Dionigi Alberto, Gremigni Paola
Federazione Nazionale Clowndottori, Cesena, Italy.
Department of Psychology, University of Bologna, Bologna, Italy.
J Clin Nurs. 2017 Mar;26(5-6):632-640. doi: 10.1111/jocn.13578. Epub 2016 Nov 14.
To test whether a combined intervention of art therapy and clown visits could enhance the efficacy of oral medication in reducing children's anxiety at parental separation prior to induction of anaesthesia.
Approximately 50% of children undergoing surgery report high anxiety at anaesthesia induction. Complementary therapies have been used to decrease children's anxiety, but no study has evaluated the efficacy of a combination of such therapies.
This is an observational study, which involved allocating different interventions to two groups and measuring their anxiety at two time points.
This study assigned 78 children (aged 3-11 years) undergoing general anaesthesia for surgery to two conditions. The control group underwent general anaesthesia following standard practice, and the intervention group received an intervention of integrated art therapy and clown visits upon their arrival at the hospital and throughout their time in the preoperating room. Each child in both groups received 0·5 mg/kg oral midazolam 30 minutes before surgery and had a parent present throughout their time in the preoperating room. Each child's anxiety was evaluated twice using the Modified Yale Preoperative Anxiety Scale: at baseline and at separation from parents. Repeated measures anova was used to test for differences between the time points and the two groups.
Children in the intervention group showed a significant (p < 0·001) reduction in Modified Yale Preoperative Anxiety Scale scores at parental separation compared to those in the control group. Additionally, the majority of parents and nurses evaluated the intervention to be effective for reducing children's anxiety.
This study found that an intervention based on art therapy and clown visits enhanced the effect of midazolam in reducing children's anxiety at preoperative separation from parents.
Paediatric staffs may consider using such a combination of strategies in preparing children for anaesthesia induction.
检验艺术疗法与小丑探访相结合的干预措施能否提高口服药物在减轻儿童麻醉诱导前与父母分离时焦虑情绪方面的疗效。
约50%接受手术的儿童在麻醉诱导时表现出高度焦虑。辅助疗法已被用于减轻儿童焦虑，但尚无研究评估此类疗法联合使用的疗效。
这是一项观察性研究，涉及将不同干预措施分配给两组，并在两个时间点测量他们的焦虑程度。
本研究将78名接受全身麻醉手术的3至11岁儿童分为两组。对照组按照标准流程接受全身麻醉，干预组在抵达医院后及整个术前准备室期间接受艺术疗法与小丑探访相结合的干预措施。两组中的每个孩子在手术前30分钟均接受0.5毫克/千克的口服咪达唑仑，且在整个术前准备室期间均有家长陪同。使用改良耶鲁术前焦虑量表对每个孩子的焦虑程度进行两次评估：基线时和与父母分离时。采用重复测量方差分析来检验时间点和两组之间的差异。
与对照组相比，干预组儿童在与父母分离时改良耶鲁术前焦虑量表得分显著降低（p < 0.001）。此外，大多数家长和护士认为该干预措施在减轻儿童焦虑方面有效。
本研究发现，基于艺术疗法和小丑探访的干预措施增强了咪达唑仑在减轻儿童术前与父母分离时焦虑情绪方面的效果。
儿科工作人员在为儿童进行麻醉诱导准备时可考虑采用这种联合策略。
