不論是源自於疾病或是手術後所造成的疼痛，外科系的患者大都會被一定程度的疼痛所困擾，如果疼痛沒有得到妥善而適當的緩解，會對患者造成身理及心理上極大的傷害，甚至影響到預後；反觀若能在疼痛刺激程度提升前，就給予止痛劑預防疼痛的發生，其效果遠超過疼痛已經發生之後才來亡羊補牢。故本研究的目的在於：希望能在術前使用合理的人力及時間，掌握病患對疼痛的耐受度，以便於術後能立即投與適當劑量的止痛劑，讓病患免於遭受疼痛的折磨；更期望藉由有效地止痛，讓病患對醫療品質的滿意度有所提升。
本研究依據古典實驗原則，針對南部某地區醫院的痔瘡手術病患進行收案研究，分成實驗組與對照組共75個有效樣本；實驗組接受客製化止痛術後照護，對照組則接受一般常規性止痛術後照護，並於出院當日收集病患滿意度調查表。研究工具包括：『視覺類比量表』（VAS：Visual Analogue Scale）以及『壓力痛覺閥值測量儀』（PThM：Pressure Threshold Meter）以及病患滿意度調查表。統計方式則採用卡方檢定與獨立T檢定來檢視兩組間樣本之基本特性，針對滿意度調查表則以無母數（Nonparametric method）的Mann-Whitney-Wilcoxon test（MWW）來說明兩組之間的滿意度表現是否存在顯著差異。
研究結果顯示，實驗組所接受的客製化止痛術後照護的止痛效果的確明顯優於對照組的一般常規性止痛術後照護，同時也提升了實驗組對醫師醫療專業技術的滿意度，但是對於整體的滿意度卻沒有顯著差異。
本研究證實了客製化止痛術後照護可以更有效地阻止術後疼痛的發生；但若想要提升整體的病患滿意度，則需全方位品質提昇，而非單單只有專業醫療品質提升就可辦到。

Patients experience some degree of pain accompanying all surgical procedures. If this pain is not adequately treated, it will cause severe physiological and psychological damage. It will even affect patients' postoperative recovery. However, if preemptive analgesia is administered before noxious stimuli arise, rather than afterwards, it is significantly more effective.
The purpose of this study is to recognize that reasonable effort and time should be spent to determine a patient's tolerance level towards pain before surgery. Then, the appropriate dosage of analgesia can be given immediately after surgery to alleviate pain. By administering effective pain relief, it will improve patient’s satisfaction with medical services.
Using classic experimental design (which consists of an experimental group and a control group), this study focuses on cases of patients who had hemorrhoid surgery in a certain hospital in southern Taiwan. The experimental group and the control group consist of a total of 75 valid samples. The experimental group received customizing analgesic postoperative care, while the control group received conventional analgesic postoperative care. Patient’s satisfaction questionnaires were gathered from patients on the day they were discharged from the hospital. Instruments used in the experiment include VAS, PThM, and patient’s satisfaction questionnaires.To examine the basic characteristics of the samples in both the experimental group and the control group, two statistical methods, Chi-square test and independent T test, were adopted. For patient’s satisfaction questionnaires, Mann-Whitney-Wilcoxon test of nonparametric method was adopted to examine if obvious differences in satisfaction levels existed between the two groups.
The result of the experiment shows the analgesic effect from customizing analgesic postoperative care is far better than conventional care. The patient’s satisfaction toward the doctor's professional skill was higher as well. On the other hand, the patient’s satisfaction level toward the whole medical process had no obvious improvement.
This study proves that customizing analgesic postoperative care can effectively prevent postoperative pain from occurring. However, to raise patient’s satisfaction towards the whole medical process, better professional medical skill is required as well as improved medical services.

論文審定書 I
致 謝 II
中文摘要 III
Abstracts IV
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 病患滿意度 4
第二節 術後疼痛 6
第三節 影響術後止痛照護成敗的因素 9
第四節 增加術後止痛照護成功率的方式 12
第五節 總結 15
第三章 研究方法 16
第一節 研究流程 16
第二節 研究架構及假設 17
第三節 研究對象與場所 18
第四節 研究設計與變項 19
第五節 研究評量工具 21
第六節 研究進行步驟 24
第七節 資料分析 25
第四章 研究結果 26
第一節 資料整理 26
第二節 敘述性統計 27
第三節 術後止痛照護方式對滿意度的影響 38
第四節 教育程度對滿意度的影響 44
第五節 依據教育程度調整後的滿意度 53

第五章 討論與建議 60
第一節 結果探討 60
第二節 研究貢獻 63
第三節 研究限制 65
第四節 建議 66
文 獻 參 考 67
附錄一 疼痛評估表 73
附錄二 住院滿意度調查表 74
附錄三 滿意度問卷之專家效度審閱名單 78
附錄四 研究同意書 79

王忠訓、周毅鵬、侯清正、李繼源、林炳煌、嚴復華（1991）胸腔切開術後病人自行控制與傳統止痛方式之比較。麻醉醫學雜誌。29（2），604-609。
何菊修、陳宗鷹（2005）急性術後疼痛。慈濟醫學。17（6），43-50。
李梅琛、賴裕和、陳美伶、劉淑娟（2001）病人疼痛特質與疼痛信念對手術後使用止痛藥物之影響。護理雜誌。48（1），49-57。
陳黛那（1997）產科醫護人員與病人滿意度研究----以某醫學中心為例。國立台灣大學醫學管理研究所碩士論文。
陳淑如、林佳靜、鄭綺、何善台（1998）探討手術後病人對疼痛護理及疼痛控制的滿意度及其影響因素。護理研究。6（6），475-487。
賀姝霞、尹祚芊（1988）探討護理人員減輕手術後病人疼痛之處理及其影響因素。護理雜誌。35（2），25-46。
曹麗英（1983）手術後24小時內病人接受護士給予酌情需要（prn）注射止痛劑-Demerol情況之探討。護理雜誌。30（3），81-92。
賴志冠（1999）類鴉片鎮痛藥之合理使用。臨床醫學。43（1），33-39。
盧德發（2003）美國健康照護與研究癌症疼痛管理守則之政策分析。慈濟護理雜誌。2（1），27-33。
蘇武龍（1999）住院服務品質與病患滿意度之探討--以成大、奇美醫院為例。國立成功大學工業管理研究所碩士論文。

Bader, M. M. (1988). Nursing care behaviors that predict patient satisfaction. Journal of Nursing Quality Assurance, 2(3), 11-17.
Beauregard, L., Pomp, A., & Choiniere, M. (1998). Severity and impact of pain after day-surgery. Canadian Journal of Anaesthesia = Journal Canadien d'Anesthesie, 45(4), 304-311.
Berde, C. B., Lehn, B. M., Yee, J. D., Sethna, N. F., & Russo, D. (1991). Patient-controlled analgesia in children and adolescents: A randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia. The Journal of Pediatrics, 118(3), 460-466.
Bingle, G. J., O'Connor, T. P., Evans, W. O., & Detamore, S. (1991). The effect of 'detailing' on physicians' prescribing behavior for postsurgical narcotic analgesia. Pain, 45(2), 171-173.
Bray, C. A. (1986). Postoperative pain. altering the patient's experience through education. AORN Journal, 43(3), 672, 674-7, 679-83.
Breivik, H. (1998). Postoperative pain management: Why is it difficult to show that it improves outcome? European Journal of Anaesthesiology, 15(6), 748-751.
Brody, D. S., Miller, S. M., Lerman, C. E., Smith, D. G., Lazaro, C. G., & Blum, M. J. (1989). The relationship between patients' satisfaction with their physicians and perceptions about interventions they desired and received. Medical Care, 27(11), 1027-1035.
Brown, A. K., Christo, P. J., & Wu, C. L. (2004). Strategies for postoperative pain management. Best Practice & Research.Clinical Anaesthesiology, 18(4), 703-717.
Carr, D. B., & Goudas, L. C. (1999). Acute pain. Lancet, 353(9169), 2051-2058.
Carr, E. (2007). Barriers to effective pain management. Journal of Perioperative Practice, 17(5), 200-3, 206-8.
Carr, E. C. (1990). Postoperative pain: Patients' expectations and experiences. Journal of Advanced Nursing, 15(1), 89-100.
Carr, E. C., & Thomas, V. J. (1997a). Anticipating and experiencing post-operative pain: The patients' perspective. Journal of Clinical Nursing, 6(3), 191-201.
Carr, E. C., & Thomas, V. J. (1997b). Anticipating and experiencing post-operative pain: The patients' perspective. Journal of Clinical Nursing, 6(3), 191-201.
Chang, A. M., Ip, W. Y., & Cheung, T. H. (2004). Patient-controlled analgesia versus conventional intramuscular injection: A cost effectiveness analysis. Journal of Advanced Nursing, 46(5), 531-541.
Choiniere, M., Rittenhouse, B. E., Perreault, S., Chartrand, D., Rousseau, P., Smith, B., et al. (1998). Efficacy and costs of patient-controlled analgesia versus regularly administered intramuscular opioid therapy. Anesthesiology, 89(6), 1377-1388.
Chumbley, G. M., Hall, G. M., & Salmon, P. (1998). Patient-controlled analgesia: An assessment by 200 patients. Anaesthesia, 53(3), 216-221.
Cohen, F. L. (1980). Postsurgical pain relief: Patients' status and nurses' medication choices. Pain, 9(2), 265-274.
Collin, E., Poulain, P., Gauvain-Piquard, A., Petit, G., & Pichard-Leandri, E. (1993). Is disease progression the major factor in morphine 'tolerance' in cancer pain treatment? Pain, 55(3), 319-326.
Devine, E. C., Bevsek, S. A., Brubakken, K., Johnson, B. P., Ryan, P., Sliefert, M. K., et al. (1999). AHCPR clinical practice guideline on surgical pain management: Adoption and outcomes. Research in Nursing & Health, 22(2), 119-130.
Dietrick-Gallagher, M., Polomano, R., & Carrick, L. (1994). Pain as a quality management initiative. Journal of Nursing Care Quality, 9(1), 30-42.
Donovan, M., Dillon, P., & McGuire, L. (1987). Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain, 30(1), 69-78.
Eisenach, J. C., Grice, S. C., & Dewan, D. M. (1988). Patient-controlled analgesia following cesarean section: A comparison with epidural and intramuscular narcotics. Anesthesiology, 68(3), 444-448.
Harmer, M., & Davies, K. A. (1998). The effect of education, assessment and a standardised prescription on postoperative pain management. the value of clinical audit in the establishment of acute pain services. Anaesthesia, 53(5), 424-430.
John, J. (1992). Patient satisfaction: The impact of past experience. Journal of Health Care Marketing, 12(3), 56-64.
Kehlet, H. (1997). Multimodal approach to control postoperative pathophysiology and rehabilitation. British Journal of Anaesthesia, 78(5), 606-617.
Kiecolt-Glaser, J. K., Marucha, P. T., Malarkey, W. B., Mercado, A. M., & Glaser, R. (1995). Slowing of wound healing by psychological stress. Lancet, 346(8984), 1194-1196.
Kluger, M. T., & Owen, H. (1990). Patients' expectations of patient-controlled analgesia. Anaesthesia, 45(12), 1072-1074.
Koh, P., & Thomas, V. J. (1994). Patient-controlled analgesia (PCA): Does time saved by PCA improve patient satisfaction with nursing care? Journal of Advanced Nursing, 20(1), 61-70.
Kuhn, S., Cooke, K., Collins, M., Jones, J. M., & Mucklow, J. C. (1990). Perceptions of pain relief after surgery. BMJ (Clinical Research Ed.), 300(6741), 1687-1690.
Layzell, M. (2008). Current interventions and approaches to postoperative pain management. British Journal of Nursing (Mark Allen Publishing), 17(7), 414-419.
Linder-Pelz, S. U. (1982). Toward a theory of patient satisfaction. Social Science & Medicine (1982), 16(5), 577-582.
Oates, J. D., Snowdon, S. L., & Jayson, D. W. (1994). Failure of pain relief after surgery. attitudes of ward staff and patients to postoperative analgesia. Anaesthesia, 49(9), 755-758.
Owen, H., McMillan, V., & Rogowski, D. (1990). Postoperative pain therapy: A survey of patients' expectations and their experiences. Pain, 41(3), 303-307.
Polomano, R. C., Rathmell, J. P., Krenzischek, D. A., & Dunwoody, C. J. (2008). Emerging trends and new approaches to acute pain management. Journal of Perianesthesia Nursing : Official Journal of the American Society of PeriAnesthesia Nurses / American Society of PeriAnesthesia Nurses, 23(1 Suppl), S43-53.
Risser, N. L. (1975). Development of an instrument to measure patient satisfaction with nurses and nursing care in primary care settings. Nursing Research, 24(1), 45-52.
Rosen, D. M., Lam, A. M., Carlton, M. A., Cario, G. M., & McBride, L. (1998). Analgesia following major gynecological laparoscopic surgery--PCA versus intermittent intramuscular injection. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, 2(1), 25-29.
Rowlingson, J. C. (2001). How can local anesthetic in the wound not help? Anesthesia and Analgesia, 92(1), 3-4.
Sjoling, M., Nordahl, G., Olofsson, N., & Asplund, K. (2003). The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Patient Education and Counseling, 51(2), 169-176.
Snell, C. C., Fothergill-Bourbonnais, F., & Durocher-Hendriks, S. (1997). Patient controlled analgesia and intramuscular injections: A comparisons of patient pain experiences and postoperative outcomes. Journal of Advanced Nursing, 25(4), 681-690.
Vaughn, F., Wichowski, H., & Bosworth, G. (2007). Does preoperative anxiety level predict postoperative pain? AORN Journal, 85(3), 589-604.
Ward, S. E., & Gordon, D. B. (1996). Patient satisfaction and pain severity as outcomes in pain management: A longitudinal view of one setting's experience. Journal of Pain and Symptom Management, 11(4), 242-251.

Watt-Watson, J., Stevens, B., Garfinkel, P., Streiner, D., & Gallop, R. (2001). Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients. Journal of Advanced Nursing, 36(4), 535-545.
Watt-Watson, J., Stevens, B., Katz, J., Costello, J., Reid, G. J., & David, T. (2004). Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery. Pain, 109(1-2), 73-85.
Weis, O. F., Sriwatanakul, K., Alloza, J. L., Weintraub, M., & Lasagna, L. (1983). Attitudes of patients, housestaff, and nurses toward postoperative analgesic care. Anesthesia and Analgesia, 62(1), 70-74.
White, C. L. (1999). Changing pain management practice and impacting on patient outcomes. Clinical Nurse Specialist CNS, 13(4), 166-172.
Yates, P., Dewar, A., Edwards, H., Fentiman, B., Najman, J., Nash, R., et al. (1998). The prevalence and perception of pain amongst hospital in-patients. Journal of Clinical Nursing, 7(6), 521-530.
Zimberg, S. E. (2003). Reducing pain and costs with innovative postoperative pain management. Managed Care Quarterly, 11(1), 34-36.