臺灣博碩士論文加值系統

術後持續性的疼痛會造成病人身理與心理負擔，導致住院天數延長增加家人們的負擔。病患自控式止痛(Patient-Controlled Analgesia,PCA)已廣泛使用在術後止痛上，允許病人控制注射止痛藥的時機。然而過程中可能會因PCA服務認知不足、止痛成效不彰或因止痛藥劑而產生用藥反應困擾，導致影響使用PCA服務的品質與滿意度。為了解決這些問題，本研究開發病患自控式止痛即時用藥反應回報系統，能讓PCA服務照護小組(PCA小組)即時了解病人狀況，進而提升醫病關係、PCA服務的品質與滿意度。
利用本系統病人隨時隨地使用自己行動裝置回報用藥反應至伺服器，PCA小組可透過網路連結至伺服器查詢各個病人用藥反應記錄，病人可透過伺服器看PCA小組回覆的訊息，PCA小組亦能透過網路電話遠端訪視病人身體狀況。前端系統上可分為兩個部分分別為使用者端與PCA小組端，使用者端四個功能元件包括系統使用說明、PCA衛教說明、用藥反應回報機制、回報歷史記錄；PCA小組端包括三個功能元件遠端電話、回報用藥反應資料管理、病人資訊管理。
本研究滿意度調查(最高5分)結果顯示使用者在止痛舒緩、減少用藥反應、系統功能滿意度分別為3.8±0.63、 3.7±0.95、 3.9±0.57，整體對PCA服務滿意度為4.1±0.57；PCA小組在提升照護效率、工作負擔、系統功能滿意度分別為3.33±0.82、2.83±0.98、3.83±0.41。其結果顯示本系統可提升醫病關係與PCA服務滿意度。

The postoperative pain of wound may cause physical and mental burden of patients which defer the recovery progress. Patient-Controlled Analgesia (PCA) service has been widely used in post-operative pain control which allows the patient to self-administer doses of analgesic through a simple electric-mechanical pumping control mechanism. However, there are some issues such as side effect, PCA cognition, and inefficient pain relief, which may affect the quality of PCA service. In order to deal with the issues, we propose the patient reporting system of drug reactions for PCA service.
The system consists of the client side and PCA group side. The client side has four function components: system operation manual, PCA education, drug reaction reporting, and reporting log. PCA group side has three function components: patient information management, remote video calls, patient drug reactions information management. Patients can use smart phone to report the level of drug reactions immediately included pain and side effects. The members of PCA group can access the patient reporting information immediately and provide comprehensive care for patients. Remote video calls function may enhance the communication between PCA group members and patients.
The satisfaction investigation of this study shows that the pain relief, drug reaction and system usage of patients’ satisfaction are 3.8±0.63, 3.7±0.95, 3.9±0.57 (based on a 1-to-5 scale). Overall PCA services satisfaction is 4.1±0.57. The satisfaction of efficiency, workload, and system usage of PCA group are 3.33±0.82, 2.83±0.98, 3.83±0.41 (based on a 1-to-5 scale). The results demonstrate that the proposed system is considered as a useful tool that enhances interaction and improve quality of care.

內容
致　謝 i
中文摘要 iv
Abstract v
第一章　序論 1
1.1研究背景 1
1.2研究動機 3
1.3研究目的 4
1.4論文架構 5
第二章　文獻回顧 6
2.1筆記型電腦 6
2.2個人數位助理Personal Digital Assistant (PDA) 7
2.3掌上型裝置 8
2.4智慧型手機 9
第三章　系統架構與研究方法 11
3.1用藥反應回報系統 11
3.1.1智慧型手機與網頁服務 11
3.1.2系統硬體設備 12
3.1.3系統軟體發展 13
3.1.4系統架構 15
3.1.5系統功能元件 16
3.2病房無線環境測試 18
3.3研究設計與研究對象 19
3.3.1研究對象 19
3.3.2研究設計 20
3.4資料分析方法 22
3.4.1描述性統計分析 22
3.4.2信度檢定 22
3.4.3相關性分析 22
第四章　結果與討論 23
4.1環境測試結果 23
4.2即時用藥反應回報系統 29
4.2.1病人使用端 29
4.2.2PCA小組使用端 35
4.3滿意度分析 39
4.3.1病人滿意度分析 39
4.3.2PCA小組滿意度分析 42
第五章　結論 44
參考文獻 45
附錄 49
附錄一 50
附錄二 53
附錄三 58
圖　目　錄
圖1　傳統的術後止痛採用疼痛注射 1
圖2　病患自控式止痛流程 2
圖3　即時用藥反應回報系統概念圖 4
圖4　筆記型電腦訪視流程[18] 7
圖5　系統架構圖[20] 8
圖6　DNH手持式不舒適回報裝置[20] 8
圖7　(a)體重紀錄(b)引管液紀錄(c)副作用紀錄[21] 9
圖8　系統首頁告知目前生理狀況[21] 9
圖9　基本手勢操作[24] 11
圖10　病患自控式裝置[25] 12
圖11　系統開發流程 14
圖12　系統架構 15
圖13　系統功能元件 17
圖14　醫院檢測網速分布圖 18
圖15　研究收案流程 20
圖16　一般外科量測圖 24
圖17　胸腔外科量測圖 24
圖18　骨外科量測圖 25
圖19　系統功能方塊圖 29
圖20　系統功能方塊圖-用藥反應 30
圖21　系統使用流程圖 31
圖22　(a)歡迎頁面(b)登錄頁面(c)首頁 32
圖23　(a)PCA使用說明(b)系統回報說明(c)回報紀錄(d)我要回報 33
圖24　(a)人體部位圖(b)留言版(c)用藥反應程度回報(d)再次確認 34
圖25　PCA小組登錄畫面 36
圖26　PCA小組即時顯示用藥反應 36
圖27　遠端網路通訊 37
圖28　歷史紀錄查詢 37
圖29　基本資料管理 38
圖30　留言回覆 38

 
表　目　錄
表1　電子化記錄設備比較 10
表2　實驗環境網路傳輸速度測量結果(Mbps) 23
表3　骨外科實驗環境網路傳輸速度量測結果(Mbps) 25
表4　一般外科實驗環境網路傳輸速度量測結果(Mbps) 27
表5　胸腔外科實驗環境網路傳輸速度量測結果(Mbps) 28
表6　受測者基本資料 40
表7　受測者滿意度結果 41
表8　PCA滿意度調查結果 43

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