臺灣博碩士論文加值系統

研究背景：親子同室雖然對母嬰身心發展及成功哺餵母乳有諸多的優點，然而國內自90年推行親善醫院以來，在措施七「實施24小時親子同室」一直是十大措施中執行程度較不好且分數偏低的措施。醫院多半擔心執行親子同室會影響導致婦女疲憊且影響其睡眠品質，然而文獻中有關親子同室型態與產後疲憊感、睡眠品質之相關性卻有不一致性的結果。
研究目的：旨在探討產後住院期間親子同室之型態與產婦疲憊感、睡眠品質之相關性。
方法：本研究採描述相關性研究，資料收集期間為102年4月至7月，採方便取樣選取懷孕37週以上、單胞胎，於懷孕、待產期間及產後之新生兒與產婦皆無異常及合併症，
沒有親子同床的禁忌，排除嬰兒出養及受性侵害之產婦，共計121位產後婦女。研究工具包括自行建構的基本屬性問卷、改良式疲憊量表、中文睡眠品質量表，以及偵測睡眠
時間長短、深睡期及淺睡期的監測器（Cadiopulmonary Coupling, CPC）。個案於住院期間在每天入睡時，於母親胸前貼上CPC監測器，每天早上填寫改良式疲憊量表及中文匹茲堡睡眠品質量表。
研究結果：在人口學資料方面，本研究結果顯示專科以下教育程度（χ2(1) = 11.08, p < .001）、有執行即刻肌膚接觸者（χ2(1) = 6.40, p < .05），在懷孕時即想採取24小時親子同室者（χ2(3) = 24.17, p < .001），有較高比例選擇夜間親子同室。在產科學相關因子方面，採陰道產（χ2(1) = 4.81, p < .05）、會陰撕裂傷程度低者（p < .05）、`生產失血量較少者（t(119) = 2.11, p < .05）、哺乳次數較多者（p < .001）有較高比例選擇夜間親子同室。
以概似化估算基準模式、時間模式及改變模式分析，在陰道產產婦之主觀睡眠品質之預測因素，有親子同室者比無親子同室者有較佳的主觀睡眠品質總分（B = -1.97, p < .001），妊娠週數越多則主觀睡眠品質越好（B = -0.35, p < .01），疲憊程度越高則主觀睡眠品質越差（B = 0.11, p < .001），哺餵次數越多則主觀睡眠品質越差（B = 0.33, p < .001），時間每多一天則主觀睡眠品質越好（B = -0.42, p < .05），疲憊程度有所改善則主觀睡眠品質也會變好（B = 0.11, p < .01），哺餵次數變少則主觀睡眠品質也會變好（B = 0.38, p < .001）；陰道產產婦在客觀睡眠品質之預測因素，有親子同室者比無親子同室者有較佳的客觀睡眠品質總分（B = 34.49, p < .001），住單人房比住多人房有較差的客觀睡眠品質總分（B = -20.40, p < .001），有使用減痛分娩會比沒有使用者有更好的客觀睡眠品質（B = 8.59, p < .05），哺餵次數越多則客觀睡眠品質越差（B = -4.93, p < .001），前一天的疲憊程度與哺餵次數與後一天的客觀睡眠品質無關，哺餵次數變少則客觀睡眠品質也會變得越好（B = -4.89, p < .001），疲憊程度的改變則與客觀睡眠品質的改變無關。
在剖腹產產婦之主觀睡眠品質之預測因素，疲憊程度越高則主觀睡眠品質越差（B = 0.20, p < .001），疲憊程度變低則主觀睡眠品質越好（B = 0.28, p < .001）；在客觀睡眠品質之預測因素，有親子同室者比無親子同室者有較佳的客觀睡眠品質總分（B = 23.47, p < .001），時間每多一天則客觀睡眠品質越好（B = 3.06, p < .05），前一天的疲憊程度與哺餵次數與後一天的客觀睡眠品質無關，疲憊程度與哺餵次數的改變與客觀睡眠品質與無關。
結論/護理應用：本研究在不同生產方式中有無親子同室睡眠品質與疲憊感預測因子上，陰道產產後主客觀睡眠品質皆以有親子同室為較佳，但疲憊感會影響主觀睡眠品質，客觀睡眠品質則無，哺餵次數多則主客觀睡眠品質愈差；在剖腹產產後客觀睡眠品質，有親子同室者有較好的睡眠品質，疲憊程度越高則主觀睡眠品質越差，哺餵次數與睡眠無關。以往總覺得親子同室的母親其睡眠時間較短或品質較差，結果顯示在執行親子同室的母親其睡眠時間與品質有其正面的意義，產後疲憊的因素有母乳哺餵及睡眠失調，尤其在剖腹產產婦需積極解決其產後疲憊感，因此建議臨床護理助產人員應給予產婦生產過程足夠的支持及協助，可以減少產後的疲憊程度，有好的睡眠品質，建議日後在產前教育及臨床護理指導之內容，應強化親子同室目的、重要性，讓產婦覺得有足夠的精神及體力實施親子同室，此結果將可提供臨床產兒科人員於照護上參考。
關鍵詞：親子同室、睡眠品質、疲憊感

Background: The practice of rooming-in has been shown to help new mothers and their newborn infants adjust physically and mentally and to increase breastfeeding success. Although “24-hour rooming-in” is one of the 10 key objectives of baby-friendly hospitals promoted in Taiwan since 2000, this objective has fallen significantly short of expectations in terms of both the number and the success of hospital implementations. In general, hospitals are concerned that rooming-in may increase fatigue and decrease sleep quality in postpartum mothers. Findings in the literature related to the impact of rooming-in on these two variables are inconclusive.
Purpose: This study examines the correlations between the practice of rooming-in and the levels of fatigue and sleep quality in postpartum mothers.
Methodology: This descriptive correlational study collected data from April to July 2013. Convenience sampling recruited primipara women who delivered after 37 or more weeks of pregnancy; experienced no abnormalities or complications during pregnancy, labor, or the postpartum period; and had no clinical contraindications for rooming-in. New mothers who planned to release their child for adoption or who had experienced sexual abuse were excluded from consideration. A total of 121 postpartum mothers met the above criteria and were enrolled as participants. Research instruments included a self-designed questionnaire, the Modified Fatigue Symptoms Checklist (MFSC), the Chinese version of the Pittsburg Sleep Quality Index (CPSQI), and cardiopulmonary coupling (CPC) analysis. Participants had a CPC monitor affixed to their upper chest prior to going to sleep each day of their hospital stay. Further, each participant filled in an MFSC and CPSQI every morning of their hospital stay.
Results: In terms of demographic variables, participants with an associate degree or lower level of education (χ2(1) = 11.08, p < .001), those who practiced early skin-to-skin contact (χ2(1) = 6.40, p < .05), and those who planned during their pregnancy to practice 24-hour rooming-in (χ2(3) = 24.17, p < .001) were all more likely to adopt nighttime rooming-in. In terms of OB/GYN variables, vaginal birth (χ2(1) = 4.81, p < .05), a relatively mild degree of perineal laceration (p < .05), relatively mild blood loss during birth (t(119) = 2.11, p < .05), and relatively high breastfeeding frequency (p < .001) were all correlated with a higher likelihood of practicing nighttime rooming-in.
Analysis using the baseline-tracking model, time-lag model, and change model found that among participants who gave vaginal birth, those who roomed-in had better subjective sleep quality than those who did not (B = -1.97, p < .001), number of gestational weeks related positively to subjective sleep quality (B = -0.35, p < .01), degree of weariness related negatively to subjective sleep quality (B = 0.11, p < .001), higher breastfeeding frequency related negatively to subjective sleep quality (B = 0.33, p < .001), number of days postpartum related positively to subjective sleep quality (B = -0.42, p < .05), improvements in the degree of weariness improved subjective sleep quality (B = 0.11, p < .01), reductions in breastfeeding frequency improved subjective sleep quality (B = 0.39, p < .001). In terms of objective-sleep-quality predictive factors among vaginal-birth participants those who roomed-in earned higher overall objective sleep quality scores than those who did not (B = 34.49, p < .001), those who stayed in single-occupancy hospital rooms earned lower overall objective sleep quality scores than those who stayed in multiple-occupancy rooms (B = -20.40, p < .001), those who used analgesics had better objective sleep quality than those who did not (B = 8.59, p < .05), those with higher breastfeeding frequencies had lower objective sleep quality than their peers (B = -4.93, p < .001), reducing breastfeeding frequency improved objective sleep quality (B = -4.81, p < .001). Furthermore, this study found no relationship between current objective sleep quality and either degree of weariness or breastfeeding frequency as measured on the previous day. Finally, no relationship was found between changes in degree of weariness and changes in objective sleep quality.
A similar analysis of predictive factors among cesarean-birth participants found degree of weariness related negatively to subjective sleep quality (B = 0.20, p < .001), reducing weariness improved subjective sleep quality (B = 0.28, p < .001), those who roomed-in earned better overall subjective sleep quality scores than those who did not (B = 23.47, p < .001), number of days postpartum related positively to subjective sleep quality (B = 3.06, p < .05), improvements in degree of fatigue related positively to improvements in objective sleep quality (B = -0.83, p < .05). Similar to vaginal-birth participants, this study found no relationship between current objective sleep quality and either degree of fatigue or breastfeeding frequency as measured on the previous day in cesarean-birth participants. Finally, changes in breastfeeding frequency did not impact objective sleep quality in this group.
Conclusions / Application to Nursing: The present study assessed the impact of predictive factors related to quality of sleep and degree of fatigue in a sample of postpartum mothers who had either given vaginal or cesarean birth and either did or did not practice rooming-in. For vaginal-birth participants, rooming-in impacted subjective and objective sleep quality; degree of fatigue impacted subjective sleep quality but not objective sleep quality; and high breastfeeding frequencies degraded both subjective and objective sleep quality. For cesarean-birth participants, rooming-in improved sleep quality; degree of fatigue related negatively to subjective sleep quality; and breastfeeding frequency was not significantly related to sleep quality. Our findings contradict the widely held assumption that mothers who room-in with their infant sleep less and have a lower quality of sleep than their non-room-in peers. Conversely, the room-in participants in our study reported improvements in terms of both sleep duration and sleep quality attributable to their practice of rooming-in. Factors found to affect postpartum fatigue include breastfeeding and irregular sleep schedule. In light of the importance of helping new mothers, especially cesarean-birth mothers, quickly overcome postpartum fatigue, the author suggests that clinical nurses and midwives provide adequate support and assistance to patients through the birthing process in order to minimize postpartum fatigue and improve patient quality of sleep. Furthermore, prenatal patient education and nursing-care guidelines should be revised to promote rooming-in, underscore its importance to postnatal health and recovery, and raise the confidence of new mothers in their emotional and physical capacities to undertake rooming-in responsibilities. The results of this study provide a reference for clinical obstetrics and pediatrics care staffs.
Key Words: mother-infant rooming in, quality of sleep, fatigue

致謝 Π
中文摘要 Ⅳ
英文摘要 Ⅶ
目錄 XI
附錄 XII
圖表目次 XIV
第一章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 3
第三節 名詞界定 4
第二章 文獻查證 6
第一節 親子同室 6
第二節 產後睡眠品質 11
第三節 產後疲憊 22
第四節 親子同室和母親睡眠及其疲憊的相關性 23
第三章 研究方法 26
第一節 研究概念架構 26
第二節 研究設計及研究對象 27
第三節 研究工具 28
第四節 研究場所 31
第五節 研究倫理 32
第六節 統計分析 33
第四章 研究結果 36
第一節 研究對象基本人口學與產科學因素之分布 36
第二節 有無親子同室與各時間點的主客觀睡眠品質與疲憊程度分布 41
第三節 主、客觀睡眠品質之預測因子分析 53
第伍章 討論 64
第一節 研究對象基本人口學及產科學 64
第二節 產後主、客觀睡眠品質及相關探討 66
第三節 產後疲憊程度及相關因素 70
第四節 產後主客觀睡眠品質與產後疲憊程度及預測因子 71
第六章 結論與建議 75
第一節 結論 75
第二節 研究結果的應用與建議 76
第三節 研究限制與建議 78
參考文獻 81
中文部份 81
英文部份 84
附錄
附件一 個人資料問卷 92
附件二 產科資料問卷 94
附件三 匹茲堡睡眠品質量表 95
附件四 疲憊量表 105
附件十三 人體實驗審查委員會申請通過書 110

圖目錄
圖一 概念架構 26
圖二 有無親子同室的自然產產婦在各項分數之趨勢圖 62
圖三 有無親子同室的剖腹產產婦在各項分數之趨勢圖 63

表目錄
表1.有無全程親子同室在背景資料之分布 37
表2.有無全程親子同室在產科史資料之分布 40
表3.有無全程親子同室在生產當天之主客觀睡眠品質與疲憊程度分布 41
表4.有無全程親子同室在生產當天之主觀睡眠品質之細項分布 42
表5.有無全程親子同室在產後第一天之主客觀睡眠品質與疲憊程度分佈 44
表6.有無全程親子同室在產後第一天之主觀睡眠品質之細項分布 45
表7.有無全程親子同室在產後第二天之主客觀睡眠品質與疲憊程度分布 46
表8.有無全程親子同室在產後第二天之主觀睡眠品質之細項分布 47
表9.有無全程親子同室在產後第三天之主客觀睡眠品質與疲憊程度分布 49
表10.有無全程親子同室在產後第三天之主觀睡眠品質之細項分布 50
表11.有無全程親子同室在產後第四天之主客觀睡眠品質與疲憊程度分布 51
表12.有無全程親子同室在產後第四天之主觀睡眠品質之細項分布 52
表13.產後當天至產後第四天之疲憊量表（MFSC）各題平均分數 53
表14.自然產產婦從生產當天至產後第二天之主觀睡眠品質（PSQI）影響因素 58
表15.自然產產婦從生產當天至產後第二天之客觀睡眠品質（CPC）影響因素 59
表16.剖腹產產婦從生產當天至產後第四天之主觀睡眠品質（PSQI）影響因素 60
表17.剖腹產產婦從生產當天至產後第四天之客觀睡眠品質（CPC）影響因素 61

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