降低學齡前期病童靜脈注射過程之壓力行為反應

靜脈注射是學齡前期病童最害怕的侵入性治療，本病房學齡前期病童佔45%，其中73.3%的病童在靜脈注射過程中出現高度壓力行為反應，經觀察及訪談分析導因有：病童曾有不良注射經驗、護理人員在靜脈注射前未予說明及護理指導、未讓病童選擇注射姿勢及部位、注射室環境單調、缺乏輔助物。專案目的為改善病童靜脈注射過程之壓力行為反應，專案執行2015年10月1日－2016年4月30日，改善策略包括：靜脈注射前使用故事繪本說明、制定靜脈注射標準流程、讓病童自主選擇注射部位及姿勢、注射時影音播放轉移注意力、注射後給予獎勵及安慰等。經策略執行後，靜脈注射高度壓力行為反應由73.3%降至11.6%，建議病童靜脈注射前運用故事繪本或遊戲方式，讓病童及家屬有正確認知避免害怕，減輕面臨注射時的壓力，提升照護品質。

關鍵字

學齡前期；靜脈注射；壓力行為

並列摘要

Intravenous injection (IV) is the most frightening procedure of invasive interventions for preschool children. In a children's ward, 45% of patients were preschool children, and among them, 73.3% had a high stress response to intravenous needle-related injection procedures. The purpose of this study was to reduce the stress response behavior of children during IV. The study was conducted from October 2015 to April 2016. Several stress factors in the IV procedure were identified, namely (1) negative experiences with needle-related procedures; (2) insufficient explanation and education from nursing staff before the IV procedure; (3) no optimal injection posture and site for children; and (4) a lack of auxiliary tools and a monotonous environment during the IV procedure. Thus, the IV procedure was improved by (1) establishing a standard procedure for IV; (2) providing a description guide through a picture storybook before the IV procedure; (3) providing an optimal injection posture and site for children; (4) transferring aural and visual attention to audio and video media; and (5) encouraging and consoling the patient after the IV procedure. After the implementation of the improvement program, the response rate of a high stress response to IV was decreased from 73.3% to 11.6%. We suggest that a providing a description through a picture storybook or playing a game yields positive responses and reduces the pressure in IV procedures, consequently improving the quality of nursing care during IV procedures.