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    Title: 初產婦懷孕期間及產後骨盆底肌肉運動之介入成效
    Effect of pelvic muscle exercise in primiparas during pregnancy and postpartum
    Authors: 曾紀萌
    Chi-Meng Tseng
    Contributors: 中山醫學大學:護理學院;護理研究所;李淑杏
    Keywords: 下泌尿道症狀;初產婦;骨盆底肌肉張力;骨盆底肌肉運動
    lower urinary tract symptoms;primiparas;pelvic floor muscle exercise;pelvic floor muscle strength
    Date: 2006/07/25
    Issue Date: 2010-10-20T07:11:20Z (UTC)
    Abstract: 本研究目的在探討醫院護理管理者工作壓力及壓力因應策略現況,並進一步分析不同背景屬性之護理管理者對於工作壓力及壓力因應策略影響。本研究採橫斷式調查法,以中部地區之醫學中心及區域醫院共275位護理管理者為研究對象,包括護理部主任、副主任、督導長、護理長及副護理長。研究工具以結構式問卷調查,包括個人背景屬性資料調查表、工作壓力來源量表及工作壓力因應策略量表。研究資料以描述性統計、單一樣本t檢定及單因子變異數分析進行資料分析。研究結果發現:(一)護理管理者在工作壓力四個構面中平均得分(最高5分,最低1分)最高為工作負荷(3.42),其次為專業知能(2.83)、角色壓力(2.51),以人際關係(2.13)平均得分為最低﹔(二)護理管理者工作壓力與年齡、學歷、任職醫院性質、護理工作總年資及擔任護理行政年資有顯著性差異,與婚姻、工作職稱、是否在職進修則無顯著性差異;(三)護理管理者壓力因應策略四個構面中(最高5分,最低1分)以理性思考平均得分最高(4.13),其次為問題解決(3.95)、尋求支持(3.70),以情緒調適得分最低(3.15);(四)護理管理者工作壓力因應策略與學歷、工作職稱有顯著性差異,與年齡、婚姻、任職醫院性質、是否在職進修、工作總年資及行政工作年資則無顯著性差異。藉此研本研究的目的在探討影響醫院門診吸菸者之拒菸自我效能、健康信念、菸害知識之因子及三者之間的關係,本研究為橫斷式研究設計,以中部某醫學中心來門診就醫之吸菸病患或家屬為收案對象,於民國95年3月至4月共收集156位個案。研究方法採立意取樣,研究工具為結構式問卷,內容包括:吸菸者個人基本屬性、尼古丁成癮情形、菸害知識、健康信念、戒菸意願、拒菸自我效能等六部份,由個案自填方式收集資料。依研究目的及變項性質,選擇統計方法包括頻率、百分比、平均值、標準差、t-test、one-way ANOVA、卡方檢定、皮爾森積差相關分析等進行統計分析。
    本研究的結果發現(一)菸害知識會因年齡、職業、教育程度而有差異。菸害知識得分與建康信念總平均相比較呈正相關。(二)健康信念會因個案年齡、職業、教育程度、菸齡而有影響。「健康信念總平均」與「罹患性認知」、「嚴重性認知」、「不吸菸的自覺利益性」與教育程度呈現正相關,即教育程度越高建康信念越好。(三)吸菸者尼古丁成癮情形越低拒菸自我效能越強(四)戒菸意願與拒菸自我效能有相關,即有戒菸意願者其拒菸自我效能較高。(五)有戒菸意願之研究對象所採的戒菸行動計畫以「意志力」最多,其次是「家人協助」,佔第三位者為採「戒菸專線」。
    本研究目的在探討懷孕期間及產後,骨盆底肌肉運動衛教措施對初產婦下泌尿道症狀及骨盆底肌肉張力之介入成效。採準實驗性研究法,研究對象為中部某醫學中心婦產科門診、產房之初產婦,收案期間於民國95年1月至95年5月間,個案分實驗與控制兩組,組別分派以星期為區段交替收案,總計收案數103人。研究個案於產前32週時,填答本研究下泌尿道症狀之問卷並接受會陰壓力器測量其陰道內肌肉收縮之壓力,實驗組個案予以護理衛教介入有關促進骨盆底肌肉張力知識,並藉由會陰壓力器輔助教導其骨盆底肌肉運動,其後於第38週及產後6週亦如前再次測量,其間研究者對實驗組個案每週以電話追蹤其執行情況。控制組以常規照顧模式,分別於32、38週及產後6週予問卷填答及測量其骨盆底肌肉收縮之壓力。資料收集經編碼,以SPSS套裝軟體進行統計分析,資料呈現採百分比、平均數、標準差、t檢定、配對t檢定及McNemar檢定。
    結果顯示:初產婦於懷孕32週時,其下泌尿道症狀盛行率前三項分別為夜尿(91.3%)、下腹酸痛(66.0%)、下腹部下墜感(62.1%),後三項分別為大便失禁(0.0%)、尿床(1.0%)、漏尿(5.8%),而尿失禁為38.8%,下泌尿道症狀之盛行率會隨著懷孕週數增加而上升,產後隨之下降。骨盆底肌肉運動介入後,以階段來看實驗組比控制組在懷孕38週至產後6週其陰道壓力之改變情形,達顯著差異。
    而實驗組比控制組在懷孕38週至產後6週其下泌尿道症狀發生次數之改變情形,並未達顯著差異。
    本實驗能提供以實證基礎之護理介入措施提升照護品質,可提供護理人員臨床照護依據。
    The aim of the research is to identify the effect of pelvic muscle exercise program in primiparas during pregnancy and postpartum .This Random control trial collected a total of 103 primiparous women from a medical center hospital OPD. DR from January,5, 2006 to May,30, 2006. Sample women were divided into study group and control group. After completing informed, all of both groups will be asked to answer the questionnaire about symptoms of lower urinary tract and tested vaginal pressure by peritron. In addition the women of study group were instructed the pelvic muscle excise program in OPD and asked to perform the experienced exercise for 60-180 times per day after go home. The control group received routine care. Both group women received internal vaginal pressure and pelvic muscle strength measurement at the 32th weeks、38th weeks of pregnancy and 6 weeks after delivery, respectively. Data will be collected coded and processed with SPSS 13.0 statistical package software. Statistical analysis include mean ±SD、percentage distribution、t-test、paired t-test and McNemar test. The results show that primiparas women at 32 weeks, the first three item rank of the prevalence of lower urinary tract symptoms were : nocturia(91.3%)、soreness(66.0%)、abdominal pressure(62.1%) and the last three item rank were fecal incontinence(0.0%)、noctural enuresis(1.0%)、unconscious incontinence(5.8%) , but urine incontinence was (38.8%). The prevalence of lower urinary tract symptoms increased with gestational weeks and decreased postpartum.
    After intervention, there was significant difference in vaginal pressure during postpartum between experimental and control groups. The differences in frequency of lower urinary tract symptoms didn’t reach statistically significant between experimental and control groups. The results of this study provided nursing staff with evidence based nursing intervention which could be of help in promotion of the quality of nursing care.
    URI: https://ir.csmu.edu.tw:8080/handle/310902500/2525
    Appears in Collections:[護理學系暨碩士班] 博碩士論文

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