Thus, the following were listed as key points: empathy (capacity to put oneself in someone else’s place), knowledge (training), specific protocol, appreciation of teamwork, work overload, recalling/sensitivity regarding the issue, and the mechanical work (non-reflective practice). The next step (theorization) was developed by seeking scientific material regarding the topics listed

as key points. Thus, at the phase of creating solution hypotheses, it was concluded that the practice needed to be modified and that some actions might encourage the necessary changes. The following were considered as urgent measures: care humanization; development and implementation of a neonatal GSK1210151A manufacturer pain management protocol at HAM (appropriate to the needs and GW3965 reality of the service, which addresses assessment, pharmacological, and non-pharmacological measures for pain relief and care humanization); creation of a new printed nursing care form, including the use of the Neonatal Infant Pain Scale (NIPS) as the fifth vital sign (every three hours); and training of all professionals of the NU, not only the NICU. The group also

identified the need to remind health professionals of the infant’s pain, creating the “pain manager”, who would be present at every shift (professional who would have the responsibility to remind all the staff to comply with the protocol). Finally, the fifth stage of the Maguerez’s Arch (application to reality) was developed through the implementation of the strategies identified in the previous phase by the OG. These

Metalloexopeptidase activities occurred during the month of September of 2012. Twenty-eight meetings were held, with a mean duration of one hour each, coordinated by members of the OG, when approximately 90% of the NU professionals were trained, as determined by the OG as the strategy. During the training, active teaching and learning methodologies were used, maintaining the reasoning of the OG and in agreement with PNEPS,6 and each professional attended two of these meetings. The protocol developed by the OG and adopted at the service was discussed with the participants at each meeting and practical training was carried out for the use of scales utilized for neonatal pain assessment – the NIPS and the Neonatal Facial Coding System (NFCS). At Phase 3 (February 2013), the initial questionnaire was reapplied to assess the changes in the professionals’ perception about pain management in the unit, as well as questions related to the educational intervention. Data collection in the third phase was performed four months after the end of training and included 60 participants, 33 college/university-level and 27 technical-level professionals, which represented 71.7% and 81.8%, respectively, of NICU professionals during that period.