臺灣博碩士論文加值系統

　　止痛藥是職護常提供員工的藥物，原因以經痛最常見，具前列腺素抑制功能藥物已證實能有效緩解經痛。故本研究欲探討職護對經痛止痛藥之認知、態度與行為及其相關性探討。
　　本研究為調查研究，以事業單位護理人員為對象，有效問卷280份，回收率67%。問卷包含經痛止痛藥認知（藥理理論、藥理應用）、成癮態度、經痛藥物處置及職護個人屬性，變項各構面的分數經標準化轉化運算。以描述性統計、、t-檢定、單因子變異數分析、線性迴歸和邏輯斯迴歸分析。
　　研究發現50.7%的受訪職護提供經痛止痛藥，40.4%認為經常使用經痛止痛藥會成癮。整體經痛止痛藥認知標準化得分為57分，各面向得分為藥理理論平均80分、藥理應用46分。職護經痛藥物處置與其成癮態度和認知不具關連性。經痛愈嚴重者，其止痛藥認知愈高及成癮態度愈低。職護經痛藥物處置分別與經痛止痛藥認知和成癮態度無關，只有經痛止痛藥認知與成癮態度有關。經痛藥物處置與女性員工主要年齡有關。
　　未來宜開辦相關課程，加強職護經痛止痛藥認知與成癮態度，有助於提供正確的經痛藥物處置。

Analgesics is occupational health nurse usually provide medicine for employee. There are NSAIDs inhibit prostaglandins, it can relieve dysmenorrhea.The aim is Occupational Health Nurses’ Cognition, Attitude and Practice about Dysmenorrhea Analgesics.
It is survey research, the object is TAOHN( http://www.taohn.org.tw/) , total 280 useful questionnaires are collected and return rate is 67%. Research tool is a dysmenorrhea analgesics cognition(pharmacological theory and pharmacological application), drug addiction attitude, analgesics knowledge and occupational health nurse personal attributes, the grade has standardization. There are descriptive statistics, t-test, ANOVA, linear regression and logistic regression.
Research findings found that 50.7% occupational health nurse provide analgesics, 40.4% think use analgesics will abuse. Total analgesics cognition standardization is 57, pharmacological theory is 80 and pharmacological application is 46. Occupation health nurse analgesics and drug addiction abuse compare analgesics cognition no correlation. Occupational health nurse medicine provider and female’s year is correlation.
In the future, push occupational health nurse for analgesics cognition and drug addiction attitude, it will currents dysmenorrhea analgesic.
Keywords: dysmenorrhea, provide medicine, drug addiction attitude, analgesics knowledge, occupational hygiene nurse.

第一章　緒論 1
第一節　研究背景與動機 1
第二節　研究目的 3
第二章　文獻探討 4
第一節　經痛止痛藥物 4
第二節　護理人員對疼痛的認知、態度與行為 15
第三節　職護的專業角色 19
第三章　研究方法 25
第一節　研究對象 25
第二節　研究架構 27
第三節　研究工具 28
第四章　結果 36
第一節　認知、態度和行為現況與相關性 36
第二節　認知、態度和行為與職護個人屬性之關係 43
第三節　認知、態度和行為與職護個人屬性之迴歸分析 55
第五章　結論與討論 61
第一節　結論 61
第二節　討論 63
第三節　限制 66
第四節　建議 67
參考文獻 68

中文文獻
全國婦女月經生理常數協作組：中國婦女月經生理常數的調查分析。中華婦產科雜誌1998;5:2192-4。
林葦青：台灣安寧及腫瘤病房護理人員疼痛認知與疼痛控制知識之比較。亞洲大健康管理研究所碩士論文，2004。
邱敏惠：系統性護理指導對護校女生經痛認知、月經態度及經痛自我照顧行為之成效。高雄醫學大學護理學研究所碩士論文，2001。
波仕特線上市調網：線上市調：「好朋友」惹麻煩怎麼辦。http://www.pollster.com.tw/report/61/index.htm。引用2012/06/01。
許夙君：從臨床治理觀點探討醫學中心病人安全的風險因素。國立成功大學高階管理研究所碩士論文，2005。
周輝政：月經疼痛（痛經）。台北市醫師公會會刊2006;50:37-43。
郭姿均：國人愛買什麼藥。常春月刊 2010;329。
陳泯瑄、陳怡樺、林勇志：經痛（Dysmenorrhea）。長庚藥學學報2010;17:1-7。
鄭尊仁：工作場所健康促進介入模式計畫。行政院衛生署89年度委託研究計劃（計畫編號：DOH89-TD-1179），2000。
張慶南、林明珍、曾秋鑾、呂春美、鄔彩香、溫滿美：護理人員對健康照護資訊的尋求及其相關因素之探討。志為護理 2007;25:237-42。
張天韻：女人的月經，女人的認知。國立台北大學社會學研究所碩士論文，2004。
張菊惠：充權導向之職場經痛行動研究。國立台灣大學衛生政策與管理研究所博士論文，2002。
張曉君：婦女經痛之防治。中華民國內膜異位症婦女協會會刊 2004;11:4-5。
張玨、徐儆暉：女性勞工者經期健康及工作保護規範研究。勞工安全衛生研究院，2009。
張明揚：痛經的診斷與處理。台北市醫師公會會刊2009;53:44-8。
湯振清、林鏡川、蘇世斌：原發性經痛的診斷與治療。家庭醫學與基層醫療2010;25:237-42。
楊捷凱：婦科中藥方劑研究第三報－經痛。台北醫學院生藥研究所碩士論文，1998。
楊賢鴻：婦女經期保健。中華民國內膜異位症婦女協會會刊 2007；14：6。
劉錦聰：不同輪班方式對月經之影響。台灣大學職業醫學與工業衛生研究所碩士論文，1999。
癌症疼痛處理指引/TCOG癌症疼痛與症狀處理委員會
謝功毅：晶圓製造廠女性員工生殖健康之研究。台北：國立台灣大學職業醫學暨工業衛生研究所碩士論文，1998。
黃家昵：一、液晶顯示器製造業職業暴露對女性員工月經週期之影響；二、液晶顯示器製造業女性員工生殖內分泌研究。臺灣大學職業醫學與工業衛生研究所碩士論文，2005。
劉昭宏：月經疼痛。劉文俊等編，家庭醫師臨床手冊。第二版。台北：台灣家庭醫學會2006；68-73.
諶悠文/綜合一日外電報導：兩種止痛藥傷肝 美FDA籲禁用。http://life.chinatimes.com/2009Cti/Channel/Life/life-article/0,5047,11051801+11 2009070200101,00.html。引用2012/06/01。
姜逸群、黃雅文：衛生教育與健康促進。初版。台北：文景，1992；25-42。
蕭淑銖：廠護之工作型態及健康情形調查研究。國民健康局，2005。
英文文獻
Akerlund M, Stromberg P. Comparison of ketoprofen and naproxen in the treatment of dys menorrhoea, with special regard to the time of onset of pain relief. Current Medical Research & Opinion 1989;11:485–90.
Akinluyi EM. Piroxicam in primary dysmenorrhea. Current Therapeutic Research 1987;41:609–13.
Al-Waili NS, Khalaf ZD. Efficacy of indomethacin suppository in primary
dysmenorrhoea. The Indian Journal of Medical Research 1990;92:298–301.
Banikarim C, Chacko MR, Kelder SH. Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Archives of Pediatrics & Adolescent Medicine 2000;154:1226-9.
Bertoni JM, Busby LC, Crespo A, Dixon D, Dutton LL, Ennis G. Professionnal guide to signs ＆ symptoms. 3rd. Springhouse 2001.
Berek JS. Berek and Novak''s Gynecology. 14th ed., Philadelphia., Lippincott
Williams & Wilkins, 2007;516-37.
Bitner M, Katternhorn J, Gao J, Kellstein D. Efficacy and tolerability of Lumiracoxibinthe treatment of primary dysmenorrhoea. International Journal of Clinical Practice 2004;58:340–5.
Borenstein J, Chiou C F, Dean B, Wong J, Wade S. Estimating direct and direct
costs of premenstrual syndrome. Journal of Occupational Environmental Medicine 2005;47:26-33.
Bhombardier C. An Evidence-Based Evaluation of the Gastrointestinal Sasfety of Coxibs. The American Journal of Cardiology 2002;89:3D-9D.
Bonnie B, Jeff E. A Prospective Assessment Investigating the Relationship Between Work Productivity and Impairment With Premenstrual Syndrome. Journal of Occupational and Environmental Medicine 2004;46:649-56.

Burgel BJ. Occupational health. Nursing in the workplace. The Nursing Clinics of North America 1994;29:431-42.
Carr ECJ, Thomas VJ. Anticipating and experiencing post-operative pain: the patients'' perspective. Journal of Clinical Nursing 1997;6:191-201.
Coyne ML, Reinert B, Cater K, Dubuisson W, Smith JF, Parker MM, Chatham C. Nurses'' knowledge of pain assessment, pharmacologic and nonpharmacologic interventions. Clinical Nursing Rearch 1999;8:153-65.
Coyne ML, Smith JF, Stein D, Hieser MJ, Hoover L. Describing pain management documentation. The Journal of Adult Health, is the official Journal of the Academy of Medical-Surgical Nurses 1998;7:45-51.
Chantler I, Mitchell D, Fuller, A. The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrhoeic pain. Clinical Journal of Pain 2008;24:39–44.
Chantler I, Mitchell D, Fuller A. Diclofenac potassium attenuates dysmenorrhea and restores exercise performance in women with primary dysmenorrhea. The Journal of Pain 2009;10:191–200.
Chen C, Cho SI, Damokosh AI, Chen D, Li G, Wang X, Xu X. Prospective study of exposure to environmental tobacco smoke and dysmenorrhea. Environmental Health Perspectives:EHP 2000;108:1019–22.
Cogdill, KW. Information needs and information seeking in primary care: A study of nurse practitioners. Journal of the Medical Library Association 2003;91:203-15.
C?t? I, Jacobs P, Cumming D. Work loss associated with increased menstrual loss in
the United States. Obstetrics & Gynecology 2002;100:683-7.
Daniels S, Gitton X, Zhou W, Stricker K, Barton S. Efficacy and tolerability of Lumiracoxib 200 mg once daily for treatment of primary dysmenorrhea: results from two randomized controlled trials. Journal of Women’s Health 2008;17:423–37.
Dawood MY. Efficacy and safety of piroxicam-B-cyclodextrin (PBCD, Brexidol).
Comparison studies with ibuprofen, naproxen sodium and placebo in the reliefofmoderate to severe abdominal pain associated with primary dysmenorrhoea. Journal of New Development in Clinical Medicine. 1999;17:273–88.
Dawood MY. Ibuprofen and dysmenorrhea.American Journal of Medicine 1984;77:87-94.
Davis GC, Hiemenz ML, White TL. Barriers to managing chronic pain of older adults with arthritis. Journal of Nursing Scholarship 2002;34:121-6.
De Rond MEJ, De Wit R, Van Dam FAM, Muller MJ. A pain monitoring program for nurses: Effects on nurses’ pain knowledge and attitudes. Journal of Pain and Symptom Management 2000;20:424-39.
Dee Cheryl, Stanley EE. Information-seeking behavior of nursing students and clinical nurses: implications for health sciences librarians. Journal of the Medical Library Association 2005;93:213-21.
De Mello NR, Baracat EC, Tomaz G. Double-blind study to evaluate efficacy and asafety of meloxicam 7.5 mg and 15 mg versus mefenamic acid 1500 mg in the treatment of primary dysmenorrhea. Acta Obstetrica et Gynecologica Scandinavica 2004;83:667–73.
Di Girolamo G, Gimeno MAF, Faletti A, De Los Santos AR, Marti ML, Zmijanovich
R. Menstrual prostaglandins and dysmenorrhea: modulation by non-steroidalantiinflammatory drugs [Prostaglandinas menstruales y dismenorrea sumodulacion por antiinflamatorios no esteroideos]. Medicina(Buenos Aires) 1999;59:259–64.
Facchinetti F, Piccinini F, Sgarbi L, Renzetti D, Volpe A. Nimesulide in the treatmentof primary dysmenorrhoea: a double blind study versus diclofenac. Drugs of Today 2001;37:39–45.
French L. Dysmenorrhea. American Family Physician 2005;71:285-91.
Ferrell BR, McCaffery M, Rhiner M. Pain and addiction: An urgent need for change in nursing education. Journal of Pain and Symptom Management 1992;7:117-24.
Fox SI. Human Physiology. 9th ed. New York: McGraw-Hill,2006; 26-50, 306-47.
Harel Z. Dysmenorrhea in Adolescents and Young Adults: Etiology and Management. Journal of Pediatric and Adolescent Gynecology 2006;19:363-71.
Herr KA. Chronic pain: Challenges and assessment strategies. Journal of Gerontological Nursing 2002;28:20-7.
Ishihara I, Yoshimine T, Horikawa J, Majima Y, Kawamoto R, Salazar MK. Defining the roles and functions of occupational health nurses in Japan: results of job analysis. AAOHN Journal: Offical Journal of the American Association of Occupational Health Nurses 2004;52:230-41.
Jones KR, Fink R, Pepper G, Hutt E, Vojir CP, Scott J, Clark L, Mellis K. Improving
Nurstin Home Staff Konwledge and Attitues About Pain. The Gerontologist 2004;44:469-78.
Khan-Dawood FS. Clinical efficacy and differential inhibition of menstrual
fluid prostaglandin F2a in a randomized, double blindcrossover treatment with placebo, acetaminophen and ibuprofen inprimary dysmenorrhea. American Journal of Obsteetrics & Gynaecology 2007;196: 35.e1–35.e5.
Kintigh JW. A multicenter, randomized, double-blind, placebo controlled study of diclofenac potassium versus naproxen sodium in the treatment of primary dysmenorrhea. Today’s Therapeutic Trends 1995;12:47–61.
Konishi K. Effect of the Menstrual Cycle on Working Memory: Comparison of Postmenstrual and Premenstrual Phases. Industrial Health 2008;46:253-60.
Lander J. Fallacies and phobias about addiction and pain. British Journal of Addiction 1990;85:803-9.
Latthe P, Latthe M, Say L, Gulmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006;6:177.
Letzel H, Megard Y, Lamarca R, Raber A, Fortea J. The efficacy and safety of aceclofenac versus placebo and naproxen in women with primary dysmenorrhoea. European Journal of Obstetrics & Gynaecology and Reproductive Biology 2006;129:162–8.
Lathey JW, Hodg B. Information seeking behavior of occupational health nurse: how nurses keep current with health information. AAOHN Journal: Offical Journal of the American Association of Occupational Health Nurses 2001;49:87-95.
Lipscomb J, Burgel B, McGill LW, Blanc P. Preventing Occupational Illness and Injury: Nurse Practitioners as Primary Care Providers. American Journal of Public Health 1994;84:643-5.
Laura F. Psychological Stress in the Work place and Menstrual Function. American Journal of Epidemiology 1999;149: 127-34.
Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews. 2010;1.
Mehlisch DR, Ardia A, Pallotta T. Analgesia with ibuprofen arginate versus conventional ibuprofen for patients with dysmenorrhea: a crossover trial. Current Therapeutic Research 2003;64:327–37.
Milsom I, Minic M, Dawood MY, et al. Comparision of the efficacy and safety of nonprescription doses of naproxen and naproxen sodium with ibuprofen, acetaminophen and placebo in the treatment of primary dysmenorrhea: a pooled analysis of five studies. Clinical Therapeutics 2002;24:1384-1400.
Messing KS-CM, Bourgine M, Kaminski M,. Menstrual cycle characteristics and work conditions of workers in poultryslaughter houses and canneries. Scandinavian Journal of Work, Environment & Health 1992;18:302-9.
McKnight, M & Peet, M. Health care providers’ information seeking: Recent research. Medical Reference Services Quarterly 2000;19:27-50.
Mobily PR, Herr K A. Barriers to managing residents’ pain. Contemporary Long Term Care 1996;19:60A–60B.
Ryan KJ, Berkowitz RS, Barbieri RL, Dunaif AE. Kistner''s gynecology and women''s health. 7th ed., St. Louis, Mo., Mosby, 1999;52-4.
Reddish S,. Dysmenorrhoea. Australian Family Physician 2006;35:842-9.
Smith RP. Cyclic pelvic pain and dysmenorrhea. Obstetric & Gynecology Clinics of North America. 1993;20:753-64.
Swanson SA, Reiner TT. Chronic pain in the elderly. Advances in gerontological nursing.1th ed., New York: Springer, 1996;82-111.
Totterdell P, SpeltenE, Pokorski J. The effects of night work on psychological changes during the menstrual cycle. Journal of Advanced Nursing 1995;21:996-1005.
University of Texas at Austin, School of Nursing, Family Nurse Practitioner Program. An evidence based practice guideline for the treatment of primary dysmenorrhoea. Available at:http://guideline.gov/content.aspx?id=16323 March 1,2012.
Weissman DE. Cancer pain education: A call for role models. Journal of Clinical Oncology 1988;6:1793–4.
WHO Regional Office for Europe. The role occupational health nurse in workplace health management. Europe: World Health Organization. 2001.
Yang KF, Yu S, Lin MS, Hsu CL. Student of basic computer competence among public health nurse in Taiwan. The Journal of Nursing Research 2004;12:1-10.
Zhang WY, Li Wan PO A. Efficacy of minor analgesics in primary dysmenorrhoea:A systematic review. British Journal of Obstetrics and Gynaecology 1998;105:780-9.