臺灣博碩士論文加值系統

本研究旨在探討並比較一般常規入院護理與運用QR code執行入院護理，增進灼傷病人家屬對入院護理滿意度與緩解急性壓力及焦慮症狀之成效。採雙組前後測非實驗性設計，以桃園某醫學中心灼傷加護中心家屬為研究對象，自2018年6月1日至2018年12月31日進行收案，研究對象分配至實驗組及控制組（各70位）。實驗組接受QR code入院護理，對照組接受常規護理。對家屬執行入院護理前給予前測（T0），入院護理後一小時（T1）、第三天（T2）及第七天（T3）共三次後測。本研究測量工具包括：自擬基本屬性資料表、自擬入院護理滿意度調查表、急性壓力症狀量表中文版及貝克焦慮量表中文版，以SPSS 22.0中文版進行資料建檔及分析。研究結果如下：一、灼傷加護病人外傷嚴重度分數越高、有放置醫療管路，及有親人住過加護病房經驗時，家屬初入院的急性壓力及焦慮越大 ; 二、家屬職業類別為工業時，其焦慮較小 ; 三、運用QR code執行入院護理，家屬急性壓力及焦慮較低，且分數降低幅度隨時間明顯較大 ; 四、接受QR code入院護理組入院護理滿意度較高。期望日後能夠將QR code入院護理措施作為病房常規，以降低灼傷中心家屬入院時的急性壓力及焦慮症狀，並提升對入院護理的滿意度。

This study compare the general and QR code admission on improving families’ satisfaction with admission nursing care and relieving acute stress and anxiety. Non-experimental and pre-test, post-test design. The study period lasted from June 1, 2018 to December 31, 2018. Families were enrolled from the Burn Unit of a Taoyuan medical center, and divided into control and experimental groups. The experimental group had the QR code admission, and the control group had the general admission. Self-reported basic data, self-reported satisfaction with admission nursing care questionnaire, Chinese version of ASDS, and BAI were used. Statistical analysis was using SPSS 22.0.The findings were as follows: 1. The families had higher degree of stress and anxious at admission when the patients had a higher severity scores, the patients were intubated or when someone has lived in ICU. 2. Families’ occupations were industrial, they would be less anxious. 3. QR code admission group had a lower degree of acute stress and anxious, and the scores had a significantly greater decrease over time. 4. The QR code admission group had a higher satisfaction with admission nursing care. It’s expected that caregivers will use QR code admission as a common routine to reduce stress and anxiety of the families admission and improve their satisfaction with admission nursing care.

指導教授推薦書.......................................................................................................
論文口試委員會審定書.........................................................................................
致謝......................................................................................................................... iii
中文摘要................................................................................................................ iv
英文摘要................................................................................................................. v
目錄......................................................................................................................... vi
附錄...................................................................................................................... viii
圖目錄...................................................................................................................... x
表目錄.................................................................................................................... xi
第一章 緒論...........................................................................................................1
第一節 研究動機.........................................................................................1
第二節 研究重要性.....................................................................................2
第三節 研究目的.........................................................................................3
第四節 研究問題與假設...........................................................................3
第五節 名詞解釋.........................................................................................5
第二章 文獻查證..................................................................................................8
第一節 灼傷..................................................................................................8
第二節 加護病房環境與特性................................................................12
第三節 入院護理重要性.........................................................................14
第四節 加護中心家屬對醫療訊息之需求....................................16
第五節 加護中心家屬之急性壓力與焦慮及其相關因素..............18
第六節 多媒體衛教工具在臨床上之運用.........................................22
第七節 多媒體工具衛教之比較............................................................25
第八節 QR code及其運用狀況.............................................................26
第三章 研究方法................................................................................................28
第一節 研究概念架構..............................................................................28
第二節 研究設計.......................................................................................29
第三節 研究對象及場所.........................................................................30
第四節 研究工具.......................................................................................31
第五節 資料收集過程..............................................................................43
第六節 資料處理與分析.........................................................................46
第七節 倫理考量.......................................................................................50
第四章 研究結果....................................................................................51
第一節 研究對象之基本屬性變項分析........................................51
第二節 研究對象之急性壓力症狀量表分析................................54
第三節 研究對象之貝克焦慮量表分析........................................58
第四節 灼傷病人及家屬基本屬性，和家屬之焦慮、急性壓力關係........................................................................................61
第五節 研究對象之入院護理整體滿意度分析................................66
第五章 討論............................................................................................74
第一節 灼傷病人及家屬基本屬性................................................74
第二節 灼傷病人及家屬基本屬性對家屬初次急性壓力與焦慮之影響................................................................................................75
第三節 家屬接受不同入院護理指導之成效................................77
第六章 結論與建議................................................................................82
第一節 結論....................................................................................82
第二節 護理應用............................................................................83
第三節 研究限制和建議................................................................84
參考文獻..................................................................................................86
附錄
附錄一 自擬基本屬性資料表.......................................................................101
附錄二 入院護理滿意度調查表（一般入院護理組）.........................104
附錄三 入院護理滿意度調查表（QR code入院護理組）.................109
附錄四 自擬入院護理滿意度調查表內容效度檢定..............................114
附錄五 急性壓力症狀量表-中文版.....................................................126
附錄六 急性壓力症狀量表-中文版使用同意書.................................128
附錄七 貝克焦慮量表中文版..............................................................129
附錄八 家屬入院資訊需求訪談問卷.........................................................130
附錄九 QR code入院護理指導內容效度檢定........................................131
附錄十 實驗組護理人員入院護理指導完整性評分表.........................138
附錄十一 專家效度檢定之專家名單.........................................................141

中文文獻
王昭慧、蘇淑芳、廖梅珍（2003）‧某教學醫院兒科病房入院環境改
善案‧新臺北護理期刊，5（2），67-78。
王敏芳、許智澔（2004）‧運用多媒體衛教光碟於C型肝炎衛生教育
之介入研究(未發表的碩士論文)‧國立台北護理學院護理研究所。
江志桓（2000）‧台北榮民總醫院重症加護精要-理論與臨床‧台北：
台北榮總內科部加護中心出版。
巫曉玲、李茹萍（2003）‧衛教光碟及單張對冠狀動脈心臟病患飲食
認知及自我效能成效探討(未發表的碩士論文) ‧台北：慈濟大學
護理學研究所。
車先蕙、盧孟良、陳錫中、張尚文、李宇宙（2006）‧中文版貝克焦慮
量表之信效度‧台灣醫學，10（4），447-454。
林一真（2000）‧貝克焦慮量表（中文版）指導手冊‧中國行為科學
社，1-29。
林琇玲、林冠語（2016）‧合併成功案例之多媒體衛教光碟介入對首
次接受脊椎手術病人術前焦慮之成效‧嘉基護理，16（1），1-13。
林雅華、鄭惠娟、謝采霞、劉晉雯、蘇麗智（2012）‧成人加護病房
病人家屬壓力感受與護理人員知覺之比較‧護理暨健康照護研
究，7（3），243-251。
吳志宏、鄭柏奇（2013）‧提升QR code在識別個人身份用之安全性‧
建國科技大學，317-321。
吳曉芸、高玉音、林梅香、紀巧玲、伍碧琦（2015）‧提升加護病房護
理人員執行入院護理之完整性‧高雄護理雜誌，32（2），10-22。
邵上智、蔡明翰、蔡培癸、劉雪娥（2015）‧多媒體衛教光碟合併護
理指導對於初次冠心病患者在疾病知識、態度及自我照顧行為之
成效探討‧護理暨健康照護研究，11（3），175-186。
胡宗鳳、江文鉅（2016）‧行動科技興起對年輕族群數位閱讀新聞行
為影響之研究‧正修學報，29，117-132。
唐高駿（1992）‧外科加護中心‧臨床醫學，30（4），240-245。
徐莞雲、陳筱瑀（2008）‧焦慮的概念分析‧志為護理，7（3），65-70。
徐雅珍、黃圓婷、明勇（2010）‧提升急診留觀病患環境介紹滿意度
之專案‧志為護理，9（3），101-110。
倪綉斐、江怡瑩、余美嬅（2012）‧提升某內科加護病房家屬護理指
導滿意度專案‧領導護理，3（13），106-116。
許國正、翁麗雀（1999）‧灼傷患童父母需求及影響因素之探討，長
庚護理，10（3），1-11。
陳淑銘、杜玉慧、吳榮州（2004）‧重症病人家屬心理需求及其影響
因素，高雄護理雜誌，21（1），1-16。
黃如萍、葉美玲（2005）‧以多媒體中西醫護理指導對糖尿病患之衛
教成效(未發表的碩士論文)‧國立台北護理學院中西醫結合護理
研究所。
連如玉、黃紀諺、邱台生（2012）‧某加護病房入院須知介紹改善方
案‧志為護理，8（1），75-85。
張美玉、劉慧玲（2000）‧實用重症護理學.台北：五南圖書公司。
張瓈方、林秀美、蘇清感、潘雪幸（2017）‧不同護理指導方案對胃
鏡檢查病人焦慮之成效‧源遠護理，11（2），23-29。
葉雅惠、江慧玲、林麗英、許凰珠（2010）‧多媒體光碟於脊椎手術
病患術前焦慮之成效‧護理暨健康照護研究，6（4），299-307。
蔣昌玲（2011）‧多媒體衛教對燒傷疤痕攣縮病患自我照顧能力、彈
性衣穿著知識及生活品質之成效‧義守大學管理學院管理碩士在
職專班。
蔡曉婷、周汎澔（2012）‧多媒體護理指導緩解冠狀動脈成形術後心
肌梗塞病患焦慮及疾病不確定感之成效‧護理雜誌，59（4），43-
53。
盧佳慧（2011）‧心理韌性與創傷後心理症狀之關聯性研究：以車禍
創傷樣本為例，臺灣大學心理學研究所。
薛玉欣、陳欣怡（2015）‧手機使用與自覺手機人際互動研究‧華岡
農科學報，35，77-87。
羅淑芬（2015）‧嚴重燒傷病人護理處置‧護理雜誌，62（4），82-
88。
蕭鵬卿、湯玉英（2004）‧壓力之概念分析‧護理雜誌，51（3），71-
75。
英文文獻
Aaron T. Beck., Gary Brown., Norman Epstein., & Robert A. Steer.
(1988). An Inventory for Measuring Clinical Anxiety: Psychometric
Properties. Journal of Consulting and Clinical Psychology, 56(6),
893-897.
Allan, H., & Dan, S. (2002). Anxiety in medical patients. British Medical
Journal, 32(5), 207-209.
Auerback, S. M., Kiesler, D. J., Wartella, J., Rausch, S., Ward, K. R., &
Ivatury, R. (2005). Optimisim, satisfaction with needs met,
interpersonal perceptions of the healthcare team, and emotional
distress in patints’ family members duing critical care hospitalization.
Am. J. Crite. Care., 14(3). 202-210.
Andrei, C., Andrew, D. B., Leo, D., Stephen, G., & Richard de, S. (2011).
Multimedia patient education to assist the informed consent process
for knee arthroscopy. ANZ Journal of Surgery, 81 , 176-180.
Alex Day., Samer Haj-Bakri., Stephanie Lubchansky., & Sangeeta Mehta.
(2013). Sleep, anxiety and fatigue in family members of patients
admitted to the intensive care unit: a questionnaire study. Critical
Care, 17(91), 1-7.
Beck A, Norman E, Brown G, et al. (1988). An Inventory for measuring
clinical anxiety : Psychometric properties. J Consult Clin Psychol,
56, 893-897.
Bryant, R. A., Moulds, M. L., & Guthrie, R. M. (2000). Acute Stress
Disorder Scale: A self-report measure of acute stress disorder.
Psychological Assessment, 12, 61-68.
Barret, J.P. (2005). Initial management and resuscitation. In Barret, J.P.&
Herndon, D.N (Ed.). Principles and practice of burn surgery. (pp.1-
32). New York: Marcel Dekker.
Browning, G., & Warren, N. A. (2006). Unmet needs of family members in the medical intensive care waiting room. Critical Care Nurse
Quarterly, 29(1), 86-95.
Bytzer, P., & Lindeberg, B. (2007). Impact of an information video before
Colonoscopy on patient satisfaction and anxiety: A randomized trial.
Endoscopy, 39, 710-714.
Black, M. D., Vigorito, M. C., Curtis, J. R., Phillips, G. S., Martin, E. W.,
McNicoll, L., Rochon, T., Ross, S., & Levy, M. M. (2013). A
multifaceted intervention to improve compliance with process
measures for ICU clinician communication with ICU patients and
families. Crit Care Med, 41, 2275-2283.
Backstrom, J., Ekselius, L., Gerdin, B., & Willebrand, M. (2013). Predict-
ion of psychological symptoms in family members of patients with burns 1 year after injury. Journal of advanced nursing, 69(2), 384-393.
Bond, S., Gourlay, C., Desjardins, A., Clermont, P. B., & Boucher, M. E.
(2017). Anxirty, depression and PTSD-related symptoms in spouses
And close relatives of burn survivors : when the supporter needs to be
supported. Burns, 43(3), 592-601.
Chien, W. T., Chiu, Y. L., Lam, L. W.,
Ip, W. Y. (2006). Effects of needs-
based education programme for family carers with a relative in an
intensive care unit: a quasi-experimental study. International Journal
of Nursing Studies, 43(1), 39-50.
Chui, W. Y. Y., & Chan, S. W. C. (2007). Stress and coping of Hong-Kong
Chinese family members during a critical illness. Journal of
Clinecal Nursing, 16(2), 372-381.
Curtis, J. R., & Tonelli, M. R. (2011). Shared decision-making in the ICU
value, challenges, and limitations. American Journal of Respiratory
and Critical Care Medicine, 183(7), 840-841.
Davidson, J. E., Jones, C., & Bienvenu, O. J. (2012). Family response to
critIcal illness : postintensive care syndrome-family. Crit Care Med,
40 (2), 618-624.
DeSousa, A., Sonavane, S., & Kurvey, A. (2013). Psychological issues in
adult burn patients. Delhi Psychiatry Journal, 16(1), 24-33.
Demircelik, M. B., Cakmak, M., Nazli, Y., Sentepe, E., Yigit, D., Keklik,
M., Arslan, M., Cetin, M., & Eryonucu, B. (2016). Effects of multime-
dia nursing education on disease-related depression and anxiety in pa-
tients staying in a coronary intensive care unit. Applied Nursing Rese-
arch, 29, 5-8.
Fumis, R. R., Ranzani, O. T., Faria, P. P., & Schettino, G. (2015). Anxirty,
Depression, and satisfacation in close relatives of patients in an open
visiting policy intensive care unit in Brazil. J Crit Care, 30(2), 440-
446.
Gail, W. S. (2005). Handbook of Psychiatric Nursing 6th edition. St.
Louis: Mosby.
Green, T., Smith, T., Hodges, R., & Fry, W, M. (2017). A simple and
inexpensive way to document simple husbandry in animal care
facilities using QR code scanning. Lab Anim, 51(6), 656-659.
Holloway, N. M. (1993). Dimensions in critical care. In N. M. Holloway
(Eds.). Nursing the critically ill adult. Redwood City: Addison-Wesley
Nursing, 31-32.

Hinkle, J. L., Fitzpatrick, E., & Oskrochi, G. R. (2009). Identifying the
pereception of needs of family members visiting and nurses working
in the intensive care unit. Journal of Neuroscience Nursing, 41(2), 85-
91.
Hinkle, J.L., & Fitzpatrick, E. (2011) Needs of American relatives of
intensive care patients: perceptions of relatives, physicians and
nurses. Intensive and Critical Care Nursing, 27(4), 218-225.
Hsueh, F. C., Chen, C. M., Sun, C. A., Chou, Y. C., Hsiao, S. M., & Yang,
T. (2016). A study on the effects of a health education intervention
on anxiety and pain during colonoscopy procedures. The Journal of
Nursing Research, 24(2), 181-189.
Johansson, I., Fridlund, B., & Hildingh, C. (2004). Coping strategies of
relatives when an adult next-of-kin is recovering at home following
critical illness. Intensive Critical Care Nursing, 20(5), 281-291.
King, S. L., & Gregor, F. M. (1992). Stress and coping in families of the
critically ill. Critical Care Nurse, 5(4), 48-51.
Keenan, A., Joseph, L. (2010). The needs of family members of severe
traumatic brain injured patients during critical and acute care: a
qualitative study. Can J Neurosci Nurs, 32 (3), 25-35.
Khalaila, R. (2014). Meeting the needs of patients’ families in intensive
care units. Nursing standard. 28(43), 37-44.
King, T. L., Kho, E. K. Y., Tiong, H. Y., & Julaihi, S. N. B. (2015).
Comparison of effectiveness and time-efficiency between multimedia
and conventional counselling on metered-dose inhaler technique
education. Singapore Medical Journal, 56(2), 103-108.
Kynoch, K., Chang, A., Coyer, F., & McArdle, A. (2016). The effective-
ess of interventions to meet family needs of critically ill patients in
an adult intensive care unit : a systematic review update. JBI Datab-
ase of Systematic Reviews and Implementation Reports, 14(3), 181-234.
Lee, Y. K., & Lau, Y. L. (2003). Immediate needs of adult family members
of adult intensive care patients in Hong Kong. Journal of Critical
Nursing, 12, 490-500.
Lim, K. H., O’Connor, M. J., Remus, W. E.(2005). The impact of
presentation media on decision making : does multimedia improve the
effectiveness of feedback. Information & Management, 42(1), 305-
316.
Lu, C. H., Kung, Y. W., Su, Y. J., & Chen, S. H. (2010). Psychometric
properties of the Chinese version of Acute Stress Disorder Scale.
Poster session presented at the 4th Asian Congress of Health
Psychology, August 27-31, Taipei, Taiwan.
Lin, K. Y., & Teng, D. (2018). Using quick response codes to increase students participation in case-based learning course. Computers, Info-
Rmatic, Nursing. 36(11), 560-566.
Mashreky, S. R., Rahman, A., Chowdhury, S. M., Giashuddin, S., Svanstr-
om, L., Khan, T. F., Cox, R., & Rahman, F. (2008). Burn injury : economic and social impact on a family. Public Health, 122, 1418-1424.
McAdam, J. L., Dracup, K. A., White, D. B., Fontaine, D. K., & Puntillo,
K. A. (2010). Symptom experiences of family members of intensive
care unit patients at high risk for dying. Critical Care Medicine, 38(4),
1078-1085.
Moore, D. C., Gary, L., Bernardini, G. L., Hinerman, R., Sigond, K.,
Dowling, J., ... Shelton, W. (2012). The effect of a family support
intervention on physician, nurse, and family perceptions of care in
the surgical, neurological, and medical intensive care units. Critical
Care Nursing Quarterly, 35(4), 378-387.
Mandell, S. P., & Gibran, N. S. (2014). Early enteral nutrition for burn
injury. Advances in Wound Care, 3(1), 64-70.
Moloud, F, F., Zahra, P., Mojtaba, G., Zohre, G, Z., & Fateme, G. (2016).
The Impact of Multimedia Software Support on Knowledge and Self-
Care Behaviors of Patients with Type 2 Diabetes : a Randomized
Clinical Trial. Journal of Caring Sciences, 5(2), 111-120.
Netzer, G., & Sullivan, D. R. (2014). Recognizing, naming, and measuring
a family intensive care unit syndrome. Ann Am Thorac Soc, 11, 435-
441.
Nates, J.L., Nunnally, M., Kleinpell, R., Blosser, S., Goldner, J., Birriel, B.,
Fowler, C. S., Byrum, D., Miles, W. S., Bailey, H., & Sprung, C. L.
(2016). ICU Admission, Discharge, and Triage Guidelines: A
Framework to Enhance Clinical Operations, Development of
Institutional Policies, and Further Research. Crit Care Med, 44(8),
1553-1602.
Obringer, K., Hilgenberg, C., & Booker, K . (2012). Needs of adult family
members of intensive care unit patients. Journal of Clinical Nursing,
21, 1651-1658.
Piotrowski, C. (1999). The status of the Beck Anxiety Inventory in
comtemporary research. Psychol Rep, 85, 261-262.
Pang, P. S. K., & Suen, L. K. P. (2009). Stress in the intensive care unit:
Comparing the perceptions of Chinese patients and their family. Stress
& Health, 25(2), 151-159.
Price, L. A., & Milner, S. M. (2013). The totality of burn care. Trauma,
15(1), 16-28.
Quintrec, J. G., Coste, J., Vastel, L., Pacault, V., Jeanne, L., Courpied, J.,
et al. (2003). Positive effect of patient education for hip surgery.
Clinical Orthopaedic and Relater Research, 414, 112-122.
Rosser, J. C., Herman, B., Risucc, D. A., Murayama, M., Rosser, L. E., &
Merrell, R. C. (2000). Effectiveness of a CD-ROM multimedia
tutorial in transferring cognitive knowledge essential for laparoscopic
skill training. American Journal of Surgery, 179(4), 320-324.
Rickels, K., & Rynn, M. (2001) . Overview and clinical presentation of
Generalized Anxiety Disorder. In:Olga Brawman-Mintzer ed.
Psychiatr Clin North Am, 24,1-17.
Rowley-Conwy, G. (2013). Management of burns in intensive and acute
care. Nursing Standard, 27(45), 63-68.
Rose, R. D., Bucky, J. C., Zbozinek, T. D., Motivala, S. J., Glenn, D. E.,
Carteine, J. A., & Craske, M. G. (2013). A randomized controlled tri-
al of a self-guided, multimedia, stress management and resilience trai-
ning program. Behaviour Research and Therapy, 51(2), 106-112.
Siegel, M. D., Hayes, E., Vanderwerker, L. C., Loseth, D. B., & Prigerson,
H. G. (2008). Psychiatric illness in the next of kin of patients who die
in the intensive care unit. Critical Care Medicine, 36(6), 1722-1728.
Serghiou, M., Cowan, A., & Whitehead, C. (2009). Rehabilitation after a
burn injury. Clinics in Plastic Surgery, 36(4), 675-686.
Sauls, J. L., & Warise, L. F. (2010). Interventions for anxiety in the
critically ill: A guide for nurses and families. Nursing Clinics of
North America, 45(4), 555-567.
Schmidt, M., & Azoulay, E. (2012). Having a loved one in the ICU: The
forgotten family. Current Opinion in Critical Care, 18(5), 540-545.
Snell, J. A., Loh, N.-H. W., Mahambrey, T., & Shokrollahi, K. (2013).
Clinical review: The critical care management of the burn patient.
Critical Care, 17(5), 241.
Tsoulou, V., Karamolegou, E., Kourakos, M., Vasllopoulos, G., & Polikan-
drioti. (2019). Association of state and trait anxiety between patients
who had undergone traumatic amputation and their family caregivers.
The Internation Journal of Lower Extremity Wound, 17, 12-20.
Upton, J., Olsson-Brown, A., Marshall, E., & Sacco, J. (2017). Using QR
codes to enable quick access to information in acute cancer care. Bri-
tish Journal of Nursing, 26(10), 4-12.
Verhaeghe S, Defloor T, Van Zuuren F, Duijnstee M, Grypdonck M.
(2005). The needs and experiences of family members of adult
patients in an intensive care unit: a review of the literature. J Clin
Nurs, 14, 501-509.
Williams, S. A., & Schreier, A. M. (2005). The role of education in
managing fatigue, anxiety, and sleep disorders in women undergoing
chemotherapy for breast cancer. Applied Nursing Research, 18(3),
138-147.
Wiechman Askay, S., Patterson, D. R., Sharar, S. R., Mason, S., & Faber,
B. (2009). Pain management in patients with burn injuries.
International Review of Psychiatry, 21(6), 522-530.
Wu, K. L., Chen, S.R., Ko, W. C., Kuo, S. Y., Chen, P.L., Su, H. F., & Ch-
ang, W. Y. (2014). The effectiveness of an accessibility-enhanced m-
ultimedia informational programme in reducing anxiety and increasi-
ng satisfaction of patients undergoing cardiac catheterization. Journal
of Clinical Nursing, 23, 2063-2073.
Zurmehly, J., & Adams, K. (2017). Using quick response code in the class-
room : quality outcomes. Computers, Informatics, Nursing, 35(10),
505-511.