| Objective:1.To design the framework and content of a perioperative therapeutic play program for school-age children with extremity fractures based on comfort theory.2.To verify the effects of this therapeutic play program on postoperative pain,perioperative anxiety,cortisol levels,comfort satisfaction,postoperative behavioral changes,and caregiver anxiety in school-aged children with extremity fractures.In order to provide a standardized,scientific and effective individualized therapeutic game plan to improve the clinical outcome and quality of life of children.Methods:1.Using a semi-structured interview method,school-age children with extremity fracture surgery and their caregivers were included in a qualitative interview to understand the child’s perioperative comfort needs.2.The research protocol needs to be formed through literature analysis,expert meeting method and pre-experiments.First,the study extracted and summarized relevant contents about the therapeutic play intervention program through literature search,and combined the results of qualitative interviews to construct the first draft of the therapeutic play program.Experts from related fields were invited to evaluate the first draft of the program through expert meetings.Further revisions and improvements were also made through pre-experiments.3.The study evaluated the effectiveness of the clinical application of the protocol through quasi-experimental research methods.School-age children patients who underwent elective surgery for Single fracture of extremity from May to October 2021 at a tertiary care hospital in Shanxi Province were recruited for the study.The test group and the control group were divided by the random number table method.A total of 80 cases eventually completed the study.There were 41 cases in the therapeutic play group and 39cases in the control group.The FLACC scale was used to assess the pain level of children in both groups at postoperative return to the ward（T1）,3h postoperative（T2）,6h postoperative（T3）,12h postoperative（T4）,and 24h postoperative（T5）.Serum cortisol concentrations were measured by drawing 4 ml of venous blood on the morning of surgery and on the morning of the first postoperative day.The Chinese version of the m-YPAS was used to assess the anxiety level of children in both groups at the preoperative visit（S1）,at the induction of anesthesia（S2）,and at the postoperative return to the ward（S3）.The SAS scale was used to assess caregiver anxiety levels during preoperative visits and postoperative return to the ward.The PHBQ scale was used to assess the behavior change of the children at 7 and 30 days after surgery.Assessment of whether the child’s perioperative comfort needs are being met at the time of discharge.Results:1.Through qualitative interviews with 12 children and caregivers,four themes of children’s perioperative comfort needs were summarized:（i）physical comfort needs;（ii）cognitive and emotional needs;（iii）environmental needs;and（iv）the need for play and games.The results of this qualitative study provide evidence for the construction of a play program.2.Based on the results of qualitative research and literature search,we initially designed the framework and content of the therapeutic game program,and revised the program by integrating the opinions from 12 experts,and finally modified 7 items,added4 items,and deleted 2 items.The authority coefficient of the experts was 0.84,indicating a high degree of credibility;and 4 children were selected for pre-experimentation to further adjust the therapeutic play program,resulting in a therapeutic play program with4 dimensions and 16 specific items.3.The differences in general information such as age and gender between the two study groups were not statistically significant and were comparable.The repeated measures analysis of variance showed that the FLACC pain scores of children in the test and control groups at different postoperative times tended to decrease over time（P<0.05 for the time effect）,and the decrease was higher in the intervention group than in the control group;there was an interaction between the two groups of children with time（P<0.001 for the interaction effect）;the FLACC scores in the intervention group at 3h,6h,12h,and 24h postoperatively The FLACC scores in the intervention group were lower than those in the control group at 3h,6h,12h,and 24h postoperatively（all P<0.05）.Serum cortisol concentrations in children in the test group were lower than those in the control group in the morning of the day of surgery and the morning of the first postoperative day（P<0.05）.4.After the intervention,the anxiety scores of children and families in the experimental group at the preoperative ward handover,before induction of anesthesia,and after returning to the ward were significantly lower than those of the control group（P<0.05）;There was a significant difference in the satisfaction of comfort needs between the two groups at different stages of the perioperative period（P<0.05）;the incidence of behavioral changes in the test group was 12.1%and 2.4%at 1 week and 1 month postoperatively,respectively,compared with 35.8%and 17.9%in the control group,and the difference between the two groups was statistically significant（P<0.05）.Conclusion:1.The study designed a perioperative therapeutic play program for school-aged children with extremity fractures based on the overall comfort needs of the child,a comprehensive literature analysis,expert meeting method and pre-experimentation.The results confirmed that the content of the program is reasonable and feasible,which is beneficial to guide clinical practice.2.The implementation of a perioperative therapeutic play intervention for school-aged children with extremity fractures reduced perioperative anxiety in the children and their families,and reduced acute postoperative pain and effectively improved the stress response of the children.It was also effective in meeting the perioperative comfort needs of the children and reducing the incidence of postoperative maladaptive behaviors.The results of the study confirmed the scientific and practical nature of the program. |
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