心理介入措施是否能減輕兒童注射之疼痛?Could psychological interventions reduce the injection pain in children?

374 0

2020-05-27 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

胡晏珏* 詹雅雯

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

兒科醫學 Pediatrics

科別

  • 嬰幼兒及兒童照護 Infant and Child Care

中文關鍵詞

兒童 心理介入措施 注射疼痛

英文關鍵詞

Child Children Injections pain vaccination pain needle-related pain Psychological interventions Psychological

機構名稱

臺北榮民總醫院

申請單位

兒科門診

中文摘要

形成臨床提問:
兒科門診在注射室最常面臨的行為便是兒童因打針疼痛哭泣,若減輕兒童對疼痛的恐懼,讓注射過程順利完成及降低注射對兒童造成的心理陰影是很重要的,因此引發筆者動機,查找簡單、可行性高且低成本的介入措施,以減少兒童注射之疼痛的文獻。 本文旨在探討「心理介入措施是否能減輕兒童注射之疼痛?」研究對象(P)為兒童、介入措施(I)為心理介入措施、比較措施(C)為常規護理,結果(O)為注射之疼痛,研究設計(S)為系統性文獻回顧、整合分析、隨機對照試驗。期望實證的結果,可作為醫護人員給予兒童注射時減輕疼痛的心理措施依據。
文獻搜尋的方法與分析:
本研究以MESH TERM找尋並設定PICO關鍵字,使用children、child、injections pain、vaccination pain、needle-related pain、psychological interventions、psychological,將關鍵字以照布林邏輯AND及OR的方式做聯集及交集,搜尋PubMed、Cochran以及CINAHL、華藝等資料庫,搜尋時間為2019年11月,納入條件為年齡19歲以下兒童及中英文文獻,刪除重覆標題、排除條件不符及非隨機對照試驗或系統性文獻回顧。 最後納入1篇系統性文獻:Psychological interventions for needle-related procedural pain and distress in children and adolescents(Birnie, Noel, Chambers, Uman, &Parker, 2018)
文獻的品質評讀:
本文採用CEBM之Systematic Review Appraisal Sheet進行嚴格評讀一篇2018年的系統性分析文獻。評析等級為Level 1。此篇文獻將59篇RCT文章納入分析,共5,550位參與者,心理介入措施包含分散注意力、混合型認知行為治療(CBT)、催眠、準備及訊息提供、呼吸、聯想和記憶轉變。評估項目為:主訴疼痛與壓力、觀察者報告的疼痛與壓力、疼痛行為、行為評估。
結論與建議:
文獻指出分散注意力、催眠、混合型聯合行為治療和呼吸等心理介入措施可減輕兒童注射疼痛。其中,催眠費時且需專業訓練,降低了可行性;呼吸法也在過程中易產生呼吸困難而中斷,說明每種介入措施的適用性可能因環境和臨床對象而異。 儘管證據質量較低,此篇文獻仍是該主題最全面的評析,結果顯示「分散注意力」相較於其他措施更可行且有顯著差異。 因此在注射前後,護理師可利用「分散注意力」的方式,舉凡看卡通或電影、聽音樂或講故事、掌上型電腦或遊戲機、卡片、虛擬實境、玩玩具、父母轉移注意力、醫療小丑、按壓橡皮球及綜合以上多種措施來減輕兒童之注射疼痛,並教導家屬使用此法來協助減輕痛苦。希望藉由此篇實證文獻探討,能讓護理人員使用心理介入措施來減輕兒童注射時之疼痛,並推廣至相關單位。另外,日後研究的設計在品質上也需強化,以確保研究成果能更有信效度及通則性。

英文摘要

Ask an answerable question (PICO):
The most common behavior faced by the pediatric clinic in the injection room is that children cry because of injection pain. If the child ’s fear of pain is reduced, the injection process is completed successfully and the psychological shadow of the injection is reduced. Therefore, the author ’s motivation is caused. Find literature on simple, feasible, and low-cost interventions to reduce the pain of injections in children.The purpose of this article is to explore whether " Could psychological interventions reduce the injection pain in children??" Then,the group of patient is children, intervention is psychological intervention, and outcome is Injections pain , vaccination pain,needle-related pain, the study design is a systematic review, integrated analysis, and randomized controlled trials. Expected empirical results can be used as a basis for medical staff to give psychological interventions reduce the injection pain in children.
The Method and Analysis of Literature Review:
In this study, empirical methods are used MESH TERM to set PICO keywords, using children, children, injections pain, vaccination pain, needle-related pain, psychological interventions, and psychological, to combine and intersect the keywords according to the Bollinger logic AND and OR. , Search PubMed, Cochran, CINAHL, Huayi databases. The search time is November 2019. The inclusion conditions are children under 19 years old and Chinese and English literature. Delete duplicate titles, exclude non-matching conditions and non-randomized controlled trials or systems. Finally included 1 systematic review: Psychological interventions for needle-related procedural pain and distress in children and adolescents (Birnie, Noel, Chambers, Uman, & Parker, 2018)
Critical Appraisal:
In this study, empirical methods are used to set PICO keywords, using children, children, injections pain, vaccination pain, needle-related pain, psychological interventions, and psychological, to combine and intersect the keywords according to the Bollinger logic AND and OR. , Search PubMed, Cochran, CINAHL, Huayi databases. The search time is November 2019. The inclusion conditions are children under 19 years old and Chinese and English literature. Delete duplicate titles, exclude non-matching conditions and non-randomized controlled trials or systems. Finally included 1 systematic review: Psychological interventions for needle-related procedural pain and distress in children and adolescents (Birnie, Noel, Chambers, Uman, & Parker, 2018)
Conclusions and Recommendations:
The literature points out that psychological interventions such as distraction, hypnosis, mixed combined behavioral therapy, and breathing can reduce injection pain in children. Among them, hypnosis is time-consuming and requires professional training, which reduces the feasibility; the breathing method is also prone to interruption of breathing difficulties during the process, indicating that the suitability of each intervention may vary depending on the environment and clinical objects.Despite the low quality of evidence, this article is still the most comprehensive analysis of the topic. The results show that "distraction" is more feasible and significantly different than other measures. Therefore, before and after the injection, the nurse can use the method of "distracting" to watching cartoons or a movie, listen to music or aspoken story, interactive handheld computer or video games, distraction cards, virtual reality, playing with a toy, parents distraction, Medical clown, squeezing a rubber ball, or a combination or selection of various distractors susch as toys, books, cartoons, games, or music to reduce children's injection pain, and teach family members to use this method to help reduce pain. Though this empirical literature, nurse can use psychological intervention to reduce the pain of children during injection and promote it to relevant units. In addition, the design of future research also needs to be strengthened in terms of quality to ensure that the research results can be more reliable and general.