Flujograma asistencial para manejo del dolor en Unidad de Terapia Intensiva Neonatal

Querido, Danielle Lemos; Christoffel, Marialda Moreira; Almeida, Viviane Saraiva de; Esteves, Ana Paula Vieira dos Santos; Andrade, Marilda; Amim Junior, Joffre

doi:10.1590/0034-7167-2017-0265

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Revista Brasileira de Enfermagem

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Sumário

RESEARCH • Rev. Bras. Enferm. 71 (suppl 3) • 2018 • https://doi.org/10.1590/0034-7167-2017-0265 copiar

Flujograma asistencial para manejo del dolor en Unidad de Terapia Intensiva Neonatal

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Describir y discutir el proceso de desarrollo de un diagrama de flujo construido colectivamente por el equipo de salud de una Unidad de Terapia Intensiva Neonatal para el manejo del dolor neonatal.

Método:

Se trata de un estudio descriptivo, exploratorio, con un abordaje cualitativo que utilizó el Aprendizaje Basado en Problemas como referencial teórico-metodológico en el proceso de desarrollo del diagrama de flujo asistencial del manejo del dolor neonatal.

Resultados:

A partir de esta metodología ocurrió una capacitación en servicio y la discusión de puntos claves del manejo del dolor por el equipo de salud, los cuales sirvieron de subsidios para la construcción del diagrama de flujo.

Consideraciones finales:

El flujograma asistencial del manejo del dolor, construido a partir de evidencias científicas, proporcionó medios para facilitar la toma de decisión del equipo de salud frente al dolor del recién nacido. Se sugiere la aplicación del diagrama de flujo con frecuencia para promover la educación permanente del equipo e identificar posibles puntos a ser ajustados.

Descriptores:
Manejo del Dolor; Unidades de Terapia Intensiva Neonatal; Flujo de Trabajo; Enfermería Neonatal; Recién Nacido

Steps of Problem-Based Learning	Steps followed in the development of the tutorial group
1- Presentation of the problem	Presentation of the problem situation through a dynamic that allowed the group to experience pleasant and painful sensations similar to those experienced by the neonates hospitalized in the Neonatal Intensive Care Unit. Once the problem was defined (neonatal pain), we tried to clarify the unknown terms.
2 - Problem analysis and identification of learning issues	The problem was analyzed by the group and culminated with the following questions: How do I manage neonatal pain? What can cause painful sensations/stimuli in newborns hospitalized in the Neonatal Intensive Care Unit? How the evaluation of neonatal pain is performed using specific scales? How do I apply non-pharmacological methods of neonatal pain relief?
3 - Formulation of hypothetical explanations	The researcher (in the role of tutor) can guide learning by coordinating a brainstorming and each member of the group participated in the formulation of hypothetical explanations for the issues listed.
4 - Identification of knowledge gaps.	Next, these explanations were organized and synthesized, exposing the limits of the knowledge of the group and making clear the gaps in this knowledge.
5 - Definition of learning objectives	To understand the management of neonatal pain; to identify the painful procedures to which the newborns are submitted; to evaluate neonatal pain with the use of specific scales (one-dimensional and multidimensional); and to employ non-pharmacological methods of neonatal pain relief.
6 - Individual studies	Copies of texts selected by the tutor were extracted from a survey of MEDLINE, LILACS and SciELO (2009 to 2013) online databases. The descriptors used in the search were: Pain, Newborn and Pain Management.
7 - Rediscussion of the problem and solution	As the problem was discussed again, the group gradually introduced information from national and international literature that supported or refuted prior knowledge. The group can identify some procedures, such as calcaneal puncture, venous puncture, aspiration of the airways, among others that promote sensations and painful stimuli in hospitalized newborns. It was possible the recognition and interpretation of pain signals of the newborn through the physiological and behavioral indicators that the newborn had in the period of pain. As to the evaluation of neonatal pain, the group identified some scales used in neonatal practice and from the demonstration of a painful video procedure could simulate the applicability of some scales and unanimously chose a scale that was more practical and had better applicability to the unit. All doubts about the use of the scale were clarified by the tutor. The literature pointed to the use of the scale along with painful procedures and also accompanied the verification of the vital signs and the group agreed that these moments were the most useful for the application of the scale in the unit. Regarding methods of neonatal pain relief, some non-pharmacological strategies of pain relief in relation to different situations were also listed, as well as the choice and the correct technique to use each of the measures of pain relief.

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[1] CORRESPONDING AUTHOR: Danielle Lemos Querido. E-mail: danyquerido@me.ufrj.br