術前準備計畫改善兒童情緒行為表現與照顧者術前焦慮之實證運用

The effectiveness of Preoperative Preparation for Improving Children’s Emotional Behavior and Caregiver’s anxiety

進行手術對兒童及照顧者皆是一件備感焦慮的事，因此，介入以醫院為主的術前準備計畫主要用以改善兒童及照顧者的情緒行為表現及術前焦慮。本文以研究文獻為實證基礎，瑜Cochrane library、PubMed、CINAHL、Medline、華藝線上圖書館中搜尋到三篇隨機控制試驗，並依Oxford Centre for Evidence Based Medicine 2011之證據等級及Critical Appraisal Skills Programme十一項查檢表進行文獻評讀。經統整後，術前準備計畫內容主要包含三關術前區和恢復室、觀看手術衛教影片及實際操作醫療設備，本文進一步將實證結果運用於臨床實務，共收案23為兒童及照顧者，收案時間為2014/07/15~2014/09/01，採隨機分派至實驗組12位、對照組11位，兩組皆予手術衛教單張，實驗組再介入術前準備照顧計畫，實證應用結果為實驗組兒童隨著手術時間接近其情緒行為表現分數僅些微上升（8.33±5.96,8.50±4.52,8.75±4.14），而對照組兒童則是明顯的上升（6.73±2.00,7.27±1.49,9.09±4.18），當分數越高代表兒童情緒行為表現越負向；而實驗組照顧者在術前報到區的焦慮指數顯著低於對照組（16.25±5.19 vs. 22.36±4.72, t=-2.95,p=.008），意味著術前準備計畫確實能緩解照顧者術前焦慮，而實驗組兒童負向情緒行為表現亦較降低，但此方面的成效未達顯著，建議此時正措施可於臨床應用。

Surgery causes children and their care-givers tremendous anxiety； therefore, provision of a preoperative preparation care plan during hospital stays mainly improves children’s emotional and behavioral exhibitions and caregivers’ anxiety prior to surgery. A literature review was used as empirical evidence. Three randomized control trial articles were searched through the databases of Cochrane Library, PubMed, CINAHL, MEDLINE, and Airiti Library. The author adopted the evidence classifications of Oxford Centre for Evidence Based Medicine 2011 and the eleven-item checklist of the Critical Appraisal Skills Program. With integration of these three literatures, a preoperative preparation program was developed consisting of a pre-operative area and recovery room visit, production of patient education videos, and operation of surgical equipment. The author collected 23 case studies from July 15 to September 1, 2014. The subjects were randomly assigned to two groups with 12 in the experimental care group and the other 11 in the controlled care group. Both groups received patient education sheets regarding surgery. The experimental group received an additional preoperative preparation care plan. The results showed that children in the experimental group reported little elevated scores in emotional and behavioral exhibitions compared to a significant increase in the control group(8.33±5.96,8.50±4.52,8.75±4.14 vs. 6.73±2.00,7.27±1.49,9.09±4.18). High scores indicated more negative emotional and behavioral exhibitions. The caregivers in the experimental group had a significantly lower anxiety score in the preoperative area than those in the control group (16.25±5.19 vs. 22.36±4.72, t=-2.95,p=.008). That is, the caregivers in experimental care group could relieve their anxiety with offered preoperative preparation. In conclusion, a preoperative preparation program is effective for reducing caregivers’ preoperative anxiety. It lowers children’s negative emotions and behaviors, although this study does not show a significant change. An appropriate preoperative preparation program for clinical practice is recommended.