The practices of occupational therapists in the pediatric ward: an integrative reviewAbstract
Introduction The pediatric ward is a field of occupational therapy, which helps patients and their companions develop strategies to cope with illness and hospitalization.
Objective To identify, in the scientific literature, the practices of occupational therapists in pediatric wards in assisting children, adolescents and accompanying family members.
Method This is an Integrative Literature Review, carried out in the databases: Virtual Health Library, MEDLINE and PubMed; and manual search in Brazilian journals: Cadernos Brasileiros de Terapia Ocupacional, Revista Interinstitucional Brasileira de Terapia Ocupacional and Revista de Terapia Ocupacional da Universidade de São Paulo. The articles were exported to the Rayyan® tool and selected by two authors independently. Data processing was carried out through Content Analysis, in thematic mode, using the ATLAS.ti® software.
Results 23 articles were included and the analysis resulted in four categories: “Intervention”; “Intervention resources”; “Overview of occupational therapy services”; and “Humanization in family monitoring care”.
Conclusion The study presents a perspective of occupational therapy in the pediatric ward, based on selected literature, offering elements that can help professionals guide their interventions and guide new studies on the topic.
Keywords:
Occupational Therapy; Hospitals; Child, Hospitalized; Adolescent, Hospitalized; Family
Resumo
Introdução A enfermaria pediátrica é um campo de atuação da terapia ocupacional, em que se verifica o auxílio ao paciente e seu acompanhante a elaborar estratégias de enfrentamento do adoecimento e da hospitalização.
Objetivo Identificar, na literatura científica, as práticas dos terapeutas ocupacionais em enfermaria pediátrica na assistência à criança, ao adolescente e ao familiar acompanhante.
Método Trata-se de uma Revisão Integrativa da Literatura, realizada nas bases de dados: Biblioteca Virtual em Saúde, MEDLINE e PubMed; e busca manual nos periódicos brasileiros: Cadernos Brasileiros de Terapia Ocupacional, Revista Interinstitucional Brasileira de Terapia Ocupacional e Revista de Terapia Ocupacional da Universidade de São Paulo. Os artigos foram exportados para a ferramenta Rayyan® e selecionados por dois autores de forma independente. O tratamento dos dados foi feito por meio da Análise de Conteúdo, na modalidade temática, com uso do software ATLAS.ti®.
Resultados Foram incluídos 23 artigos e a análise resultou em quatro categorias: “Intervenção”; “Recursos de intervenções”; “Panorama dos atendimentos da terapia ocupacional”; e “Humanização no cuidado ao acompanhamento familiar”.
Conclusão O estudo apresenta uma perspectiva da terapia ocupacional na enfermaria pediátrica, baseado na literatura selecionada, oferecendo elementos que podem auxiliar os profissionais a guiar suas intervenções e a balizar novos estudos sobre o tema.
Palavras-chave:
Terapia Ocupacional; Hospitais; Criança Hospitalizada; Adolescente Hospitalizado; Família
Introduction
Daily hospital life is mostly made up of activities related to health care, whether hygiene, food, medication administration, exams, playing, sleeping and clinical care (Simonato et al., 2019). Traumatic experiences can be part of the hospitalization process: the removal of emotional and social bonds, the performance of invasive and painful therapeutic procedures and the change in the ways of exploring the world (Angeli et al., 2012).
In the perception of the hospitalized child and adolescent, hospitalization can be understood as a necessary experience due to the treatment, however, this process is crossed by feelings of anxiety due to the medication, the longing for meaningful places and activities and the pain in carrying out the puncture (Freitas & Agostini, 2019). Furthermore, they observe a change in the family’s routine for monitoring them in the hospital (Freitas & Agostini, 2019; Lino et al., 2021).
In parallel, companions have difficulty adapting to the hospital environment, experiencing various negative feelings, social isolation, physical and mental fatigue, observation of painful procedures and expectations regarding the child's future (Almeida et al., 2016). It should be noted that the care provided to the child during the hospitalization period can generate overload and frustration, as it will require a new organization, with possible consequences for self-care. Therefore, mothers start to prioritize their children and neglect themselves (Souza; 2021).
In the context of the pediatric ward, the occupational therapist's focus is to provide the patient with quality of life, seeking to help in coping with illness and hospitalization. In this direction, on the one hand, the professional uses activities that are significant for the subject, considering aspects of development, culture, life history, autonomy and potential. On the other hand, for the family/caregivers, the occupational therapist's actions include guidelines to prevent, minimize or monitor neuropsychomotor development, through techniques to stimulate the child's development and guidelines regarding technical aspects related to the process. hospitalization, treatment and childcare (Kudo et al., 2018).
The literature highlights childhood as one of the areas of greatest publication in occupational therapy in hospital contexts (Galheigo & Antunes, 2008; Ferreira et al., 2022). In view of this, the interest of occupational therapists in the development of studies aimed at childhood hospitalization stands out, and it is important to highlight the contributions of occupational therapy in this field and favor the insertion and consolidation of professionals in pediatric wards, considering the different realities found in the Brazilian territory.
Considering the hospital as a place for the production of health care and that occupational therapy is inserted as a professional nucleus (Galheigo, 2008), it is necessary to identify in the literature the production of knowledge about the practices carried out by these professionals in the pediatric ward, together with to the pediatric patient and their companion. Thus, the objective of the study is to identify in the scientific literature the practices of occupational therapists in pediatric wards in assisting children, adolescents and accompanying family members.
Method
This is an integrative literature review with a qualitative approach, which followed six steps: elaboration of the research question, definition of inclusion and exclusion criteria for studies, categorization of included studies, evaluation of studies, interpretation of results and synthesis of knowledge (Mendes et al., 2008).
The research question formulated for the study was: “What and how are the occupational therapy practices in the pediatric ward in assisting hospitalized patients and their accompanying family members?”
The searches took place in February 2023, in the databases: Virtual Health Library (VHL), MEDLINE and PubMed. During this period, manual searches were also carried out in Brazilian occupational therapy journals: Cadernos Brasileiros de Terapia Ocupacional, Revista Interinstitucional Brasileira de Terapia Ocupacional (REVISRATO) and Revista de Terapia Ocupacional da Universidade de São Paulo.
Database searches were carried out using descriptors consulted in Medical Subject Headings (MeSH), with the Boolean operator “AND”, through the following combinations: 1) “Occupational Therapy” AND Hospital AND “Hospitalized Children”; 2) “Occupational Therapy” AND Hospital AND “Hospitalized Adolescents”; 3) “Occupational Therapy” AND Hospital AND Family AND Child; 4) “Occupational Therapy” AND Hospital AND Family AND Adolescents. Manual searches took place with the descriptors in Portuguese, selected from the “Descriptors in Health Sciences” (DeCS) portal, used individually, they were: “occupational therapy”, “hospital”, “pediatrics” and “family”.
Inclusion criteria were publications that address the care practice of occupational therapists in the pediatric ward with hospitalized pediatric patients and/or their families, in Portuguese, Spanish and English; including original publications, current topics, analysis of practice, and experience reports; available in full, in journals that adopt peer review. Other types of publications were excluded due to the feasibility of constructing the study (Mendes et al., 2008), including books, book chapters, course completion works, dissertations, theses, editorials, letters or reviews. The year of publication was not adopted as an exclusion criterion.
The results in the databases were exported to Rayyan® (Ouzzani et al., 2016), which allowed the selection of articles by two researchers (LRSS and RHVTJ), independently, based on reading the titles and abstracts. Articles that met the inclusion criteria were selected for complete reading and analysis of the material. The studies selected by manual search followed the same process of reading the title, abstract and full text. The final result was agreed by both researchers.
The articles were analyzed using the Content Analysis method, in the thematic modality (Gomes, 2007). The inductive coding process was carried out in the ATLAS.ti® software by the main researcher, adopting peer review (LRSS and RHVTJ) in the process of consolidating the emerging codes, for subsequent categorization, as a strategy to ensure the rigor of the analysis (Moreira, 2018).
Results
1,946 articles were found in the databases. Of these, PubMed had the largest number of publications (n=1,061), followed, respectively, by MEDLINE (n=727) and VHL (n=158), as explained in Table 1.
Number of publications found in the PubMed, MEDLINE and VHL databases, according to the search strategies.
Of the total of 1,946, 594 articles were subsequently excluded due to duplication. After reading the title and summary of 1352 publications, 13 were selected for full reading as they met the selection criteria. In the manual search, 23 articles were selected.
After selecting the publications in the databases and manual search, by title and abstract, ten were archived by reading the full text so as not to address the practices of occupational therapists, one was for full access, one was a literature review, and one does not meet the language requirements. The final review sample consisted of 23 articles (Table 2).
Table 1 shows that the studies in the sample were published between 1998 and 2023, with the highest publication peak in 2017 (n=4). Among them, there is a greater number of publications in the journal Cadernos Brasileiros de Terapia Ocupacional (n=11), in the Brazilian Portuguese language. It is noteworthy that the studies were categorized thematically, 19 address intervention, 14 intervention resources, 10 present an overview of care and 10 the humanization of care for family companions.
Next, the thematic categories will be presented.
Intervention
In the pediatric ward, occupational therapists carry out various actions together with other health professionals who assist patients and their companions through multidisciplinary care, such as group activities, guidance and team meetings (Joaquim et al., 2017). Furthermore, occupational therapists are contacted by the team through inter-consultation requests (Galheigo & Angeli, 2008; Pacciulio et al., 2011; Joaquim et al., 2017).
The study developed by Fonseca et al. (2015) points out that the child's assessment is carried out through clinical observation and interviews with parents, evaluating neuropsychomotor development. The interview with the mother was mentioned by Jacob et al. (2018), also evaluating the patient's home environment after hospital discharge.
Galheigo et al. (2017) indicate that patients' needs can be identified through direct observation, reading medical records and team meetings. In this sense, the patient's profile is evaluated, considering their interests, their history and that of their family, their experience with the disease/disability, the consequent impacts on their occupations, and the types of support needed or available. Play, the illness and hospitalization process, diagnosis and prognosis, the available support network, the patient's understanding of their condition and the need for referrals and guidance for discharge are also assessed (Galheigo et al., 2017).
Souza and Joaquim (2023) present an evaluation carried out with accompanying mothers. Possible demands are met through listening, without the use of systematized assessment instruments, in addition to the demands listed in the team meeting and through observation, during patient care.
It is noteworthy that in this field of activity the focus is not the patient's pathology, but what results from hospitalization (Freitas & Agostini, 2019). The objectives are to prevent delay and/or promote neuropsychomotor development (Giardinetto et al., 2009; Pacciulio et al., 2011; Fonseca et al., 2015; Vieira & Cazeiro, 2017; Freitas & Agostini, 2019; Maia et al., 2022); prescribing assistive technology devices (Jacob et al., 2018; Freitas & Agostini, 2019); assist the patient in empowering and accepting treatment (Giardinetto et al., 2009; Joaquim et al., 2010; Freitas & Agostini, 2019; Maia et al., 2022), rescuing everyday life (Ribeiro et al., 2008), give new meaning to daily life in the hospital (Maia et al., 2022), facilitate social participation (Galheigo & Angeli 2008; Maia et al., 2022), promote health, independence (Maia et al., 2022), assist in promoting ambience (Galheigo & Angeli, 2008) and promoting engagement in occupations (Freitas & Agostini, 2019).
With accompanying mothers, objectives can be aimed at them, such as: developing strategies to cope with hospitalization, mediating the relationship between companions and health professionals, promoting social participation in the hospital, reception, minimizing the impacts of hospitalization on the family relationship and planning of the future. The objectives may include the relationship between the mother-child binomial: guide and equip the caregiver to facilitate neuropsychomotor development, enable the mother to care for the patient during hospitalization, empower the understanding of health condition factors, developmental milestones and of the child’s treatment (Souza & Joaquim, 2023). Assisting in care and guiding parents was also mentioned by Freitas & Agostini (2019).
In pediatric oncology, objectives may include motor rehabilitation, training in activities of daily living, cognitive and perceptual functions, using energy conservation techniques and orthotic devices, promoting neuropsychomotor development, providing educational support and stimulation (tactile , visual, sound), stimulate the dyad's bond, promote play, welcome the family, facilitate playful and expressive activities, provide leisure in the hospital, promote the bond between patients, adapt the environment, promote self-esteem and guide the family (Lima & Almohalha, 2011).
As theoretical references for practice, professionals use models, methods, approaches and techniques. Among the models, the Human Occupation Model (Lima & Almohalha, 2011; Souza & Joaquim, 2023), the Playful Model (Lima & Almohalha, 2011) and the Canadian Model of Occupational Performance (Souza & Joaquim, 2023) were mentioned; the Dynamic Occupational Therapy Method (Joaquim et al., 2017; Souza & Joaquim, 2023); Among the approaches, Ayres' Sensory Integration (Lima & Almohalha, 2011; Joaquim et al., 2017), Client-Centered Practice (Souza & Joaquim, 2023), biomechanics and compensatory (Lima & Almohalha, 2011). A diversity of knowledge is necessary for intervention in this field, which includes: child development, child hospitalization, palliative care, maternal and child health, humanization of care (Souza & Joaquim, 2023) and hospital occupational therapy (Joaquim et al., 2017). However, there are occupational therapists who do not use a specific framework (Lima & Almohalha, 2011; Joaquim et al., 2017; Souza & Joaquim, 2023).
Regarding the results of the interventions, playing has been shown to improve patients' mood, motivation for activity and advancement in playful and social behavior. There were also improvements in the expression of feelings (Rodrigues & Albuquerque, 2020); gains in motor and cognitive aspects (Pacciulio et al., 2011; Panceri et al., 2017; Jacob et al., 2018); in addition to differences in playing and socialization (Fontes et al., 2010). Playing in occupational therapy with children with cancer enabled the reduction of pain, fatigue and anxiety, providing greater participation in playful activities (Mohammadi et al., 2017).
The research with health professionals developed by Giardinetto et al. (2009) demonstrated that they observe that occupational therapy activities promote improvements in children's mood, understanding and adherence to treatment, reduced stress and loss of fear of the hospital. The story box was used with children, helping to cope with hospitalization, facilitating the performance of procedures related to treatment and creating a positive change in the perspective of hospital admission (Garcia et al., 2012). The intervention with the story box provided improvements in the children's emotional state (Garcia-Schinzari et al., 2014). Reduction in anxiety, increase in socialization with other patients and rescue of daily life during hospitalization were observed. For parents, improvements were noted in rest and bonding with the child (Joaquim et al., 2010).
Regarding the benefits for companions, occupational therapists observe that their assistance helps in organizing routine, care and adaptation during the children's hospitalization period (Souza & Joaquim, 2023). Furthermore, they contribute to improving the relationship with professionals in the sector (Giardinetto et al., 2009; Souza & Joaquim, 2023), strengthening the bond between the mother-child dyad, participation in the child's treatment and in the elaboration of grief (Souza & Joaquim, 2023) and better understanding of the child's treatment (Giardinetto et al., 2009; Fonseca et al., 2015).
Intervention resources
Studies on the practices of occupational therapists characterize or recommend resources for interventions with patients or their companions. For patients, they mention: puzzles, dominoes, tic-tac-toe on the board, memory games, plastic instruments, among others (Vieira & Cazeiro, 2017); story books, reasoning games, basting, marbles, modeling clay (Rodrigues & Albuquerque, 2020); graphic materials (cutting, painting and collage), puppets and games (Giardinetto et al., 2009); paints, stamps, paper materials, colored pencils, puzzles, magazines, toilet paper rolls, modeling clay, puppets (Joaquim et al., 2010); rattles (Pacciulio et al., 2011); puzzles, memory games, books, plastic toys (Maia et al., 2022); doll and hospital materials to dramatize hospital treatment procedures (Fontes et al., 2010); materials (graphic and craft), games, toys and resources (media and electronic) (Joaquim et al., 2017). For companions, graphic, craft or reading materials, hygiene products, guidance booklets on child development, games and electronic equipment are used. Regarding resources for companions, the authors emphasize that the materials used in these services are, for the most part, acquired for pediatric care (Souza & Joaquim, 2023).
In addition, professionals develop resources for use in practices in the pediatric ward. Among them, a designed table, made by the institution's carpentry shop, with inclination at different levels, to help carry out activities in bed (Ribeiro et al., 2008). For accompanying caregivers, illustrated guides were created to provide early intervention during hospitalization (Oliveira et al., 2022).
The study conducted by Silva et al. (2020) shows that professionals needed to modify their interventions during the COVID-19 pandemic, starting to use exclusively disposable materials, aiming to avoid contamination of patients. The creation of playful resources was recommended, such as educational material with guidelines for companions to carry out with children on hand hygiene. Maia et al. (2022) illustrated some playful resources developed for patients. Silva et al. (2020) recommended creating materials for companions that could promote mental health, such as mandalas for coloring. Another material was intended to provide guidance on routine care upon discharge from hospital for home isolation.
Assistive technology resources in the hospital context are used to promote functionality and carry out expressive activities with E.V.A. resources. (Ribeiro et al., 2008; Jacob et al., 2018), and to facilitate patient communication with the communication boards. Another feature to promote functionality is the elastic band to assist in using the conventional mouse, in addition to the handmade actuator on the back of the wheelchair for playful activities. Furthermore, to facilitate activities of daily living, thickened cutlery and a wheelchair were prescribed for home use after discharge. The home visit facilitated the adjustment of the adult commode chair and adaptation of the spoon with thickener (Jacob et al., 2018).
In analyzing materials for games and games in the hospital context, Vieira & Cazeiro (2017) made a series of recommendations for the hygiene of resources: that the materials be plasticized; if they are made with cardboard or objects with holes or difficult to clean, they must be given for the patient's exclusive use or discarded. Among the recommendations, there was washing plastic or acrylic objects, using soap and water, after drying, rubbing cotton with 70% alcohol three times. Resources such as pens, plastic materials and clipboards must be sanitized in the same way.
During the COVID-19 pandemic, many materials for carrying out interventions could not be used to avoid the risk of contamination of patients, limiting resource possibilities. One of the biosafety measures adopted was the use of printed designs, stored for more than 72 hours in plastic bags, to avoid contamination by the virus. It should be noted that the child's age and preference were considered when delivering the material. Furthermore, the material had to be handled with clean hands, it was accompanied by a box with colored pencils, which was discarded when the patient was discharged (Maia et al., 2022).
Overview of services
Regarding care locations, most studies mention interventions at the patient's bed (Joaquim et al., 2010; Pacciulio et al., 2011; Panceri et al., 2017; Maia et al., 2022). Other locations are: ward spaces, common areas and ward corridors (Rodrigues & Albuquerque, 2020); recreation room (Panceri et al., 2017); internal spaces and cafeterias (Pacciulio et al., 2011); lecture room (Maia et al., 2022); common area (Galheigo & Angeli, 2008; Maia et al., 2022) and toy library (Galheigo & Angeli, 2008; Joaquim et al., 2017). In addition to the pediatric ward, there is the patient's home environment, highlighting home monitoring as continuity of care (Jacob et al., 2018). The ward spaces are also used for care for accompanying mothers, which can be carried out in the playroom, hospital classroom, companions' room or external area of the hospital (Souza & Joaquim, 2023).
Studies state that care for pediatric patients is provided daily (Panceri et al., 2017; Joaquim et al., 2017; Rodrigues & Albuquerque, 2020), as well as for companions (Joaquim et al., 2017; Souza & Joaquim, 2023). However, there are weekly sessions (Giardinetto et al., 2009; Joaquim et al., 2010; Pacciulio et al., 2011), which can be carried out individually or in groups (Rossit & Kovács, 1998; Galheigo & Angeli, 2008; Joaquim et al., 2010; Joaquim et al., 2017).
Humanization and Family care
Parents/family members are targets of interventions in pediatric oncology, with mothers mainly being mentioned (Joaquim et al., 2017). They participate in group activities to promote: improving self-esteem, minimizing the impacts of hospitalization, sharing experiences, reducing anguish and improving the relationship between the mother-child dyad. Among the activities, the following were mentioned: expressive, self-care, artistic and cultural (Giardinetto et al., 2009). Sharing experiences and expressing feelings arising from hospitalization was something worked on in groups with companions, mostly mothers. Furthermore, in individual care, it was reported that the mental health improvement provider offered activities to a mother in order to restore her daily life (Ribeiro et al., 2008). From the perspective of baby care, in the Ninar project – part of the ACCALANTO extension project –, activities were developed to strengthen the bond and development of the child, life management and access to the support network; Workshops were held to exchange information, use nursery rhymes and games, make objects and toys (Galheigo & Angeli, 2008).
Another activity with the companions is demonstrations of handling techniques to assist in the instrumentation of care (Souza & Joaquim, 2023). In addition, guidelines are provided for providing sensory and motor stimulation to the child (Pacciulio et al., 2011). Guidance for parents was provided to form a family support network (Fonseca et al., 2015), but, given the child's hospital discharge and COVID-19, interventions aim to monitor development and health education (Maia et al., 2022).
During the pandemic, occupational therapists participated in humanization strategies at the hospital. Among the actions, family support was mentioned through teleservice/telemonitoring, offered in cases of confirmed or suspected diagnosis of COVID-19 in hospitalized patients (Silva et al., 2020). Foster care has already been mentioned previously during this period (Lima & Almohalha, 2011).
Discussion
The sample studies are similar to the results found in the review by Santos & De Carlo (2013) on occupational therapy in the hospital field, pointing to a greater number of publications in the Portuguese language and in professional journals. Another review on the subject highlights a significant growth in productions in the area, being correlated with the increase in undergraduate courses at public universities, postgraduate programs in occupational therapy and related areas, and multi-professional residency programs in health (Ferreira et al., 2022).
In relation to the evaluation, the subjects involved – patient and companion – and the aspects investigated, such as neuropsychomotor development, the support network, the patient's interests, the history of the illness, occupational performance, data from medical records and meetings of the team, corroborate the recommendations made by Kudo et al. (2018) on the role of occupational therapy in the pediatric ward.
Standardized tests complement the evaluation process, which can help verify the patient's eligibility for the intervention, monitor progress and define the appropriate method (Mancini et al., 2020). Study by Mazak et al. (2021) on systematized instruments created by occupational therapists for child and adolescent care in Brazil revealed that there are 15 instruments available, mostly for childhood. Since only one was developed in Brazilian territory, the authors recommend that instruments be developed that consider the social reality of Latin America and Brazil (Mazak et al., 2021). Therefore, it is important that standardized, quickly applicable tests are developed for the hospital context, helping occupational therapists to evaluate their clients during the intervention process and responding to the specificity of the field.
Regarding the objectives with the pediatric patient, it is highlighted that they must be punctual, prioritizing short and medium-term goals, due to the patient's clinical instability and the dynamics of the hospital. One of the ways to achieve this is through reframing everyday life (Kudo et al., 2018).
The objectives outlined for care for accompanying mothers are similar to those presented in pediatric and neonatal intensive care units (Joaquim et al., 2014; Silva et al., 2015; Joaquim et al., 2016). Mendonça (2018) points out the repercussions on mothers resulting from accompanying their child during hospitalization, mentioning tiredness and sadness. In this way, the importance of occupational therapists in assisting companions is observed, helping with the demands inherent to child hospitalization, especially with regard to the process of adapting the hospital routine, instrumentalizing care and promoting development.
The study by Goldstein (2013) states that the occupational therapist must train parents of premature babies, identifying the important aspects for them and how they can play an active role in the care. From this perspective, the role of the therapist in working with the caregiver and having as objectives the relationship between him and the hospitalized child is reaffirmed, pointing out that the incorporation of family-centered care makes it possible to guide and encourage them to learn and perform appropriate care for the child, highlighting that developing a practice focused on the caregiver leads the family to feel included and empowered in the treatment (Dirks & Hadders-Algra, 2011; Levin et al., 2015).
In relation to work in pediatric oncology, it is necessary to consider that this illness process may require the foundations of palliative care. In this sense, intervention must be based on the production of life projects and preparation for death. Furthermore, in the face of the patient's death, the professional must be part of the team that will monitor the family's grieving process, in view of the consequences of mourning in occupations (Bombarda et al., 2022).
Regarding occupational therapy models, despite studies citing the use of the Human Occupation Model and the Canadian Model of Occupational Performance, in addition to the use of other Models and references, Cruz (2018) assumes that the use of existing models in the profession is not a reality in Brazil, a note that converges with the data that indicate that there are professionals who do not use a certain reference in practice.
Study by Alves et al. (2016) reaffirms playing as a way of expression, an occupation in which the child will verbalize their pain, traumas and fears, and which will enable them to feel welcomed and confident with the treatment. In line with the findings related to the advancement in social and cognitive behavior through playing, the authors point out that the practice of playing brings benefits to the patient's social and psychological development, adding that it is important for their clinical development and a way of helping help her to better understand her real situation during hospitalization. In this direction, Barcelos et al. (2012) indicate playing as a possible therapeutic resource, in order to promote learning through interaction between the professional and the child in the pediatric ward, during the tasks proposed in an intervention.
In addition to the resources used for companions, Silva et al. (2018) exemplify the beauty salon within the hospital space for mothers of babies admitted to the NICU as a powerful resource, which allows them to carry out their daily activities, enabling the maintenance of self-care and socialization. In this sense, there is a need to allocate interventions aimed at caregivers, in order to promote opportunities for self-care, exchanges with other companions and professionals regarding hospitalization, as well as other content that goes beyond the hospital dimension and that enable minimize the anxieties present in this context.
It is observed, as pointed out in this review, that, during the COVID-19 pandemic, occupational therapy services underwent changes, including in these changes the resources that were used in interventions. The reports presented by Joaquim et al. (2023) show that professionals felt limited in the pandemic scenario, needing to intensify the hygiene of materials, follow the guidelines received and select available materials. It is possible to observe the care taken to avoid contamination of patients, through the resources used in interventions, and, consequently, the proliferation of a disease that caused a significant mortality rate in Brazil and around the world.
Assistive technology was conceptualized in Brazil by the Technical Aid Committee (CAT) as an “area of knowledge, with an interdisciplinary characteristic, which encompasses products, resources, methodologies, strategies, practices and services that aim to promote functionality, [...] autonomy, independence, quality of life and social inclusion” (Brasil, 2007a, b). In the hospital context, its use has aimed to promote the health and occupational quality of life of hospitalized patients (Pelosi & Gomes, 2018).
According to Vieira et al. (2023), hospitalized children present changes in several areas of occupation, including: playing, activities of daily living, instrumental activities of daily living, leisure and education. Among the demands raised by caregivers for assistive technology are: hand positioning orthoses, wheelchair, augmentative and alternative communication devices, and wheelchair adaptation; similar to those used in the practices of occupational therapists, obtained as a result of the review study. The authors emphasize that, although the pediatric hospital environment routinely serves chronically ill children and those with disabilities, biomedical logic becomes a barrier in the assessment of functionality, making the needs in the area of assistive technology unfeasible (Vieira et al., 2023), and, consequently, it may limit intervention.
The results of the review indicate that occupational therapists use a variety of spaces in the pediatric ward and hospital institution to carry out the intervention with the patient and/or their accompanying family member. Such locations are similar to those found by Leôncio et al. (2022).
The toy library is a mandatory environment in pediatric hospitalization units, characterized as a “space provided with toys and educational games, designed to encourage children and their companions to play” (Brasil, 2005). The toy library environment provides children with an immersion in the playful universe, in addition to helping to distract them from aspects related to hospitalization, such as their clinical condition and the hospital context (Carvalho et al., 2020). However, although the toy library is guaranteed by Brazilian laws and is an important space for promoting play and interventions in the hospital environment, it is observed, through the actions of occupational therapists, that other spaces in the institution have potential for the development of therapeutic interventions.
Group care, in hospital contexts, is described in other studies, aimed mainly at companions (Dittz et al., 2006; Dahdah et al., 2013; Silva et al., 2015). In this context, the group can assist in exchanging experiences, providing guidance on the patient's clinical condition, helping to organize the extra-hospital routine, expanding the support network and providing a space for self-care in the hospital environment (Silva et al., 2015).
According to Aniceto & Bombarda (2020), providing assistance to companions in the hospital context encourages the importance of comprehensive care and recognizes that these individuals have demands that require the attention of a healthcare team. Thus, when considering the singularities of the subjects, which permeates the expanded clinic, the professional is aligned with the guidelines of the National Humanization Policy (PNH) (Aniceto & Bombarda, 2020; Brasil, 2013).
Reception is also based on the PNH guidelines, and is carried out with qualified listening to the needs of the subjects (Brasil, 2013). Remote care, whether for the patient or family members, via phone call or video call, corroborates the national and international guidelines proposed for occupational therapy assistance during the COVID-19 pandemic period (Cabrejo et al., 2020; De-Carlo et al., 2020). In this sense, occupational therapists included family members of infected patients in interventions.
Final Considerations
The results of the review show how the occupational therapist's practices occur and what they are in the pediatric ward, highlighting the locations and modalities in which care is provided; the aspects that are considered in the assessment of the patient and their companion; the objectives of the interventions; the theoretical foundations that support practices in the pediatric ward; and the resources used. They also provide a brief overview of practices during the COVID-19 pandemic, demonstrating the changes in assistance resources and services that were offered in the Brazilian context.
Regarding the limitations of the study, the small number of publications in other languages that met the selection criteria for the present study is highlighted. Based on the criteria adopted, the results found pointed to foreign studies in the hospital context with outpatient practices and, therefore, were not added to the sample. Given this, it can be assumed that the practices of occupational therapists in pediatric wards present a panorama of interventions that respond to the needs of the Brazilian population.
Therefore, the results found can demonstrate the relevance of occupational therapy in the pediatric ward, guide new studies on practices, as well as assist professionals in providing care, providing care consistent with the profession's guidelines.
-
How to cite: Souza, L. R. S., Rodrigues, L. C., Silva, V. N., & Joaquim, R. H. V. T. (2024). The practices of occupational therapists in the pediatric ward: an integrative review. Cadernos Brasileiros de Terapia Ocupacional, 32, e3718. https://doi.org/10.1590/2526-8910.ctoAR286037182
-
Funding Source
The research was funded by the Coordination for the Improvement of Higher Education Personnel (CAPES) – Code 001.
References
- Almeida, C. R. V., Leite, I. C. O., Ferreira, C. B., & Corrêa, V. A. C. (2016). Sobre o cotidiano no contexto do adoecimento e da hospitalização: o que dizem as mães acompanhantes de crianças com diagnóstico de neoplasia?Cadernos Brasileiros de Terapia Ocupacional, 24(2), 247-259.
- Alves, J. F., Lima, M. D. O., Ribeiro, R. M., Camargos, M. C. S., & Silva, K. R. (2016). Promoção do Brincar: ação de gestão estratégica no enfrentamento da hospitalização infantil. Gerais (Universidade Federal de Juiz de Fora), 4(1), 89-100.
- Angeli, A. A. C., Luvizaro, N. A., & Galheigo, S. M. (2012). O cotidiano, o lúdico e as redes relacionais: a artesania do cuidar em terapia ocupacional no hospital. Interface: a Journal for and About Social Movements, 16(40), 261-271.
- Aniceto, B., & Bombarda, T. B. (2020). Cuidado humanizado e as práticas do terapeuta ocupacional no hospital: uma revisão integrativa da literatura. Cadernos Brasileiros de Terapia Ocupacional, 28(2), 640-660.
- Barcelos, T. A., Fonseca, C. F. S., Muniz, L. C., & Coelho, Z. A. C. (2012). Atuação da terapia ocupacional em hospital pediátrico. Revista Médica de Minas Gerais, 22(Supl 2), 88-91.
- Bombarda, T. B., Ferreira, E. A. L., & Joaquim, R. G. V. T. (2022). Cuidados paliativos pediátricos. In M. O. Figueiredo (Orgs.), Terapia Ocupacional no Ciclo de Vida da Infância: histórico, proposições atuais e perspectivas futuras (pp. 223-241). São Paulo: Memnon.
- Brasil. (2005). Lei nº. 11.104, de 21 de março de 2005. Dispõe sobre a obrigatoriedade de instalação de brinquedotecas nas unidades de saúde que ofereçam atendimento pediátrico em regime de internação. Diário Oficial [da] República Federativa do Brasil, Brasília.
- Brasil. (2007a). Resolução nº 324, de 25 de abril de 2007. Dispõe sobre a atuação do terapeuta ocupacional na brinquedoteca e outros serviços inerentes, e o uso dos recursos terapêutico-ocupacionais do brincar e da brinquedoteca e dá outras providências. Diário Oficial [da] República Federativa do Brasil, Brasília.
-
Brasil. Secretaria Especial dos Direitos Humanos. Coordenadoria Nacional para Integração da Pessoa Portadora de Deficiência. (2007b). Ata. VII Reunião do comitê de ajudas técnicas– CAT CORDE/SEDH, PR Brasília: Secretaria Especial dos Direitos Humanos. Recuperado em 5 de outubro de 2023, de https://www.assistiva.com.br/Ata_VII_Reuni%C3%A3o_do_Comite_de_Ajudas_T%C3%A9cnicas.pdf
» https://www.assistiva.com.br/Ata_VII_Reuni%C3%A3o_do_Comite_de_Ajudas_T%C3%A9cnicas.pdf -
Brasil. (2013). Política Nacional de Humanização. Recuperado em 5 de outubro de 2023, de https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_humanizacao_pnh_folheto.pdf
» https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_humanizacao_pnh_folheto.pdf - Cabrejo, P. T., Guacaneme-García, F., Montufar-Dulce, R., Rubio-Grillo, M. H., León-Perilla, V., Beltrán, L., & Duarte-Torres, S. (2020). Lineamientos del colegio colombiano de terapia ocupacional para la atención hospitalaria aguda y subaguda de pacientes con COVID-19. Revista Ocupación Humana, 20(1), 124-145.
- Carvalho, E. O., Lima, L. N., Melo, M. C., Beckmann, L. M. M., & Silva, V. B. (2020). Experiência da criança sobre a hospitalização: abordagem da sociologia da infância. Cogitare Enfermagem, 25, e71321.
- Cruz, D. M. C. (2018). Os modelos de Terapia Ocupacional e as possibilidades para a prática e pesquisa no Brasil. Revista Interinstitucional Brasileira de Terapia Ocupacional, 2(3), 504-517.
- Dahdah, D. F., Carvalho, A. M. P., Delsim, J. C., Gomes, B. R., & Miguel, V. P. (2013). Grupo de familiares acompanhantes de pacientes hospitalizados: estratégia de intervenção da Terapia Ocupacional em um hospital geral. Cadernos de Terapia Ocupacional da UFSCar, 21(2), 399-404.
- De-Carlo, M. M. R. P., Gomes-Ferraz, C. A., Rezende, G., Buin, L., Moreira, D. J. A., Souza, K. L., Sacramento, A. M., Santos, W. A., Mendes, P. V. B., & Vendrusculo-Fangel, L. M. (2020). Diretrizes para a assistência da terapia ocupacional na pandemia da COVID-19 e perspectivas pós-pandemia. Medicina (Ribeirão Preto),53(3), 332-369.
- Dirks, T., & Hadders-Algra, M. (2011). The role of the family in intervention of infants at high risk of cerebral palsy: a systematic analysis. Developmental Medicine and Child Neurology, 53(4), 62-67.
- Dittz, E. S., Melo, D. C. C., & Pinheiro, Z. M. M. (2006). A terapia ocupacional no contexto da assistência à mãe e à família de recém-nascidos internados em unidade de terapia intensiva. Revista de Terapia Ocupacional da Universidade de São Paulo, 17(1), 42-47.
- Ferreira, G. P., Arthur, M. A., & Galheigo, S. M. (2022). Caracterização da produção brasileira em terapia ocupacional e contextos hospitalares de 2006 e 2019: um estudo de dois periódicos nacionais. Revista de Terapia Ocupacional da Universidade de São Paulo, 32(1-3), 1-8.
- Fonseca, C. F. S., Barcelos, T. A., Muniz, L. C., & Coelho, Z. (2015). Terapia ocupacional em criança hospitalizada com desnutrição grave e atraso no desenvolvimento neuropsicomotor: relato de caso. Revista Médica de Minas Gerais, 25(1), 120-123.
- Fontes, C. M. B., Mondini, C. C. S. D., Moraes, M. C. A. F., Bachega, M. I., & Maximino, N. P. (2010). Utilização do brinquedo terapêutico na atenção à criança hospitalizada. Revista Brasileira de Educação Especial, 16(1), 95-106.
- Freitas, T. B., & Agostini, O. S. (2019). Impactos da hospitalização parcial recorrente sob a perspectiva de crianças e adolescentes com mucopolissacaridoses em um hospital pediátrico. Cadernos Brasileiros de Terapia Ocupacional, 27(3), 564-573.
- Galheigo, S. M. (2008). Terapia ocupacional, a produção do cuidado. Revista de Terapia Ocupacional da Universidade de São Paulo, 19(1), 20-28.
- Galheigo, S. M., & Angeli, A. A. C. (2008). Terapia Ocupacional e o cuidado integral à saúde de crianças e adolescentes: a construção do Projeto ACCALANTO. Revista de Terapia Ocupacional da Universidade de São Paulo, 19(3), 137-143.
- Galheigo, S. M., & Antunes, J. R. (2008). A caracterização da produção bibliográfica nas práticas hospitalares em terapia ocupacional no Brasil: uma revisão da literatura de 1990 a 2007. Revista de Terapia Ocupacional da Universidade de São Paulo, 19(2), 91-99.
- Galheigo, S. M., Braga, C. P., Mieto, F. S. R., Parreira, F. V., Sarmento, G. Q., Motta, M., Silva, M. C. A., Santos, M. F., Spinola, P. F., Serpa, R. B. L., Mitre, R. M. A., Lagôa, T. R. O., Oliveira, T. A., Santos, W. A., Magalhães, L., & Kinsella, E. A. (2017). Exchanging knowledge within a community of practice: toward an epistemology of practice in Occupational Therapy paediatric hospital care. Cadernos Brasileiros de Terapia Ocupacional, 25(3), 449-459.
- Garcia, N. R., Pfeifer, L. I., & Pinto, P. P. (2012). As caixas de histórias na visão de profissionais de saúde como estratégia de enfrentamento da hospitalização infantil. Revista de Terapia Ocupacional da Universidade de São Paulo, 23(2), 169-177.
- Garcia-Schinzari, N. R. S., Pfeifer, L. I., Sposito, A. M. P., Santos, J. L. F., Nascimento, L. C., & Pinto, M. P. P. (2014). Caixas de histórias como estratégia auxiliar do enfrentamento da hospitalização de crianças e adolescentes com câncer. Cadernos de Terapia Ocupacional da UFSCar, 22(3), 569-577.
- Giardinetto, A. R. S. B., Martini, E. C., Cruz, J. A., Moni, L. O., Ruiz, L. M., Rodrigues, P., & Pereira, T. (2009). A importância da atuação da terapia ocupacional com a população infantil hospitalizada: a visão dos profissionais da área da saúde. Cadernos de Terapia Ocupacional da UFSCar, 17(1), 63-69.
- Goldstein, L. A. (2013). Family support and education. Physical & Occupational Therapy in Pediatrics, 33(1), 139-161.
- Gomes, R. (2007). Análise e interpretação de dados de pesquisa qualitativa. In M. C. S. Minayo (Org.), Pesquisa social: Teoria, método e criatividade (pp. 79-108) Petrópolis: Vozes.
- Jacob, L. R., Maia, F. N., & Mitre, R. M. A. (2018). Tecnologia assistiva no ambiente hospitalar: uma análise da prática. Revista Interinstitucional Brasileira de Terapia Ocupacional, 2(2), 468-480.
- Joaquim, R. H. V. T., Albuquerque, I., Cunha, T. T., Paez, L., & Takeda, B. (2010). A proposta e a implantação de um projeto de extensão: resgate do cotidiano de jogos e brincadeiras em uma enfermaria pediátrica. Cadernos de Terapia Ocupacional da UFSCar, 18(2), 191-198.
- Joaquim, R. H. V. T., El-Khatib, U., & Barba, P. C. S. D. (2016). A integração do processo ensino e aprendizagem de alunas de Terapia Ocupacional e o cuidado de mães de bebês de risco na hospitalização. Cadernos de Terapia Ocupacional da UFSCar, 24(2), 397-402.
- Joaquim, R. H. V. T., Silvestrini, M. S., & Marini, B. P. R. (2014). Grupo de mães de bebês prematuros hospitalizados: experiência de intervenção de Terapia Ocupacional no contexto hospitalar. Cadernos de Terapia Ocupacional da UFSCar, 22(1), 145-150.
- Joaquim, R. H. V. T., Soares, F. B., Figueiredo, M. O., & Brito, C. M. D. (2017). Terapia ocupacional e oncologia pediátrica: caracterização dos profissionais em centros de referência no Estado de São Paulo. Revista de Terapia Ocupacional da Universidade de São Paulo, 28(1), 36-45.
- Joaquim, R. H. V. T., Souza, L. R. S., Sousa, D. F., Beltrame, V. H., Buin, L., & Moraes, A. B. (2023). Aspectos da atuação do terapeuta ocupacional no contexto hospitalar no primeiro ano da pandemia de COVID-19. Cadernos Brasileiros de Terapia Ocupacional, 31, 1-15.
- Kudo, A. M., Barros, P. B. M., & Joaquim, R. H. V. T. (2018). Terapia Ocupacional em Enfermaria Pediátrica e Brinquedoteca Hospitalar. In M. M. R. De Carlo, & A. M. Kudo (Orgs.), Terapia Ocupacional em Contextos Hospitalares e Cuidados Paliativos (pp. 127-143). São Paulo: Editora Payá.
- Leôncio, J. S. M., Silva, M. V. C. F., Agostini, O. S., Souza, L. R. S., & Araújo, C. R. S. A. (2022). A perspectiva de crianças e adolescentes sobre brincar durante a hospitalização. Revista Interinstitucional Brasileira de Terapia Ocupacional, 6(4), 1295-1307.
- Levin, A. B., Fisher, K. R., Cato, K. D., Zurca, A. D., & October, T. W. (2015). An evaluation of family-cen tered rounds in the PICU: room for improvement suggested by families and providers. Pediatric Critical Care Medicine, 16(9), 801-807.
- Lima, M. S., & Almohalha, L. (2011). Desvelando o papel do terapeuta ocupacional na oncologia pediátrica em contextos hospitalares. Revista de Terapia Ocupacional da Universidade de São Paulo, 22(2), 172-181.
- Lino, T. B., Jacob, L. R., & Galheigo, S. M. (2021). O adoecimento crônico e o tratamento pelo olhar do adolescente: considerações com base em uma história de vida. Cadernos Brasileiros de Terapia Ocupacional, 29, 1-16.
- Maia, J. T. M., Folha, D. R. S. C., Maciel, M. L., Aita, K. M. S. C., & Corrêa, V. A. C. (2022). Terapia ocupacional em uma clínica pediátrica cardiológica durante a pandemia de COVID-19: relato da experiência de uma residente. Cadernos Brasileiros de Terapia Ocupacional,30, 1-13.
- Mancini, M. C., Pfeifer, L. I., & Brandão, M. B. (2020).Processo de avaliação de Terapia Ocupacional. In L. I. Pfeifer & M. M. M. Sant’Anna (Orgs.), Terapia Ocupacional na Infância: procedimentos na prática clínica (pp. 25-40). São Paulo: Memnon.
- Mazak, M. S. R., Fernandes, A. D. S. A., Lourenço, G. F., & Cid, M. F. B. (2021). Instrumentos de avaliação da terapia ocupacional para crianças e adolescentes no Brasil: uma revisão da literatura. Cadernos Brasileiros de Terapia Ocupacional, 29, 1-21.
- Mendes, K. D. S., Silveira, R. C. C. P., & Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto Enfermagem, 17(4), 758-764.
- Mendonça, C. R. L. F. (2018). Sobre ocupar-se de cuidar do filho no hospital. Revista de Terapia Ocupacional da Universidade de São Paulo, 29(3), 263-269.
- Mohammadi, A., Mehraban, A. H., & Damavandi, S. A. (2017). Effect of play‑based occupational therapy on symptoms of hospitalized children with cancer: a single‑subject study. Asia-Pacific Journal of Oncology Nursing, 4(2), 168-172.
- Moreira, H. (2018). Critérios e estratégias para garantir o rigor na pesquisa qualitativa. Revista Brasileira de Ensino de Ciência e Tecnologia, 11(1), 405-424.
- Oliveira, M. L. V. M., Hirosue, D. Y., Paulino, V. U., Werneck, A. L., Castioglini, L., & Bianchin, M. A. (2022). Guia de intervenção precoce como recurso terapêutico ocupacional para cuidadores de crianças hospitalizadas. Revista Interinstitucional Brasileira de Terapia Ocupacional,6(2), 909-921.
- Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan: a web and mobile app for systematic reviews. Systematic Reviews, 5(210), 1-10.
- Pacciulio, A. M., Carvalho, T. S. E., & Pfeifer, L. I. (2011). Atuação terapêutica ocupacional visando à promoção do desenvolvimento de uma criança em internação prolongada: um estudo de caso. Cadernos de Terapia Ocupacional da UFSCar, 19(1), 93-99.
- Panceri, C., Pereira, K. R. G., & Valentini, N. C. (2017). A intervenção motora como fator de prevenção de atrasos no desenvolvimento motor e cognitivo de bebês durante o período de internação hospitalar. Cadernos Brasileiros de Terapia Ocupacional, 25(3), 469-479.
- Pelosi, M. B., & Gomes, C. A. (2018). Tecnologia assistiva e terapia ocupacional no contexto hospitalar. In M. M. R De Carlo & A. M. Kudo (Orgs.), Terapia Ocupacional em Contextos Hospitalares e Cuidados Paliativos (pp. 103-126). São Paulo: Editora Payá.
- Ribeiro, M. B. S., Bernal, M., & Zaponi, E. P. G. (2008). Relato da experiência de aprimorandas do programa de terapia ocupacional em saúde mental numa enfermaria de pediatria. Cadernos de Terapia Ocupacional da UFSCar, 16(2), 113-121.
- Rodrigues, A. A., & Albuquerque, V. B. (2020). O brincar e o cuidar: o olhar do terapeuta ocupacional sobre o comportamento lúdico de crianças em internação prolongada. Revista Interinstitucional Brasileira de Terapia Ocupacional, 4(1), 27-42.
- Rossit, R. A., & Kovács, A. C. (1998). Intervenção essencial de terapia ocupacional em enfermaria pediátrica. Cadernos Brasileiros de Terapia Ocupacional, 7(2), 58-67.
- Santos, C. A. V., & De Carlo, M. M. R. P. (2013). Hospital como campo de práticas: revisão integrativa da literatura e a terapia ocupacional. Cadernos Brasileiros de Terapia Ocupacional, 21(1), 99-107.
- Silva, C. C., Silva, E. D., & Rocha, L. L. B. (2018). O salão de beleza como recurso no acompanhamento das mães de recém-nascidos internados na Unidade de Terapia Intensiva Neonatal. Cadernos Brasileiros de Terapia Ocupacional, 26(3), 569-579.
- Silva, F. R., Ballarin, M. L. G. S., & Oliveira, J. C. (2015). Grupo de acompanhantes de crianças internadas em Unidade de Terapia Intensiva. Cadernos de Terapia Ocupacional da UFSCar, 23(4), 871-877.
- Silva, M. R., Silva, P. C., Rabelo, H. D., & Vinhas, B. C. V. (2020). A Terapia Ocupacional pediátrica brasileira diante da pandemia da COVID-19: reformulando a prática profissional. Revista Interinstitucional Brasileira de Terapia Ocupacional, 4(3), 422-427.
- Simonato, M. P., Mitre, R. M. A., & Galheigo, S. M. (2019). O cotidiano hospitalar de crianças com hospitalizações prolongadas: entre tramas dos cuidados com o corpo e as mediações possíveis. Interface: a Journal for and About Social Movements, 23, 1-15.
- Souza, L. R. S. (2021). Intervenção de terapia ocupacional com mães acompanhantes na enfermaria pediátrica (Dissertação de mestrado). Universidade Federal de São Carlos, São Carlos.
- Souza, L. R. S., & Joaquim, R. H. V. T. (2023). A prática de terapeutas ocupacionais com mães acompanhantes em enfermarias pediátricas. Cadernos Brasileiros de Terapia Ocupacional, 31, 1-14.
- Vieira, D. K. O., Maia, F. N., Silva, J. V. N., Ribeiro, C. T. M., & Ferreira, H. S. (2023). Perfil das necessidades de tecnologia assistiva de pacientes pediátricos em hospital de alta complexidade: um estudo de caso. Revista Interinstitucional Brasileira de Terapia Ocupacional, 7(2), 1685-1699.
- Vieira, S. R., & Cazeiro, A. P. M. (2017). Análise de jogos e brincadeiras para o contexto hospitalar. Revista Interinstitucional Brasileira de Terapia Ocupacional, 1(2), 127-148.
Edited by
-
Section editor
Profa. Dra. Mariana Midori Sime
