試管嬰兒胚胎植入護理衛教對不孕症婦女接受胚胎植入期間成效之探討

Effects of Nurse-lead In Vitro Fertilization Psychoeducation Program on Infertility Women During the Stages of Treatment

許雅婷(Ya-Ting Hsu)

指導教授 ： 許玫琪 ； 顏永杰

義守大學/管理學院/管理碩博士班/碩士(2017年)

摘要

本研究設計為隨機分派臨床試驗，選擇南部某醫學中心之不孕症門診婦女為收案對象，目的在探討試管嬰兒胚胎植入護理衛教對不孕婦女接受胚胎植入期間成效。以隨機分派方式將受試者分為實驗組及對照組，每組各30個人。實驗組除一般常規護理外，給予總共四次的試管嬰兒胚胎植入護理衛教，分別在不孕婦女月經來第二天至第三天給予第一次護理諮詢衛教、在打完排卵針之後給予第二次護理衛教、在回診打破卵針之後給予第三次護理衛教、在植入當天給予第四次護理衛教，每次一小時，而對照組僅接受一般常規護理。第一次衛教重點包含建立良好的生活型態及給予執行試管嬰兒胚胎植入過程中之注意事項；第二次衛教重點為處理施打排卵針過程的衛教；第三次衛教重點為濾泡發育階段之衛教；第四次衛教重點為胚胎植入後之衛教。研究工具包含不孕自我效能量表、情緒調節策略量表、不確定感量表、因應方式量表。以描述性統計、卡方檢定、獨立樣本t檢定、配對t檢定、單因子變異數分析、廣義估計方程式。分析試管嬰兒胚胎植入護理衛教介入的成效，以及衛教前後不孕自我效能、情緒調節、不確定感、因應方式的差異。
研究結果收案人數實驗組30個人和對照組30個人，此次受試者年齡在35歲以上至43歲間，結婚至少4.5年以上，懷孕次數為0~1次居多、佔70%以上，且大多無生產經驗也無小孩、佔80%以上，教育程度以大學以上居多、佔70%以上，宗教信仰以道教為主、佔35%、不孕症治療次數大多以0~1次為主，不孕症治療時間以1~3年居多。研究結果發現護理衛教介入的成效在自我效能的組別及時間上皆能看出有顯著差異，且具有交互作用存在，表示實驗組相較對照組在護理衛教介入後能有較高的改善效果，實驗組的自我效能比對照組在後測上能有較高的表現。在情緒調節策略、不確定感、因應方式方面，試管嬰兒胚胎植入護理衛教未達統計學上的顯著差異。本研究結果，可提供臨床護理人員運用試管嬰兒胚胎植入護理衛教的內容方式提升不孕婦女自我效能之參考，以達到成功受孕的機會，進而促進心理健康之護理目標。

關鍵字

胚胎植入 ； 試管嬰兒 ； 不孕 ； 護理衛教 ； 不孕自我效能 ； 情緒調節 ； 不確定感 ； 因應方式

並列摘要

With randomized clinical trial, this study aimed to conduct research on women receiving obstetrics and gynecology services at a medical center in Southern Taiwan and investigated the effect of Nurse-lead In Vitro Fertilization Psychoeducation Program (IVF-PP) on infertility women receiving embryo transfers from in vitro fertilization. This study divided the infertile women into the experimental and the control groups perspectively. The experimental group received IVF-PP 4 times, and each time lasted for 60 minutes. The 1st time of IVF-PP was conducted at 2 to 3 days after women starting their menstruation. The 2nd time was conducted after the injection for ovarian stimulation. The 3rd time was performed after the injection for ovulation induction. The 4th time was performed when embryo transfer was conducted. The control group received only usual care. The research instruments included the demographic data, the Pregnancy Anxiety Scale, the Emotion Regulation Scale, the Mishel Uncertainty in Illness Scale (MUIS), and the Jalowiec Coping Scale (JCS). SPSS v.22 for Windows was used on the data analysis for descriptive analysis, chi-square analysis, independent sample t-test, paired-sample t test, one-way analysis of variance, and analysis of generalized estimating equations.
The results showed that there were 30 women in the experimental group of 30 in the control group. The subjects aged between 35 to 43 years old, married at least 4.5 years or more, and mostly had 0 to 1 times of pregnancies (70%). They mostly had no labor and birth experience and no children (80%). The majority of them had a university degree (70%) and a religious belief (35%), and had 0 to 1 time of infertility treatment in the past. The treatment duration of infertility was 1 to 3 years. The results found that there was a statistically significant differences in self-efficacy between the time and group effects in the control and experimental groups (p≦.05). The model showed an interaction effect which was significant. The IVP-FF significntly improved self-efficacy in the experimental group. However, there were no statistically significant differences in emotion regulation, uncertainty and coping between the two groups (p>.05). The results of this study provide helpful information for nurses to improve self-efficacy for infertility women during the stages of treatment in order to achieve the opportunity to successful fertilization, and thus promote mental health.

並列關鍵字

In vitro fertilization embryo transfer ； test tube baby ； infertility ； nurse-lead psychoeducation intervention ； Infertility self-efficacy scale ； Profile of mood states ； Jalowiec coping scale

參考文獻

呂翠夏(2010)‧母親與父親的情緒社會化行為與幼兒的情緒調節與同懠其互動的關係‧教育研究學報，44(2)，1-29。

謝碧玲、郭彥廷、葉盈均、張肇松、吳英璋(2010)‧情緒調節與罹病義義對急性血癌病患因應疾病的影響:兩名女性個案之初探結果‧高雄行為科學學刊，2，147-162。

余珠琴(2013)‧不孕症治驗談‧中醫婦科醫學雜誌，(17)，60-63。

楊鯉源、陳欣瑜、賴榮年(2016)‧中西醫整合療法治療多次試管嬰兒療程失敗之高齡不孕症婦女醫案報告‧中醫藥研究論叢，19(1)，195-203。

蔡岳庭、陳曉萱、賴榮年(2012)‧慢性反覆不癒白帶合併子宮腺肌症及卵巢巧克力囊腫多致因不孕症之中醫療法病例報告‧中醫藥研究論叢，15(2)，56-73。