Brinquedoteca em hospital pediátrico: diminuição do estresse agudo e crônico e a relação com o sono da criança
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Data
2013-09-25
Autores
Potasz, Clarisse [UNIFESP]
Orientadores
Prado, Gilmar Fernandes do [UNIFESP]
Tipo
Tese de doutorado
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ISSN da Revista
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OBJETIVOS Estudar como uma intervenção como a brincadeira livre, influencia o estresse e o sono de crianças internadas por doenças respiratórias infecciosas, em enfermarias comuns. MÉTODOS Foram estudadas crianças internadas num hospital público pediátrico da cidade de São Paulo, nas faixas etárias de 4 a 14 anos, de ambos os sexos. Todas as crianças incluídas na pesquisa deveriam ser internadas com o diagnóstico de doenças infecciosas respiratórias, sem outras comorbidades neurológicas ou psiquiátricas e sem restrições à locomoção. Fez parte dos critérios de inclusão, estar acompanhada por um cuidador capaz de responder aos questionários e fichas usados, e não fazer uso (previamente ou durante a internação) de medicamentos que pudessem alterar os níveis de cortisol ou influenciar os padrões de sono. A amostra foi estratificada segundo faixas etárias e a participação ou não em atividades de brincadeiras livres. Foram estudados os níveis de cortisol na urina de 24 horas, os padrões de sono através de diários do sono e o sono em casa, usando-se um questionário validado no Brasil. Para estudarmos os valores do cortisol antes e após a intervenção do brincar, determinamos uma estadia mínima de cinco dias no hospital. Para a participação no segundo estudo – sono e brincar- foi determinado que as crianças estivessem sempre acompanhadas por um cuidador que pudesse preencher os diários do sono por ao menos três dias de internação. E para o estudo comparando sono em casa e no hospital, estabelecemos um período mínimo de dois dias de internação, além do cuidador capaz de responder aos questionários. RESULTADOS A amostra apresentou dados demográficos equilibrados, totalizando 139 crianças. Destas, 53 participaram no estudo que incluiu o exame dos níveis de cortisol na urina de 24 horas, 131 participaram na pesquisa que avaliou o sono em crianças que brincaram e que não brincaram, e em 139 foram comparados os parâmetros do sono em casa e no hospital. Esta diferença nos números de crianças estudadas ocorreu devido aos diferentes períodos de internação. Nossos resultados mostram que a participação em brincadeiras livres é realmente eficiente para reduzir os níveis de cortisol urinário (e presumivelmente os níveis de estresse), com um número necessário para tratar de 3 (considerando-se uma redução de 20% nos níveis de cortisol urinário). A atividade também pareceu eficiente para melhorar o sono das crianças internadas, cooperando para que este estado não fosse usado como recurso para fugir ao estresse da internação, principalmente na idade escolar. Na comparação entre o sono em casa e o sono no hospital, as crianças em geral dormiram mais tempo em casa à noite quando comparado ao tempo de sono no hospital. As crianças que raramente despertavam em casa à noite, despertaram mais vezes durante a internação quando comparadas àquelas que despertavam frequentemente à noite em casa. CONCLUSÃO A metodologia utilizada foi adequada para responder às hipóteses da pesquisa. Ficou
comprovado clinicamente que a brincadeira livre pode diminuir o estresse em crianças internadas,
e também melhorar a qualidade de sono neste período. Ainda assim, as crianças dormiram melhor
em casa do que no hospital.
GOALS The goal of this research was to study how an intervention like free play activities could influence levels of stress and sleep in children hospitalized for infectious respiratory diseases, in common wards. METHODS AND PROCEEDINGS: We studied children hospitalized in a public pediatric hospital in the city of São Paulo, in age ranges from 4 to 14 years old, from both genders. All children included in the research should be hospitalized due to respiratory infectious diseases, show no psychiatric or neurologic comorbidities, and could have no restrictions to locomotion. Additional inclusion criteria were to be accompanied by a caretaker able to answer to the questionnaires and cards used in the study, and not be on medication during or previously to hospitalization, that could alter cortisol levels or influence sleep parameters. The sample was stratified according to age ranges and the engagement or not in free play activities. Levels of cortisol in 24 hour urine samples were studied, as well as sleep parameters collected in sleep logs, and sleep at home, applying a specific questionnaire validated in Brazil. To study values of cortisol before and after the free play activities intervention, we determined a minimal stay of five days in the hospital. For the second study – sleep and play activities – it was determined that children should be always with a caretaker able to fill the sleep logs for at least three days. And for the study comparing sleep at home and in the hospital, we established a minimum stay of two days in the hospital, besides the caretaker able to answer the questionnaires RESULTS The sample presented even demographic data, adding to 139 children. From these, 53 were included in the research that examined levels of cortisol in a 24 hour urine sample, 131 participated in the study that assessed sleep parameters in children that played and in those who did not, and in 139 sleep parameters at home and in the hospital were compared. This variation in the number of children included in the studies was due to different lengths of hospitalization. Our results showed that engagement in free play activities is really efficient to lower levels of urinary cortisol (and presumably levels of stress), with a number necessary to treat of 3 (considering a reduction of 20% in levels of urinary cortisol). The activity also seemed efficient to improve hospitalized children’s sleep, helping in that this state was not used as a way to escape stress of hospitalization, mainly in school aged children. Comparing sleep at home and in the hospital, data showed that children in general, slept more at home during the night in relation to the time they slept in the hospital. Children that rarely or never woke up at home during the night did so more times during hospitalization when compared to those who woke frequently CONCLUSION The methodology used in the researches was adequate to answer to the proposed hypothesis. It was proved that free paly activities can decrease levels of stress in hospitalized children, as well as improve their sleep quality. Nonetheless, children slept better at home than in the hospital.
GOALS The goal of this research was to study how an intervention like free play activities could influence levels of stress and sleep in children hospitalized for infectious respiratory diseases, in common wards. METHODS AND PROCEEDINGS: We studied children hospitalized in a public pediatric hospital in the city of São Paulo, in age ranges from 4 to 14 years old, from both genders. All children included in the research should be hospitalized due to respiratory infectious diseases, show no psychiatric or neurologic comorbidities, and could have no restrictions to locomotion. Additional inclusion criteria were to be accompanied by a caretaker able to answer to the questionnaires and cards used in the study, and not be on medication during or previously to hospitalization, that could alter cortisol levels or influence sleep parameters. The sample was stratified according to age ranges and the engagement or not in free play activities. Levels of cortisol in 24 hour urine samples were studied, as well as sleep parameters collected in sleep logs, and sleep at home, applying a specific questionnaire validated in Brazil. To study values of cortisol before and after the free play activities intervention, we determined a minimal stay of five days in the hospital. For the second study – sleep and play activities – it was determined that children should be always with a caretaker able to fill the sleep logs for at least three days. And for the study comparing sleep at home and in the hospital, we established a minimum stay of two days in the hospital, besides the caretaker able to answer the questionnaires RESULTS The sample presented even demographic data, adding to 139 children. From these, 53 were included in the research that examined levels of cortisol in a 24 hour urine sample, 131 participated in the study that assessed sleep parameters in children that played and in those who did not, and in 139 sleep parameters at home and in the hospital were compared. This variation in the number of children included in the studies was due to different lengths of hospitalization. Our results showed that engagement in free play activities is really efficient to lower levels of urinary cortisol (and presumably levels of stress), with a number necessary to treat of 3 (considering a reduction of 20% in levels of urinary cortisol). The activity also seemed efficient to improve hospitalized children’s sleep, helping in that this state was not used as a way to escape stress of hospitalization, mainly in school aged children. Comparing sleep at home and in the hospital, data showed that children in general, slept more at home during the night in relation to the time they slept in the hospital. Children that rarely or never woke up at home during the night did so more times during hospitalization when compared to those who woke frequently CONCLUSION The methodology used in the researches was adequate to answer to the proposed hypothesis. It was proved that free paly activities can decrease levels of stress in hospitalized children, as well as improve their sleep quality. Nonetheless, children slept better at home than in the hospital.
Descrição
Citação
POTASZ, Clarisse. Brinquedoteca em hospital pediátrico: diminuição do estresse agudo e crônico e a relação com o sono da criança. 2013. 326 f. Tese (Doutorado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2013.