Discordância entre pais e profissionais de saúde quanto à intensidade da dor no recém-nascido criticamente doente

Abstract

Objective: To verify whether parents and health professionals homogeneously evaluate presence and intensity of neonatal pain. Methods:This cross-sectional study enrolled 52 neonates and 154 adults. Inclusion criteria for neonates were admission to neonatal intensive care unit, presence of gastric tube, tracheal tube, and venous lines. Each newborn was observed by a different group of three adults (parent, nurse assistant and pediatrician) for 1 minute at the same time to evaluate presence and intensity of infant's pain. Homogeneity of pain evaluation was analyzed by a modified BlandAltman plot and by intraclass correlation coefficient (ICC). Multiple linear regression analysis was used to evaluate association of neonatal characteristics and heterogeneity of pain scores for adults.Results: ICC showed disagreement of the pain scores given by the three groups of adults (ICC 0.066, agreement > 0.75). Bland-Altman analysis showed agreement among adults when they thought pain was absent. When they thought pain was present, there was heterogeneity of opinions regarding intensity of neonatal pain. Multiple regression analysis indicated that 10% of this disagreement could be explained by infant's gender and mode of delivery. Conclusions:Disagreement among adults about intensity of neonatal pain is a marker of the difficulty in deciding the need for analgesia in preverbal patients.J Pediatr (Rio J). 2008;84(1):35-40: Pain, pain measurement, infant, newborn.

Medical Record Documentation and Symptom Management at the End of Life in the NICU

“…Parent report of infant symptoms may be important during this time. Discrepancies between parent report and nursing assessment have been reported in the literature, 16,17 that can cause difficulties with communication and relationships between families and clinicians during a very critical time in the dying process. Advances in knowledge regarding the recognition and management of symptoms may alleviate infant suffering, as well as emotional distress experienced by parents and clinicians at the EOL.…”

Perception of pain and distress in intubated and mechanically ventilated newborn infants by parents and health professionals

“…Inclusion and exclusion criteria for neonates, parents and health professionals enrolled in this study and the procedures related to the interviews about neonatal pain evaluation by the adults were previously described by our group [13]. In summary, newborn infants enrolled in this study met the following inclusion criteria: signed informed consent by parents; postnatal age of 24 to 96 hours old; placement in an incubator, and presence of gastric tube, peripheral and/or central venous access, and conventional mechanical ventilation by a tracheal tube, independent of the ventilator settings.…”

A New Framework to Evaluate the Quality of a Neonatal Death

“…Context may influence the nurse’s interpretations. For example, nurses often disagree on pain assessment (Elias, Guinsburg, Peres, Balda, & dos Santos, 2008). Years of experience with pain assessment increases neonatal nurses’ comfort level with this important skill (Pölkki et al, 2010).…”

“…Caregivers and parents also often disagree on the intensity of the infant’s pain (Franck et al, 2005). In one study, caregivers and parents agreed when there was no indication of pain, but as the pain ratings increased, the discrepancy in pain ratings also widened (Elias et al, 2008). This divergence certainly has ramifications for pain management (Elias et al).…”

“…In one study, caregivers and parents agreed when there was no indication of pain, but as the pain ratings increased, the discrepancy in pain ratings also widened (Elias et al, 2008). This divergence certainly has ramifications for pain management (Elias et al). For parents, disagreements with the nurse about their infant’s pain increases stress (Gale, Franck, Kools, & Lynch, 2004).…”