サイケツ ヲ ウケル 1サイ ノ コドモ ト オヤ ヘノ エンジョ ナイヨウ

背景 小児看護領域において, 子どもの権利条約の批准後, プレパレーションの概念が広まった. しかし, 小児専門病院の看護師に比べ, 総合病院の看護師のプレパレーションの認識は低く, プレパレーションの実践の普及がされていない実態がある. さらに, 採血を受ける子どもに関する研究は多いが, 自己の思考により物事をみることができない発達段階である2歳未満の年少の子どもを対象とした研究は少ない. 目的 採血を受ける1歳の子どもとその親への援助内容を明らかにする. 方法 全国の小児外来を標榜する総合病院131施設の外来に勤務する看護師のうち, 子どもの採血に関わる786名を対象に質問紙調査を行い, 自由記述の内容を分析しカテゴリー化した. 結果および考察 282名 (回収率35.8%) から回答が得られた. 看護師のプレパレーションの認知は, 知っている51.1%, 知らない45.0%であり先行研究より認識が高まっていた. しかし, 親の付き添いがないと回答した看護師は66.5%であり, さらに子どもの姿勢は寝かされ, 身体の抑制を受けながら採血を受けていたことが明らかとなった. 自由記述の内容分析では, 1歳の子どもと親への援助内容から看護師は, 子どもの発達段階に応じた援助ができていたが, 親が付き添う採血のケアモデル提示が少ないことが明らかとなった. 結論 看護師が, 1歳の子どもの発達段階に応じた援助を行うために, 子どもの権利およびプレパレーションの概念を学習する機会の提供が必要である. さらに, 親が付き添う採血のケアモデルの提示をする必要があることが示唆された.Background Nurses\u27 awareness of preparation at general hospitals is lower than that of nurses at specialist pediatric clinics, which has impeded the spread of preparation being put into practice throughout Japan. Although many studies have investigated children undergoing blood collection, few have examined young subjects aged less than two years.Objective This study aimed to clarify the state of blood collections conducted on one-year-old patients and support offered to parents.Methods A questionnaire survey targeting 786 outpatient nurses who routinely collected blood from pediatric patients at 131 general hospital facilities nationwide was conducted. Free comments were analyzed and content was categorized.Results/Discussion Answers were received from 282 nurses (recovery rate: 35.8%). It was found that nurses\u27 awareness of preparation had increased from that reported in previous studies to 51.1%. However, 66.5% of nurses reported that parents did not accompany children during blood collection. Analysis of free comments revealed that although nurses were offering parents support in accordance with children\u27s developmental stage, few care models incorporating parental attendance during blood collection had been presented.Conclusions Opportunities to study the concepts of child rights and preparation need to be provided so that nurses can give support in accordance with the developmental stage of one-year-old children undergoing blood collection. Results also suggested that a care model incorporating parental attendance during blood collection needs to be presented

カゾク ガ ツキソッタ バアイ ノ ヨウジ ノ サイケツ ニ タイスル タイショ コウドウ ノ カンサツ ブンセキ

背景 1994年に児童の権利に関する条約をわが国が批准してから, 小児看護領域では子どもの権利の保障としてプレパレーションの概念が広まった. 特に認知能力や言語的表現力が未熟な幼児に対して, 身体的苦痛が伴う検査や処置では子どもの理解力に応じたプレパレーションの実施が重要であることが明らかにされている. しかし検査や処置の場面構成は医療者が主体であるため, 採血場面に親の付き添いを除外する施設が多い. そのため親から分離された幼児は, 不安の増大により処置室への入室も困難な状態を引き起こす. 親が採血に付き添う場合に, 子どもがどのような反応や行動をとるかは明らかにされていない. 目的 家族が付き添う幼児後期の子どもの採血場面をビデオに録画し, 子どもと家族の相互の関係性から対処行動を明らかにする. 方法 小児外来で家族が付き添って採血を受ける幼児後期の子どもが, 採血を受けて退室するまでの行動をビデオに録画し, 採血終了後に家族へ半構成的面接を行った. 結果 採血前は【緊張の高まり】【誘導を受け入れる】【抵抗する】【自分なりの方法で心の準備をする】の4カテゴリーと8サブカテゴリー, 採血中は【誘導を受け入れる】【自分なりの方法で取り組む】【苦痛を表現する】【緊張をとく】の4カテゴリーと8サブカテゴリー, 採血後は【終了を行動する】【緊張がとける】【満足感を得る】の3カテゴリーと5サブカテゴリーが抽出された. 結論 採血場面に家族が付き添った幼児後期の子どもは, 家族が寄り添うことで安心を得ることができ, 調整能力を発揮し, 子どもは自分なりの方法で立ち向かうことができる. また採血中は痛みや苦痛をその場で受け止めてもらえる家族の存在により, 子どもは少しずつ緊張をとくことができる. さらに家族からの称賛により子どもは満足を得ることができ, 早期に日常の姿に戻ることができた.Background Japan ratified a treaty about the Child Rights in 1994, a general idea of preparation spread out as security of the rights of children in the child care region. For the infants that cognitive ability and verbal power of expression are immature, it is revealed that enforcement of preparation which accepted the understanding of children is important by testing and the treatment that physical pain is associated with. However, as for the scene constitution of testing and the treatment, there are many institutions excluding the attendant of the parent in the drawing blood scene because a medical person is the main constituent. Therefore the infants isolated from a parent cause a state having difficulty in admission to the dressing room by an increase of the anxiety. When a parent goes with drawing blood, it is uncertain what kind of response and behavior children take. Also, it is uncertain what kind of response and behavior children take when a parent goes with drawing blood.Purpose We determine coping behavior from the mutual relations of children and the family by shooting the drawing blood scene of the infants whom a family attends with a video camera.Methods We recorded behavior before undergoing drawing blood, and being discharged from the infants who underwent drawing blood with a family in pediatric outpatient department on a video .And had an interview to a family

ヨウジ ゼンキ ノ コドモ ガ ウケル サイケツ ニ ドウセキ スル ハハオヤ ノ ストレス

背景 近年,小児看護領域において急速にプレパレーションという概念が普及してきた.医療処置を受ける子どもにプレパレーションを提供し,その効果を最大に引き出すためには,子どもが最も信頼している母親の存在が重要である.しかし,我が国では,母親が同席し泣き叫ぶ子どもをみることで不安が増大する,また子どもは母親が助けてくれないことによって不審感をもつなどを理由に,同席を推奨する施設は少ない.目的 幼児前期の子どもの採血に同席した母親27名を対象に,唾液中アミラーゼ(AMY値),STAI(状態不安得点)の測定及び母親へのインタビューを行い,子どもが受ける採血に同席する母親のストレスを明らかにすることを本研究の目的とした.結果及び考察 AMY値と状態不安得点は採血前から10分後に有意に低下したが,採血前の状態不安得点は標準レベルであった.また,母親は採血に同席することについて【一緒が安心】と感じていた.子どもが不安や恐怖で泣くことがあっても,子どもの年齢や過去の経験から予測可能な子どもの反応であり,心の準備ができていたことから【泣くことの受容】に繋がったと考えられる.結論 子どもが受ける採血に同席した母親のAMY値と状態得点からは,これまで医療者の間で信じられてきた同席による母親の不安の増大は否定された.しかしながら,母親は採血時の姿勢について【抱っこの難しさ】も感じているため,単に同席を勧めるだけでなく,安全性の高い固定法や幼児期前期に有効なディストラクションを具体的に示し,母親が自信をもって採血に臨めるよう支援することが重要である.Background Mothers are the persons who are often the most trusted individual by their children and their presence is important when preparing children for medical treatment that can be invasive,painful or generally frightening.This concept is often referred to as "preparation" and is at the heart of caring for the parent and child; as both go through the procedure,one as the patient the other as comforter and safe trusted presence for the child.In Japan,however,few hospitals agree with the concept of preparation that believing mothers may become increasingly anxious as they see their children crying and children may mistrust their mothers for failing to help.This paper seeks to examine stress levels of mothers who are participating in a preparation procedure of drawing blood. Method 27 mothers of children aged 1-3 years who were present when blood samples were taken from their children,agreed to participate in the research project.Informed consent was given for this research by the participants A sample of saliva was taken pre and post procedure and examined for salivary amylase(AMY) levels which are stress indicators.An increase would indicate higher stress and a decrease would indicate lower stress.A State-Trait Anxiety Interview (STAI)was also performed per and post procedure a high score would indicate high anxiety.A low score would indicate low score. Findings Salivary AMY levels and STAI scores decreased significantly 10 min after the blood sampling compared with before,STAI scores before blood sampling were normal,and mothers also felt reassured if they were present while the blood was being drawn. Discussion Mothers felt reassured when they were present while the blood was being drawn.Even if children cried due to anxiety or fear,mothers considered this reaction predictable because of the child\u27s age and their own experience; because the mothers were prepared for it as a result,they were able to tolerate the crying remaining calm and giving reassurance to the child.These findings go against the widespread belief among medical professionals that mothers become more anxious if they are present during treatment.However,mothers also found it difficult to hold their children during the blood drawing,so in addition to recommending that they be present,physicians must assist mothers in facing blood sampling with confidence,by teaching them how to hold the child still in a safe manner and showing them effective ways of distracting infants

ハハオヤ ガ ツキソッタ バアイ ノ ヨウジ ゼンキ ノ コドモ ノ サイケツ ニ タイスル タイショ コウドウ ノ ブンセキ

背景 子どもの権利条約において親からの分離の禁止"が謳われているが,子どもの採血場面では親が付き添う施設は少ない現状である.採血場面に親が付き添い親の助けを受けた子どもは,安心を得ることができ,親の支援を受けながら自分なりの方法で採血に立ち向かうことができる.しかし,これらはほとんどが幼児後期の子どもが対象であり,親の存在の意義が大きい幼児前期の子どもを対象とした研究は少ない.目的 幼児前期の子どもの採血場面に,母親が付き添った場合の子どもの対処行動を明らかにすることを目的とする.方法 幼児前期の子どもに,母親が付き添った場合の行動をビデオ撮影し,採血終了後,母親へ半構成的面接を行った.結果 採血前は【緊張を高める】,【周囲を確認する】,【抵抗する】,【誘導に従う】,【安心を求める】,【覚悟する】の6カテゴリーと10サブカテゴリー,採血中は【緊張の持続】,【苦痛を表現する】,【誘導に従う】,【終了を予測する】,【安心を求める】,【進行を確認する】の6カテゴリーと11サブカテゴリー,採血後は【終了を確認する】,【緊張がとける】,【満足感を得る】の3カテゴリーと7サブカテゴリーが抽出された.結論 母親が付き添った場合の幼児前期の子どもの対処行動は,採血の経過をイメージすることができないため,母親が主体的に身体的接触を持ち,具体的な対処行動を示すことで見通しを得ることができる.また母親からの賞賛は,子どもの採血に対する緊張感を早期に解くことができる.Background In the "Convention on the Rights of the Child," it is prohibited to separate the child from his/her parent,but the reality is that there are few facilities where the parent is in attendance when a child\u27s blood is being sampled.Children whose parents are in attendance and who receive support from their parent are able to feel secure and endure the blood sampling in their own way.However,this usually applies to children in late infancy, and there are few studies regarding early infancy where the parent\u27s presence is of great significance. Objective The objective was to clarify the coping behavior of children in early infancy when the mother was in attendance during blood sampling. Methods We recorded video footage of children in early infancy whose mothers were in attendance during blood sampling and then held semi-structured interviews with the mothers. Results/Discussion Before blood sampling,6 categories including [increase in tension],[checking surroundings],[resisting],[following instructions],[desiring security],[being prepared] in addition to 10 subcategories were extracted.During blood sampling,6 categories including [continued tension],[expressing pain],[following instructions],[anticipating completion],[desiring comfort],[checking progress] in addition to 11 subcategories were extracted.After blood sampling 3 categories including [verifying completion],[relief of tension],[feeling satisfied] in addition to 7 subcategories were extracted. Conclusions In the coping behavior of children in early infancy whose mother is in attendance,the mother can proactively maintain physical contact and offer the child an outlook by demonstrating specific coping behavior because the child cannot picture the blood sample process.Further,praise from the mother can relieve the child\u27s tension at an early stage