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1 :,,. 1. (v aginal deliv ery ) (Lafoy & Geden, 1989 ; Lorenzi, 1991 ; Roch elle, 1995). 2., (, 1991 ; Hill, 1989 ; Kitzinger, 1984 ; Reeder, 1992 ; Sleep, 1984 ; T hack er & Banta, 1983)..,, Kegel,, (, 1988)., (Reeder, 1992 ; Sny der, 1992) (, 1991 ;, 1991). (ray lamp ) (, 1991 ; Greener, 1989 ; Lafoy & Geden, 1989) (Reeder, 1992).,, (, 1990 ; Hill, 1989 ; Pla stang a, 1988 ; Rhode & Barg er, 1990). (
2 , 1991 ;, 1991 ; Barclay & M artin, 1983 ; Droeg emueller, 1980) )? 2)? 3. 1). 2). 4. 1), (Cunningham, 1993) ),,, (Stev en, 1987).
3 Davidson (1974) REEDA (Redness, Edem a, Eccym osis, Discharge, Approx im ation ; REEDA ). 3) soddy,,,,, (cold ) (Sny der, 1992) , Pom eroy Delee (, 1991). 2,, (Cunningham & M cdon ald, 1993 ; Hill, 1989 ; Reeder, 1992 ; T hacker & Banta, 1983). (Rochelle, 1995).,,,,,, (, 1991 ; Kemp ster, 1987 ; T hacker & Banta, 1983). (Loren zi, 1991) (, 1991 ; Hlii, 1989)., Histamin e Plasmakinin,. (Hill, 1989). 3,,
4 ,,. Kitzing er (1984) Lorenzi(1991),,,,. (1987), 38, (Droegemu eller, 1980), Ramler (1984) (Rhode & Barger, 1990). (, 1991). (ray lamp ),, (, 1991).. ( 39, 1994 ; M ccaffery &Beeb e, 1989). 36, (, 1989). Droeg emueller (1980) Reeder (1992),,,, (Bu gaj, 1975 ; M cm aster, 1978 ; M elzack & Bentley, 1983 ; W aylonis, 1967).,,. soddy,.
5 ... ( 39, 1994 ; Hill, 1989 ; Sny der, 1992).,,., Palastan ga (1988) Sny der (1992) 2, Hocutt (1981) 1-3, H ocutt (1981) Lehm ann, W arren Scham (1974) 30. Licht (1965) Droeg emueller (1980) 24,. Barclay M artin (1983),, W itch - hazel sw ab s 3-4. Ramler Romler Robert s (1986) Hill(1989), 20 2, Lafoy Geden (1989) Bolles (1972) 2 1. (1991) 30 2, (1991).
6 , (, 1995 ;, 1995 ;,, 1986 ; M elzack & Bentley, 1983) (Rhode & Barger, 1990).. 1., (n on - equiv alent control group ) (repeated m ea sures design ) (E) E a X E b E a X E b E a X E b (C) C a C b C a C b C a C b a :, b : K G (v agin al deliv ery ) (accessible population ) 20, [ ] 1) ) ) cold allergy,. 4). 5). 6). 3. (0-10 ) REEDA. REEDA 1970 Davidson 1971 Carey 1972
7 Bolles Redn ess, Edem a, Eccymosis, Discharge, Approx im ation 5 (Hill, 1990). REEDA,,,, , REEDA , SA S,. t - test chisqu are- test. (repeated m easures AN OVA ). (repeated measures ANOVA ) ) < 1>,.
8 < 1> N =40 No(%) No(%) X or t ( ) (55) 13(65) (45) 7(35) 7(35) 7(35) (25) 6(30) 5(25) 3(15) 3(15) 4(20) 5(25) 4(20) (75) 16(80) 9(45) 12(60) (55) 8(40) 11(55) 8(40) (45) 12(60) (25) 2(10) (75) 16(80) (0) 2(10) 2(10) 1(5) (90) 19(95) (75) 10(50) (25) 10(50) (45) 7(35) (35) 10(50) (20) 3(15) 20(100) 20(100) 0(0) 0(0) 20(100) 20(100) 0(0) 0(0) 2) < 2>. < 2> N =40 (n=20) (n=20) Mean SD Mean SD t , 4.85, REEDA 0.95, 0.75.
9 2. 1) 1 : < 3, 4>. (repeated m easures AN OVA ) Greenh ou se- Geisser Epsilon 0.60, Huynh - F eldt Epsilon (df (1.38), F =24.12, p =.0001), (df=5, F =10.32, p =.0001), (df=5, F =38.33, p =.0001) < 3 >. < 3> N =40 F Adj G- G *** *** *** *** p<.001 < 4> N =40 df F Bonferroni *** *** *** *** p <.001
10 , , , < 1 >. < 1> 1 1 (F =2.10, p =.16, Bonferroni =0.78), 1 2 (F =37.97, p =.0001, Bonferroni =0.0005), 2 2 (F =28.99, p =.0001, Bonferroni =0.0005). 2 3 (F =4.24, p =.05, Bonferroni =0.23), 3 3 (F =43.62, p =.0001, Bonferroni =0.0005)< 1, 4 > 1. 2) 2 : < 5, 6>. < 5> N =40 F Adj G- G * **
11 * p<.05 ** p<.001 < 6> N =40 df F Bonferroni *** *** 0.0 *** p<.001 (repeated m ea sures AN OVA ) Greenh ou se- Geisser Epsilon 0.39, Huynh - F eldt Epsilon (df(1.38), F =0.48, p =.49), (df=5, F =4.40, p =.0008), (df=5, F =0.40, p =.85) < 5 >., , , , < 2 >.
12 < 2> 1 1 (F =1.0, p =.32, Bonferroni =1.62) 1 2 (F =2.0, p =.17, Bonferroni =0.83), 2 2 (F = , p =.0, Bonferroni =0), 2 3 (F = , p =0, Bonferroni =0)< 6 > < 3, 4, 1 >, , (F =24.12m p =.0001). (p =.0001, 3 ). (1991) 2 0, (1991), 2 0 Bolles (1972) , (15-18 ), 30 Ramler (1983), 4 6 (1991), (1991).,. 2 2 ( 2.85, 0.45, F =28.99, p =.0001, 4 ), 3.
13 6.,. 2. < 5, 6, 2 >, , (F =0.48, p =.49, 5 ), (F =0.4, p =.85, 5 ) REEDA (1991), 6 0 VA S (v aginal an alogu e scale : ) Lafoy Geden (1989). REEAD Discharge Approx im ation 0, 5 A pproxim ation Flemin g (1990). 24, 3-5 ( 7, 1994)
14 , 1 (v aginal deliv ery ) 20, 20, , Davidson (1974) REEDA. 1, 1, 1, 3 2, 2, 2, 6 3, 3, 3, 1. SA S program t - test, chi- squ are test, (repeated m easures ANOVA ) (df (1,38), F =24.12, p =.0001) (df=(1,38), F =0.48, p =.49).. (v aginal deliv ery ),. 2. 1). 2). 3). (1990).., 29(2), (1995).., 2(2),
15 (1988)..., (1991).., 21(1), , (1991).. ;. (1987). 2 : -., 26(4), ).. ;. (1991).,.,, (1991).. ;., (1993) ;., (1993).., 23 (2), (1984) (1994).. ;.,, (1986).., 4 (2), (1996). SA S. ;. Bug aj, R. (1975). T he coolin g, an alg esic, and rew armin g effect of ice m assage on localized skin. Phy sical T herapy, 55, Cogan, R. an d Edmun d, E. P. (1977). T h e unkin dest? T emporary Ob stetrics and Gyn ecology, 19 (April), Cunnin gh am, F. G.. M cdon ald, P. C., Gant, N. F., Levino, K. J., and Gilstrap, L. C. (1993). W illiam s Ob stetrics, (19th ed ). N ew York ; Appleton & Lang e. Davidson, N. (1974). REEDA : Ev aluation postpartum healing. Journ al of Nur se - Midw ifery, 19 (2), 6-8. Droeg em ueller, W. (1980). Cold sitz bath s for r eleaf of pospartum perineal pain. Clinical Ob stetrics & Gyn ecology, 23 (4), E dzard, E. and V eronica, F. (1994). Ice freezes pain? A rev iew of the clinical effectiv enes s of An alg esic cold therapy. Joural of Pain an d Symptom M anag em ent, 9 (1), Greener, D.L. (1989). T ran scultural Con cept s in Nur sing Care. Illinois ; Scott F orea sm an and Company. H elen, K. (1987). Confu sed, b attered and un w anted. Community Outlook, Jun e, Hill, P. D. (1989). Effect of h eat an d cold on the perineum after episiotomy/ laceration. Journ al of Ob stetrics & Gynecology and Neonatal Nur sing, 18 (2), Hill, P. D. (1990). P sy chom etric properties of the REEDA. Journal of Nur se Midw ifery, 35 (3), H ocutt, J. E. (1981). Cry otherapy. A merican F amily Phy sician, 23,
16 Jen sen, D., M argaret, D., and Bobak, M. I. (1985). M aternity and gyn ecologic care, T he Nur se and T he F amily, (3rd ed ). St. Louis : T h e C. V. M osby Company. Julice, T. S., M olly, C. D., Abram s, R. M. an d Christopher D. B. (1988). T h e dynamic characteristics of the circumv aginal mu scles. Journal of Ob stetrics & Ggyn ecology an d N eon atal Nur sing, 17 (3), Kitzinger, S. (1984). Episiotomy pain, T ex t book of pain. N ew York ; Chuchill Livin g stone. Lafoy, J. O. and Geden, E. A. (1989). P ostepisiotomy pain : w arm v er su s cold sitz bath. Journ al of Ob stetrics & Gynecology and Neonatal Nur sing, 18 (5), Lehm ann, J. F. an d Barbara, J. L. (1982). Ultr soun d, sh ortw av e, microw av e, uperficial h eat an d cold in the tr eatm ent of pain, T ex tbook of pain. New York : Chur chill liv in g stone. Lorenzi, E. A. (1991). Relax ation : episiotomy in cisional pain and ov erall discomfort. Journ al of A dv an ced Nur sin g, 16(6), M aureen, H. (1993). Droppin g stitch es. Nur sing T im es, 89 (33), M cma ster, W. C., Liddlie, S. and W au gh, T. R. (1978). Laboratory ev aluation of v ariou s cold therapy m odalities. Am erican Journ al of Sports M edicine, 6 (5), M cguire, D. B. (1984). T he m an agem ent of clinical pain. Nur sing Research, 33 (3), M elzack, R. and Bentley, K. C. (1983). Relief of dental pain by ice m assage of either h and or the contralateral arm. Joun al of Can adian Dental A ssociation, 4, P alastang a, N. P. (1988). H eat and cold, Pain, M an agem ent and Control in Phy siotherapy, (1st ed). Lon don ; H einem ann. P olit, D. F. an d Hungler, B. P. (1987). Nur sing Research Principles and M ethods, (3rd ed). Philadelphia ; J. B. Lippincott Company. Ramler, D. A. and Joy ce, R. (1986). Comparison of cold and w arm sitz bath s for relief of postpartum perin eal pain. Journal of Ob st etrics & Gyn ecology and Neon atal Nur sing, 15, M arch/ April, Readin g, A. E., Sledm ere, C. M., Cox, D. N. an d Campbell, S. (1982). H ow w om an view postepisiotm y pain. British M edical Journ al, 284 (23), January, Reeder, S. J. and M artin, L. L. (1992). M aternity nur sin g, (17th ed ). Philadelph a ; J. B. Lippincott Company. Rhode, M. A. an d Barger, M. K. (1990). P erin eal care. Journ al of Nur se- Midw ifery, 35 (4), Roch elle, M. T. (1995). Perin eal outcom es an d nurse midw ifery m anagm ent. Journ al of Nur se - Mid w ifery, 40(1), Janu ary/ F ebru ary, Sleep, J. (1984). Episiotomy in norm al deliv ery. Nursin g T im es, 80(47), Sny der, M. (1992). Independent nur sing interv ention (2n d ed). N ew York ; Delm ar Publisher s In c., T hack er, S. B. an d Banta, D. (1983). Benefits an d risk s of episiotomy : An interpretativ e rev iew of the En glish lan gu age literature, Ob stetrical an d Gyn ecological
17 Surv ey, 38(6), W aylonis, G. W. (1967). T h e phy siologic effect s of ice m as sag e. Archiv es of phy sical m edicine & rehabilitation, Jan, A b s tract - T h e In flu en c e of Cold T h erapy on th e P erin e al D is c om fort an d th e H e alin g S t at e of th e P o s tpartum W om en Shin, Hyun Jeong A qu asi- ex perim ent, repeated m easures design w ith non - equiv alent control group w as u sed to t est th e influ en ce of cold therapy on the perin eal discom fort and the healing state of the postpartum w om en under goin g v agin al deliv ery w ith episiot om y. Ex perim ent w a s carried out fr om July 28, thr ou gh October 2, 1996 w ith 40 postpartum w om en conv eniently sampled from one univ er sity hospital located in Seoul. T he 40 postpartum w om en un derg oing v agin al deliv ery w ith episiotomy w ere as sign ed to experim ental and control groups ev enly (20 each ). T h e in strum ent of m easurem ent of perin eal discomfort w as 0-10 ratin g scale th at w as m ade by researcher an d that of perineal healin g state w as Davidson ' s REEDA tool. T h e perineal discomfort an d the h ealin g state lev el w ere m easured before an d after each treatm ent. T he treatm ent u sin g ice glov e that w as giv en for the only ex perim ental group w as carried out at three point s ; as soon as returning to the recov ery room, 3 h our s after returnin g to the recov ery room an d 6 hour s after returning to the recov ery room. T h e data w as an aly sed by u sin g t - test, chi- square test to determin e th e similarity b etw een experim ental and control group s. T he hypotheses w ere tested u sin g repeated m ea sures ANOVA. T h e result s of this study are summ arized as follow s ; 1. T he fir st hypoth esis that th e perin eal discom fort lev el of the experim ental gr oup w ill be significantly low er th an that of the contr ol gr oup (df (1,38), F =24.12, p =.0001) w as supported. 2. T h e second hypothesis that th e perineal healin g state of the ex perim ental group w il b e better than th at of the control group (df(1,38), F =0.48, p =.49) w a s not supported. Ba sed on th e r esult s of this stu dy, could th er apy w as turned out to h av e significant effect on the perineal discom fort of the postpartum w om en under g oing v aginal deliv ery w ith episiotomy.
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