Differences in the child, mother, and nurses' pain score measurements during pediatric venipuncture.

BACKGROUND: Self-reporting is the gold standard for measuring pain in adult pain management; however, this issue is unique and different in children. Accurate pain assessment for the appropriate management of children's pain is important. PURPOSE: This study was conducted to assess the pain level by the child, mother, and nurse during intravenous line insertion in preschool children, candidates for surgery in Tabriz Children's Hospital. DESIGN AND METHODS: This is descriptive observational study. A total of 140 eligible children were included in the study using convenience and sequential methods. The intravenous line was inserted by an experienced nurse and pain assessment was performed by the child, mother, and nurse immediately after procedure, using the Wong-Baker face scale (WBFS). The data were analyzed through descriptive statistics and repeated measures ANOVA test using SPSS version 13 software. RESULTS: The difference between child-mother and nurse-mother mean scores was not statistically significant; however, there was a statistically significant difference between the score measured by the child and the nurse (P = 0.017). CONCLUSION: The children's pain assessment score during venipuncture was higher than that of mothers and nurses. The mothers' score was more closely related to the children's score. As a result, a mother's assessment can be considered a reliable estimation of proper pain management in young children and mothers can act as a moderator and actualize the nurses' score. Consequently, establishing a three-way communication between mother, child, and nurses is necessary to precisely estimate the child's actual pain and take appropriate measures to reduce it.

Parents' Time Perspective as a Predictor of Child's Postsurgical Pain, Emergence Delirium, and Parents' Posttraumatic Stress Disorder Symptoms after Child's Surgery.

BACKGROUND: The aim of this study was to predict children's postsurgical pain, emergence delirium and parents' posttraumatic stress disorder symptoms after a child's surgery based on the parents' time perspective. METHOD: A total of 98 children, aged 2 to 15, and their accompanying parents participated in this study. Measures of parents' time perspective and posttraumatic stress disorder symptoms were obtained based on questionnaires. The level of children's postsurgical pain and delirium were rated by nurses and anaesthesiologist. RESULTS: Parents' future-negative perspective was a predictor of emergence delirium in the group of children aged 8-15 years. Low parents' past-positive perspective turned out to be a predictor of parents' posttraumatic stress disorder symptoms after child's surgery. CONCLUSIONS: The results provide evidence for associations between parents' time perspective with child's emergence delirium and parents' posttraumatic stress disorder symptoms after child's surgery.

Management of Procedural Pain in Children.

In recent years, there has been increased interest in the study of pain in children and its treatment. It is known that when facing diagnostic and therapeutic procedures similar to those performed on adults, children either do not receive specific pain treatment or receive it on a significantly lower scale. However, recent research suggests a change in attitude and an improvement in the current treatment of children's pain. Although current knowledge demonstrates the falsity of many preconceived ideas about pain and its management, our results suggest that attitudinal change towards childhood pain remains slow and that real improvement in the training and practical application of the pediatrician who has to treat childhood pain is urgently needed. In this context, this manuscript has prepared standards and guidelines to improve pain management practices in a large number of national and international professional settings.

Efficacy of Buzzy® on pain and anxiety during catheterization in children.

BACKGROUND: The use of a peripheral intravenous cannula is a common clinical practice, and it is known to be a major source of pain and anxiety in children. The aim of this study was to examine the effect of the use of the Buzzy® on pain and anxiety in children during peripheral cannula application. METHODS: The research sample consisted of 60 children between the ages of 8 and 16. For children in the experimental group, external cold and vibration were applied by means of the Buzzy® device. Before and during the peripheral intravenous cannula procedure, the levels of fear and anxiety relating to the procedure of the child patients in both the experimental and control groups were assessed by the children themselves and by an independent observer. Immediately after the vein entry procedure had been carried out, the level of pain felt by the children was determined. RESULTS: The results of the statistical analysis showed no statistically significant difference between the anxiety levels of the groups before and after the procedure (P > 0.05). The results of the statistical analysis also showed no statistically significant difference between the postprocedural mean pain scores of the children as reported by the children themselves and by the observer (P > 0.05). CONCLUSIONS: In this study, unlike most studies in the literature, the conclusion was reached that the use of the Buzzy® to reduce pain and anxiety during the application of a peripheral intravenous cannula in children was not effective.

Anatomy of the greater occipital nerve block in infants.

BACKGROUND: Pain relief for posterior fossa craniotomies as well as occipital neuralgia, are indications for the use of the greater occipital nerve block in children. The greater occipital nerve originates from the C2 spinal nerve and is accompanied by the occipital artery as it supplies the posterior scalp. AIMS: The aim of this study was to develop a unique, yet simple technique for blocking the greater occipital nerve in children through the evaluation of the anatomy of this nerve and the accompanying occipital artery in the occipital region. METHODS: The greater occipital nerve and occipital artery were dissected and exposed in six formalin-fixed cadavers (five infants [average age of 51.4 days] and one 2-year-old) from the Department of Anatomy, University of Pretoria. Measurements between the nerve and selected bony landmarks were obtained. The relationship between the greater occipital nerve and the occipital artery at the trapezius muscle hiatus was also evaluated. RESULTS: The greater occipital nerve is on average 22.6 ± 5.6 mm from the external occipital protuberance in infants. The average width of the medial three fingers measured at the proximal interphalangeal joint, for each respective cadaver is 20.4 ± 4.0 mm, with a strong correlation coefficient of 0.97 between the aforementioned distances. In 83.3% of the specimens, the occipital artery lies lateral to the greater occipital nerve at the trapezius muscle hiatus. CONCLUSION: In infants, the greater occipital nerve can be blocked approximately 23 mm from the external occipital protuberance, medial to the occipital artery. This distance is equal to the width of the medial three fingers at the proximal interphalangeal joint of the patient.

Changing healthcare provider and parent behaviors in the pediatric post-anesthesia-care-unit to reduce child pain: Nurse and parent training in postoperative stress.

BACKGROUND: Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain. METHODS: In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically-based intervention which was then evaluated by experienced nurses (N = 8) and parents (N = 9) during focus groups. After revising the intervention based on focus group feedback, it was tested in Phase 2 using a pre-post study design. Nurses (N = 23) who worked in the recovery room were recruited to be part of both pre- and post-intervention data collection periods. Parents were recruited to be part of either the pre- (N = 52) or post-intervention (N = 60) data collection periods. Nurses and parent-child dyads were recorded in the post anesthesia care unit and videos were coded for the desired (ie, behaviors that may decrease child pain) and non-desired (ie, behaviors that may increase child pain) behaviors. Pain data was collected from the children's medical records to assess pain after surgery. The intervention was given to the nurses and parents in the post-intervention data collection period. RESULTS: Nurses significantly increased their rate of desired behaviors by 231% (P = 0.001; Somer's D = 1) and significantly decreased their rate of non-desired behaviors by 62% (P = 0.004, Somer's D = -0.88, 95% CI [-1.74, -0.03]). Parents significantly increased their rate of desired behaviors by 124% (P = 0.033). Moreover, the intervention significantly decreased child pain in the post anesthesia care unit (b = -2.19, SE = 0.63, z = -3.46, P = 0.001, 95%CI [-3.43, -0.95]). CONCLUSION: The intervention was effective in changing nurse and parent behaviors as well as child pain after surgery.

Parent Perspectives on Pain Management in Preschool-Age Children With Sickle Cell Disease.

Pain episodes occur for many preschoolers with sickle cell disease (SCD), but little is known about parent perceptions of managing pain episodes in young children. We surveyed parents of young children with SCD who had managed pain episodes in the past year to assess their management and satisfaction with their strategies, challenges of pain management, and interest in additional education. Parents were recruited from health maintenance visits at a SCD specialty clinic. Forty-two of 51 parents (82%) of 2- to-6-year-olds reported managing pain over the past year. Parents who had managed pain primarily reported using medications. These parents reported at least moderate satisfaction with current management strategies and resources. At least one-third of parents found each facet of pain management queried as at least somewhat challenging. Identifying when their child was in pain, encouraging functional activities, and managing irritable behavior were reported as most challenging. Parents of young children with SCD reported interest in additional pain management education, which could promote better parent and child coping skills.

[The Experience of Caring for a Child Suffering From Incontinent Dermatitis].

This paper describes the experience of caring for a child with incontinent dermatitis that was caused by improper family care. From March 27, 2015 to April 2, 2015, the authors used Gordon's 11 functional health parameters to collect subjective and objective data on the physical, mental and social conditions of the care recipient. To understand the nursing-related problems, including impaired skin integrity, acute pain, and caregiver anxiety, the data for this case and his mother were conducted by observation, physical assessment, the process of caring, and communication. For the three nursing problems, we established a good relationship with the family by providing individual care, continuously active care, listening, and companionship. In order to reduce the pain during wound dressing, we used game therapy and an attention-transfer technique that was based on the case's preferences. We encouraged family members to participate in treatment in order to ensure that the case continued to receive proper and continuous care after returning home. The authors taught the family members the correct information for treating incontinent dermatitis in order to reduce their concerns and to enhance their confidence and care abilities. We hope that this nursing experience may provide a reference for other nursing staffs when caring for similar cases in order to ensure appropriate quality of care.

State Versus Trait: Validating State Assessment of Child and Parental Catastrophic Thinking About Children's Acute Pain.

Pain catastrophizing has emerged as one of the most robust predictors of child pain outcomes. Although assessments of state (ie, situation-specific) pain catastrophizing in children and parents are often used, their psychometric properties are unknown. This study aimed to assess factor structure, reliability, and predictive validity of state versions of Pain Catastrophizing Scales for children and parents relative to corresponding trait versions for child and parental pain-related outcomes. Data were pooled from 8 experimental pain studies in which child and/or parent state catastrophizing (measured immediately before application of a pain stimulus) and trait catastrophizing were assessed in community-based samples of children aged 8 to 18 years (N = 689) and their parents (N = 888) in Dutch or English. Exploratory factor analyses were conducted to examine the underlying factor structure of the state versions of the Pain Catastrophizing Scale for parents/children, revealing a single factor solution that explained 55.53% of the variance for children and 49.72% for parents. Hierarchical linear regression analyses were used to examine relative influence of state versus trait catastrophizing on child and parent pain-related outcomes. Child and parent state catastrophizing were significantly associated with child pain intensity, child state anxiety and parental distress. State catastrophizing scores showed stronger associations than trait scores for most outcomes. PERSPECTIVE: This article presents the psychometric properties of state pain catastrophizing measures for children and parents. Findings underscore the importance of assessing state pain catastrophizing about acute pain experiences in parents and children, and provide a basis for robust and valid measurement of state pain catastrophizing about child pain.

Relaciones interpersonales en el nuevo modelo de atención sanitarista al niño con dolor / Interpersonal relationships within the new model of health care for children with pain

Introducción: el alivio del dolor debe considerase un derecho fundamental de la persona, porque el respeto a la dignidad humana exige que nadie sufra dolor innecesario. Objetivo: valorar cómo se establecía la relación de los profesionales con el paciente y representantes válidos, en la atención a niños con dolor, y si se ajustaban a un modelo de afrontamiento ético de las relaciones interpersonales y las valoraciones sobre virtudes y cualidades presentes en los profesionales que atienden niños con dolor. Métodos: se realizó una investigación descriptiva-transversal utilizando métodos cualitativos. Se realizaron encuestas a tutores válidos de niños que padecían dolor ingresados en el Hospital Pediátrico Juan Manuel Márquez, y a profesionales de ese hospital de diferentes servicios que atienden a niños con dolor. Las valoraciones de los profesionales sobre estas relaciones se contrastaron con las que hicieron los representantes legales de los niños con dolor atendidos en el hospital. Resultados: el personal de salud considera generalmente (casi siempre) correctas las valoraciones bioéticas en la relación médica con los enfermos y familiares. Los tutores válidos de los niños ingresados escogieron la alternativa siempre correcta en los procederes orientados desde la Bioética por parte del personal de salud. Las cualidades que caracterizan al personal médico y de enfermería son apreciadas en el rango de suficiente, y estas, con relación a cómo deberían estar presentes, las frecuencias no fueron lo suficientemente elevadas para esta profesión. Conclusiones: se constató que la ponderación de valores deseados para la profesión no alcanza las expectativas necesarias para considerar que se estén formando profesionales virtuosos. Los profesionales valoraron que no siempre se cumplen los procederes orientados desde la bioética, sin embargo los padres consideran que estos son cumplidos siempre(AU)

Introduction: pain relief should be considered a fundamental right of a person since the respect to human dignity demands that no one suffer from unnecessary pain. Objective: to find out how the relationship between the health professionals and the patient and his/her legal representative was developed in the care of children with pain, and whether they adapted to a model of ethical coping with interpersonal relationship, and the assessment on virtues and qualities present in those professionals who treat children with pain. Methods: a descriptive cross-sectional research study using qualitative methods was carried out. Guardians of children suffering pain and admitted to Juan Manuel Márquez pediatric hospital, and health professionals in different hospital services, who treat children with pain, were surveyed. The professionals' assessment on these relationships was compared with those of the legal representatives of children with pain, who were seen at the hospital. Results: the health staff considered that almost all the bioethical assessments in terms of the medical relationships with patients and relatives were correct. The guardians of hospitalized children chose the alternative always correct to qualify the procedures which were oriented from a bioethical viewpoint by the health staff. The qualities of the medical and nursing staffs were regarded as sufficient, but when comparing them with the way they should present themselves, then the frequencies were not high enough for this profession. Conclusions: it was proved that weighing of wanted values for this profession did not reach the required expectations to consider that virtuous professionals are being formed. The professionals stated that not always the bioethically oriented procedures are complied with; however, the parents think that they are always implemented(AU)

Relaciones interpersonales en el nuevo modelo de atención sanitarista al niño con dolor / Interpersonal relationships within the new model of health care for children with pain

Introducción: el alivio del dolor debe considerase un derecho fundamental de la persona, porque el respeto a la dignidad humana exige que nadie sufra dolor innecesario. Objetivo: valorar cómo se establecía la relación de los profesionales con el paciente y representantes válidos, en la atención a niños con dolor, y si se ajustaban a un modelo de afrontamiento ético de las relaciones interpersonales y las valoraciones sobre virtudes y cualidades presentes en los profesionales que atienden niños con dolor. Métodos: se realizó una investigación descriptiva-transversal utilizando métodos cualitativos. Se realizaron encuestas a tutores válidos de niños que padecían dolor ingresados en el Hospital Pediátrico Juan Manuel Márquez, y a profesionales de ese hospital de diferentes servicios que atienden a niños con dolor. Las valoraciones de los profesionales sobre estas relaciones se contrastaron con las que hicieron los representantes legales de los niños con dolor atendidos en el hospital. Resultados: el personal de salud considera generalmente (casi siempre) correctas las valoraciones bioéticas en la relación médica con los enfermos y familiares. Los tutores válidos de los niños ingresados escogieron la alternativa siempre correcta en los procederes orientados desde la Bioética por parte del personal de salud. Las cualidades que caracterizan al personal médico y de enfermería son apreciadas en el rango de suficiente, y estas, con relación a cómo deberían estar presentes, las frecuencias no fueron lo suficientemente elevadas para esta profesión. Conclusiones: se constató que la ponderación de valores deseados para la profesión no alcanza las expectativas necesarias para considerar que se estén formando profesionales virtuosos. Los profesionales valoraron que no siempre se cumplen los procederes orientados desde la bioética, sin embargo los padres consideran que estos son cumplidos siempre(AU)

Introduction: pain relief should be considered a fundamental right of a person since the respect to human dignity demands that no one suffer from unnecessary pain. Objective: to find out how the relationship between the health professionals and the patient and his/her legal representative was developed in the care of children with pain, and whether they adapted to a model of ethical coping with interpersonal relationship, and the assessment on virtues and qualities present in those professionals who treat children with pain. Methods: a descriptive cross-sectional research study using qualitative methods was carried out. Guardians of children suffering pain and admitted to Juan Manuel Márquez pediatric hospital, and health professionals in different hospital services, who treat children with pain, were surveyed. The professionals' assessment on these relationships was compared with those of the legal representatives of children with pain, who were seen at the hospital. Results: the health staff considered that almost all the bioethical assessments in terms of the medical relationships with patients and relatives were correct. The guardians of hospitalized children chose the alternative always correct to qualify the procedures which were oriented from a bioethical viewpoint by the health staff. The qualities of the medical and nursing staffs were regarded as sufficient, but when comparing them with the way they should present themselves, then the frequencies were not high enough for this profession. Conclusions: it was proved that weighing of wanted values for this profession did not reach the required expectations to consider that virtuous professionals are being formed. The professionals stated that not always the bioethically oriented procedures are complied with; however, the parents think that they are always implemented(AU)

Relaciones interpersonales en el nuevo modelo de atención sanitarista al niño con dolor / Interpersonal relationships within the new model of health care for children with pain

INTRODUCCIÓN: el alivio del dolor debe considerase un derecho fundamental de la persona, porque el respeto a la dignidad humana exige que nadie sufra dolor innecesario. OBJETIVO: valorar cómo se establecía la relación de los profesionales con el paciente y representantes válidos, en la atención a niños con dolor, y si se ajustaban a un modelo de afrontamiento ético de las relaciones interpersonales y las valoraciones sobre virtudes y cualidades presentes en los profesionales que atienden niños con dolor. MÉTODOS: se realizó una investigación descriptiva-transversal utilizando métodos cualitativos. Se realizaron encuestas a tutores válidos de niños que padecían dolor ingresados en el Hospital Pediátrico "Juan Manuel Márquez", y a profesionales de ese hospital de diferentes servicios que atienden a niños con dolor. Las valoraciones de los profesionales sobre estas relaciones se contrastaron con las que hicieron los representantes legales de los niños con dolor atendidos en el hospital. RESULTADOS: el personal de salud considera generalmente (casi siempre) correctas las valoraciones bioéticas en la relación médica con los enfermos y familiares. Los tutores válidos de los niños ingresados escogieron la alternativa siempre correcta en los procederes orientados desde la Bioética por parte del personal de salud. Las cualidades que caracterizan al personal médico y de enfermería son apreciadas en el rango de suficiente, y estas, con relación a cómo deberían estar presentes, las frecuencias no fueron lo suficientemente elevadas para esta profesión. CONCLUSIONES: se constató que la ponderación de valores deseados para la profesión no alcanza las expectativas necesarias para considerar que se estén formando profesionales virtuosos. Los profesionales valoraron que no siempre se cumplen los procederes orientados desde la bioética, sin embargo los padres consideran que estos son cumplidos siempre.

INTRODUCTION: pain relief should be considered a fundamental right of a person since the respect to human dignity demands that no one suffer from unnecessary pain. OBJECTIVE: to find out how the relationship between the health professionals and the patient and his/her legal representative was developed in the care of children with pain, and whether they adapted to a model of ethical coping with interpersonal relationship, and the assessment on virtues and qualities present in those professionals who treat children with pain. METHODS: a descriptive cross-sectional research study using qualitative methods was carried out. Guardians of children suffering pain and admitted to "Juan Manuel Márquez" pediatric hospital, and health professionals in different hospital services, who treat children with pain, were surveyed. The professionals' assessment on these relationships was compared with those of the legal representatives of children with pain, who were seen at the hospital. RESULTS: the health staff considered that almost all the bioethical assessments in terms of the medical relationships with patients and relatives were correct. The guardians of hospitalized children chose the alternative always correct to qualify the procedures which were oriented from a bioethical viewpoint by the health staff. The qualities of the medical and nursing staffs were regarded as sufficient, but when comparing them with the way they should present themselves, then the frequencies were not high enough for this profession. CONCLUSIONS: it was proved that weighing of wanted values for this profession did not reach the required expectations to consider that virtuous professionals are being formed. The professionals stated that not always the bioethically oriented procedures are complied with; however, the parents think that they are always implemented.

Relação intersubjetiva do enfermeiro e a criança com dor pós-operatória / Intersubjective relationship between nurse and child in post-surgical pain

Resumo: Este estudo visa compreender como se processa a relação intersubjetiva estabelecida entre o enfermeiro e a criança com dor pós-operatória no ato de cuidar, tendo como referencial a Teoria Humanística de Paterson e Zderad (1979). Trata-se de uma pesquisa qualitativa, efetivada através do método exploratório-descritivo. Teve como objetivos identificar a relação intersubjetiva estabelecida no ato de cuidar e desvelar como se desenvolve o cuidado do enfermeiro à criança com dor pós-operatória. Teve como questão norteadora "Como se estabelece a relação intersubjetiva no cuidado do enfermeiro à criança com dor pós-operatória?" Os sujeitos participantes do estudo foram oito enfermeiros que atuam em seis unidades distintas de cuidado à criança no período pós-operatório de um Hospital Pediátrico de Curitiba. As informações foram coletadas por meio da entrevista semi-estruturada gravada. O projeto foi submetido ao Comitê de Ética, tendo sido aprovado com o registro N.0360-06. Para o processo analítico dos discursos, utilizou-se a Análise Textual Qualitativa proposta por Moraes (2003). A partir das Unidades de Significado apreendidas, foi possível atingir a compreensão a respeito da experiência dos sujeitos. Da análise do apreendido emergiram três categorias, com sete unidades de significado referentes ao cuidado do enfermeiro à criança com dor pós-operatória e a relação intersubjetiva estabelecida no ato de cuidar. As categorias apreendidas foram: 1) O diálogo intuitivo ao ver, ouvir e sentir o outro numa relação EU-TU: o encontro de subjetividades 2) O diálogo científico de experiências, informações e conhecimentos: a relação EU-ISSO 3) O diálogo intuitivo-científico: a fusão do encontro intuitivo e científico em um momento simultâneo e recíproco. O caminho trilhado neste estudo possibilitou desvelar que o cuidado humanístico do enfermeiro deve ser delineado a partir da percepção multidimensional da experiência existencial de dor que a criança vivencia. Requer do enfermeiro habilidades muito peculiares, que representam sua subjetividade, sua maneira singular de cuidar, seu eu interior. Ser sensível ao sofrimento do outro, fazer-se presença, saber ouvir, tocar, relacionar-se; requer aproximação, na perspectiva de perceber sensivelmente os aspectos subjetivos da criança, a maneira como reage física e emocionalmente ao sofrimento que a dor lhe proporciona. Cada vivência é única e o cuidado é delineado a partir de percepções genuínas, que atendem as necessidades da criança de uma forma muito particularizada, humanizada, numa relação EU-TU. A articulação de saberes permite ampliar a perspectiva de efetividades das ações de cuidado. Deve incluir os familiares/significantes da criança e a equipe de saúde como um todo, visando um atendimento integral, que

Abstract: This study aims to understand how intersubjective relation between nurse and child in post-surgical pain is processed within the caring action having as theoretical background, Paterson and Zderad's Humanistic Theory (1979). It is a qualitative research carried out through a descriptive-exploratory approach. It objectified to identify intersubjective relationship brought about during caring action as well as to unveil how nursing care is undertaken to a child in postsurgical pain. The guiding question was "How is intersubjective relationship established during nursing care to a child in post-surgical pain?" The subjects of this study were eight nurses working at six different units who deliver postsurgical care to children at a Pediatric Hospital in Curitiba/ Brazil. Information was gathered by means of a recorded semi-structured interview. The project was submitted to the Ethics Committee and approved under register number 0360-06. Qualitative Text Analysis proposed by Moraes (2003) was used for the analytical process of the accounts. It was possible to understand the subjects' experience through the apprehended Units of Meaning. Three categories emerged from that analysis with six units of meaning concerning nursing care to a child in post-surgical pain and the inter-subjective relation established during the caring action. The apprehended categories were as follows: 1) the intuitive dialogue of looking, listening and feeling the other in an I/YOU relationship: the encounter of subjectivities 2) The scientific dialogue of experiences, information and knowledge: I/THAT relationship 3) The intuitive-scientific dialogue: the blend of the intuitive, scientific encounter in a simultaneous and reciprocal moment. The path trailed in this study enabled to uncover that humanistic nursing care must be delineated from a multidimensional perception of the existential pain experience that a child undergoes. It requires nurses unique skills which stand for their subjectivity, their unique way of caring, their self. It deems to be sensitive to others' suffering, to be a presence, to know how to listen, to touch, to relate, it requires to get closer in order to perceive a child's subjective features, how he/she reacts physically and emotionally to suffering from pain. Each experience is unique and caring is delineated from genuine perceptions which meet a child's needs in a particular, humanized manner, in an I/YOU relationship. The articulation of kinds of knowing enables to broaden the perspective of effective caring actions. A child's family members/ meaningful beings as well as the health team as a whole must be included, objectifying integral care which meets a child's calls for caring with human and ethic responses.

Cuidando para a criança crescer apesar da dor: o cotidiano da família da criança com artrite reumatóide juvenil / Caring for the child to grow despite the pain: the daily routine of the family's child with Juvenile Rheumatoid Arthritis

Este trabalho teve como objetivos compreender o cotidiano da família da criança que vivencia situação de dor decorrente de Artrite reumatóide juvenil, compreender o significado atribuído pela família à dor e desenvolver um Modelo Teórico explicativo do significado dessa experiência da família. A Teoria Fundamentada nos Dados e o Interacionismo Simbólico foram utilizados como referencial metodológico e como referencial teórico, respectivamente. Os dados foram obtidos por intermédio de entrevistas semiestruturadas com 12 famílias. A experiência que emergiu da integração dos conceitos revela uma trajetória vivida pela família em que os significados e os objetivos interagem o tempo todo. O modelo teórico descreve uma experiência estruturada em torno de dois elementos (definidos como motivacionais e intervenientes) e uma categoria central CUIDANDO PARA A CRIANÇA CRECER APESAR DA DOR, que se configurou como componente essencial ao cotidiano da família que tem sob seus cuidados uma criança com Artrite reumatóide juvenil.

This work aimed at understanding the daily routine of the family having a child experiencing pain due to Juvenile Rheumatoid Arthritis, at understanding the meaning attributed to pain by the family and at developing a Theoretical Model explaining the meaning of this experience to the family. Grounded Theory and Symbolic Interactionism were used as methodological framework and theoretical framework, respectively. Data were collected by means of semi-structured interviews to 12 families. The experience emerging form concept integration reveals the path lived by the family in which meanings and objectives interact all the time. The Theoretical Model describes an experience having two elements as basis (defined as motivational and intervenient) and a central category CARING FOR THE CHILD TO GROW, DESPITE THE PAIN, which turned out be an essential component for the family having to take care of a child suffering from Juvenile Rheumatoid Arthritis.