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研究生:李青容
研究生(外文):Li Qing-Rong
論文名稱:探討以手部按摩減輕學齡前期兒童靜脈注射疼痛感之成效
論文名稱(外文):An Investigation into the effect of hand massage on reducing the pain of intravenous administration to preschool children
指導教授:陳秀蓉陳秀蓉引用關係
指導教授(外文):Chen hsiu-Jung
口試委員:陳鳳櫻陳維恭
口試委員(外文):Chen Fong-YingChen Wei-Kung
口試日期:2018-12-10
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:護理研究所
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:2019
畢業學年度:107
語文別:中文
論文頁數:79
中文關鍵詞:學齡前期兒童手部按摩靜脈注射疼痛急診室
外文關鍵詞:preschool childrenhand massageintravenous injectionpainemergency department
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背景:急診室許多醫療程序過程中,常須使用到靜脈注射做為醫療措施之一,學齡前期兒童在面對靜脈注射時,面對疼痛和害怕可能會對兒童發展產生長期的負面影響,進而影響照護上對兒童日後醫療態度。
目的:本研究目的為以手部按摩於學齡前期兒童接受靜脈注射時介入處置,檢驗處置的成效。
方法:本研究為量性研究,採立意取樣之類實驗性研究設計,對象為三歲到未滿六足歲需接受靜脈注射的學齡前兒童,各收集一組實驗組與對照組各45位兒童。對照組於靜脈注射過程中採急診護理工作常規;實驗組則以閘門控制理論手部按摩之主動策略介入靜脈注射過程中。
本研究應用閘門理論以手捏按摩方式,緩解兒童在接受醫療時所經歷的一些疼痛和痛苦程序,測量主觀疼痛程度之工具為「兒童臉譜疼痛量表(Faces Pain Scale, FPS)」,並收集注射前後兒童的生理數據,收集資料以SPSS for Window 22.0版本之電腦套裝軟體進行建檔及統計,以描述性統計、一般線性模式中的單變量等方法進行分析。
結果:兒童因為疾病就診時,可以透過心跳、呼吸及血氧等數值來反應兒童的疼痛不適感,因此藉由手部按摩可以舒緩緊繃肌肉,降低緊張情緒種種反應可以透過心跳、呼吸及血氧等數值監看,以確定介入措施可以減輕兒童面對靜脈注射後所產生的疼痛及壓力。
研究結果中基本資料實驗組平均年齡為4.37歲;控制組平均年齡為4.21歲。在實驗組接受介入措施後,在靜脈注射後及靜脈注射後5分鐘這兩階段,實驗組都比控制組疼痛感顯著為低,分別低2.4跟3.7,疼痛分數統計上均有達顯著差異。若對於靜脈注射越抗拒反應越激動者,執行靜脈注射成功率下降,最後導致施打時間增長。在靜脈注射5分鐘後,靜脈注射時間每增加1分鐘,兒童疼痛感就顯著增加0.5。年齡方面,研究發現兒童年齡每增加一歲,在面對靜脈注射時的疼痛感顯著減少0.3。顯示年齡層較高的兒童認知能力比較好,能正確理解靜脈注射涵意,表現出的疼痛感較低。
結論: 此研究運用閘門理論中粗大神經傳遞訊息快的纖維阻斷細小神經傳遞疼痛訊息,暫時緩解疼痛感介入方式,減輕學齡前期兒童接受靜脈注射過程中,包括靜脈注射前使用手部按摩五分鐘,執行靜脈注射至靜脈注射結束,這個過程中透過揉捏行為介入降低其肌肉緊繃感,減緩靜脈注射疼痛程度,期望透過本研究成果能提供護理人員在對於學齡前期兒童接受靜脈注射前,能給予適時的輔助成效,減少兒童面對靜脈注射產生恐懼和害怕感,建立正向治療協助降低兒童對於靜脈注射的疼痛感,進而提供良好的注射經驗。

關鍵字:學齡前期兒童、手部按摩、靜脈注射、疼痛、急診室
Background: Intravenous injection is a commonly used medical treatment for medical procedures performed in the emergency room. For preschool children, the pain and fear caused by receiving an intravenous injection may have a long-term negative influence on their development, thereby affecting their subsequent attitudes toward medical care.
Purposes: In this study, hand massaging was applied to preschool children as an intervention treatment while they received intravenous injections and its effectiveness was examined.
Methods: This quantitative study adopted a quasi-experimental design with purposive sampling. Participants were preschool children who required intravenous injections and aged above 3 but below 6 years. The experimental and control groups each comprised 45 children. For children in the control group, conventional emergency care was applied during intravenous injections; for children in the experimental group, the active intervention of hand massage based on gate control theory was applied during intravenous injections.
In this study, the hand massage based on gate control theory was applied to children to alleviate their pain during medical treatment. The instrument used for measuring subjective pain levels was the Faces Pain Scale, and the physiological data of children before and after injections were collected and processed with the statistical software package SPSS for Windows 22.0. The statistical methods used for data analysis were descriptive statistics and general linear model univariate analysis.
Results: During medical diagnosis, pulse, breathing rate, and blood oxygen levels were used to evaluate child pain and discomfort. Hand massage effectively soothed tight or strained muscles and reduced anxiety. Such responses could be monitored according to data on the pulse, breathing rate, and blood oxygen levels of the participants to determine whether the intervention treatment could relieve the pain and stress caused by intravenous injections.
Regarding demographic information, the average ages of children in the experimental and control groups were 4.37 and 4.21 years, respectively. Following the intervention treatment, the average pain level of participants in the experimental group during two phases (5 minutes before and 5 minutes after the intravenous injection) was significantly lower than that of participants in the control group (2.4 and 3.7, respectively). The success rate of an intravenous injection was lower for children who were highly resistant and displayed reluctance to undergo the intravenous injection, leading to long injection times. Moreover, 5 minutes after intravenous injections, the average pain scores of children significantly increased by 0.5 as the injection duration increased by 1 minute. The results also indicated a significant decreasing trend of 0.3 in the pain score of children during intravenous injections for each year older they were. This suggested that older children had superior cognitive ability and understood why they required intravenous injections and thus exhibited lower pain levels.
Conclusion: According to gate control theory, large nerve fibers, which quickly transmit signals, can block the pain signals transmitted by small nerve fibers, thereby temporarily alleviating pain. The present study applied the intervention method of hand massage based on the gate control theory to relieve pain and muscle tension caused by intravenous injections in preschool children. Hand massage was performed for 5 minutes prior to the intravenous injection. This kneading action during intravenous injections can reduce muscle tension and mitigate pain caused by such injection. We hope that the results of this study can provide a reference for nurses to help preschool children overcome their fear of intravenous injections and reduce the pain they cause, thereby providing positive and satisfactory treatments and injection experiences.

Keywords: preschool children, hand massage, intravenous injection, pain, emergency department
致 謝 …………………………………………………………………………I
中文摘要…………………………………………………………………… II
英文摘要……………………………………………………………………… IV
目 錄 ……………………………………………………………………… VI
圖 目 錄………………………………………………………………………VIII
表 目 錄………………………………………………………………………VIII
第壹章 緒論 …………………………………………………………………… 1
第一節 研究背景及重要性 ……………………………………………… 1
第二節 研究目的………………………………………………………… 3
第三節 研究問題 ……………………………………………………… 3
第四節 研究假設 ……………………………………………………… 3
第五節 名詞解釋 ……………………………………………………… 4
第貳章 文獻探討 ……………………………………………………………… 6
第一節 疼痛生理機轉 ………………………………………………… 6
第二節 兒童疼痛影響因素 …………………………………………… 12
第三節 學齡前期兒童的疼痛評估與照護 …………………………… 14
第参章 研究方法 ………………………………………………………………20
第一節 研究設計 ………………………………………………………… 20
第二節 研究對象及場所 ………………………………………………… 23
第三節 研究工具 ………………………………………………………… 24
第四節 資料收集流程 …………………………………………………… 26
第五節 前驅性研究 ……………………………………………………… 29
第六節 資料處理及分析 ………………………………………………… 31
第七節 研究倫理考量 …………………………………………………… 33
第肆章 研究結果 …………………………………………………………… 34
第一節 研究樣本之描述資料分析 ……………………………………… 34
第二節 研究參與者之主要照顧者基本屬性資料分析 ………………… 36
第三節 手部按摩介入學齡前期兒童接受靜脈注射疼痛之程度…………37
第四節 兩組兒童接受靜脈注射前後之生理指數分析…………………38
第伍章 討論 ……………………………………………………………………48
第一節 急診學齡前期兒童接受靜脈注射疼痛之程度探討 ………………48
第二節 手部按摩介入學齡前期兒童接受靜脈注射生理指標之成效 ……50
第陸章 結論及建議 ……………………………………………………………………52
第一節 結論…………………………………………………………………52
第二節 研究應用……………………………………………………………53
第三節 研究限制與建議……………………………………………………54
參考文獻 …………………………………………………………………………55
中文文獻 ……………………………………………………………………55
英文文獻 ……………………………………………………………………57

附錄
附錄一 兒童及主要照顧者的基本資料表………………………………………64
附錄二 參與研究同意書…………………………………………………………66
附錄三 兒童靜脈注射照護原則衛教指導………………………………………70
附錄四 中國醫藥大學暨附設醫院研究倫理委員會審核通過函………………71

圖目錄
圖1-3 閘門疼痛理論架構圖……………………………………………………10
圖3-1-1研究架構圖………………………………………………………………21
圖3-3-1臉譜疼痛評估工具………………………………………………………25
圖3-3-2生理監測器測量工具……………………………………………………25
圖3-3-3聽診器測量工具…………………………………………………………25
圖3-4 G-Power估算樣本圖……………………………………………………26
圖3-5 資料收集步驟流程 ………………………………………………………28

表目錄
表3-1-2研究設計………………………………………………………………22
表3-4-1兩組收樣順序表………………………………………………………27
表3-5 前驅性試驗資料收集……………………………………………………30
表3-6 資料處理與資料分析方法………………………………………………31
表4-1 收案兒童人口學基本屬性資料…………………………………………35
表4-2 兒童的主要照顧者基本屬性資料分析………………………………36
表4-3 兩組兒童不同年齡層的疼痛程度資料…………………………………37
表4-3-1兩組兒童於疼痛程度一般線性單變量分析……………………38
表4-4 兩組兒童的生理指標平均值及標準差分析…………………………40
表4-4-1兩組兒童於心跳數之一般線性單變量分析……………………42
表4-5 兩組兒童於呼吸數之一般線性單變量分析………………………44
表4-6 兩組兒童於血氧濃度之一般線性單變量分析……………………46
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