臺灣博碩士論文加值系統

背景及目的：正念減壓（Mindfulness-Based Stress Reduction, MBSR）是一種以正念冥想 (Mindfulness Meditation) 為基礎，並結合瑜伽所發展而成的減壓放鬆治療法，由美國麻州大學醫學院的卡巴金博士 (Dr. Kabat-Zinn) 於 1979 年所創導，近年來應用於減緩臨床患者的疼痛、睡眠障礙、壓力反應等，有良好的成效。研究也證實正念減壓能緩解高壓力族群的身心壓力與焦慮，改善睡眠品質、慢性疲勞並提升專注力。緊急醫療救護人員屬高壓力族群，本研究的目的在於探討正念減壓介入對於緊急醫療救護人員的身心壓力與睡眠品質之影響。
材料及方法：本研究採兩組前後測之類實驗研究設計，收案時間為民國106年6月9日至民國106年7月28日，以中部某縣市緊急醫療救護人員為收案研究對象，包括急診醫師、急診室護理師、消防救護技術員等緊急醫療救護人員共40人，採立意取樣分派為實驗組與對照組，每組各20位，實驗組由專業正念老師帶領每週一次，每次2.5小時的正念減壓課程，連續八週。研究工具包括『匹茲堡睡眠品質量表』、『壓力知覺量表』、『工作滿意度量表』及『華人健康問卷』，資料以SPSS18.0 for Windows、Excel 進行分析。使用成對樣本t檢定及單因子共變數分析（one way ANCOVA）檢定以評估介入之成效。
結果與結論：八週減壓介入後，實驗組睡眠品質和壓力知覺之前後測達顯著差異(p＜0.05)；對照組之睡眠品質和壓力知覺之前後測則無顯著差異(p＞0.05)，以共變數分析控制前測分數，實驗組與控制組兩組後測之睡眠品質與壓力知覺差異皆達顯著水準(p＜0.01)，顯示實驗組優於對照組。正念減壓能改善緊急醫療救護人員之身心壓力及睡眠品質，本研究結果可作為臨床應用及相關研究之參考。

Background and purpose : Mindfulness-based stress reduction (MBSR) has been proven to be effective in alleviating physical and mental stress, improving sleep quality and chronic fatigue, and enhancing concentration ability in workers under high stress environment. It also has positive impact on reducing burnout, anxiety and mood disorders. Many studies have signified that emergency medical personnel have high stress and low level of satisfaction to sleep and life quality. Therefore, the purpose of this study is to explore the effects of MBSR intervention on the impact of emergency medical personnel about stress and sleep quality
Materials and methods: This study was designed with pre-test and post-test of two groups of Quasi-Experimental Design. Forty emergency medical technicians, including Emergency Medicals, Emergency Room nurses and Emergency Medical technicians of fire control were recruited in a hospital that in the middle of Taiwan during June 9th to July 28th, 2018. There totally 40 samples, via purposive sampling, each group includes 20 subjects. A 2.5-hour MBSR program was performed for experimental group once a week and lasted for 8 weeks. We also adopted Pittsburgh Sleep Quality Index (PSQI) scale, Chinese14-item Perceived Stress Scale (PSS), Job Satisfaction scale and Chinese Health Questionnaire (CHQ) as research tools. We coded the data and analyzed with SPSS18.0 and Excel for Windows. Paired t-test and analysis of covariance (ANCOVA) were used for data analysis.
Results and Conclusion: After 8 weeks MBSR program, experimental group showed a significant improvement in PSQI and PSS (p＜0.05) between pre-test and post-test. However, the difference between pre- and post-test of control group were not significant (p＞0.05) in both PSQI and PSS. After controlling the pre-test of both groups, the ANCOVA showed that post-tests of experimental group were better than those of control group in both PSQI and PSS (p＜0.01). In conclusion, 8 weeks MBSR program can improve the quality of sleep and Stress of life on emergency medical personnel.

致謝 i
摘要 ii
ABSTRACT iv
目次 vi
表目次 viii
圖目次 ix
第一章 緒 論1
1.1 研究背景1
1.2 研究動機及目的3
第二章 文獻回顧5
2.1 正念減壓（MBSR）定義與發展5
2.2 正念減壓之臨床應用5
2.3 正念減壓之身心效益 8
2.4 緊急醫療救護人員10
2.5 緊急醫療救護人員睡眠品質及身心壓力相關研究14
2.6 睡眠品質16
第三章 研究方法18
3.1研究架構與流程18
3.2 研究對象20
3.3 研究工具20
3.4 正念減壓 (MBSR) 八週課程內容24
3.5 資料處理與分析27
第四章 研究結果28
4.1 兩組研究對象基本資料之同質性分析28
4.2 介入前後各變項之組內差異分析 31
4.3 介入前後各變項之組間差異分析33
4.3.1 介入前兩組間各研究變項之比較33
4.3.2 介入後兩組間各研究變項之比較34
4.4 正念減壓之介入成效36
4.4.1 睡眠品質之共變數分析結果37
4.4.2 壓力知覺之共變數分析結果39
4.4.3 工作滿意度之共變數分析結果41
4.4.4 華人健康之共變數分析結果43
第五章 討論45
5.1 研究對象人口學特質分析45
5.2 緊急醫療救護人員身心壓力與睡眠品質分析 46
5.3 正念減壓對緊急醫療救護人員身心壓力睡眠品質之成效49
第六章 結論與建議54
6.1 結論54
6.2 研究建議55
6.3 未來研究方向56
參考文獻57
後記65
附錄一 研究倫理審查同意證明70
附錄二 研究問卷71
附錄三 八週正念減壓自我練習紀錄表77
表目次
表3-1 八週正念減壓課程內容 26
表4-1 研究對象基本資料 29
表4-2 實驗組各變項之前後測T 檢定結果 ( N=20) 32
表4-3 對照組各變項之前後測T 檢定結果 ( N=20) 32
表4-4 介入前兩組在各研究變項的差異 35
表4-5 介入後兩組在各研究變項的差異 35
表4-6 睡眠品質之組內迴歸係數同質性檢定 38
表4-7 組別在睡眠品質之單因子共變數分析 38
表4-8 兩組研究對象在睡眠品質前後測比較 38
表4-9 壓力知覺量之組內迴歸係數同質性檢定 40
表4-10 組別在壓力知覺量之單因子共變數分析 40
表4-11 兩組研究對象在壓力知覺前後測比較 40
表4-12 工作滿意度之組內迴歸係數同質性檢定 42
表4-13 工作滿意度之單因子共變數分析 42
表4-14 兩組研究對象在工作滿意度前後測比較 42
表4-15 華人健康之組內迴歸係數同質性檢定 44
表4-16 華人健康之單因子共變數分析 44
表4-17 兩組研究對象在華人健康前後測比較 44
圖目次
圖1 研究流程 19

中文部分
王秀禾、葉美玲、鍾聿琳、楊千慧 (2008)。應用耳穴貼壓改善睡眠之成效。實證護理 4(3)， 243-250。
石兆珀 (2012)。提昇消防機關到院前緊急救護品質之研究-以金門縣為例。未出版之碩士論文，國立高雄大學高階經營管理碩士在職專班，高雄市。
李明和 (2011)。影響消防人員睡眠品質之相關因子及解決失眠之對應策略。未出版之碩士論文，南華大學自然醫學研究所，嘉義縣。
初麗娟、高尚仁 (2005)。壓力知覺對負面心理健康影響: 靜坐經驗， 情緒智能調節效果之探討。中華心理學刊，47(2)，157-179。
常佑康、溫宗堃、李嘉富 (2017) 。 正念的醫學應用。臺灣醫界， 60(6)，20-23。
溫宗堃 (2013)。正念減壓的根源與作用機轉: 一個佛教學的觀點。 新世紀宗教研究, 12(2)，27-48。
樊修珊、許承先、余錦美 (2013)。輪班護理人員之睡眠品質及自律神經系統功能。北市醫學雜誌, 10(2)，144-156。
英文部分
Adetona, O., Reinhardt, T. E., Domitrovich, J., Broyles, G., Adetona, A. M., Kleinman, M. T., . . . Naeher, L. P. (2016). Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhal Toxicol, 28(3), 95-139.
Adriaenssens, J., De Gucht, V., Van Der Doef, M., & Maes, S. (2011). Exploring the burden of emergency care: predictors of stress‐health outcomes in emergency nurses. Journal of advanced nursing, 67(6), 1317-1328.
Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research. Int J Nurs Stud, 52(2), 649-661. doi: 10.1016/j.ijnurstu.2014.11.004
Bajaj, J. S., Ellwood, M., Ainger, T., Burroughs, T., Fagan, A., Gavis, E. A., Wade, J. B. (2017). Mindfulness-Based Stress Reduction Therapy Improves Patient and Caregiver-Reported Outcomes in Cirrhosis. Clinical and translational gastroenterology, 8(7), e108.
Bazzano, A., Wolfe, C., Zylowska, L., Wang, S., Schuster, E., Barrett, C., & Lehrer, D. (2015). Mindfulness based stress reduction (MBSR) for parents and caregivers of individuals with developmental disabilities: a community-based approach. Journal of Child and Family Studies, 24(2), 298-308.
Beaton, R. D., & Murphy, S. A. (1993). Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes. Prehospital and Disaster Medicine, 8(2), 140-150.
Bennett, P., Williams, Y., Page, N., Hood, K., Woollard, M., & Vetter, N. (2005). Associations between organizational and incident factors and emotional distress in emergency ambulance personnel. British journal of clinical psychology, 44(2), 215-226.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193-213.
Carlson, S. M., Moses, L. J., & Claxton, L. J. (2004). Individual differences in executive functioning and theory of mind: An investigation of inhibitory control and planning ability. Journal of experimental child psychology, 87(4), 299-319.
Cheng, T. A., Wu, J., Chong, M., & Williams, P. (1990). Internal consistency and factor structure of the Chinese Health Questionnaire. Acta Psychiatrica Scandinavica, 82(4), 304-308.
Chiesa, A., & Malinowski, P. (2011). Mindfulness‐based approaches: are they all the same? Journal of clinical psychology, 67(4), 404-424.
Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. The journal of alternative and complementary medicine, 15(5), 593-600.
Chung, M. H., Chang, F. M., Yang, C. C., Kuo, T. B., & Hsu, N. (2009). Sleep quality and morningness–eveningness of shift nurses. Journal of clinical nursing, 18(2), 279-284.
Duchemin, A.-M., Steinberg, B. A., Marks, D. R., Vanover, K., & Klatt, M. (2015). A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary α-amylase levels. Journal of occupational and environmental medicine/American College of Occupational and Environmental Medicine, 57(4), 393.
Ersser, S., Wiles, A., Taylor, H., Wade, S., Walsh, R., & Bentley, T. (1999). The sleep of older people in hospital and nursing homes. Journal of clinical nursing, 8(4), 360-368.
Fox, K. C., Nijeboer, S., Dixon, M. L., Floman, J. L., Ellamil, M., Rumak, S. P., . . . Christoff, K. (2014). Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neuroscience & Biobehavioral Reviews, 43, 48-73.
Goldhagen, B. E., Kingsolver, K., Stinnett, S. S., & Rosdahl, J. A. (2015). Stress and burnout in residents: impact of mindfulness-based resilience training. Advances in medical education and practice, 6, 525.
Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and improves well-being among healthcare providers. The International Journal of Psychiatry in Medicine, 43(2), 119-128.
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of psychosomatic research, 57(1), 35-43.
Hom, M. A., Stanley, I. H., Rogers, M. L., Tzoneva, M., Bernert, R. A., & Joiner, T. E. (2016). The association between sleep disturbances and depression among firefighters: emotion dysregulation as an explanatory factor. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 12(2), 235.
Hughes, R. G., & Rogers, A. E. (2004). Are You Tired?: Sleep deprivation compromises nurses’ health—and jeopardizes patients. AJN The American Journal of Nursing, 104(3), 36-38.
Hutchinson, T. A., & Dobkin, P. L. (2009). Mindful medical practice: just another fad? Canadian Family Physician, 55(8), 778-779.
Jahnke, S. A., Poston, W. S. C., Haddock, C. K., & Murphy, B. (2016). Firefighting and mental health: Experiences of repeated exposure to trauma. Work, 53(4), 737-744.
Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice, 10(2), 144-156.
Kurdyak, P., Newman, A., & Segal, Z. (2014). Impact of mindfulness-based cognitive therapy on health care utilization: a population-based controlled comparison. Journal of psychosomatic research, 77(2), 85-89.
Lan, H. K., Subramanian, P., Rahmat, N., & Kar, P. C. (2014). The effects of mindfulness training program on reducing stress and promoting well-being among nurses in critical care units. Australian Journal of Advanced Nursing, The, 31(3), 22.
Lao, S.-A., Kissane, D., & Meadows, G. (2016). Cognitive effects of MBSR/MBCT: a systematic review of neuropsychological outcomes. Consciousness and cognition, 45, 109-123.
Leggett, A., Burgard, S., & Zivin, K. (2015). The impact of sleep disturbance on the association between stressful life events and depressive symptoms. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(1), 118-128.
Ludwig, D. S., & Kabat-Zinn, J. (2008). Mindfulness in medicine. Jama, 300(11), 1350-1352.
Luken, M., & Sammons, A. (2016). Systematic review of mindfulness practice for reducing job burnout. American Journal of Occupational Therapy, 70(2), 7002250020p7002250021-7002250020p7002250010.
Mackenzie, C. S., Poulin, P. A., & Seidman-Carlson, R. (2006). A brief mindfulness-based stress reduction intervention for nurses and nurse aides. Applied Nursing Research, 19(2), 105-109.
Marconato, R. S., & Monteiro, M. I. (2015). Pain, health perception and sleep: impact on the quality of life of firefighters/rescue professionals. Revista latino-americana de enfermagem, 23(6), 991-999.
Matchim, Y., Armer, J. M., & Stewart, B. R. (2011). Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. Western Journal of Nursing Research, 33(8), 996-1016.
Milen, D. (2009). The ability of firefighting personnel to cope with stress. Journal of Social Change, 3(1), 2.
Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical psychology review, 31(6), 1032-1040.
Schutte, N. S., & Malouff, J. M. (2014). A meta-analytic review of the effects of mindfulness meditation on telomerase activity. Psychoneuroendocrinology, 42, 45-48.
Smith, J. E., Richardson, J., Hoffman, C., & Pilkington, K. (2005). Mindfulness‐Based Stress Reduction as supportive therapy in cancer care: systematic review. Journal of advanced nursing, 52(3), 315-327.
Spenceley, S. M. (1993). Sleep inquiry: a look with fresh eyes. Journal of Nursing Scholarship, 25(3), 249-256.
Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PLoS One, 9(4), e96110.
Teasdale, J. D., & Chaskalson, M. (2011). How does mindfulness transform suffering? I: the nature and origins of dukkha. Contemporary Buddhism, 12(01), 89-102.
Tenkanen, L., Sjöblom, T., Kalimo, R., Alikoski, T., & Härmä, M. (1997). Shift work, occupation and coronary heart disease over 6 years of follow-up in the Helsinki Heart Study. Scandinavian journal of work, environment & health, 257-265.
Vargas de Barros, V., Martins, L. F., Saitz, R., Bastos, R. R., & Ronzani, T. M. (2013). Mental health conditions, individual and job characteristics and sleep disturbances among firefighters. Journal of health psychology, 18(3), 350-358.
Westphal, M., Bingisser, M.-B., Feng, T., Wall, M., Blakley, E., Bingisser, R., & Kleim, B. (2015). Protective benefits of mindfulness in emergency room personnel. Journal of affective disorders, 175, 79-85.
Whitebird, R. R., Asche, S. E., Thompson, G. L., Rossom, R., & Heinrich, R. (2013). Stress, burnout, compassion fatigue, and mental health in hospice workers in Minnesota. Journal of palliative medicine, 16(12), 1534-1539.
Williams, H., Simmons, L. A., & Tanabe, P. (2015). Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control. J Holist Nurs, 33(3), 247-259. doi:10.1177/0898010115569349
Wilson, J. L. (2002). The impact of shift patterns on healthcare professionals. Journal of Nursing Management, 10(4), 211-219.
Witek-Janusek, L., Albuquerque, K., Chroniak, K. R., Chroniak, C., Durazo-Arvizu, R., & Mathews, H. L. (2008). Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, behavior, and immunity, 22(6), 969-981.