Psicologia

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http://repositorio.ufes.br/handle/10/17534
Programa de Pós-Graduação em Psicologia

Centro: CCHN
Telefone: (27) 4009 2501
URL do programa: http://www.psicologia.ufes.br/pos-graduacao/PPGP

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    Avaliação da dor pediátrica e do pensamento de catastrofização no processo de hospitalização
    (Universidade Federal do Espírito Santo, 2017-08-24) Bacellar, Andreza Mourão Lopes; Paula, Kely Maria Pereira de; Loss, Alessandra Brunoro Motta; Guerra, Valeschka Martins; Ramos, Fabiana Pinheiro; Dias, Tatiane Lebre
    Pediatric pain is commonly present in hospital environments due to sickness and invasive procedures inherent to the hospitalization process. Health professionals are the ones responsible for properly measuring and managing this experience. In this process, it is also relevant to identify the presence of catastrophizing thoughts of pain that can hinder the way the patients deal with the sickness, the treatment or the pain. Therefore, this research had as general goal to analyze the relationship among pediatric pain and catastrophic thoughts with data sampled from four public hospitals of Greater Vitoria Area (in Espirito Santo State, Brazil), two of them being pediatric hospitals. This thesis is organized in three studies. Study 1 shows a description of the pediatric pain in terms of prevalence, epidemiology, evaluation and management according to the children/teenagers, their parents and the health professionals (Physicians and Nurses); in Study 2 the professionals’ perception about pain treatment and the repercussion of its experience in infant development was analyzed; lastly, in Study 3 the relationship between pain and catastrophizing thoughts of patients and their companions. The sample collected contains data of 253 patients (37 newborn, 94 infants, 54 pre-schoolers, 49 schoolers and 37 teenagers), 228 companions, 28 physicians and 67 professionals from the nursing team, evaluated by scripted interviews and data sampled from medical records, Faces Pain Scale-revised - FPS-R, Numerical Rating Scale – NRS, Body Map, Pain Catastrophizing Scale for Children - PCS-C, Pain Catastrophizing Scale for Parents – PCS-P. Descriptive and correlational statistics were adopted with the use of Chi-square test, combination of Kappa e Mcnemar, Pearson correlation, t test of independente samples, paired and linear regression, in addition to qualitative analysis of interview data. Study 1 pointed out that 66% of children/teenagers report moderate to intense pain in the last 24 hours of hospitalization. Family members identified pain in 41,2%, the nursing team in 33% and the physicians in 29,6%. Based on the perception of pain presence, it was found moderate concordance in patients with companions (kappa = 0,5), reasonable with physicians (kappa = 0,3) and low with nurses (kappa = 0,1). Patients and companion used more pain descriptors related to intensity, and professionals indicated more of the acute-procedural paint type. In most of the cases, the pain was evaluated and managed by the team, mainly with pharmacological treatment. In Study 2, it was identified that the majority of the professionals did not have specific training in the pain field but reported the importance in treating it due to its impact in the patients development; those with less experience consider that pain in a child is different from the pain in an adult, but those with more experience indicate they are equal. In study 3, high levels of pain catastrophization were found in pediatric patients (being greater for children than teenagers) and their companions. Intensity and pain catastrophization of the patients relate positively (r = 0,424). Age, companions’ rumination and duration of hospitalization were predictors of pain catastrophization. It was concluded that the patient sample examined felt pain during the evaluation period, which was managed mostly with pharmacological treatments, was accompanied by the strong presence of catastrophic thoughts related to age, pain experience and companions’ feelings. These data alert future studies that aim to properly control of pediatric pain, training of the health professional and programs that instrumentalize the pacient in the adaptive coping of stressful situations as pain and hospitalization. The study also contributes with researches that maps and analyse the prevalence of pediatric pain in public hospital in the country.