腹部手術後急性疼痛定義性特徵之臨床效度

　　　　　本研究目的為建立一套具有信度與效度的評量表，並找出手術後急性疼痛的必要性 特徵。採用研究者所擬定之腹部手術急性痛定義特徵評量表，進行手術後急性痛定義特徵之 直接觀察，共收集個案 78 人。研究結果顯示：在量表信度方面，評估者間有良好的一致性 達 88%,，定義性特徵的內在一致性α值 0.8447，項間相關係數 0.3810； 在量表的效度方 面，建構效度經相關係數矩陣檢視後，刪除第 13 項定義特徵。依 14 項定義性特徵進行最 大變異量分析，並萃取出兩個次概念即身體與生理反應表現和防衛性情緒表徵。兩因素具有 良好的內在一致性，α值分別為 0.7595，0.8386，解釋共變量 47.2%。 並依中數值、矯正 單項與總項關係、固有值與因素係數等四個條件選出喊痛、皺眉、張大眼或閉眼、身體固定 不動、不敢翻身活動、脈搏次數改變、睡眠干擾、身體活動時僵硬和身體活動減少或變慢等 九項必要性之定義性特徵。由上述結果之呈現顯示，臨床疼痛之評估除了病人是否喊痛外， 護理人員在執行各項護理活動時，運用觀察病人身體與生理反應表現和防衛性情緒表徵上的 疼痛表現更是重要。而引流管數量的多少和過去病史是影響疼痛表現有意義的相關因素。
　　　　　The purpose of this study were to establish the construct validity and reliability of assessment tools, and to identify the essential defining characterisitics (DC). A postoperative pain characteristics scale was designed by the researcher. Seventy-eight abdominal surgical patients were assessed to collect the DC of postoperative pain. Results of this study indicated that: in pain scale reliability, there was good consistence (88%) between raters. The Cronbach's alpha coefficient of DC of "postoperative pain" was 0.8447. The correlation between items was 0.3810. In pain scale validity, construct validity which was tested for 14 items of DC accounting for common variance is 2%. According to factor loading, tw sub-concepts of defining characteristics are identified: physiological response and defensive emotional characteristics. The alpha coefficient of the two sub-concepts is 0.76 and 0.84 respectively. Based on the criteria of medium, corrected item/total items correlation, eigenvalue and factor loading, nine items of the essential DC are selected including pain descriptors, frowns, closed or open eyes, fixed body position, slowing or decreasing body movement, fear to change position or cough, rigid muscles during body movement, pulse rate change and sleep interuption. Findings showed that clinical pain assessment involves not only assessing patients' pain descriptors, but also observing their non-verbal behaviors to physiological response and defense emotional characteristics. The number of drainage tubes inserted and past history of patients were significantly related factors affecting postoperative pain characteristics.