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系統識別號 U0007-0902201114165000
論文名稱(中文) 加護病房留置導尿管護理照護方式與醫療照護相關泌尿道感染相關因素探討
論文名稱(英文) Relative Factors of Foley Care Mode In Intensive Care Unit and Healthcare-associated Urinary Tract Infection
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 99
學期 1
出版年 100
研究生(中文) 林煜真
研究生(英文) Yu-Chen Lin
學號 M406096001
學位類別 碩士
語文別 中文
口試日期 2010-12-31
論文頁數 72頁
口試委員 指導教授-邱艶芬
委員-張元玫
委員-羅美芳
中文關鍵字 加護病房  導尿管護理照護  醫療照護相關泌尿道感染 
英文關鍵字 Intensive care unit  Foley care  Healthcare-associated urinary tract infection 
學科別分類
中文摘要 本研究目的主要探討加護病房導尿管護理照護方式與醫療照護相關泌尿道感染之關係,以找尋可改善之空間。本研究將採描述性相關性研究設計,以台北市某醫學中心六個不同成人加護病房中留置導尿管的病人為對象,以立意取樣方式收集個案,採縱貫性追蹤方式,符合收案條件者,經簽屬同意書後以自擬之「病人基本資料調查表」、「導尿管使用與照護調查表」,無特定時間至單位,由直接觀察、護理記錄表單、詢問當班照護之護理人員及病歷記載收集資料,共收案180位。以SPSS 17.0套裝軟體進行資料分析與檢定,並以p<.05作為判斷意義之標準,本研究採用描述性統計、Mann-Whitney U、Fisher’s exact test、Chi-square分析有無發生醫療照護相關泌尿道感染兩組之差異,找尋影響的主要危險因子,並估計相對風險,以Multiple linear Regression估算預測力。
研究結果顯示加護病房導尿管留置原因與發生醫療照護相關泌尿道感染無統計上顯著差異(p>.05) ,而年齡≧70歲、無使用抗生素、平均排尿量<2000ml/day、腹瀉天數≧2day、接觸引流系統前後無洗手、排空引流系統有接觸收集容器,為發生醫療照護相關泌尿道感染危險因子(p<.05);以「排空引流系統是否接觸到收集容器」層面的預測力最佳,其解釋量為38%,其餘依次為「是否使用抗生素」、「腹瀉天數是否≧2day」層面,其解釋量分別為12%、8%,這三個聯合預測力達57%。此結果提供臨床護理照護品質改善的方向,更對於醫療照護相關泌尿道感染發生的高危險群,評估留置之必要性及早期移除之相關指標,期減少發生醫療照護相關泌尿道感染之機率。
英文摘要 The purpose of this research is to explore the relationships between the Foley care mode in intensive care units and healthcare-associated urinary tract infection in order to find a great improvement. This is in descriptive and correlation research design, taking six adult intensive care units in a Taipei medical center as an object.
180 Foley catheter possessed cases are collected by judgment sampling and longitudinal follow-up. The data were collected by patient information sheets and foley care information sheets from direct observation, healthcare records, inquiring on-duty healthcare nursing people and medical records.
SPSS 17.0 is utilized for data analysis and statistical tests; p value set at 0.05. Descriptive statistics, Mann-Whitney U, Fisher's exact test, Chi-square were employed to analyze this significant test of urinary tract infection which happen or not, and seek main danger factors to evaluates the corresponding risk. A multiple linear regression analysis is carried out to predict the values of a dependent variable.
The results shown there were no statistically significant (p< .05) between Foley catheter possessory and healthcare-associated urinary infection. Whether the patient older than or equal to 70 years old? Whether the patient taking antibiotic or not? Whether the average void volume less than 2000ml per day? Whether the patient having diarrhea more than or equal to 2 days? Whether the employ haven't disinfected hand before or after the shunts and drainage system? Whether the employ touched the container of the shunt system while falling? The risk factors of infection were list above, and the most predictable factor was "Whether the employ touched the container of the shunts and drainage system ", which represents 38%, next in sequence was "Whether the patient taking antibiotic or not?" and "Whether the patient having diarrhea more than or equal to 2 days?", which respectively represents 12% and 8%. These three factors had united predictive ability reached 57%.
The results suggest the direction of clinical healthcare improvement, the index of the necessity of possessory of Foley catheter for the high-risk group, reducing the possibility of healthcare-associated urinary tract infection.
論文目次 目 錄
頁數
致 謝....................................................I
中文摘要..................................................II
英文摘要..................................................IV
目 錄..................................................VI
圖表目次..................................................IX

第一章 緒論
第一節 研究動機與目的....................................1
第二節 研究問題..........................................2
第三節 名詞定義..........................................3
第四節 研究範圍..........................................4
第五節 研究意義..........................................4
第二章 文獻查證與概念架構
第一節 院內泌尿道感染之定義..............................6
第二節 加護病房病人尿管留置之必要性及泌尿道感染危險因子..9
第三節 控制泌尿道感染照護標準之相關探討.................11第四節 操作性定義.......................................13

第三章 研究方法
第一節 本研究概念架構........................................................14
第二節 研究設計.........................................15
第三節 研究對象.........................................16
第四節 研究工具.........................................16
第五節 研究工具信效.....................................18
第六節 研究步驟.........................................18
第四章 研究結果
第一節 研究對象之基本資料...............................21
第二節 研究對象之住院期間健康狀況分佈...................23
第三節 研究對象之導尿管使用情形分佈.....................25
第四節 研究對象之導尿管照護情形........................ 26
第五節 研究對象之導尿管引流系統維持密閉與無菌情形...... 27
第六節 醫療照護相關泌尿道感染之相關危險因素分析…...... 29
第五章 討論
第一節 基本資料對醫療照護相關泌尿道感染影響.............31
第二節 住院期間健康狀況對醫療照護相關泌尿道感染影響.....33
第三節 導尿管使用情形對醫療照護相關泌尿道感染影響.......34
第四節 導尿管照護情形對醫療照護相關泌尿道感染影響.......35
第五節 導尿管引流系統維持密閉與無菌情形對醫療照護相關泌尿道感染影響................................................35
第六節 導尿管照護方式與文獻之建議相符性探討.............36
第六章 結論與建議
第一節 結論.............................................39
第二節 建議.............................................41
第三節 研究限制.........................................43

參考文獻
中文部分..................................................44
英文部分..................................................44

附錄
附錄一 病人基本資料調查表...............................55
附錄二 導尿管使用與照護調查表...........................56
附錄三 人體試驗委員會通過書.............................60
附錄四 病人知情同意書...................................62
附錄五 專家內容效度名單.................................66
附錄六 專家效度問卷.....................................67

圖表目次
圖一 加護病房留置導尿管護理執行情形與院內泌尿道感染率相關因素探討之概念架構..........................................14

表一 個案基本資料........................................48
表二 個案住院期間健康狀況................................49
表三 個案導尿管使用......................................50
表四 個案導尿管照護......................................51
表五 引流系統維持密閉與無菌情形..........................52
表六 以單變項分析檢定醫療照護相關泌尿道感染之相關危險因素53
表七 以Multiple linear Regression stepwise檢定醫療照護相關
泌尿道感染之相關危險因素............................54
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