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研究生:王淑蓉
論文名稱:骨科病患主訴疼痛及使用止痛針顧慮之探討
論文名稱(外文):An Exploratory Study of Orthopedic Patients' Concerns abut Self-Reporting Pain and Receiving Analgesic's Injections
指導教授:邱艷芬邱艷芬引用關係
學位類別:碩士
校院名稱:慈濟大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:1997
畢業學年度:85
語文別:中文
論文頁數:79
中文關鍵詞:骨科手術手術後疼痛顧慮
外文關鍵詞:orthopedic surgerypostoperative painconcern
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本研究屬於描述性研究,旨在探討骨科病患主訴疼痛及使用止痛針之顧慮,採立意取樣方式,以北市某教學醫院接受非惡性骨科手術,術後以「依需要給予」(即每4小時可注射一次Demerol處方)之處方,且承認術後有疼痛現象並曾猶豫或不願主訴疼痛及施打止痛針者為對象,以深入訪談方式及Ward問卷進行資料之收集,時間自八十五年十月一日起至八十六年一月十五日止,共有25位個案完成訪談。訪談資料經內容分析法加以分析及歸納,共得十六項不願主訴疼痛及施打止痛針之顧慮,前五項依次為:擔心成癮、擔心造成身體器官組織傷害、即使主訴也不會獲得適當處理、擔心產生耐藥性及擔心影響傷口癒合,而此十六項顧慮依其性質可分析為五大方向,分別為:1).對止痛針之認知;2)注射行為受介入;3).個人術後疼痛信念;4).手術對個體之意義及5).對自我之維護。在施打止痛針之時機方面,25位個案表示當疼痛平均分數至8.3分(以10為滿分)時才願意施打止痛針。會談結果與Ward問卷類項之前三項次序相同,而問卷中之「宿命論」及「主訴疼痛會轉移醫師在疼痛治療上之注意力」項目不適合骨科病患使用。本研究結果可提供護理人員在術後疼痛評估及術前護理指導時之參考,期使護理人員能得知病患之真正疼痛情形及術後止痛之擔憂事項,以加強措施,進而得到最佳之止痛效果。
The purpose of this study was to explore the orthopedic patients' concerns about self-reporting pain and receiving analgesic injections. The study was designed as a descriptive research and was carried out in a teaching hospital of Taipei. Subjects were recruited during October 1, 1995~January 15, 1996 and were selected by purposive sampling. The inclusive criteria were: 1).on third to fifth day after nonmalignant orthopedic surgery; 2).way of relieved pain was “on demand” prescription (to give Demerol every four hour if necessary); 3).experienced postoperative pain and had ever hestitated or not been willing to report and receive analgesic's injections. A total of 25 subjects were included. Data were obtained by in-depth interview and Ward's questionnaire. Data were processed by content analysis techique. Sixteen items of concerns of the orthopedic patient regarding unwillingness to report and receive analgesic's injections were included. The top five in order were fear of addiction, fear of doing hurt to organ and tissue, no proper pain management given even though reporting pain, fear of tolerance and fear of delayed wound healing. The above-mentioned concerns could be categorized into five dimentions: 1).the perception about analgesic injection; 2).interruption of receiving pain-relieve; 3).the belief about postoperative pains; 4).the meaning of surgery to each patient, and 5). self-protection. As to the timing of analgesic injection, 3 of the 25 subjects rejected receiving analgesic injections, no matter how severe the pain was. The other 22 subjects expressed their willing to receive analgesic if the pain was severe enough. The average pain score to receive analgesics was above 8.3 on a scale of 10 points. The top three concerns of unwilling to report pain obtained from interviews were as same as the three obtained from Ward's questionnaire. However, "Fatalism" and "Distraction" items of questionnaire were not seen in orthopedic patients. The results of this study provided references for nurse to assess patient's postoperatiive pain and to prepare patient's preoperative teaching regarding the use of analgesics. With a better understanding of patient's pains and their concerns in reporting pain and receiving analgesics, nurses can implement proper and effective intervention to help patient's relieve pains.
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