臺灣博碩士論文加值系統

摘 要
本研究係以質性研究深入探討高齡孕婦於獲知需接受羊膜穿刺術至實際執行期間的經歷與因應行為。研究對象是二十二位三十四歲或以上的高齡孕婦，研究方法係運用田野研究法，採觀察者即參與者的方式，以主護護理師的身份於高齡孕婦從門診獲知需接受羊膜穿刺術開始至實際執行約2-4週期間，藉由會談法及參與式觀察法深入瞭解研究對象的想法與行為反應，提供其所需之諮詢、護理。研究者將觀察所得有關研究對象語言部分的資料寫成行為過程實錄，再經由內容分析法進行資料的分析與歸納，直至穩定、適切為止。其結果如下：
高齡孕婦獲知需接受羊膜穿刺術至實際執行期間的經歷，可歸納為五項：壹、陷於醫病互動資訊不對等之處境。貳、困於母職之壓力。參、歷經內心抉擇之掙扎。肆、面臨支持系統間之抗衡。伍、面臨身體界限侵入與完整性破壞之恐懼等五項。
而其對於經歷所衍生之因應行為則有：壹、嘗試認清羊膜穿刺術對胎兒之影響。貳、尋求他人經驗或資訊，以求自我支持。參、尋求內心之自我支持與肯定。肆、確保檢查流程之安全。伍、企圖順利安全通過。陸、嘗試減緩親友關注之壓力。柒、努力維持身體界限之完整性等七項。
本研究之結果顯示，有助於醫、衛政單位制定產前遺傳篩檢政策之參考及依據，並可提供產科醫療照護團隊深入瞭解高齡孕婦獲知羊膜穿刺術後之實際需求，以提供更適切之護理與照護！

Abstract
The objective of this qualitative study is to explore the experienced and coping behaviors of advanced maternal age from the time of being informed need to perform acceptance amniocent
esis to actual implementing period. The subjects to be studied were 22 women who were pregnancy after age 34. The field methodo
logy “observer as participant” was adopted in this study. In this study, the researcher served as a caregiver as well as nurs
e-participant observer while researching data was being collect
ed. The period of data collection started from the time of bei
ng informed need to perform acceptance amniocentesis to actual implementing was about 2-4 weeks. During this period, the research used “conversation” and “participant observation” method to understand researched subjects’ opinion and behavior reaction, and provide necessary consultation and nursing. The researcher wrote down as narrative process recording including the spontaneous verbal and non-verbal behavior expressed by these advanced maternal age. The data were analyzed, classif
ied, and categorized through out content analysis. The results of this study are as follows.
The five themes of the experienced by advanced maternal age from the time of being informed need acceptance amniocentesis to actual implementing period are: 1. enmeshing information in the negative of doctor-patient relationship, 2. besiege mother
hood distress, 3. experienced struggle of innermost choices, 4.facing balancing problem of supporting system, 5. facing afrai
d of body boundary invaded and integrity destroyed.
There are also seven other themes derived from these women’s coping strategies: 1. recognizing the fetus impact of amniocen
tesis, 2. looking for experience and information from someone else in order to support themselves, 3. looking for innermost support and approve from themselves, 4. making sure examination process safety, 5. seeking safety process for themselves and babies, 6. reducing concerned distress from families and friend
s, 7. exerting themselves to maintain body boundary integrity.
In conclusion, the results of this research indicate that it can help physics and hygiene unite together to make prenatal genetic diagnosis policy. Besides, it also can support medical professionals as well as nursing staffs deeply understand actu
al need of advanced maternal age from the time of being informed
need to perform acceptance amniocentesis, therefore lead to better nursing practices.
Key words：
Advanced maternal age；amniocentesis；experience；coping behavior

目錄 頁數
摘要…………………………………………………………………i
Abstract……………………………………………………………iii
目錄…………………………………………………………………v
圖表目次……………………………………………………………viii
第一章 緒論…………………………………………………………1
第一節 研究動機與背景……………………………………………1
第二節 研究問題……………………………………………………4
第三節 名詞界定……………………………………………………4
第四節 研究範圍……………………………………………………5
第二章 文獻查證……………………………………………………6
第一節 高齡孕婦的身、心、社會壓力……………………………6
第二節 羊膜穿刺術的臨床應用與安全性…………………………9
第三節 高齡孕婦對羊膜穿刺術的心理反應………………………11
第四節 身體界限……………………………………………………14
第五節 相關研究……………………………………………………15
第三章 研究方法…………………………………………………18
第一節 研究對象……………………………………………………20
第二節 研究情境……………………………………………………20
第三節 嘗試研究(Pilot study)…………………………………21
第四節 研究資料之蒐集與記錄……………………………………26
一.研究工具…………………………………………………………26
二.資料收集過程……………………………………………………27
三.資料之記錄………………………………………………………31
第五節 資料之分析…………………………………………………32
第六節 資料收集與分析的嚴謹度…………………………………33
第四章 研究結果與分析…………………………………………37
第一節 研究對象之基本資料………………………………………37
第二節 經歷與因應行為綱要………………………………………41
第三節 經歷細說……………………………………………………47
第四節 因應行為細說………………………………………………90
第五章 討論………………………………………………………109
第一節 研究結果之討論……………………………………………109
一、完美嬰兒與科技母職…………………………………………110
二、孕婦接受羊膜穿刺之決策權…………………………………114
三、醫病互動資訊之不對等………………………………………117
四、對醫療之不安全感……………………………………………120
第二節 研究架構之形成……………………………………………123
第三節 相關研究之比較……………………………………………125
一、與國內相關研究之比較………………………………………125
二、與國外相關研究之比較………………………………………132
三、高齡初胎孕婦與高齡經產婦獲知需接受羊膜穿刺
術至實際執行期間之母性任務比較………………………………138
第六章 結論與建議………………………………………………144
第一節 結論…………………………………………………………144
第二節 臨床應用與建議……………………………………………146
第三節 研究限制……………………………………………………155
第四節 對未來之建議………………………………………………156
參考資料
一、中文部份……………………………………………………………157
二、英文部份……………………………………………………………159
附錄
附錄一 羊膜穿刺術衛教手冊……………………………………………163
附錄二 參與研究同意書…………………………………………………171
附錄三 行為過程實錄及內容分析………………………………………172
圖表目錄
圖一 研究方法及資料收集過程之流程圖………………………………19
圖二 研究資料收集次數與妊娠週數之關係圖…………………………28
圖三 高齡孕婦獲知需接受羊膜穿刺術至實際執行期間之經歷與因應行
為概念架構圖………………………………………………………124
表一 資料收集階段接觸之原因…………………………………………29
表二 資料收集過程表……………………………………………………30
表三 研究對象之基本及相關資料………………………………………39
表四 與國內相關研究之比較……………………………………………131
表五 與國外相關研究之比較……………………………………………137
表六 高齡初胎孕婦與高齡經產婦獲知需接受羊膜穿刺術至實際執行
期間之母性任務比較………………………………………………143

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