降低學齡前期兒童接受靜脈注射恐懼程度之專案

Reducing Fear in Preschool Children Receiving Intravenous Injections

背景：本單位為兒童內科病房，每月平均約80人次的學齡前兒童需執行靜脈注射，發現有91.1%學齡前期兒童接受靜脈注射時有恐懼行為，其中77.8%為重度恐懼，因恐懼掙扎難以注射，造成人力、物力更多的負荷，使得家屬產生不好觀感及信任度降低，同時增加護病關係緊張。作者經由觀察及訪談學齡前期兒童和家屬發現恐懼原因包括過去不良經驗、兒童接受注射事前準備溝通不足、缺乏控制感、護理人員缺乏運用認知行為策略及輔助物缺乏。目的：學齡前期兒童靜脈注射重度恐懼比例由77.8%降至為38.9%， 依成員改善能力設定目標50%為設定值。方法：自2009年8月1日至2010年4月30日，小組成員參考文獻制定解決策略，以打針繪本、治療性遊戲方式、自行選擇注射姿勢、運用認知行為策略及轉移注意力的輔助工具等措施設計成一套「兒童靜脈注射標準執行程序」。結果：專案執行後針對45位學齡前期兒童，發現靜脈注射重度恐懼比例為37.8%。結論：本專案使兒童接受注射恐懼降低、更合作，也增進兒童正向治療經驗，進而提升護理照護品質。

Background & Problem: Our pediatric medical ward administers an average of 80 intravenous injections to preschool children. We found that 91.1% exhibit behavior indicative of fear and anxiety. Over three-quarters (77.8%) of this number suffer severe fear and actively resist receiving injections. Such behavior places a greater than normal burden on human and material resources and often gives family members negative impressions that lower their trust in the healthcare service while raising nurse-patient tensions. Using observation and interviews, we found primary factors in injection fear to be: Past negative experiences, lack of adequate prior communication, measures taken to preemptively control child resistance, and default cognitive behavioral strategies from nursing staff.Purposes: This project worked to develop a strategy to reduce cases of severe injection fear in preschool children from 77.8% to 38.9% and achieve a capacity improvement target for members of 50%.Resolutions: Our team identified several potential strategy solutions from research papers and books between August 1st, 2009 and April 30th, 2010. Our proposed method included therapeutic games, self-selection of injection position, and cognitive behavioral strategies to divert attention. Other measures were also specified as standard operating procedures for administering pediatric intravenous injections.Result: We applied the strategy on 45 preschool children and identified a post-injection ”severe fear” level of 37.8%.Conclusions: This project was designed to reduce fear in children to make them more accepting of vaccinations and to enhance childrens' positive treatment experience in order to raise nursing care quality.