[[alternative]]Effectiveness of the Preparation Program Video In Relieving Anxiety Level For School Aged Children Before Surgery

[[abstract]]本研究目的為探討術前準備計劃影片對學齡期兒童術前焦慮的影響。參考國內外術前準備之研究，本研究假設為實驗組與控制組兒童之焦慮分數隨手術前期面臨不同情境而逐漸上升且在手術室等待區與麻醉誘導時，實驗組之焦慮分數較控制組為低。採類實驗研究設計，民國99年7月至民國100年1月期間，於台北某區域醫院進行方便取樣並採非隨機分配，先收控制組個案，接受醫院常規的術前準備；再收實驗組個案，除接受醫院常規的術前準備外，另外給予術前準備計畫影片與接觸相關醫療設備和練習麻醉面罩。兩組各收10位滿7至12歲之住院手術兒童及其父或母參與研究且無人退出研究過程。為瞭解兒童於麻醉誘導時的焦慮程度以觀察之兒童情緒表現評分量表（children’s emotional manifestation scale; CEMS）進行測量；為比較不同測量方法之焦慮程度差異，另以兒童自填之中文版兒童焦慮狀態量表（Chinese version of the state anxiety scale for children; CSASC）進行焦慮程度之測量。資料收集過程：手術當天，接受措施前（前測），由研究者本人介紹研究目的、方法後，手術兒童與父母分別簽署參與研究同意書後，進行第一次焦慮程度測量，給予手術兒童CSASC，並由研究者使用觀CEMS測量其術前焦慮程度；父母自填修訂之情境－特質焦慮量表（state-trait anxiety inventory; STAI）測量其焦慮程度；進入手術等待區時（後測1）及兒童麻醉誘導（後測2）時，由另一位不知道個案組別的研究者以CEMS觀察測量其焦慮程度、父母自填STAI量表，兒童僅於手術室等待區自填CSASC量表。 以SPSS 17.0版統計軟體進行描述性與推論性統計。以概化估計方程式（generalized estimating equation; GEE）進行介入措施成效分析，結果顯示：焦慮分數隨施測時間不同，整體CEMS與CSASC焦慮分數皆呈上升趨勢，CEMS之整體分數，後測1較前測增加2.3分（p<.001）、後測2較前測增加5.5分（p<.001）；CSASC之整體分數於後測1較前測增加4.8分（p=.12）。分析術前準備計畫影片對學齡期兒童術前焦慮之成效，CEMS焦慮分數具有時間與組別之交互作用，接受本研究介入措施後，後測1之CEMS焦慮分數實驗組較控制組下降1.8分（p<.05）、後測2之CEMS焦慮分數實驗組較控制組下降5.4分（p<.001）；CSASC焦慮分數不受組別及組別與時間交互作用的影響，實驗組後測1的CSASC焦慮分數較控制組後測1的焦慮分數下降4.9分（p=.13）。共變數的影響：加入共變項分析CEMS分數，顯示兒童年齡愈小焦慮程度愈高；CSASC焦慮分數，即使加入共變項分析介入措施之成效仍無顯著影響。實驗組接受介入措施後，於手術室等待區與麻醉誘導時之CEMS焦慮分數能顯著低於控制組，建議各醫院配合學齡期兒童的發展特色，發展並提供兒童術前準備計畫影片，以減少其術前焦慮程度。[[abstract]]The purpose of this study is to examine the effectiveness of this preparation program video in relieving anxiety level for school-aged children before surgery. Via consulting the pre-operative preparation of the domestic and international studies, hypothesis of this study were anxiety scores of experimental and control group were increased with different measuring time and anxiety scores of experimental group was lower than control group at holding area and anesthesia induction. From July 2010 to January 2011, using a quasi- experiment design, subjects of this study were recruited from a Taipei regional hospital, by convenient sampling and none of them withdrew from this study. Using non-randomized method, subjects were divided into two groups of ten that are 7 to 12 children performed administration surgery and one of their parents. First group is the control group receives traditional routine care. The second group is the experimental group receives the routine care, pre-operative preparation program video, and practice with the anesthesia equipment. To measure the anxiety level of children at anesthesia induction uses observational tool, children’s emotional manifestation scale (CEMS). Using another self-reported questionnaire, Chinese version of the state anxiety scale for children (CSASC) examined the difference of anxiety level. Data collecting process: surgery day before children were exposed to the pre-operation preparation (pretest), after researcher introduced study purpose and method, children and their parents signed the consent form of study then examined first anxiety level, children given the self report questionnaire of CSASC and are observed with CEMS while one of the parents filling out the STAI questionnaire. When children are at the holding area (post-test1) and while receiving anesthesia induction (post-test2), another researcher who didn’t know the study group examined the second (post-test1) anxiety level with CEMS, CSASC and STAI and third (post-test2) anxiety level by CEMS and STAI.The data were analyzed descriptive and inferential statistics with SPSS 17.0 for Windows. Generalized Estimating Equation (GEE) model was used for analyzing the effectiveness of intervention. Result: with different measuring time in overall CEMS and CSASC anxiety score rose; comparing overall scores of the CEMS, post-test1 increased 2.3 points (p<.001) than pretest, post-test2 increased 5.5 points (p<.001) than pre-test 1; comparing overall CSASC scores, post-test1 increased 4.8 points (p=.12). To examine the effectiveness of the preparation program video in relieving anxiety level for school aged children before surgery used GEE model. CEMS anxiety score has the time and group interaction, experimental group, accepted the study intervention, decreased 1.8 points (p<.05) than control group at the post-test1 and decreased 5.4 points (p<.001) than control group at the post-test2. CSASC anxiety score is not affected by group and interaction of group and time. With time and group interaction, post-test1 CSASC anxiety score of experimental group decreased 4.9 points (p=.13). After added the covariant, children’s age, to analyze the CEMS scores showed lower ages with higher anxiety in children, however the CSASC scores still showed no significance. In conclusion, receiving routine care plus pre-operative preparation program video and practice with the anesthesia equipment reduces the anxiety level of holding area and anesthesia induction. Therefore, this preoperative preparation program video that takes into consideration of developmental characteristics is strongly recommended for the future nursing care prior to any surgeries