臺灣博碩士論文加值系統

疼痛是一種複雜、主觀且難以捉摸的現象，特別是在評估與處理嬰兒的疼痛問題上。而疼痛減輕是新生兒照護重要的課題，根據Brazelton (1983)的理念發展出的寧握護理 (Containment) -主張限制嬰兒無意識的四肢揮動，或助以一臂之力將嬰兒的四肢移向軀體，使其成為未出生胎兒的姿勢，可使躁動不安的嬰兒立即安靜下來，且寧握護理具有增加嬰兒的安全感、促進寧靜及自我控制並提昇生理穩定、促進能量保存、減少生理行為壓力並對壓力有較佳的忍受力等功能，期望達到疼痛減輕的目的。因此本研究的目的探討寧握護理對早產兒扎足跟血時疼痛減輕的成效。
本研究採取交叉配對之實驗性研究設計，以台北市設有新生兒加護中心的早產兒為對象，採重複測量、隨機分派法進行取樣，共選取33位符合條件的早產兒進行研究，每位早產兒都是實驗組亦為自己的控制組，其中又以在扎足跟血時有寧握護理措施的進行實驗組步驟；而沒有寧握護理措施的進行控制組步驟，兩次測量時間間隔24小時。而寧握護理的時機為扎足跟血前5分鐘到扎足跟血後5分鐘，並於扎足跟血前5分鐘時收集心跳速率及氧氣飽和濃度的資料作為基準值，於扎足跟血後30秒、5分鐘及10分鐘觀測早產兒疼痛分數，以作為比較同一個早產兒接受寧握護理措施對疼痛減輕的成效。
本研究之研究工具包含寧握護理工具、研究量表及生理、行為測量儀器四大部份。研究所得的資料，以SPSS8.0 / Win95和SAS 6.12 / Win95套裝軟體進行次數分布、百分比、平均值、標準差、t 檢定、配對t檢定及GEE等統計方法分析。
研究結果發現在生理反應方面：扎足跟血時的心跳速率會比基準值時高，且氧氣飽和濃度會比基準值時低。接受寧握護理的早產兒在扎足跟血後的心跳速率變化會比未接受寧握護理的早產少，且回復到基準值的時間快（P = 0.010），具有統計上差異；而氧氣飽和濃度變化亦會比未接受寧握護理的早產兒少（P = 0.493），雖然在統計上無顯著差異，但仍比控制組下降程度少。在行為反應方面：早產兒行為反應會受出生週數的影響，在上臉部表情方面，尤以眉頭皺起最為顯著。在早產兒疼痛評估方面：僅有第二次早產兒疼痛評估及第三次早產兒疼痛評估（P < 0.001），具有統計上差異。
整體而言，寧握護理可穩定生理及行為上的壓力，達到疼痛減輕的功效，也期望在常規的檢查中，運用寧握護理的措施，提供發展性的照護，並減少因侵入性治療所造成的傷害，進而達到改善護理品質的目的。

The experience of pain in the newborn is a complicated issue as it is subjective and difficult to assess. Reducing the pain from the newborn is a big issue. According to Brazelton (1983), inhibiting the stimulating the unconsciousness of the movement of the four limbs or moving the limbs toward the body like in the posture of a fetus in the uterus will calm the restless newborn down. The containment will improve the newborn''s sense of security, calm the newborn down control the newborn, save energy, alleviate pain, and improve the pain tolerance, and so on. The purpose of this study is to investigate pain reduction with and without containment for the newborn while taking blood samples from the heel.
This is a crossover, experimental, and randomized designed research. The data was obtained from 33 clients in the NICU in Taipei hospitals. The measurements were repetitive. Each premature baby in the experimental group was his or her own control group. The comparisons of pain reduction after taking blood samples from the heel with and without containment in each subject were investigated. The interval of each measurement was 24 hours. The containment was given before and after 5 minutes taking blood samples from the heel. Moreover, the heart rate and saturation were measured 5 minutes before taking the blood sample from the heel to compare with the baseline. The premature infant pain was observed and scored 30 seconds, 5 minutes and 10 minutes after taking blood sample from the heel. These data were used to compare the pain reduction with and without containment for the same newborn while taking blood samples from the heel.
The parameters of each measurement included nursing containment, research scale, physiological scale, and behavioral scale. The collected data was run with SPSS8.0 / Win95 and SAS 6.12 / Win95 and was analyzed by frequency distribution, percentile, mean, standard deviation, student t test, paired t test, GEE and etc.
The major finding as the following :
1. Physical reaction: the heat rate was higher than the baseline while taking the blood sample from the heel. The saturation was lower than the baseline. When the premature received the containment, their heat rate changed less than these did not received. The premature received the containment their heat rate got back to normal shorter than these did not received (p = 0.010). Moreover, the premature received the containment their saturation changed less than these did not received (p = 0.493). Even thought there were no statically difference, the control group still had smaller change than the experimental group.
2. Behavioral reaction: The premature behavioral reactions were affected by the age (week) of premature. The premature frowned mostly in their facial expression. In the premature infant pain assessment, only second and third premature infant pain assessments has statically difference (p < 0.001).
Overall, the containment can stable the stress physically and behaviorally and also reduce the pain. The author suggests that the uses of containment provides developmental care, reduces discountable and also aims to provide better nursing care.

第一章 緒論
第一節 研究動機
第二節 研究重要性
第三節 研究目的
第二章 文獻探討
第一節 嬰兒的疼痛機轉
第二節 早產兒扎足跟血的疼痛反應
第三節 影響早產兒扎足跟血疼痛反應的相關因素
第四節 寧握護理
第五節 早產兒扎足跟血疼痛反應緩解方法之探討與比較
第三章 研究架構
第一節 概念架構
第二節 名詞界定
第三節 研究問題
第四節 研究假設
第四章 研究方法
第一節 研究對象與場所
第二節 研究設計
第三節 研究工具
第四節 資料收集過程
第五節 資料處理與分析
第五章 研究結果
第一節 研究對象的基本屬性
第二節 早產兒扎足跟血時疼痛反應
第三節 影響早產兒扎足跟血疼痛反應的相關因素
第四節 寧握護理對早產兒扎足跟血疼痛減輕之成效探討
第五節 影響早產兒接受寧握護理的干擾因素
第六章 討論
第一節 早產兒扎足跟血疼痛反應之分析
第二節 影響早產兒扎足跟血疼痛反應的相關因素分析
第三節 寧握護理減輕疼痛之成效探討與比較
第七章 結論與建議
第一節 結論
第二節 護理上的應用
第三節 研究限制與建議

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