Manejo del dolor en niños hospitalizados: desvelando barreras desde la perspectiva de enfermería

Souza, Danton Matheus de; Lestinge, Giovanna Sanches; Carvalho, Joese Aparecida; Rossato, Lisabelle Mariano

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Revista Gaúcha de Enfermagem

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Sumário

Original Article • Rev. Gaúcha Enferm. 45 • 2024 • https://doi.org/10.1590/1983-1447.2024.20230151.en copiar

Manejo del dolor en niños hospitalizados: desvelando barreras desde la perspectiva de enfermería

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Comprender las percepciones del equipo de enfermería sobre las barreras en el manejo del dolor en el cuidado de niños hospitalizados.

Método:

Estudio descriptivo-exploratorio, con abordaje cualitativo, realizado con ocho enfermeros y siete técnicos de enfermería. Los datos fueron recolectados en el Hospital Universitario de la Universidade de São Paulo, entre junio y septiembre de 2022, a través de entrevistas individuales, analizados en la perspectiva del análisis de contenido temático y a la luz del Interaccionismo Simbólico.

Resultados:

Emergieron las siguientes categorías: 1) Traducción del conocimiento: ¿Se realiza realmente el manejo del dolor? y 2) Reflejar cambios: ¿Cómo alcanzar la potencialidad del manejo del dolor? Los profesionales tienen conocimientos teóricos sobre el manejo del dolor, pero enumeraron numerosas barreras en cada etapa, principalmente relacionadas con el cotidiano institucional, y, al reflejar ese contexto, señalaron la necesidad de un protocolo institucional.

Consideraciones finales:

las barreras se destacan del conocimiento teórico y hacen que se desestime el manejo del dolor en niños hospitalizados. Conocer este contexto se vuelve relevante para aplicar las estrategias de cambio.

Descriptores:
Dolor; Manejo del dolor; Niño hospitalizado; Barreras de acceso a los servicios de salud; Enfermería pediátric

THEORETICAL CATEGORY: “Knowledge translation: is pain management actually performed?”
Subcategory: “Assessment: the mechanicism of a subjective assessment”
What I see is that the assessment is based on our experience rather than using scales. We look at the patient, we see that he is not in pain, we don't even apply the scale, we already mark it as zero there (instrument).(N1) When the child is undergoing a procedure, is going to be intubated, and is half awake, you notice that the child is moving in pain, it must be horrible. Venous punctures also, but we do not assess this pain. [...] we don't score it, we don't document it at all. And the child screams, cries... no type of procedure records the pain the child is experiencing... we don't do that.(N3) A child who, in theory, would not have a diagnosis, such as a fracture and surgery, would have no reason to be in pain. (N2) The assessment is mechanical, in the sense that it only assesses whether the patient complains. (N2) We have barriers such as professional scale, accumulation of tasks, routine, high demand, high occupancy rate. There is overload. (N5) In the emergency room, I've never seen anyone thinking about pain. (N6) Pain assessment is based on experience, as we didn't have scales before. (N12)
Subcategory: “Intervention: the pharmacological culture and devaluation of non-pharmacological strategies”
We need the physician's assessment to medicate. Even if we prove that the child is in pain, even if we say that we applied the scale, there is always the barrier of depending on clinical assessment, and they have difficulty medicating. (N1) There is a culture that newborns do not feel pain. [...] when you say that the child is in pain, pediatricians listen to you more than neonatologists. (N9) The application of non-pharmacological interventions depends on each professional, once again subjectivity. (N1) I am trained in ICPs, but I feel afraid and coerced, because there is prejudice, especially on the medical side. It's as if he were practicing charlatanism. I know that* (ICPs) will help, but I'm scared of someone seeing it, anyone, and creating a situation, even if the mother authorizes it.* [...] I'm afraid of being punished: “Who told you to do that? You’re not hired for this.”(N6) Like I told you, I comfort, hold, give affection, massage, but always following medical guidance. (N15)
Subcategory: “Reassessment: Is intuition the new reassessment?”
The reassessment is intuitive, we deduce that, if he/she stopped crying, the pain improved. We don't go back to check, but there will be the next record (every 4 hours) that the pain has gone away. (N1) We know that once the patient is in pain, that I have performed an intervention, I have to reassess. We have that in the instrument, but it is not a routine, there is no protocol, it is neglected. (N1) I don't use scales, we see if the child has calmed down. If they calm down, it's because there's no pain. (N15)

THEORETICAL CATEGORY: Reflecting changes: how to achieve the potential of pain management?

Subcategory: Moving towards the solution: redefining routines by applying new routines

I believe the instrument needs to be readapted. (N6) It is necessary to implement training. On how the steps will be done, when to do them. The dissemination of this information. (N7) I think we need to implement a protocol and training. That’s missing, there should be encouragement for that. (N3) I think that, in the emergency room, things must be practical, there is no point in inventing protocols that do not streamline and hinder our service. In practice, it will be left aside. It should be something practical, like a checklist. After a while, we can adapt better and do it by memory by knowing the steps. (N14)

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author:
Danton Matheus de Souza E-mail: danton_souza@usp.br