臺灣博碩士論文加值系統

研究背景：病童接受心臟手術或心導管治療時，常使父母親面臨龐大壓力，加上COVID-19疫情期間，父母因缺乏相關知識及擔憂病童住院治療被感染之風險，更會造成高度焦慮、憂鬱與不確定感。
研究目的：本研究旨在探討於常規衛教外加入術前健康教育影片對病童父、母親情緒困擾之成效。整體研究包括兩部份：第一部份探討於常規衛教外加入術前健康教育影片，是否可降低病童接受心臟手術，及手術後發生併發症於出院時母親之焦慮及憂鬱；第二部份則探討於COVID-19疫情期間，提供入院前心導管健康教育影片，是否可降低父母親於兒童接受心導管治療時之焦慮與不確定感進而接受治療。
研究設計:本研究採隨機對照試驗，皆在某醫學中心進行收案。第一部份於兒童加護病房，邀請心臟手術治療之病童母親為研究對象，並隨機分為對照組和實驗組各60名。實驗組於入院時接受常規衛教及術前健康教育影片，對照組接受常規衛教。以貝氏焦慮量表及憂鬱量表，評估母親於病童入院當天衛教前、衛教4小時後，心臟手術前、病童出院時以及病童心臟手術發生併發症時之焦慮及憂鬱程度。
研究第二部份:於小兒心臟科門診針對可能接受心導管治療之病童父母親進行收案，並將同意參與者隨機分為對照組和實驗組各70名。對照組和實驗組皆在門診接受相關介入措施，實驗組父母接受心導管健康教育影片及常規衛教，對照組接受常規衛教；參與研究之父母有7天時間決定是否同意讓病童接受心導管治療。於病童入院時，實驗組接受心導管健康教育影片及常規衛教，對照組接受常規衛教，以貝氏焦慮量表及雙親不確定感認知量表，分別評估(1)病童住院當天，衛教前， (2)衛教後，心導管治療前 (3) 以及病童出院時父母親之焦慮與不確定感之情形。資料以SPSS18.0 for Windows 進行描述性、使用chi-square test、paired t- test 、Independ-t test、Multiple regression analysis等統計分析。
研究結果:與傳統常規衛教相比，加入術前健康教育影片，母親衛教後和病童出院當天之焦慮下降更多。在衛教後，憂鬱程度亦明顯降低﹔但於出院當天並無顯著差異﹔病童有手術或術後併發症時，母親觀看術前健康教育影片與接受常規衛教之母親比較，於出院當天焦慮下降更多，並達顯著差異。於心導管治療之病童父母親方面：前測實驗組雙親不確定感量表低於對照組，並達顯著差異。此外父母拒絕病童接受心導管治療於實驗組為14名和對照組26名(p = .025)。衛教後測及出院當日，實驗組於焦慮及不確定感量表降低程度均優於對照組，並可持續至出院且達顯著差異(.p < .05)。
結論:於常規衛教加入術前健康教育影片，能有效降低母親於病童接受心臟手術之焦慮直到出院當天，當病童有術後併發症時，添加術前健康教育影片能降低母親於病童出院當天之焦慮。於常規衛教加入心導管健康教育影片，能有效降低父母親焦慮及不確定感，進而降低父母對病童心導管治療之拒絕。

Background: Parents of children undergoing catheterization or surgery for congenital heart disease (CHD) experience significant stress. During the COVID-19 pandemic, inadequate knowledge for the infection and worry about being infected during admission contributes to an increase in parental uncertainty, anxiety and depression.
Purpose: This study contains two parts.
First part: to examine whether adding preoperation health education video to routine education can reduce maternal anxiety and depression when their children undergo CHD surgery and when surgical or postsurgical complications occur.
Second part: during COVID-19 pandemic, we examined whether supplying cardiac catheterization health education video before admission can reduce parental rejection of pediatric cardiac catheterization for CHD, and reduce parental uncertainty and anxiety.
Study design:
First part: In a teaching hospital, 120 mothers whose children underwent elective CHD surgery were randomly and equally divided into two groups: mothers receiving routine education plus a preoperation health education video before surgery and

mothers receiving only routine education. Mothers’ anxiety and depression levels were compared before education, after education (before surgery), and on discharge day. The effect of watching the preoperation health education video on maternal anxiety and depression on discharge day was evaluated for the participants whose children had surgical or postsurgical complications.
Second part: Parents of 70 children with CHD selected for cardiac catheterization treatments were randomly allocated to the cardiac catheterization health education video (received pre-admission cardiac catheterization health education video in the outpatient department; 70 parents of 35 children) or routine education groups. (receive the routine education); 70 parents of 35 children). The parents could reject the admission of their children within 7 days. In parents who received cardiac catheterization, parental uncertainty and anxiety levels were compared before education, after education (before surgery), and on discharge day.
Statistical analyses: All statistical analyses were performed using Predictive Analytics Software Statistics 18. the chi-square test, paired t- tes, independent t-test, multivariate regression analysis was used for the analysis.

Result:First part: Compared to only routine education, mothers’ anxiety after education and on the discharge day decreased more if d preoperation health education video was added. Depression decreased more after education, but no difference was found on the discharge day. Anxiety levels of mothers whose children had surgical or postsurgical complications on the discharge day decreased more if they watched the preoperation health education video, compared to those receiving only routine education (Beck Anxiety Inventory score 3.4 ± 1.9 and 6.1 ± 2.4 respectively; p-value 0.001).
Second part: Cardiac catheterization was rejected by 14 (20.0%) and 26 (37.1%) parents in the DVD and non-DVD groups, respectively (p = 0.025). Parent Perceptions of Uncertainty Scale scores were lower in the DVD (128.3 ± 8.9 points) than in the non-DVD group (134.1 ± 7.3 points; p <0.001). Decreased uncertainty due to pre-admission cardiac catheterization health education video watching could have contributed to the increased parental willingness for cardiac catheterization treatment. Compared to only routine education, parental uncertainty and anxiety after education and on the discharge day decreased more if cardiac catheterization health education video was added.

Conclusion: Compared to only routine education, adding preoperation health education video could decrease mothers’ anxiety, and until the day of discharge. Compared to only routine education, adding preoperation health education video could decrease mothers’ anxiety on the discharge day if their child had surgical or postsurgical complications. Offering cardiac catheterization health education video to parents of children selected for cardiac catheterization for CHD may decrease the parental rejection rate of the treatment.

誌謝…………………………………………………………….…I
中文摘要……………………………………………………III
英文摘要………………………………………………………VI
目次……………………………………………………………….X
圖次…………………………………………………………….XIV
表次……………………………………………………....XVI
附 錄……………………………………………………….XVII
第一章緒論…………………………………………………1
第一節 研究動機及重要性…………………1
第二節 研究目的..............5
第三節 研究問題……………………………………6
第四節 名詞定義……………………………………7
第二章 文獻查證……………………………………12
第一節 先天性心臟病與心臟手術及心導管治療對病童之影響………12
第二節 兒童心臟手術及心導管治療對父母親之影響……...........14
第三節 衛教指導之重要性及方法………………………...................16
第四節 不確定感之定義及疫情期間住院治療對病童父母親之影響……18
第五節 衛教指導對焦慮與憂鬱及不確定感影響之相關研究……………………20
第三章 研究方法…………………………………………….23
第一節 研究概念架構……………………………………23
第二節 研究設計…………………………………………..25
第三節 研究工具及其信效度………………………30
第四節 研究步驟及資料收集過程……………34
第五節 資料處理及統計分析………………………42
第六節 研究倫理考量…………………………………….46
第四章 研究結果………………………………………………47
第一部份…………………………………………………......47
第一節 母親及病童基本人口學特徵…………47
第二節 術後護理和併發症之特徵…………….50
第三節 每一組及兩組不同時間焦慮及憂鬱程度之比較....52
第四節 併發症組與非併發症組於出院日焦慮程度及憂鬱程度之比較………56
第二部份……………………………………......................58
第一節 父母親及病童基本人口學特質……………….......58
第二節 先天性心臟病心導管治療之拒絕率…………......59
第三節 每一組及兩組父母衛教前、後及出院不確定感量表之比較………...60
第四節 每一組及兩組父母衛教前、後及出院焦慮之比較………………………………..62
第五章 討論………………………………………………64
第一節 病童接受心臟手術，母親焦慮及憂鬱對病童之影響…….…........64
第二節 術前健康教育影片於病童接受心臟手術對母親焦慮及憂鬱之影響…66
第三節 比較不同衛教方式對降低病童心臟手術或術後併發症時母親焦慮與憂鬱之效果………….67
第四節 心導管健康教育影片於疫情期間對病童父母焦慮與不確定感及接受病童治療之影響….69
第六章 結論…………………………………………………....73
第七章 本研究於實務之貢獻…………………………75
第八章 研究限制……………………………………………….77
參考文獻……………………………………………………….....79
中文部份…………………………………………......79
英文部份…………………………………………………...82

 
圖次
第三章
圖 1 1病童心臟手術研究概念架構圖....24
圖 1 2病童心導管治療研究概念架構圖..24
圖 1 3心臟手術收案流程圖...........38
圖 1 4心臟手術研究流程圖...........39
圖 1-5心導管治療研究流程圖.........41


表次
第四章
第一部份:
表 1 1 Demographic and post-surgery care data DVD..........49
表 1 2 Surgical and post-surgical complications.............51
表 1 3 comparison of Beck Anxiety Inventory (BAI)before and after each group and
discharge day…….......................................52
表1 4 comparison of Beck Depression Inventory (BDI) before and after each group and
discharge day…………......................................53
表1 5 Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI)scores between
DVD and non-DVD groups………….............................55
表 1 6 Discharge day scores on Beck Anxiety Inventory (BAI) and Beck Depression
Inventory (BDI) in complication and non-complication groups……………57


第二部份:
表2 1 Demographic data, between DVD group and non-DVD group ………………………………………58
表2 2 The rate of rejection for cardiac catheterization treatment between DVD group
and non-DVD group in total and in different characteristics. ………………………59
表2 3 comparison of Mishel’s Parent Perceptions of Uncertainty Scale (PPUS) before
and after each group and on the day of discharg…………………………………………………....60
表2 4 Mishel’s Parent Perceptions of Uncertainty Scale (PPUS) between the DVD and
non-DVD groups in different time points during admission…………………………………..61
表2 5 comparison of anxiety scale before and after each group and on the day of
discharge………………………………………...............................................62
表 2 6 Beck Anxiety Inventory (BAI) scores between the DVD and non-DVD groups in
different time points during admission……………………………………………….............…63
附錄
附錄一 母親及兒童基本資料表………………….100
附錄二 貝氏焦慮量表…………………………………….101
附錄三 貝氏憂鬱量表…………………………………….103
附錄四 父母親及兒童基本資料表………………105
附錄五 雙親不確定感認知量表……………………106

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