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研究生:蔡宜倫
研究生(外文):Tsai, Yi-Lun
論文名稱:運用決策樹探討陰道生產的婦女選擇減痛分娩的相關因素
論文名稱(外文):Decision-Making Trees for Analysis of Related Factors in Women With Vaginal Birth Considering Epidural Analgesia
指導教授:高美玲高美玲引用關係
指導教授(外文):Meei-Ling Gau
口試委員:林寬佳高千惠
口試委員(外文):Kuan-Chia LinChien-Huei Kao
口試日期:2011-01-14
學位類別:碩士
校院名稱:國立臺北護理學院
系所名稱:護理助產研究所
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:2011
畢業學年度:99
語文別:中文
論文頁數:116
中文關鍵詞:二元決策樹陰道生產減痛分娩
外文關鍵詞:binary decision-making treevagina birthepidural analgesia
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本研究旨在探討孕婦在懷孕末期對減痛分娩的態度,與待產期間對減痛分娩的決策因素,並藉由二元決策樹的運用,建立孕產婦接受減痛分娩的分類預測模型。
本研究以陰道自然生產的婦女為研究對象,共計收案102個,以健康信念理論做為本研究之基礎,研究工具包括自行建構基本屬性問卷、生產期望量表、減痛分娩多屬性效用量表以及生產支持與控制量表。研究結果顯示:孕期婦女對於減痛分娩的態度分為三組:傾向不使用減痛分娩42人(41.18%)、傾向使用減痛分娩21人(20.56%),和尚未決定的婦女有39人(38.24%),三組在基本人口學的比較結果並無差異,在產科史方面,傾向使用減痛分娩的婦女在「產前減痛」(p<.001)和「拉梅茲呼吸法」(p=.001)的參與率顯著的低於不使用減痛分娩的婦女。個人信念的次概念比較,三組在「止痛」的分數呈現顯著性的差異(p=.006),傾向使用減痛分娩與尚未決定的婦女得分均比傾向不使用減痛分娩的婦女高;傾向不使用減痛分娩的婦女在「生產的期待」分數顯著的高於傾向使用減痛分娩的婦女(p=.001);傾向使用減痛分娩的婦女在「錯誤的認知」得分顯著的高於傾向不使用減痛分娩和尚未決定的婦女(p=.009)。尚未決定的婦女在「親友」的意見得分則顯著的比傾向不使用減痛分娩的婦女高(p=.032)。
在待產期間,使用減痛分娩的婦女共43人(42.16%),未使用使用減痛分娩的婦女共59人(57.84%),初產婦使用減痛分娩比率顯著高於經產婦(p=.005)。在個人信念的次概念中,未使用減痛分娩的婦女在「生產的期待」分數顯著的高於使用減痛分娩的婦女(p=.03);在「社會大眾」的意見得分結果則是使用減痛分娩的婦女分數顯著的高於未使用減痛分娩的婦女(p=.02)。決策樹的因子,在孕期婦女對減痛分娩的態度受到減痛分娩的「止痛」效果、對減痛分娩的「錯誤認知」、「不良反應」和親友的意見等四個變項的影響;待產時的影響因子則包括先生的建議、減痛分娩的止痛效果、母親或婆婆與職業對減痛分娩的建議等5個變項。當先生、母親或婆婆的建議為沒意見或反對,婦女通常會選擇不使用減痛分娩,認同減痛分娩的止痛效果的婦女才會選擇減痛分娩(止痛分數>0),職業非專業人員與非事務人員比較可能選擇使用減痛分娩。懷孕期間的決策樹預測力為66.67%,生產期間的決策樹的預測力為87.36%。
不論是孕期或是待產期間,如何能夠減輕生產疼痛是婦女們重視的問題。鼓勵婦女多參與產前父母教室,以瞭解生產過程;產前護理指導要提供多方面的資訊-減痛分娩以及其他非藥物的止痛方式,讓婦女能在充分瞭解之後,自主的選擇適當的減痛方式。

Purpose: This study explored factors that influence pregnant women’s decisions during their third trimester to receive epidural analgesia. Researchers established a binary decision-making tree model to identify significant factors related to epidural analgesia use.
Methods: Participants included 102 prenatal vaginal birth women. The questionnaires consisted of demographics information, childbirth expectations questionnaire, epidural labor analgesics with multi-attribute utility model questionnaire, and support and control in birth questionnaire.
Results: Participant attitudes toward epidural analgesia included a preference for non-epidural analgesia (42 participants, 41.18%), preference for epidural analgesia (21 participants, 20.56%), and undecided (39 participants, 38.42%). Demographic attributes were non-statistically difference among the three attitude groups. In terms of obstetric history, participants favoring epidural analgesia had lower means in “prenatal pain relief” and “Lamaze breathing” scores (p<.001 and p=.001, respectively) than who favored non-epidural analgesia. In the area of personal belief, participants who favored epidural analgesia or were undecided had a significantly higher mean pain relief score (p=.006) than the non-epidural analgesia group; participants who favored non-epidural analgesia had a significantly higher mean “expectation of labor experience” score (p=.001) than those who favored epidural analgesia; those who favored epidural analgesia had a significantly higher mean “incorrect assumptions” score (p=.009) than others; and those in the undecided group had a significantly higher mean “opinions of relatives” score (p=.005) than their non-epidural analgesia peers. During labor, 43 (42.16%) participants accepted and 59 (57.84%) rejected epidural analgesia. Significantly more primiparous participants accepted epidural analgesia than mulitparous participants. Participants who refused epidural analgesia had a significantly higher mean score on the personal belief item “expectations of labor experience” than those who accepted epidural analgesia (p=.03). In terms of the “social trend” opinion score, those accepting epidural analgesia scored higher than those who did not.
Decision-making tree factors found participant attitudes toward epidural analgesia affected by four factors, including “effect of pain relief,” “misunderstanding,” “side effects,” and “opinion of relatives.” Five factors found to influence attitudes during labor included: “husband’s suggestion,” “pain relief effect,” “mother or mother-in-law’s suggestion,” and “occupation.” Likelihood of rejecting epidural analgesia increased when the participant’s husband, mother, or mother-in-law provided no opinion or a negative opinion regarding epidural analgesia use. Participants with confidence in the pain relief effect of epidural analgesia (pain relief score >0) were likely to choose such. This study also found non-professional and non-orderly staff to prefer epidural analgesia. The predictive power of the decision-making tree was 66.67% during pregnancy and 87.36% during labor.
Conclusions / Implications for Practice: Relief of birth pain is a major concern for women in labor. Those preparing to give birth should be encouraged to participate in antenatal parenting classes to learn more about the labor process. Such instruction should provide information on epidural analgesia and non-pharmacological pain relief methods to allow women to make informed pain-relief decisions.

「論文目次」
目 錄
誌謝 ………………………………………………………………………………………I
中文摘要………………………………………………………………………………… II
英文摘要………………………………………………………………………………… IV
目錄 …………………………………………………………………………………… VII
圖表目次………………………………………………………………………………… IX
附錄……………………………………………………………………………………… XI
第壹章 緒論
第一節 研究動機與重要性……………………………………………………………… 1
第二節 問題陳述……………………………………………………………………… 3
第三節 研究目的……………………………………………………………………… 5
第四節 名詞解釋………………………………………………………………………… 5
第貳章 文獻探討
第一節 婦女與生產疼痛……………………………………………………………… 8
第二節 減痛分娩………………………………………………………………………15
第三節 減痛分娩對母嬰的影響………………………………………………………23
第四節 婦女選擇減痛分娩的相關因素………………………………………………28
第五節 婦女選擇減痛分娩之理論模式………………………………………………32
第参章 研究方法
第一節 研究對象與地點………………………………………………………………40
第二節 研究工具………………………………………………………………………40
第三節 資料收集程序…………………………………………………………………44
第四節 資料分析………………………………………………………………………44
第五節 研究倫理………………………………………………………………………46
第肆章 研究結果
第一節 研究對象之人口學及產科資料………………………………………………47
第二節 孕期婦女選擇減痛分娩態度之相關因子……………………………………52
第三節 生產期婦女選擇減痛分娩之相關因子………………………………………55
第四節 孕期與待產期減痛分娩不同決策之比較……………………………………59
第五節 孕期婦女選擇減痛分娩之決策樹模式………………………………………62
第六節 生產期婦女選擇減痛分娩之決策樹模式……………………………………67
第伍章 討論
第一節 孕期婦女選擇減痛分娩態度之相關因子……………………………………73
第二節 生產期婦女選擇減痛分娩之相關因子………………………………………74
第三節 生產期婦女選擇減痛分娩之相關因子………………………………………76
第四節 孕期婦女選擇減痛分娩之決策樹模式………………………………………76
第五節 生產期婦女選擇減痛分娩之決策樹模式……………………………………77
第陸章 結論與建議
第一節 結論……………………………………………………………………………78
第二節 研究貢獻及護理應用…………………………………………………………79
第三節 研究限制……………………………………………………………………81
第四節 研究建議……………………………………………………………………81
參考文獻 ………………………………………………………………………………82
圖表目次
圖一 健康信念模式……………………………………………………………………34
圖二 健康信念模式……………………………………………………………………34
圖三 減痛分娩多屬性效用模式………………………………………………………36
圖四 研究架構圖………………………………………………………………………37
圖五 收案流程圖………………………………………………………………………44
圖六 二元樹的基本結構………………………………………………………………45
圖七 收案過程圖………………………………………………………………………47
圖八-1 孕期對減痛分娩的態度傾向相關因子最適樹………………………………65
圖八-2 孕期對減痛分娩的態度傾向相關因子最適樹………………………………65
圖八-3 孕期對減痛分娩的態度傾向相關因子最適樹………………………………66
圖九 懷孕期間對減痛分娩態度傾向之決策樹 ……………………………………67
圖十-1 生產期間選擇減痛分娩的決策相關因子最適樹……………………………70
圖十-2 生產期間選擇減痛分娩的決策相關因子最適樹……………………………70
圖十-3 生產期間選擇減痛分娩的決策相關因子最適樹……………………………71
圖十一 待產期間選擇減痛分娩決策之決策樹………………………………………72
表格
表一 懷孕期間對減痛分娩傾向的基本人口學及產科資料……………………………49
表二 生產時對減痛分娩決策的基本人口學及產科資料………………………………51
表三 懷孕期間的個人信念………………………………………………………………54
表四 生產期間影響減痛分娩決策的相關因素…………………………………………55
表五 生產時對減痛分娩不同決策的個人信念…………………………………………57
表六 生產資料與使用減痛分娩與否的相關性…………………………………………58
表七 對減痛分娩不同決策的基本人口學屬性及產科史之比較………………………59
表八 對減痛分娩不同決策的個人信念之比較…………………………………………61
表九 影響婦女懷孕期對減痛分娩態度傾向之變項尺度………………………………62
表十-1 孕期對減痛分娩的態度傾向之交叉確認結果………………………………64
表十-2 孕期對減痛分娩的態度傾向之交叉確認結果………………………………64
表十一 影響婦女產時對減痛分娩決策之變項尺度…………………………………68
表十二-1待產期間對減痛分娩的決策之交叉確認結果……………………………69
表十二-2待產期間對減痛分娩的決策之交叉確認結果……………………………69
附錄
附錄一 懷孕期問卷 …………………………………………………………………94
附錄二 產後量表………………………………………………………………………104
附錄三 減痛分娩多屬性效用問卷使用同意書………………………………………108
附錄四 生產期望量表問卷使用同意書………………………………………………109
附錄五 生產支持及控制(SCIB) 量表原著使用同意書……………………………110
附錄六 生產支持及控制(SCIB) 中文量表使用同意書 ……………………………111
附錄七 同意臨床試驗證明書…………………………………………………………112
附錄八 懷孕期間對減痛分娩態度傾向之決策樹電腦output…………………....……113
附錄九 待產期間選擇減痛分娩決策之決策樹電腦output……………………………115


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