| Abstract: | 不孕及治療本身均給不孕婦女帶來身心社會壓力與困擾，是一生活危機事件。此身心社會壓力與困擾會隨著治療過程、時間長短、及懷孕結果而改變。本研究的目的為評估在不同治療階段，包括決定接受生殖科技治療時、治療中胚胎植入時、等待驗孕階段、獲知懷孕結果後一星期及獲知懷孕結果後後二個月等階段，運用危機處置護理模式對不孕婦女的身心社會壓力反應之改善情形。本研究擬採類實驗研究法，樣本選自中部某不孕症研究中心，以正在接受試管嬰兒治療之不孕婦女為研究對象；隨機分為實驗組及對照組二組。實驗組（n=29）在第一次收集資料後施以危機處置護理模式介入方案，此方案內容包括媒體治療過程認知介紹、自我暗示及肌肉放鬆技巧訓練、情緒－行為－認知反應諮商輔導，對照組（n=38）不予此模式之介入，比較二組個案在不同治療階段身心社會壓力反應的差異。研究結果顯示兩組婦女除家庭收入外，在年齡、教育程度、社經階層、不孕時間、不孕原因、接受生殖科技治療次數及傳統生育觀念等基本資料沒有顯著差異。評估護理介入措施之成效，實驗組（n=27）及對照組（n=27）婦女在胚胎植入時於自我心像/自尊、罪惡感/責難、性問題、人際關係、情境焦慮、特質焦慮、憂鬱、JCS調適量表之情緒調整導向及問題解決導向等心理社會反應平均得分之變化量並無統計學上之顯著差異（p>0.05）﹔在等待驗孕階段，實驗組（n=26）於自我心像╱自尊反應平均得分之變化量顯著低於對照組（n=22）（p<0.05）；在獲知結果後一週階段，懷孕失敗之實驗組（n=14）其人際關係反應及情緒導向調適反應平均得分之變化量顯著低於對照組（n=13）（p<0.05）；懷孕成功之實驗組（n=7）與對照組（n=10）於各項身心社會反應平均得分之變化量均無顯著差異（p>0.05）；在獲知結果後二個月階段，懷孕失敗之實驗組（n=8）其特質焦慮反應及情緒導向調適反應平均得分之變化量顯著低於對照組（n=9）（p<0.05）；懷孕成功之實驗組（n=9）與對照組（n=4）於各項身心社會反應平均得分之變化量均無顯著差異（p>0.05）。
Infertility and its treatment bring infertile women with quite a lot psychosocial distress and disturbance, which being considered as a life crisis event. Those bothers could be changed according to the process of treatment, duration of treatment, or outcome of treatment. The purpose of this study is to evaluate the effects of crisis intervention nursing model used for infertile women attending assisted reproductive technique program in the following 5 stages: being decided to receive treatment, performing embryo transfer before, waiting for results of treatment, and 1 week and 2 months after the finish of treatment course. Using quasi-experimental study design, sample will be collected from a infertility center in the middle Taiwan, who attend the assisted reproductive technique program. Samples will be randomly divided into experimental group with nursing intervention and control group. Statistical analysis shows there were no significance in demographic data except income between these two groups. In performing embryo transfer stage, the change of mean scores on psychosocial distress include body image/self esteem, guilty/blame, sexual problem, interpersonal relationship, state anxiety, trait anxiety, depression, Jalowiec coping scale (emotion oriented and problem oriented) in experimental group (n=27) showed no significantly difference when compared to control group (n=27). In the stage of waiting for result of treatment, the change of mean scores in body image/self-esteem for experimental group (n=26) is significantly lower than that of control group (n=22) (p<0.05). During one week after knowing the result of treatment, in experimental group who failed to be pregnancy (n=14) had a significantly lower change of mean scores in interpersonal relationship and emotion-oriented adaptation than that of control group (n=13) (p<0.05). During two months after knowing the result of treatment, in experimental group who failed to be pregnancy (n=8) had a significantly lower change of mean scores in trait anxiety and emotion-oriented adaptation than that of control group (n=9) (p<0.05). There was no significant difference (p>0.05) in all psychosocial responses between while those who were pregnant in experimental group and control group. The results of this study could be of reference for health professionals involving in infertility care through understanding of subjects' continuing changes in psychosocial responses and through providing adequate nursing intervention to adjust related crisis. |
