Study On The Application Of Clown Care In Children's Vaccination

Objective:To explore the influence of clown care on children's vaccination anxiety,pain,vaccination compliance and crying time,and to further understand the inner experience of children's caregivers,medical staff and intervention practitioners on clown care,so as to provide theoretical basis for the promotion and application of clown care.Methods:This study is divided into two parts.The first part:Through literature review,qualitative interview and group discussion,the clown care plan suitable for children inoculation was initially developed,and the preliminary plan was developed through expert consultation and preliminary experiment.The final draft of clown care plan was further improved according to the expert's opinions and the problems found in the preliminary experiment.The children who were vaccinated in the preventive health care department of a third class hospital from March 2019 to October 2019 were selected as the research objects by convenient sampling.According to the sequence of vaccination,the children who were vaccinated in the first four months were selected as the control group,and the children who were vaccinated in the last four months were selected as the intervention group.The control group was given routine vaccination measures,and the intervention group was given clown care program on the basis of routine vaccination measures,including intervention links,intervention sites,intervention measures and intervention forms.The intervention time of each vaccinated child was about 30 minutes.The anxiety,pain degree,vaccination compliance,crying time,caregivers'anxiety degree and satisfaction of vaccination nursing were compared between the two groups.SPSS 21.0 software was used to analyze the data.The statistical methods included Mann Whitney U test,?~2 test and two independent samples t test.P<0.05 was considered statistically significant.The second part:Objective to select the caregivers of vaccinated children who have received clown care,the medical staff who have witnessed the implementation of clown care and the intervention implementers for semi-structured interviews.The data obtained were analyzed and sorted out by Colaizzi seven step analysis method,and the theme was extracted.Results:The first part:1.Comparison of general data:There was no significant difference in gender,age,injection method and vaccine type between the two groups(all P>0.05),with baseline comparability.There was no significant difference in age,education level and relationship between caregivers and children between the two groups of caregives(P>0.05).2.Comparison of children's anxiety degree:Before the intervention,there was no significant difference between the two groups in VAS-A score(reported by caregivers)(P>0.05),which was comparable;The VAS-A score(reported by caregivers)of the intervention group before injection was lower than that of the control group,and the difference was statistically significant(P<0.05).3.Comparison of children's pain degree:(1)Behavioral evaluation:there was no significant difference in MBPS scores between the two groups before the intervention(P>0.05),which was comparable;MBPS scores of the intervention group at the time of injection were lower than those of the control group,which was statistically significant(P<0.05).(2)Self report:the Wong Baker score of the intervention group was lower than that of the control group at the time of injection,the difference was statistically significant(P<0.05).4.Comparison of children's vaccination compliance:The compliance of children in the intervention group was significantly higher than that in the control group(P<0.05).5.Comparison of crying time of children:The crying time of intervention group was shorter than that of control group(P<0.05).6.Comparison of caregivers'anxiety:There was no statistical significance(P>0.05)in caregivers'S-AI score of the two groups before intervention,which was comparable;After intervention,S-AI score of caregivers in the intervention group was lower than that in the control group,but the difference was not statistically significant(P>0.05).7.Comparison of caregivers'satisfaction with vaccination nursing work:the satisfaction score of caregivers in the intervention group was higher than that in the control group,the difference was statistically significant(P<0.05).The second part:After collating and analyzing the interview data,2 themes and 11 sub-themes were extracted.1.Positive effects of clown care on different populations in the process of vaccination:For vaccinated children(1)Soothe the mind;(2)Distract the mind;For parents of children(1)Relieve physical and mental pressure;(2)Promote parent-child relationship;For medical staff(1)Improve working atmosphere;(2)Make the doctor-patient relationship harmonious;For clown doctors(1)Cultivate nursing professional values;(2)Improve humanistic care quality.2.The deficiencies in the process of clown care are as follows:(1)Lack of awareness of prevention and control of hospital infection;(2)Improvisation ability needs to be improved;(3)Safety awareness needs to be enhanced.Conclusion:1.Clown care can effectively relieve children's anxiety before injection,relieve the pain of vaccination,improve the compliance of children's vaccination,shorten the crying time,and improve the satisfaction of caregivers with vaccination care,which is worthy of clinical application.2.Clown care can optimize the inoculation experience of children and caregivers,enhance the humanistic care ability of nursing students and improve the relationship between doctors and patients,which is worth promoting and applying in hospitals and communities.However,there are still some problems such as insufficient concept of prevention and control of hospital infection,improvisational performance ability and safety awareness.In the future,we need to strengthen the training,improve the professionals'knowledge and practical skills of the intervention practitioners to enhance the intervention effect of clown care.