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系統識別號 U0007-1208201013280700
論文名稱(中文) 乳癌患者之健康知能與健康照護結果之相關性研究
論文名稱(英文) Related health literacy and health care outcomes of research in the breast cancer patients
校院名稱 臺北醫學大學
系所名稱(中) 醫務管理學研究所
系所名稱(英) School of Health Care Administration
學年度 98
學期 2
出版年 99
研究生(中文) 張秀雲
學號 G159094008
學位類別 碩士
語文別 中文
口試日期 2010-07-06
論文頁數 62頁
口試委員 委員-俞至誠
委員-黃國哲
指導教授-湯澡薰
關鍵字(中) 知能
健康知能
自我照護
乳癌
淋巴水腫
關鍵字(英) literacy
health-literacy
self-care
breast cancer
lymphedema
學科別分類
中文摘要 健康民眾2020(Healthy People 2020)將健康知能及自我照護能力列為國家級目標之一,健康知能不足的民眾因對健康訊息的理解力差,健康知識不足,未遵從治療,或無法有效與醫師溝通而影響健康狀況,導致失能及慢性病的盛行率高,預防保健的利用率低,醫療照護費用較高,可能缺乏疾病知識,展現較差的照護與較差的照顧行為。國內女性乳癌發生率與死亡率逐年增加,而術後合併症可能出現在20 年後。有研究結果顯示,上肢有問題的病人相較於無上肢併發
症的病人其生活品質顯著較差。唯有輔導病人如何預防合併症的發生,及早發現,早期治療,才有助於提升他們的生活品質。
本研究係對台北市某醫學中心須執行手術治療之90 位乳癌婦女,採立意抽樣的方式收集,調查其健康知能程度,並且於手術前及手術後進行手臂圍測量及復健運動方法之衛教,了解其手術後自我照護結果以及術後整體生活品質之相關性。使用的統計方法包括描述性統計、t 檢定、單因子變異數分析與事後薛費氏檢定等方法,以SPSS18.0 版軟體進行統計分析。
研究結果發現,病患是否會主動搜尋與手術相關訊息及是否習慣閱讀醫療保健訊息等變項,與健康知能狀態有顯著性的相關,然而健康知能與健康照護及整體生活品質並無統計上的顯著關連性。
整體看來健康知能高低與自我照護結果似乎沒有直接的影響,這攸關乎臨床上醫師的不斷叮嚀、甚而用電話追蹤確認交代過的醫囑、整個醫療團隊的緊密連結及追蹤時間的長短,都是可能會影響到患者照護結果的相關因素,因而,未來若能增加樣本數及延長追蹤個案的時間,甚而,納入不同屬性的醫療院所或不同區域的民眾,可能會有不同結果的呈現。
英文摘要 Background:According to the report of AHRQ shows that healthy consciousness shortage will be absolutely negative influence on the disease recovery and patient safety. Health
literacy is seen by scholar in order to predict healthy status and important index sign after recovery. The incidence rate of female breast cancer is the first place in the survey of National cancers. One of them, the surgery is the choice of majority. By the same case study, breast cancer patient survival rates reaches average 60 percent in ten years, zero period of breast patient or even close to 100 percent in the rest of their lives for coexistence with breast cancer and its complications. To sum up, only to
understand the extent of health knowledge and relevant factors, to counseling patients on how to prevent the occurrence of complications, early detection, early treatment, it will help improve theirs life of quality.
Purpose:1. The influence related factors for breast cancer surgical patient’s the healthy literacy. 2. The influence for breast cancer surgical patient’s the healthy literacy more or less. 3. The influence of breast cancer surgical patient’s literacy more or less for healthy life quality.
Methods:This research focus on the 90 women who have to accept surgical breast cancer treatment in the Medical Hospital Center of Taipei. Adopt the collection way of
purpose sampling, it will investigate the level of health literacy. Before the surgical and after that, we will offer them the education courses about measure theirs arm rounds and rehabilitation exercise methods, and analysis on the related of the result for surgical self-carrying and the life quality after surgery. Usage of the statistical
methods, including descriptive statistics, t test, and single factor variation number analyze to examine, Scheffe's test etc, and statistical analysis of SPSS18.0 version.
Results:The research found that patients actively search for surgery-related information or medical and health information have significantly related, but health literacy, health care and overall quality of life there no significantly correlated on statistics.
Conclusion:It seems that health literacy level, the results of self care have not directly affected, the clinical doctor’s ordered, even patient’s confirm delivery by telephone, keep it touch with the all medical team and the long or short of following time , it would be influence on the factors of patient’s care results. Thus in the future, if increase the sampling cases even following the cases for long period, even collects the different attributes of hospitals or the people from other regions , it would presents the significantly results.
論文目次 目錄
頁數
致謝……………………………………………………………………..I
中文摘要………………………………………………………………III
英文摘要..……………………………………………………………..V
目錄………..…………………………………………………………VII
表目次………………………………………………………………...IX
圖目次…………………………………………………………………..X
第一章 緒論…………………………………………………………...1
第二章 研究背景……………………………………………………...1
第一節 研究動機……………………………………………………….3
第二節 研究目的…………………………………………….………..5
第三節 研究重要性與預期效益…………………………….………..6
第三章 文獻探討……………………………………………………….7
第一節 健康知能的相關定義………………………………………...7
第二節 乳癌介紹……………………………………………………..10
第三節 健康照護結果指標…………………………………………..13
第四節 生活品質……………………………………………………..15
第四章 研究方法……………………………………………………..16
第一節 研究架構……………………………………………………..16
第二節 研究假說……………………………………………………..18
第三節 研究變項與其操作型定義…………………………………..19
第四節 研究工具……………………………………………………..23
第五節 研究對象與資料收集方式……………………..…………..25
第六節 資料處理與統計分析方法…………………………………..26
第五章 研究結果……………………………………………………..27
第一節 受訪者個人特質的分布狀況………………………………..27
第二節 受訪者特定疾病健康知能分數之分布狀況………………..29
第三節 影響乳癌手術患者健康知能高低之相關因素……………..31
第四節 健康知能的高低對於乳癌手術患者手術後照護結果之影響37
第五節 健康知能的高低對於乳癌手術患者健康生活品質之影響..44
第六章 討論…………………………………………………………..47
第一節 健康知能高低之影響………………………………………..47
第二節 健康知能與手術後自我照護結果…………………………..48
第三節 健康知能與整體健康生活品質……………………………..49
第四節 結論…………………………………………………………..50
第五節 研究限制……………………………………………………..51
第六節 建議…………………………………………………………..52
參考文獻
中文部份……………………………………………………………….53
英文部分……………………………………………………………….54
附錄一、乳癌術前健康知能問卷…………………………………….55
附錄二、乳癌術後健康相關生活品質……………………………….58
附錄三、乳癌術後復健運動…………………..…………………….59
參考文獻 中文部份
王家詮(1985)各國醫療保險制度的研究.台北:茂昌。
余金燕、潘德樑(2003)疾病分類實務.台北:合計圖書出版社。
洪維河(1991)病人住院日數與住院費用的關係—以DRG155 為例.國立台灣大學,台北市。
張美娟、陳月枝、章淑娟(2009).健康素養概念分析.護理雜誌,56(5),93-97。
張美娟(2009).健康素養與健康照護.志為護理,8(3),65-69。
張麗春(2008).健康素養—評價衛生教育計畫成效的新指標. 護理雜誌,55(1),81-86。
詹廖明義(2009).健康知能與病人安全.醫療品質雜誌,3(2),64-66。
簡聰建(1992).某省立醫院之住院日數與住院費用分析.台灣大學,台北。
蘇哲能、張淑鳳、陳榮基、潘豐泉、陳清軒、劉偉文(2008).台灣健康知能量表之初探性研究.
台灣醫學,12(5),535-536。
陳克誠(2010).運動對乳癌病患的好處. Health World,http://health-world.com.tw.
英文部分
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administrative databases to support planning activities: The case of the evaluation of neonatal
case-mix in the Emilia-Romagna region using DRG and APR-DRG classification systems. Eur J Public
Health, 13, 138-145.
Horn, S. D., Horn, R. A., Sharkey, P. D., & Chambers, A. F. (1986). Severity of illness within DRGs.
Homogeneity study. Medical Care,24(3),225-235.
.Kenkel DS. Health behavior, health knowledge, and schooling. J Polit Econ 1991;99:287-305.
Lee,S.Y.,Arozullah,A.M.,& Cho,Y.I.(2004).Health literacy,social support,and health:A research
agenda.Social. Science & Medicine,58(7),1309-1321.
Nayga Jr. RM.(2000) Schooling, health knowledge and obesity. Appl Econ,32:815-22.
Nielsen-Bohlman,L., Panzar, A. M., & Kindig, D. A.(2004). Health literacy:A prescription to end
confusion. Washington, DC: National Academies Press.
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(3),259-267.
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Adolescent Health Care, 37(7),258-286.

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系統識別號 U0007-1704200714550148
論文名稱(中文) 自我照顧方案對乳癌病患接受化學治療期間疲憊程度的改善成效之探討
論文名稱(英文) The Effects of Self-Care Program on Decreasing Fatigue in Breast Cancer Patients Receiving Chemotherapy
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 93
學期 2
出版年 94
研究生(中文) 陳麗雪
學號 M406092010
學位類別 碩士
語文別 中文
口試日期
論文頁數 94頁
口試委員 指導教授-賴裕和
關鍵字(中) 自我照顧方案
乳癌
化學治療
疲憊
焦慮
憂鬱
關鍵字(英) breast cancer
chemotherapy
self-care
fatigue
anxiety
學科別分類
中文摘要 論文名稱:自我照顧方案對乳癌病患接受化學治療期間疲憊程度的改善成效之探討 研究所名稱:臺北醫學大學護理學研究所 研究生姓名:陳麗雪 畢業時間:九十三學年度第二學期 指導教授:賴裕和 臺北醫學大學護理學研究所教授 疲憊是乳癌病患接受化學治療期間最困擾的症狀,為改善乳癌病患於化學治療期間的疲憊問題,本研究目的在測試自我照顧方案對於術後乳癌病患接受輔助性化學治療期間疲憊改善的成效。研究設計採實驗法及前、後縱貫式收集資料,選取符合收案條件之乳癌病患,以抽籤方式將個案隨機分派到實驗組(接受疲憊自我照顧方案)及控制組(接受一般常規照護),實驗組10人,控制組13人,比較兩組在化學治療前、化學治療後第7天、化學治療後第21天、再次化學治療後第7天、再次化學治療後第21天的疲憊程度及焦慮憂鬱程度的變化及差異。分析方法採描述性分析、卡方檢定、獨立t檢定、單因子變異數分析及重複測量變異數分析。研究結果:(1)兩組個案的疲憊程度、焦慮及憂鬱程度在化學治療後第七天明顯高於前測和化學治療後第二十一天且在統計上有顯著的差異;(2)兩組個案的疲憊程度、焦慮及憂鬱程度,經介入自我照顧方案後,兩組前後測的改變量在統計上沒有顯著差異(p > .05)。 關鍵詞:自我照顧方案、乳癌、化學治療、疲憊、焦慮、憂鬱
英文摘要 Abstract Title of Thesis: The Effects of Self-Care Program on Decreasing Fatigue in Breast Cancer Patients Receiving Chemotherapy Institution: Graduate Institute of Nursing, Taipei Medical University Author: Li-Hsueh Chen Thesis directed by: Yeur-Hur Lai, Ph. D., Professor Fatigue is one of the most annoyed problems in the breast cancer patients receiving chemotherapy. The purpose of this study is to assess the effects of self-care program on decreasing fatigue in breast cancer patients receiving adjuvant chemotherapy. A control clinical trial was conducted to evaluate the effects of the self-care program. Eligible breast cancer patients were randomized assigned into experimental group (receiving fatigue self-care program) (n=10) or control group (receiving routine hospital care) (n=13). Fatigue experiences were evaluated by the levels of fatigue, anxiety and depression across 5 time points (pre-chemotherapy, the 7th and 21 days of both first and courses of chemotherapy). Data were analyzed by descriptive statistics, Chi-Square test, t-test, one-way ANOVA and repeated measures ANOVA. The results showed that there were no statistical differences in the levels of fatigue, anxiety and depression between control and experimental groups. Possible reasons for the results were discussed. Future study should further validate the effects of this fatigue self-care program after considering the potential reasons found in this study. Key word: breast cancer, chemotherapy, self-care, fatigue, anxiety
論文目次 目 錄 頁數 致謝﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅰ 論文摘要﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅱ 目錄﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅵ 圖表目次﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅷ 第一章 緒論﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 1 第一節 研究動機與重要性﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 1 第二節 研究目的﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 4 第二章 文獻查證﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 5 第一節 疲憊的相關概念﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 5 第二節 乳癌化學治療與疲憊﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 11 第三節 疲憊的處置﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 14 第三章 研究方法﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 17 第一節 研究設計﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 17 第二節 研究對象、收案場所及時間﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 19 第三節 研究工具﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 20 第四節 研究方案﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 24 第五節 研究步驟﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 27 第六節 研究人權保障﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 29 第七節 資料統計與分析﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 30 第四章 分析與結果﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 32 第一節 研究對象的基本資料﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 32 第二節 研究對象的疲憊程度﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 36 第三節 研究對象的疲憊對生活之影響﹒﹒﹒﹒﹒﹒﹒﹒﹒ 50 第四節 研究對象的焦慮憂鬱程度﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 57 第五章 討論﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 67 第一節 疲憊自我照顧方案改善疲憊程度的成效﹒﹒﹒﹒﹒ 67 第二節 疲憊自我照顧方案改善焦慮憂鬱程度的成效﹒﹒﹒ 69 第六章 結論與建議﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 71 參考資料﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 73 中文部份﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 73 英文部份﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 76 附錄﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 80 附錄一 參與研究同意書﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 80 附錄二 研究工具﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 81 附錄三 Karnofsky 身體功能狀態量表﹒﹒﹒﹒﹒﹒﹒﹒﹒ 88 圖表目次 圖一 研究步驟﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 28 圖二 兩組於化學治療期間的最疲憊程度﹒﹒﹒﹒﹒﹒﹒﹒﹒ 42 圖三 兩組於化學治療期間的最不疲憊程度﹒﹒﹒﹒﹒﹒﹒﹒ 43 圖四 兩組於化學治療期間的平均疲憊程度﹒﹒﹒﹒﹒﹒﹒﹒ 44 圖五 兩組於化學治療期間的現在疲憊程度﹒﹒﹒﹒﹒﹒﹒﹒ 45 圖六 兩組於化學治療期間的整天疲憊天數﹒﹒﹒﹒﹒﹒﹒﹒ 46 圖七 兩組於化學治療期間的整天平均疲憊程度﹒﹒﹒﹒﹒﹒ 47 圖八 兩組最疲憊前後測曲線﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 48 圖九 兩組最不疲憊前後測曲線﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 49 圖十 兩組於化學治療期間疲憊對生活的整體影響﹒﹒﹒﹒﹒ 56 圖十一 兩組於化學治療期間的焦慮曲線﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 63 圖十二 兩組於化學治療期間的憂鬱曲線﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 64 圖十三 兩組焦慮前後測曲線﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 65 圖十四 兩組憂鬱前後測曲線﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 66 表一 研究設計﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 18 表二 研究變項與測量工具一覽表﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 23 表三 資料統計分析﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 31 表四 研究個案基本屬性﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 34 表五 研究個案的疾病特徵及化學治療的分佈情形及比較﹒﹒ 35 表六 研究個案化學治療前的疲憊情形及比較﹒﹒﹒﹒﹒﹒﹒ 39 表七 兩組疲憊強度的變化﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 40 表八 研究個案化學治療前的疲憊對生活影響情形及比較﹒﹒ 53 表九 兩組疲憊對生活影響的變化﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 54 表十 研究個案於化學治療前後的焦慮情形及比較﹒﹒﹒﹒﹒ 60 表十一 研究個案於化學治療前後的憂鬱情形及比較﹒﹒﹒﹒﹒ 61 表十二 兩組焦慮憂鬱程度的變化﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 62
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Piper, B. F. (2003). Fatigue. In V. Carrieri, A. M. Lindsey, & C. M. West, (Eds.), Pathophysiological phenomena in nursing: human response to illness. Philadelphia: Saunders. Piper, B. F., Lindsey, A. M., & Dodd, M. J. (1987). Fatigue mechanisms in cancer patients: developing nursing theory. Oncology Nursing Forum, 14(6), 17-23. Polit, D. F., & Beck, C. T. (2003). Nursing Research: principles and methods (7th ed., pp. 495-498). Philadelphia: Lippincott. Schipper, H., Clinch, J., Mcmurray, A., & Levitt, M. (1984). Measuring the quality of life cancer patients: The functional living index-cancer: development and validation. Journal of Clinical Oncology, 2(5), 472- 483. Schwartz, A. L. (2000). Daily fatigue patterns and effect of exercise in women breast cancer. Cancer Practice, 8(1), 16-24. Schwartz, A. L., Mori, M., Kao, R., Nail, L. M., & King, M. E. (2001). Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine Science in Sports & Exercise, 33(5), 718-23. Segar, M. L., Katch, V. L., Roth, R. S., Garcia, A. W., Portner, T. I., Glickman, S. G., et al., (1998). The effect of aerobic exercise on self-esteem and depr essive and anxiety symptoms among breast cancer. Oncology Nursing Forum, 25(1), 107-113. So, Winnie K. W. & Tai, Josepha W. M. (2005). Fatigue and Fatigue-Reliev-ing Strategies Used by Hong Kong Chinese Patients After Hemopoietic Stem Cell Transplantation. Nursing Research, 54(1), 48-55. Winningham, M. L. (1993). Fatigue. In S. L. Groenwald, M. H. Frogge, M. Goodman & C. H. Yarbro (Eds.), Cancer nursing: Principle and practice (pp. 42-54). Boston: Jones & Bartlett. Zigmnd, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatry Scand, 67, 361-370.

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系統識別號 U0007-1704200715034710
論文名稱(中文) 糖尿病患者與其治療團隊成員之互動對於患者自我照顧行為的影響
論文名稱(英文) Impact of the Interaction between Diabetic Patients and Their Health Care Providers Team on Patients’Self-care Behavior
校院名稱 臺北醫學大學
系所名稱(中) 醫務管理學研究所
系所名稱(英) School of Health Care Administration
學年度 94
學期 2
出版年 95
研究生(中文) 鄭曉璘
學號 M111093007
學位類別 碩士
語文別 中文
口試日期
論文頁數 100頁
口試委員 指導教授-黃國哲
關鍵字(中) 糖尿病
患者自我照顧行為
互動關係
關鍵字(英) diabetes
patient''s self-care behavior
interaction
學科別分類
中文摘要 本研究之主要目的在於探討糖尿病患者與其治療團隊成員之互動關係及病患特質,對於患者自我照顧行為的影響,研究發現希望可以提供給糖尿病治療團隊的成員與病患參考,並進一步達到提高患者自我照顧行為的遵從性之目的。 本研究為一橫斷性研究,以加入糖尿病照護網的台北市某區域醫院為個案醫院,並以在該院已接受過兩次(包括初診)完整衛教的糖尿病患者為研究對象。本研究於民國九十五年四月四日至五月三十一日,以面訪方式對上述研究對象進行問卷調查,以了解糖尿病患者與其治療團隊成員的互動關係及患者自我照顧行為的執行情形,共成功面訪154份問卷。 本研究的主要發現如下: 一、糖尿病患者與其治療團隊成員的互動關係 糖尿病患者絕大多數都滿意與其治療團隊成員的互動關係,尤其是與糖尿病衛教護理師以及營養師的互動關係方面,約有90%的患者都給予高度的認同。就糖尿病患者的特性與其治療團隊成員的互動關係而言,僅有年齡此變項與新陳代謝科的醫師互動達到統計上的顯著意義。複迴歸分析的結果則顯示,糖尿病患者的特質僅對於與新陳代謝科醫師互動關係此應變項達顯著的影響力,對於與糖尿病衛教護理師以及營養師的互動關係方面則均未達統計上的顯著意義。 二、患者的自我照顧行為 受訪的糖尿病患者在自我照顧行為方面,以「藥物與血糖的自我照顧及定期回診」此項行為平均得分最高。而就互動關係與患者的自我照顧行為之相關性而言,糖尿病患者與衛教營養師的互動關係越好,在其飲食自我照顧行為的執行度則越高。糖尿病患者若與整個治療團隊成員的互動關係越好,在其藥物與血糖的自我照顧行為以及定期回診的執行度則越高。就患者特質與其自我照顧行為之相關性而言,70歲以上的患者在飲食自我照顧行為控制上比30-49歲的患者為佳。罹病時間在二年至未滿五年及滿十年以上的患者,在服藥狀況、血糖監測及定期回診方面都比五年至未滿十年的患者為佳。而複迴歸分析的結果則顯示,患者的特質及與其治療團隊成員的互動關係對患者的「飲食」與「藥物與血糖的自我照顧及定期回診」這兩項行為具有顯著性的影響力。 根據研究結果,本研究提出以下的建議: 一、針對糖尿病治療團隊的建議 醫師應開設「衛教門診」以增進醫病關係,並加強病人正確的衛教觀念及提高患者自我照顧行為的執行程度。治療團隊成員針對自我照顧行為執行度較差的個案應加強衛教或採行個案管理的方式。另一方面,醫院可以多舉辦病友團體講座,透過病友的經驗分享與鼓勵,使患者更有信心控制好糖尿病。 二、對未來研究者的建議 後續研究者可以從醫病雙方分別發放問卷進行調查,以了解糖尿病治療團隊成員與患者的互動感受之間是否有落差,進而找出需改善的部份。此外,未來研究者也可運用糖尿病共同照護網的病患護理及營養衛教的相關記錄檔案,可使研究結果更為客觀且深入。
英文摘要 The purpose of this research was to investigate the impact of the interaction between diabetic patients and their health care providers team and patients’ characteristics on patients’ self-care behavior. Research findings may help to increase compliance of diabetic patients regarding their self-care behavior. The cross-sectional study took place at one regional hospital of Taipei which has joined the medical care network of diabetics. The research used face-to-face interview with diabetic patients at the sample hospital, from April 4th to May 31st 2006. In the end, 154 patients were successfully interviewed. The main results of the research were as follows: 1. Interaction between diabetic patients and their health care providers team (1)Ninety percent of diabetic patients felt satisfied with the interaction with their health care providers team, especially with nurses and nutritionists. (2)There was the significant difference between patients’ age and the interaction between diabetics and metabolic physicians. (3)Characteristics of diabetic patients was significantly related to the interaction between patients and metabolic physicians, only. 2.Patients’ self-care behavior (1)Among all diabetic patients’ self-care behavior, taking medication was done most well. (2)The interaction between diabetics and nutritionists was significantly related to diabetics’ self-care behavior of diet. (3)The interaction between diabetics and health care providers team was significantly related to diabetics’ self-care behavior of taking medication. (4)Patients over 70 years old conducted self-care behavior of diet better than those between 30 and 49 years old. (5)Patients who had been sick for 2 to 5 years or more than 10 years performed the self-care behavior of taking medication better than those for 5-10 years. (6)Patient’s characteristics and the interaction between diabetics and health care providers team were significantly related to diabetics’ self-care behavior of diet and taking medication . According to research findings, health education clinics can improve the doctor-patient relationship. Besides, health care providers team can use case management to improve diabetics’ self-care behavior. Diabetic patients can share experiences of self-care behavior in the hospital. Further research should compare relationship among diabetics and health care providers team or refer to patients’ health care records to enrich the depth.
論文目次 誌 謝 I 中 文 摘 要 II Abstract IV 目錄 VI 表目次 VIII 圖目次 X 第一章 緒論 1 第一節 研究動機與重要性 1 第二節 研究目的 3 第二章 文獻探討 4 第一節 糖尿病之簡介 4 第二節 糖尿病共同照護網 7 第三節 醫療照護提供者與病患間的互動關係之相關研究 12 第四節 糖尿病患者自我照顧行為 15 第三章 研究方法 18 第一節 研究架構 18 第二節 研究變項及其操作型定義 20 第三節 研究假說 24 第四節 研究對象 25 第五節 研究工具 26 第六節 資料蒐集方法 27 第七節 資料處理與分析方法 28 第四章 結果 29 第一節 受訪者的基本資料分析結果 29 第二節 糖尿病患者與其治療團隊成員的互動關係 31 第三節 糖尿病患者的自我照顧行為 36 第四節 病患特質與其治療團隊成員的互動關係之分析 41 第五節 影響糖尿病患者的自我照顧行為之相關因素 51 第五章 討論 73 第一節 重要研究發現 73 第二節 研究限制 75 第三節 結論 76 第四節 建議 77 參考文獻 79 頁數 附錄一 原始問卷 82 附錄二 專家內容效度專家名單與背景一覽表 85 附錄三 問卷專家效度評量結果 85 附錄三 問卷專家效度評量結果 86 附錄四 正式研究問卷 98
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系統識別號 U0007-1704200715050228
論文名稱(中文) 門診精神分裂病患者憂鬱之相關因素探討
論文名稱(英文) Exploring the Related Factors With Depression in Schizophrenic Outpatients
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 唐珊
學號 G455091017
學位類別 碩士
語文別 中文
口試日期
論文頁數 162頁
口試委員 指導教授-蔡欣玲
指導教授-劉淑娟
關鍵字(中) 精神分裂病
憂鬱
精神症狀
錐體外徑症狀
自我照顧
社會支持
關鍵字(英) schizophrenia
depression
psychiatric symptoms
extrapyramidal symptoms
self-care
social support
學科別分類
中文摘要 本研究目的在探討門診精神分裂病患者憂鬱之相關因素,包括個人因素、疾病因素、自我照顧、社會支持等因素。採橫斷式之研究設計,以立意取樣,在台中市某醫學中心精神科門診選取精神分裂病患者為研究對象,共計收案143名。研究工具為結構式問卷,內容包括基本資料、社區精神病患症狀評量表、錐體外徑症狀評量表、自我照顧量表及社會支持量表。由研究者親自訪談患者,所得資料以描述性及推論性統計進行分析。 研究結果發現:(1)門診精神分裂病患者之活性症狀以「妄想」、「幻覺」較常見,負性症狀以「活力低、沒有朝氣」、「不喜歡活動」較常見。整體精神症狀介於無到輕度之間。(2)錐體外徑症狀以「四肢僵硬,動作緩慢不靈活」、「臉部表情少、僵硬」較常見,整體錐體外徑症狀介於無到輕度之間。(3)患者自我照顧執行狀況與獨立程度皆以「生理性自我照顧」較佳,其次是「健康性自我照顧」,「社會性自我照顧」較差。(4)社會支持方面,患者主觀感受來自家人親戚及醫療人員之支持程度為中等偏佳程度;來自同學朋友之支持程度則為中等偏差程度。(5)49%患者有顯著憂鬱症狀,男性憂鬱比率高於女性,憂鬱症狀以「自我輕視」、「憂鬱情緒」較常見。整體憂鬱症狀介於無到輕度之間。(6)患者憂鬱的高相關因素:男性、與父母及兄弟姊妹同住、生活費主要來源為父母或兄弟姊妹、食慾改變(尤其是食慾降低)、睡眠品質差、精神症狀及錐體外徑症狀嚴重、自我照顧執行狀況差及獨立程度低、主觀感受之社會支持程度低者。(7)「負性症狀」、「活性症狀」、「睡眠」、「同學朋友的社會支持」及「進食」等五項為憂鬱的顯著預測因子,其解釋的總變異量為39.5% ,其中以「負性症狀」及「活性症狀」之預測力較佳,可以解釋25.3%變異量。 本研究結果可協助精神科護理人員評估及了解門診精神分裂病患者之精神症狀、錐體外徑症狀、自我照顧及社會支持與憂鬱的相關性,作為相關照護計畫之參考,以協助患者減輕及避免憂鬱發生,並增加其對憂鬱的處置能力,進而提升醫療的照護品質。 關鍵詞:精神分裂病、憂鬱、精神症狀、錐體外徑症狀、 自我照顧、社會支持。
英文摘要 The purpose of this study was to explore the related factors with depression in schizophrenic outpatients, including the personal demographic data, psychopathology, extrapyramidal symptoms, ability of self-care and social support. This study was a cross-sectional design. One hundred and forty three schizophrenic outpatients from a medical center in Taichung city, were recruited in the study. A structured questionnaire with six components was used, including: (1) Personal Demographic questionnaires, (2) Psychotic Symptoms Scale, (3) extrapyramidal symptoms scale, (4) Self-care Questionnaire, (5) Social Support Questionnaire, (6) Calgary Depression Scale for Schizophrenia. The results of this study showed that: (1) “Delusion” and “hallucination” were more common positive symptoms of schizophrenic outpatients, and “low vitality or no vigor” and “poor activity” were more common negative symptoms. The average grading of Psychotic Symptoms was between asymptomatic and mild. (2) “Rigidity of extremities, brady kinesia” and “mask face” were more common extrapyramidal symptoms. The average grading of extrapyramidal symptoms was between asymptomatic and mild. (3) The performance and independence of subjects’ self-care were better expressed by physical self-care, followed by health self-care and social self-care. (4) The social support from families and health caregivers was rated higher than medium level. The social support from friends was rated lower than medium level. (5) Up to 49% of the subjects were symptomatically depressed, and the male were more depressed than the female. “Self-depreciation” and “depressive mood” were more common depressive symptoms. The average grading of depressive symptoms was between asymptomatic and mild. (6) The significant risk factors related to depression were male gender, living with original family, living expenses from original family, appetite change, sleep disturbance, severity of psychotic symptoms and extrapyramidal symptoms, poor self-care performance and independence, poor social support from friends. (7) The significant predictors for depression in schizophrenia were “negative symptoms”, “positive symptoms”, “sleep”, “social support from friends” and “appetite”, which accounted for 39.5% of total variances. The “negative symptoms” and “positive symptoms” were more predictor, which accounted for 25.3% of total variances. The results of the study highlighted the important relationship between psychotic symptoms, extrapyramidal symptoms, self-care, social support and depression. It provides important reference for psychiatric care plan, focusing on preventing and reducing the severity and incidence of depression in schizophrenic outpatients. Therefore, it enhances the quality of psychiatric nursing. Key words: schizophrenia, depression, psychiatric symptoms, extrapyramidal symptoms, self-care, social support
論文目次 目 錄 頁 碼 致 謝 ----------------------------------------------------------------------- Ⅰ 中文摘要 ----------------------------------------------------------------------- Ⅲ 英文摘要 ----------------------------------------------------------------------- Ⅴ 目 錄 ----------------------------------------------------------------------- Ⅷ 圖表目次 ----------------------------------------------------------------------- XI 第一章 緒論 ------------------------------------------------------------------- 1 第一節 研究動機及研究重要性 ------------------------------------- 2 第二節 研究目的 ------------------------------------------------------- 5 第三節 名詞定義 ------------------------------------------------------- 6 第二章 文獻查證 -------------------------------------------------------------11 第一節 精神分裂病患者憂鬱之相關概念 ------------------------ 11 第二節 精神分裂病患者憂鬱之相關因素 ------------------------ 23 第三節 精神分裂病患者憂鬱之心理社會因素 ------------------ 30 第三章 研究方法 ------------------------------------------------------------ 43 第一節 研究問題 ------------------------------------------------------ 43 第二節 研究架構 ------------------------------------------------------ 44 第三節 研究設計 ------------------------------------------------------ 46 第四節 研究對象及場所 -------------------------------------------- 47 第五節 研究工具 ----------------------------------------------------- 48 第六節 研究工具之信效度------------------------------------------- 53 第七節 研究步驟 ----------------------------------------------------- 58 第八節 資料處理與分析---------------------------------------------- 60 第九節 倫理考量------------------------------------------------------- 62 第四章 研究結果 ------------------------------------------------------------63 第一節 精神分裂病患者個人因素之描述------------------------- 64 第二節 精神分裂病患者疾病因素之描述------------------------- 71 第三節 精神分裂病患者自我照顧之評量結果------------------- 80 第四節 精神分裂病患者社會支持之評量結果------------------- 85 第五節 精神分裂病患者憂鬱之評量結果------------------------- 91 第六節 精神分裂病患者個人因素、疾病因素、 自我照顧、社會支持與憂鬱之相關性------------------ 93 第七節 精神分裂病患者憂鬱之重要預測因子------------------107 第五章 討論 第一節 精神分裂病患者之憂鬱 ---------------------------------- 111 第二節 精神分裂病患者個人因素與憂鬱之關係-------------- 113 第三節 精神分裂病患者疾病因素與憂鬱之關係---------------116 第四節 精神分裂病患者自我照顧與憂鬱之關係-------------- 119 第五節 精神分裂病患者社會支持與憂鬱之關係-------------- 121 第六節 精神分裂病患者憂鬱之重要預測因子----------------- 124 第六章 結論與建議 ------------------------------------------------------- 126 第一節 結論 ---------------------------------------------------------- 126 第二節 護理之運用與建議------------------------------------------129 第三節 研究限制----------------------------------------------------- 132 參考資料: 中文部份 ---------------------------------------------------------------- 133 英文部份 ---------------------------------------------------------------- 138 附錄: 附錄一 精神分裂病患者憂鬱的診斷流程圖 ----------------- 146 附錄二 社會階層等級表 ------------------------------------------- 147 附錄三 病人參與研究同意書 ------------------------------------- 148 附錄四 問卷內容專家效度名單 ---------------------------------- 149 附錄五 研究問卷 ---------------------------------------------------- 150 附錄六 量表使用同意書 ------------------------------------------- 166 圖表目次 頁 碼 圖一 研究架構 --------------------------------------------------------------- 45 表一 各量表之信度檢測 --------------------------------------------------- 57 表二 資料分析方法 --------------------------------------------------------- 61 表三 研究對象個人因素-基本資料分佈 ------------------------------ 67 表四 研究對象目前最擔心的事之排序 --------------------------------- 69 表五 研究對象個人因素-生活習慣分佈 ------------------------------ 70 表六 研究對象疾病因素-疾病史分佈 --------------------------------- 72 表七 研究對象疾病因素-精神症狀各向度之評量結果 ------------ 76 表八 研究對象疾病因素-精神症狀各項目之評量結果 ------------ 76 表九 研究對象疾病因素-錐體外徑症狀各向度之評量結果 ------ 79 表十 研究對象疾病因素-錐體外徑症狀各項目之評量結果 ------ 79 表十一 研究對象自我照顧-執行狀況各向度之評量結果 --------- 83 表十二 研究對象自我照顧-執行狀況各項目之評量結果 --------- 83 表十三 研究對象自我照顧-獨立程度各向度之評量結果 --------- 84 表十四 研究對象自我照顧-獨立程度各項目之評量結果 ----------84 表十五 研究對象社會支持各面向之評量結果 ------------------------ 87 表十六 研究對象社會支持-家人親戚各向度之評量結果 --------- 88 表十七 研究對象社會支持-家人親戚各項目之評量結果 --------- 88 表十八 研究對象社會支持-同學朋友各向度之評量結果 --------- 89 表十九 研究對象社會支持-同學朋友各項目之評量結果 --------- 89 表二十 研究對象社會支持-醫療人員各向度之評量結果 --------- 90 表二十一 研究對象社會支持-醫療人員各項目之評量結果 ------ 90 表二十二 研究對象憂鬱量表之評量結果 ------------------------------ 92 表二十三 研究對象憂鬱量表各項目之評量結果 --------------------- 92 表二十四 研究對象憂鬱量表評量結果之分佈 ------------------------ 92 表二十五 研究對象個人因素-基本屬性與憂鬱之差異性分析----- 96 表二十六 研究對象個人因素-生活習慣與憂鬱之差異性分析----- 98 表二十七 研究對象疾病因素與憂鬱之差異性分析 ------------------ 99 表二十八 研究對象治療藥物種類與BMI之差異性分析 -----------101 表二十九 研究對象個人因素、疾病因素-疾病史等距變項與 憂鬱之相關分析-------------------------------------------------101 表三十 研究對象疾病因素-精神症狀與憂鬱之相關分析-------102 表三十一 研究對象自我照顧與憂鬱之相關分析----------------------104 表三十二 研究對象社會支持與憂鬱之相關分析 ---------------------106 表三十三 階層式複迴歸分析-精神分裂病患者憂鬱程度之預測---109
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系統識別號 U0007-2202201008143900
論文名稱(中文) 腹膜透析病患治療成效之相關因素探討
論文名稱(英文) Factors Related to Treatment Outcome in Peritoneal Dialysis Patients
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 98
學期 1
出版年 99
研究生(中文) 廖秋萍
學號 M406095007
學位類別 碩士
語文別 中文
口試日期 2009-01-15
論文頁數 129頁
口試委員 指導教授-廖媛美
委員-陳品玲
委員-林秋菊
關鍵字(中) 腹膜透析
治療成效
生活品質
自我照顧自我效能
自我照顧行為
關鍵字(英) Peritoneal dialysis
Treatment outcome
Quality of life
Self-care efficacy
Self-care behavior
學科別分類
中文摘要 本研究為橫斷式之描述性、相關性研究,旨在瞭解腹膜透析病患之自我照顧自我效能、自我照顧行為及治療成效,探討個人基本資料、疾病特性、自我照顧自我效能及自我照顧行為與治療成效之關係,並探討影響治療成效之的相關因素。研究對象為來自臺北地區兩所醫學中心及兩所區域教學醫院之200位腹膜透析病患,研究者採用自擬式結構性問題、「CAPD自我效力量表」、「CAPD自我照顧量表」、「臺灣簡明版世界衛生組織生活品質問卷」及病患之病歷完成資料收集,以描述性統計、皮爾森積差相關值檢定(Pearson's correlation)、單因子變異數分析(one way ANOVA)、獨立t檢定(t-test)、強迫進入變數法迴歸分析(enter multiple regression)及邏輯斯迴歸分析(Logistic regression)進行資料處理與統計分析。
研究結果顯示:本研究腹膜透析病患之自我照顧自我效能量表得分平均值為208.75±28.09分(range = 0~250),自我照顧行為量表得分平均值為219.13±30.07分(range = 0~250)。自我照顧自我效能各因素之得分,以處理異常狀況之得分最高,調整生活型態之得分最低。自我照顧行為各因素得分以護理導管及導管出口處之得分最高,調整生活型態之得分最低。腹膜透析病患生活品質之總分平均得分為91.88±14.81分(range = 28~140),量表中環境功能層面之得分最高,心理層面之得分最低。本研究大部分腹膜透析病患達到美國腎臟醫學會建議之標準的治療成效指標:每週尿素氮(BUN)清除率Kt/V平均值為2.08±0.47(建議標準:>1.7)血清白蛋白濃度為3.90±0.52 gm/dl(建議標準:>4.0 gm/dl);血比容積為30.82±4.70%(建議標準:33~36%);正常化蛋白質代謝率為1.03±0.23 gm(建議標準:>0.9 gm)。透析院所、性別、年齡、宗教信仰、個人收入、家庭收入、合併罹患其他慢性疾病及自我照顧自我效能,為可能影響腹膜透析病患治療成效之相關因素。
相關因素之確認,可協助健康政策擬定者制定合適的相關政策、協助臨床照護者發展有效之健康促進介入措施。為促進病患之治療成效,可使用以下之策略;例如:落實透析病患相關之社會福利措施、提供透析專業人員訓練及繼續教育、定期舉辦個人/團體護理指導、建立腎友支持性團體及提供腹膜透析病患之持續訓練等。
英文摘要 This study was a cross-sectional, descriptive, correlational study. Research aims were: (a) to understand peritoneal dialysis patients’ self-care efficacy, self-care behavior, and treatment outcomes, and (b) to examine the relationships between patients’ treatment outcomes and individual characteristics, disease-related characteristics, self-care efficacy, and self-care behavior, and (c) to explore possible factors related to patients’ treatment outcomes. The 200 subjects of this study were recruited from the peritoneal dialysis centers at two medical centers and two regional hospitals in Taipei. Self-developed questions, CAPD self- efficacy scale, CAPD self-care scale, the Taiwanese world organization quality of life-BREF, and patients’ medical records were used to collect the related information. Data analyses were completed by descriptive statistics, Pearson’s correlation, one way ANOVA, independence t test, enter multiple regression and Logistic regression.
Study results showed the mean scores of the peritoneal dialysis patients’ self-care efficacy and self-care behavior were 208.75±28.09 (range = 0~250) and 219.13±30.07 (range = 0~250), respectively. The result of CAPD self- efficacy factors, the highest score was found at the managing abnormal conditions factor, and the lowest score was found at the adjusting life style. The result of CAPD self- behavior factors, the highest score was found at the caring for the catheter exit site factor, and the lowest score was found at the adjusting life style. The mean score of peritoneal dialysis patients’ quality of life was 91.88±14.81 (range = 28~140). With the highest score was found at the environment domain, and the lowest score was found at the psychological domain. The majority treatment outcomes were within the standard levels recommended by the National Kidney Foundation: Kt/V 2.08±0.47 (recommendation: >1.7), serum albumin 3.90±0.52 gm/dl (recommendation: > 4.0gm/dl), hematocrit 30.82±4.70% (recommendation: 33-36%), and nPNA 1.03±0.23 gm (recommendation: > 0.9gm). Study results also showed peritoneal dialysis patients’ treatment outcomes were associated with dialysis institution, gender, age, religion, personal income, family income, co morbidities and self-care efficacy.
Confirming the possible factors related to peritoneal dialysis patients’ treatment outcomes could help policy makers constitute appropriate health care policies and help clinical healthcare providers develop related health promotion interventions. In order to improve patients’ treatment outcomes, the following strategies could be utilized: accomplishing related social welfare policy, providing professional personnel’s continuing training/education, conducting patient individual/group consult, constructing patient support groups, and delivering patients’ retraining program.
論文目次 目 錄
頁數
致 謝………………………………………………………… Ⅰ
中文摘要………………………………………………………… Ⅱ
英文摘要………………………………………………………… Ⅵ
目 錄………………………………………………………… Ⅶ
圖表目次………………………………………………………… Ⅹ
第壹章 緒論
第一節 研究動機及重要性 ……………………………… 1
第二節 研究目的 ………………………………………… 6
第三節 名詞定義 ………………………………………… 7
第四節 研究假設 ………………………………………… 9
第五節 概念架構…………………………………………… 10
第貳章 文獻查證
第一節 腹膜透析 ………………………………………… 12
第二節 腹膜透析治療成效………………………………… 17
第三節 影響腹膜透析治療成效之相關因素……………… 24


頁數
第叁章 研究方法
第一節 研究設計…………………………………………… 35
第二節 研究對象 ………………………………………… 36
第三節 研究工具 ………………………………………… 37
第四節 研究步驟………………………………………….. 45
第五節 資料分析 ………………………………………… 47
第肆章 研究結果
第一節 個人基本資料、疾病特性、自我照顧自我效能及自我照顧行為………………………………………

53
第二節 治療成效……………………….…………………. 64
第三節 個人基本資料及疾病特性與治療成效之關係…… 68
第四節 自我照顧自我效能及自我照顧行為與治療成效之關係…………………………………………………

75
第五節 影響治療成效之相關因素…………..…………… 78





頁數
第伍章 討論
第一節 自我照顧自我效能與自我照顧行為……………… 82
第二節 治療成效…………………………………..……… 85
第三節 影響治療成效之相關因素……………………….. 90
第四節 研究限制與建議…………………………………. 96
第五節 結論……………………………………..………… 99
參考資料
中文部分 …………………………………………………… 101
英文部分……………………………………………………… 110
附錄
附錄一、臺北地區公私立教學醫院腹膜透析院所名單及病人數

118
附錄二、受訪者同意書…………………………………… 119
附錄三、個人基本資料與疾病特性問卷…………………… 121
附錄四、腹膜透析自我效力量表..…………………..……… 122
附錄五、腹膜透析自我照顧量表..……………..…………… 125
附錄六、臺灣簡明版世界衛生組織生活品質問卷…..……… 128

圖表目次
圖目次 頁數
圖一 概念架構…………………………………………………… 11
圖二 資料收集流程……………………………………………… 52




















表目次 頁數
表一 個人基本資料各變項之問卷題目、答案選項及編碼方式… 39
表二 疾病特性各變項之問卷題目、答案選項及編碼方式…… 40
表三 研究資料之描述性統計分析……………………………… 50
表四 研究資料之推論性統計分析……………………………… 51
表五 個人基本資料……………………………………………… 54
表六 疾病特性…………………………………………………… 57
表七 自我照顧自我效能量表各因素得分……………………… 58
表八 自我照顧自我效能量表單項題目得分………..…………… 59
表九 自我照顧行為量表各因素之得分………………………… 61
表十 自我照顧行為量表單項題目得分………………………… 62
表十一 生活品質量表各層面得分……………………………… 65
表十二 生活品質量表單項題目得分…………………………… 66
表十三 治療成效…………………………………………….…… 67
表十四 個人基本資料與之治療成效之關係……………..……… 70
表十五 疾病特性與治療成效之關係…………………………….. 74
表十六 治療成效之邏輯斯迴歸分析…………...…………….…. 77
表十七 治療成效之強迫進入變數法迴歸分析…………………. 81
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系統識別號 U0007-2807200921415800
論文名稱(中文) 在職工作之心臟衰竭患者疾病知識、自我照顧行為與睡眠品質之探討
論文名稱(英文) Study of Disease Knowledge, Self-Care Behavior and Sleep Quality of Workers With Chronic Heart Failure
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 97
學期 2
出版年 98
研究生(中文) 吳曉雲
學號 G455096009
學位類別 碩士
語文別 中文
口試日期 2009-07-13
論文頁數 94頁
口試委員 指導教授-邱艶芬
委員-蔡仁貞
委員-曹麗英
關鍵字(中) 心臟衰竭
疾病知識
自我照顧行為
睡眠品質
關鍵字(英) heart failure
disease knowledge
self-care
sleep quality
學科別分類
中文摘要 本研究目的主要探討在職工作之心臟衰竭病患的疾病知識、自我照顧行為與睡眠品質結果之相關性,以作為確認國內仍在職工作之心臟衰竭病患自我照顧行為之現況,以建立此類病患自我照顧相關之資料參考。本研究收案對象為北部某區域教學醫院心臟衰竭門診病患共50位,以結構式問卷分疾病知識、自我照顧行為、睡眠品質等三部份填答,並運用心率變異測量儀紀錄患者之心率變異度。所得資料以 SPSS 16.0套裝軟體進行資料分析與檢定。
研究結果顯示:1.本研究之研究對象在疾病知識方面之認知程度不高,其整體知識總平均得分僅有7.5±3.9。2.年齡、教育程度與疾病知識以及教育程度與自我照顧行為在統計上達顯著差異(p< .05)。3. 整體性自我照顧行為與整體性疾病知識呈現正相關(r = .54, p< .01)。4.研究對象之基本屬性與睡眠品質在統計上均未達顯著差異,但其中NYHA疾病分級與白天嗜睡情形在統計上達顯著差異(p< .05)。5. 研究對象之HRV與睡眠品質好壞及白天嗜睡情形均無統計上之顯著差異。
藉由本研究結果能讓護理人員知道病患實際上的專業需求,並在適時適切的護理時機下,協助患者產生動機及認知到自我照顧對疾病治療的重要性,使其能與疾病共存,進而達到良好的自我照顧。
英文摘要 The purpose of this study was to investigate the relationship amount the disease knowledge, self-care abilities and self-reported sleep quality of patients with heart failure but still in working. According to our study, we can confirm the current condition of self-care abilities in heart failure workers and establish the database of this kind of patients.
We recruited fifty patients with heart failure from cardiologist outpatient clinics of a regional teaching hospital in the Northern Taiwan. We used structured questionnaire to analyze the disease knowledge, self-care abilities and self-reported sleep quality of these patients. Their short-term heart rate variability (HRV) was also examined. All Data was analyzed with SPSS 16.0 software package.
Our result revealed that: 1. The disease knowledge cognition level of our subjects was low and the total knowledge cognition score was only 7.5±3.9. 2. There was significant relationship between age, education level, disease knowledge and self-care abilities (p< .05). 3. There was positive correlation between self-care ability and total disease knowledge score (r= .54, p< .01). 4. There was no significant correlation between the characteristics of the subjects and their self-reported sleep quality. There was significant correlation between New York Heart Association (NYHA) classification and daytime sleepiness (p< .05). 5. There was no significant correlation between HRV parameters, self-reported sleep quality and daytime sleepiness.
This study is helpful for nurses to understand the importance of self-care of these patients. Under proper nursing situations, they can help patients to motivate and understand the importance of self-care. This can lead to the best self-care of these patients.
論文目次 致 謝…………………………………………………………………Ⅰ
中文摘要…………………………………………………………………Ⅱ
英文摘要…………………………………………………………………Ⅳ
目 錄…………………………………………………………………Ⅵ
圖表目次…………………………………………………………………Ⅹ
第壹章 緒論
第一節 研究動機及重要性 ………………………………………
1
第二節 研究目的 …………………………………………………
3
第三節 研究假說 …………………………………………………
4
第四節 名詞定義 …………………………………………………
4
第貳章 文獻查證
第一節 心臟衰竭 …………………………………………………
6
第二節 心臟衰竭與心率變異度…………………………………
9
第三節 疾病知識對心臟衰竭患者之重要性 ……………………
12
第四節 心臟衰竭患者之疾病知識與自我照護 …………………
13
第五節 心臟衰竭患者之睡眠困難 ………………………………
16
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第六節 研究架構 …………………………………………………
21
第叁章 研究方法
第一節 研究對象及地點 …………………………………………
23
第二節 研究設計 …………………………………………………
23
第三節 研究工具 …………………………………………………
24
第四節 資料收集過程 ……………………………………………
29
第五節 資料分析 …………………………………………………
30
第六節 研究倫理考量 ……………………………………………
31
第肆章 研究結果
第一節 在職工作之心臟衰竭病患基本特性……………………
32
第二節 在職工作之心臟衰竭病患的疾病知識…………………
36
第三節 在職工作之心臟衰竭病患的自我照顧行為……………
40
第四
節 在職工作之心臟衰竭病患背景資料與其疾病知識及自
我照顧行為之關係………………………………………
45
第五節
在職工作之心臟衰竭病患其自我照顧行為與疾病知識之相關性…………………………………………………
48
第六節 在職工作之心臟衰竭病患的睡眠品質…………………
51
第七節 在職工作之心臟衰竭病患背景資料與其睡眠品質之關
係…………………………………………………………
56
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第八節
在職工作之心臟衰竭病患其自我照顧行為與睡眠品質
之相關性…………………………………………………
59
第九節 在職工作之心臟衰竭病患其睡眠品質與HRV之差異…
61
第伍章 討論
第一節 在職工作之心臟衰竭病患的疾病知識與自我照顧行為…………………………………………………………
65
第二節
在職工作之心臟衰竭病患背景資料與疾病知識、自我照
顧行為的關係……………………………………………
68
第三節
在職工作之心臟衰竭病患的疾病知識與自我照顧行為
的相關性…………………………………………………
70
第四節 在職工作之心臟衰竭病患的睡眠品質及其相關影響…
71
第五節 不同睡眠品質的在職工作之心臟衰竭病患其HRV之差異…………………………………………………………
72
第陸章 結論與建議
第一節 結論…………………………………………………………
74
第二節 建議…………………………………………………………
76
第三節 研究限制與展望……………………………………………
77
第柒章 參考文獻
中文部分…………………………………………………………………
79
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英文部分…………………………………………………………………
80
附錄1、基本資料問卷……………………………………………………
87
附錄2、心臟衰竭知識量表………………………………………………
88
附錄3、自我照顧行為量表………………………………………………
89
附錄4、匹茲堡睡眠品質量表……………………………………………
90
附錄5、EPWORTH嗜眠程度評量表(ESS)………………………………
91
附錄6、心率變異測量儀及資料…………………………………………
92
附錄7、受試者同意書……………………………………………………
94
附錄8、人體試驗研究計畫執行許可書…………………………………
97
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系統識別號 U0007-2807201015500100
論文名稱(中文) 愛滋病患者憂鬱程度與自我照顧行為相關因素之探討
論文名稱(英文) Factors Related to Depression and Self Care Behavior With AIDS Patients
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 98
學期 2
出版年 99
研究生(中文) 張簡英茹
學號 G455095004
學位類別 碩士
語文別 中文
口試日期 2010-07-08
論文頁數 98頁
口試委員 指導教授-鄭綺教授
委員-賴甫誌助理教授
委員-柯乃熒
關鍵字(中) 愛滋病
憂鬱程度
自我照顧行為
關鍵字(英) AIDS patients
self-care behavior
depression level
學科別分類
中文摘要 論文名稱:愛滋病患者憂鬱程度與自我照顧行為相關因素之探討
研究所名稱:臺北醫學大學護理學研究所
研究生姓名:張簡英茹
畢業時間:九十八學年度第二學期
指導教授:鄭綺 臺北醫學大學護理學研究所教授
本研究旨在探討愛滋病患者的憂鬱程度與自我照顧行為的相關因素。本研究為描述性、相關性研究,以結構式問卷及訪談方式對研究對象進行橫斷式研究。研究對象以北部區域醫院與關愛之家愛滋病人為母群體,共收案121名,研究工具包括「基本資料表」、自擬之「自我照顧行為量表」與「貝克憂鬱量表」共三部份,自擬之自我照顧行為量表共15題,分為四大類,經專家效度檢定,取內容重要性CVI達 .86之項目,信度檢定採取內在一致性Chronbach’s Alpha值為 .70。研究資料以SPSS 17.0統計軟體進行次數、百分比、平均值、標準差等描述性統計,推論統計則以獨立t檢定(t-test)、單因子變異數分析(One way ANOVA)、皮爾森積差相關值檢定(pearson’s correlation)與Multiple Regression with stepwise進行資料處理與統計分析。研究結果顯示:
一、本研究對象憂鬱程度得分平均值為10.93分(標準差為±8.81分)。
二、自我照顧行為量表得分平均值為33.26分(標準差為±4.79分)。
三、研究對象之基本屬性與憂鬱程度在統計上均未達顯著差異。
四、「是否使用抗病毒藥物」與自我照顧行為在統計上有顯著差異(t= -8.01, p= .00)。
五、整體自我照顧行為與憂鬱未有顯著相關(r=-.16, p = .08),進一步分析憂鬱與自我照顧行為四大面向的「飲食與運動」項目呈顯著負相關(r= -.19, p= .03)。
六、具有中度憂鬱(n=17)以上的研究對象,其「是否服用抗病毒藥物」為預測憂鬱之主要變項,整體解釋達41.7%(F=10.72, p= .05)。
七、使用抗病毒藥物是預測自我照顧行為之主要變項,整體解釋力達35%(F=64.25, p= .00),具輕度憂鬱傾向(BDI>19)者(n=47),使用抗病毒藥物與經濟情況(薪水)為預測自我照顧行為之主要變項(F=21.17, p= .00),整體解釋力達37%。
本研究結果可了解愛滋個案的憂鬱程度與自我照顧行為現況與影響因素,提供臨床醫護人員照護愛滋病人參考,及早察覺其憂鬱傾向,給予適切性護理,使個案能與疾病自然共存,進而達到良好自我照顧行為以增進生活品質。
關鍵字:愛滋病、憂鬱程度、自我照顧行為
英文摘要 Title of Thesis: Factors Related to Depression and Self care behavior With AIDS Patients
Institution: Graduate Institute of Nursing, Taipei Medical University
Author: Ying-Ru Chang Chien
Thesis directed by: Chii Jeng, Ph.D., Professor

The purpose of this study was to investigate the factors related to depression and self -care behavior in AIDS patients.
The study was in a cross-sectional and correlational research design with convenience sampling technique applied in this study. Participants included 121 AIDS patients recruited from two local teaching hospitals and Harmony Home association in Taipei.
The research instruments administered were as follows:
(1) Demographic and disease characteristics;(2) Beck Depression Inventory;(3) The Self-care behavior Scale. The self-established self-care scale included four dimensions with fifteen items which was carried out under the circumstances of CVI= .86 and Chronbach’s Alpha .70. Data were analyzed by descriptive statistics, correlation, independent sample t-tests, and multiple regression analysis. Data analysis was conducted with the SPSS/17.0 Windows software statistical package.
The main results are as follows: (1)the mean score of Beck Depression Inventory was10.93±4.79;(2) the mean score of self care scale was 33.26±8.80;(3) There were no significant differences in the individual attributes and depression level;(4) significant differences were revealed between “Use the HAART(Anti-viral drugs)” and self care behavior(t =-8.01, p= .00);(5) There was no significant correlation between depression and self care ( r=-.16, p= .08), but there was a negative correlation between depression and “diet and exercise” of self-care behavior(r=-.19, p= .03); (6) “Use the HAART (Anti-viral drugs)” was a significant predictor in moderate depression and explained 41.7% of the variation (F=10.72, p= .05); (7)the significant predictor of self -care behavior was “Use the HAART(Anti-viral drugs)” .The variable could explain 35% of the variation (F=64.25, p= .00 ) and “Use the HAART(Anti-viral drugs)” and individual economic circumstance were predictive factors of self -care behavior in mild depression patients(BDI>19), these variables could be explained as 37% of the variations( F=21.17, p= .00 ).
This study is helpful for clinical staff to understand the importance and factors of depression level and self-care behavior of these patients and early detection of the sign of depression in AIDS patients. Under proper nursing situations, they can help patients to understand the importance of self-care, which elevates the quality of self-care of these patients and improves their live quality.
Key words: AIDS patients, self-care behavior, depression level

論文目次 目 錄
頁數
致 謝..............................................Ⅰ
中文摘要............................................III
英文摘要.............................................V
目 錄.............................................VII
圖表目次.............................................XI
第一章 緒論
第一節 研究的重要性與動機............................1
第二節 研究目的......................................4
第三節 研究假設......................................4
第四節 名詞界定......................................5
第二章 文獻查証
第一節 愛滋病人的憂鬱................................6
第二節 愛滋病人的自我照顧行為.......................15
第三節 憂鬱與自我照顧行為的相關性研究...............19
第三章 研究方法
第一節 研究設計.....................................21
第二節 研究對象與取樣...... ........................21
第三節 研究工具及信效度.............................22
第四節 資料收集過程.................................27
第五節 倫理考量.....................................27
第六節 統計方法.....................................28
第四章 研究結果
第一節 研究對象基本資料........................... .30
第二節 愛滋病患者的憂鬱.............................35
第三節 基本屬性對愛滋病患者憂鬱之影響...............38
第四節 愛滋病患者憂鬱的預測因子.....................42
第五節 自我照顧行為.................................43
第六節 基本屬性對自我照顧行為之影響.................47
第七節 自我照顧行為影響的預測因子...................51
第八節 憂鬱與自我照顧行為之相關性...................53
第五章 討論
第一節 研究對象基本屬性.............................55
第二節 憂鬱程度.....................................57
第三節 自我照顧行為.................................61
第六章 結論與建議
第一節 結論 ........................................66
第二節 研究限制 ....................................67
第三節 應用與建議...................................68
參考資料
中文部份............................................71
英文部份............................................75
附錄
附錄一 研究同意書...................................83
附錄二 個案基本屬性資料表...........................86
附錄三 愛滋病人自我照顧行為量表.....................87
附錄四 愛滋病人自我照顧行為量表內容效度專家名單.....88
附錄五 自我照顧行為量表專家鑑定函...................89
附錄六 自我照顧行為量表之專家內容效度評分表.........90
附錄七 自我照顧行為量表專家內容評分結果.............92
附錄八 貝克憂鬱量表.................................94
附錄九 修訂後的自我照顧行為量表.....................96
附錄十 臺北市立聯合醫院人體試驗委院會同意函.........97
圖表目次
頁數
表一 研究目的及統計方法............................29
表二 研究對象基本屬性..............................32
表三 醫療相關資料分佈形............................34
表四 愛滋病患者憂鬱程度............................36
表五 貝克憂鬱量表得分情形..........................37
表六 人口學特性、疾病狀況與憂鬱之得分差異分析......39
表七 愛滋個案憂鬱的相關分析........................41
表八 自我照顧行為量表各題之得分情形............... 45
表九 使用抗病毒藥物與自我照顧行為之差異分析........46
表十 基本屬性和疾病狀況於自我照顧行為量表得分差異分析48
表十一基本屬性和自我照顧行為量表之相關性分析.........50
表十二自我照顧行為之迴歸分析.........................52
表十三憂鬱與自我照顧行為相關分析.....................54


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