臺灣博碩士論文加值系統

懷孕生產是家庭的大事，對於準父母來說也是極大的挑戰。目前產前教育課程能教導待產相關的調適策略，但在臨床上卻常見產婦未積極運用調適策略而默默忍受產痛。本研究目的探討自然產初產婦在第一產程，面對待產不適的調適策略之知識、態度與實際運用狀況及其相關因素。採事後回溯法之研究設計，以調查法進行，研究情境為台北市某醫學中心之產後病房，該院年生產數約為2600名。研究對象為自然產初產婦，採立意選樣共53名。研究工具為自擬之結構式產時調適策略量表，包括知識、態度與實際使用三個次量表。資料收集於研究對象產後72小時內收集，以自填方式作答，共發出59份問卷，回收53份，有效問卷53份，回收率達89.8%。
研究結果顯示，婦女之產時調適策略的知識程度平均為3.59 (total=5) 屬中等程度，產時調適策略的態度平均為3.17 (total=5)，趨於微正向。使用與重複使用調適策略的頻率較多的前三種依序為呼吸技巧(29.3%)、姿勢改變(21.8%)及放鬆模式(21.3%)。年齡越大，對產時調適策略之知識程度越低；知覺陪產者參與程度越高，調適策略使用態度越正向；曾經停用的策略頻率最高的為姿勢改變，策略停用的原因比例最高者是自己覺得無法有效緩解不適。第ㄧ產程時間越長，待產婦對產時調適策略使用程度越高。結論：自然產初產婦於第一產程之產時調適策略的知識程度中等，使用之態度微正向，而實際使用最多之策略為呼吸技巧；年齡、知覺陪產者之參與及產程時間長短分別為知識、態度與實際使用程度之相關因素。建議臨床上，對待產婦給予適時的產時調適策略指導，並指導與協助陪產者共同參與產時調適策略的運用；此外，另類療法之使用，亦可提供產婦更多的選擇。

Pregnancy is a family event; it is also an enormous challenge for prospective parents. At present, it is observed that part of the prenatal education courses can be provided in the classroom to wait for relevant coping strategies, but in clinical practice has failed to be used actively; mothers usually endure the pain silently.
The purpose of this study is aimed to analyze the coping strategies and relative factors in primiparous women in the first stage of labor. Retrospective survey and purposive sampling were used for this study. Following Ethics Committee approval and providing informed consent, 53 nulliparous women completed a questionnaire at 72 hours of the birth of their first child at a medical center in North Taiwan were subjects for the study. SPSS 12.0 software for Windows was used to analysis the data.
The research results indicate that nulliparous women’s knowledge of the use of copying strategies is in a middle level. The average score for this knowledge was 3.59 (total=5).
Knowledge and age are negatively inter-correlated. The average score for women’s attitude was 3.17(total=5). It was positive. Attitude and birth companion’s involvement in the use of copying strategies are positively inter-correlated. The most used continuous strategy throughout the first stage of labor was the breathing strategy, and for discontinuous strategy, postural change showed to be more used. The highest proportion of reasons for stopping use of postural change was no longer working. The degree of using of coping strategies and duration first stage of labor are positively inter-correlated. The correlation analysis showed that continuous using of massage was significantly related to duration first stage of labor and nurse’s involvement in the use of coping strategies; stopping relaxation was significantly related to birth companion’s involvement in the use of coping strategies.
Based on the results of this study, it is recommended to obstetric nurses: first ensure that the women have learned the knowledge and skills, second fit the current situation of the women to coping strategy, and third consider the importance and function of birth companion. In addition, aromatherapy and the use of music also could be useful. Aromatherapy and music is provided by the usage of reference for women at antenatal classes.

口試委員會審定書 I
誌謝 II
中文摘要 III
英文摘要 IV
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 3
第四節 重要名詞說明 4
第二章 文獻查證 5
第一節 自然產婦女第一產程生理心理變化 5
第一項 正常分娩生理變化 5
第二項 第一產程心理變化 8
第二節 產時調適策略 10
第一項 調適的定義-自我效能 10
第二項 實用的產時調適策略 12
第三節 相關研究 17
第一項 調適策略的效用 17
第二項 調適策略使用的好處與影響因素 19
第三章 研究架構與假設 21
第一節 研究架構 21
第二節 研究假設 22
第四章 研究方法 23
第一節 研究情境 23
第二節 研究對象 24
第三節 研究工具 25
第四節 研究工具的信效度檢測 28
第五節 資料收集過程 30
第六節 資料分析 32
第七節 研究倫理考量 34
第五章 研究結果 35
第一節 研究對象基本屬性 35
第二節 產前教育的準備 38
第三節 待產概略狀況 40
第四節 調適策略使用知識 43
第五節 調適策略使用態度 44
第六節 產時調適策略實際使用情形 46
第七節 研究對象基本屬性及其與調適策略使用知識、態度及使用程度的關係 52
第八節 產前教育的準備情形及其與調適策略使用知識、態度及產時調適策略實際使用情形的關係 53
第九節 待產概略狀況及其與調適策略使用知識、態度及產時調適策略實際使用情形的關係 54
第一項 待產概略狀況與調適策略使用知識、態度及使用程度的關係 54
第二項 待產概略狀況與七項調適策略使用頻率的關係 55
第三項 無痛分娩與調適策略使用知識、態度及使用程度的關係 61
第十節 調適策略使用知識及態度與產時調適策略實際使用情形的關係 62
第六章 討論 66
第一節 待產時調適策略使用情形 66
第一項 放鬆模式 66
第二項 呼吸技巧 67
第三項 撫觸按摩 67
第四項 姿勢改變(包括下床活動及產球運用) 68
第五項 芳香療法、冷熱刺激、音樂聆聽 69
第二節 調適策略使用相關因素 70
第七章 結論與建議 72
第一節 結論 72
第二節 護理之應用與建議 74
第一項 護理教育方面 74
第二項 護理實務方面 74
第三節 研究限制與未來研究建議 76
參考文獻 77
附錄一 產時調適策略使用概況問卷 82
附錄二 專家效度名單 91
附錄三 專家內容效度審查結果 92
附錄四 研究倫理委員會審查通過公文 111

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