| 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、胚胎植入、等待驗孕、獲知懷孕結果後一星期及獲知懷孕結果後二個月等階段，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=64 ）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=68 ）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，在年齡、教育程度、家庭收入、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=64 ）及對照組（n=68 ）婦女在胚胎植入階段於各項身心社會壓力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=64 ）於人際關係壓力反應平均得分之變化量顯著低於對照組（n=68 ）（p<0.05 ）；在獲知結果後一週階段，實驗組中懷孕失敗者（n=30 ）其身體症狀數目及人際關係壓力反應平均得分之變化量顯著低於對照組中懷孕失敗者（n=41 ）（p<0.05 ）；實驗組中懷孕成功者（n=34 ）其隔離心思/緩和身體之因應方式平均得分之變化量顯著高於對照組中懷孕成功者（n=26 ）（p<0.05 ）；在獲知結果後二個月階段，實驗組中懷孕失敗者（n=25 ）其人際關係壓力反應平均得分之變化量顯著低於對照組中懷孕失敗者（n=38 ）（p<0.05 ）；實驗組中懷孕成功者（n=39 ）其特質焦慮壓力反應平均得分之變化量顯著低於對照組中懷孕成功者（n=30 ），隔離心思/緩和身體之因應方式平均得分之變化量顯著高於對照組中懷孕成功者（p<0.05 ）。研究結果顯示，危機處置護理模式對於接受試管嬰兒治療的不孕婦女在不同治療階段之壓力反應有部分改善，其成效可應用於護理實務上。關鍵詞：不孕症、試管嬰兒治療、身心社會壓力反應、護理措施
Infertility and its treatment bring infertile women with quite a lot psychosocial distress and disturbances, which are ever 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, waiting for result of treatment, and 1 week and 2 months after the ending of treatment course. Using quasi-experimental study design, sample was collected from a infertility center in the middle Taiwan, who attended the assisted reproductive technique program. Subjects were randomly divided into experimental group with nursing intervention and control group. Statistical analysis shows that there were no significance in demographic data and psychosocial distress of initiate survey between these two groups. In performing embryo transfer stage, the change of mean scores on psychosocial distress include physical discomforts, body image/self esteem, guilty/blame, sexual problem, interpersonal relationship, state anxiety, trait anxiety, depression, Jalowiec coping scale (confronted, emotional, isolated/palliative, anxious/ seek for support coping styles) had no significant difference between experimental and control group （n=68 ）. In the stage of waiting for result of treatment, the change of mean scores in interpersonal relationship for experimental group （n=64 ） is significantly lower than that of control group （n=68 ）（p<0.05 ）. During one week after knowing the result of treatment, in experimental group who failed to be pregnancy （n=30 ）had a significantly lower of mean scores in physical discomforts and interpersonal relationship （n=41 ）（p<0.05 ）. In experimental group （n=34 ）who succeeded to be pregnancy had a significantly higher mean scores in using isolative/palliative coping style than that of control group （n=26 ）（p<0.05 ）. During two months after knowing the result of treatment, in experimental group who failed to be pregnancy （n=25 ）had a significantly lower change of mean scores in interpersonal relationship than that of control group （n=38 ）. In experimental group （n=39 ） who succeeded to be pregnancy had a significantly lower change of mean scores in trait anxiety and had a significantly higher change of mean scores in using isolative/palliative coping style than those of control group （n=30 ）（p<0.05 ）. The results of this study indicate that crisis intervention nursing model could be of help 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. |
