Parents' Participation in Managing Their Children's Postoperative Pain at Home: An Integrative Literature Review.

OBJECTIVES: This integrative review aimed to synthesize and critically evaluate the methodological quality of the evidence on parent's participation in managing their children's postoperative pain at home. DESIGN: Integrative review. DATA SOURCES: To locate relevant articles, two reviewers independently searched four electronic databases systematically using predefined inclusion and exclusion criteria. REVIEW/ANALYSIS METHODS: The methodological quality of 23 eligible studies was critically appraised using published evaluation criteria. A qualitative content analysis was then conducted to synthesize findings of the studies to identify thematic trends and factors on the nature of parents' participation and ability to effectively manage their children's pain at home. RESULTS: Methodological quality of most of the 15 surveys was adequate, whereas shortcomings were identified in 6 of the 7 clinical trials and the 1 qualitative study that were included in this review. The three themes identified pertained to parent use of informational sources, postoperative pain medications, and nonpharmacologic pain treatment approaches. Results indicate parents lack the information they need to effectively make use of pharmacologic and nonpharmacologic pain treatment approaches. CONCLUSIONS: There is need to improve communication between parents and health professionals before and after the child's surgery and to provide parents with specific verbal and written instructions and strategies on how to assess and manage their children's pain.

[Evaluation of digital educational student-technology interaction in neonatal nursing]. / Avaliação da interação estudante-tecnologia educacional digital em enfermagem neonatal.

OBJECTIVE: To assess the digital educational technology interface Caring for the sensory environment in the neonatal unit: noise, lighting and handling based on ergonomic criteria. METHODS: Descriptive study, in which we used the guidelines and ergonomic criteria established by ISO 9241-11 and an online Likert scale instrument to identify problems and interface qualities. The instrument was built based on Ergolist, which follows the criteria of ISO 9141-11. There were 58 undergraduate study participants from the School of Nursing of Ribeirao Preto, University of Sao Paulo, who attended the classes about neonatal nursing content. RESULTS: All items were positively evaluated by more than 70% of the sample. CONCLUSION: Educational technology is appropriate according to the ergonomic criteria and can be made available for teaching nursing students.

Development of the e-Baby serious game with regard to the evaluation of oxygenation in preterm babies: contributions of the emotional design.

The present study aimed to describe the development process of a serious game that enables users to evaluate the respiratory process in a preterm infant based on an emotional design model. The e-Baby serious game was built to feature the simulated environment of an incubator, in which the user performs a clinical evaluation of the respiratory process in a virtual preterm infant. The user learns about the preterm baby's history, chooses the tools for the clinical evaluation, evaluates the baby, and determines whether his/her evaluation is appropriate. The e-Baby game presents phases that contain respiratory process impairments of higher or lower complexity in the virtual preterm baby. Included links give the user the option of recording the entire evaluation procedure and sharing his/her performance on a social network. e-Baby integrates a Clinical Evaluation of the Preterm Baby course in the Moodle virtual environment. This game, which evaluates the respiratory process in preterm infants, could support a more flexible, attractive, and interactive teaching and learning process that includes simulations with features very similar to neonatal unit realities, thus allowing more appropriate training for clinical oxygenation evaluations in at-risk preterm infants. e-Baby allows advanced user-technology-educational interactions because it requires active participation in the process and is emotionally integrated.

[Handling of preterm infants in a neonatal intensive care unit]. / A manipulação de prematuros em uma Unidade de Terapia Intensiva Neonatal.

While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.

[Human milk for neonatal pain relief during ophthalmoscopy]. / O leite humano no alívio da dor neonatal no exame de fundo de olho.

Ophthalmoscopy performed for the early diagnosis of retinopathy of prematurity (ROP) is painful for preterm infants, thus necessitating interventions for minimizing pain. The present study aimed to establish the effectiveness of human milk, compared with sucrose, for pain relief in premature infants subjected to ophthalmoscopy for the early diagnosis of ROP. This investigation was a pilot, quasi-experimental study conducted with 14 premature infants admitted to the neonatal intensive care unit (NICU) of a university hospital. Comparison between the groups did not yield a statistically significant difference relative to the crying time, salivary cortisol, or heart rate (HR). Human milk appears to be as effective as sucrose in relieving acute pain associated with ophthalmoscopy. The study's limitations included its small sample size and lack of randomization. Experimental investigations with greater sample power should be performed to reinforce the evidence found in the present study.

The setting of research production by nursing and management graduate programs in Brazil. / Cenário das pesquisas na pós-graduação na área de enfermagem e gerenciamento no Brasil.

This documental, descriptive study was performed using a quantitative approach with the objective to characterize the production by nursing graduates in Brazil in the 2007-2009 triennium, with emphasis on nursing management. Data was collected from the CAPES database, which allows access to the abstracts of theses and dissertations. The material was analyzed and categorized according to areas/fields and the respective lines of research, as defined in Nursing. The overall production analysis was descriptive and analytical in the field of organization, namely management. The results showed that, compared to previous studies, production underwent some changes in the triennium, with an increase in the area of health care, maintenance in the organizational area, and decrease in the professional area. Regarding the management theme, most studies addressed health assessment, the conceptions/perceptions regarding planning/organizing work-services and permanent education.

Development and evaluation of an educational video for families on the relief of acute pain in babies.

OBJECTIVE: To develop and evaluate an educational video for active family participation in the relief of acute pain in babies. METHODS: A methodological and experimental study produced at the University of São Paulo at Ribeirão Preto School of Nursing and at a university hospital in southeastern Brazil, conducted in three operational stages, from January to July 2017. RESULTS: The video lasts nine minutes and 31 seconds, and it was validated by 19 expert judges with a 90% agreement among them for content and appearance items. Regarding the evaluation, 16 family members and pregnant women did it and were favorable to its use as an educational technology for learning. CONCLUSIONS: Both the experts and the target population positively evaluated the video, which can be used as a health education strategy to empower families to engage in the baby pain relief with more autonomy and proactivity.

Baby-Friendly Hospital Initiative for Neonatal Wards: impact on breastfeeding practices among preterm infants.

OBJECTIVE: to assess breastfeeding support practices for preterm infants at two Baby-Friendly hospitals in southeastern Brazil, comparing the effect of implementing the guidelines for Baby-Friendly Hospital Initiative for Neonatal wards. METHODS: a quasi-experimental study, pre- and post-intervention with control. Implementation of this initiative in the intervention hospital using Knowledge Translation. Data collection on compliance with the adapted Ten Steps, Three Guiding Principles and the Code before and after the intervention was carried out via interviews with mothers of preterm babies and professionals, unit observation and documentary analysis in the intervention and control hospitals. Intra-intergroup comparison was performed. RESULTS: increases in global compliance with the Three Principles, Ten Steps, the Code, partial compliance with each Principle and in most Steps was greater in the intervention hospital. Conclusion: this initiative improved practices related to breastfeeding in the intervention hospital, demonstrating the potential to improve care and breastfeeding in neonatal wards.

[The interview in qualitative research of pediatric nursing]. / A entrevista nas pesquisas qualitativas de enfermagem pediátrica.

This systematic review aimed to explore the contributions of Brazilian nursing literature about the use of interviews as a data collection technique in research with children. Articles were searched in the Virtual Health Library, using Health Terminology, between 1998 and 2008. Thirteen articles were selected, whose analysis allowed for reflections on the type of study, investigated age range, ethical considerations, data collection techniques, among others. Data indicated that nurses have used interviews isolated or associated with other techniques. Studies need to present the data collection phase in further detail, so as to indicate ways to improve the interview technique with children in nursing research.

[Nursing diagnoses of premature infant under intermediary care]. / Diagnósticos de enfermagem de prematuros sob cuidados intermediários.

The study aims at identifying nursing diagnoses of premature infants attended in a neonatal intermediary care unit in the countryside of São Paulo State, Brazil. That was a retrospective study conducted from 118 patient records of hospitalized premature infants. The most frequent nursing diagnosis were sleep deprivation (83.1%), risk for infection (76.3%) and dysfunctional family processes (75.4%), belonging to NANDA domains: activity/rest, security/protection and role relations, this order. Study results articulated the diagnosis frequency with NANDA domain to which they belong identifying their approach limitation and main domains pointed in assistance systematization to premature newborn in intermediary care.

Online information use on health/illness by relatives of hospitalized premature infants.

OBJECTIVE: To analyze the use of online information on health/illness by relatives of premature infants admitted to the Neonatal Intensive Care Unit. METHOD: Exploratory, qualitative study conducted at a Neonatal Intensive Care Unit from a University Hospital in the state capital of southern Brazil, with 33 relatives of hospitalized premature infants. The data were collected through a semi-structured interview and were submitted to thematic analysis, with the aid of the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ®). RESULTS: From the data analysis, two thematic categories emerged: Online information on health/illness researched by relatives; and Online sources of information consulted by relatives. FINAL CONSIDERATIONS: Health professionals need to consider the use of online information by relatives in the care process, adding it in their practice in relation to the informational needs presented, and stimulating spaces for dialogue about the data found.

Exposure and reactivity of the preterm infant to noise in the incubator. / Exposição e reatividade do prematuro ao ruído em incubadora.

PURPOSE: To evaluate preterm infants' exposure and reactions to intense noise during incubator care. METHODS: An observational and prospective study was performed in the intermediary care unit of a hospital in Ribeirão Preto (SP). Thirty-five preterm infants participated in the first stage of the study (measuring noise) and 20 in the second (analysis of responses to intense noise). Noise was measured for two hours using a dosimeter, and the responses were video recorded by three cameras connected to a computer. The preterm infants' responses to an Lmax higher than 65 decibels were analyzed. RESULTS: Every preterm infant presented Leq above the limit recommended by international organizations, and more than half of the babies had a mean Leq above the limit permitted by the Brazilian standard. Regarding the babies' responses to the intense noise, the majority of them showed blink reflex, startle reflex, facial mimics, changed bodily activities or changed sleep and wake state, all with statistically significant differences. CONCLUSION: The sound levels measured were intense. The noises that preterm infants are exposed to while being cared for in incubators constitute a stressor event. Sudden, intense noises change their behavioral state and causes reflexive and bodily responses, facial manifestations and changes in their sleep and wake state.

OBJETIVO: Avaliar a exposição e a reatividade do prematuro ao ruído intenso durante o cuidado em incubadora. MÉTODO: Estudo observacional prospectivo na unidade de cuidados intermediários de um hospital de Ribeirão Preto (SP). Na primeira etapa do estudo (dimensionamento do ruído) participaram 35 prematuros e na segunda (análise da reatividade diante de um ruído intenso), 20. O ruído foi mensurado durante duas horas por um dosímetro e a reatividade filmada por três câmeras conectadas no computador. Diante de Lmáx superior a 65 decibéis analisou-se a reatividade dos prematuros. RESULTADOS: Todos os prematuros apresentaram Leq acima do limite recomendado por organizações internacionais e mais da metade dos bebês esteve com Leq médios superiores ao limite permitido em incubadora pela norma brasileira. Diante do ruído intenso, grande parte dos bebês desencadeou reflexo cócleo-palpebral, sobressalto, mímica facial, modificou as atividades corporais ou apresentou padrão de sono e vigília, com diferenças estatisticamente significativas. CONCLUSÃO: Os níveis sonoros mensurados foram intensos. O ruído a que os prematuros estão expostos nas incubadoras durante os cuidados recebidos constitui um evento estressante, modifica o estado comportamental e desencadeia respostas reflexas, corporais, manifestações faciais e mudança no estado de sono e vigília diante dos ruídos intensos e súbitos.

Exclusive breastfeeding of premature infants and reasons for discontinuation in the first month after hospital discharge. / Aleitamento materno exclusivo de prematuros e motivos para sua interrupção no primeiro mês pós-alta hospitalar.

OBJECTIVE: To estimate the prevalence of exclusive breastfeeding premature infants at hospital discharge, and after 15 and 30 days, and to identify the mothers' claims for discontinuation. METHODS: Cross-sectional study with 108 premature infants born in two Baby-Friendly Hospitals between April and July 2014. A survey was conducted on medical records and through telephone interviews. A descriptive analysis, Pearson's chi-square test, and Fisher's exact test were used, with a 95% confidence interval. RESULTS: The prevalence of exclusive breastfeeding at discharge was 85.2%, 75% after 15 days, and 46.3% after 30 days. The main claim for the introduction of other foods and/or liquids was insufficient milk. CONCLUSIONS: There was a significant reduction in the rates of exclusive breastfeeding after discharge, pointing out the importance of continuity of patient care to reduce early weaning, especially with educational actions that help prevent real and perceived deficits in milk supply.

Predictive factors of the interruption of exclusive breastfeeding in premature infants: a prospective cohort.

OBJECTIVE: to evaluate the incidence of exclusive breastfeeding and the risk factors associated to its interruption in premature infants after hospital discharge. METHOD: this is a prospective cohort with 113 premature infants in a neonatal unit, whom were followed-up from 7 to 15 days after hospital discharge. The outcome was the interruption of exclusive breastfeeding. Maternal and neonatal exposure variables were evaluated by a regression model and described by the confidence interval (95%) and risk ratio. RESULTS: exclusive breastfeeding rate was 81.4% at discharge and 66.4% at 7 to 15 days after discharge. Double gestation, time of mechanical ventilation and birth weight were associated with higher risks of interruption of exclusive breastfeeding after discharge. CONCLUSION: there is a need for the implementation of actions that promote the early onset and maintenance of exclusive breastfeeding of premature infants.

[Reliability of an instrument to assess the readiness of preterm infants for oral feeding]. / Confiabilidade do instrumento de avaliação da prontidão do prematuro para alimentação oral.

BACKGROUND: The transition from gastric to oral feeding of preterm infants is one of the greatest concerns of health professionals and therefore needs an objective criterion to support the beginning of this process. AIM: To test the reliability of an instrument that assesses the readiness of preterm infants for the transition from gastric to oral feeding. METHOD: The instrument is composed by the following items: corrected gestational age; behavioral state; global posture and tonus; lips and tongue posture; rooting, suck, bite and gag reflexes; tongue and jaw movements; tongue cupping; sucking strain; sucking and pause; maintenance sucking/pause; maintenance alert state and stress signs. The study was conducted at the Intermediate Care Unit of the Hospital de Clínicas da Faculdade de Medicina de Ribeirão Preto-University of São Paulo. The research sample consisted of 30 preterm infants who attended the following inclusion criteria: corrected gestational age<36 weeks and 6 days; clinically stable; absence of facial deformities; respiratory, cardiovascular, gastrointestinal and neurological disorders or syndromes that prevent or make oral feeding difficult; and not having received oral feeding of milk. The Kappa Test was used to verify interjudge reliability. RESULTS: The items that presented high reliability levels were: behavioral state, global posture and tonus, lips and tongue posture, gag reflex and maintenance of alert state. The items that presented satisfactory reliability levels were: rooting reflex, sucking and biting and jaw movement, sucking strain and sucking and pause. Only the items of tongue cupping, maintenance of sucking/pause and stress signs presented unsatisfactory reliability levels. CONCLUSION: In general, the items investigated by the assessment instrument presented adequate interjudge reliability.

[Managing postoperative pain in pediatric nursing: searching for subsides to improve nursing care]. / Manejo da dor pós-operatória na enfermagem pediátrica: em busca de subsídios para aprimorar o cuidado.

This study reports on a literature review about child postoperative pain management by nursing professionals, in the period from 1993 to 2005. Three themes were identified: factors influencing nurses' management of child pain, interventions to relieve child pain, and nurses' assessment and response to children's pain experience. Child pain management is a complex act that involves elements of the dimensions related to the children themselves, health professionals and family members. The lack of studies in this area reveals the need for research, with a view to (re)considering pediatric nursing care.

Analgesic effect of kangaroo position method versus sucrose during heel punctures in newborn: randomized clinical trial / Efeitos analgésicos da posição canguru versus sacarose durante punções de calcâneo em recém-nascidos: ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: 25% sucrose and kangaroo position are effective for neonatal analgesia in single procedures and sucrose is also effective in repeated procedures. Behavioral and physiological responses and adverse effect on newborns submitted to kangaroo position or 25% sucrose for analgesia were compared in two heel punctures applied during the first hours of life. METHODS: Randomized clinical trial with 80 newborns and 40 mothers. Data were collected during two heel punctures. The kangaroo position was performed for three minutes before, during and three minutes after the punctures. Oral 25% sucrose (0.5 mL/kg) was administered two minutes before the punctures and the newborns were kept in a crib. Each data collection was divided into nine phases. The facial action, crying and heart rate data were analyzed using descriptive and comparative analyses. Facial actions, assessed by the Newborn Facial Coding System scale, was used to test the hypothesis. The frequency of gastric side effects was calculated. Ethical aspects were preserved. RESULTS: Facial actions did not differ (p>0.05) between groups in the two data collections. There were no relevant changes in heart rate between and within groups. The newborns in the kangaroo group cried more than in the sucrose group (p<0.05) in the second collection. In the administration of sucrose, more side effects were observed in the first (p=0.02) and second collection (p=0.007). CONCLUSION: The kangaroo position is as effective as the administration of 25% sucrose to relieve pain resulting from two repeated heel punctures.

RESUMO JUSTIFICATIVA E OBJETIVOS: Sacarose a 25% e posição canguru são efetivos para analgesia neonatal em procedimentos únicos e a sacarose também é efetiva em procedimentos repetidos. Comparou-se as respostas comportamentais e fisiológicas e o efeito adverso entre recém-nascidos submetidos a posição canguru ou sacarose a 25% na analgesia em duas punções de calcâneo, aplicadas durante as primeiras horas de vida. MÉTODOS: Ensaio clínico randomizado com 80 recém-nascidos e 40 mães. Os dados foram coletados durante duas punções de calcâneo. A posição canguru foi realizada por três minutos antes, durante e três minutos após as punções. A sacarose a 25% oral (0,5 mL/kg) foi administrada dois minutos antes das punções e os recém-nascidos permaneceram em berço. Cada coleta de dados foi dividida em nove fases. Os dados da mímica facial, choro e frequência cardíaca foram analisados por meio de análises descritivas e comparativas. A mímica facial, avaliada pela escala Newborn Facial Coding System, foi utilizada para testar a hipótese. A frequência dos efeitos adversos gástricos foi calculada. Os aspectos éticos foram preservados. RESULTADOS: A mímica facial não diferiu (p>0,05) entre os grupos nas duas coletas de dados. Não houve alterações relevantes na frequência cardíaca entre e intragrupos. Os recém-nascidos do grupo canguru choraram mais que no grupo sacarose (p<0,05) na segunda coleta. Na administração de sacarose, foram observados mais efeitos adversos, na primeira (p=0,02) e segunda coleta (p=0,007). CONCLUSÃO: A posição canguru é tão eficaz quanto a administração de sacarose a 25% para aliviar a dor decorrente de duas punções de calcâneo repetidas.

Newborn self-regulation and mother comfort in kangaroo position versus sucrose during repeated heel punctures: randomized clinical trial / Autorregulação e conforto materno ao recém-nascido em posição canguru versus sacarose submetidos a punções de calcâneo: ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: Self-regulation is the ability to control mental functions, satisfying physical, social and emotional needs. The objective of this study was to compare self-regulatory actions in newborns submitted to kangaroo position or 25% sucrose for analgesia during two heel punctures in the first hours of life, and to describe the comfort actions offered by mothers to their infants in kangaroo position. METHODS: Randomized equivalence clinical trial with newborns submitted to two heel punctures and their mothers. The kangaroo position group remained in contact with the mother for three minutes before, during and three minutes after the punctures. The sucrose group received 25% sucrose orally two minutes before the punctures and remained in a common crib, without manipulation. The self-regulation actions and maternal comfort were microanalytically analyzed in the two punctures (18 data collection phases). The percentages of self-regulation/comfort actions duration were compared between intragroup and between groups. RESULTS: The sample consisted of 80 newborns (40 per group) and 40 mothers (kangaroo position group). Sucking fingers/fist/tongue was the only self-regulation action that statistically differed in the two punctures (p<0.001), being higher in the sucrose group. In the kangaroo position group, mothers offered comfort actions to the child at all stages of collection, especially rocking and caressing. CONCLUSION: Self-regulation actions of the newborns were observed in all phases of collection in both groups, such as sucking and taking hand to mouth. In the kangaroo position group, there were maternal comfort actions, especially hugging and caressing.

RESUMO JUSTIFICATIVA E OBJETIVOS: Autorregulação é a habilidade de controlar as funções mentais, satisfazendo necessidades físicas, sociais e emocionais. O objetivo deste estudo foi comparar ações de autorregulação em recém-nascidos submetidos à posição canguru ou a sacarose 25% para analgesia durante duas punções de calcâneo, nas primeiras horas de vida, e descrever as ações de conforto oferecidas pelas mães aos filhos na posição canguru. MÉTODOS: Ensaio clínico de equivalência randomizado, com recém-nascidos submetidos a duas punções de calcâneo e suas mães. O grupo posição canguru permaneceu em contato materno por três minutos antes, durante e três minutos após as punções. O grupo sacarose recebeu sacarose oral 25% dois minutos antes das punções e permaneceu em berço comum, sem manipulação. As ações de autorregulação e conforto materno foram analisadas microanaliticamente nas duas punções (18 fases de coleta de dados). As porcentagens de duração das ações de autor-regulação/conforto foram comparadas entre as fases intragrupo e entre grupos. RESULTADOS: A amostra foi composta por 80 recém-nascidos (40 por grupo) e 40 mães (grupo posição canguru). Sugar dedos/punho/língua foi a única ação de autorregulação que diferiu estatisticamente nas duas punções (p<0,001), sendo maior no grupo sacarose. No grupo posição canguru, as mães ofereceram ações de conforto ao filho em todas as fases da coleta, especialmente embalar e acariciar. CONCLUSÃO: Foram observadas ações de autorregulação dos recém-nascidos em todas as fases da coleta em ambos os grupos, como sugar e levar mão à boca. No grupo posição canguru, houve ações de conforto materno, especialmente abraçar e acariciar.

Community nursing in Brazil and child care in the family context.

This paper describes the critical elements that characterise current public policy on child and family care in Brazil and discusses the implications of these changes for the practice and teaching of child and family health nursing in Brazil.

[Can breastfeeding promote acute pain relief in newborns?]. / Pode a amamentação promover alívio da dor aguda em recém-nascidos?

This review study aimed to identify the efficacy of breastfeeding and its component aspects (contact, sucking, odor and milk) as nonpharmacological measures for pain relief in newborns. 14 articles from Medline/PubMed were analyzed. We observed methodological differences related to sampling, painful procedures, periods, treatment administration and variables measured. Breastfeeding and its component aspects were perceived as efficient to relieve acute pain. We observed the need for studies to evaluate the analgesic effect of breastfeeding before the painful procedure until recovery. This period is sufficient to achieve the analgesic effect after milk absorption. The interaction between all breastfeeding components must be considered.