Intervenção do palhaço hospitalar na redução da percepção da dor e ansiedade em pacientes de oncologia pediátrica antes da punção lombar.

Conteúdo do artigo principal

Karina Senyase Zamarripa Martínez
Gabriela Navarro Contreras
Carolina Villada Rodriguez
Resumo

Pacientes com doenças crônicas frequentemente enfrentam procedimentos potencialmente estressantes e invasivos como parte do tratamento. Palhaços hospitalares têm se mostrado um recurso valioso para melhorar aspectos psicológicos e emocionais em pacientes crônicos. O objetivo deste estudo foi avaliar o efeito do palhaço hospitalar na ansiedade e na percepção da dor em pacientes pediátricos com leucemia linfoblástica aguda (LLA) antes da punção lombar. Para isso, foi elaborado um protocolo quase-experimental com a intervenção do palhaço hospitalar. A amostra foi composta por 17 pacientes pediátricos com LLA, com idades entre 4 e 16 anos (Média=8,93 e Desvio Padrão=4,11). Os participantes foram avaliados usando a escala de dor Wong-Baker FACES e o instrumento de autoavaliação SAM, antes e depois da punção lombar sem intervenção, e depois de aproximadamente 6-8 semanas com a intervenção dos palhaços hospitalar. Foi realizado uma ANOVA de medidas repetidas com 2 fatores intra-sujeito. Os resultados mostraram uma diminuição significativa nos níveis de percepção da dor e ansiedade nos pacientes após a intervenção. Pode-se concluir que a intervenção do palhaço hospitalar pode ser uma ferramenta eficaz para reduzir os níveis de percepção da dor e ansiedade nesse tipo de paciente. Essas descobertas destacam a importância de criar ambientes adequados em contextos hospitalares, o que beneficiará a saúde mental de crianças com doenças crônicas. Destaca-se a necessidade de realizar mais estudos, incluindo medidas fisiológicas, para apoiar essas descobertas em outros contextos e com outras populações.

Downloads

Não há dados estatísticos.

Detalhes do artigo

Referências

Anes, L., & Obi, M. (2014). Hospital Clowning as Play Stimulus in Healthcare. Children (Basel, Switzerland), 1(3), 374–389. https://doi.org/10.3390/children1030374 DOI: https://doi.org/10.3390/children1030374

Bennett, M., Zeller, J., Rosenberg, L., & McCann, J. (2003). The effect of mirthful laughter on stress and natural killer cell activity. Altern Ther Health Med, 9(2), 38–45. http://digitalcommons.wku.edu/nurs_fac_pub/9

Ben-Pazi, H., Cohen, A., Kroyzer, N., Lotem-Ophir, R., Shvili, Y., Winter, G., Deutsch, L., & Pollak, Y. (2017). Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- A quasi-randomized controlled crossover study. PLoS ONE, 12(4). https://doi.org/10.1371/journal.pone.0175028 DOI: https://doi.org/10.1371/journal.pone.0175028

Bradley, M., & Lang, P. (1994). Measuring emotion: The self-assessment manikin and the semantic differential. Journal of Behavior Therapy and Experimental Psychiatry, 25, 49–59. DOI: 10.1016/0005-7916(94)90063-9 DOI: https://doi.org/10.1016/0005-7916(94)90063-9

Caci, L., Zander-Schellenberg, T., & Gerger, H. (2023). Effectiveness of hospital clowning on pediatric anxiety and pain: Network meta-analysis. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 42(4), 257–269. https://doi.org/10.1037/hea0001285 DOI: https://doi.org/10.1037/hea0001285

Campbell, D., & Stanley, J. (1963). Experimental and quasi-experimental designs for research on teaching. (In N. L. Gage). Handbook of research on teaching. https://www.sfu.ca/~palys/Campbell&Stanley-1959-Exptl&QuasiExptlDesignsForResearch.pdf

Dowling, J. S., Hockenberry, M., & Gregory, R. L. (2003). Sense of humor, childhood cancer stressors, and outcomes of psychosocial adjustment, immune function, and infection. Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses, 20(6), 271–292. https://doi.org/10.1177/1043454203254046 DOI: https://doi.org/10.1177/1043454203254046

Fernández Hawrylak, M., Heras Sevilla, D., Cepa Serrano, A., & Bastida Susinos, J. (2017). Uso del humor como método de intervención terapéutica. En menores afectados por procesos oncológicos. Revista De Pedagogía De La Universidad De Salamanca, 23, 91–105. https://doi.org/10.14201/aula20172391105 DOI: https://doi.org/10.14201/aula20172391105

García, L. Y., Meléndez, J. V., & Valenzuela, D. K. (2016). Intervención de la risoterapia en el dolor del paciente en edad escolar diagnósticado con Leucemia Linfoblástica Aguda. Universidad Peruana Cayyetano Heredia. https://hdl.handle.net/20.500.12866/681

Ibarra, J. (2020). Día Mundial Contra el Cáncer Infantil. https://santafe.lat/cancer-infantil/

Jones, B., Currin-Mcculloch, J., Pelletier, W., Sardi-Brown, V., Brown, P., & Wiener, L. (2018). Psychosocial standards of care for children with cancer and their families: A national survey of pediatric oncology social workers. Social work in health care, 57(4), 221–249. https://doi.org/10.1080/00981389.2018.1441212 DOI: https://doi.org/10.1080/00981389.2018.1441212

INEGI. (2021, February 4). Estadísticas a propósito del día mundial contra el cáncer(4 de Febrero). https://www.inegi.org.mx/contenidos/saladeprensa/aproposito/2021/cancer2021_Nal.pdf

Karisalm, N., Mäenpää, K., Kaipio, J., & Lahdenne, P. (2020). Measuring patient experiences in a Children’s hospital with a medical clowning intervention: a case-control study. BMC Health Services Research, 360(20). https://doi.org/10.1186/s12913-020-05128-2 DOI: https://doi.org/10.1186/s12913-020-05128-2

Koller, D., & Gryski, C. (2008). The life threatened child and the life enhancing clown: Towards a model of therapeutic clowning. Evidence-Based Complementary and Alternative Medicine, 6(1), 17–25. https://doi.org/10.1093/ecam/nem033 DOI: https://doi.org/10.1093/ecam/nem033

Kristensen, H. N., Sørensen, E. E., Stinson, J., & Haslund‐Thomsen, H. (2019). An ongoing WE: A focused ethnographic study of the relationship between child and hospital clown during recurrent pain‐related procedures and conditions. Paediatric and Neonatal Pain, 2(1), 5–14. https://doi.org/10.1002/pne2.12005 DOI: https://doi.org/10.1002/pne2.12005

Lancheros, E., Tovar, J., & Rojas, C. (2011). Laughter and health: therapeutic approaches. Med UNAB, 14(1), 69–75. https://biblat.unam.mx/hevila/Medunab/2011/vol14/no1/8.pdf

Lopes-Júnior, L. C., Bomfim, E., Olson, K., Neves, E. T., Silveira, D. S. C., Nunes, M. D. R., Nascimento, L. C., Pereira-Da-Silva, G., & Lima, R. A. G. (2020). Effectiveness of hospital clowns for symptom management in paediatrics: Systematic review of randomised and non-randomised controlled trials. BMJ (Clinical research ed.), 371, m4290. https://doi.org/10.1136/bmj.m4290 DOI: https://doi.org/10.1136/bmj.m4290

Lopes-Junior, L. C., Silveira, D. S. C., Olson, K., Bomfim, E. O., Veronez, L. C., Santos, J. C., Alonso, J. B., Nascimento, L. C., Pereira-Da-Silva, G., & Lima, R. A. G. (2020). Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients with Cancer Undergoing Chemotherapy. Cancer Nursing, 43(4), 290–299. https://doi.org/10.1097/NCC.0000000000000690 DOI: https://doi.org/10.1097/NCC.0000000000000690

Maratos, A. S., Gold, C., Wang, X., & Crawford, M. J. (2008). Music therapy for depression. The Cochrane database of systematic reviews, (1), CD004517. https://doi.org/10.1002/14651858.CD004517.pub2 DOI: https://doi.org/10.1002/14651858.CD004517.pub2

Ministerio de Salud. (2010). Guía Clínica Leucemia en menores de 15 años. https://www.minsal.cl/portal/url/item/7220fdc433e944a9e04001011f0113b9.pdf

Newman, N., Kogan, S., Stavsky, M., Pintov, S., & Lior, Y. (2019). The impact of medical clowns exposure over postoperative pain and anxiety in children and caregivers: An Israeli experience. Pediatric Reports, 11(3), 44–48. https://doi.org/10.4081/pr.2019.8165 DOI: https://doi.org/10.4081/pr.2019.8165

Organización Panamericana de la Salud [OPS]. (2022, February 15). El 55% de los niños y adolescentes con cáncer se curan en América Latina y el Caribe. Día internacional contra el cáncer infantil. https://www.paho.org/es/temas/cancer-ninez-adolescencia

Osorio-Sandoval, J. A., Torres Reyes, A., Tenahua-Quitl, I., De-Ávila-Arroyo, M. L., Morales-Castillo, Francisco.-A., García-López, M. A., Gracía-Verónica, R., & González-Hernández, A. R. (2019). Efectividad de la risaterapia en manejo el dolor en pacientes pediátricos postoperados de apendicetomía. Journal Health NPEPS, 4(2), 44–57. https://doi.org/10.30681/252610103698 DOI: https://doi.org/10.30681/252610103698

Pai, A. L. H., McGrady, M., & Ventura, A. K. (2016). Psychological Interventions to Improve Adherence to Oral Medications in Adolescents With Chronic Conditions: A Systematic Review. Journal of Pediatric Psychology, 41(8), 859-874. doi: 10.1093/jpepsy/jsw007. DOI: https://doi.org/10.1093/jpepsy/jsw007

Quesada, C., Belén, A., Díaz, J., Dolores, M., López, R., Berbén, G., & Trinidad, M. (2014). La enfermedad crónica infantil. Repercusiones emocionales en el paciente y la familia. International Journal of Developmental and Educational Psychology INFAD Revista de Psicología, No1, 4(0214–9877), 569–576. https://www.redalyc.org/articulo.oa?id=349851787062 DOI: https://doi.org/10.17060/ijodaep.2014.n1.v4.832

Salinas Morales, C. A. (2007). Efectividad de la risoterapia en el estado de ánimo y percepción del dolor en niños hospitalizados. In Lexus (Vol. 4, Issue None). http://dspace.unitru.edu.pe/handle/UNITRU/13340

Sánchez, C. A. V., & Lozano, J. A. F. (1995). El niño ante el hospital. Programas para reducir la ansiedad hospitalaria. Universidad de Oviedo.

https://books.google.com.mx/books?id=zzfIWcPmBV4C&printsec=frontcover&hl=es&source=gbs_vpt_buy#v=onepage&q&f=false

Sridharan, K., & Sivaramakrishnan, G. (2016). Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials. European journal of pediatrics, 175(10), 1353–1360. https://doi.org/10.1007/s00431-016-2764-0 DOI: https://doi.org/10.1007/s00431-016-2764-0

Taddio, A., Soin, H. K., Schuh, S., Koren, G., & Scolnik, D. (2005). Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: A randomized controlled trial. CMAJ: Canadian Medical Association Journal = Journal de L´Associatioon Medicale Canadienne, 172(13), 1691–1695. https://doi.org/10.1503/cmaj.045316 DOI: https://doi.org/10.1503/cmaj.045316

Tan, S., Tan, L., Lukman, S., & Berk; Lee. (2007). Humor, as an adjunct therapy in cardiac rehabilitation, attenuates catecholamines and myocardial infarction recurrence. Adv Mind Body Med ., 22(3–4), 8–12. https://pubmed.ncbi.nlm.nih.gov/20664127/

Vagnoli, L., Caprilli, S., Robiglio, A., & Messeri, A. (2005). Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics, 116(4), e563-e567. https://doi.org/10.1542/peds.2005-0466 DOI: https://doi.org/10.1542/peds.2005-0466

Vagnoli, L., Caprilli, S., & Messeri, A. (2010). Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option?. Pediatric Anesthesia, 20(10), 937-943. https://doi.org/10.1111/j.1460-9592.2010.03403.x DOI: https://doi.org/10.1111/j.1460-9592.2010.03403.x

Vessey, J. A., Carlson, K. L., MacKinnon, M. J., & Tudiver, F. (2002). Pediatric stress and parental perceptions during invasive procedures. Pediatric Nursing, 28(5), 453-459.

https://doi.org/10.1177/089431841984539

Wong, D. L., & Baker, C. M. (1988). Pain in children: comparison of assessment scales. Pediatric nursing, 14(1), 9–17. https://pubmed.ncbi.nlm.nih.gov/3344163/

Wong-Baker FACES Foundation. (1988). Wong-Baker FACES® Pain Rating Scale. https://wongbakerfaces.org DOI: https://doi.org/10.1037/t05330-000

Citaciones