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研究生:黃芳梅
研究生(外文):Fang -Mei Huang
論文名稱:運用分散注意力策略於急診學齡前兒童接受靜脈注射疼痛與害怕之成效
論文名稱(外文):The Effectiveness of Distraction Strategies on Pain and Fear in Preschool Children Undergoing Intravenous Placement in Emergency Department
指導教授:陳紀雯陳紀雯引用關係
指導教授(外文):Chi-Wen Chen
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床暨社區護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:73
中文關鍵詞:急診室學齡前兒童分散注意力靜脈注射疼痛害怕
外文關鍵詞:Emergent departmentpreschool childrendistractionintravenous cannulationpainfear
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背景:建立靜脈注射管路是兒科急診最常見的處置之一,兒童在此緊急且陌生的情境中接受靜脈注射易造成其疼痛與害怕,實有必要發展出減輕此負面情緒的有效護理策略。
研究目的:旨在探討運用分散注意力策略介入於急診學齡前兒童接受靜脈注射,其主觀疼痛與害怕感受之成效。
研究設計:採隨機分派之實驗性研究,對象為滿三歲到未滿七足歲學齡前病童,收案樣本數共90人,於接受靜脈注射的過程中共分為三組,A組為對照組,B組採用觀看卡通影片,C組則採用觀看卡通影片加手握壓力球之介入策略。
研究工具: 以黑色籌碼片(Poker Chip Tool) 來測量兒童害怕程度;中文籌碼片(Chinese Poker Chip Tool),紅色來測量兒童疼痛程度,評估分數各為0-4分。0籌碼片代表沒有痛或怕,1片是代表一點點痛或怕,2片是代表多一點點痛或怕,3片代表更多一點痛或怕,怕或痛到受不了則以 4 片紅色籌碼片表示。
研究結果:研究結果發現,運用分散注意力策略成效中,觀看卡通影片可以顯著減輕其疼痛(F=5.38, p=.006)與害怕(F=6.58, p=.002),而對於卡通影片加手握壓力球只能顯著減輕其害怕(F=5.49, p=.006),但對疼痛無顯著差異(F=1.11, p=.334)。
結論與建議:本研究結果運用分散注意力策略介入於急診學齡前兒童接受靜脈注射過程中觀看卡通影片,此策略有效減輕兒童靜脈注射過程的疼痛與害怕,,病童抗拒行為減少,增加了病童正向的治療經驗,降低恐懼,藉由此研究可增加護理人員與學齡前病童間之互動,尤其在忙碌急診單位,亦可減輕護理人員照護初期之焦慮感,提升護病之間的關係及醫療照護品質。

Background: Intravenous cannulation is a common procedure in the pediatric emergent department. This invasive procedure with pain and panic often induce an uncomfortable experience and anxiety especially in the emergent setting for the pediatric patient and their parents. Developing an effective nursing strategy to reduce and/or prevent the negative responses should be very important and crucial.
Objective: The aim of this study was to determine whether a distraction strategy could reduce pain during intravenous cannulation for preschool children by observation the self-report scale in the emergent department.
Study Design: This study was a randomized controlled trial. The participants were randomly assigned into three groups, control group (Group A), cartoon watching group (Group B), and cartoon watching with soft ball pressing group (Group C).
Study Material: Acute pain, anxiety and distress were evaluated by the Porker Chip Tool and Chinese Porker Chip Tool. The tool consists of four red chips that represent "pieces of hurt" (with one chip indicating a little hurt and all four chips indicating the most hurt a child could have), and four black chips that represent "pieces of fear".
Results: 90 preschool children ages between 3 to 7 years old for who an intravenous catheter insertion was indicated in the emergent department. We found that in the two distraction strategies, cartoon watching significantly reduced patient's pain and fear. However, Cartoon watching combined soft ball pressing could only reduce patient's fear but not obvious reduction of pain.
Discussion and Suggestion: This study tried to evaluate and demonstrate the efficacy of the distraction strategy by using watching cartoon during the intravenous cannulation in the emergent department for preschool children. This strategy successfully reduces pain, fear, agitation, and anxiety during the intravenous cannulation. By the effective distraction strategy, it could decrease the anxiety in early stage of procedure for the preschool patients, promote the nursing-patient relationship, provide positive medical treatment experience and improve the quality of health care.

誌謝……………………………………………………………………i
中文摘要……………………………………………………………iii
英文摘要……………………………………………………………v
目錄…………………………………………………………………vii
圖目錄…………………………………………………………………x
表目錄………………………………………………………………xi
第壹章 緒論…………………………………………………………1
第一節 研究動機與重要性……………………………………1
第二節 研究目的………………………………………………3
第三節 研究問題及假設……………………………………3
第四節 名詞界定………………………………………………4
第貳章 文獻查證……………………………………………………6
第一節 學齡前兒童認知發展的特性…………………………6
第二節 學齡前兒童接受靜脈注射的疼痛跟害怕的反應7
第三節 兒童靜脈注射治療相關研究與分散注意力之運用9
第四節 學齡前兒童疼痛與害怕工具的測量………16
第叁章 研究方法……………………………………………………20
第一節 研究設計………………………………………………20
第二節 研究場所及收案對象…………………………………22
第三節 研究倫理考量…………………………………………23
第四節 研究工具……………………………………………23
第五節 研究步驟………………………………………………28
第六節 資料處理與分析…………………………………31
第肆章 研究結果……………………………………………………32
第一節 研究樣本之描述性資料分析…………………………34
第二節 比較各組接受靜脈注射前後疼痛與害怕程度之差異
分析……………………………………………39
第伍章 討論…………………………………………………………45
第一節 不同分散注意力策略介入急診學齡前期兒童接受靜脈
注射之疼痛成效………………………………………45
第二節 不同分散注意力策略介入急診學齡前期兒童接受靜脈
注射之害怕成效………………………………………48
第三節 不同分散注意力策略介入急診學齡前期兒童接受靜脈
注射人口學基本屬性、治療情境因素相關…………51
第四節 結論…………………………………………………… 54
第陸章 結論及建議………………………………………………56
第一節 結論……………………………………………………56
第二節 本研究的貢獻及優勢…………………………………57
第三節 研究限制與未來研究建議……………………………60
第四節 未來展望……………………………………………62
參考文獻……………………………………………………………63
附錄一 研究工具使用同意書………………………………………72
附錄二 成大醫院人體試驗委員會核准收案同意書………………73
圖目錄
圖3-1 研究架構圖…………………………………………………21
圖3-2 分貝機………………………………………………………27
圖3-3 投影機………………………………………………………27
圖3-4 影機投射影像………………………………………………27
圖3-5 壓力球………………………………………………………27
圖3-6 害怕評估工具………………………………………………27
圖3-7 疼痛評估工具………………………………………………27
圖3-8 資料收集步驟流程圖………………………………………30
圖4-1 收案流程圖…………………………………………………33
表目錄
表2-1兒童靜脈注射疼痛與害怕相關因素之文獻…………………8
表2-2運用分散注意力策略於兒童接受經脈注射之國內相關研究9
表2-2運用分散注意力策略於兒童接受經脈注射之國外相關研究11
表3-1 研究設計……………………………………………………20
表3-2 隨機密碼分配方式…………………………………………29
表3-3 資料處理與資料分析方法…………………………………31
表4-1 研究參與者基本屬性資料…………………………………34
表4-2 主要照顧者基本屬性資料分析……………………………35
表4-3 研究參與者治療情境資料分析資料………………………38
表4-4 各組接受靜脈注射疼痛與害怕之描述性統計量表………41
表4-5 各組接受靜脈注射疼痛與害怕之多重比較………………44


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