Child pain in pediatric intensive care unit

Uvod: Kritično bolni otroci, ki so sprejeti v pediatrično enoto intenzivnega zdravljenja, so v času hospitalizacije v ranljivem položaju. Pomembno vlogo pri oskrbi prevzemajo zdravstveni delavci. Ti morajo zaradi izvajanja številnih bolečih intervencij imeti veliko praktičnega, teoretičnega in specifičnega znanja o bolečini ter o prepoznavanju in lajšanju le-te. Sprejem otroka v enoto intenzivnega zdravljenja ne predstavlja težke situacije samo za otroka, ampak tudi za starše oz. skrbnike. Da se vzpostavi čim bolj pozitiven odnos med starši, otrokom in zdravstvenim delavcem, se po bolnišnicah uporablja koncept v družino usmerjene skrbi. Namen: Namen diplomskega dela je bil opisati bolečino pri kritično bolnem otroku. Cilji diplomskega dela so: ugotoviti, katere boleče intervencije so najpogosteje izvajane ter katere lestvice za oceno bolečine pri kritično bolnem otroku so najpogosteje uporabljene, in opisati vlogo staršev pri lajšanju bolečine. Metode dela: Pri izdelavi diplomskega dela je bila uporabljena deskriptivna metoda dela s pregledom znanstvene in strokovne literature. Domača in tuja literatura je bila iskana od decembra 2018 do julija 2019 v podatkovnih bazah MEDLINE, Cochrane, Science Direct ter z iskalnikom Google učenjak. Uporabljena je literatura iz obdobja od leta 2008 do leta 2019. Rezultati: Boleče in stresne intervencije so neizogibne v pediatrični enoti intenzivnega zdravljenja. Število in vrsta bolečih intervencij, ki se jih na dnevni ravni izvede v takšni enoti, sta odvisna od zdravstvenega stanja posameznika. Raziskave prikazujejo, da se kritično bolan otrok sreča z vsaj sedmimi bolečimi in tremi stresnimi intervencijami dnevno. Za ocenjevanje bolečine v pediatrični enoti intenzivnega zdravljenja se uporablja večdimenzionalne lestvice, ki ocenjujejo fiziološke in vedenjske kazalce. Starši sodelovanje pri izvajanju bolečih intervencij opisujejo kot pomembno in koristno za njih in njihovega otroka. Razprava in zaključek: Kritično bolan otrok je občutljiv in dovzeten za bolečinske dražljaje. Ker je bolečinski dražljaj senzorično in čustveno doživetje, ga kritično bolni otroci kažejo na več ravneh. Pogoji za uspešno prepoznavanje in lajšanje bolečine so dobro znanje zdravstvenih delavcev, opazovanje otroka, ocena bolečine s pomočjo lestvic, čim hitrejše odzivanje ter lajšanje bolečine z različnimi metodami lajšanja in vključevanje staršev.Introduction: Critically ill children admitted to the pediatric intensive care unit are in a vulnerable position at the time of hospitalization. Healthcare workers play an important role in care of these children. Because of many painful interventions, they must have a great deal of practical, theoretical and specific knowledge of pain and of identifying and alleviating pain. Admission of a child to the intensive care unit presents a difficult situation not only for the child but also for the parents or caregivers. In order to establish a positive relationship between parents, child and healthcare worker, the concept of family-centred care is used throughout hospitals. Purpose: The purpose of the thesis was to describe the pain of a critically ill child. The goals of the diploma thesis are: to find out which painful interventions are most often implemented and which pain assessment scales for critically ill children are most commonly used and to describe the role of parents in the relief of pain. Methods of work: A descriptive method of work with a review of scientific and professional literature was used to prepare the diploma thesis. Domestic and foreign literature was searched from December 2018 to July 2019 in the MEDLINE, Cochrane, Science Direct and Google Scholar databases. The literature from 2008 to 2019 is used. Results: Painful and stressful interventions are inevitable in the pediatric intensive care unit. The number and type of painful interventions performed on a daily basis in such a unit depend on the individual\u27s medical condition. Studies show that a critically ill child experiences at least seven painful and three stressful interventions a day. Multidimensional scales which assess physiological and behavioural indicators are used to evaluate pain in the pediatric intensive care unit. Parents describe their engaging in painful interventions as important and beneficial for them and their child. Discussion and conclusion: A critically ill child is sensitive and susceptible to painful stimuli. Because pain stimulus is a sensory and emotional experience, critically ill children show it on multiple levels. Conditions for successful recognition and alleviation of pain are good knowledge of healthcare workers, observation of the child, assessment of pain by using scales, quick responses and pain relief with various methods and parental involvement