관심전환중재가 학령전기 아동의 예방접종 시 통증 및 두려움 행동반응에 미치는 효과

Abstract

Currently national immunization programs provide eight different vaccines as regular immunization coverage in South Korea, and all children are recommended to be vaccinated in a total of 22 times. Most vaccinations for childhood diseases are administered by an invasive measure, injection, and painful stimulation in the immunization process causes fear and anxiety among children. Pediatric nurses can reduce the pain and fear by the provision of pain management measures that are appropriate to the age and developmental stage of children, and such effort is important responsibility for nurses. The present study examines the effects of a distraction intervention with Spin & Sing Alphabet ZooTM during immunization. Children's physiological pain responses were measured using pulse rates, children's self-reporting pain responses were evaluated on the Faces Pain Rating Scale, children's pain responses perceived by parents were evaluated using the Visual Analogue Scale, children's fear behavioral responses observed by researchers were assessed by the Procedure Behavioral Check List. Quasi-experimental research and nonequivalent control group pretest-posttest design was employed. Data were from 82 pairs of 3 to 6 year-old preschool children and their parents who visited a pediatric clinic located in B city for vaccination against influenza, collected from September to October 2010. In order to prevent the diffusion effect of this experiment, first 41 children were assigned randomly to a control group and next 41 children were assigned to an experimental group who received distraction during immunization. Statistical analyses were conducted with SPSS 18.0 to examine the characteristics of the study participants using descriptive statistics, t-test, and chi-square tests including the homogeneity test between the control and experimental groups. ANCOVA and t-test procedures were utilized for hypotheses testing. The major findings of this study are as follow. 1. Levels of physiological pain of children in the experimental group were significantly lower than their counterparts in the control group (F=4.537, p=.036). 2. Children's self-reporting pain responses in the experimental group were significantly lower than those in the control group (t=2.162, p=.034). 3. Children's pain responses perceived by parents in the experimental group were not significantly different from those in the control group (t=.138, p=.334). 4. Children's fear behavioral responses observed by researchers in the experimental group was significantly lower than those in the control group (t=2.175, p=.033). Specifically, ‘muscle tension', ’resistance,' and ‘suppression' scores were significant low in the experimental group. 5. Treatment duration in the experimental group were significantly lower than those in the control group(t=2.209, p=.03). The distraction intervention involving Spin & Sing Alphabet ZooTM during immunization had positive effects on reducing physiological pain, subjective pain, and fear behavioral responses in preschool age children, while pain responses appraised by parents remained unchanged. It may be that parents predicted the level of the child’s pain reflecting their negative perception of injection regardless of the implementation of the intervention. Findings suggest that prior to injection, education and resources should be provided to parents to reduce anxiety or concerns over immunization in order to alleviate pain among preschool children. Additionally, with distraction, reduced fear behavioral responses manifested as children's muscle tension and resistance led to less suppression, and thus treatment duration was significantly decreased.;현재 우리나라에서는 8종의 국가필수예방접종을 실시하고 있으므로 모든 아동이 총 22회의 예방접종을 받게 된다. 그러나 질병예방을 위한 예방접종이 대부분 침습적 처치인 주사로 제공되며, 이 통증자극은 아동에게 두려움과 불안의 원인이 된다. 그러므로 아동의 연령과 발달수준에 적합한 통증관리중재를 제공하여 통증과 두려움을 줄여주고, 아동의 부정적 반응을 감소시키려는 노력은 아동간호사의 중요한 일이다. 이에 본 연구는 학령전기 아동의 예방접종 시 디스커버리 볼(Spin & Sing Alphabet ZooTM)을 이용한 관심전환중재의 제공이 아동의 통증과 두려움 행동반응에 미치는 효과를 알아보고자 시도되었으며, 비동등성 대조군 전후설계의 유사 실험 연구이다. 자료 수집은 2010년 9월에서 10월까지 B시에 소재한 일개 소아청소년과 병원에 가을 인플루엔자 예방접종을 위해 방문한 만 3-6세의 학령전기 아동과 부모 82쌍을 대상으로 하였다. 수집된 자료는 SPSS 18.0 프로그램으로 통계처리 하였다. 대상자의 일반적 특성은 실수와 백분율, 평균과 표준편차를 산출하고, 실험군과 대조군의 동질성 검증은 χ2 test와 t-test로 하였으며, 가설 검증은 t-test와 ANCOVA를 사용하였다. 연구의 결과는 다음과 같다. 1. 예방접종 시 디스커버리 볼로 관심전환중재를 제공받은 실험군이 제공받지 않은 대조군보다 생리적 통증 반응과 자가보고 통증반응이 낮았으나(F=4.537, p=.036); t=2.162, p=.034), 부모가 지각한 아동의 통증반응은 차이가 없었다(t=.138, p=.334). 2. 실험군이 대조군보다 연구자가 관찰한 아동의 두려움 행동반응이 적게 나타났고(t=2.175, p=.033), ‘근육 긴장’, ‘신체적 저항’, ‘억제법 사용’의 항목이 유의하게 낮았다. 3. 실험군이 대조군보다 처치진행시간이 유의하게 감소하였다(t=2.209, p=.03). 이상의 결과로 학령전기 아동의 예방접종 시 디스커버리 볼을 이용한 관심전환중재가 아동의 통증과 두려움 완화에 효과적이며, 또한 짧은 처치 시간과 적은 비용이 소요되는 간편한 간호중재임이 확인되었다. 그러나 부모가 지각한 아동의 통증반응에서는 유의한 결과가 나타나지 않았는데, 이는 예방접종에 대한 아동의 반응과 통증에 대한 부모의 예상이 반영된 결과이다. 그러므로 아동의 예방접종 시 관심전환중재의 시행뿐 아니라 부모의 불안이나 걱정을 줄여주기 위한 부모대상의 중재가 필요하다.