臺灣博碩士論文加值系統

背景：高危險新生兒因周產期各種因素必須住院，而被迫與父母分離，臨床醫療處置往往造成高危險新生兒疼痛及生理壓力。許多文獻已證實母親聲音能幫助新生兒之生理表現更趨穩定，卻極少針對父親聲音作研究，然而育兒過程不僅是母嬰關係的連結，應同時探討父母親聲音對高危險新生兒之影響，以期望父母皆能發揮親職角色功能。
目的：本研究目的是在探討父母聲音介入於高危險新生兒足跟穿刺時降低疼痛，並進一步分析母親與父親聲音特性對高危險新生兒疼痛程度之影響。
方法：本研究為實驗性研究設計，研究對象為105位妊娠週數32週以上之高危險新生兒，採隨機分配方式分成一組控制組及兩組實驗組。在新生兒出生後第三天經歷足跟穿刺前三分鐘持續到穿刺結束後十分鐘過程中，控制組僅接受一般常規護理，而兩組父母親實驗組則另接受錄製朗讀繪本聲音之介入。三組皆於執行足跟穿刺前三分鐘、穿刺當下及穿刺後第一、五及第十分鐘，以心跳速率、呼吸速率、血氧濃度及新生兒疼痛評估量表(Neonatal Infant Pain Scale, NIPS)測量新生兒之疼痛程度，並將實驗組中母親及父親聲音分別以Praat語音學分軟體進行聲學特性之分析。資料分析則採重複測量變異數分析以及廣義估計方程式。
結果：母親聲音於穿刺後一至十分鐘之心跳速率皆顯著低於控制組，而在穿刺後五分鐘及十分鐘之疼痛程度與呼吸速率顯著低於控制組 ; 父親聲音於穿刺後一至十分鐘之疼痛程度皆顯著低於控制組，而在穿刺後五分鐘及十分鐘之心跳及呼吸速率顯著低於控制組 ; 母親及父親聲音於穿刺當下至穿刺後十分鐘之血氧濃度，皆與控制組無顯著差異。母親聲音介入於穿刺過程之疼痛程度及生理參數皆與父親聲音無顯著差異。而父母聲音特性之時長越長，疼痛程度可顯著降低，而最低音頻及平均音頻之頻率越高，心跳速率可顯著趨於穩定，於呼吸速率及血氧濃度方面則無顯著差異。
結論：母親與父親以緩慢且提高音頻的聲音介入，兩者皆可有效地減緩住院高危險新生兒心跳速率以及疼痛程度，父母皆能發揮角色功能並幫助育兒技巧提升，將可使改善高危險新生兒疼痛問題之非藥物性措施更多元，並作為臨床護理介入之重要參考。

Background: High-risk newborns must be hospitalized not only to experience painful treatment, but also are forced to be separated from their parents. Previous literature has confirmed that mother’s voice is positively influence on newborn’s physiology; however, few studies have been conducted on father’s voice.
Aims: The aims of this study were to explore the reduction of pain when parents’ voice is involved in heel puncture of high-risk newborns, and to further analyze the effect of mother’s and father’s voice acoustics on the pain degree of high-risk newborns.
Methods: A randomized controlled trial with a parallel group design was conducted in which 105 high-risk newborn–parent dyads were randomly assigned to two experimental groups, including mother’s voice and father’s voice or a control group. On the third day after birth, the control group received only general routine care during a heel puncture procedure, while the two parental experimental groups received the intervention of recording the sound of reading the children’s book. The outcome measures included heart rate, respiratory rate, oxygen saturation, and pain response assessed using the Neonatal Infants Pain Scale before, during and after the procedure. Acoustic characteristics of the mother and father voices were analyzed using Praat software. Data were analyzed using generalized estimation equations.
Results: In the mother's voice group, the heart rates from 1 to 10 minutes after the puncture, the pain degree and respiratory rate at 5 and 10 minutes after the puncture were significantly lower than the control group. In the father's voice group, the pain degree from 1 to 10 minutes after the puncture, the heart rates and respiratory rates at 5 and 10 minutes after the puncture were significantly lower than the control group. But there is no significant difference between the mother's and father's voice group during the puncture process. The slower voice speed of the parents, the less pain degree was significantly reported. The higher voice pitch, the slower heart rate was significantly found.
Conclusion: Parents’ voice with slower speed and higher pitch can stabilize the heart rates and reduce pain in hospitalized high-risk newborns. The non-invasive intervention serves as a reference to provide more parental participation in care.
Keywords: parents’ voice, pain, high-risk newborn

封面
書名頁
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誌謝 i
中文摘要 ii
英文摘要 iii
目錄 iv
圖目錄、表目錄 v
附錄 vi
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第壹章 緒論
第一節 研究動機及重要性 1
第二節 研究目的 3
第三節 研究問題及假設 4
第貳章 文獻查證
第一節 高危險新生兒現況與照護發展趨勢 7
第二節 住院新生兒疼痛之探討 9
第三節 住院新生兒與父母親子連結之探討 13
第四節 以聲音介入於高危險新生兒之成效探討 15
第五節 聲音特性對高危險新生兒之影響探討 27
第參章 研究方法
第一節 名詞界定 30
第二節 研究架構及設計 32
第三節 研究對象及場所 37
第四節 研究工具 39
第五節 研究步驟 43
第六節 研究倫理考量 45
第七節 資料處理與分析 47
第肆章 研究結果
第一節 研究收案流程結果分析 48
第二節 高危險新生兒及父母之基本屬性 50
第三節 比較三組組內於足跟穿刺過程之生理參數及疼痛程度之差異 53
第四節 比較控制組與兩組實驗組對生理參數及疼痛程度之差異 63
第五節 比較實驗組父母聲音對生理參數及疼痛程度變化之影響 73
第六節 比較聲音特性對生理參數及疼痛程度變化之影響 83
第伍章 討論
第一節 父母聲音介入於疼痛過程對高危險新生兒之影響 96
第二節 父母聲音特性於疼痛過程對高危險新生兒之影響 98
第陸章 結論與建議
第一節 研究限制與建議 100
第二節 結論 101
第三節 研究應用 102
參考文獻 103
附錄1 基本資料問卷 117
附錄2 新生兒疼痛評估量表 118
附錄3 作者授權使用函 119
附錄4 隨機分派編號表 120
附錄5 人體試驗許可證明書 121
附錄6 人體試驗許可變更證明書 122
附錄7 同意人體研究結案證明書 123

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