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研究生:莊詠淑
研究生(外文):CHUANG, YUNG-SHU
論文名稱:運用圖像式麻醉護理指導 緩解脊椎手術病患術前焦慮、自我效能及生理指標之成效
論文名稱(外文):Using image-based preoperative anesthesia education to reduce anxiety, self-efficacy, and physiological indicators of patients with spinal surgery
指導教授:彭逸稘彭逸稘引用關係
指導教授(外文):PENG, YI-CHI
口試委員:吳樺姍陳嘉雯彭逸稘
口試委員(外文):WU, HUA-SHANCHEN, CHIA-WENPENG, YI-CHI
口試日期:2020-06-19
學位類別:碩士
校院名稱:亞洲大學
系所名稱:健康產業管理學系健康管理組碩士在職專班
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:87
中文關鍵詞:脊椎手術護理指導全身麻醉圖像式術前焦慮自我效能
外文關鍵詞:spinal surgerynursing instructiongeneral anesthesiaimagepreoperative anxietyself-efficacy
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背景:手術患者在術前焦慮的發生率約為60-80%,而脊椎手術患者中更有87%曾經歷術前焦慮情
   形,焦慮所帶來的負面影響,使得患者在手術過程中面臨更大的挑戰,因此是一項值得關注
   的議題。
目的:本研究旨在探討術前圖像式脊椎手術麻醉護理指導對於脊椎手術患者術前焦慮、自我效能及
   生理指標之成效。
方法:本研究為單盲雙組前後測實驗性研究設計,於2019年11月至2020年2月止,以中部某地區醫
   院預行脊椎手術並採全身麻醉之患者為研究對象,採簡單隨機抽樣分派方式分為兩組,接著
   兩組皆在麻醉諮詢後給予前測。實驗組及控制組之受試者皆接受「常規麻醉口頭護理指
   導」,此外實驗組額外提供「圖像式脊椎手術全身麻醉衛教手冊」說明。兩組患者接受介入
   措施後分別於獨立安靜的休息區等候60分鐘再進行後測,以評估兩種護理指導方式之成效。
   前、後測資料收集包括:情境焦慮量表、自我效能量表及生命徵象等分數。
結果:兩組患者的基本屬性(年齡、性別、全身麻醉經驗等)無顯著差異(p>.05);焦慮程度方面,
   兩組在護理指導前焦慮程度未達顯著差異(p=0.81),進一步比較兩種衛教方式之成效,發現
   提供圖像式衛教手冊組,在焦慮程度方面顯著低於控制組 (p=0.00);在自我效能方面,介
   入前兩組間未達顯著差異(p=0.79),在介入措施後,接受圖像式的術前麻醉指導患者,其自
   我效能顯著高於控制組(p=0.00);兩組的生理指標方面,經過介入措施後實驗組收縮壓有
   顯著下降的趨勢(p=0.01),其餘生理指標(心跳及呼吸…等)未達顯著差異(p>.05)。進一步
   比較基本屬性與焦慮之相關分析,研究結果焦慮與性別、職業、教育程度、婚姻、全身麻醉
   經驗、全身麻醉護理指導經驗之間並無呈現顯著相關性(p>.05)。
結論:運用圖像式脊椎手術麻醉護理指導可有效減少脊椎手術病患術前焦慮及收縮壓值,並提高自
   我效能感。


Background:The preoperative anxiety rate of surgical patients is about 60-80%,
     and 87% of spine surgery patients have experienced preoperative
     anxiety. The negative impact of anxiety makes patients face greater
     challenges during surgery, so it is a topic worthy of attention.
Purpose:The purpose of this study was investigate to the effect of image-based
     preoperative anesthesia education on preoperative anxiety, self-
     efficacy, and physiological indicators of patients with spinal
     surgery.
Methods: This study is a single-blind double-group experimental design. From
     November 2019 to February 2020, patients with preoperative spinal
     surgery and general anesthesia in a regional hospital in the central
     part of the study will be the subjects. A simple random sampling
     distribution method was used to divide into two groups, and then both
     groups were given pre-test after anesthesia consultation.
     The subjects in the experimental group and the control group all
     received the "Conventional Anesthesia Oral Nursing Guidance", but the
     experimental group additionally provided the "Image-based Spine
     Surgery General Anesthesia Education Manual". The two groups of
     patients were rested for 60 minutes in an independent and quiet rest
     area and then post-tested to evaluate the effectiveness of the two
     methods of education. The pre-test and post-test data collection
     includes: Scores of State Anxiety Inventory, Anesthesia self-efficacy
     Scale, and vital signs.
Results: There were no significant differences in the basic attributes (age,
     gender, general anesthesia experience, etc.) of the two groups of
     patients (p> .05); In terms of anxiety level, the anxiety level of the
     two groups did not reach a significant difference before the nursing
     guidance (p=0.81). Further comparison of the effectiveness of the two
     health education methods found that the provision of the image-based
     preoperative anesthesia education group was significantly lower than
     the control group (p=0.00); In terms of self-efficacy, there was no
     significant difference between the two groups before the intervention
     (p=0.79). After the intervention, the patients who received the image-
     based preoperative anesthesia education had significantly higher self-
     efficacy than the control group (p=0.00); In terms of physiological
     indicators of the two groups, the systolic blood pressure of the
     experimental group showed a significant downward trend after
     intervention (p=0.01), and the remaining physiological indicators
     (heartbeat, breathing, etc.) did not reach significant differences (p>
     .05). There was no significant correlation between anxiety and gender,
     occupation, education, marriage,experience of general anesthesia , and
     nursing education of general anesthesia (p>.05)
Conclusion:Using an image-based spinal anesthesia education can effectively
     reduce preoperative anxiety and systolic blood pressure and improve
     self-efficacy.


目錄………………………………………………………………Ⅰ
表目錄……………………………………………………………Ⅲ
圖目錄……………………………………………………………Ⅳ
致謝………………………………………………………………Ⅴ
中文摘要…………………………………………………………Ⅵ
英文摘要…………………………………………………………Ⅷ

第一章 緒論………………………………………………………………………………1
第一節 研究背景及動機…………………………………………………………………1
第二節 研究目的…………………………………………………………………………3
第三節 名詞界定…………………………………………………………………………3

第二章 文獻探討…………………………………………………………………………6
第一節 脊椎手術與麻醉安全監測………………………………………………………6
第二節 焦慮對手術病患之衝擊…………………………………………………………8
第三節 臨床護理指導類型及術前焦慮之應用…………………………………………11
第四節 護理指導對自我效能的影響……………………………………………………14
第五節 研究架構…………………………………………………………………………17
第六節 研究假設…………………………………………………………………………17

第三章 研究方法…………………………………………………………………………18
第一節 研究設計…………………………………………………………………………18
第二節 研究對象…………………………………………………………………………18
第三節 研究工具…………………………………………………………………………19
第四節 研究步驟…………………………………………………………………………23
第五節 研究倫理考量……………………………………………………………………24
第六節 資料處理及分析…………………………………………………………………25

第四章 研究結果…………………………………………………………………………26
第一節 基本屬性描述……………………………………………………………………26
第二節 圖像式麻醉護理指導方式之成效比較…………………………………………27
第三節 衛教成效間的相關性分析………………………………………………………29

第五章 討論與結論………………………………………………………………………30
第一節 文獻與討論………………………………………………………………………30
第二節 結論與建議………………………………………………………………………33

參考文獻
中文文獻 …………………………………………………………………………………36
外文文獻 …………………………………………………………………………………38

附錄
附錄一 脊椎手術全身麻醉衛教手冊……………………………………………………55
附錄二 基本屬性.情境焦慮量表.自我效能量表.生命徵象紀錄單 ……………………70
附錄三 專家內容效度名單………………………………………………………………73
附錄四 專家內容效度評鑑………………………………………………………………74
附錄五 專家內容效度評分結果…………………………………………………………76
附錄六 參與研究同意書…………………………………………………………………78
附錄七 研究倫理委員會(IRB)同意臨床試驗證明書 ..…………………………………82
附錄八 人體臨床試驗研究訓練證書……………………………………………………83
附錄九 情境焦慮量表授權同意書………………………………………………………86
附錄十 自我效能問卷授權同意書………………………………………………………87


表 目 錄
表一 研究設計過程表……………………………………………………………………49
表二 基本屬性分析表……………………………………………………………………50
表三 情境焦慮程度差異表………………………………………………………………51
表四 自我效能程度差異表………………………………………………………………51
表五 生理指標差異表……………………………………………………………………51
表六 基本屬性對焦慮改善成效之相關性分析…………………………………………52


圖 目 錄
圖一 Bandura自我效能理論架構圖 ……………………………………………………53
圖二 研究架構圖…………………………………………………………………………53
圖三 收案流程圖…………………………………………………………………………54
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