79 降低學齡前期兒童接受靜脈注射 恐懼程度之專案 謝宜娟 1* 劉惠姿 2 卓燕華 3 1 林口長庚紀念醫院兒童內科病房護理師暨輔仁大學護理系碩士班學生 紀念醫院兒童內科病房護理師 2 林口長庚 3 林口長庚紀念醫院兒童內科病房護理長 本單位為兒童內科病房, 每月平均約 80 人次的學齡前兒童需執行靜脈注射, 發現有 91.1% 學齡前期兒童接受靜脈注射時有恐懼行為, 其中 77.8% 為重度恐懼, 因恐懼掙扎難以注射, 造成人力 物力更多的負荷, 使得家屬產生不好觀感及信任度降低, 同時增加護病關係緊張 作者經由觀察及訪談學齡前期兒童和家屬發現恐懼原因包括過去不良經驗 兒童接受注射事前準備溝通不足 缺乏控制感 護理人員缺乏運用認知行為策略及輔助物缺乏 學齡前期兒童靜脈注射重度恐懼比例由 77.8% 降至為 38.9%, 依成員改善能力設定目標 50% 為設定值 自 2009 年 8 月 1 日至 2010 年 4 月 30 日, 小組成員參考文獻制定解決策略, 以打針繪本 治療性遊戲方式 自行選擇注射姿勢 運用認知行為策略及轉移注意力的輔助工具等措施設計成一套 兒童靜脈注射標準執行程序 專案執行後針對 45 位學齡前期兒童, 發現靜脈注射重度恐懼比例為 37.8% 本專案使兒童接受注射恐懼降低 更合作, 也增進兒童正向治療經驗, 進而提升護理照護品質 關鍵詞 : 學齡前期 靜脈注射 恐懼 2007 Child Medical Fears Scale, CMFS 100 46 74.2% Lacey, Finklestein, & Thygeson, 2008 Wong, 1998/2003 81.82% 2006 99% 40% 2006 101 4 17 * 33305 5 0332812008601E-mailjane855455@yahoo.com.tw doi:10.6224/jn.59.3.79
80 Reducing Fear of Intravenous Injection in Children 4420 6 30%3650%3 20%86% 33%67%80 7 6.3 Fear-mometer Wagner, 2002 1~10 1~3 4~78~10 76.25 98/06/01~06/30 36 45 4.332 ㈠ 41 91.1% 2560.9% ㈡ 45 35 77.8% 8~10 45 8.1 62.3%2 3.8% ㈠ 98/06/01~06/30 45 3525 4 6 35 2262.9% N = 45 n % 4 8.9 41 91.1 41 100.0 25 60.9 22 53.6 11 26.8 7 17.1 7 17.1 5 12.1 N = 45 % 13 47 810 8.1 4 6 35 8.9 13.3 77.8
81 80 60 40 20 0 33 9 6 3 2 62.3 16.9 11.3 5.7 3.8 N = 53 14 40% 1645.7% 29 82.9% 1337.1%11 31.4%5 14.3% ㈡ 98/06/01~06/30 45 35 35 100% 2 16.7% 33 94.3% 25.7% 3085.7% 乖! 不要哭 你很棒喔!514.3% 38.5% 12.9%1 2.9% 77.8% ㈠ 62.9% ㈡ 82.9% 83.3% ㈢ 94.3% ㈣ 85.7% ㈤ 77.8% 38.9% 81.82%40% 50%=
82 Reducing Fear of Intravenous Injection in Children 2007 2007Wong, 1998/2003 ㈠ 2007 Li & Lopez, 2008 ㈡ 2009 Standish, 2009 10046 Wagner, 2002 9 5 Lacey et al., 2008SparksSetlik Luhman2007N = 118 ㈢ superhero Young, 2005312 Standish, 2009 3 15 36 ㈠ ㈡ ㈢ ㈣ ㈤ 2009/08/01~2010/04/30 9 ㈠ 2009/08/01~10/30 1. 用一根細細管子放進皮膚裡面, 把蟲蟲抓出來關進去管子裡面, 讓醫生檢查才知道他們叫什麼名字, 然後接上點滴從手手喝水進去身體裡面, 然後尿尿把蟲蟲沖出來
83 1. 15 15 15 15 60 2. 9 10 9 7 35 X 3. 8 6 14 9 33 X 4. 12 10 14 11 47 5. 14 15 15 12 56 6. 15 13 12 15 55 7. 15 15 15 15 60 8. 10 9 9 8 36 X 9. 15 15 15 15 60 10. 15 15 15 13 58 11. 15 15 15 13 58 12. 10 9 10 6 35 X 13. 14 14 13 15 56 554 3 21 1. 2. 3. 4. 5. 6. 7. 8. 2009 2010 8 9 10 11 12 1 2 3 4 1. 2. 3. 1. 2. 3. 7 4 2.
84 Reducing Fear of Intravenous Injection in Children 3. 4. 1,000 5. 6. 74 7. 10 3 8. ㈡ 2009/11/01~2010/02/28 1. 2. 40 3. ㈢ 2010/03/01~04/302010/03/01~03/31 36 45 4.2 2010/4/01~04/30 N = 45 n % 13 47 810 5.2 77.8%37.8% 40%1.1%45 100% 45100% 45100% 2555.6%1840% 24.6% 28 62.2% 1737.8% 45 5.2 17 3.614 3 17 45 100% 18 10 17 40.0 22.2 37.8
85 77.8% 37.8% 2006533 7983[Wang, Y. L., & Lo, L. H. (2006). Therapeutic play. The Journal of Nursing, 53(3), 7983.] 2007 163200[Wang, L. M. (2007). Hospitalized children: Their conditional reactions and related nursing care. In H. F. Liang, B. Y. Lin, F. Z. Lin, Y. R. Li, L. M. Wu, H. R. Ciou,... L. J. Ye (Eds.), Pediatric nursing (1st ed., pp. 163200). Taipei City, Taiwan, ROC: Farseeing.] 2006 172 195205[Hsiao, C. W., Wu, Y. H., & Yang, P. Y. (2006). Reducing fear in preschool children during intravenous injection. Chang Gung Nursing, 17(2), 195205.] Wong, D. L.2003 11331192 1998[Wong, D. L. (2003). Family-centered care of the children during illness and hospitalization (M. Y. Zhang, Trans.), Pediatric nursing (5th ed., pp. 11331192). Taipei City, Taiwan, ROC: Farseeing. (Original work published 1998)] Lacey, C. M., Finklestein, M., & Thygeson, M. V. T. (2008). The impact of positioning on fear during immunizations: Supine versus sitting up. Journal of Pediatric Nursing, 23(3), 195200. Li, H. C., & Lopez, V. (2008). Effectiveness and appropriateness of therapeutic play intervention in preparing children for surgery: A randomized controlled trial study. Journal for Specialists in Pediatric Nursing, 13(2), 6373. Sparks, L. A., Setlik, J., & Luhman, J. (2007). Parental holding and positioning to decrease IV distress in young children: A randomized controlled trial. Journal of Pediatric Nursing, 22(6), 440447. doi:10.1016/j.pedn.2007.04.010 Standish, M. A. (2009, November). Child and family friendly haelthcare practices to improve outcomes. Sponsored by Chang Gung Children s Hospital and Child Welfare League Foundation, International symposium on child and family friendly healthcare, Chang Gung Children s Hospital, Taoyuan County, Taiwan, ROC. Wagner, A. P. (2002). Cognitive-behavioral therapy for anxiety. Worried no more: Help and hope for anxious children (pp. 5371). Deerfield Beach, FL: Lighthouse Press. Young, K. D. (2005). Pediatric procedural pain. Annals of Emergency Medicine, 45(2), 160171. doi:10.1016/j.annemergmed.2004.09.019
86 Reducing Fear of Intravenous Injection in Children Reducing Fear in Preschool Children Receiving Intravenous Injections Yi-Chuan Hsieh 1 * Hui-Tzu Liu 2 Yen-Hua Cho 3 1 RN, BSN, Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch & Master Student, Department of Nursing, Fu Jen Catholic University; 2 RN, BSN, Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch; 3 RN, BSN, Head Nurse, Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch. Abstract Background & Problem: Our pediatric medical ward administers an average of 80 intravenous injections to preschool children. We found that 91.1% exhibit behavior indicative of fear and anxiety. Over three-quarters (77.8%) of this number suffer severe fear and actively resist receiving injections. Such behavior places a greater than normal burden on human and material resources and often gives family members negative impressions that lower their trust in the healthcare service while raising nurse-patient tensions. Using observation and interviews, we found primary factors in injection fear to be: Past negative experiences, lack of adequate prior communication, measures taken to preemptively control child resistance, and default cognitive behavioral strategies from nursing staff. Purposes: This project worked to develop a strategy to reduce cases of severe injection fear in preschool children from 77.8% to 38.9% and achieve a capacity improvement target for members of 50%. Resolutions: Our team identified several potential strategy solutions from research papers and books between August 1st, 2009 and April 30th, 2010. Our proposed method included therapeutic games, self-selection of injection position, and cognitive behavioral strategies to divert attention. Other measures were also specified as standard operating procedures for administering pediatric intravenous injections. Result: We applied the strategy on 45 preschool children and identified a post-injection severe fear level of 37.8%. Conclusions: This project was designed to reduce fear in children to make them more accepting of vaccinations and to enhance childrens positive treatment experience in order to raise nursing care quality. Key Words: preschool children, intravenous injection, fear. Accepted for publication: April 17, 2012 *Address correspondence to: Yi-Chuan Hsieh, No. 5, Fuxing St., Guishan Township, Taoyuan County 33305, Taiwan, ROC. Tel: +886 (3) 328-1200 ext. 8601; E-mail: jane855455@yahoo.com.tw