Çocuk Yoğun Bakım Ünitesinde Oyuncaklı Bileklik Kullanılarak Uygulanan Fiziksel Kısıtlamanın Çocukların Fizyolojik Parametreleri, Korku ve Anksiyete Düzeyi Üzerindeki Etkisi: Randomize Kontrollü Çalışma
Abstract
Yoğun bakım ortamı, çocuklar için hem fiziksel hem de psikolojik açıdan stres verici bir deneyim olabilir. Özellikle fiziksel kısıtlama gereksinimi olan çocuklarda bu durum, korku ve anksiyete düzeylerini artırabilir. Bu araştırmanın amacı, fiziksel kısıtlama ihtiyacı olan 4-12 yaş arası çocuklara takılan oyuncaklı bilekliklerin fizyolojik parametreler, korku ve anksiyete düzeyleri üzerindeki etkilerini incelemektir. Bu randomize kontrollü deneysel çalışma, Aralık 2023 - Aralık 2024 tarihleri arasında İstanbul Şehit Prof. Dr. İlhan Varank Eğitim ve Araştırma Hastanesi Çekmeköy Devlet Hastanesi 3. Düzey Çocuk Yoğun Bakım Ünitesi'nde 65 çocuk (deney grubu: 32, kontrol grubu: 33) ile yürütülmüştür. Veriler Çocuk Bilgi Formu, Çocuk Korku Ölçeği ve Çocuk Anksiyete Skalası-Durumluluk (ÇAS-D) ile toplanmış, fizyolojik veriler kalibre edilmiş cihazlarla izlenmiştir. Çocukların fizyolojik parametreleri ile (oksijen satürasyonu, solunum sayısı, kalp atım hızı, diastolik/sistolik basın) korku ve anksiyete puanları başlangıç, birinci, ikinci ve üçüncü saatte değerlendirildi. Deney grubunun üçüncü saat diastolik kan basıncı ortalaması kontrol grubundan yüksek bulunmuş, bu fark anlamlı çıkmıştır (p = 0.006). Nabız sayısında ise özellikle birinci, ikinci ve üçüncü saatte gruplar arasında anlamlı fark gözlenmiştir (p <0.05). Bununla birlikte, sistolik kan basıncı (p = 0.124), oksijen satürasyonu (p = 0.106), solunum sayısı (p = 0.304) açısından grupların zamanla arasında anlamlı fark bulunmamıştır. Korku ve anksiyete düzeylerinde zamanla anlamlı azalma gözlenmiş olup, özellikle zaman etkisi, korku (p < 0.001) ve anksiyete (p < 0.001) puanları için anlamlı olarak bulunmuştur. Anksiyete puanlarında grup*zaman etkileşimi anlamlılığa yakın değer göstermiştir. Sonuç olarak, çocukların yoğun bakım ortamına zamanla uyum sağladıkça korku ve anksiyete düzeylerinde azalma gözlenmiş, oyuncaklı bileklik uygulamasının özellikle korku düzeylerinde zamana bağlı etkileri olabileceği belirlenmiştir. Bu doğrultuda, oyuncaklı bilekliklerin hem fizyolojik hem psikolojik etkilerinin daha uzun süreli takiplerle değerlendirilmesi ve klinik kullanımı için daha geniş örneklemlerle desteklenmesi önerilmektedir. Anahtar Kelimeler: Fiziksel kısıtlama, Anksiyete, Korku, Ölçek, Oyuncaklı bileklik, Pediatri
The intensive care unit can be a stressful experience for children, both physically and psychologically. This is particularly true for children who require physical restraint, as such procedures may elevate levels of fear and anxiety. The aim of this study was to examine the effects of toy bracelets used during physical restraint on physiological parameters, fear, and anxiety levels in children aged 4 to 12 years. This randomized controlled experimental study was conducted with 65 children (intervention group: 32, control group: 33) between December 2023 and December 2024 in the Level 3 Pediatric Intensive Care Unit of Istanbul Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Çekmeköy State Hospital. Data were collected using the Child Information Form, the Child Fear Scale, and the State-Trait Anxiety Scale for Children (STAI-C), and physiological parameters were monitored using calibrated devices. Children's physiological parameters (oxygen saturation, respiratory rate, heart rate, diastolic/systolic blood pressure), as well as fear and anxiety levels, were assessed at baseline and at the first, second, and third hour of observation. The mean diastolic blood pressure at the third hour was significantly higher in the intervention group compared to the control group (p = 0.006). A significant difference in heart rate between groups was also observed at the first, second and third hour (p < 0.05). However, no statistically significant differences were found between the groups in terms of systolic blood pressure (p = 0.124), oxygen saturation (p = 0.106), or respiratory rate (p = 0.304). A significant decrease over time was observed in both fear and anxiety levels, with time effects being statistically significant for fear (p < 0.001) and anxiety (p < 0.001). Notably, the group*time interaction was found to be significant only for anxiety scores. In conclusion, as children gradually adapted to the intensive care environment, their levels of fear and anxiety decreased. The toy bracelet intervention showed potential time-dependent effects on fear levels. Therefore, it is recommended that the physiological and psychological effects of toy bracelets be further investigated through long-term follow-ups and validated with larger sample sizes for broader clinical implementation. Keywords: Physical restraint, Anxiety, Fear, Scale, Bracelet with toys, Pediatric
The intensive care unit can be a stressful experience for children, both physically and psychologically. This is particularly true for children who require physical restraint, as such procedures may elevate levels of fear and anxiety. The aim of this study was to examine the effects of toy bracelets used during physical restraint on physiological parameters, fear, and anxiety levels in children aged 4 to 12 years. This randomized controlled experimental study was conducted with 65 children (intervention group: 32, control group: 33) between December 2023 and December 2024 in the Level 3 Pediatric Intensive Care Unit of Istanbul Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Çekmeköy State Hospital. Data were collected using the Child Information Form, the Child Fear Scale, and the State-Trait Anxiety Scale for Children (STAI-C), and physiological parameters were monitored using calibrated devices. Children's physiological parameters (oxygen saturation, respiratory rate, heart rate, diastolic/systolic blood pressure), as well as fear and anxiety levels, were assessed at baseline and at the first, second, and third hour of observation. The mean diastolic blood pressure at the third hour was significantly higher in the intervention group compared to the control group (p = 0.006). A significant difference in heart rate between groups was also observed at the first, second and third hour (p < 0.05). However, no statistically significant differences were found between the groups in terms of systolic blood pressure (p = 0.124), oxygen saturation (p = 0.106), or respiratory rate (p = 0.304). A significant decrease over time was observed in both fear and anxiety levels, with time effects being statistically significant for fear (p < 0.001) and anxiety (p < 0.001). Notably, the group*time interaction was found to be significant only for anxiety scores. In conclusion, as children gradually adapted to the intensive care environment, their levels of fear and anxiety decreased. The toy bracelet intervention showed potential time-dependent effects on fear levels. Therefore, it is recommended that the physiological and psychological effects of toy bracelets be further investigated through long-term follow-ups and validated with larger sample sizes for broader clinical implementation. Keywords: Physical restraint, Anxiety, Fear, Scale, Bracelet with toys, Pediatric
Description
Keywords
Hemşirelik, Çocuk Sağlığı ve Hastalıkları, Nursing, Child Health and Diseases
Turkish CoHE Thesis Center URL
WoS Q
Scopus Q
Source
Volume
Issue
Start Page
End Page
88
Collections
