胃部手術後病患使用疼痛因應策略及其影響因素探討
Pain coping and related factors in patients receiving stomach surgery.
中文摘要
疼痛是術後病人最常面臨的問題，而病人如何因應疼痛往往受多種因素影響，
為瞭解及協助病人更有效地因應術後疼痛，本研究目的為：(1)探討胃部手術後 病患使用疼痛因應策略的特質；及(2)探討疼痛感覺及認知層面特質、疼痛及麻 醉性止痛藥信念、多層面健康控制重心信念與病患使用藥物與非藥物疼痛因應之 相關性。研究採橫斷式相關性設計，以立意取樣方式於北部某醫學中心及區域教 學醫院，針對胃部手術後病患進行量性問卷訪談，研究工具包括簡易疼痛評估 表、疼痛及麻醉性止痛藥信念量表-手術疼痛版、多層面健康控制重心量表、簡易 疼痛因應量表。資料以描述性統計、Cronbach’s α、因素分析、逐步迴歸方法分析。
收案數為126 人，結果顯示：(1)本研究個案以內在自我控制信念特質為主，感
受中等到嚴重的最痛疼痛強度及輕微程度的平均疼痛強度，對疼痛及麻醉性止 痛藥有負向認知，且病患多採取以藥物處理疼痛的因應策略；可有意義地預測 病人使用藥物處理疼痛的因應；(2)病人有越高的最痛強度、診斷為癌症、越負向 的疼痛及麻醉性止痛藥信念及越高的平均疼痛強度，能有意義地預測藥物處理 疼痛的因應策略 (R2= .23，p< .05)，而病人有越負向的疼痛及麻醉性止痛藥信 念及越強的醫師控制信念能預測其使用非藥物處理疼痛的因應策略 (R2= . 12，p< .05)。本研究結果支持病人的疼痛信念、人格特質及疼痛強度均會影響術 後疼痛因應，臨床照護中應同時評估及處理該相關因素，以促進更有效的疼痛 控制。
英文摘要
The purpose of this study was to explore (1) the characteristics of patients’ coping with pain, who have received stomach surgery; and (2) the factors related to
predicting a patient’s choice of pharmacological or non-pharmacological pain coping strategies. A cross-sectional descriptive design was used in this study. Eligible subjects were patients who received stomach surgery. Patients were recruited using purposive sampling from the general surgical inpatient wards at four teaching hospitals in Taipei. The following research instruments were used to measure the variables in this study: Background Information Form、Pain Assessment Form (PAF)、Pain and Narcotic Analgesics Belief Scale — Surgical Pain Version
(PANABS-SP)、Multidimensional Health Locus of Control Scale — Form C (MHLC- Form C) and Brief Pain Coping Inventory (BPCI). Data were analyzed using
descriptive analyses、Cronbach’s alpha analysis、factor analysis and stepwise regression. One hundred and twenty-six subjects were recruited. In general, the
psychometric characteristics of each instrument was at an acceptable level. The major results showed that patients used both pharmacological and non-pharmacological coping strategies in dealing with their post-surgery pain. Patients with higher “worst pain intensity”、”higher pain intensity on average”、”diagnosed with cancer” and
“lower negative beliefs regarding surgical pain and narcotics analgesics”, tended to use pharmacological pain coping strategies more frequently. Patients with higher
“doctoral health control belief ” and lower “negative beliefs regarding surgical pain and narcotics analgesics” tended to use non-pharmacological pain coping strategies more frequently. The results strongly indicate that patient pain coping strategies related to their beliefs regarding pain and narcotics、doctoral control health locus belief、diagnosis with cancer and pain intensity. Health care professionals should assess patients’ pain beliefs and pain characteristics to increase the effectiveness of pain management.
