Ponašanje Roditelja i Nivo Anksioznosti kod Dece Tokom Preoperativne Procedure

Abstract

Disertacije je u najširem smislu usmerena na ispitivanje faktora koji doprinose povišenju preoprativne anksioznosti kod dece. Teorijski okvir rada predstavlja Proksimo-distalni model ponašanja dece tokom akutnih medicinskih procedura (Blount, Bunke, & Zaff, 2000a; 2000b; Varni, Blount, Waldon, & Smith, 1995). Prema modelu, sva ponašanja, kako roditeljska tako i dečija, mogu da se podele na ona koja produbljuju uznemirenost (“distress” ponašanja), i ona koja olakšavaju prevladavanje stresne situacije (“coping” ponašanja). Takođe se naglašava da interakciju između deteta i roditelja za vreme akutnih medicinskih procedura treba posmatrati u širem kontekstu, uz isticanje da veliki broj faktora utiče na suočavanje sa akutnim medicinskim stresom. Proveravano je na koji način su osobine dece (ankioznost i temperament), osobine roditelja (anksioznosti) i ponašanja dece i roditelja („coping“ i „distress“) povezani sa stepenom izraženosti preoperativne anksioznosti i procenom bola kod dece. Dodatno, proveravan je efekat psihološke preoperativne pripreme na roditelje različitog stepena izraženosti osobine anksioznosti.

Uzorak u istraživanju je činilo 99 dece predškolskog uzrasta (3-6 godina) koja su imala zakazanu operaciju krajnika (Dg Tonsillectomia i/ili Adenoidectomia) na Institutu za zdravstvenu zaštitu dece i omladine Vojvodine u Novom Sadu. Interakcija između roditelja i dece, kao i preoperativna anksiozna ponašanja kod dece su snimana video kamerom i merena u sedam situacija: prilikom prijema u bolnicu, po ulasku u prostoriju premedikacije, pre primljenog sedativa, za vreme primanja sedativa, nakon primljenog sedativa, prilikom separacije od roditelja i za vreme stavljanja maske kod uvoda u anesteziju. Posmatran je međusobni uticaj roditeljskog i dečijeg ponašanja kroz različite vremenske tačke pri čemu su podaci analizirani tzv. “Actor-Partner Interdependence modelom” (APIM; Cook & Kenny, 2005).

Rezultati pokazuju da mlađa deca sa izraženijom separacionom anksioznošću u odnosu na stariju i mlađu decu sa slabije izraženom separacionom anksioznošću imaju viši stepen preoperativne anksioznosti u svim situacijama, ali je ta razlika posebno izražena u situaciji separacije i stavljanja maske kod uvoda u anesteziju. Deca će intenzivnije procenjivati bol nakon injekcije ukoliko imaju viši stepen preoperativne anksioznosti, kada su pored njih roditelji koji imaju visoko izraženu osobinu anksioznosti i pokazuju viši stepen ponašanja kojim podstiču „distress“ dece. Prilikom procene interakcije između roditelja i dece u pojedinačnim fazama procedure rezultati pokazuju da ispoljena ponašanja u prethodnim fazama utiču na ponašanja u sledećim fazama procedure. Viši stepen preoprativne anksioznosti kod dece u prethodnim fazama procedure utiče na ponašanja roditelja u sledećim fazama procedure. Ukoliko se ponašanja dece i roditelja iz različitih faza sumiraju, rezultati pokazuju da su „coping“ ponašanja dece i roditelja u vezi sa nižim stepenom preoperativne anksioznosti, dok su „distress“ ponašanja u vezi sa višim stepenom preoperativne anksioznosti. Rezultati sugerišu da neposredno nakon psihološke preoperativne pripreme, dan pre operacije, dolazi do pada situacione anksioznosti kod roditelja nezavisno u kom stepenu imaju izraženu osobinu anksioznosti. Na dan operacije, efekat pripreme se smanjuje i anksioznost se vraća gotovo na nivo pre psihološke pripreme.

Praktične i teorijske implikacije rezultata će biti predstavljene u radu.

Alternate abstract:

Thise dissertation is generally focused on examination of factors that contribute to an increase in child anxiety in the pediatric surgery context. Theoretical framework of thise dissertation is the Proximo-distal model of behavior of children during painful medical procedures (Blount, Bunke, & Zaff, 2000a; 2000b; Varni, Blount, Waldon, & Smith, 1995). According to the model, all parental and children's behaviors in a surgical context, can be divided into the type that elevates emotional distress (“distress” behavior), and the type that contributes to coping with stressful situations (“coping” behavior). It also emphasizes that parent-child interactions during acute medical procedures should be considered within in broader context, and highlighting that a number of factors influence coping with an acute medical stress. In this dissertation it was examined in what way children's characteristics (trait-anxiety and temperament), their parents' characteristics (trait-anxiety), and coping and distress behavior of children and parents were related to the level of preoperative anxiety and level of pain in the children. Additionally, the effect of psychological preoperative preparation on parents with different level of trait-anxiety was examined.

The sample included 99 pre-school children aged 3-6 undergoing tonsil surgery (Dg Tonsillectomy and/or Adenoidectomy) at the Institute for Health Protection of Children and Adolescents of Vojvodina in Novi Sad. Parent-child interactions, as well as preoperative anxious behavior in children were recorded by a video-camera and in 7 seven situations: at the reception into hospital, at the entry into the premedication room, before the sedative, during receiving the sedative, after receiving the sedative, at the moment of separation from parents, and at the moment of putting a mask for anesthetic induction. Mutual influence of parents' and children's behaviors was observed at different points of time and the data were analyzed using the “ActorPartner Interdependence model” (APIM; Cook & Kenny, 2005).

The results indicate that younger children with higher levels of separation anxiety, compared to older and younger children with lower levels of separation anxiety, experience higher levels of preoperative anxiety in all situations, but the difference is especially prominent in the situations of separation and for anesthetic induction. Children assess pain after injection as more intensive when they have higher levels of preoperative anxiety, when they are accompanied by parents with higher level of anxiety and „distress“ promoting behavior. The results of evaluation of parent-child interactions in each phase of the procedure indicate that behavior in each preceding phase influences behavior in the subsequent phases of the procedure. Higher levels of child preoperative anxiety in the preceding phases of the procedure influence behavior of their parents in the subsequent phases of the procedure. When the behavior of children and parents is summarized accros all phases of procedures, it appears that ''coping“ behavior of children and parents is related to lower levels of preoperative anxiety, while ''distress“ behavior is related to higher level of preoperative anxiety. The results suggest that immediately after psychological preoperative preparation, on the day before the surgery, there is a decrease in the level of state anxiety in parents, regardless of the level of their trait-anxiety. On the day of the surgery, the effect of preparation seems to decrease with anxiety returning approximately to its initial level (i.e., the level prior to preoperative preparation) Practical and theoretical implications of the results are discussed.