Intervención educativa para mejorar el diagnóstico y manejo del dolor en unidades de recién nacidos en Colombia
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nov 30, 2022
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Resumen
Objetivo: Evaluar el impacto en profesionales y pacientes de desarrollar e implementar una estrategia educativa en tres unidades neonatales en Bogotá (Colombia) para el reconocimiento y manejo del dolor. Metodología: Estudio de antes y después para evaluar el cambio en los conocimientos y aptitudes de los profesionales mediante encuestas consecutivas, y el cambio en el registro y manejo del dolor, evaluando la información consignada en las historias clínicas en ambos periodos. Resultados: Se encuestaron 70 profesionales de la salud antes y después de la implementación de la estrategia. Se encontró un cambio en sus aptitudes con respecto al uso de escalas de dolor (p = 0,03), el conocimiento de medidas no farmacológicas (p = 0,009) y el uso de medidas farmacológicas (p = 0,009). Adicionalmente, se analizaron las historias clínicas de 75 neonatos antes y 75 después de la implementación de la estrategia, lo que evidenció un incremento en el uso de escalas para evaluar el dolor asociado con procedimientos diagnósticos (1,3% vs. 20%; p < 0,01), y terapéuticos (0% vs. 56,7%; p < 0,01) y en la proporción de pacientes que recibieron manejo farmacológico (17,3% vs. 53,7%; p < 0,01). Conclusión: Los resultados sugieren que la implementación de una estrategia educativa mejora los conocimientos y aptitudes de los profesionales, así como el compromiso con las medidas dirigidas a diagnosticar y tratar adecuadamente el dolor en las unidades neonatales.
Keywords
dolor, unidad de recién nacidos, educación en saludpain, newborn unit, health education
References
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3. The Ottawa Neonatal Pain Interest Group. Newborn pain management: a practical approach [Internet]. 2015. Available from: http://www.cmnrp.ca/uploads/documents//Newborn_Pain_SLM_2015_02_19_FINAL.pdf
4. Jeong IS, Park SM, Lee JM, Choi YJ, Lee J. Perceptions on pain management among Korean nurses in neonatal intensive care units. Asian Nurs Res (Korean Soc Nurs Sci). 2014 Dec;8(4):261-6. https://doi.org/10.1016/j.anr.2014.05.008
5. Cong X, McGrath J, Cusson R, Zhang D. (2018). Pain assessment and measurement in neonates: an updated review. Adv Neonatal Care. 2013 Dec;13(6):379-95. https://doi.org/10.1097/ANC.0b013e3182a41452
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7. Nimbalkar AS, Dongara AR, Phatak AG, Nimbalkar SM. Knowledge and attitudes regarding neonatal pain among nursing staff of pediatric department: an Indian experience. Pain Manag Nurs. 2014 Mar;15(1):69-75. https://doi.org/10.1016/j.pmn.2012.06.005
8. Dunbar AE 3rd, Sharek PJ, Mickas NA, Coker KL, Duncan J, McLendon D, Pagano C, Puthoff TD, Reynolds NL, Powers RJ, Johnston CC. Implementation and case-study results of potentially better practices to improve pain management of neonates. Pediatrics. 2006 Nov;118 Suppl 2:S87-94. https://doi.org/10.1542/peds.2006-0913E
9. Ozawa M, Yokoo K. Pain management of neonatal intensive care units in Japan. Acta Paediatr. 2013 Apr;102(4):366-72. https://doi.org/10.1111/apa.12160
10. Sharek PJ, Powers R, Koehn A, Anand KJ. Evaluation and development of potentially better practices to improve pain management of neonates. Pediatrics. 2006 Nov;118 Suppl 2:S78-86. https://doi.org/10.1542/peds.2006-0913D
11. Dunbar AE 3rd, Sharek PJ, Mickas NA, Coker KL, Duncan J, McLendon D, Pagano C, Puthoff TD, Reynolds NL, Powers RJ, Johnston CC. Implementation and case-study results of potentially better practices to improve pain management of neonates. Pediatrics. 2006 Nov;118 Suppl 2:S87-94. https://doi.org/10.1542/peds.2006-0913E
12. Anand KJ, Hall RW. Pain management in newborns. Clin Perinat. 2014;41 (4): 895-924.
13. Hall R, Anand KJS. Physiology of pain and stress in the newborn. Neoreviews. 2005;6;e61.
14. Anand KJ; International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001 Feb;155(2):173-80. https://doi.org/10.1001/archpedi.155.2.173
15. Lemus-Varela ML, Sola A, Golombek S, Baquero S, Borbonet D, Dávila-Aliaga C, et al. Consenso sobre el abordaje diagnóstico y terapéutico del dolor y el estrés en el recién nacido. Rev Panam Salud Publica. 2014; 36(5):348-54.
16. Sociedad Internacional para el Estudio del Dolor [Internet]. Available from: http://www.iasp-pain.org
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18. Hohmeister J, Kroll A, Wollgarten-Hadamek I, Zohsel K, Demirakça S, Flor H, Hermann C. Cerebral processing of pain in school-aged children with neonatal nociceptive input: an exploratory fMRI study. Pain. 2010 Aug;150(2):257-267. https://doi.org/10.1016/j.pain.2010.04.004
19. Mitchell A, Boss BJ. Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature. J Neurosci Nurs. 2002 Oct;34(5):228-36. https://doi.org/10.1097/01376517-200210000-00002
20. van Dijk M, Roofthooft DW, Anand KJ, Guldemond F, de Graaf J, Simons S, de Jager Y, van Goudoever JB, Tibboel D. Taking up the challenge of measuring prolonged pain in (premature) neonates: the COMFORTneo scale seems promising. Clin J Pain. 2009 Sep;25(7):607-16. https://doi.org/10.1097/AJP.0b013e3181a5b52a
21. Stevens BJ, Gibbins S, Yamada J, Dionne K, Lee G, Johnston C, Taddio A. The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. Clin J Pain. 2014 Mar;30(3):238-43. https://doi.org/10.1097/AJP.0b013e3182906aed
22. Taylor BJ, Robbins JM, Gold JI, Logsdon TR, Bird TM, Anand KJ. Assessing postoperative pain in neonates: a multicenter observational study. Pediatrics. 2006 Oct;118(4):e992-1000. https://doi.org/10.1542/peds.2005-3203
23. Hummel P, Puchalski M, Creech S, Weiss M. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol. 2018; 28(1):55-60.
24. Pölkki T, Korhonen A, Axelin A, Saarela T, Laukkala H. (2014). Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). Int J Nurs Stud. 2014; 51(12):1585-94.
25. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993 Sep;12(6):59-66.
26. Bordin C, Lecalire M, Demeester A. L’échelle de douleur et d’inconfort du nouveau-né (EDIN): étude de validité portant sur 160 nouveau-nés en maternité entre quatre et 12 heures de vie. La Revue Sage-Femme. 2012;11(3):120-7.
27. Villamil González AL, Ríos Gutiérrez MM, Bello Pacheco MS, López Soto NC, Pabón Sánchez IC. Valoración del dolor neonatal: una experiencia clínica. Aquichan [Internet]. 2009 [cited 2022 ago 2];7(2). Available from: https://aquichan.unisabana.edu.co/index.php/aquichan/article/view/107
28. Aymar CL, Lima LS, Santos CM, Moreno EA, Coutinho SB. Pain assessment and management in the NICU: analysis of an educational intervention for health professionals. J Pediatr (Rio J). 2014 May-Jun;90(3):308-15. https://doi.org/10.1016/j.jped.2013.09.008
29. Bueno M, Yamada J, Harrison D. A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag. 2013;18(3):153-61.
30. Choudhary M, Dogiyal H, Sharma D, Datt Gupta B, Madabhavi I, Choudhary JS, Choudhary SK. To study the effect of Kangaroo Mother Care on pain response in preterm neonates and to determine the behavioral and physiological responses to painful stimuli in preterm neonates: a study from western Rajasthan. J Matern Fetal Neonatal Med. 2016 Mar;29(5):826-31. https://doi.org/10.3109/14767058.2015.1020419
31. Lefrak L, Burch K, Caravantes B. Sucrose analgesia: identifying potentially better practices. Pediatrics. 2006;118(suppl. 2):S197-S202.
32. Harrison D, Reszel J, Bueno M, Sampson M, Shah VS, Taddio A, Larocque C, Turner L. Breastfeeding for procedural pain in infants beyond the neonatal period. Cochrane Database Syst Rev. 2016 Oct 28;10(10):CD011248. https://doi.org/10.1002/14651858.CD011248.pub2
2. Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. Prevention and management of procedural pain in the neonate: an update. Pediatrics. 2016 Feb;137(2):e20154271. https://doi.org/10.1542/peds.2015-4271
3. The Ottawa Neonatal Pain Interest Group. Newborn pain management: a practical approach [Internet]. 2015. Available from: http://www.cmnrp.ca/uploads/documents//Newborn_Pain_SLM_2015_02_19_FINAL.pdf
4. Jeong IS, Park SM, Lee JM, Choi YJ, Lee J. Perceptions on pain management among Korean nurses in neonatal intensive care units. Asian Nurs Res (Korean Soc Nurs Sci). 2014 Dec;8(4):261-6. https://doi.org/10.1016/j.anr.2014.05.008
5. Cong X, McGrath J, Cusson R, Zhang D. (2018). Pain assessment and measurement in neonates: an updated review. Adv Neonatal Care. 2013 Dec;13(6):379-95. https://doi.org/10.1097/ANC.0b013e3182a41452
6. Christoffel MM, Castral TC, Daré MF, Montanholi LL, Scochi CG. Knowledge of healthcare professionals on the evaluation and treatment of neonatal pain. Rev Bras Enferm. 2016 Jun;69(3):552-8. English, Portuguese. https://doi.org/10.1590/0034-7167.2016690319i
7. Nimbalkar AS, Dongara AR, Phatak AG, Nimbalkar SM. Knowledge and attitudes regarding neonatal pain among nursing staff of pediatric department: an Indian experience. Pain Manag Nurs. 2014 Mar;15(1):69-75. https://doi.org/10.1016/j.pmn.2012.06.005
8. Dunbar AE 3rd, Sharek PJ, Mickas NA, Coker KL, Duncan J, McLendon D, Pagano C, Puthoff TD, Reynolds NL, Powers RJ, Johnston CC. Implementation and case-study results of potentially better practices to improve pain management of neonates. Pediatrics. 2006 Nov;118 Suppl 2:S87-94. https://doi.org/10.1542/peds.2006-0913E
9. Ozawa M, Yokoo K. Pain management of neonatal intensive care units in Japan. Acta Paediatr. 2013 Apr;102(4):366-72. https://doi.org/10.1111/apa.12160
10. Sharek PJ, Powers R, Koehn A, Anand KJ. Evaluation and development of potentially better practices to improve pain management of neonates. Pediatrics. 2006 Nov;118 Suppl 2:S78-86. https://doi.org/10.1542/peds.2006-0913D
11. Dunbar AE 3rd, Sharek PJ, Mickas NA, Coker KL, Duncan J, McLendon D, Pagano C, Puthoff TD, Reynolds NL, Powers RJ, Johnston CC. Implementation and case-study results of potentially better practices to improve pain management of neonates. Pediatrics. 2006 Nov;118 Suppl 2:S87-94. https://doi.org/10.1542/peds.2006-0913E
12. Anand KJ, Hall RW. Pain management in newborns. Clin Perinat. 2014;41 (4): 895-924.
13. Hall R, Anand KJS. Physiology of pain and stress in the newborn. Neoreviews. 2005;6;e61.
14. Anand KJ; International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001 Feb;155(2):173-80. https://doi.org/10.1001/archpedi.155.2.173
15. Lemus-Varela ML, Sola A, Golombek S, Baquero S, Borbonet D, Dávila-Aliaga C, et al. Consenso sobre el abordaje diagnóstico y terapéutico del dolor y el estrés en el recién nacido. Rev Panam Salud Publica. 2014; 36(5):348-54.
16. Sociedad Internacional para el Estudio del Dolor [Internet]. Available from: http://www.iasp-pain.org
17. Witt N, Coynor S, Edwards C, Bradshaw H. A Guide to Pain Assessment and Management in the Neonate. Curr Emerg Hosp Med Rep. 2016;4:1-10. https://doi.org/10.1007/s40138-016-0089-y
18. Hohmeister J, Kroll A, Wollgarten-Hadamek I, Zohsel K, Demirakça S, Flor H, Hermann C. Cerebral processing of pain in school-aged children with neonatal nociceptive input: an exploratory fMRI study. Pain. 2010 Aug;150(2):257-267. https://doi.org/10.1016/j.pain.2010.04.004
19. Mitchell A, Boss BJ. Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature. J Neurosci Nurs. 2002 Oct;34(5):228-36. https://doi.org/10.1097/01376517-200210000-00002
20. van Dijk M, Roofthooft DW, Anand KJ, Guldemond F, de Graaf J, Simons S, de Jager Y, van Goudoever JB, Tibboel D. Taking up the challenge of measuring prolonged pain in (premature) neonates: the COMFORTneo scale seems promising. Clin J Pain. 2009 Sep;25(7):607-16. https://doi.org/10.1097/AJP.0b013e3181a5b52a
21. Stevens BJ, Gibbins S, Yamada J, Dionne K, Lee G, Johnston C, Taddio A. The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. Clin J Pain. 2014 Mar;30(3):238-43. https://doi.org/10.1097/AJP.0b013e3182906aed
22. Taylor BJ, Robbins JM, Gold JI, Logsdon TR, Bird TM, Anand KJ. Assessing postoperative pain in neonates: a multicenter observational study. Pediatrics. 2006 Oct;118(4):e992-1000. https://doi.org/10.1542/peds.2005-3203
23. Hummel P, Puchalski M, Creech S, Weiss M. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol. 2018; 28(1):55-60.
24. Pölkki T, Korhonen A, Axelin A, Saarela T, Laukkala H. (2014). Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). Int J Nurs Stud. 2014; 51(12):1585-94.
25. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993 Sep;12(6):59-66.
26. Bordin C, Lecalire M, Demeester A. L’échelle de douleur et d’inconfort du nouveau-né (EDIN): étude de validité portant sur 160 nouveau-nés en maternité entre quatre et 12 heures de vie. La Revue Sage-Femme. 2012;11(3):120-7.
27. Villamil González AL, Ríos Gutiérrez MM, Bello Pacheco MS, López Soto NC, Pabón Sánchez IC. Valoración del dolor neonatal: una experiencia clínica. Aquichan [Internet]. 2009 [cited 2022 ago 2];7(2). Available from: https://aquichan.unisabana.edu.co/index.php/aquichan/article/view/107
28. Aymar CL, Lima LS, Santos CM, Moreno EA, Coutinho SB. Pain assessment and management in the NICU: analysis of an educational intervention for health professionals. J Pediatr (Rio J). 2014 May-Jun;90(3):308-15. https://doi.org/10.1016/j.jped.2013.09.008
29. Bueno M, Yamada J, Harrison D. A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag. 2013;18(3):153-61.
30. Choudhary M, Dogiyal H, Sharma D, Datt Gupta B, Madabhavi I, Choudhary JS, Choudhary SK. To study the effect of Kangaroo Mother Care on pain response in preterm neonates and to determine the behavioral and physiological responses to painful stimuli in preterm neonates: a study from western Rajasthan. J Matern Fetal Neonatal Med. 2016 Mar;29(5):826-31. https://doi.org/10.3109/14767058.2015.1020419
31. Lefrak L, Burch K, Caravantes B. Sucrose analgesia: identifying potentially better practices. Pediatrics. 2006;118(suppl. 2):S197-S202.
32. Harrison D, Reszel J, Bueno M, Sampson M, Shah VS, Taddio A, Larocque C, Turner L. Breastfeeding for procedural pain in infants beyond the neonatal period. Cochrane Database Syst Rev. 2016 Oct 28;10(10):CD011248. https://doi.org/10.1002/14651858.CD011248.pub2
Cómo citar
Devia Neira, C. P., Atencia Herrera, C. M., Lonngi, G., & Muñoz Velandia, O. M. (2022). Intervención educativa para mejorar el diagnóstico y manejo del dolor en unidades de recién nacidos en Colombia. Universitas Medica, 63(3). https://doi.org/10.11144/Javeriana.umed63-3.eiep
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