系統性護理指導對不孕婦女接受體外受精治療的認知程度及焦慮之影響

The Effects of Systematic Nursing Intervention on Cognition and Anxiety in Infertile Women with In Vitro Fertilization treatment

顏乙媛(I-Yuan Yen)

指導教授 ： 蘇燦煑

國立臺灣大學/醫學院/護理學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.02126

摘要

生殖科技治療的進步帶給不孕夫婦懷孕的希望，但複雜的治療過程，也帶給他們身心的煎熬。接受治療的婦女需要全面完整的訊息和情感支持，以度過治療的程序。本研究目的為探討系統性護理指導對不孕婦女接受體外受精治療的認知程度與焦慮之影響。
本研究採類實驗重複測量設計( repeated measure design)，研究情境為北部某醫學中心，研究對象為決定接受體外受精治療（IVF）的不孕婦女。以系統性護理指導為實驗處置；包括一次面對面指導，使用多媒體輔助說明，以問答方式雙向互動及示教與回覆示教和兩次電話追蹤指導。研究工具為自擬之體外受精治療認知程度自評表及情境焦慮量表。第一次資料收集於系統性護理指導前，第二次資料收集於面對面指導之後，共收案95位，第三次資料收集於第一次電話追蹤指導之後，共收案76位，第四次資料收集於第二次電話追蹤指導之後，共收案61位。回收之有效問卷資料，以SPSS for Windows 15.0套裝軟體進行建檔，使用Generalized Estimation Equation（簡稱GEE）統計法分析。
研究結果：個案的治療認知程度得分與系統性護理指導前比較，得分改變量均正值，且p＜0.001，顯示個案在接受系統性護理指導後，對於試管嬰兒治療認知程度有顯著的增加；個案的焦慮程度得分與系統性護理指導前比較，得分改變量均為負值，且p＜0.001，顯示個案在接受系統性護理指導後，焦慮程度有顯著的降低。而調整相關變項之效應後，職業及曾IVF治療的次數與IVF治療認知程度具有差異性；而接受人工授精治療次數、曾IVF治療次數、陪同參與護理指導者與焦慮程度具有差異性；而治療認知程度與焦慮程度之間有負相關性(p < 0.001)。
結論：系統性護理指導能增進不孕婦女之認知，亦能減輕焦慮。其中面對面護理指導，對增進治療的認知效果具顯著性，而電話追蹤指導能減輕焦慮。建議臨床護理指導能面對面以多媒體輔助解說，配合雙向互動及示教等策略。

關鍵字

不孕症 ； 體外受精治療 ； 系統性護理指導 ； 認知 ； 焦慮

並列摘要

Although reproductive technology treatment brings the hope to the infertile couple, complicated treatment process also bring them the hardship of mind and body. Women who receive Assisted Reproductive Technology treatment need overall message and emotional support to during the course of treatment. The purpose of this study is to explore the effect of the systematic nursing instruction on the improvement of the cognition and anxiety in infertile women who received In Vitro Fertilization (IVF) treatment.
This research uses quasi-experimental repeated measure design. We collect research objects from a medical center in northern Taiwan. In this study, infertile women were given systematic nursing instruction which include once face-to-face guide and twice telephone following-up guide. The face-to-face guide by group health education method, incclude mulimedia assisted explaination of IVF treatment, interaction with case by question and answer, and hand-on practice. The first time data were collected before systematic nursing instruction, and the second time data (n=95) collecting after face-to-face guide. The third time data (n=76) were collected after the first time telephone follow-up guide, and the fourth time data (n=61) were collected after the second time telephone follow-up guide, total accepting 61 cases.
Data were analyzed with SPSS for Windows 15.0 software packages. Generalized Estimation Equation (GEE) statistics method was used. The data show that cognition degree scores of infertile women were increased after accepting systematic nursing instruction (p<0.01); the anxiety scores of infertile women were reduced after accepting system nursing instruction ( p<0.01). The occupation of infertile women and the number of IVF cycles variables are related to cognition degree through the covariance analysis after adjusting the effect of other related variables. And the degree of anxiety degree is correlated with the number of Intrauterine Insemination (IUI) treatment cycles, the number of IVF treatment cycles, accompanied participation to face-to-face nursing guide. Additionally, the cognition degree negatively correlated with anxiety (p<0.01).
According to the results, the systematic nursing instruction can really promote the infertile women's cognition to the treatment and contribute to decrease anxiety. The face-to-face nursing instruction has a better effect on the cognition of infertile women. On the other hand, the telephone follow-up guide is more helpful in reducing anxiety. The results suggest that clinical nursing instruction could include mulimedia assisted explaination and two-way interactive discussion. The clinical nurses should pay more attention of those who repeated IUI or IVF treatment.

並列關鍵字

infertility ； IVF ； systematic nursing instruction ； cognition ； anxiety

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