Implementación de prácticas basadas en evidencias para manejar el dolor perineal durante el período posparto

Tomaz, Raquel Gomes de Oliveira; Brito, Ana Paula Almeida; Riesco, Maria Luiza Gonzalez

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (2) • 2022 • https://doi.org/10.1590/0034-7167-2021-0084 copiar

Implementación de prácticas basadas en evidencias para manejar el dolor perineal durante el período posparto

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

Implementar estrategias para manejar el dolor perineal en puérperas en una maternidad pública de São Paulo y evaluar su conformidad con prácticas basadas en evidencias.

Métodos:

Estudio de implementación realizado mediante el modelo JBI con profesionales de enfermería y puérperas, entre septiembre-diciembre de 2019. Se utilizaron entrevistas con puérperas y datos de registros hospitalarios para auditar siete criterios basados en evidencias. Las intervenciones fueron: protocolo de atención; capacitación de los profesionales; preparación de una carpeta para puérperas.

Resultados:

Antes de la intervención, se identificaron déficits en las prácticas y barreras en el manejo del dolor, que se superaron con las estrategias empleadas. La auditoría de seguimiento trajo mejoras en el cumplimiento de las prácticas de cuidado.

Conclusiones:

Hubo aumento en la conformidad de los criterios evaluados tras las estrategias implementadas, lo que contribuyó a mejorar la atención de enfermería en el manejo del dolor perineal basada en evidencias científicas.

Descriptores:
Capacitación en Servicio; Dolor; Perineo; Periodo Posparto; Práctica Clínica Basada en la Evidencia

Audit Criteria	Sample	Method used to measure % compliance with best practices
1. Did the nursing staff receive education on the puerperal woman's guidance for perineal care?	Nursing Professionals baseline audit: n=41 follow-up audit: n=41	Interview with staff to determine their knowledge. It was considered as compliant if the professional answers were "yes".
2. Were ice packs implemented for perineal pain in the first 24-72 hours after birth?	Puerperal women baseline audit: n=81 follow-up audit: n=88	Medical record analysis, by observing records on ice pack implementation. It was considered compliant if there was an entry in the medical record.
3. Was daily assessment/monitoring of perineal pain performed after birth?	Puerperal women baseline audit: n=81 follow-up audit: n=88	Medical record analysis, by observing assessment records on perineal pain. It was considered compliant if there was an entry in the medical record.
4. Were oral analgesics prescribed for pain relief offered to women with postpartum perineal pain?	Puerperal women baseline audit: n=81 follow-up audit: n=88	Medical record analysis, by observing records on oral analgesics administration. It was considered compliant if there was an entry in the medical record.
5. Did women receive education about postnatal perineal care?	Puerperal women baseline audit: n=81 follow-up audit: n=88	Interview with women to determine if they had received education about postnatal perineal care It was considered compliant if the puerperal women answers were "yes".
6. Were prescribed oral opioids offered when oral analgesics are not sufficient for pain relief?	Puerperal women baseline audit: n=81 follow-up audit: n=88	It was considered according to whether there was a record in the medical record. Not applicable when the woman does not report pain or when oral analgesics are sufficient for pain relief.
7. If an oral opioid was being considered, did women and their families receive counseling about its risks, benefits, and toxicity signs?	Puerperal women baseline audit: n=81 follow-up audit: n=88	Interview with puerperal women. It was considered compliant if the puerperal claimed to have received orientation and was not applicable if an oral opiate was not needed.

Obstacles Encountered	Strategies	Resources	Results
Non-existence of institutional protocol	Elaboration of a protocol, together with the teaching and quality service, on the postpartum perineal pain management.	Computer with Internet; books on NANDA-I, NOC, and NIC	The protocol has been implemented and is available on the hospital's intranet.
Nursing professionals' lack of knowledge	An educational program, in the form of training, on evidence-based best practices.	Computer with Internet; meeting room	100% of the nursing staff trained.
No registry on perineal pain assessment and the application of ice packs	Reinforcement, through educational video. Elaboration and fixation of the flowchart for registry on perineal pain assessment in the puerperal women's medical chart.	Computer with Internet; printer with black ink and bond paper	Flowchart elaboration and 100% of the nursing team trained.
Puerperal woman's lack of knowledge about perineal care	Elaboration and fixation in educational folder wards, containing the main orientations related to perineal care.	Computer with Internet; printer with color ink and bond paper	Educational folders were fixed in 100% of the wards, in a place visible to all puerperal women.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Raquel Gomes de Oliveira Tomaz. E-mail: got.raquel@gmail.com