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系統識別號 U0007-1704200715050338
論文名稱(中文) 手術前疼痛衛教對改善脊椎術後病人疼痛經驗之成效探討
論文名稱(英文) The Effects of Preoperative Pain Education on Patients' Pain Experience After Spinal Surgery
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 鄭玉華
研究生(英文) Yu-Hua Cheng
學號 M406091011
學位類別 碩士
語文別 中文
口試日期
論文頁數 101頁
口試委員 指導教授-盧美秀
中文關鍵字 脊椎手術  手術前疼痛衛教  疼痛經驗 
英文關鍵字 spinal surgery  preoperative pain education  pain experience 
學科別分類
中文摘要 病人對疼痛處置的知識與信念會影響其手術後的疼痛處置結果,因此手術前提供病人適當的疼痛衛教能幫助病人正確處理其手術後疼痛。本研究的目的即是要探討對脊椎手術病人施予手術前疼痛衛教對改善術後疼痛經驗之成效。研究採兩組前後測之類實驗設計法(quasi-experimental design),於中部某區域教學醫院骨科病房中,針對進行脊椎手術之病人收案。收案之研究對象共80人,隨機分配(random assignment)至(1)控制組40人:接受病房護理人員的手術前常規照護(2)實驗組40人:接受研究者給予之手術前常規照護及手術前疼痛衛教之介入措施。成效評值包括以部分修正之美國疼痛協會病人結果問卷(American Pain Society Patient Outcome Questionnare-Modified; APS-POQ-Modified)(APS, 1995)比較兩組手術後疼痛強度、疼痛干擾程度、疼痛處置滿意度及疼痛處置信念之差異,以及比較兩組止痛藥使用劑量(由病人之病歷紀錄收集)之差異。研究資料以描述性統計、卡方檢定(Chi-square)、t檢定及重複測量變異數分析(RM-ANOVA)等進行分析。 研究結果顯示:(1)實驗組接受手術前疼痛衛教介入措施後,手術後最劇烈疼痛強度低於控制組達統計上顯著差異。(2)實驗組手術後疼痛對日常生活、情緒及睡眠的干擾程度低於控制組,達統計上顯著差異。(3)手術後實驗組錯誤疼痛處置信念的改善程度,與控制組達統計上顯著差異。(4)手術後的疼痛處置滿意度及止痛藥使用劑量,兩組間無統計上顯著差異。 本研究結果顯示手術前疼痛衛教可以改善病人不正確的疼痛處置信念,降低病人手術後的最劇烈疼痛強度及疼痛對日常生活、情緒、睡眠的干擾程度。因此,在臨床上應加強手術前的疼痛衛教,以改善病人術後的疼痛經驗。 關鍵詞:脊椎手術、手術前疼痛衛教、疼痛經驗。
英文摘要 Patients’ knowledge and beliefs about pain management may contribute to pain outcomes after surgery. Therefore, preoperative pain education is considered to be an important tool in helping patients to manage pain after surgery. This study proposed to evaluate a preoperative pain education program to improve patients’ pain experience after spinal surgery. The study is a quasi-experimental design with two groups pre-test and post-test comparison. Subjects were chosen from one orthopedic ward in a region medical teaching hospital in middle of Taiwan. Subjects (N=80) were randomly assigned to (1) control group which received routine preoperative care by ward nurses (n=40), or (2) experimental group which received routine preoperative care and a preoperative pain education program by researcher. Outcomes were pain intensity, pain interference, satisfaction with pain management, beliefs about pain management, measured by American Pain Society Patient Outcome Questionnare -Modified (APS-POQ-Modified), and the amount of analgesics gathered from the patient’s chart. Data were analyzed by using descriptive statistics, Chi-square, t-test, and repeated measures ANOVA. The results showed that (1) the intervention of preoperative pain education resulted in statistically significant reductions of worst pain intensity after surgery in experimental group compared to control group, (2) subjects in the experimental group experienced statistically significant reductions of pain interference in general activity, mood, and sleep, compared to control subjects, (3) the misbeliefs about pain management were significantly improved after surgery in experimental group compared to control group, (4) no statistically significant differences were found in the score of satisfaction with pain management, or amount of analgesics between the two groups. In conclusion, the results of this study indicate that preoperative pain education could improve patients’ misbeliefs about pain management, reduce the worst pain intensity and pain interference in general activity, mood, and sleep after surgery. Therefore, preoperative pain education should be administered for patients in clinic to improve patients’ pain experience after sugery. Key words: spinal surgery, preoperative pain education, pain experience.
論文目次 目 錄 頁 數 致 謝....…………………………………………………….… I 中文摘要………………………………………………………..… II 英文摘要…………………………………………………………. IV 目 錄…………………………………………………………. VI 圖表目次…………………………………………………………. IX 第一章 緒論 第一節 問題背景及重要性……………….………………… 1 第二節 研究目的……………………………………………. 4 第三節 名詞界定……………………………………………. 5 第二章 文獻查證 第一節 脊椎融合手術簡介…………………………………. 7 第二節 手術後疼痛的相關探討……………………………. 9 第三節 手術前疼痛衛教……………………………………. 16 第四節 疼痛處置的成效評量………………………………. 24 第五節 研究概念架構………………………………………. 27 第六節 研究假設……………………………………………. 29 第三章 研究方法 第一節 研究設計…………………………………………… 30 第二節 研究對象及場所…………………………………… 32 第三節 研究倫理考量……………………………………… 33 第四節 研究工具…………………………………………… 34 第五節 研究進行步驟……………………………………… 39 第六節 資料處理及分析…………………………………… 43 第四章 研究結果 第一節 基本屬性及手術前疼痛情形……………………… 45 第二節 手術前疼痛衛教介入之成效……………………… 49 第五章 討論 第一節 基本屬性及手術前疼痛情形……………………… 61 第二節 手術前疼痛衛教介入成效之比較………………… 62 第六章 結論與建議 第一節 結論………………………………………………… 68 第二節 研究貢獻…………………………………………… 70 第三節 研究限制與建議…………………………………… 71 參考資料 中文部份……………………………………………………… 73 英文部分……………………………………………………… 75 附錄 附錄一 專家內容效度名單(案姓氏筆劃排列)……........ 83 附錄二 致專家效度鑑定函………………………………… 84 附錄三 疼痛衛教手冊之專家內容效度評分結果………… 88 附錄四 疼痛衛教手冊之專家內容效度及建議…………… 89 附錄五 疼痛衛教手冊……………………………………… 90 附錄六 病人基本屬性問卷………………………………… 95 附錄七 部分修正之美國疼痛協會病人結果問卷專家內 容效度評分結果………………………………….... 96 附錄八 部分修正之美國疼痛協會病人結果問卷專家內 容效度及建議…………………………………….... 98 附錄九 部分修正之美國疼痛協會病人結果問卷……....... 100 附錄十 研究同意書…………………………………………. 105 圖表目次 頁數 圖一 手術前疼痛衛教對改善術後疼痛經驗成效之研究概 念架構…………………………………………………… 28 圖二 研究進行流程圖………………………………………… 42 表一 研究設計………………………………………………… 31 表二 資料統計方法…………………………………………… 44 表三 兩組病人基本屬性與術前疼痛之比較………………… 47 表四 兩組病人手術前疼痛強度及疼痛干擾程度之比較…… 48 表五 手術後中度至重度疼痛強度分佈比較………………… 55 表六 兩組病人手術後疼痛強度比較………………………… 56 表七 兩組病人手術後疼痛干擾程度比較…………………… 57 表八 兩組病人手術後對疼痛處置滿意度之比較…………… 58 表九 兩組病人手術前後疼痛處置信念比較………………… 59 表十 兩組病人手術後止痛藥使用劑量之比較……………… 60
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