Assistance flowchart for pain management in a Neonatal Intensive Care Unit

To describe and discuss the process of developing a flowchart collectively constructed by the health team of a Neonatal Intensive Care Unit for the management of neonatal pain.

Method:

This is a descriptive and an exploratory study with a qualitative approach that used Problem-Based Learning as a theoretical-methodological framework in the process of developing the assistance flowchart for the management of neonatal pain.

Results:

Based on this methodology, there was training in service and the discussion of key points of pain management by the health team, which served as input for the construction of the flowchart.

Final considerations:

The assistance flowchart for pain management, based on scientific evidence, provided means to facilitate the decision-making of the health team regarding the pain of the newborn. It is suggested to use the flowchart frequently to promote the permanent education of the team and identify possible points to be adjusted.

Descriptors:
Pain Management; Neonatal Intensive Care Units; Workflow; Neonatal Nursing; Newborn

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