Conocimiento y prácticas de enfermeros acerca del manejo del dolor en recién nacidos

Costa, Taine; Rossato, Lisabelle Mariano; Bueno, Mariana; Secco, Izabela Linha; Sposito, Natália Pinheiro Braga; Harrison, Denise; Freitas, Júnia Selma de

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Revista da Escola de Enfermagem da USP

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 51 • 2017 • https://doi.org/10.1590/S1980-220X2016034403210 copiar

Conocimiento y prácticas de enfermeros acerca del manejo del dolor en recién nacidos

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

OBJETIVO

Verificar el conocimiento y las prácticas de los enfermeros sobre el manejo del dolor de recién nacidos admitidos en Unidades de Tratamiento Intensivo Neonatal.

MÉTODO

Estudio descriptivo y transversal. Los datos fueron recolectados con 51 enfermeros, mediante un cuestionario adaptado que tiene el fin de evaluar el conocimiento y las prácticas acerca del manejo del dolor neonatal, en seis hospitales de Curitiba y Región Metropolitana.

RESULTADOS

Para la mayoría de los enfermeros (86,0%), los neonatos sienten dolor. Un total del 34,7% afirmaron nunca utilizar escalas de evaluación del dolor. El registro del manejo del dolor fue realizado por el 84,3% de los enfermeros. Las medidas farmacológicas realizadas fueron Paracetamol y Fentanilo (47,1%) y Morfina (17,6%); las no farmacológicas adoptadas fueron solución azucarada (68,6%), succión no nutritiva (58,8%) y posicionamiento (56,9%).

CONCLUSIÓN

Los enfermeros consideraron el dolor neonatal como un evento real; sin embargo, no realizaban evaluación o tratamiento del dolor en el recién nacido de modo sistematizado. Es necesario implantar estrategias de traducción del conocimiento a fin de perfeccionar el manejo del dolor de recién nacidos.

Descriptores
Dolor; Manejo del Dolor; Recién Nacido; Enfermería Neonatal; Unidades de Cuidado Intensivo Neonatal.

	D		PD		DK		PA		A
	n	%	n	%	n	%	n	%	n	%
1. PRNB feel pain	4	8.0	1	2.0	-	-	2	4.0	43	86.0
2. Full-termNBsfeel pain	4	8.0	-	-	-	-	5	10.0	41	82.0
3. Pain can affect newborn’s HR, RR, T, BP, SatO₂ and IP	-	-	-	-	-	-	3	5.9	48	94.1
4. Pain can affect newborn’s facial expressions, limb movements and crying	-	-	-	-	-	-	2	3.9	49	96.1
5. Light and noise may affect newborn’s reactions to pain	-	-	1	2.0	1	2.0	5	9.8	44	86.3
6. NB pain is not recognized by professionals	13	26.0	7	14.0	-	-	23	46.0	7	14.0
7. NB pain is not considered by researchers	21	41.2	12	23.5	1	2.0	17	33.3	-	-
8. NBs react to pain ina particular way	2	4.0	3	6.0	-	-	11	22.0	34	68.0
9. Pain is considered as one of the VS in NBs	-	-	1	2.0	2	3.9	7	13.7	41	80.4
10. Pain assessment in NBs must be systematized	-	-	-	-	-	-	5	9.8	46	90.2
11. Pain assessment should be part of the NP	-	-	-	-	-	-	1	2.0	50	98.0
12. NBs do not require painkillers due to immaturity of the nervous system	38	74.5	7	13.7	2	3.9	3	5.9	1	2.0
13. Neonatal pain can be assessed without the use of scales	20	39.2	10	19.6	1	2.0	8	15.7	12	23.5
14. The use of scales for pain assessment is important to the practice	-	-	-	-	-	-	7	13.7	44	86.3
15. It is important to record pain on the newborn’s chart	-	-	-	-	-	-	1	2.0	50	98.0
16. Recording pain assessment is a prerequisite to its control	-	-	-	-	-	-	4	7.8	47	92.2
17. Nurses have sufficient knowledge to assess pain in NBs	-	-	2	3.9	-	-	23	45.1	26	51.0
18. Pain management in NBs depends on its assessment	1	2.0	1	2.0	-	-	14	27.5	35	68.6
19. Recording newborn’s painassessment will result in relief	8	15.7	7	13.7	1	2.0	20	39.2	15	29.4
20. Having knowledge of NPMs for pain relief helps its relief	2	4.0	-	-	-	-	4	8.0	44	88.0
21. Using NPMs for pain relief is necessary	-	-	-	-	-	-	4	7.8	47	92.2
22. Parents can help pain management in NB	1	2.0	-	-	-	-	6	11.8	44	86.3
23. Despite feeling pain, NBs can sleep or not react to pain	11	21.6	2	3.9	3	5.9	20	39.2	15	29.4
24. NBs submitted to repeated painful procedures may have harmful effects on their development	3	6.0	1	2.0	5	10.0	8	16.0	33	66.0
25. The medical/clinical diagnosis of NBs influences pain management	2	3.9	3	5.9	1	2.0	11	21.6	34	66.7
26. Professional’s joint decisions are needed for pain management in NBs	-	-	1	2.0	-	-	1	2.0	49	96.1
27. Sedatives relieve pain in NBs	7	14.0	4	8.0	-	-	16	32.0	23	46.0
28. Opioid analgesics are appropriate to relieve pain in NBs	2	3.9	4	7.8	6	11.8	26	51.0	13	25.5
29. Opioid analgesics are suitable for NBsundergoingMV	1	2.0	-	-	9	17.6	17	33.3	24	47.1
30. Non-opioid analgesics are suitable for pain relief in NBs	-	-	1	2.0	8	15.7	18	35.3	24	47.1

	N		R		ST		M T		A
	n	%	n	%	n	%	n	%	n	%
1. I assess NB pain through crying	-	-	-	-	14	29.2	23	47.9	11	22.9
2. I assess NB pain through facial expressions	-	-	-	-	12	24.5	17	34.7	20	40.8
3. I assess NB pain throughbody movement and agitation	-	-	1	2.0	6	12.0	17	34.0	26	52.0
4. I assess NB pain through the VS	-	-	1	2.0	11	22.0	7	14.0	31	62.0
5. I use scales to assess pain in NBs	17	34.7	8	16.3	8	16.3	6	12.2	10	20.4
6. Irecord NBs pain scores on their medical chart	7	14.0	4	8.0	9	18.0	11	22.0	19	38.0
7. I communicate and discuss the pain scores in NBs with the team	3	5.9	4	7.8	5	9.8	14	27.5	25	49.0
8. I use NNS to relieve pain in NBs	-	-	-	-	8	15.7	19	37.3	24	47.1
9. I encourage breastfeeding to relieve the pain in NBs	9	17.6	10	19.6	20	39.2	5	9.8	7	13.7
10. I encourage skin-to-skin contactto relieve the pain in NBs	3	5.9	13	25.5	17	33.3	13	25.5	5	9.8
11. I offer oral glucose or sucrose to relieve NB pain prior to painful procedures	1	2.0	2	3.9	6	11.8	20	39.2	22	43.1
12. I offer oral glucose or sucrose to relieve NB pain during painful procedures	2	3.9	3	5.9	8	15.7	18	35.3	20	39.2
13. I position the NB to relieve their pain	-	-	1	2.0	6	11.8	17	33.3	27	52.9
14. I perform facilitated tuckingin NBs during painful procedures	3	5.9	2	3.9	11	21.6	21	41.2	14	27.5
15. Iswaddle NBs before painful procedures	2	4.0	5	10.0	11	22.0	18	36.0	14	28.0
16. I use more than one NPM to relieve the pain of NBs	3	5.9	4	7.8	7	13.7	24	47.1	13	25.5
17. I use PMs and NPMs combined to relieve pain in NBs	-	-	3	6.0	17	34.0	19	38.0	11	22.0
18. I discuss NPMs used for prevention and relief ofpain in NBs with the team	3	5.9	6	11.8	12	23.5	15	29.4	15	29.4
19. I record the pain scores on the newborn’s medical chart	6	11.8	3	5.9	5	9.8	16	31.4	21	41.2
20. I record NPMs for the prevention and relief of painon the newborn’s medical chart	6	11.8	5	9.8	9	17.6	9	17.6	22	43.1
21. I record the complications in administration of NPMs used onthe newborn’s medical chart	6	12.0	8	16.0	5	10.0	9	18.0	22	44.0
22. I inform parents/family about painful procedures to be performed	1	2.0	1	2.0	8	15.7	14	27.5	27	52.9
23. I ask parents/families to be part of the prevention and relief of pain in NBs	3	6.0	6	12.0	16	32.0	13	26.0	12	24.0
24. I administer opioid painkillers, prescribed IN, to relieve the pain of NBs	1	2.0	8	15.7	12	23.5	20	39.2	10	19.6
25. I administer opioid painkillers, prescribed IN, to NBs undergoingMV	1	2.0	7	14.3	20	40.8	12	24.5	9	18.4
26. I administer non-opioid painkillers, prescribed IN, for pain relief in NBs	1	2.0	10	20.0	19	38.0	13	26.0	7	14.0
27. I administer non-opioid painkillers, prescribed IN, for pain relief caused by painful procedures in NBs	2	3.9	10	19.6	21	41.2	10	19.6	8	15.7
28. I administer sedatives prescribed IN for pain management in NBs	10	19.6	14	27.5	13	25.5	9	17.6	5	9.8
29. I record the PMs used on the newborn’s medicalchart	1	2.0	3	5.9	2	3.9	6	11.8	39	76.5
30. I record the complications from administration of PMson the newborn’s medical chart	2	3.9	3	5.9	4	7.8	3	5.9	39	76.5
31. I discuss the PMs used with the team	5	9.8	2	3.9	8	15.7	16	31.4	20	39.2

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author
Lisabelle Mariano Rossato. Av. Dr. Enéas de Carvalho Aguiar, 419 - Cerqueira César. CEP 05403-000 - São Paulo, SP, Brazil. rossato@usp.br