Parent/Health Care Provider Behaviors & Child's Anxiety

家长/医疗保健提供者的行为

• 批准号: 7643144
• 负责人: Zeev Kain
• 金额: $ 39.58万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7643144
• 关键词: Address; Adult; Advocacy; Advocate; Affect; Anesthesia procedures; Anxiety; Area; Beds; Behavior; Behavioral; Bone Marrow Aspiration; Caring; Certified registered nurse anesthetist; Characteristics; Child; Child Behavior; Child health care; Chronic Disease; Clinical; Coping Behavior; Crying; Data; Development; Distress; Effectiveness; Family; Fright; Gender; Great Britain; Health Personnel; Healthcare; Hospitals; Humor; Intervention; Investigation; Laboratories; Lead; Literature; Malignant Neoplasms; Medical; Minority; Modality; Modification; Nursing Staff; Observational Study; Operating Rooms; Operative Surgical Procedures; Outcome; Pain; Parenting behavior; Parents; Patients; Perioperative; Pharmacy facility; Phase; Postoperative Period; Preparation; Procedures; Process; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recovery; Reporting; Research; Research Personnel; Resistance; Rights; Schedule; Staging; Surgeon; Surveys; Techniques; Temperament; Time; Training; United States; Walking; base; clinical practice; coping; cost; distraction; effective intervention; exhibitions; experience; improved; parental influence; pressure; programs; psychologic; sedative; therapy development; trait

DESCRIPTION (provided by applicant): Over five million children undergo surgery in the US each year and it is reported that up to 50 percent of these children develop significant fear prior to surgery. As a result, about 20 percent of children who undergo surgery are subsequently forcefully restrained while crying, kicking and screaming throughout the induction of anesthesia process. Preoperative sedatives and parental presence during induction of anesthesia (PPIA) are available at the current time to help children during this extremely stressful period. However, preoperative sedatives, although effective, are associated with significant increases in operational costs; thus, many hospitals actively discourage their routine use. As a result, PPIA is currently used to a varying degree by about 50 percent of all anesthesiologists in the US. Interestingly, whereas initial observational studies suggested that PPIA reduces children's anxiety, recent randomized trials indicate that PPIA is not reliably beneficial. All PPIA research to date, however, only deals with one question - whether or not parents should be present in the or during induction of anesthesia. It is our opinion that the question we need to address is not that of parental presence or absence, but rather what parents actually do while in the OR. In fact, previous preliminary investigations involving children with cancer who underwent painful procedures indicate that parental and health care provider behaviors significantly influence children's anxiety during painful procedures. It is because PPIA as practiced today is ineffective, and because the use of PPIA is on the rise, that we call for the development of an intervention that will convert parental presence in the OR into an effective, clinically applicable, low-cost modality that reduces anxiety and improves postoperative outcomes. To convert PPIA into an effective intervention, however, it is of utmost importance to first empirically identify the specific parent and health-care personnel behaviors that increase or decrease children's anxiety during induction of anesthesia and the postoperative period. This will be achieved by obtaining a preoperative sequential process-oriented view of parent-child-health care provider behavioral interaction and by using robust sequential analysis techniques. As the next step we will develop data-driven behavioral preparation programs that will train parents, nurses, anesthesiologists and surgeons in how to reduce children's distress during the preoperative process.

描述（由申请人提供）：美国每年有超过 500 万儿童接受手术，据报道，其中高达 50% 的儿童在手术前表现出明显的恐惧。因此，大约20%的接受手术的儿童在麻醉诱导过程中被强行束缚，哭、踢、尖叫。目前可以使用术前镇静剂和麻醉诱导期间家长在场（PPIA）来帮助儿童度过这个极度紧张的时期。然而，术前镇静剂虽然有效，但会导致手术成本显着增加；因此，许多医院积极劝阻其常规使用。因此，目前美国约 50% 的麻醉师都不同程度地使用 PPIA。有趣的是，虽然最初的观察性研究表明 PPIA 可以减少儿童的焦虑，但最近的随机试验表明 PPIA 并不可靠。然而，迄今为止所有 PPIA 研究仅涉及一个问题 - 父母是否应该在麻醉诱导期间或过程中在场。我们认为，我们需要解决的问题不是父母在场或不在场的问题，而是父母在手术室期间实际做了什么。事实上，之前针对接受痛苦手术的癌症儿童进行的初步调查表明，父母和医疗保健提供者的行为会显着影响儿童在痛苦手术期间的焦虑。正是因为目前实行的 PPIA 无效，而且 PPIA 的使用正在增加，我们呼吁开发一种干预措施，将家长在手术室的存在转变为一种有效的、临床适用的、低成本的方式，以减少焦虑并改善术后结果。然而，要将 PPIA 转化为有效的干预措施，最重要的是首先凭经验确定在麻醉诱导和术后期间增加或减少儿童焦虑的特定家长和医护人员的行为。这将通过获得亲子保健提供者行为互动的术前顺序过程导向视图并使用强大的顺序分析技术来实现。下一步，我们将开发数据驱动的行为准备计划，培训家长、护士、麻醉师和外科医生如何在术前过程中减少儿童的痛苦。