La valoración del dolor en los pacientes preverbalesindicadores fisiológicos y conductuales utilizados por las enfermeras en las UCI pediátricas

Abstract

Introduction: Pain is defined as "unpleasant sensory and emotional experience, associated with tissue damage, actual or potential, or described in terms of such damage." In the face of pain, verbal communication by the patient is the ideal form of evaluation. Given the characteristics of patients younger than three years, preverbal, with communication difficulties and seriously ill, it is necessary to look for other ways to assess if they suffer pain. Objective: To know the different categories that are most used by nurses to assess pain, in children of preverbal age, admitted to Pediatric Intensive Care Units (PICU). Methodology: Descriptive, quantitative, multicentric study. This study is composed of several stages: Bibliographic review of pain assessment scales in children admitted to PICU, specifying which of them are translated and validated in Spain; Construction of an exhaustive questionnaire, from this review, and administration to a group of experts to collect and analyze the categories (physiological and behavioral / behavioral) used to assess pain in children admitted to a PICU under three years. Elaboration of a new questionnaire based on the findings of the previous work and administration to all the nurses working in the PICU of the public hospitals of the Autonomous Region of Madrid. And subsequent analysis of the categories identified through the questionnaire and its association with professional experience in pediatrics. Results: It is observed that in Spain only the scales LLANTO, CHEOPS and Susan Givens are validated psychometrically for the population of our country. The dimensions most used by nurses to think that the child in preverbal age presents pain are the vital signs (HR, RR and BP) and behavioral parameters such as crying, adopting a protective posture in the fetal position, gesture of approximation to the painful area and changes in facial expression. The results also shows that there is no association between professional experience in pediatrics and questionnaire responses. Conclusions: Participating nurses have sensitivity and clinical skills to assess pain in PICU patients; It is evident the scarcity of regulated and organized training on the approach, assessment and control of pain in childhood that is reflected in the confusion and ignorance about the numerous scales published and the rigor in the use of some of them. More studies are needed to modify and / or create, translate and validate psychometrically scales and instruments that allow to unify the form of pain assessment in preverbal children admitted to a Pediatric Intensive Care Unit.