一项针对加拿大儿科急诊就诊儿童体验和需求的全国性调查。
A national survey of children's experiences and needs when attending Canadian pediatric emergency departments.
机构信息
Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
出版信息
PLoS One. 2024 Jun 25;19(6):e0305562. doi: 10.1371/journal.pone.0305562. eCollection 2024.
BACKGROUND
Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition.
METHODS
514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020.
RESULTS
Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect.
INTERPRETATION
While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.
背景
优化儿童急诊部门（ED）的体验会对他们的记忆和未来的医疗保健互动产生积极影响。我们的目标是描述儿童在 ED 就诊期间对自身需求和体验的看法，并将其与他们对自身病情的理解联系起来。
方法
2018 年至 2020 年，来自加拿大 10 家儿科 ED 的 514 名 7-17 岁的儿童及其护理人员完成了一项描述性横断面调查。
结果
儿童的中位年龄为 12.0 岁（IQR 9.0-14.0）；56.5%（290/513）为女性。78.8%（398/505）在医疗保健对话期间和 78.3%（395/504）在检查期间报告有足够的隐私。69.5%（348/501）理解他们的诊断，89.4%（355/397）理解所进行的检查的原理，67.2%（338/503）理解他们的治疗计划。护士（90.9%，457/503）和医生（90.8%，444/489）都得到了孩子们的高度评价。总体而言，94.8%（475/501）的儿童对 ED 就诊感到满意。儿童更好地理解其诊断的预测因素包括医生与他们直接沟通（比值比 2.21 [1.15, 4.28]）、有人回答问题和担忧（比值比 2.51 [1.26, 5.01]）和年龄较大（比值比 1.08 [1.01, 1.16]）。与儿童更好地理解治疗相关的是与医生的直接沟通（比值比 2.08 [1.09, 3.99]），而在就诊时或出院时感到更大的恐惧/“害怕”（比值比 0.59 [0.39, 0.89]或 0.46 [0.22, 0.96]）则有相反的效果。
解释
虽然几乎所有的孩子都觉得得到了很好的照顾并且对就诊感到满意，但近 1/3 的孩子并不理解他们的诊断或其管理。ED 中儿童的报告满意度不应等同于他们对自身病情的理解。此外，在使用护理人员满意度作为儿童对 ED 就诊满意度的替代指标时应谨慎，因为护理人员满意度与满足他们自身的需求高度相关。
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