Factors explaining children's responses to intravenous needle insertions.
Factors explaining children's responses to intravenous needle insertions.
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DOI：
10.1097/nnr.0b013e3181f80ed5
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发表时间：
2010-11
期刊：
影响因子：
2.5
通讯作者：
Allen S
中科院分区：
文献类型：
--
作者：
McCarthy AM;Kleiber C;Hanrahan K;Zimmerman MB;Westhus N;Allen S
先前的研究表明，许多儿童，父母和程序变量影响儿童的痛苦反应的程序。认知行为干预，如分散注意力，是有效地减少疼痛和痛苦的许多儿童接受这些程序。本报告的目的是检查儿童，父母和程序变量，解释儿童痛苦在预定的静脉插入时，父母是他们的孩子分心教练。共有542名4至10岁的儿童及其父母参加。儿童的年龄，性别，诊断和种族是通过为这项研究开发的问题来衡量的。标准化的工具被用来测量儿童的经验与程序，气质，参加能力，焦虑，应对方式和疼痛敏感性。制定问题以测量父母变量，包括种族、性别、既往经历和期望，以及手术变量，包括局部麻醉剂的使用和手术难度。标准化的工具被用来测量父母的教养方式和父母的焦虑，而一个新的工具被开发来衡量父母的分心表现。儿童的苦恼反应与行为苦恼观察量表修订版（行为），唾液皮质醇（生物），Oucher疼痛量表（自我报告），和家长报告的儿童苦恼（家长报告）。回归方法用于数据分析。解释行为、儿童报告和父母报告测量的变量包括儿童年龄、典型应对反应和父母对痛苦的期望（p <0.01）。父母的分心指导水平解释了行为，生物和父母报告的痛苦措施的显着部分（p <0.05）。儿童冲动和学校的特殊帮助也可以显著解释儿童自我报告的疼痛（p <0.05）。解释皮质醇反应的其他变量包括：门诊前早晨儿童的痛苦、注意缺陷多动障碍或焦虑障碍的诊断以及门诊就诊准备的时间。这些发现可用于识别在手术过程中有高度痛苦风险的儿童。这是第一个发现儿童行为困扰与父母分心辅导水平之间关系的研究。
Previous research shows that numerous child, parent, and procedural variables affect children’s distress responses to procedures. Cognitive-behavioral interventions such as distraction are effective in reducing pain and distress for many children undergoing these procedures. The purpose of this report was to examine child, parent, and procedural variables that explain child distress during a scheduled intravenous insertion when parents are distraction coaches for their children. A total of 542 children, between 4 and 10 years of age, and their parents participated. Child age, gender, diagnosis, and ethnicity were measured by questions developed for this study. Standardized instruments were used to measure child experience with procedures, temperament, ability to attend, anxiety, coping style, and pain sensitivity. Questions were developed to measure parent variables, including ethnicity, gender, previous experiences, and expectations, and procedural variables, including use of topical anesthetics and difficulty of procedure. Standardized instruments were used to measure parenting style and parent anxiety, whereas a new instrument was developed to measure parent performance of distraction. Children’s distress responses were measured with the Observation Scale of Behavioral Distress–Revised (behavioral), salivary cortisol (biological), Oucher Pain Scale (self-report), and parent report of child distress (parent report). Regression methods were used for data analyses. Variables explaining behavioral, child-report and parent-report measures include child age, typical coping response, and parent expectation of distress (p < .01). Level of parents’ distraction coaching explained a significant portion of behavioral, biological, and parent-report distress measures (p < .05). Child impulsivity and special assistance at school also significantly explained child self-report of pain (p < .05). Additional variables explaining cortisol response were child’s distress in the morning before clinic, diagnoses of attention deficit hyperactivity disorder or anxiety disorder, and timing of preparation for the clinic visit. The findings can be used to identify children at risk for high distress during procedures. This is the first study to find a relationship between child behavioral distress and level of parent distraction coaching.