• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Master's Dissertation
DOI
https://doi.org/10.11606/D.22.2023.tde-31082023-085224
Document
Author
Full name
Rosivalda Ferreira de Oliveira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2023
Supervisor
Committee
Laus, Ana Maria (President)
Menegueti, Mayra Gonçalves
Oliveira, Marília Pilotto de
Santana, Mary Elizabeth de
Title in Portuguese
Implantação de avaliação da dor em pacientes sedados sob ventilação mecânica em unidade de terapia intensiva
Keywords in Portuguese
Behavioral pain scale
Dor
Enfermagem
Manejo da dor
Unidade de terapia intensiva
Abstract in Portuguese
A dor é uma experiência subjetiva variando na sua forma e intensidade de pessoa para pessoa, que vem, ao longo dos anos, sendo um elemento subnotificado, não avaliado e subtratado na Unidade de Terapia Intensiva (UTI), principalmente, pelos pacientes estarem sedados. Dessa maneira, observa-se também a existência de várias escalas padronizadas, amplamente divulgadas e utilizadas para analisar prováveis sintomas de dor expressadas pela população sob efeito de sedativos e dependentes de ventilação mecânica em UTIs. O estudo foi desenvolvido junto a dois grupos de participantes: o primeiro grupo foi constituído pelos enfermeiros envolvidos na assistência direta ao paciente na unidade investigada, em todos os turnos de trabalho, com tempo de trabalho na unidade superior a três meses, que aceitarem participar da pesquisa e que se encontravam em atividade laboral no período de coleta de dados e o segundo grupo foi composto por pacientes internados que foram avaliados pelo instrumento proposto, durante o período de internação na UTI selecionada. Foram elegíveis os pacientes com idade superior a 18 anos, de ambos os sexos, que estavam sedados e inconscientes e sob ventilação mecânica, impossibilitados de verbalizar a percepção de dor, mediante consentimento de participação fornecido por responsável legal. A coleta de dados foi realizada no período de fevereiro a abril de 2023. Utilizou-se a Behavioral Pain Scale (BPS) , um instrumento observacional de avaliação da dor, composto por três domínios comportamentais: expressão facial, movimentos de membros superiores e conformidade com o ventilador mecânico. A amostra pesquisada, composta em sua maioria de profissionais do sexo do feminino (85%), com predominância na faixa etária de 36 a 40 (30%) e mesmo percentual acima de 45 anos. A idade média dos enfermeiros foi de 42,5 anos, com mediana de 39,5 anos. Observa-se ainda que houve discrepâncias nas avaliações em relação aos valores obtidos pelos enfermeiros, quando comparados com o enfermeiro padrão ouro da pesquisa, em alguns momentos de observação dos pacientes, o que indica a necessidade de ampliar as oportunidades de avaliação com objetivo de capacitar os enfermeiros para uso mais sistemático deste instrumento. O instrumento BPS mostrou-se de boa compreensão e utilização pelos enfermeiros participantes deste estudo, o que indica sua utilização dentro de uma boa perspectiva pelos profissionais atuantes em unidades de terapia intensiva. Deve-se destacar a relevância desta pesquisa, em razão de poucos estudos na literatura brasileira, quanto a utilização desta ferramenta pelos enfermeiros intensivistas, na direção de um cuidado de excelência aos pacientes críticos.
Title in English
Implementation of pain assessment in sedated patients under mechanical ventilation in an intensive care unit
Keywords in English
Behavioral pain scale
Intensive care unit
Nursing
Pain
Pain management
Abstract in English
Pain is a subjective experience varying in its form and intensity from person to person, which has, over the years, been an underreported, unassisted and undertreated element in the Intensive Care Unit (ICU), mainly because patients are sedated. Thus, it is also observed the existence of several standardized scales, widely disseminated and used to analyze probable pain symptoms expressed by the population under the effect of sedatives and dependent on mechanical ventilation in ICUs. This study aimed to describe the process of implantation of a validated instrument for pain assessment of sedated and unconscious patients under mechanical ventilation in an ICU. This is a cross-sectional and descriptive study, with a quantitative and qualitative approach. This investigation was carried out in the Intensive Care Center of a public hospital located in the municipality of Belém, Pará State, which meets the demand referred by the basic, outpatient and hospital network, allocating 100% of its installed capacity to SUS patients. The study was developed with two groups of participants: the first group consisted of nurses involved in direct patient care in the unit investigated, in all work shifts, with more than three months of work in the unit, who agreed to participate in the research and who were in work activity during the data collection period and the second group was composed of hospitalized patients who were evaluated by the proposed instrument, during the period of hospitalization in the selected ICU. Patients older than 18 years, of both sexes, who were sedated and unconscious and under mechanical ventilation, unable to verbalize the perception of pain, were eligible, with the consent of participation provided by a legal guardian. Data collection was conducted from February to April 2023. The Behavioral Pain Scale (BPS) was used, an observational pain assessment instrument composed of three behavioral domains: facial expression, upper limb movements and compliance with the mechanical ventilator. The sample surveyed, composed mostly of female professionals (85%), with predominance in the age group of 36 to 40 (30%) and the same percentage over 45 years. The mean age of the nurses was 42.5 years, with a median of 39.5 years. It is also observed that there were discrepancies in the evaluations in relation to the values obtained by the nurses, when compared with the nurse gold standard of the research, in some moments of observation of the patients, which indicates the need to expand the opportunities for evaluation in order to train the nurses for more systematic use of this instrument. The BPS instrument was shown to be well understood and used by the nurses participating in this study, which indicates its use from a good perspective by professionals working in intensive care units. The relevance of this research should be highlighted, due to few studies in the Brazilian literature, regarding the use of this tool by intensive care nurses, in the direction of excellent care for critically ill patients.
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Publishing Date
2023-09-15
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2024. All rights reserved.