降低學齡前期兒童於急診接受靜脈注射疼痛指數

Reducing Pain Indexes for Preschool Children When Receiving Emergency Room Intravenous Injections

李睿軒(Jui-Hsuan Li) ； 張怡貞(Yi-Chen Chang) ； 胡芳綺(Fang-Chi Hu) ； 石惠美(Whei-Mei Shih) ； 陳麗貞(Chen-Li Chen) ； 施美娟(Mei-Chuan Shih)

《健康科技期刊》 4卷2期 (2018/03) Pp. 20-34

https://doi.org/10.6979/TJHS.201803_4(2).0002

摘要

本專案目的在降低急診學齡前期兒童接受靜脈注射疼痛指數，進而提升兒童及家屬對於接受靜脈注射的滿意度。本單位為醫學中心急診，兒科佔就診人數25.1%，學齡前期兒童占75%，其中73.3%兒童在靜脈注射時出現重度疼痛。經調查發現原因為1.人員想盡快完成注射，未適時給予獎勵、2.兒童過去不好的注射經驗，缺乏控制感及對醫療人員制服印象、3.家屬不知道如何安撫兒童情緒及未告知兒童需注射、4.環境設備設計單調。造成注射時間過長兒童更加抗拒，引起家屬抱怨，並耗費護理人力及時間，故引發此動機。藉由修訂兒科靜脈注射流程、規劃護理人員在職教育、「針真不可怕」宣導海報、環境改善及輔具添購，改善後123位學齡前期的兒童重度疼痛比例由73.3%降至34.1%，依成員改善能力50%為設定值，超過預期目標。故本專案有效降低學齡前期兒童重度疼痛情形，促進兒童正向治療經驗，增進友善醫療環境。

關鍵字

疼痛 ； 治療性遊戲 ； 靜脈注射 ； 學齡前期兒童 ； 急診

並列摘要

Purpose: The incidence rate of malnutrition is approximately 30-50% in intensive care units (ICU). The risk of malnutrition is closely associated with patient prognosis. The purpose of this study is to investigate the relationship between SGA grading and the objective clinical data and prognosis of critically ill surgical patients. Method: In this study, a retrospective chart review was conducted on 1646 critically ill surgical cases between January 2010 and June 2013. The nutritional status of the patients was assessed and classified using the Subjective Global Assessment (SGA). Patients were classified into Class SGA:A (well-nourished) and Class SGA:B & C (malnourished). The objective clinical indicators used in this study include the Acute Physiology and Chronic Health Evaluation (APACHE-II), the Therapeutic Intervention Scoring System (TISS) and the length of hospital stay. Nutrition indicators include body weight, body mass index (BMI), albumin, pre-albumin and total lymphocyte count (TLC). Univariate analysis was performed on the data, and propensity score-matched case-control was used to reduce gender and age bias. Approximately 600 cases each were selected from the cases classified as Class SGA:A and Class SGA:B & C, and matched-pair analysis was performed according to gender and age. Differences were considered statistically significant for p-values ＜0.05. Results: Malnourished patients had poorer APACHE-II and TISS scores, and had a longer length of stay in ICU and a longer total length of hospital stay.After adjustments for interference factors were performed using multivariate regression analysis, it was determined that BMI＜18.5kg/m2, albumin＜3.5 g/dl, pre-albumin＜20 mg/dl and TLC＜900 cell/mm3 and TLC between 900 and 1500 cell/mm3 were associated with a higher risk of malnutrition (Class SGA: B & C). Conclusion: The assessment of malnutrition status of critically ill surgical patients through the Subjective Global Assessment or objective clinical or nutrition indicators is extremely important. Dietitians must be aware of changes in malnutrition indicators, so as to provide immediate nutrition therapy for the reduction of malnutrition rate, with the aim of reducing relevant health care costs in the future. These indicators can provide real-time nutritional status information, which is useful for the formulation of nutrition intervention strategies.

並列關鍵字

Pain ； Therapeutic play ； Intravenous injection ； Preschool children ； Emergency care

參考文獻

張綺紋、姜月桃、余幸宜(2017)。兒童治療性遊戲臨床運用之探討。源遠護理，11 (1)，44-51。Doi:10.6530/YYN/2017.5.4

陳宜君、賴寶純、許振偉、陳淑暖(2011)。一位11 歲女童燙傷之護理經驗。北市醫學雜誌，8 (3)，69-78。doi:10.6200/TCMJ.2011.8.3.08

張玉俠、沈國妹(2003)。EMLA 膏劑對兒科常見有創操作的鎮痛作用研究。中國護理研究，17 (21)，1247-1248。Doi:10.3969/j.issn.1009-6493.2003.21.003

Salmela, M., Salanterä, S., & Aronen, E. T. (2010). Coping with hospital-related fears: Experiences of pre-schoolaged children. Journal of Advanced Nursing, 66 (6), 1222-1231. Doi : 10.1111/j.1365-2648. 2010.05287.x

許家樺、馮瑞鶯（2015）。運用治療性遊戲於一位罹患噬血症候群學齡前期兒童之加護照顧經驗。護理雜誌，62 （2），96-102 。