進階搜尋


  查詢北醫館藏
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
研究生(英文) Hsiao-Yun Wu
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
中文關鍵字 心臟衰竭  疾病知識  自我照顧行為  睡眠品質 
英文關鍵字 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
- 8 -
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
- 9 -
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
- 10 -
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
參考文獻 中文部分
史曉寧、林麗蟬、許淑蓮、宋琇鈺(2000)•評價衛教對老年充血性心臟衰竭知識與順從性之效果•慈濟醫學,12,49-57。
行政院衛生署(2007)•民國96年主要死因統計:死亡統計結果分析2008•年7月6日取自http://www.doh.gov.tw/statistic/data/衛生統計叢書2/96/記者會專區/index.htm
林敏玲、邱艶芬(2001)•花蓮地區心臟衰竭病患對疾病認知、態度及自我照顧行為相關性之探討•慈濟醫學,13(1),57-64。
林雅蘋、蔡芸芳(2001)•系統性護理指導對心臟衰竭患者疾病知識、態度及自我照顧行為之影響•慈濟醫學,13(2),105-111。
- 88 -
林嘉玲、蘇東平、張媚(2003)•機構老人之睡眠品質及其相關因素•台灣醫學,7(2),174-184。
高紀惠(2005)•NANDA護理診斷手冊2005~2006 (三版)•台北:華杏。
陳淑如、蔡月霞、羅映琪、蔡宜珊、鄭綺(2005)•心率變異度的簡介及護理上的應用•新台北護理期刊, 7(1),1-11。
賴裕和、林佳靜、廖媛美、鄭素月、林美良、鄭綺、陽莉娌、魏玲玲、方
薇雲合譯(2003﹚•拉克曼內外科護理學•台北:華杏。
謝博生、楊泮池、林肇堂、李明濱(2002)•一般醫學疾病概論(上冊)•台北:國立臺灣大學醫學院。
英文部分
Arora, R., Krummerman, A., Vijayaraman, P., Rosengarten, M., Suryadevara, V., Lejemtel, T., et al. (2004). Heart Rate Variability and Diastolic Heart Failure. Pacing and clinical electrophysiology 27, 299-303.
Backhausa, J., Junghannsa, K., Broocksa, A., Riemannb, D., & Hohagen, F. (2002). Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research, 53(3), 737– 740.
Baldwin, C. M., Griffith, K. A., Nieto, F. J., O'Connor, G. T., Walsleben, J. A., & Redline, S. (2001). The Association of Sleep-Disordered Breathing and Sleep Symptoms with Quality of Life in the Sleep Heart Health Study. SLEEP, 24(1), 96-105.
Beck, S. L., Schwartz, A. L., Towsley, G., Dudley, W., & Barsevick, A. (2004).
- 89 -
Psychometric Evaluation of the Pittsburgh Sleep Quality Index in Cancer Patients. Journal of Pain and Symptom Management, 27(2), 140-148.
Brostrom, A., Stromberg, A., Dahlstrom, U., & Fridlund, B. (2001). Patients with congestive heart failure and their conceptions of their sleep situation. Journal of Advanced Nursing 34(4), 520-529
Brostrom, A., Stromberg, A., Dahlstrom, U., & Fridlund, B. (2004). Sleep Difficulties, Daytime Sleepiness, and Health-related Quality of Life in Patients With Chronic Heart Failure. Journal of Cardiovascular Nursing, 19(4), 234–242.
Buysse, D. J., Reynolds , C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. Ⅲ(1989). The Pittsburg Sleep Quality Index: A new instrument for psychiatric and research. Journal of Psychiatric Research, 28(2), 193-213.
Carlson, B., Riegel, B., & Moser, D. K. (2001). Self-care abilities of patients with heart failure. Heart & Lung, 30(5), 351-359
Casolo, G., Balli, E., Taddei, T., Amuhasi, J., & Gori, C. (1989). Decreased spontaneous heart rate variability in congestive heart failure. The American Journal of Cardiology, 64(18), 1162-1167
Chen, H.-M., & Clark, A. P. (2007). Sleep Disturbances in People Living With Heart Failure. Journal of Cardiovascular Nursing, 22(3), 177-185.
Chen, N.-H., Johns, M. W., Li, H.-Y., Chu, C.-C., Liang, S.-C., Shu, Y.-H., et al. (2002). Validation of a Chinese version of the Epworth sleepiness scale. Quality of Life Research, 11(8), 817-821
D' Alto, M., Pacileo, G., & Calabro, R. (2003). Nonpharmacologic care of heart falure: patient, family, and hospital organization. American Journal
- 90 -
of Cardiology, 91, 51F-54F.
Doi, Y., Minowa, M., Uchiyama, M., Okawa, M., Kim, K., Shibui, K., et al. (2000). Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects. Psychiatry Research, 97(2-3), 165-172.
Dunagan, W. C., Littenberg, B., Ewald, G. A., Jones, C. A., Emery, V. B., & Materman, B. M. (2005). Randomized trial of a nurse-administered, telephone-based disease management program for patients with heart failure. Journal of Cardiac Failure, 11(5), 358-364.
Dunbar, S. B., Jacobson, L. H., & Deaton, D. (1998). Heart failure: Strategies to enhance patient self -management. Advanced Practice in Acute Critical Care, 9(2), 244-256
Erickson, V. S., Westlake, C. A., Dracup, K. A., Woo, M. A., & Hage, A. (2003). Sleep Disturbance Symptoms in Patients With Heart Failure. AACN Clinical Issues, 14(4), 477-487.
Fauchier, L., Babuty, D., & Cosnay, P. (1999). Prognostic value of heart rate variability for sudden death and major arrhythmic events in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol, 33, 203–1207.
Fauchier, L., Babuty, D., Melin, A., Bonnet, P., Cosnay, P., & Fauchier, J. P. (2004). Heart rate variability in severe right or left heart failure: the role of pulmonary hypertension and resistances. The European Journal of Heart Failure, 6, 181–185
Galinier, M., Pathak, A., Fourcade, J., Androdias, C., Curnier, D., Varnous, S., et al. (2000). Depressed low frequency power of heart rate variability as
- 91 -
an independent predictor of sudden death in chronic heart failure. European Heart Journal 21, 475–482
Goldman, L., & Bennett, J. C. (2000). Cecil Textbook of Medicine (21 ed.). London, UK: W.B. Saunders.
Jaarsma, T., Halfens, R., Abu-Saad, H., Dracup., K., Gorgels, T., Ree, J., et al..
(1999). Effect of educationand support on self-care and resource utilization in
patients with heart failure. Europe Heart Journal, 20(9), 673-682.
Jaarsma, T., Stromberg, A., Martensson, J., & Dracup, K. (2003). Development and testing of the European Heart Failure Self-Care Behaviour Scale. The European Journal of Heart Failure, 5, 363–370
Kageyamai, T., Nishikido, N., Kobayashi, T., Kurokawa, Y., Kaneto, T., & Kabuto, M. (1998). Self-Reported Sleep Quality, Job Stress, and Daytime Autonomic Activities Assessed in Terms of Short-Term Heart Rate Variability among Male White-Collar Workers. Industrial Health 36, 263-272.
Koelling, T. M., Johnson, M. L., Cody, R. J., & Aaronson, K. D. (2005). Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation, 111, 179-185
Lainscaka, M., & Keberb, I. (2003). Patient's view of heart failure: from the understanding to the quality of life. European Journal of Cardiovascular Nursing, 2, 275-281.
Lupon, J., Gonzalez, B., Mas, D., Urrutia, A., Arenas, M., Domingo, M., et al. (2008). Patients' self-care improvement with nurse education intervention in Spain assessed by the European heart failure self-care behaviour scale.
- 92 -
European Journal of Cardiovascular Nursing, 7, 16–20
M.W. Johns. (1993). Daytime sleepness,snoring and obstructive sleep apnea. The Epworth Sleep Scale. Chest, 103, 30-36.
Magner, J. J., & Royston, D. (2004). Heart failure. British Journal of Anaesthesia, 93(1), 74-85.
Malik, M., Bigger, J. T., Camm, A. J., Kleiger, R. E., Malliani, A., Moss, A. J., et al. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 17, 354 - 381.
Manocchia, M., Keller, S., & Ware, J. (2001). Sleep problems, health-related quality of life, work functioning and health care utilization among the chronically ill. Quality Of Life Research, 10(3), 31-45.
Newman, A. B., Nieto, F. J., Guidry, U., Lind, B. K., & Redline, S. (2001). Relation of Sleep-disordered Breathing to Cardiovascular Disease Risk Factors. American Journal of Epidemiology, 154(1), 50-59.
Ni, H., Nauman, D., Burgess, D., Wise, K., Cripell, K., Hershberger, R.H. (1999). Factor influencing knowledge of and adherence to self – care among patients with heart failure. Arch Intern Medicine, 159, 1613-1619.
Nolan, J., Batin, P. D., Andrews, R., Lindsay, S. J., Brooksby, P., Mullen, M., et al. (1998). Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-Heart). Circulation, 98(15), 1510-1516
Oldenburg, O., Lamp, B., Faber, L., Teschler, H., Horstkotte, D., & Topfer, V. (2007). Sleep-disordered breathing in patients with symptomatic heart
- 93 -
failure: a contemporary study of prevalence in and characteristics of 700 patients. European Journal Heart Fail, 9(3), 251-257.
Redeker, N. S., & Hilkert, R. (2005). Sleep and Quality of Life in Stable Heart Failure. Journal of Cardiac Failure 11(9).
Redeker, N. S., & Stein, S. (2006). Characteristics of sleep in patients with stable heart failure versus a comparison group. Heart Lung, 35(4), 252-261.
Riegel, B., Garlson, B., & Glaser, D. (2000). Development and and testing of a linical tool measuring self-management of heart failure. Heart & Lung, 29(1), 4-12.
Rockwell, J. M., & Riegel, B. (2001). Predictors of self-care in persons with heart failure. Heart & Lung, 30(1), 18-25.
Shah, N. B., Der, E., Ruggerio, C., Heidenreich, P. A., & Masie, B. M. (1998). Prevention of Hospitalizations for heart failure with an interactive home monitor program. American Heart Journal, 135(3), 373-378.
Shuldham, C., Theaker, C., Jaarsma, T., & Cowie, M. R. (2007). Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population. Journal of Advanced Nursing, 60(1), 87–95
Stromberg, A., Dahlstrom, U., & Fridlund, B. (2006). Computer-based education for patients with chronic heart failure A randomized, controlled, multicentre trial of the effects on Knowledge, compliance and quality of life. Patient Education and Counseling, 64, 128-135.
Sueta, C. A., & Hill, C. (2003). Heart rate variability in chronic heart failure: Target for therapy? American Heart Journal, 146(3), 385-387.
Sui, X., Gheorghiade, M., Zannad, F., Young, J. B., & Ahmed, A. (2007).
- 94 -
Apropensitymetached study of the association of education and outcomes in chronic heart failure. International Journal of Cardiology, In Press, Corrected poof, Available online 23.
Trupp, R. J. (2004). The Heart of Sleep: Sleep-Disordered Breathing and Heart Failure. Journal of Cardiovascular Nursing, Vol. 19( 6S), S67–S74
Tsai, P.-S., Wang, S.-Y., Wang, M.-Y., Su, C.-T., Yang, T.-T., Huang, C.-J., et al. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(8), 1943–1952
van der Wal, M. H. L., Jaarsma, T., Moser, D. K., & van Veldhuisen, D. J. (2005). Development and testing of the Dutch Heart Failure Knowledge Scale. European Journal of Cardiovascular Nursing 4, 273 – 277
van der Wal, M. H. L., Jaarsma, T., Moser, D. K., Veeger, N. J. G. M., Gilst, W. H., & van Veldhuisen, D. J. (2006). Compliance in heart failure patients: the importance of knowledge and beliefs. European Heart Journal 27, 434–440
論文全文使用權限
  • 同意授權瀏覽/列印電子全文服務,於2012-08-10起公開。


  • 若您有任何疑問,請與我們聯絡!
    臺北醫學大學 圖書館 沈佩芳
    臺北市信義區吳興街 250 號
    E-mail:peifang@tmu.edu.tw
    Tel:(02) 2736-1661 ext.2502
    Fax:(02) 2737-5446