Research On Construction And Analysis Of Preoperative Therapeutic Play Program For Children With Congenital Heart Disease

Background:According to statistics from World Health Organization,about 1.5 million children with Congenital Heart Disease(CHD)are born each year in the world.60%of whom have Ventricular Septal Defect(VSD),Atrial Septal Defect(ASD),or Patent Ductus Arteriosus(PDA).Surgery is a main way for the children to cure Congenital Heart Disease.In the research,there are more than half of children experienced anxiety before surgery,and 40 to 60%of these young children are affected by severe preoperative anxiety when they undergo anesthesia.In another research,children aged from 1 to 5 years who undergo surgery are more likely to develop preoperative anxiety.Previous studies have shown that therapeutic play is a part of Child Life Services,which can improve the adaptation ability of children to cope with stress,and then reduce children’ anxiety,and promote the mental health.In addition,the quality of Child Life Services for children is also an important index for evaluating the quality of hospital services in developed countries,while only a few hospitals in China carry out related exploration.Due to the differences in the medical system in China and abroad,which meet the needs of clinical practice in China,the preoperative therapeutic play program focusing on the growth and development characteristics of children with Congenital Heart Disease,which still lacks of guidance and operational.Therefore,the aim of the research is to explore the construction of a preoperative therapeutic play program for children with congenital heart disease and to analyze the program in order to guide clinical nurses to carry out Child Life Services better.Objective:To construct the framework and content of preoperative therapeutic play program for children with Congenital Heart Disease;to analyze the feasibility of preoperative therapeutic play program for children with congenital heart disease.Methods:At first,using the method of content analysis to form category system of preoperative therapeutic play for children with CHD and main contents;Secondly,using Delphi method to inquire 15 experts in order to construct the preoperative therapeutic play program for children with CHD;At last,20 children undergoing surgery were selected for the experiment,and the result of experiment was used to analyze the feasibility of the program.Results:①Combining with the theory of cognitive development and reviewing the literature in recent 10 years,the content analysis method was applied to form the program’s framework and main contents,and the content analysis reliability of the program framework’s category system was 0.92(>0.90).② After 3 rounds of Delphi method,all of the Enthusiasm Coefficient of specialists were 100%,and the Authority Coefficient of experts was 0.83;the average of Coefficients of Variation of each item were 0.107,0.105 and 0.106,respectively,all of that<0.25;and Kendall Coordination Coefficients(W)were 0.14,0.16,and 0.14,respectively,and P<0.01.It mean that the opinions of expert were significantly consistent.The program was modified in combination with expert opinions to finally form the Preoperative Therapeutic Play Program for Children with Congenital Heart Disease.The program consists of three dimensions,play preparation,play implementation and precautions.The program composed of 3 domain,10 first indexes,and 47 items.3 Preliminary experiments to verify the feasibility of the program.The simplified modified Yale Preoperative Anxiety Scale Form was used to observe the pediatric preoperative anxiety of 20 children who received intervention of therapeutic play program at different time:preoperative waiting period on the day of surgery,children entering the operating room,children going to the operation room,and anesthesia induction period.The score of preoperative anxiety of the children was measured,respectively is 26.43±4.70,35.58±9.63,37.97± 20.92,and 47.02± 21.51.Conclusion:The research was analyzed feasibility from the perspective of scientific,safety and feasibility through clinical practice.The program is specific and available,which will provide an empirical reference for guiding the practice of Child Life Service for children with Congenital Heart Disease.