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研究生:張佳珍
研究生(外文):Chia-Chen Chang
論文名稱:比較不同疼痛管理方案對機構住民之成效初探
論文名稱(外文):Comparison of the effect of different pain management programs in institutional residents
指導教授:林麗嬋林麗嬋引用關係
指導教授(外文):Li-Chan Lin
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床暨社區護理研究所
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:2020
畢業學年度:108
語文別:中文
論文頁數:92
中文關鍵詞:長照機構疼痛管理品質指標
外文關鍵詞:Long-term care facilitiespain managementquality indicators
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背景:疼痛是長期照護機構住民常見的問題,但卻被低估且未得到適當處置。疼痛對機構住民造成生理、心理、社會各層面不良的影響,降低住民生活品質。

目的:比較兩種疼痛管理方案對於改善長照機構住民疼痛照護之成效。

研究設計與方法:採類實驗研究設計(quasi-experimental study),方便取樣(convenient sampling)北部8家長照機構,非隨機對照試驗設計分派至6家教育組(對照組)與2家管理組(實驗組);兩組主管及負責疼痛護理師接受8小時的疼痛教育工作坊,授課後兩組主管及負責疼痛護理師皆接受一次2~3小時的實地輔導;管理組在一個月內接受第二次8小時實地輔導,包括疼痛規範制定、疼痛評估演練、跨領域疼痛管理介紹與討論,且輔導對象多納入護理師及照服員。兩組皆使用疼痛監測指標收集追蹤住民資料,進行為期7個月的逐日測量。資料以描述性統計分析參與機構基本屬性,概化估計方程式(Generalized estimating equations, GEE)檢定兩組於疼痛發生密度、疼痛處置率及處置後改善率之成效差異。

研究結果:1.介入後管理組的疼痛發生密度上升幅度較教育組明顯改善,在第2、3、4、7月達到顯著差異(p= <0.001~0.027);2.介入後第2個月管理組的藥物處置率上升幅度顯著高於教育組(p= 0.032)、第6個月非藥物處置率上升幅度顯著高於教育組(p= 0.038);介入後第1個月,管理組的轉介率即顯著優於教育組(p <0.001);3.介入後第7個月,教育組機構的疼痛處置改善率有顯著進步(p= 0.046),介入後第4個月及第7個月,管理組的處置改善率上升幅度顯著高於教育組(p= 0.020, p= 0.046)。
Background. Pain is common among institutional residents but underreconized and undertreated. It has significant negative effects on physical, mood, and social interaction, which can lead to a reduction in quality of life.

Objective. To compare the effect of different institutional pain management programs in residents’ pain care quality.

Method. The quasi-experimental design was employed, eight long-term care facilities located in Northern Taiwan were selected by convenient sampling. Facilities were non-randomized assigned to six control (educational) group and two experimental (institutional) group. For both groups, an 8-hour-educational workshop was conducted for the administrators and the nurses in charge of pain management in LCFs. Next, the administrators and the nurses attended the lecture all received a 2 to 3 hours’ site visit. Within one month of the workshop, nurses and nursing assistants in the institutional group received an extra 8-hour site visit which focused on pain specification development, pain assessment exercises, interdisciplinary pain management introduction, and discussion. Pain quality indicators were used to collect residents' data every day for seven months. Descriptive statistics were presented the demographic data of participants and organizations. To evaluate the difference in these two pain management programs on the effectiveness of pain incidence density, pain treatment rate, and improvement after treatment, Generalized estimating equations(GEE) was used in this study.

Results. 1. The institutional (experimental) group had significantly more improvement than the educational(control) group in pain incidence density. There was signigicant difference between theses two group in the second, third, fourth and seventh months (p= <0.001~0.027). 2. In the second month after the intervention, pharmacologic treatment rate in the institutional group was significantly increasing than the educational group (p= 0.032). Non-pharmacologic treatment rate was significantly improving than the educational group (p= 0.038); referral rate of the institutional group in the first month after the intervention had an immediate effect (p=<0.001). 4. In the seventh month, the improvement rate after treatment in the educational group was significantly increasing (p= 0.046). The improvement rate in the institutional group was significantly increasing than the educational group in the fourth and seventh months after the intervention (p=0.020, p=0.046).

Conclusion. The institutional pain management program is beneficial for detecting residents’ pain, improving the quality indicators of pain management in process and outcome. It is recommended to employ in long term care facilities for bettering the quality of pain management.
誌謝……………………………………………………………………………………………………………………………i
中文摘要…..………………………………………………………………………………………………………ii
英文摘要……………………………………………………………………………………………………………iii
目錄…………………………………………………………………………………………………………………………v
圖目錄…………………………………………………………………………………………………………………vii
表目錄………………………………………………………………………………………………………………viii
第一章 緒論…………………………………………………………………………………………………1
第一節 研究背景………………………………………………………………………………………2
第二節 研究重要性…………………………………………………………………………………3
第二章 文獻查證………………………………………………………………………………………6
第一節 長照機構的疼痛盛行率…………………………………………………………6
第二節 影響長照機構疼痛管理品質的因素…………………………………10
第三節 長照機構疼痛品質管理…………………………………………………………15
第四節 國內外疼痛品質監測指標的發展………………………………………19
第五節 長照機構疼痛管理之介入與成效………………………………………24
第三章 研究方法………………………………………………………………………………………28
第一節 研究架構與假設…………………………………………………………………………28
第二節 名詞界定…………………………………………………………………………………………29
第三節 研究設計…………………………………………………………………………………………30
第四節 研究對象與場所…………………………………………………………………………31
第五節 介入方案內容………………………………………………………………………………32
第六節 研究工具…………………………………………………………………………………………34
第七節 研究步驟…………………………………………………………………………………………36
第八節 倫理考量…………………………………………………………………………………………38
第九節 資料處理與分析……………………………………………………………………………39
第四章 結果……………………………………………………………………………………………………40
第一節 研究機構基本屬性………………………………………………………………………40
第二節 比較介入後各研究變項之成效………………………………………………43
第五章 討論與結論………………………………………………………………………………………61
第一節 研究假設驗證…………………………………………………………………………………61
第二節 疼痛管理介入方案之成效…………………………………………………………62
第三節 研究限制……………………………………………………………………………………………68
第四節 護理應用與建議……………………………………………………………………………69
第五節 結論……………………………………………………………………………………………………71
參考文獻………………………………………………………………………………………………………………72
附錄…………………………………………………………………………………………………………………………88
附錄3-1 參與機構基本資料問卷……………………………………………………………88
附錄3-2 研究說明書及同意書…………………………………………………………………89

圖目錄
圖3-1 研究架構…………………………………………………………………………………………………28
圖3-2 收案流程及研究步驟圖……………………………………………………………………37
圖4-1 兩組於不同時間點之疼痛發生密度平均值變化……………………44
圖4-2 兩組於不同時間點之輕度疼痛率平均值變化…………………………46
圖4-3 兩組於不同時間點之中度疼痛率平均值變化…………………………48
圖4-4 兩組於不同時間點之重度疼痛率平均值變化…………………………50
圖4-5 兩組於不同時間點之藥物處置率平均值變化…………………………52
圖4-6 兩組於不同時間點之非藥物處置率平均值變化……………………54
圖4-7 兩組於不同時間點之轉介處置率平均值變化…………………………56
圖4-8 兩組於不同時間點之處置改善率平均值變化…………………………59

表目錄
表2-1 疼痛管理指標發展實例…………………………………………………………………22
表3-1 研究設計模式………….………………………………………………………………………30
表4-1 參與機構基本屬性…………………………………………………………………………41
表4-2 兩組於不同時間點之疼痛發生密度平均值…………………………44
表4-3 GEE在不同時間點疼痛發生密度之比較分析………………………45
表4-4 兩組於不同時間點之輕度疼痛率平均值………………………………46
表4-5 GEE在不同時間點輕度疼痛率之比較分析……………………………47
表4-6 兩組於不同時間點之中度疼痛率平均值………………………………48
表4-7 GEE在不同時間點中度疼痛率之比較分析……………………………49
表4-8 兩組於不同時間點之重度疼痛率平均值………………………………50
表4-9 GEE在不同時間點重度疼痛率之比較分析……………………………51
表4-10 兩組於不同時間點之藥物處置率平均值.……………………………52
表4-11 GEE在不同時間點疼痛藥物處置率之比較分析…………………53
表4-12 兩組於不同時間點之非藥物處置率密度平均值…………………54
表4-13 GEE在不同時間點疼痛非藥物處置率之比較分……………………55
表4-14 兩組於不同時間點之轉介處置率平均值….….………………………56
表4-15 GEE在不同時間點疼痛轉介處置率之比較分析……………………57
表4-16 兩組於不同時間點之處置改善率平均值…………………………………58
表4-17 GEE在不同時間點疼痛處置改善率之比較分析……………………59
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