職護經痛認知研究

Occupational Health Nurse’s Cognition of Dysmenorrhea

洪筱婷(Hsiao-Ting Hung)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2012年)

https://doi.org/10.6833/CJCU.2012.00137

摘要

生理痛是職場女性常見健康議題，職護為最直接的健康照護者，其認知程度將影響照護行為。本研究主旨在瞭解職護之經痛認知程度，及個人屬性與工作經歷是否影響經痛認知。
本研究採用調查研究方式，以事業單位護理人員學會會員為調查施測之對象，共回收有效問卷280份，回收率為67％。問卷內容包含個人屬性、工作經歷及經痛認知量表，認知量表經探索性因素分析後區分為經痛病理及藥理、經痛評估、經痛處置三個構面，共44題項。以描述性統計、單因子變異數分析、皮爾森相關係數檢定及迴歸模式進行統計分析。
結果顯示原發性經痛的壓力成因認知率為89.3％，前列腺素僅39.9％，子宮內膜異位及骨盆腔發炎為續發性經痛最常見的成因，但認知率僅有64.9％及55.4％，且原發性的經痛症狀辨識率較續發性經痛高。NSAIDs與口服避孕藥正確服用時機的認知率分別為54.3％及45.0％，對於NSAIDs具抗血小板凝集的特性認知率偏低（15.0％），對於經血量大者需謹慎使用的認知率亦不佳（21.8％）。NSAIDs品項辨識以mefenamin acid最高（55.7％），diclofenac potassium最低（14.6％），另有62.9％的職護將acetaminophen錯誤歸類。年齡愈大、職護年資愈淺及用藥行為屬很痛才用藥者，其經痛病理與藥理認知愈佳。有婦產科工作經驗者，其經痛評估認知愈佳。職護年資愈淺及無婦產專科工作經驗者，其經痛處置認知愈佳。
整體來說職護的經痛問題評估及實證護理處置認知不足。多數職護無法由經痛症狀分辨經痛類型，續發性經痛恐有延遲轉介就醫之虞，僅四成職護瞭解前列腺素與原發性經痛的關聯，NSAIDs藥物服用時機及注意事項認知不足，易造成疼痛緩解效果降低且增加用藥危險。由於經痛為職場女性常見之健康主訴，且為生育健康之前哨事件，建議未來職護之專業訓練應加強經期健康相關素養。

關鍵字

職業衛生護理人員 ； 經痛認知 ； 經痛成因 ； 經痛評估 ； 經期健康素養

並列摘要

Dysmenorrhea is a common health issue for occupational women. Occupational health nurses are the most direct health caregivers whose cognition of dysmenorrhea will influence nursing behaviors. This study aims to learn about the level of the dysmenorrheal cognition of occupational health nurses and whether personal attributes and work experiences can influence such.
This study adopts the investigative method, taking the members of the Taiwan Association of Occupational Health Nurses as the survey respondents. 280 valid questionnaires were retrieved in total and the recovery ratio was at 67%. The questionnaires contained personal attributes, work experiences and the cognition scale of dysmenorrhea. The cognition scale was divided into dysmenorrheal pathology and pharmacology, dysmenorrheal assessment, dysmenorrheal disposition - three perspectives after exploratory factor analysis, with 43 questions involved in total. Then, a statistical analysis was conducted using descriptive statistics, one-way ANOVA, the Pearson Correlation Coefficient verification and the Regression Pattern.
The results showed that the cognition rate of stress-associated causes of primary dysmenorrhea was at 89.3%, while the prostaglandin was only at 39.9%. The endometriosis and pelvic inflammation are the most common attributes of secondary dysmenorrhea and the cognition rates were only at 64.9% and 55.4%. The recognition rate of primary dysmenorrhea was higher than that of secondary dysmenorrhea. The cognition rates of correct occasion to take NSAIDs and oral contraceptives were at 54.3% and 45.0%, and the cognition rate about the anti-platelet aggregation character of the NSAIDs went as lowas 15.0%. What’s more, the cognition that people with large menstrual volume should use it with caution was also poor, only at 21.8%. As for the item identification about NSAIDs, mefenamin acid was the highest at 55.7%, diclofenac potassium was the lowest at only 14.6%. However, as much as 62.9% of the occupational health nurses have mistakenly classified the acetaminophen. The older the age and the lower the qualification was, the later the people took the medicine so the better the cognition of dysmenorrheal pathology and pharmacology would be. Nurses with obstetrics and gynecological working experience had a better cognition of dysmenorrheal assessment, while occupational nurses with low qualification and without obstetrics and gynecological working experience had a better cognition of the dysmenorrheal disposition.
Overall, the cognition of occupational health nurses about dysmenorrheal assessment and evidence-based nursing disposition is not enough. Most of the occupational health nurses can’t distinguish the types of the dysmenorrhea just by the symptoms. With secondary dysmenorrhea, most patients put off seeking medical treatment. Only forty percent of the occupational health nurses know about the association between PG and primary dysmenorrhea. The cognition of occasions to take NSAIDs and high precautions are not enough. This may easily reduce the effect of pain remission and increase the dangers of taking medicines. Aside from dysmenorrhea being the major health complaint of occupational women, it is also a critical issue of the reproductive health. Thus, it is suggested that the professional training of all future occupational health nurses be strengthened in relation to menstrual health literacy.

並列關鍵字

occupational health nurse ； cognition of dysmenorrhea ； cause of dysmenorrhea ； assessment of dysmenorrhea ； menstrual health literacy

參考文獻

邱敏惠，王秀紅：護校女生經痛與月經態度關係之探討。護理雜誌 2004；51：45-52。

紀麗梅、徐南麗、邱慧洳、蕭正光：穴位指壓對原發性經痛成效之探討。慈濟護理雜誌 2004；3：29-36。

秦唯珊、洪筱瑩、郭浩然、徐畢卿：認識職業衛生護理人員之現況工作。中華職業醫學雜誌 2004；11：217-228。

張慶南、林明珍、曾秋鑾、呂春美、鄔彩香、溫滿美：護理人員對健康照護資訊的尋求及其相關因素之探討。志為護理 2007；25：237-242。

陳芬苓：企業規模與實施職場健康促進之調查研究。台灣管理學刊 2005，5:149-168。