外科的小手術を受けた子どもの退院後の心理的混乱およびその関連要因

Psychological Upset and Its Related Factors of Children after Leaving Hospital from Undergoing Minor Surgery

要旨

　外科的小手術 (以下, 小手術) を受けた子どもの退院後の心理的混乱についての実態把握および関連要因の探索を目的とし, 小手術が決定した幼児期後期の子どもとその母親 24 組を対象に調査を実施した. 心理的混乱の測定・評価にはPost-Hospital-Behavior-Questionnaire (PHBQ) を用い, 当変数を目的変数とした重回帰分析を行った．

　結果, 54.2％の子どもに心理的混乱がみられ, とりわけ『分離不安』が45.8％と高く, 「夜泣き」「癇癪」「自立性の欠如」等の症状が顕著であった. また, 心理的混乱の関連因子として, 「入院の趣旨に対する理解 (β=-0.591, p＜0.001)」「病気に対する自覚 (β=ー0.317, p＜0.01)」「服従的な親子関係 (β=0.250, p＜0.05)」が抽出され, 病気や入院・手術に対する子どもなりの自覚や理解を医療者と家族が協働して促すこと, 「親子関係」については事前にアセスメントを行い個別に注意を払うこと, の必要性が示唆された．

Abstract

　The purpose of this research was to investigate the psychological upset and its related factors of children after leaving the hospital from undergoing minor surgery. Twenty-four patients, aged 4-7 y, and their mothers were enrolled in this study. Psychological upset was measured with the Post Hospital Behavior Questionnaire (PHBQ), and it was made into the ependent variable of multiple linear regression analysis.

　The results could be summarized as follow: 1) 54.2% of children tended to change their behavior in the direction of psychological upset after leaving the hospital; “separation anxiety” in particular was as hihg as 45.8%, and behaviors such as “crying at night (33.3%)”, “temper tantrums (20.8%)”, and “needing help to do things (20.8%)” were reported. 2) Multiple linear regression analysis demonstrated that psychological upset is improved by “Understanding of hospitalization by the child (β=-0.591, p＜0.001)”, “Awareness of self illness by the child (β=-0.317, p＜0.01)”, but it is aggravated by “Mother's obedience to her child (β=0.250, p＜0.05)”. These results suggested that health professionals need to cooperate with the family in order to help the child understand his or her own illness, hospitalization, and operation, and meanwhile they need to assess the child-parent relationships.