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博碩士論文 etd-1207106-122703 詳細資訊
Title page for etd-1207106-122703
論文名稱
Title
探討疼痛測量的在職教育與制度化對改善 護理人員癌症疼痛測量之成效
Effect of Nurses’continuing Education and Institutionalizations on Their Cancer Pain Assessment
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
81
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2006-09-27
繳交日期
Date of Submission
2006-12-07
關鍵字
Keywords
癌症疼痛、疼痛測量、在職教育、制度化
cancer pain, pain assessment, continuing education, institutionalization
統計
Statistics
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The thesis/dissertation has been browsed 5671 times, has been downloaded 9898 times.
中文摘要
於積極抗腫瘤治療期間,有30%-50%癌症病人有疼痛的經驗,而在侵襲性癌的病人中,高達60-90%的病人有疼痛問題。不適當的疼痛測量是用藥不足的根本原因之一。因此,本研究的目的是在評值實施在職教育與制度化後,對護理人員癌症疼痛測量之成效。於三個不同階段各57組(課程前、課程後與制度化後),共171組採病人-護理人員配對,並藉由結構式問卷訪談。這171位病人出院後,則進行病歷審閱。資料分析以卡方檢定、ANOVA檢定及事後多重比較,進行統計分析。研究結果顯示:在職教育僅在病人主動向醫護人員報告疼痛,有統計上顯著的改善。另外,制度化後,護理人員與病人痛分差距(取絕對值)疼痛最輕微、可接受的疼痛及疼痛評估紀錄有顯著的改善。結論:在職教育和制度化是兩個不同領域的癌症疼痛處置對改善癌症疼痛測量是有效的,在職教育對病人的疼痛程度和滿意度有改善,而制度化則對護理人員癌症疼痛測量的臨床實務有改善。建議:因品質結果來自於過程的改善,而不是結果的評值。護理部須持續監測「疼痛控制品質」,因良好的品質管理繫於良好的高階管理者,各護理長亦可制定單位病歷審查機制,與病歷書寫優良獎賞,因堅信品質改進工作永無休止,可再進一步研究分析制度化後五年之比較。
Abstract
Pain is experienced in 30-50% of cancer patients during active antineoplastic
therapy and in 60-90% of patients with advanced cancer. One of the root causes for inadequate medication is inadequate pain assessment. Therefore, a hospital-based quasi-experimental study was implemented to evaluate the effect of a continuing education and institutionalization program(CEI)on nurses’ cancer pain assessment. There were 57 frequency-matched patient-nurse dyads were interviewed by the structured questionnaire at three different stages (pre-test, post-continuing education and post- institutionalization ). After these 171 patients were discharged, their charts were reviewed and abstracted. Chi-square test and ANOVA were used in the statistical analysis. The results showed that CE only made statistically significant improvement on patients’ pain impact of relationship, pain impact of sleep, satisfaction, and hesitancy to report pain. Additionally, institutionalization made significant improvement on patient’s now pain and average pain severity, nurses’ accurate assessment of patient’s pain ratings of mild pain and expected pain, and documentation of pain assessment. In conclusion, CE and institutionalization of cancer pain assessment were effective in cancer pain management in two different fields, one was the improvement of patient’ pain severity and satisfaction and the other was the improvement of nurse’s practices of cancer pain assessment. Quality comes from improving the process , not evaluating the output after fact. The suggestion was that the head nurse of the ward audited actively on unit and rewards for chart documentation. The management of good quality required the good administrator. To whom persisted endless of quality improvement , they can study the further analysis and comparison within five years after institutionalization.
目次 Table of Contents
【目 錄】
中文摘要………………………………………………………………Ⅰ
英文摘要………………………………………………………………Ⅱ
【表目錄】……………………………………………………………Ⅴ
【圖目錄】……………………………………………………………Ⅵ

第一章 緒論……………………………………………………….1
第一節 研究背景與動機……………………………………….1
第二節 研究目的……………………………………………… 6
第三節 研究問題……………………………………………….6
第四節 名詞定義……………………………………………….7

第二章 文獻探討………………………………………………….8
第一節 癌症疼痛與疼痛評估技巧…………………………….8
第二節 全面品質管理(TQM)與在職教育策略…………….16
第三節 疼痛評估在職教育……………………………………24
第四節 概念架構………………………………………………27
第五節 研究假設………………………………………………29

第三章 研究方法…………………………………………………30
第一節 研究設計………………………………………………30
第二節 研究對象………………………………………………32
第三節 在職教育課程設計……………………………………33
第四節 研究材料與方法………………………………………36

第四章 研究結果…………………………………………………39
第一節 三組護理人員與病人其個人基本資料之比較………40
第二節 三組護理人員曾使用、病人被教導疼痛測量
工具評估疼痛與護理紀錄之比較……………………44
第三節 三組病人主動向醫護人員報告疼痛、最近24
小時護理人員與病人痛分差距之比較………………48
第四節 三組病人對護理人員疼痛治療滿意度之比較…… 52

第五章 討論………………………………………………………53
第一節 三組護理人員與病人其個人基本資料之差異………53
第二節 三組護理人員曾使用、病人被教導疼痛測量
工具評估疼痛與護理紀錄之差異……………………54
第三節 三組病人主動向醫護人員報告疼痛、最近24
小時護理人員與病人痛分差距之差異………………57
第四節 三組病人對護理人員疼痛治療滿意度之差異……… 59

第六章 結論與建議……………………………………………….60
第一節 結論…………………………………………………….60
第二節 建議…………………………………………………….63
第三節 研究限制……………………………………………….64

參考文獻………………………………………………………………65
一、中文參考文獻………………………………………………65
二、英文參考文獻………………………………………………67

附錄一:直氏0-10數字量表與臉譜量表硬卡紙
附錄二:橫式0-10數字量表與臉譜量表硬卡紙
附錄三:綠色0-10數字量表與臉譜量表之使用說明單張
附錄四:藍色0-10數字量表與臉譜量表之使用說明單張
附錄五:黃色簡明疼痛量表之使用說明單張
附錄六:體溫表0-10疼痛強度供護理人員每日紀錄
附錄七:初步疼痛評估表及持續疼痛評估表單
附錄八:病人疼痛自我評估表單
附錄九:正式問卷
附錄十:「疼痛的測量」護理技術
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