第四章 研究結果 研究結果 研究結果 研究結果
第二節 護理實務應用與建議 護理實務應用與建議 護理實務應用與建議 護理實務應用與建議
第二節 第二節 第二節
54
息的提供應盡早於懷孕12週之前。並建議訂定孕期唐氏症篩檢護理照護指引，
針對第一孕期頸部透明帶合併母血唐氏症篩檢中，需加強孕婦對於34歲以下孕 婦懷有唐氏兒的風險比率、第一孕期唐氏症篩檢的檢出率、篩檢結果為高風險 時的意義等項目之說明。而第二孕期母血唐氏症篩檢中，需加強孕婦對於唐氏 兒的壽命、篩檢結果為高風險時胎兒是唐氏症比率、篩檢結果為低風險的比率 等項目之說明，以增加孕婦對於唐氏症篩檢的正確觀念。孕期唐氏症篩檢護理 指引如附錄六。
（三）、遺傳諮詢護理師介入孕期唐氏症篩檢諮詢
遺傳諮詢護理師為進階臨床護理師的角色功能之一，除具備良好的評估技 能、診斷推理、具有領導與研究的能力外，透過具備遺傳專業的能力，與孕婦 進行一對一的討論及個別諮詢，並讓孕婦於接受唐氏症篩檢前能有完整的認 知，且有足夠的時間進行思考，以做出最合適的決策。於孕婦獲知篩檢結果後，
主動協助孕婦正確的了解篩檢結果的意義，針對篩檢結果為高危險群者，能提 供後續的遺傳諮詢及心理支持，因此不僅改善臨床中因常規的匆促作業下，無 法提供完整的篩檢資訊及進行詳細諮詢的現況，更讓護理角色有更多元的展現。
三、 衛生政策方面建議
（一）、規範孕期唐氏症篩檢流程及品質監控
Ingvoldstad、Georgsso 和Lindgren（2014）研究指出，在瑞典因各產科機
構提供的唐氏症篩檢的方式無一定的標準，且收費方式也有所差異，有 15％的 孕婦，其產前檢查機構無法提供第一孕期的唐氏症篩檢，進而影響孕婦接受篩 檢之權益，因此研究建議孕期唐氏症篩檢方式，必需由國家衛生主管機關建立 指導方針，讓孕婦在接受產前篩檢時能獲得一致的權利，不因城鄉差距而不同。
然而目前國內衛生主管機關未訂定孕期唐氏症篩檢之相關規範及流程，大部份 醫療院所皆以常規之例行產檢項目，執行臨床作業，且提供之唐氏症篩檢項目，
無標準化之內容，孕婦獲得的篩檢方式會因產檢的醫療院所的規模，而有所限 制，如執行第一孕期頸部透明帶合併母血唐氏症篩檢的醫師，需具有「胎兒頸
部透明帶合格證書」，才可於臨床執行相關檢查，進而影響孕婦對於選擇接受 第一孕期唐氏症篩檢的意願。且價格之訂定亦由各家醫療院所決定，對於有經 濟因素考量的孕婦，便無法選擇檢出率較高的篩檢方式，因此建議應由衛生主 管機關建立一套，以各孕期為分類之唐氏症篩檢臨床作業指標，包含篩檢方式、
檢驗項目、建議篩檢週數、篩檢費用標準化等，供醫護人員於孕婦接受唐氏症 篩檢時，依照規範作業進行說明，並針對無法提供第一孕期頸部透明帶合併母 血唐氏症篩檢的醫療院所，安排由鄰近之主責醫院協助進行，讓孕婦不因受限 於產檢院所的規模而影響孕婦知情選擇及接受篩檢的權利。
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第三節 第三節
第三節 第三節 研究限制 研究限制 研究限制 研究限制
本研究僅收桃園市某區域教學醫院127位之孕婦為收案對象，有收案人數及 城鄉地區之差異，因此對於國內孕婦對於唐氏症篩檢的知識程度及態度，較無 法推論於其他不同地區之孕婦，未來需要更擴大範圍進行調查，可讓研究結果 更符合國內孕婦的現況。且本研究針對第一孕期的唐氏症篩檢知識，僅對胎兒 頸部透明帶合併母血唐氏症篩檢部份進行探討，而近年來，第一孕期的非侵入 性產前檢測(NIPT)的篩檢方式，檢出率較其他篩檢方式高，讓許多孕婦直接選 擇此項篩檢方式，而孕婦對於此項篩檢方式的了解，亦是值得加以深入探討的 議題。
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附錄 附錄 附錄 附錄 附錄一 附錄一
附錄一 附錄一 問卷授權同意書 問卷授權同意書 問卷授權同意書 問卷授權同意書
Measure of attitude toward undergoing Down syndrome screening Measure of knowledge about Down syndrome screening
原文版作者同意書 原文版作者同意書 原文版作者同意書 原文版作者同意書
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First-trimester Down syndrome screening：：：：pregnant women’s knowledge 原文版作者同意書
原文版作者同意書 原文版作者同意書 原文版作者同意書
附錄 附錄
附錄 附錄二 原版 原版問卷 原版 原版 問卷 問卷 問卷
Appendix A. Measure of attitude towards undergoing DSS
For each of the following questions, please circle a number from 1 to 7 on the scale that best describes how you feel at the moment.
(1) For me, having the screening test for Down syndrome when I am 15–16 weeks pregnant will be:
A bad thing 1 2 3 4 5 6 7 Not a bad thing
(2) For me, having the screening test for Down syndrome when I am 15–16 weeks pregnant will be:
Beneficial 1 2 3 4 5 6 7 Not beneficial
(3) For me, having the screening test for Down syndrome when I am 15–16 weeks pregnant will be:
Harmful 1 2 3 4 5 6 7 Not harmful
(4) For me, having the screening test for Down syndrome when I am 15–16 weeks pregnant will be:
A good thing 1 2 3 4 5 6 7 Not a good thing
(5) For me, having the screening test for Down syndrome when I am 15–16 weeks pregnant will be:
Worthwhile 1 2 3 4 5 6 7 Not worthwhile
(6) For me, having the screening test for Down syndrome when I am 15–16 weeks pregnant will be:
Important 1 2 3 4 5 6 7 Unimportant