Whenever possible, interventions will be grouped into conceptual categories to highlight patterns identified in the literature.

In addition to tabular presentation, results may be represented graphically or through diagrams that summarise the distribution of interventions described in the literature and their relationship with reported outcomes, particularly regarding improvements in children’s respiratory symptoms and parental empowerment.

The presentation of results will be complemented by a narrative synthesis linking the findings to the objectives and research questions of the review, highlighting the main types of interventions identified, the contexts in which they are applied, and the existing gaps in the available evidence.

4. Conclusions

This protocol describes the methodological procedures for conducting a scoping review aimed at mapping Rehabilitation Nursing Specialist interventions directed at children with acute bronchiolitis aged between 1 and 23 months, as well as interventions targeted at their parents as key elements in the care process. Therefore, this review seeks to synthesise the available evidence regarding Rehabilitation Nursing Specialist interventions within this specific clinical context, simultaneously integrating the therapeutic dimension associated with paediatric respiratory rehabilitation and the educational dimension focused on parental empowerment.

Considering that the preliminary search did not identify reviews integrating these two dimensions in a structured manner, this review will enable the mapping and organisation of strategies described in the literature regarding the management of children with bronchiolitis and their families. Thus, mapping the available evidence is expected to contribute to increasing the visibility of the scope of Rehabilitation Nursing Specialist interventions in this area, clarifying how these interventions are conceptualised and implemented across different healthcare settings.

Furthermore, by identifying intervention patterns, areas of convergence, and knowledge gaps, this review may support reflection on paediatric rehabilitation nursing practice and inform the development of future research and clinical initiatives aimed at improving care provided to children with bronchiolitis and their families.