臺灣博碩士論文加值系統

本研究目的在探討鬆弛訓練對緩解外科加護病房術後病患急性疼痛及焦慮的成效，並瞭解鬆弛訓練對外科加護病房病患生理指標及住院滿意度的影響。
本研究以立意取樣方式選取90位台北巿某醫學中心外科加護病房術後病患，並隨機分配至介入組(45位)和對照組(45位)。介入組患者於術後第一天開始，接受每日兩次的鬆弛訓練，對照組則只給予常規的護理處置。資料收集以結構式問卷進行訪談，研究工具包括視覺疼痛量表、醫院焦慮量表，以及住院滿意度量表。所得資料以描述性統計、配對T檢定，以及GEE進行分析。
本研究結果顯示如下:
1. 加護病房患者的疼痛程度介於中度至重度疼痛。87.8%的疼痛是因手術傷口所致。疼痛會因為呼吸、咳嗽及移動身體而更加嚴重。
2. 在介入措施前，介入組與對照組的最痛程度並無顯著差異(6.60±2.21 vs. 6.67±2.72)；兩組的平均疼痛亦無顯著不同(3.84±2.68 vs. 3.84±2.77)。而在介入措施後患者轉出加護病房時，兩組患者的疼痛程度均有減輕。然而，介入組與對照組患者的最痛程度(4.69±2.53 vs. 3.97±2.60)，和平均疼痛程度(1.84±2.03 vs. 1.33±2.29)均無顯著差異。因此鬆弛訓練對外科加護病房術後患者的緩解疼痛並無顯著效果。
3. 在介入措施前，介入組和對照組患者的焦慮程度屬於輕度焦慮(8.18±5.00 v.s. 6.96±3.66)。而兩組患者的焦慮程度在介入措施後患者轉出ICU時均有減輕(4.18±3.46 v.s. 4.64±3.92)，並且兩組患者焦慮減輕的程度具有統計上的顯著差異，因此鬆弛訓練能有效降低外科加護病房術後患者的焦慮程度。
4. 介入組患者的住院滿意度雖然高於對照組，但並未達到統計上的顯著意義。
5. 鬆弛訓練可有效地降低外科加護病房術後患者的收縮壓達2.26mmHg (P<0.05)，並能提升患者的指溫0.71。C(P<0.001)。
本研究證實鬆弛訓練可有效降低外科加護病房病患之焦慮程度。建議針對加護病房處理外科手術後病患的焦慮問題上，可藉肌肉鬆弛訓練，輔以播放輕柔的音樂，經病患自主性等長性肢體活動，運用調和呼吸的方法，增加自我控制能力，轉移病患焦躁的情緒，降低病患的焦慮程度。藉由此研究之結果可提供臨床護理人員參考，增加鬆弛訓練之相關專業知識與技能，並運用於臨床照護上，以提昇臨床照護品質。

The purpose of this experimental study was to investigate the effect of relaxation training on the release of acute pain and anxiety in post-operative patients in surgical intensive care units (ICU), and to understand the influence of relaxation on patients’ physical status and their hospitalized satisfaction.
The convenience samples of 90 postoperative patients were recruited from the surgical ICU of a large medical center in North Taiwan. Subjects were randomized divided into two groups: 45 patients in the intervention group and the other 45 patients in the control group. Patients in the intervention group received the relaxation training twice a day, while patients in the control group received only routine nursing care. Data were collected by interview using a structured questionnaire including demographic data, Visual Analog Scale (VAS) pain scale, Hospital Anxiety and Depression Scale (HADS) - anxiety subscale, and the Hospitalized Satisfaction Scale. Data were analyzed using descriptive statistics, paired t-test, and generalized equation estimate (GEE).
Results of this study included:
1. Patients suffered from moderate to severe degree of pain. Most of pain was caused by surgical wound. The level of pain was worsen by breathing, coughing, and moving body.
2. On the baseline data, there was no significant difference between the intervention group and the control group on the highest pain of a day (6.60±2.21 vs. 6.67±2.72) as well as in the average pain of a day (3.84±2.68 vs. 3.84±2.77). On the day of patients transferred out of ICU, the level of pain on both groups was decreased. However, there was no significant difference between both groups on the highest pain of a day (4.69±2.53 vs. 3.97±2.60) as well as on the average pain of a day (1.84±2.03 vs. 1.33±2.29). Thus, the relaxation training has no significant effect on reducing pain of postoperative patients in surgical ICU.
3. On the baseline data, both the intervention group and the control group had mild degree of anxiety (8.18±5.00 vs. 6.96±3.66). The intensity of anxiety on both groups was decreased on the day of patients transferred out of ICU (4.18±3.46 vs. 4.64±3.92). In additions, there was significant difference between both groups on the degree of reducing pain. Thus, the relaxation training had significant effect on reducing anxiety of postoperative patients in surgical ICU.
4. The hospitalized satisfaction score in the intervention group was higher than the control group. However, there was no significant difference between two groups.
5. The relaxation training contributed to the change of patients’ physical status by reducing systolic blood pressure 2.26 mmHg (p<0.05) and increasing finger’s temperature 0.71oC(p<0.001).
This study confirmed that relaxation training had significant effect on reducing anxiety in postoperative patients in surgical ICU. It is suggested that relaxation could be performed to manage patients’ anxiety in ICU. Nurses should enhance their knowledge on relaxation for better quality of nursing care focusing on patients’ psychological needs.

目 錄
第一章. 緒論
第一節. 研究動機與重要性……………………………..…..2
第二節. 研究目的……………………………………………6
第二章. 文獻查證
第一節. 疼痛的概念…………………………………………7
第二節. 手術後疼痛的相關研究……………………………12
第三節. 焦慮的概念及影響…………………………………18
第四節. 漸進式肌肉鬆弛訓練對疼痛之成效………………22
第三章. 研究方法
第一節. 研究架構……………………………………………26
第二節. 名詞界定……………………………………………28
第三節. 研究問題與研究假設………………………………29
第四節. 研究設計……………………………………………30
第五節. 研究對象及場所……………………………………32
第六節. 研究工具及其信效度檢定…………………………33
第七節. 研究步驟……………………………………………39
第八節. 資料統計與分析……………………………………42
第九節. 收案樣本之估計……………………………………….43
第四章. 研究結果
第一節. 研究樣本之基本資料分析…………………………….45
第二節. 介入組與對照組之疼痛部位與程度分析…………….49
第三節. 介入組與對照組之焦慮分析………………………….62
第四節. 介入組執行鬆弛訓練前後各項生理指標變化情形….68
第五節. 介入組與對照組患者之住院滿意度比較及介入組對
介入措施之主觀成效………………………………….74
第五章. 討論
第一節. 病患的人口學特性…………………………………….77
第二節. 研究對象的疼痛程度與鬆弛訓練對病患疼痛的影響.78
第三節. 研究對象的焦慮程度與鬆弛訓練對病患焦慮的影響.83
第四節. 鬆弛訓練對病患各項生理指標的影響……………….86
第五節. 鬆弛訓練對病患住院滿意度的影響………………….88
第六章. 結論與建議
第一節. 結論…………………………………………………….89
第二節. 護理上的應用………………………………………….91
第三節. 研究限制與建議……………………………………….93

參考資料:
中文部分……………………………………………………………95
英文部分……………………………………………………………99

表 目 錄

表一.研究設計………………………………………………………..31
表二.焦慮量表專家效度之平均得分………………………………..36
表三.加護病房住院滿意度專家量表效度之平均得分……………..37
表四.研究所需樣本數估算，兩組獨立樣本T檢定之檢力分析…..43
表五.比較兩組研究對象的基本屬性………………………………..48
表六.比較兩組患者手術相關資料與疼痛部位之差異分析………..53
表七.比較兩組研究對象術後疼痛程度之變化……………………..54
表八.比較兩組研究對象在介入措施前後疼痛程度隨天數之
變化差異性…………………………………………………….54
表九.以GEE檢定研究對象術後疼痛程度，控制相關因子後
，隨時間之差異比較(N=90)………………………………….61
表十.兩組研究對象術後焦慮程度資料(連續變項變化)…………...64
表十一.兩組研究對象術後焦慮程度變化(類別變項變化)………...67
表十二.介入組患者鬆弛訓練前後各項生理指標變化……………..69
表十三.比較兩組研究對象術後隨天數各項生理指標變化………..70
表十四.兩組研究對象術後住院滿意度調查資料…………………..75

圖 目 錄
圖一.探討鬆弛訓練對外科加護病房術後病患急性疼痛及焦慮緩
解之成效研究架構……………………………………………..27
圖二.探討鬆弛訓練對外科加護病房術後病患急性疼痛及焦慮緩
解之成效研究步驟流程圖……………………………………...40
圖三.臨床收案篩選過程………………………………………………..47
圖四.介入組與對照組於加護病房最痛程度疼痛分數得分變化……..55
圖五.介入組與對照組於加護病房平均程度疼痛分數得分變化……..56
圖六.介入組依不同停留天數分組最痛程度之變化情形……………..57
圖七.介入組依不同停留天數分組之平均疼痛程度之變化情形……..58
圖八.對照組依不同停留天數分組之最痛程度之變化情形…………..59
圖九.對照組依不同停留天數分組平均疼痛程度之變化情形………..60
圖十.介入組介入措施前後醫院焦慮量表七題得分及總分前後變化.65
圖十一.對照組轉出加護病房前後醫院焦慮量表七題得分及總分前後
變化……………………………………………………………66
圖十二、介入組與對照組於加護病房收縮壓變化…………………..71
圖十三、介入組與對照組於加護病房舒張壓變化…………………..72
圖十四、介入組與對照組於加護病房心跳變化……………………..73
圖十五、介入組與對照組滿意度面向之比較………………………..76


附 錄 目 錄
附錄一.國內鬆弛訓練對急性疼痛之相關研究…………………….109
附錄二.國外鬆弛訓練對急性疼痛之相關研究…………………….110
附錄三.研究工具-問卷
一.病患基本屬性資料……………..………………………….113
二.疼痛量表…………………………..……………………….114
三.焦慮量表……………………………..…………………….115
四.加護病房病患及病患家屬對護理服務品質滿意度調
查表……………………………………………………116
附錄四.焦慮量表同意使用函……………………………………….118
附錄五.專家效度鑑定說明書
一. 專家效度鑑定(焦慮量表)……………………………….122
二. 專家效度鑑定(住院滿意度)…………………………….125
附錄六.參與問卷內容效度之專家名單…………………………….128
附錄七.參與研究同意書…………………………………………….129
附錄八.漸進式肌肉鬆弛訓練音樂光碟內容……………………….130

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英文部分
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