第五章 討論
第四節 研究限制與未來展望
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幼兒睡眠的知識，或許就能降低嬰幼兒發展出睡眠問題，也能夠避免照顧者受到 孩子睡眠問題的影響；而治療介入階段，提供衛教知識以及信念的釐清和調整也 會是重點之一，或許只是認知信念上的改變，就能夠降低照顧者的困擾程度。最 後總括來說，未來協助照顧者處理嬰幼兒睡眠問題的困擾時，除了評估孩子的睡 眠狀態是否確實符合睡眠問題的標準外，還需進一步釐清照顧者的困擾是否受到 其他內外在因素的影響，尤其與配偶及祖輩教養態度的一致性、照顧者嬰幼兒睡 眠的知識、照顧者睡眠品質、憂鬱情緒及憤怒相關失功能信念等，並視個別的需 求給予不同的協助，而臨床上針對不同方法是否確實能協助照顧者降低困擾程度，
則有待未來實際應用與研究中進一步探討。
第四節 研究限制與未來展望
根據研究結果，我們已對可能影響台灣照顧者主觀困擾的因素有進一步的 了解，但研究方法上仍有許多限制。首先，本研究為問卷研究，嬰幼兒的睡眠 狀態並非透過客觀測量工具所測得，而是由照顧者所知覺到的狀態為依據，因 此，其平日的觀察力、與孩子相處的時間多寡、晚上是否與孩子一起睡等因素 皆有可能影響其知覺到的嬰幼兒睡眠狀態，未來可增加對嬰幼兒及照顧者客觀 睡眠資料的蒐集，例如配戴活動記錄腕錶（actigraph）以作為客觀指標的依據，
比較照顧者主客觀指標的差異及可能影響其中差異的因素。其次，本研究是透 過網路為媒介，於網路上張貼招募訊息，且照顧者必需在網路系統中填答問卷，
因此可能無法涵蓋到較少使用網路的族群，而願意參與本研究的照顧者也可能 是對嬰幼兒議題較有興趣，或本身受嬰幼兒睡眠困擾程度較大者，此外，本研 究填答者的教育程度為研究所的比例有27.2%，然而，根據內政部統計處 101 年報中的統計結果顯示，15-44 歲者教育程度為研究所的比例僅 5.43%，因此本 研究所招募到的族群的代表性可能有所限制，要將研究結果推論至一般或臨床 場域的照顧者時仍需要更多研究或臨床經驗的支持，未來必需增加一般族群及
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臨床場域中嬰幼兒睡眠的樣本資料，以對不同族群照顧者的樣貌有更清楚的了 解。第三，本研究並未詢問照顧者的家庭型態（如：單親家庭），但根據內政部 99 年單親家庭狀況的調查結果顯示，在 0-5 歲兒童家庭中，單親家庭占總戶數 之1.89 至 6.14%，因此，家庭型態對此議題造成的影響是未來可再進一步釐清 的問題。第四，本研究並未評估照顧者對壓力調適的能力，然而，其壓力調適 的能力亦可能影響照顧者對孩子睡眠狀態的知覺，因此，壓力調適能力對照顧 者造成的影響也是未來可再進一步探討的議題。最後未來研究可透過實驗法的 方式，於臨床場域中實際進行介入，探討本研究發現影響照顧者困擾的變項，
若實際處理是否確實能改善照顧者的困擾，以及與行為取向治療法結合的效果。
最後，照顧者的嬰幼兒睡眠知識及失功能信念對其照顧行為及孩子睡眠問題的 發展有何影響，其影響的層面與結果是否與國外研究有所不同，而祖輩的知識 與失功能信念在此議題上扮演甚麼樣的角色，是否能夠發展出以家庭為中心的 介入方法協助照顧者降低困擾，這些都是未來可進一步探討的議題。
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6. 您在照顧孩子的睡眠遇到困難時，大多如何處理？（請選擇「最常使用」的方法，最多「兩項」）
例如：孩子難以安撫入睡、孩子半夜醒來哭鬧...等。
□視為成長必經過程，不特別處理
□問親朋好友的經驗
□找專業人員協助（如：醫師、睡眠心理師、護理師）
□自行蒐集資訊（如：看書、看Baby Home網站、PTT媽寶版的分享）
□滿足孩子的需求（如：耐心陪伴、努力安撫）
□尋求民間信仰（如：收驚）
□以處罰的方式訓練（如：打罵）
□其他：＿＿＿＿＿＿＿＿＿
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g. 感覺很熱 1 2 3 4
h. 作惡夢 1 2 3 4
i. 疼痛 1 2 3 4
5 過去一個月來，您有多少次需要藉 助藥物（醫師處方或成藥）來幫助 睡眠？
1 2 3 4
6 過去一個月來，您在開車、用餐、
或參與社交活動時，無法維持清醒 的情形有多頻繁？
1 2 3 4
7 過去一個月來，您無法有足夠的熱忱去完成工作的情形有多嚴重？
( 1 ) 完全沒困擾 ( 2 ) 只有一點點的困擾 ( 3 ) 有相當程度的困擾 ( 4 ) 造成非常大的困擾
8 過去一個月來，您對自己的睡眠品質整體評價如何：
( 1 ) 非常好 ( 2 ) 好 ( 3 ) 不好 ( 4 ) 非常不好 9 您有無室友或有床伴？
( 1 ) 沒有室友或床伴 ( 2 ) 有，但不同房 ( 3 ) 有，同一房間，但不同床 ( 4 ) 有，同床
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