Elaboração e Implementação de Protocolos de Avaliação da Dor em Pacientes em Cuidados Paliativos

Abstract

Introduction: population ageing and the development of new technologies for diagnosing and discovering new diseases have been involving the reality of health care and demanding an approach that seeks to improve the quality of life of patients and their families facing the imminence of death through prevention and relief of symptoms and suffering during this process. One of the biggest problems addressed is the treatment of pain, which is related to the difficulty of measuring it and its diagnosis in its various aspects, be it physical, emotional, social and spiritual. Currently, several scales help in the assessment of pain in the reality of care institutions. However, there must be a complete tool to assess pain thoroughly, evidencing the lack of studies in this area. Objective: to develop and implement a Pain Assessment Protocol in health institutions that assist patients in Palliative Care. Materials and Methods: this methodological study was developed in two health units that assist patients in Palliative Care, Ashbury Nursing Home in Ireland and Policlínica Santa Maria in Brazil. It took place between October 2022 and April 2023, totalling 504 hours of contact. The sample had 17 patients after selection by the leading researcher of this study, according to the research eligibility criteria: adult patients over 18 years old admitted to the health institutions mentioned above. Included in this protocol was an instrument to be completed based on eight scales (Visual Numerical Scale, Visual Analog Scale, Faces Scale, Brief Pain Inventory, McGill Scale, Bristol Scale, Palliative Performance Scale and Palliative Prognostic Index), to assess pain and provide better assistance to patients in terms of physical, emotional and social skills. A quantitative, descriptive and cross-sectional research study was carried out. Descriptive statistics were used through frequencies and percentages for categorical and median variables and interquartile range to describe quantitative variables. Spearman's coefficient of influence was calculated to study the association of quantitative variables, which did not show normal distribution. Discussion/Conclusion: during the internship, the investigator was able to monitor 28 patients who were under Palliative Care, with neoplasms being the disease with the highest prevalence of observed cases, followed by cardiorespiratory diseases. It was observed that 38 patients required palliative interventions in daily activities due to pain, insomnia, dyspnea, and mental confusion. The protocol was applied to 17 patients where the pain was observed in all cases included in the study through the use of the Numerical Scale, the Analog Scale and the Faces Scale. The pain was observed in 100% of patients admitted to the Brief Pain Inventory. According to the McGill Scale, the patients presented physical and psychological pain. The Bristol Scale was used to monitor bowel movements and pain caused by constipation in patients at some point in the study. The Palliative Performance Scale and Palliative Prognóstic Index were used to assess the ability to carry out the activities developed and the prognosis of the patients and to outline a better therapeutic plan for the period. This protocol represents a valuable tool for the clinical practice of Palliative Care in institutions that are starting to develop these activities and provides a support tool for future studies. Descriptors: Nursing. Oncology Nurse. Palliative care. Methodological studies.