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研究生： 莊玲如
Chuang, Ling-Ju
論文名稱： 運用發展性照護於早產兒行視網膜病變檢查減輕疼痛及壓力之成效探討
Effects of developmental care on reducing pain and stress for preterm infants during retinopathy of prematurity (ROP) examinations
指導教授： 黃美智
Huang, Mei-Chih
學位類別： 碩士
Master
系所名稱： 醫學院 - 護理學系
Department of Nursing
論文出版年： 2015
畢業學年度： 103
語文別： 英文
論文頁數： 49
中文關鍵詞： 發展性照護 、早產兒視網膜病變 、早產兒
外文關鍵詞： developmental care, retinopathy of prematurity, preterm infant
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    • 研究目的：探討運用發展性照護減輕早產兒行視網膜病變檢查(Retinopathy of prematurity)過程的疼痛及壓力之成效。
    研究方法：此篇採交叉試驗研究設計(Crossover design)，將接受眼底檢查之早產兒於第一次眼底檢查前，以隨機分派方式分成實驗及對照兩組，並於眼底檢查之前、中、後給予發展性照護或常規照護，於第二次眼底檢查時，兩組交換照護方式。發展性照護組於眼底檢查前、中、後提供之措施包括：環境修正、擺位和寧握、氧氣供給、互動和接近之方法以及依暗示行為給予個別性照護等；對照組則依照臨床常規提供照護。觀察之成效變項包含：早產兒疼痛量表修訂版(Premature Infant Pain Profile-Revised, PIPP-R)、行為觀察以及生理變項復原時間(心跳速率、呼吸速率以及血氧濃度)。
    結果與結論：共十一位早產兒參與此研究，以廣義估計方程式(Generalized Estimating Equations, GEEs)分析發現：發展性照護組與臨床常規組在疼痛分數(早產兒疼痛量表修訂版)和行為觀察分數之組別比較達統計上顯著差異(分別為p < 0.001；p = 0.001)，以及疼痛分數和行為觀察分數之時間與組別交互作用亦達統計上顯著差異(分別為p = 0.002；p = 0.003)；以Wilcoxon 符號排序檢定(Wilcoxon signed rank test)分析發現：接受發展性照護組之早產兒在放入第一隻眼張眼器以及檢查後第一分鐘之疼痛分數較臨床常規組低且達統計上顯著差異(分別為p = 0.049；p = 0.012)；在行為觀察之分數方面，接受發展性照護組之早產兒在檢查後第一和第五分鐘之疼痛分數較臨床常規組低且達統計上顯著差異(分別為p = 0.026；p = 0.038)，以及檢查後所需花費之生理變項復原時間也較少(p = 0.005)。此研究發現運用發展性照護能降低早產兒行視網膜病變檢查之疼痛和壓力反應以及生理變項所需復原之時間。

    Objective
    The aim of the study was to examine the effects of developmental care on reducing pain and stress for preterm infants during retinopathy of prematurity (ROP) examinations.
    Methods
    We conducted a randomized crossover trial to examine the effect of developmental care for preterm infants during eye examinations for retinopathy of prematurity (ROP). The developmental care intervention, which involved environment modification, positioning and containment, oxygen supplement, interaction and approach, and cue-based and individual care, were applied before, during and after ROP examination. The primary outcomes were evaluated pain and stress scores by using Premature Infant Pain Profile-Revised (PIPP-R) and behavioral evaluation. The recovery time for physiological variables (heart rate, respiratory rate and oxygen saturation) to return to baseline constituted the secondary outcome.
    Results
    A total of 11 preterm infants were evaluated. In comparison with the standard care group, the developmental care group had statistically-significant lower PIPP-R scores at speculum insertion (p = 0.049), 1 minute after exam (p = 0.012), and also had statistically-significant lower behavioral evaluation scores at 1 minute after exam (p = 0.026), 5 minutes after examination (p = 0.038) by Wilcoxon signed rank test analysis. Additionally, there were statistically-significant differences in PIPP-R and behavioral evaluation scores between two groups (p < 0.001, p = 0.001, respectively) and group by time interaction (p = 0.002, p = 0.003, respectively) by Generalized Estimating Equations (GEEs) analysis. Moreover, the developmental care group had a statistically-significant difference in recovery time, compared with standard care group (7.7 minutes vs 24.7 minutes, p = 0.005) by Wilcoxon signed rank test analysis.
    Conclusion
    ROP examination is a necessary but recognized painful and stressful procedure. Developmental care for ROP examination reduced pain and stress responses and also reduced the time that infants needed to recover.

    CONTENTS ABSTRACT ii 中文摘要 iv ACKNOWLEDGEMENT v CONTENTS vi LIST OF TABLE ix LIST OF FIGURE x CHAPER ONE INTRODUCTION 1 1.1 Research Background and Significant 1 1.2 Research Purpose 2 CHAPTER TWO LITERATURE REVIEW 3 2.1 Retinopathy of Prematurity (ROP) 3 2.2 Developmental Care and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) 5 2.3 Pain and Stress Relief Managements during ROP 6 2.4 Recovery Time 7 2.5 Summary 8 CHAPTER THREE RESEARCH FRAMWORK 9 3.1 Conceptual Model - Synactive Theory 9 3.2 Research Framework 10 CHAPTER FOUR METHODOLOGY 12 4.1 Subjects and Setting 12 4.2 Study Process and Data Collection 13 4.3 Description of the Developmental Care Intervention 13 4.4 Intervention Scores during ROP Eye Examination 15 4.5 Instruments 15 4.6 Statistical Analysis 16 4.7 Ethical Consideration 17 CHAPTER FIVE RESULTS 18 5.1 Infants Characteristics 18 5.2 Intervention Scores 18 5.3 Primary Outcomes - Pain Scores and Behavioral Evaluation Scores 19 5.4 Secondary Outcome - Recovery Time 23 5.5 Summary of Results 25 CHAPTER SIX DISCUSSION 26 6.1 Summary of Findings 26 6.2 Relationship of Results with Literature 26 6.3 Discussion of Developmental Care Intervention’s Effect 27 6.4 Sample Size 29 6.5 Difficulties in Study Process 29 6.6 PIPP-R and BE scores 29 CHAPTER SEVEN CONCLUSION 31 7.1 Conclusion 31 7.2 Study Limitations 32 7.3 Recommendations for Future Research 32 7.4 Recommendations for Clinical Practice 32 REFERENCES 34 APPENDIX A – Certificate of IRB 39 APPENDIX B - Intervention Score for ROP Examination 40 APPENDIX C – PIPP-R 48 APPENDIX D – Behavioral Evaluation 49 LIST OF TABLE Table 1 Time of initial ROP eye examinations for infants 4 Table 2 Contents of developmental care intervention 14 Table 3 Participant information (N=11) 18 Table 4 Comparison of PIPP-R and BE scores between two groups by Wilcoxon signed rank test (N = 11) 21 Table 5 Comparison of PIPP-R scores between two groups by GEEs (N = 11) 22 Table 6 Comparison of BE scores between two groups by GEEs (N = 11) 23 LIST OF FIGURE Figure 1. Research framework 11 Figure 2. Participant flow chart 12 Figure 3. Intervention scores of the two care strategies 19 Figure 4. PIPP-R scores and behavioral evaluation scores of two groups 20 Figure 5. Mean of recovery time in two groups (n = 10) 24

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