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Abstract(s)
Introdução: A doença é um importante fator de stress para a criança e o ambiente hospitalar pode agravar a sua experiência, sendo possível mobilizar recursos e estratégias para a ajudar a lidar com a hospitalização e evitar problemas com a mesma. Dentro destas estratégias encontram-se as intervenções não farmacológicas, nomeadamente as baseadas no humor, tais como a Clown Therapy (CT) que recorre aos Medical Clowns (MC). As suas skills de comunicação e empatia são usadas como complemento ao corpo clínico da equipa pediátrica para se reduzir o potencial impacto da experiência de dor e hospitalização.
Objetivos: Esta dissertação pretende analisar a evidência científica sobre as intervenções baseadas no humor na criança hospitalizada e o seu impacto na criança, equipa hospitalar e pais e/ou cuidadores da criança. Pretende-se, também, retirar ilações e discutir a inclusão deste tipo de terapêutica não farmacológica nos Cuidados de Saúde Hospitalares, e a possibilidade de vir a ser considerada, futuramente, pelo médico em Portugal, como uma opção terapêutica complementar efetiva e viável.
Metodologia: Foi efetuada uma revisão integrada de literatura a partir da pesquisa de artigos sobre a temática nas bases de dados Pubmed, b-on e Science Direct. Foram incluídas dissertações de mestrado e doutoramento, publicadas em português, inglês e espanhol, cujo texto integral estivesse disponível. A pesquisa foi complementada com a procura de referências bibliográficas que constavam nos artigos disponíveis. A revisão foi efetuada entre setembro de 2018 e fevereiro de 2019.
Resultados: Algumas das investigações revistas obtiveram resultados claros e consistentes, em relação ao impacto deste tipo de intervenções, enquanto outras apresentaram resultados não tão consistentes, sendo sinalizada a fraca robustez metodológica de algumas investigações e a escassez de estudos realizados no contexto hospitalar. A redução do stress e da ansiedade foi constatada na totalidade dos estudos revistos. A dor, nalguns dos estudos revistos, apresentou uma redução, sendo a intervenção dos Medical Clowns uma distração para a criança enquanto está a ser submetida a procedimentos invasivos. Noutras investigações os resultados não foram consensuais. As emoções positivas, tanto em estudos qualitativos como quantitativos, revelaram um aumento com a intervenção dos Medical Clowns. Destacam-se os resultados positivos quando é avaliada secreção de cortisol e de endorfinas na criança com os Medical Clowns.
Conclusão: A Clown Therapy permite atenuar e neutralizar implicações afetivas negativas que podem estar associadas ao processo de doença e à hospitalização. O facto de a Clown Therapy poder contribuir para que a criança lide de forma mais adaptativa com o processo de doença e hospitalização, o seu potencial de custo-efetividade e a redução da necessidade de medicação psicotrópica e analgésica, alertam para a importância de se pensarem em políticas consistentes e formação do staff hospitalar neste tipo de intervenção. É, contudo, necessária investigação mais consistente de monitorização e avaliação das intervenções para se solidificar a evidência científica e para se sensibilizarem médicos e restantes profissionais de saúde para as intervenções baseadas no humor com os Medical Clowns e sua implementação no contexto de saúde.
Introduction: The disease itself is an important stress factor for children and the clinical environment can aggravate their experience, being possible to combine resources and strategies to help dealing with the hospitalization and avoid problems emerging from it. Amongst these strategies, there are humour-based ones, namely the Clown Therapy that calls upon Medical Clowns. Their communication and empathy skills complement the clinical body of the paediatric team. Objectives: This thesis main goal is to analyse scientific evidence regarding humour-based interventions on the hospitalized children and their impact on them, clinical team and parents and/or children´s caretakers. Its purpose is also to conclude and discuss the inclusion of this kind of non-pharmacological therapeutics in Health Care, as well as the possibility of, in the future, it being considered as a viable and effective complementing therapeutic option by Portuguese doctors. Methodology: An integrated literature review was made based on topic-related articles research focused on the databases Pubmed, b-on and Science Direct. Masters and PhD dissertations whose text was fully available and published in Portuguese, English or Spanish were also included. The research took place between september of 2018 and february of 2019. Results: Some of the analysed variables in the articles and other references presented clearer and more consistent results, whereas others showed not as consistent ones, fact that we can relate not only to the lack of methodological robustness of some investigations but also to the small amount of studies in clinical environment. Stress and anxiety reduction was verified in all the reviewed studies. In some of the reviewed studies pain did present a reduction, being noticed that Medical Clowns intervention represent a distraction for children being subject to evasive procedure. In other investigations, results did not generate any consensus. Positive emotions, both in qualitative and quantitative studies, revealed an increase with Medical Clown´s intervention. Positive results can be highlighted when cortisol and endorphins secretion is evaluated in children in contact with Medical Clowns. Conclusion: The Clown Therapy allows to attenuate and neutralize negative affective implications that may be associated with the disease and hospitalization process. The fact that Clown Therapy might contribute to help the children dealing in a more adaptative way with the disease and hospitalization process, its cost-benefit potential and the reduction of the need of usage of psychotropic and analgesic medication, creates awareness for the importance of thinking in coherent policies and formation of the clinical staff in this kind of intervention. It is, however, necessary to further develop a more consistent monitoring and evaluation investigation of this interventions so that scientific evidence becomes more solid and more doctors and other health-related professionals get aware of humour-based interventions with Medical Clowns in order to implement them in health contexts.
Introduction: The disease itself is an important stress factor for children and the clinical environment can aggravate their experience, being possible to combine resources and strategies to help dealing with the hospitalization and avoid problems emerging from it. Amongst these strategies, there are humour-based ones, namely the Clown Therapy that calls upon Medical Clowns. Their communication and empathy skills complement the clinical body of the paediatric team. Objectives: This thesis main goal is to analyse scientific evidence regarding humour-based interventions on the hospitalized children and their impact on them, clinical team and parents and/or children´s caretakers. Its purpose is also to conclude and discuss the inclusion of this kind of non-pharmacological therapeutics in Health Care, as well as the possibility of, in the future, it being considered as a viable and effective complementing therapeutic option by Portuguese doctors. Methodology: An integrated literature review was made based on topic-related articles research focused on the databases Pubmed, b-on and Science Direct. Masters and PhD dissertations whose text was fully available and published in Portuguese, English or Spanish were also included. The research took place between september of 2018 and february of 2019. Results: Some of the analysed variables in the articles and other references presented clearer and more consistent results, whereas others showed not as consistent ones, fact that we can relate not only to the lack of methodological robustness of some investigations but also to the small amount of studies in clinical environment. Stress and anxiety reduction was verified in all the reviewed studies. In some of the reviewed studies pain did present a reduction, being noticed that Medical Clowns intervention represent a distraction for children being subject to evasive procedure. In other investigations, results did not generate any consensus. Positive emotions, both in qualitative and quantitative studies, revealed an increase with Medical Clown´s intervention. Positive results can be highlighted when cortisol and endorphins secretion is evaluated in children in contact with Medical Clowns. Conclusion: The Clown Therapy allows to attenuate and neutralize negative affective implications that may be associated with the disease and hospitalization process. The fact that Clown Therapy might contribute to help the children dealing in a more adaptative way with the disease and hospitalization process, its cost-benefit potential and the reduction of the need of usage of psychotropic and analgesic medication, creates awareness for the importance of thinking in coherent policies and formation of the clinical staff in this kind of intervention. It is, however, necessary to further develop a more consistent monitoring and evaluation investigation of this interventions so that scientific evidence becomes more solid and more doctors and other health-related professionals get aware of humour-based interventions with Medical Clowns in order to implement them in health contexts.
Description
Keywords
Ansiedade Clown Therapy Criança Dor Hospitalização Infantil Intervenções Baseadas No Humor Medical Clown Stress