Aspectos contextuais sobre o gerenciamento do cuidado de enfermagem à criança com dor oncológica crônica

Thiago Privado da Silva; Laura Johanson da Silva; Maria José Carvalho Ferreira; Ítalo Rodolfo Silva; Benedita Maria Rêgo Deusdará Rodrigues; Joséte Luzia Leite

Thiago Privado da Silva Universidade Federal do Rio de Janeiro (UFRJ) (Macaé, Rio de Janeiro, Brasil)
Laura Johanson da Silva Universidade Federal do Estado do Rio de Janeiro (UNIRIO) (Rio de Janeiro, Rio de Janeiro, Brasil)
Maria José Carvalho Ferreira Tenente da Marinha do Brasil (Rio de Janeiro, Rio de Janeiro, Brasil)
Ítalo Rodolfo Silva Universidade Federal do Rio de Janeiro (UFRJ) (Macaé, Rio de Janeiro, Brasil)
Benedita Maria Rêgo Deusdará Rodrigues Universidade do Estado do Rio de Janeiro (Rio de Janeiro, Rio de Janeiro, Brasil)
Joséte Luzia Leite Escola de Enfermagem Anna Nery (EEAN). Universidade Federal do Rio de Janeiro (UFRJ) (Rio de Janeiro, Rio de Janeiro, Brasil)

Palabras clave: Enfermería pediátrica, Cuidado del niño, Niño hospitalizado, Dolor crónico, Neoplasias

Key-words: Pediatric nursing, Child care, Hospitalized child, Chronic pain, Neoplasms

Palavras chave: Enfermagem pediátrica, Cuidado da criança, Criança hospitalizada, Dor crônica, Neoplasias

Resumen

Objetivo: discutir los aspectos contextuales relacionados al gerenciamiento del cuidado de enfermería para el niño hospitalizado con dolor oncológico crónico. Método: investigación de abordaje cualitativo y desarrollado con base en el referencial metodológico de la Teoría Fundamentada en Datos y en el referente teórico del Pensamiento Complejo a partir de Edgar Morin. La recolección de datos ocurrió por medio de la entrevista semiestructurada y de la observación no participante. Los 21 participantes de la investigación fueron organizados en tres grupos de muestras: el primero fue compuesto por siete enfermeros; el segundo fue constituido por siete técnicos de enfermería y el tercero fue formado por siete profesionales del equipo multiprofesional de salud. Los resultados de la investigación fueron validados por cinco examinadores y tres de ellos mostraron experiencia en el método de investigación. Resultados: la categoría titulada “Esclareciendo los aspectos contextuales sobre el gerenciamiento del cuidado de la enfermería para el niño con dolor oncológico crónico” rebeló, por medio de sus subcategorías, que la hospitalización de ese niño es larga, marcada por cambios en la dinámica familiar, pérdidas y limitaciones impuestas por la enfermedad y/o tratamiento. El gerenciamiento del cuidado de la enfermería es complejo y realizado por medio del trabajo en equipo y de la demanda de un planeamiento que valorice las múltiples necesidades del niño y del familiar. Conclusión: los resultados señalan la necesidad del profesional de enfermería de contextualizar sus relaciones de cuidado a partir de la valorización de aspectos que transcienden la dimensión biológica del niño hospitalizado y con dolor oncológico crónico

Abstract

Objective: to discuss the contextual aspects related to nursing care management of hospitalized children with chronic cancer pain. Method: a qualitative research developed and based on the methodological framework of the Grounded Theory and the Complex Thought theoretical framework of Edgar Morin. Data were collected through a semi-structured interview and non-participant observation. The 21 participants of the research were organized into three sample groups: the first was composed of seven nurses; the second was made up of seven nurse technicians and the third was formed by seven professionals from the multiprofessional health team. The results of the research were validated by five examiners, three of whom were experts in the research method. Results: the “Unveiling contextual aspects of nursing care management of children with chronic cancer pain” category and subcategories revealed that hospitalization of these children is long and is marked by changes in family dynamics, losses and limitations imposed by the disease and / or treatment. Nursing care management is complex, performed through teamwork and requires planning that values the various needs of the child and the family. Conclusion: the results show that nursing professionals must contextualize their care relationships, by putting value on the aspects that transcend the biological dimension of hospitalized children with chronic cancer pain

Resumo

Objetivo: discutir os aspectos contextuais relacionados ao gerenciamento do cuidado de enfermagem à criança hospitalizada com dor oncológica crônica. Método: pesquisa de abordagem qualitativa, desenvolvida com base no referencial metodológico da Teoria Fundamentada em Dados e no referencial teórico do Pensamento Complexo, a partir de Edgar Morin. A coleta de dados ocorreu por meio da entrevista semiestruturada e da observação não participante. Os 21 participantes da pesquisa foram organizados em três grupos amostrais: o primeiro foi composto por sete enfermeiros; o segundo foi constituído por sete técnicos de enfermagem e o terceiro foi formado por sete profissionais da equipe multiprofissional de saúde. Os resultados da pesquisa foram validados por cinco examinadores, dos quais três apresentavam expertise no método de pesquisa. Resultados: a categoria intitulada “Desvelando aspectos contextuais sobre o gerenciamento do cuidado de enfermagem à criança com dor oncológica crônica” revelou por meio de suas subcategorias que a hospitalização dessa criança é longa, marcada por mudanças na dinâmica familiar, perdas e limitações impostas pela doença e/ou tratamento. O gerenciamento do cuidado de enfermagem é complexo, realizado por meio do trabalho em equipe e da demanda um planejamento que valorize as múltiplas necessidades da criança e do familiar. Conclusão: os resultados apontam para a necessidade do profissional de enfermagem contextualizar suas relações de cuidado, a partir da valorização de aspectos que transcendem a dimensão biológica da criança hospitalizada com dor oncológica crônica

Bibliografía

1. Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Incidência, mortalidade, morbidade hospitalar por câncer em crianças, adolescentes e adultos jovens no Brasil: informações dos registros de câncer e do sistema de mortalidade [Internet]. 2016 [cited 2017 Feb 23]. Available from: http://www1. inca.gov.br/inca/Arquivos/incidencia-mortalidademorbidade- hospitalar-por-cancer.pdf
2. Reis RS, Santos MO, Camargo B, Oliveira JFP, Thuler LCS, Pombo-de-Oliveira MS. Early childhood leukemia incidence trends in Brazil. Pediatr Hematol Oncol [Internet]. 2016 [cited 2017 Sep 08]; 33(2):83-93. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/26925506
3. Ward E, De Santis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin [Internet]. 2014 [cited 2017 Feb 22]; 64(2):83-103. Available from: https://www.ncbi.nlm. nih.gov/pubmed/24488779
4. Van Cleve L, Muñoz CE, Savreda M, Riggs M, Bosset E, Grant M, et al. Symptoms in children with advanced cancer. Cancer Nurs [Internet]. 2012 [cited 2017 Feb 22]; 35(2):115-25. Available from: https://www.ncbi. nlm.nih.gov/pubmed/21760496
5. Fortier MA, Wahi A, Bruce C, Maurer EL, Stevenson R. Pain Management at home in children with cancer: a daily diary study. Pediatr Blood Cancer [Internet]. 2014 [cited 2017 Feb 22]; 61(6):1029-33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24376073
6. Olagunju AT, Sarimiye FO, Olagunju TO, Habeedu MYM, Aina OF. Child’s symptom burden and depressive symptoms among caregivers of children with cancers: an argument for early integration of pediatric palliative care. Ann Palliat Med [Internet]. 2016 [cited 2017 Sep 08]; 5(3):157-65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27199271
7. World Health Organization (WHO). WHO guidlines on the pharmacological treatment of persisting pain in children with medical illnessess [Internet]. 2012 [cited 2017 Feb 22]. Available from: http://whqlibdoc.who. int/publications/2012/9789241548120_Guidelines. pdf
8. American Pain Society (APS). Assessment and management of children with chronic pain. [Internet]. 2012 [cited 2017 Feb 22]. Available from: http://www. americanpainsociety.org/uploads/pdfs/aps12-pcp. pdf
9. Morin E. O método 5: a humanidade da humanidade. 5ª ed. Porto Alegre (RS): Sulina; 2012.
10. Afshan G, Bashir K. Cancer pain in children: a twostep strategy. Anaesthesia Pain & Intensive Care [Internet]. 2014 [cited 2017 Feb 22]; 18(1):106-10. Available from: http://www.apicareonline.com/ special-article-cancer-pain-in-children-a-two-stepstrategy/
11. Batalha LMC, Fernandes AM, Campos C, Gonçalves AMPMPC. Pain assessment in children with cancer: a systematic review. J Nurs Ref [Internet]. 2015 [cited 2017 Feb 22]; 4(5):119-27. Available from: https:// rr.esenfc.pt/rr/index.php?module=rr&target=pu blicationDetails&pesquisa=&id_artigo=2516&id_ revista=24&id_edicao=78
12. Jones P, Blunda M, Biegel B, Carlson LE, Biel M, Wiener L. Can mindfulness-based interventions help adolescents with cancer? Psychooncology [Internet]. 2013 [cited 2017 Feb 22]; 22(9):2148-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23417883
13. Neale KL. The fifth vital sign: chronic pain assessment of the adolescent oncology patient. J Pediatr Oncol Nurs [Internet]. 2012 [cited 2017 Feb 22]; 29(4):185- 98. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/22797680
14. Tarozzi, M. O que é a grounded Theory: metodologia de pesquisa e de teoria fundamentada nos dados. Petrópolis (RJ): Vozes; 2011.
15. Strauss AL, Corbin J. Pesquisa qualitativa: técnicas e procedimentos para o desenvolvimento de teoria fundamentada. 2ª ed. Porto Alegre (RS): Artmed; 2008.
16. Petrorius A, Searle J, Marshall B. Barriers and enablers to emergency departament nurses´ management of patients´ pain. Pain Manag Nurs [Internet]. 2015 [cited 2017 Feb 22]; 16(3):372-9. Available from: https:// www.ncbi.nlm.nih.gov/pubmed/25440235
17. Santos JLG, Pestana AL, Guerrero P, Meirelles BSH, Erdmann AL. Nurses´practices in the nursing and health care management: integrative review. Rev Bras Enferm [Internet]. 2013 [cited 2017 Feb 22]; 66(2):257-63. Available from: http:// www.scielo.br/scielo.php?script=sci_arttext&pid =S0034-71672013000200016
18. Gray WN, Szulczewski LJ, Regan SM, Williams JA, Pai AL. Cultural influences in pediatric cancer from diagnosis to cure/end of life. J Pediatr Oncol Nurs [Internet]. 2014 [cited 2017 Feb 22]; 31(5):252-71. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/25299000
19. Battista AD, Dupuis LL, Cassidy M, Portwine C, Johnston DL, Silva MP, et al. Parent attributions about child symptoms related to cancer therapy. J Pediatr Oncol Nurs [Internet]. 2016 [cited 2017 Sep 08]; pii:104345215628002. Available from: https:// www.ncbi.nlm.nih.gov/pubmed/26825448
20. Popp JM, Conway M, Pantaleao A. Parents’ experience with their child’s cancer diagnosis: do holpefulness, family functioning, and perceptions of care matter? J Pediatr Oncol Nurs [Internet]. 2015 [cited 2017 Feb 22]; 32(4):253-60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25556107
21. Brannstrom CA, Norberg A. Children undergoing cancer treatment describe their experiences of comfort in interviews and drawings. J Pediatr Oncol Nurs [Internet]. 2014 [cited 2017 Feb 22]; 31(3):135-46. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/24651546
22. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, et al. European Palliative Care Research Collaborative (EPCRC). Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol [Internet]. 2012 [cited 2017 Feb 22]; 13(2):58-68. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/22300860
23. Silva TP, Silva MM, Silva LJ, Silva IR, Leite JL. Contextual especificities of nursing care to hospitalized children with chronic condition. Cienc Cuid Saude [Internet]. 2015 [cited 2017 Feb 22]; 14(2):1082-90. Available from: http://periodicos.uem.br/ojs/index. php/CiencCuidSaude/article/view/23814/14719
24. Gomes IP, Lima KA, Rodrigues LV, Lima RAG, Collet N. From diagnosis to survival of pediatric cancer: children´s perspective. Texto Contexto Enferm [Internet]. 2013 [cited 2017 Feb 22]; 22(3):671- 9. Available from: http://www.scielo.br/pdf/tce/ v22n3/en_v22n3a13.pdf
25. Sousa MLXF, Reichert APS, Sá LD, Assolini FEP, Collet N. Stepping into a new world: the meaning of sicken for the child with cancer. Texto Contexto Enferm [Internet]. 2014 [cited 2017 Feb 22]; 23(2):391- 9. Available from: http://www.scielo.br/pdf/tce/ v23n2/pt_0104-0707-tce-23-02-00391.pdf
26. Nikfarid L, Rassouli M, Borimnejad L, Alavimajd H. Chronic sorrow in mothers of children with cancer. J Pediatr Oncol Nurs [Internet]. 2015 [cited 2017 Feb 22]; 32(5):314-9. Available from: https://www.ncbi. nlm.nih.gov/pubmed/25576316
27. Viero V, Beck CLC, Coelho APF, Lima SBS, Machado BP. Coping of children with cancer on school removal because of hospitalization. Rev Enferm UFSM [Internet]. 2014 [cited 2017 Feb 22]; 42(2):368-77. Available from: https://periodicos.ufsm.br/reufsm/ article/view/10956/pdf
28. Silva LF, Cabral IE. Cancer repercussions on play in children: implications for nuring care. Texto Contexto Enferm [Internet]. 2014 [cited 2017 Feb 22]; 23(4):935- 43. Available from: http://www.scielo.br/pdf/tce/ v23n4/pt_0104-0707-tce-23-04-00935.pdf
29. Silva LF, Cabral IE. Rescuing the pleasure of playing of child with cancer in a hospital setting. Rev Bras Enferm [Internet]. 2015 [cited 2017 Feb 22]; 68(3):391- 7. Available from: http://www.scielo.br/pdf/reben/ v68n3/0034-7167-reben-68-03-0391.pdf
30. Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective. Am Psychol [Internet]. 2014 [cited 2017 Feb 22]; 69(2):142-52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24547800
31. Wiener L, Viola A, Kearney J, Mullins LL, Sherman- Bien S, Zadeh S, et al. Impact of caregiving for a child with cancer on parenteral health behaviours, relationship quality, and spiritual faith: do lone parents fare worse? J Pediatr Oncol Nurs [Internet]. 2015 [cited 2017 Sep 08]; 33(5)378-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26668211
32. Atlay N, Kilicarslan E, Sari Ç, Kisecik Z. Determination of social support needs and expectations of mothers of children with cancer. J Pediatr Oncol Nurs [Internet]. 2014 [cited 2017 Feb 22]; 31(3):147-53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24647009
33. O’Shea ER, Shea J, Robert T, Cavanaugh C. The needs of siblings of children with cancer: a nursing perspective. J Pediatr Oncol Nurs [Internet]. 2012 [cited 2017 Feb 22]; 29(4):221-31. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22797684
34. Zegaczewski T, Chang K, Coddington J, Berg A. Factors related to healthy siblings psychosocial adjustment to children with cancer: an integrative review. J Pediatr Oncol Nurs [Internet]. 2015 [cited 2017 Sep 08]; 33(3):218-27. Available from: https:// www.ncbi.nlm.nih.gov/pubmed/26483426
35. World Health Organization (WHO). Global atlas of palliative care at the end of life [Internet]. 2014 [cited 2017 Feb 22]. Available from: http://www.who.int/ nmh/Global_Atlas_of_Palliative_Care.pdf
36. Borghi CA, Rossato LM, Damião EB, Guedes DM, Silva EM, Barbosa SM, et al. Living with pain: the experience of children and adolescents in palliative care. Rev Esc Enferm USP [Internet]. 2014 [cited 2017 Feb 22]; 48(esp):68-74. Available from: http://www. scielo.br/pdf/reeusp/v48nspe/pt_0080-6234-reeusp- 48-esp-068.pdf
37. Downing J, Jassal SS, Mathews L, Brits H, Friedrichsdorf SJ. Pediatric pain management in palliative care. Pain Manag [Internet]. 2015 [cited 2017 Sep 08]; 5(1):23-35. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/25537696
38. Rodrigues AJ, Bushatsky M, Viaro WD. Palliative care in children with cancer: integrative review. J Nurs UFPE on line [Internet]. 2015 [cited 2017 Sep 08]; 9(2):718-30. Available from: http://www.revista.ufpe. br/revistaenfermagem/index.php/revista/article/ view/7129/pdf_7201
39. Mariotti H. Pensando diferente: para lidar com a complexidade, a incerteza e a ilusão. São Paulo (SP): Atlas; 2010.
40. Souza e Souza LP, Ribeiro JM, Rosa RB, Gonçalves RCR, Silva CSO, Barbosa DA. Death and the dying process feelings expressed by nurses. Enferm Global [Internet]. 2013 [cited 2017 Sep 08]; 12(32):230-37. Available from: http://scielo.isciii.es/pdf/eg/ v12n32/pt_administracion4.pdf
41. Silva MM, Vidal JM, Leite JL, Silva TP. Estratégias de cuidados adotados por enfermeiros na atenção à criança hospitalizada com câncer avançado e no cuidado de si. Cienc Cuid Saude [Internet]. 2014 [cited 2017 Feb 22]; 13(3):471-8. Available from: http:// periodicos.uem.br/ojs/index.php/CiencCuidSaude/ article/view/19937
42. Reis TLR, Paula CC, Potrich C, Padoin SMM, Bin A, Mutti CF, Bubadué RM. Relações estabelecidas pelos profissionais de enfermagem nos cuidados às crianças com doença oncológica avançada. Aquichan [Internet]. 2014 [cited 2017 Feb 22]; 14(4):496-508. Available from: http://aquichan.unisabana.edu.co/ index.php/aquichan/article/view/3070/pdf
43. Mutti CF, Padoim SMM, Paula CC. Spaciality of beingnursing- professional in the world of caring to children who has cancer. Esc Anna Nery Rev Enferm [Internet]. 2012 [cited 2017 Feb 22]; 16(3):493-9. Available from: http://www.scielo.br/pdf/ean/v16n3/10.pdf
44. Viero V, Beck CLC, Coelho APF, Pai DP, Freitas PH, Fernandes MNS. Pediatric oncology nursing workers: the use of defensive strategies at work. Esc Anna Nery [Internet]. 2017 [cited 2017 Sep 08]; 21(4):e20170058. Available from: http://www.scielo.br/pdf/ean/ v21n4/1414-8145-ean-2177-9465-EAN-2017-0058.pdf
45. Silva TP, Silva MM, Valadares GV, Silva IR, Leite JL. Nursing care management for children hospitalized with chronic conditions. Rev Bras Enferm [Internet]. 2015 [cited 2017 Feb 22]; 68(4):556-63. Available from: http://www.scielo.br/pdf/reben/v68n4/en_0034- 7167-reben-68-04-0641.pdf
46. Silva TP, Leite JL, Santos NLP, Silva IR, Mendonça ACA, Santos MJM, et al. Nursing care to the child with cancer: an integrative review of the literature. Rev Enferm UFSM [Internet]. 2013 [cited 2017 Feb 22]; 3(1):68-78. Available from: https://periodicos.ufsm. br/reufsm/article/view/6918

Aspectos contextuais sobre o gerenciamento do cuidado de enfermagem à criança com dor oncológica crônica

Contextual aspects related to nursing care management of the child with chronic cancer pain

Aspectos contextuales sobre el gerenciamiento del cuidado de la enfermería para el niño con dolor oncológico crónico

Resumen

Abstract

Resumo

Bibliografía