Investigation Of Nursing Needs Of School-age Children With Acute Leukemia During Lumbar Puncture

Objective. This study focused on the nursing needs of school-age children with acute leukemia(AL) during lumbar puncture(LP), which aimed to explore the current situation of their nursing needs, and analyze the demand characteristic and the influencing factors; to provide the scientific evidence for the development of individualized interventions for these children.Methods.This study was based on Abraham Maslow’s hierarchy of needs theory. The questionnaire on the needs of AL children during LP was developed using concept defining,literature review, referring to evidence-based guidelines of hemopathy, semi-structured interviews, and Delphi expert consultation, which included 31 items in five dimensions,i.e.information needs(10 items), communication needs(8 items), esteem needs(5 items),comfort needs(4 items), and Self-actualization needs(4 items). To examine the feasibility of the questionnaire, the pre-survey was carried out in 20 AL children with different age,gender, level of education. And then the questionnaire was modified accordingly to the analysis. The reliability and validity of the questionnaire was reliable according to the results of investigating 100 school-age children with AL during LP. The finally formal questionnaire retained 30 entries of the original and added one open-ended question,Totally 240 school-age children with AL during LP were investigated using the questionnaire, and finally we received 216 valid questionnaires. All data was entered using epidata3.1, and analyzed using SPSS17.0. Data analysis included descriptive statistical analysis, independent sample t-test, analysis of variance and multivariate stepwise regression analysis. P<0.05 was considered statistically significant, all P values for bilateral probability. Statistical analysis was used to compare the differences of nursing needs of AL children during LP who had different demographic factors, and then to explorethe factors infulencing the AL children’ nursing needs during LP.Results.1、The overall score of nursing needs was124.37±14.27. Five dimensions, level of demand from high to low in turn is: information needs, communication needs,esteem needs,comfort needs,Self-actualization needs.2、According to the mean score of the nursing needs of each item, the needs of the top five included: “Try to reduce my body exposure during lumbar puncture”, “Nurses comfort me and transfer attention to relieve my malaise and nervousness”, “Nurses provide a screen and pull the bed curtain while I’m defecating and urinating in bed”,“nurses teach me some relaxation techniques”, “nurses can consider my feelings and try to satisfy my request”. The needs of the last five was: “The nurse told me the reason and methods about feeding and excreting in the bed ”, “nurses told me in advance the possible discomfort caused by lumbar puncture”, “The nurse told me in advance the cause that parents can’t accompany me during lumbar puncture”, “The nurse told me the necessity of the lumbar puncture and explain its process”, “The nurse show me around the lumbar puncture room”.3、We compared the different demand characteristics of school-aged children with AL according to the variations of gender, age, domicile of origin, the only child, the highest grade that these children have completed, medical history, the type of disease,the number of lumbar puncture, caregivers, education degree of caregivers, marital status of caregivers and mode of medical expenses and so on. According to the results, the nursing needs score of school-age AL children was statistically different among the variations of gender, age, domicile of origin, whether the only child, the highest grade that these children have completed, the number of lumbar puncture, caregivers, education degree of caregivers(P<0.05).4、Multiple linear regression analysis of different demographic variables showed that the main factors influencing the nursing needs of school-aged children with AL during LP included the number of lumbar puncture, children’s gender, children’s age and caregivers.The main influencing factors of information needs level is the number of lumbar puncture and children’s gender. The main influencing factors of communication needs level is children’s gender, children’s age, the number of lumbar puncture, domicile of origin and caregivers. The main influencing factors of esteem needs level is children’s gender,whether the one-child, the highest grade that these children have completed and education degree of caregivers. The main influencing factors of comfort needs level is children’s gender, the number of lumbar puncture, children’s age, caregivers and education degree of caregivers. The main influencing factors of Self-actualization needs level is children’s age, children’s gender and the number of lumbar puncture.5、We also found other needs by the open-ended question, i.e, person should be less when I undergo lumbar puncture in the operation room, I don’t want to see the needle,syringe and blood, I need the accompany of parents when lumbar puncture.Conclusion.1、Nursing needs of school-age children with AL during LP shows diversification,their main demand is still about the information, of which, three of the top five nursing needs are about three esteem needs, showing that children hope medical staff to consider their true feelings and protect their privacy when pay attention to their illness, they want to build a relationship of equality with medical staff. Hospital managers should encourage nurse to expand knowledge about humanities and psychology, respect for children, pay attention to communication with children, truly “people-oriented, patient-centered”.2. The main factors influencing the nursing needs of school-aged children with AL during LP include the number of lumbar puncture, children’s gender, children’s age and caregivers, which suggests that managers should strengthen the attention to these aspects and implement the service concept about "precise care", Eventually provide individualized interventions with demand as the direction.3.Medical staff should listen to the voice from children while they pay attention to their external physical state, we should take various methods to meet children’s reasonable demands, thus, we can reduce the level of fear and anxiety of children, minimize theirdiscomfort and improve their compliance with LP, and eventually improve their quality of life.