臺灣博碩士論文加值系統

本研究目的為了解多胞胎妊娠婦女確定減胎時、減胎當天及減胎後的不確定感、懷孕焦慮、情境及特質焦慮程度與趨勢，並比較系統性護理指導與常規護理指導介入前後之不確定感、懷孕相關焦慮、情境焦慮與特質焦慮程度成效差異。採前、中及後測實驗設計法，以立意取樣於中部某不孕症生殖科技治療中心收案，以多胞胎妊娠婦女減胎者為母群體，隨機分為實驗組和對照組，實驗組給予研究者編著之系統性指導衛教手冊，逐一說明與相互討論；對照組按照原醫院訂定減胎常規護理指導及接受醫院之衛教單張與資訊。研究工具為結構式問卷與系統性指導衛教手冊。問卷內容表包含基本資料、視覺不確定感量表、懷孕相關焦慮量表、情境焦慮量表及特質焦慮量，於確定減胎、減胎當天及減胎後第三天完成問卷測量，資料以SPSS/PC(+) 12.0 window套裝軟體分析，主要以次數、百分比、平均值、標準差、最大值及最小值呈現描述性統計，以卡方檢定或 t 檢定測試兩組研究對象之同質性，比較兩組在接受不同護理措施的差異，以平均值畫出趨勢圖比較，Pair-T test分析介入前後成效。
研究結果：實驗組與對照組不確定感、懷孕相關焦慮、情境焦慮及特質焦慮的趨勢共同特點為減胎當天呈現上升趨勢，減胎後第三天呈現下降趨勢。不確定感、懷孕相關焦慮、情境焦慮及特質焦慮，三次測量時間點兩組比較，實驗組平均值均小於對照組。減胎後第三天，實驗組不確定感小於對照組，達統計顯著差異。
不確定感在確定要減胎配對減胎後第三天和減胎當天配對減胎後第三天之差異，實驗組得分小於對照組呈統計顯著差異。懷孕相關焦慮在實驗組於確定要減胎配對胎後第三天之差達統計顯著差異。情境焦慮實驗組在三個測量時間點之差，皆未達統計上顯著差異；而實驗組與對照組在確定要減胎與減胎後第三天之差達統計顯著差異。特質焦慮實驗組三次配對差皆未達統計顯著差異。



本研究結果：提供護理人員對多胞胎妊娠婦女減胎時採系統性護理指導，可降低多胞胎妊娠婦女減胎急性期壓力之不確定感，並使特質焦慮達穩定狀態，可提供臨床照護之參考。

The goal of this research is to evaluate the efficacy of systemic nursing guidance intervention in reduction of uncertainty、the pregnancy anxiety and the trend state-trait anxiety within the fetal reduction period among multiple gestational women.. This research adopts purposive sampling ,pretest-midtest-posttest study design. The population is composed of sixty multiple gestational women and is collected from certain obstetrics and gynecology department in the midland of Taiwan .The population is divided into experimental group and control group. Experimental group receives intervention with systemic nursing guidance manual which is redacted with clinical experience and individual discussion. Control group receives routine intervention according to the nursing guidance manual setting up by original hospital and handout forms. The study tool takes structured questionnaire and the systemic nursing guidance manual The content of questionnaire includes basic data, State-Trait anxiety inventory, the pregnancy anxiety inventory, and the uncertainty in pregnancy vision scale. Data is collected on the day of confirmative fetal reduction (gestational period for nine weeks), on the day of receiving fetal reduction and on the third day post fetal reduction. Data analysis introduces statistics methods with SPSS/PC(+) 12.0 window and reveals descriptive statistics mainly displayed by the frequency, percentage, mean, standard deviation, maximum and minimum in both groups. This research adopts chi-square or t test to compare homogeneity between the experimental group and the control group and the difference between the experimental group and the control group after different nursing care intervention. Besides, we compare the efficacy in pre-intervention period and post-intervention period via trend graph drawn by mean and paired –T-test.。


Research result: The experimental group and control group share some common points: The trend of State-Trait anxiety inventory, the pregnancy anxiety inventory, and the uncertainty in pregnancy vision scale rise on the day of receiving fetal reduction and descend on the third day post fetal reduction. The mean of State-Trait anxiety inventory, the pregnancy anxiety inventory, and the uncertainty in pregnancy vision scale in the experimental group is smaller than the control group. The uncertainty in pregnancy vision scale between the experimental group and the control group achieves apparent difference either on the day of receiving fetal reduction or on the third day post fetal reduction. The pregnancy anxiety inventory reveals apparent difference in mean via paired –T-test among the experimental group either on the day of receiving fetal reduction or on the third day post fetal reduction. The trend of State-Trait anxiety inventory doesn’t reveal statistic difference in mean via paired-T-test among the experimental group。
Our study hope to provide nursing staff about how to apply the systemic nursing guidance intervention during acute stress period about fetal reduction in multiple gestational female in order to relief their stress。
Our study provide clinical evidence that the systemic nursing guidance intervention within the reduction period among multiple gestational women lessen the uncertainty of acute stress period and stabilize their State-Trait anxiety。

目 錄
頁數
口試委員會審定書----------------------------------------- I

致謝-----------------------------------------------------II

中文摘要------------------------------------------------III

英文摘要--------------------------------------------------V
目錄----------------------------------------------------VII

圖目錄----------------------------------------------------X
表目錄---------------------------------------------------XI
第一章 緒論-----------------------------------------------1
第一節 研究動機與重要性----------------------------1
第二節 研究目的------------------------------------2
第三節 研究問題------------------------------------2
第四節 研究假設------------------------------------3
第五節 研究架構------------------------------------4
第六節 名詞界定------------------------------------5
第二章 文獻查證-------------------------------------------8
第一節 醫源性多胞胎--------------------------------8
第二節 選擇減胎婦女心理困境-----------------------10
第三節 不確定感-----------------------------------11
第四節 懷孕相關焦慮--------------------------------------12
第五節 壓力與焦慮---------------------------------13
第六節 系統性護理指導-----------------------------14
第三章 研究方法------------------------------------------16
第一節 研究設計-----------------------------------16
第二節 研究對象與場所-----------------------------17
第三節 研究工具-----------------------------------17
第四節 資料收集-----------------------------------20
第五節 資料分析-----------------------------------21
第六節 倫理考量-----------------------------------21
第四章 研究結果------------------------------------------22
第一節 受試者人口學與相關變數之分布---------------22
第二節 懷孕相關焦慮量、情境焦慮量表及特質焦慮量表等之各項
目描述-------------------------------------------27
第三節 孕視覺不確定感量表、懷孕相關焦慮量表、情境焦慮量 表及特質焦慮量表等之趨勢圖----------------------35
第四節 懷孕視覺不確定感量表、懷孕相關焦慮量表、情境焦慮量
表及特質焦慮量表兩組之比較----------------------38
第五節 視覺不確定感量表於確定要減胎、減胎當天及減胎後第三
天之比較----------------------------------------41
第六節 懷孕相關焦慮量表於確定要減胎、減胎當天及減胎後第三
天之比較-----------------------------------------43
第七節 情境焦慮量表於確定要減胎、減胎當天及減胎後第三天之
比較---------------------------------------------45
第八節 特質焦慮量表於確定要減胎、減胎當天及減胎後第三天之
比較---------------------------------------------47
第九節 護理措施介入成效之兩組比較-----------------------49
第十節 系統性護理措施介入對不確定感於確定要減胎、減胎當天
及減胎後第三天之差異-----------------------------51
第十一節 系統性護理措施對懷孕相關焦慮於確定要減胎、減胎當天
及減胎後第三天之差異----------------------------53
第十二節 系統性護理措施介入對情境焦慮於確定要減胎、減胎當天
及減胎後第三天之差異----------------------------55
第十三節 系統性護理措施介入對特質焦慮於確定要減胎、減胎當天
及減胎後第三天之差異----------------------------57
第五章 討論----------------------------------------------59
第一節 受試者人口學的特質-------------------------59
第二節 懷孕視覺不確定感量表之趨勢與介入前後差異性討
論-----------------------------------------60
第三節 懷孕相關焦慮量表之趨勢與介入前後差異性討論-61
第四節 情境焦慮量表之趨勢與介入前後差異性討論-----62
第五節 特質焦慮量表之趨勢變化與介入前後差異性討論-63
第六章 結論與建議----------------------------------------65
第一節 結論---------------------------------------65
第二節 護理上應用與建議---------------------------66
第三節 研究限制與建議-----------------------------67
参考資料-------------------------------------------------68
中文部分-------------------------------------------68
英文部分-------------------------------------------70
附錄-----------------------------------------------------74
【附錄一】中山醫學大學附設醫院人體試驗委員會審查通過證明
書--------------------------------------------------74
【附錄二】基本資料------------------------------------75
【附錄三】研究問卷------------------------------------76
【附錄四】受試者同意書--------------------------------79
【附錄五】情境與特質焦慮量表授權使用同意書------------82
【附錄六】系統性指導衛教手冊--------------------------83

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