Efeito do knowledge translation para melhoria do manejo da dor em recém-nascidos em uma unidade neonatal
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2017-07-03
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Universidade Federal de Goiás
Resumo
There are strategies and interventions with proven effectiveness for the adequate management of
neonatal pain. However, the simple dissemination of knowledge at the end of a research and/or
training do not guarantee the use of knowledge by health professionals in clinical practice,
resulting in a gap between knowing and doing. Given the frequent and repeated exposure of
newborns to painful procedures in the neonatal unit and the deleterious consequences of untreated
pain, it is urgent to implement innovative actions that promote changes in clinical practice to
transform the available evidence into action. Thus, the objective of this study was to evaluate the
effect of a multifaceted Knowledge Translation (KT) intervention to improve the management of
neonatal pain. It is a quasi-experimental study, with no control group, of pre- and posttest type,
performed at the neonatal unit of a public maternity hospital in Goiás, Brazil, from February 2015
to March 2016. The intervention used was Evidence-Based Practice for Improving Quality (EPIQ),
which was divided into two phases: preparation and implementation, and change. A Research and
Practice Council consisting of health professionals of the neonatal unit led and facilitated the
proposed changes. Implementation was carried out in three rapid cycles, with one target for each
cycle being established. Several KT strategies were used in combination, according to what the
goal and barriers indicated, such as: reminders, bedside training, videos, educational leaflets,
auditing and feedback, clinical protocols and didactic presentation. In Cycle 1, all professionals
were sensitized to the adequate management of neonatal pain, and 89.4% of the professionals
considered it possible to use the presented strategies. In cycle 2, the PIPP-R and EDIN scales were
used to assess pain. At the first audit of cycle 2, of the total of 64 painful procedures (aspiration,
blood collection and catheter insertion), the PIPP-R scale was applied in 30.8% of these procedures
and EDIN in 26.2%. In the second audit of cycle 2, from 38 painful procedures, the PIPP-R scale
was registered in 23.7% and EDIN, 23.8%. In cycle 3, the goals of cycle 2 were maintained and 20% oral glucose administration was included for relief of acute pain during peripheral catheter
insertion and blood collection. In the audit of cycle 3, glucose was administered in 29.6% from the
total of 54 painful procedures. After the completion of the implementation process, a final audit
was carried out for 25 days. From the total of 444 painful procedures, the PIPP-R scale was applied
in 26.6% and the EDIN scale was applied 50.7%; and glucose was 17 administered in 25.1% of
these procedures. We conclude that, while faced with a challenging context and with the
multifaceted KT intervention used in this study (EPIQ), it was possible to observe a significant
increase, by health professionals, in the use of scales to assess pain and oral glucose administration
to relieve neonatal pain. However, strategies to improve and sustain these outcomes are needed to
ensure that every newborn has their pain evaluated and treated.
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CARVALHO, J. C. Efeito do knowledge translation para melhoria do manejo da dor em recém-nascidos em uma unidade neonatal. 2017. 157 f. Dissertação (Mestrado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2017.