幼兒期孩童靜脈注射時由照顧者抱著是否可減輕恐懼Could holding toddler by the caregiver relieve fear during intravenous injection

946 4

2019-05-27 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

黃芳儀* 林月娥 林素雯

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

其他 other

科別

  • 嬰幼兒及兒童照護 Infant and Child Care

中文關鍵詞

幼兒期 靜脈注射 姿勢 坐姿 平躺 恐懼

英文關鍵詞

Peripheral Catheterization injections children positioning Holding sitting Lying down Fears toddler

機構名稱

長庚醫療財團法人林口長庚紀念醫院

申請單位

護理部兒科病房組11L病房

中文摘要

形成臨床提問:
幼兒期孩童於靜脈注射時被壓制於治療床時常出現恐懼及害怕行為,此醫療處置不僅造成幼童對靜脈注射產生痛苦的記憶,且影響日後對醫療照護的態度,也易引發護病關係緊張。故擬以實證方法深入探討幼兒期孩童接受靜脈注射時採用何種姿勢可改善焦慮、疼痛或壓力等問題,並減輕患童恐懼的程度。
文獻搜尋的方法與分析:
設定關鍵字為幼兒期、靜脈注射、照顧者、抱著、坐著、躺著及恐懼、疼痛等,經由PubMed MeSH Database搜尋同義字及廣義字彙,以布林邏輯「OR」、「AND」搜尋資料庫包括:Cochrane Library、PubMed、Medline、CEPS。本探討議題為治療型類別,限制條件為系統性文獻回顧或隨機控制研究文獻,共找到378篇相關文獻。排除重複文獻、接受中心靜脈擺位、坐著吸藥、注射疫苗、抽血等非相關文獻,得到2篇隨機控制研究文獻進行探討。
文獻的品質評讀:
所評讀的2篇文獻依2011年Oxford證據等級標準來評定皆為Level 2,並以CASP對其有效性、重要性及應用性進行評析。對象9個月~4歲;實驗組由照顧者抱在大腿或幼兒坐注射床由照顧者環抱幼童軀幹;對照組採仰臥姿勢。使用測量工具包括痛苦量表、家屬及護師滿意度,其中測量痛苦程度,包含焦慮、恐懼和疼痛,兩篇皆採隨機的分配。第一篇研究進行靜脈注射前(T1)、注射中(T2),及注射後(T3)三個階段得分,以ANOVA變異數分析得知,抱在大腿或讓幼兒坐於注射床由家屬環抱其軀幹,皆較幼兒採用仰臥姿勢,其痛苦程度顯著降低(P<.001),且父母對打針過程以幼兒坐於家屬大腿滿意最高(P<.001),而父母滿意度以姿勢坐立最滿意76.3分(範圍0-100分)(P= .34)。第二篇研究結果則以Mann-Whitney U檢驗分析結果實驗組和對照組之間疼痛評分有顯著差異(P<.001),且表示由父母環抱以保持直立姿勢可作為接受靜脈注射過程幼兒的非藥物性疼痛管理策略。由父母環抱姿勢增強幼兒與父母間身體接觸,進而增強幼兒自我控制感、減輕恐懼和焦慮,並提升對靜脈注射處置的接受度。
結論與建議:
透過父母協助於靜脈注射過程將幼兒抱在大腿、胸前或幼兒自己坐在注射床父母環抱軀幹方式,證據顯示可以減輕幼兒靜脈注射過程痛苦程度,其中疼痛、恐懼皆具統計上意義,且提高父母對處置過程滿意度,及不會因此影響靜脈注射成功率,此方法是一種安全、簡單且具有成本效益的非藥物輔助措施。 幼兒對自己身體界限不是很有概念,即使是無痛的侵入性檢查與治療,都會造成幼兒很大焦慮與害怕。父母協助抱著執行靜脈注射具有減少恐懼的好處,加上現行注射前使用局部麻醉藥膏,或各種治療性遊戲工具可以輔助幫助幼童減緩恐懼,但礙於臨床作業時間及疾病嚴重度的限制,建議未來可進一步驗證其成效性,及期望可提供兒科臨床護理人員照護上的參考指引。

英文摘要

Ask an answerable question (PICO):
Fear and scared behavior are often shown in toddler while experiencing when are suppressed in the treatment bed during intravenous injection. Children will member this unpleasant experience if they are treated inappropriate as well as their attitude toward provided health care. This leads to strained relationship between Nurse-Patient. The purpose of this evidenced- based study was to explore what kind of caregivers’ holding position on toddler can decrease children’s fear and pain.
The Method and Analysis of Literature Review:
Key words for search are toddler, intravenous injection, hold, sit, lie down, fear and pain through PubMed MeSH Database using 「OR」and 「AND」. Database includes Cochrane Library, PubMed, Medline, and CEPS. This is a therapeutic issue. The inclusion criteria were systemic review or randomization articles. A total of 378 articles were searched and 2 randomization articles were included at the end due to excluding repetitive literature, accepting prone and sitting position.
Critical Appraisal:
According to Oxford CEBM 2011 Levels of Evidence grading system, the two articles belonged to level 2 evidence. Both articles were appraised by CASP (Critical Appraisal Skills Program). The three broad issues should be considered: Validity, Importance, and Practice. The participants were between 9 months to 4 years old. Family holding children on the leg or children sitting on a therapeutic bed and family holding their trunk were as experimental group while children lay down were as control group. Anxiety, fear, and pain were measured. The first article of ANOVA statistical analysis was used to analyze three stages (T1: before injection, T2: during injection, T3: after injection). There was significant difference between experimental group and control (P< .001) on fear and satisfaction. The second article result of a Mann-Whitney U test analysis showed a significant difference in the pain score between the intervention and control groups (P< .001). The parental holding and upright position can be applied as a non-pharmacological pain management strategy for children who undergo intravenous injection procedures.
Conclusions and Recommendations:
This study revealed the through evidence-based search, children’s fear can be reduced significantly when patients held them on the leg, in front of chest, or holding their trunk while they were sitting on a therapeutic bed as well as improving parents’ satisfaction on care. This is a safe, effective, and non-invasive method but the samples are too little. In the clinical practice, local anesthetic paste or therapeutic play are used to alleviate children’s fear. We would recommend future study on these two methods for pediatric nursing staff.