運用標靶遊憩減輕學齡前期兒童接受靜脈注射治療程序之行為反應

Behavioral Responses of Preschool Children Undergoing Intravenous Injection Procedures after Applying Target Play

郭亭伶(Ting-Ling Kuo)

指導教授 ： 李雅玲

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01695

摘要

本研究主要在探討運用標靶遊憩介入於學齡前期兒童接受靜脈注射治療程序時的行為反應、變化、相關及影響因素。
本研究為量性研究，採隨機分派之實驗性研究法，對象為3到未滿7足歲，需接受靜脈注射治療程序之病童。收案以縱貫式三個時間點來收集實驗組及對照組資料。每次的靜脈注射施打者為同一人（兒科靜脈注射治療師、醫師或專科護理師），實驗組之遊憩的介入措施及觀察皆為研究生本人進行，以控制研究的信度，　觀察時間每次約為5-10分鐘。
測量工具為「兒童行為反應量表」，總計四個面向，13個觀察項目。四個面向包括：1.聲音語言方面，2.臉部表情，3.動作反應及4.情緒依賴。每項行為反應依程度不同而給予0-3分，得分越高表示病童該行為表現的強度越強。觀察地點於北部一所醫學中心兒科病房注射室。每次觀察完成後，回饋主要照顧者其孩童行為反應之結果，同時給予紙本單張指導主要照顧者靜脈注射後的照護重點。共收得實驗組及對照組各22人的資料列入分析。
採用SPSS 15.0套裝軟體進行資料的統計分析，包括描述性統計、Wilcoxon sign rank test檢定、Mann-Whitney檢定、一般線性模式分析、回歸分析等方法。
研究結果發現，運用標靶遊憩介入於學齡前期兒童接受靜脈注射治療程序，
可以顯著減輕其行為反應。病童接受靜脈注射治療程序之行為反應與年齡、性別、在場陪伴者、陪伴者態度之變項顯著相關。並引用此發現來建立迴歸模式，實驗組實驗前其年齡與過去注射經驗有被告知有禮物對行為反應解釋力為40.7%；實驗後僅與過去注射經驗有被告知有禮物有關，行為反應模式解釋力為33.9%。此外，以聲音的分貝值為自變數所建立的模式顯示，不僅有好的解釋能力，即分貝與行為反應有顯著正相關，且能預測接受靜脈注射時行為反應。而且透過兩迴歸線檢定方法，顯示實驗組與對照組在實驗後的迴歸模式有顯著差異（p < 0.001），表示遊憩介入對病童的行為反應有明顯降低。
站在人性化及友善醫療照護的立場，本研究結果有助於減輕及安撫病童在接受靜脈注射時所感受到的不安及恐懼，以提供兒科臨床護理人員在照護上的重視及參考指引。

關鍵字

行為反應 ； 學齡前期兒童 ； 靜脈注射治療程序 ； 標靶遊憩

並列摘要

The purposes of this study were two fold: (1) to understand behavioral responses of preschool children undergoing intravenous injection procedures after applying target play; and (2) to analyze the possible factors predicting behavioral responses of preschool children undergoing intravenous injection procedures. A quantitative and experimental method with random selection was used for this study. Participants were sick children aged 3-6 years who received intravenous injection treatment. Forty-four children were recruited to an experimental (22 children) and control (22 children) group. Data were collected from both groups at three time points. The behavioral responses of children receiving intravenous injections were observed by the researcher. Intravenous puncture was performed three times by the same intravenous batter (IV nurse). Each intravenous injection took about 5-10 minutes. In the experimental group, in parallel with intravenous puncture, the researcher implemented target play and observed participants’ behavioral responses. Intravenous puncture, target play and observation took place in the pediatric injection rooms. After observation, the researcher offered the primary caregiver the findings of the observation of behavioral responses of their child during the intravenous puncture. A pamphlet on care tips was also explained and provided to the primary caregiver. Statistical analyses included Wilcoxon sign rank test, Mann-Whitney test, general linear model, and regression analysis. SPSS 15.0 software was used for the data analysis. The results suggested that target play can significantly reduce the negative behavioral responses in children undergoing intravenous puncture treatment. Age and sex of children, accompaniment during intravenous puncture, and attitude of accompany adults were significantly related to the behavioral responses of children undergoing intravenous puncture. In the experimental group before intervention, the strength of the variables “age” and “previous experience of receiving a present after the injection” in the regression model of behavioral responses was 40.7%. After the intervention, the strength of “previous experience of receiving a present after the injection” in the regression model of behavioral responses was 33.9%. In addition, “decibels of crying” was also significantly positively correlated with behavioral response and was found to be a predictor of behavioral responses. Finally, there was a significant difference in behavioral response between the experimental group and control group post-test. Therefore I conclude that target play can effectively reduce negative behavioral responses in sick children receiving intravenous injection. The findings of the current study may offer a means by which pediatric nurses can reduce children’s anxiety during intravenous injection. The effects of applying target play in clinical practice need further research.

並列關鍵字

Behavioral Responses ； Preschool Children ； Intravenous Injection Procedure ； Target Play

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