Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T13:29:35Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AlessandraMarinSantini.pdf: 1830343 bytes, checksum: 44e24e0c29bcd690a003ba0b900a9e73 (MD5) / Made available in DSpace on 2018-08-22T13:29:35Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AlessandraMarinSantini.pdf: 1830343 bytes, checksum: 44e24e0c29bcd690a003ba0b900a9e73 (MD5) Previous issue date: 2017-06-09 / The care given to a child seriously sick and in an Pediatric Intensive Therapy Unit must provide comfort to her. So, to operationalize the main study, still in the research project elaboration, it was done an opinion research searching for a first contact with the study object, resulting in the article entitled “Nurse perceptions in the pain evaluation in the pediatric intensive therapy unit”. After that, it was done a basis review with the aim of adding content referring to the Comfort thematic and to the Kolcaba Theory, main reference of this study, which originated the article “ Scientific contribution of the national nursing based on the Theory of Comfort by Kolcaba: an integrative review”. The results obtained in the opinion research and in the integrative review sustained the elaboration of the main proposal of this dissertation with the aim of implementing the use of the pain scale by nurses to improve the evaluation of the 5th vital signal in children at PITU, promoting the comfort based on the Theory of Kolcaba. The specific objectives were to analyse with the nurses the care that can be given to release the pain and promote comfort of children at PITU and describe the potentialities and weaknesses emerged in the process of implementation of the pain scale. A research of a descriptive exploratory type, with a qualitative design, being the action research in the modality of participant, elected as the investigative means to the process of development of this study. Twelve nurses from a PITU from the South of Brazil participated. The data collection occurred from July to November, 2016 by the generation of meetings and interviews to which two scales were used in the pilot test, being afterwards elected the most adequate scale for the unity. The data were grouped in categories and after that, in units of analysis. The results were grouped in two main thematic: I) the perceptions motivated by the implementation of the Pain Scale and II) the Pain Scale as co-actor in the promotion of comfort. The use of the Comfort Theory as theoretical basis of this study showed a strict link to the objective chosen, contributing and spreading the true importance in providing the comfort, by means of the improvement of the know-how and the art of doing the assistance in nursing with quality. The findings showed the relevance in the implementation of the pain evaluation scale, for a more effective care in nursing allied to the use of the Comfort Theory to which it contributed with the study object, providing the promotion of physical, psycospiritual, socialcultural and/or environmental comfort for kids highly ill. Therefore, it is emphasized that the product generated by this investigative process was the implementation of the Pain Evaluation Scale in children at PITU. / O cuidado proporcionado à criança gravemente enferma e internada em Unidade de Terapia Intensiva Pediátrica (UTIP) deve prover conforto para a mesma. Assim, para operacionalização do estudo principal, ainda na fase de elaboração desse projeto de pesquisa, realizou-se uma pesquisa de opinião visando um primeiro contato com o objeto de estudo, para resultar no artigo intitulado “Percepções de enfermeiros na avaliação da dor em unidade de terapia intensiva pediátrica”. Posteriormente, realizou-se uma revisão em bases de dados, com o objetivo de agregar conteúdo referente à temática “Conforto e a Teoria de Kolcaba”, referência principal desse estudo, que originou o artigo “Contribuição científica da enfermagem nacional fundamentada na Teoria do Conforto de Kolcaba: revisão integrativa”. Os resultados obtidos na pesquisa de opinião e na revisão integrativa sustentaram a elaboração da proposta principal dessa dissertação, com o objetivo de implementar o uso de escala da dor por enfermeiros para melhorar a avaliação do quinto sinal vital em crianças internadas em UTIP, promovendo o conforto à luz da Teoria de Kolcaba. Os objetivos específicos foram analisar com os enfermeiros os cuidados que podem ser realizados para aliviar a dor e promover conforto às crianças internadas em UTIP e descrever as potencialidades e fragilidades emergidas no processo de implementação da escala de dor. Pesquisa do tipo descritivo exploratória, com delineamento qualitativo, sendo a pesquisa-ação na modalidade participante eleita como forma investigativa para o desenvolvimento do estudo. Participaram 12 enfermeiros de uma UTIP do Sul do Brasil. A coleta dos dados ocorreu no período de julho a novembro de 2016, por meio de encontros e entrevistas, quando duas escalas foram utilizadas em teste piloto, sendo posteriormente eleita a escala mais apropriada à unidade. Os dados foram agrupados em categorias e posteriormente, em unidades de análise. Os resultados foram agrupados em duas temáticas principais: percepções motivadas pela implementação da escala da dor e escala da dor como coadjuvante na promoção do conforto. A utilização da Teoria do Conforto como fundamento teórico desse estudo demostrou uma estreita afinidade ao objetivo elencado, contribuindo e disseminando a real importância em proporcionar o conforto, por meio do aprimoramento do saber e da arte em realizar uma assistência de enfermagem com qualidade. Os achados evidenciaram a relevância da utilização da escala de avaliação da dor, para um cuidado efetivo de enfermagem aliado à utilização da Teoria do Conforto, a qual contribuiu com o objetivo do estudo oportunizando a promoção do conforto físico, psicoespiritual, sociocultural e/ou ambiental às crianças gravemente enfermas. Portanto, enfatiza-se que o produto gerado por esse processo investigatório foi a implementação da escala de avaliação da dor em crianças internadas em UTIP.

Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.