From theory to practice: the inclusion of hospitalized children’s families in painful procedures

Abstract

Objective: To understand nursing team professionals’ strategies to include the family in painful procedures performed on hospitalized children. Method: An exploratory-descriptive, qualitative study, carried out with nursing professionals. Data were collected through semi-structured interviews, guided by a script of topics, transcribed and submitted to thematic content analysis, in the light of Symbolic Interactionism, discussed considering the Family-Centered Care philosophy assumptions. Results: Two central categories emerged, “Theoretical perspective: the family as a care agent in painful procedures” and “Practical perspective: experiences, challenges and strategies in painful procedures for family inclusion”, with their respective subcategories. Conclusion: Nursing professionals have theoretical knowledge about family inclusion in painful procedures based on the assumptions: Family-Centered Care: dignity and respect; information sharing; joint participation; and family collaboration. However, knowledge is not applied in clinical practice; consequence of the interaction between beliefs and attitudes unfavorable to family presence.

Pain management in hospitalized children: unveiling barriers from the nursing perspective

“…In addition to the aforementioned steps, a concept analysis recently recommended that the family be included at the center of the pain management steps, with the with a collaborative communication, in a trustworthy environment, with a genuine partnership (9) . The recognition of the family in this process aligns with the premises of Family-Centered Care, a philosophy that guides the work of pediatric nurses (10) , and their presence is considered as a non-pharmacological intervention for pain relief (11) .…”

“…Along this path, nursing team professionals, with an emphasis on nurses, have an active role in managing pain management, being responsible for the assessment, implementation of pharmacological intervention, autonomy in the use of non-pharmacological interventions, reassessment and inclusion of the family in this process (7) . However, recent studies demonstrate that these steps are undervalued and remain below ideal standards (7,11,12) .…”

“…In Brazil, in a cross-sectional, retrospective study conducted with the medical records of 1,251 hospitalized children, it was noted that 11.2% were not assessed for pain; 481 had pain validated by scales, but the absence of analgesia occurred in 18.3%, even with prescription; 99.6% had no documentation of non-pharmacological interventions; and 59.7% required reassessment (7) . Furthermore, in a qualitative investigation conducted with nursing team professionals in Brazil, it was reported that in clinical practice there is no family inclusion in painful procedures, mainly due to professional beliefs and attitudes (11) .…”

Manejo da dor de crianças hospitalizadas: desvelando barreiras sob a perspectiva da enfermagem

“…Para além das etapas supracitadas, recentemente, uma análise de conceito recomendou que a família seja inclusa no centro das etapas do manejo da dor, com o estabelecimento de uma comunicação colaborativa, em um ambiente confiável, com uma parceria genuína (9) . O reconhecimento da família nesse processo está de acordo com as premissas do Cuidado Centrado na Família, filosofia que guia a atuação de enfermeiros pediátricos (10) , e sua presença é considerada como uma intervenção não farmacológica para alívio álgico (11) .…”

“…Nesse percurso, os profissionais da equipe de enfermagem, com ênfase no enfermeiro, possuem papel ativo no gerenciamento do manejo da dor, sendo os responsáveis pela avaliação, implementação da intervenção farmacológica, autonomia no uso de intervenções não farmacológicas, reavaliação e inclusão da família nesse processo (7) . Contudo, investigações recentes demonstram que essas etapas são desvalorizadas e permanecem abaixo do ideal (7,11,12) .…”