評估麻醉前衛教對全身麻醉脊椎手術患者之成效探討

Evaluating the Effects of a pre-Anesthesia EducationProgram for Spinal Surgery Patients With General Anesthesia

施素梅(Su-Mei Shih)

指導教授 ： 張文英

臺北醫學大學/護理學院/護理學研究所/碩士(2004年)

摘要

衛教是護理人員的重要職責之一，亦被認為是具有成本效益的護理措施。然在手術麻醉前如能提供病人相關的資訊及適當的護理指導，不但可降低病患對手術之焦慮，更可促進整個手術順利完成。故本研究目的在於比較採全身麻醉之脊椎手術患者，經由病房護理人員或麻醉護士執行全身麻醉前衛教之成效差異。本研究採兩組前後測設計法，樣本來源為中部某一家區域教學醫院之骨科住院病人，以隨機分派方式，將研究對象分為實驗組與控制組，收案時間為93年2月至93年4月，共計收案65人，實驗組33人，控制組32人，分別比較兩組之成本、焦慮程度、血壓、呼吸、心跳變化情形、及滿意度之差異。研究資料以描述性統計及卡方檢定、t檢定、配對t檢定、皮爾森積差相關等進行分析。 結果為：1.研究對象中，性別以男性佔多數，共35人；佔53.8﹪，女性30人；佔46.2﹪，教育程度以國小程度者居多，共20人；佔30.8﹪，手術次數以無經驗者佔多數，共37人；56.9﹪，以上變項均無顯著性差異(p=.540;.542;.886)。2.護理人員所花費的衛教人力時間成本，實驗組為44.95元，而控制組為54.48元；在降血壓藥物之成本方面，實驗組為3.21元；而控制組為101.38元；在住院成本上，實驗組的平均住院日為11.27天（25,035.84元），控制組為12.19天（27,011.14元）；以上三項之總成本，實驗組為25,084元，而控制組為27,167元，且在兩組比較上並無顯著性差異（p=.173；p=.958）。3.在焦慮程度方面，兩組在衛教實施前後的得分平均差，實驗組為0.94分，控制組為0.16分，結果顯示兩組具有顯著差異（p=.006）。4.在收縮壓、舒張壓、心跳及呼吸上亦均達顯著性差異（p=.006；p=.002； p=.005；p=.009）。5.在滿意度方面，實驗組的總分平均為47.67分（總分為52分），而控制組為40.88分，兩組在衛教實施後滿意度達顯著差異（p=.000）。 本研究結果顯示由麻醉護士實施全身麻醉衛教，不但可以節省衛教時間與藥物成本，亦可減輕手術患者之焦慮程度，且提升病患滿意度，因此，在臨床上應大力推廣由麻醉護士執行手術前衛教指導，以提升病患照護品質與減輕其焦慮程度。 關鍵詞：脊椎手術患者、麻醉前衛教、全身麻醉。

關鍵字

脊椎手術患者 ； 麻醉前衛教 ； 全身麻醉

並列摘要

Health education is one of an important task for nurses, and to be thought as a cost-effective intervention program. However, if patients could obtain related information and receive appropriate nursing education before surgery, not only anxiety can be reduced, but also made operation completed. Therefore, the purpose of this study was to compare the effectiveness of a pre-anesthesia education program for spinal surgery patients with general anesthesia by ward nurses or anesthesia nurses. The design was two groups pre-test and post-test comparison. Subjects were chosen from a region medical teaching hospital in middle of Taiwan and randomly assigned to experimental or control group, 33 for the experimental group and 32 for the control group. Data were collected from February of 2004 to April of 2004. Costs, level of anxiety, blood pressure, respiration rate, and heart rate, patient satisfaction between two groups were compared. Data were analyzed using descriptive statistics, chi-square, t-test, paired t-test, and Pearson’s correlation. The results were as follows: 1).For the demographic of the subjects, 35 were males (53.8%)，30 were females (46.2%). Twenty subjects (30.8%) were elementary graduates. Patients with no previous surgery experience were the most (n= 37; 56.9%). However, no significant differences were founbetween these two groups in three variables (p=.540; p=.542; p=.886, respectively). 2). For the nurses’ labor costs, NT$ 44.95 was for the experimental group, NT$54.48 for the control group. For the hypertensive medication costs, NT$ 3.21 was for the experimental group, NT$101.38 for the control group. For the hospitalization costs, 11.27 days (NT$25,035.84) were found for the experimental group, 12.19 days (NT$27,011.14) for the control group. The total costs (labor costs + hypertensive medication costs+ hospitalization costs) were NT$25,084 for the experimental group and NT$27,167 for the control group. But, no significant difference was found between these two groups. 3). The average different scores of the anxiety before and after education, 0.94 points for the experimental group and 0.16 points for the control group and a significant difference was found (p=.000). 4). There was significant difference between these two groups in the changes of blood pressure, respiration rate, and heart rate. (p=.006; p=.002; p=.005; p=.009, respectively). 5. For the patient satisfaction, the average scores were 47.67 points (total scores equal to 52 points) for the experimental group and 40.88 points for the control group and a significant difference was found (p=.000). The findings indicate that pre-surgery education should be performed by anesthetic nurses in order to decrease the labor and medication costs, to reduce patient’s anxiety, and to improve patient satisfaction. Hence, extending pre-surgery education by anesthetic nurses is needed to improve the quality of patient care and to reduce patient’s anxiety. Key words: Spinal surgery patient, Pre-anesthesia education program, General anesthesia.

並列關鍵字

spinal surgery patient ； pre-anesthesia education program ； general anesthesia

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