臺灣博碩士論文加值系統

背景：研究者工作於產科地區醫院數十年，每年約有 1800-2200位產婦，觀察其進入待產室時對產痛的不安與焦慮，而 Parse 人類轉變理論以病人爲照顧中心，理論的建構意義、共創相關性節律型態，和共同超越轉變等三個原則，可運用於初產婦生產的三個產程階段，以瞭解其獨特的生產經驗。

目的：本研究目的乃探討 Parse 理論於初產婦的生產經驗。

方法：本研究採 Parse 理論銓釋現象學設計，立意取樣標準為初產婦、自然生產者、剖腹生產，懷孕週數 38 到 42 週間，初產婦及新生兒均無產前或產後內科合併症、願意參加此研究，並簽署書面同意書者為研究參與者。本研究於 IRB 通過後即開使收案，採半結構式會談指引，依 Colaizzi現象學研究步驟進行資料的分析，研究嚴謹度採Lincoln 及 Guba(1985)提出可信賴性做資料的評量。

研究結果：四位初產婦的生產經驗包括（ㄧ）家人、同事、同學的生產經驗，（二）網路搜尋相關生產資訊，（三）傳統風俗文化，（四）生產方式的選擇，（五）初產婦的生產過程，（六）初產婦生產過程的支持，（七） 初產婦生產過程的協助。此外，研究者再將四種類型初產婦生產經驗進行結構性整合，進行啟發性的銓釋，呈現生產前想像真實與虛擬的生產經驗，透過語言和文化來建構生產方式的價值與意義。生產中能或不能配合呼吸的教導，用力或拒絕用力的限制，揭露或隱藏麻醉的恐懼和產痛，自我掙扎或接受他人的指引。生產後反思自然產超越產痛的經驗，剖腹產和自然產轉剖腹產超越陌生手術環境的恐懼，剖腹產轉自然產超越自我控制的平衡點，化阻力為助力的生產過程。

Background:The principal author has decades of experience in the obstetrics department of a regional hospital, where approximately 1800–2200 mothers give birth each year. The signs of anxiety and apprehension over labor pains can be observed among the mothers upon their entry to the delivery room, and Parse’s human becoming theory focuses on patientorientated care with three principles of meaning, rhythmicity, and transcendence could apply into three stages of delivery primipara to understand their unique delivery experiences.

Purpose of the Study: The purpose of this study is to explore the Parse theory in childbirth experience of primipara.

Methods:This study used Parse theory hermeneutic phenomenology design and purposive sampling was adopted to recruit participants that conformed to the following criteria: primipara, normal spontaneous vaginal delivery, caesarean section, 38–42 weeks of pregnancy, no antepartum or postpartum complications in mother and child, and voluntary participation with written consent. This study was started to collect data after IRB approved (No.17-034-B1) by following the semi-structured interviews. Analysis of the data was based on the phenomenological procedures of Colazzi, and the reliability and validity of the present study were ensured by adherence to the trustworthiness standards detailed by Lincoln and Guba(1985).

Results: The childbirth experiences of four primiparas were classified into the following categories: (a) The childbirth experiences of family members, colleagues, and school friends, (b) Search of childbirth-related information on the Internet, (c) Traditional customs and culture, (d) Choice of delivery methods, (e) The delivery process of the primiparas, (f) Support received by the primiparas during the delivery, and (g) Assistance provided for the primiparas during the delivery. Additionally, Four categories of the childbirth experiences were structurally integrated for heuristic interpretation to present the realistic and unrealistic expectations of the childbirth experience before the delivery, and the value and meaning of the delivery methods constructed through language and culture. The primiparas’ childbirth experiences included whether they were able to adopt the breathing technique they were taught, their limitation to push, the disclosure or disguise of their fear of anesthesia and the delivery pain, and their self-struggle or acceptance of instructions. The primiparas reflected their individual childbirth experiences after the delivery that some primiparas overcame the pain during the vaginal delivery, another overcame the fear of an unfamiliar surgical environment when undergoing caesarian section, and the other surpassed the threshold of selfcontrol and turned resistance to assistance when the mode of delivery was changed from caesarian section to vaginal delivery.

目 錄
誌謝 -------------------------------------------------------------------------------i
中文摘要 ---------------------------------------------------------------------------ii
英文摘要 ---------------------------------------------------------------------------iv
目錄 -------------------------------------------------------------------------------v
表目錄 -----------------------------------------------------------------------------vii
圖目錄 -----------------------------------------------------------------------------viii
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----------------------------------------------------------------------4
第三節 名詞解釋----------------------------------------------------------------------4
一 Parse理論 --------------------------------------------------------------------4
二 初產婦------------------------------------------------------------------------5
三 生產經驗----------------------------------------------------------------------5
第二章 文獻探討----------------------------------------------------------------------6
第一節 Parse 人類轉變理論---------------------------------------------------------6
第二節 Parse 理論的研究文獻-------------------------------------------------------9
第三節 初產婦的生產經驗------------------------------------------------------------12
第三章 研究方法----------------------------------------------------------------------19
第一節 銓釋現象學和 Parse 護理研法-------------------------------------------------21
第二節 研究對象與和研究場所--------------------------------------------------------22
第三節 研究結果------------------------------------------------------------------23
第四節 資料收集過程和資料分析------------------------------------------------------25
第五節 研究倫理------------------------------------------------------------------29
第四章 討論與結論--------------------------------------------------------------------30
第一節 研究參與者的基本資料--------------------------------------------------------30
第二節 初產婦生產經驗的擷取與綜合---------------------------------------------------32
第三節 啟發性的詮釋研究結果.-------------------------------------------------------46
第四節 研究者的解讀與反思.---------------------------------------------------------49
一 研究者的解讀----------------------------------------------------------------49
二 研究者反思------------------------------------------------------------------51
第五節 研究討論-------------------------------------------------------------------54
一 初產婦的生產經驗------------------------------------------------------------54
二 Parse 理論詮釋初產婦的生產經驗-----------------------------------------------56
第五章 結論與建議--------------------------------------------------------------------58
第一節 研究結論-------------------------------------------------------------------58
第二節 研究建議-------------------------------------------------------------------59
一 醫療機構實務---------------------------------------------------------------64
二 護理實務-------------------------------------------------------------------60
三 護理教育-------------------------------------------------------------------60
四 護理研究-------------------------------------------------------------------61
第三節 研究限制--------------------------------------------------------------------61
第四節 研究者個人的反思與應用-----------------------------------------------------------61
參考文獻 -----------------------------------------------------------------------------65
中文文獻 -----------------------------------------------------------------------------65
英文文獻 -----------------------------------------------------------------------------68
附錄一 人體實驗委員同意書---------------------------------------------------------------75
附錄二 研究同意書----------------------------------------------------------------------76
附錄三 深入對談同意書-------------------------------------------------------------------78
附錄四 個案基本資料表-------------------------------------------------------------------79
附錄五 引用鈕教授之表格-----------------------------------------------------------------80

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