音樂措施介入對於初次氣管內管留置病人焦慮程度及舒適改善之成效探討

A Study on the Effects of Musical Intervention on Anxiety Levels and Improvement to Comfort for First-time Patients with Endotracheal Tube Intubation

蔡艷雲(Yen-Yun Tasi) ； 石惠美(Whei-Mei Shih) ； 陳麗貞(Lee-Chen Chen) ； 徐侑瑩(Yu-Ying Hsu) ； 許榕珊(Jung-Shan Hsu)

《健康科技期刊》 7卷1期 (2020/09) Pp. 1-11

https://doi.org/10.6979/TJHS.202009_7(1).0001

摘要

目的：加護病房中病人壓力來源以氣管內管放置，導致疼痛焦慮不適比率佔最高。過程中需要頻繁抽痰、無法說話、處於不確定環境下並且與他人隔離，常導致焦慮程度上升、舒適感受下降，本研究目的為探討音樂措施介入對於初次氣管內管留置病人之生理數據反應、焦慮程度緩解效果及增加舒適感受成效。方法：以隨機分派法，收得60人分為實驗組31人控制組29人，一天三次每次40分鐘，接受音樂措施介入為期一天，於最後一次音樂措施介入後，給予收集焦慮程度及舒適感受量表資料，並採用SPSS Statistics 22版進行資料分析與處理。結果：音樂措施介入對於前、後，測量焦慮程度實驗組改變幅度比控制組改變幅度降低29.06分，達顯著差異（p＜.001），舒適感受實驗組改變幅度比控制組改變幅度多了1.51分，達顯著差異（p＜.001）；生理指標方面包括早上、中午、晚上心跳、呼吸、收縮壓、舒張壓均有顯著下降成效達顯著差異（p＜.001）。結論：音樂措施介入運用於初次放置氣管內管病人，生理指標及焦慮程度均有顯著下降情形，舒適感受顯著上升，且均達統計上顯著差異，本研究結果，可提供臨床護理人員運用音樂措施介入的方式緩解初次放置氣管內管病人焦慮程度及提高舒適感受之參考，以達到人性化護理之目標。

關鍵字

初次氣管內管留置病人 ； 音樂措施介入 ； 焦慮程度與舒適感受

並列摘要

Purpose: Endotracheal tube intubation is used as a source of pressure to maintain airways of patients in intensive care units, and it leads to the highest proportion of pain, anxiety, and discomfort. During intubation, it is necessary to frequently clear mucus from tubes, the patient has no ability to speak, is in an uncertain environment, and is separated from other people. This situation often leads to high levels of anxiety and low levels of comfort for the patient. The purpose of this study is to investigate the effects of musical intervention on physiological response data, lessening of anxiety levels, and comfort of first-time patients with endotracheal tube intubation. Methods: A total of 60 subjects were randomized into an experimental group (31 subjects) and a control group (29 subjects). Subjects in the experimental group received three 40-minute musical interventions over the course of one day; after the final intervention, subjects were given an anxiety and comfort scale, data from which were collected and applied to analysis using SPSS Statistics 22. Results: The change in anxiety levels before and after musical intervention in the experimental group was 29.06 points lower than that of the control group, which was statistically significant (p＜.001); the change in comfort levels was 1.51 points higher than that of the control group, which was also statistically significant (p＜.001). Physiological indicators including pulse, respiration, systolic and diastolic blood pressure taken in the morning, at noon, and at night all showed significantly lower values, which was statistically significant (p＜.001). Conclusion: Physiological indicators and anxiety levels in first-time patients with endotracheal tube intubation were significantly reduced, and comfort significantly increased, after musical intervention, the results of which were statistically significant. The results of this study may be used as reference for clinical nurses using musical intervention to alleviate anxiety and give comfort to patients undergoing endotracheal tube intubation for the first time, and thus attain the goal of humanized care.

並列關鍵字

First-time Patients with Endotracheal Tube Intubation ； Musical Intervention ； Anxiety Level and Comfort

參考文獻

武香君、周浩凡 (2008)．音樂治療緩解呼吸器使用患者焦慮之心理及生理反應成效．護理雜誌，55(5)，35-44。doi:10.6224/JN.55.5.35

Beaulieu-Boire, G., Bourque, S., Chagnon, F., Chouinard, L., Gallo-Payet, N., & L e s u r, O . ( 2 0 1 3 ) . Music and biological stress dampening in mechanically-ventilated patients at the intensive care unit ward--a prospective interventionalrandomized crossover trial. Journal of critical care, 28(4), 442-450. doi: 10.1016/j.jcrc.2013.01.007

Bradt, J., & Dileo, C. (2014). Music interventions for mechanically ventilated patients. CochraneDatabase of Systematic Reviews,(12). doi: 10.1002 /14651858.CD006902.pub3

Chlan, L. L., Weinert, C. R., Heiderscheit, A., Tracy, M. F., Skaar, D. J., Guttormson, J. L., & Savik, K. (2013). Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. Jama, 309(22), 2335-2344. doi: 10.1001/jama.2013.5670

Chlan, L. L. (2000). Music therapy as a nursing intervention for patients supported by mechanical ventilation. AACN Advanced Critical Care, 11(1), 128-138. doi: 10.1097/00044067-200002000-00014