臺灣博碩士論文加值系統

序論：目前前十字韌帶的重建，其術後的結果對治療長期膝部不穩定、改善膝關節功能以及恢復股四頭肌肌力皆有長足的進步。然而，對於接受前十字韌帶重建術患者本身在健康照護需求之改善狀況，則尚未有相關的調查研究。因此本研究目的在於比較前十字韌帶損傷病患接受重建手術前及手術後之健康信念、自我照顧自我效能與健康照護需求的差異情形，以及瞭解「健康信念」、「自我照顧自我效能」與「健康照護需求」三者間之相關性。
方法：本研究採單組前後測，做描述性與相關性之探討。研究對象取自於北市某一醫學中心之骨科門診及骨科病房，接受前十字韌帶重建術的45位個案，以「健康促進策略量表」、「健康信念量表」測量其手術前後自我照顧自我效能和健康信念，以「健康照護需求量表」測量手術前後健康照護需求的重要程度，分別於住院進行手術治療前及手術治療後三週進行資料收集。主要以描述性統計瞭解研究對象的分布及各變項得分情形；以廣義估計方程式(generalized estimating equation; GEE)分析手術前後健康信念、自我照顧自我效能及健康照護需求之差異，以及瞭解三者間之相關性。
結果：接受前十字韌帶重建術術後三週之健康信念、自我照顧自我效能的平均得分皆顯著高於術前得分；而整體健康照護需求、訊息需求、生理照護需求以及心理社會需求，其平均得分皆比術前低，且達統計上顯著性差異；在本研究中，雖然健康信念與健康照護需求間則無顯著相關，但自我照顧自我效能與健康照護需求間有顯著負相關，而健康信念與自我照顧自我效能亦有顯著正相關。
結論：經由瞭解影響健康照護需求的相關因素，可協助健康照護專業人員提升病患照護品質。且藉由本研究結果，將來可作為針對接受前十字韌帶重建術病患所發展護理指導計畫之重要參考依據。

Background: The benefits of anterior cruciate ligament reconstruction (ACLR) have been well documented including treating chronic instability, improved knee functions and restored quadriceps strength. However, there is a lack of data about patients’ needs after surgery. The purpose of this study was to: 1) explore the relationship among health belief, self-care self-efficacy, and health care needs. ; 2) assess the health belief, self-care self-efficacy and health care needs after surgery.
Methods: Using a one-group pre and post-test design 45 subjects who received ACLR completed the Strategies Used by People to Promotion Health Scale(SUPPHS), the Health Belief Scale, and the Health Care Needs Scale prior to surgery and 3 weeks after surgery. Descriptive statistics, Generalized Estimating Equation(GEE) assessing differences in each of health belief, SUPPHS, and health care needs between pre and post-surgery, and GEE was used to analyze the statistical relationship among health belief, self-care self-efficacy and health care needs.
Results: Significant positive change were found for measures of health belief and self-care self-efficacy, and the 3-weeks post surgery health care needs score was significantly lower than the pre-surgery score. Although there were no significant correlation between health belief and health care needs, the self-care self-efficacy was positively related to health belief, and self-care self-efficacy was negatively related to health care needs.
Conclusions: Understanding of factors that influence patients’ perceived health care needs can help health care professionals to promote patients’ well-being. The results could be need as a reference in future multi-
component interventions for patients receiving ACLR.

【目錄】
頁次
正文目錄…………………………………………………………Ⅱ
表目錄……………………………………………………………Ⅵ
圖目錄……………………………………………………………Ⅷ
附錄目錄…………………………………………………………Ⅸ
中文摘要…………………………………………………………Ⅹ
英文摘要…………………………………………………………ⅩⅡ
【正文目錄】
頁次
第壹章 緒論…………………………………………………………...1
第一節 研究背景與動機...............................................................1
第二節 研究目的...........................................................................5
第貳章 文獻查證……………………………………………………...6
第一節 前十字韌帶損傷之相關概念...........................................6
一、前十字韌帶功能與損傷機轉.........................................6二、前十字韌帶損傷之治療.................................................7
第二節 前十字韌帶重建術的相關概念.......................................8
一、前十字韌帶重建術之簡介.............................................8
二、前十字韌帶重建術之適應症與合併症.........................8
第三節 健康信念...........................................................................9
一、健康信念之概念.............................................................9
二、影響健康信念的相關因素.............................................11
第四節 自我照顧自我效能...........................................................12
一、自我照顧自我效能之概念..............................................12
二、影響自我照顧自我效能的相關因素..............................14
第五節 健康照護需求....................................................................15
一、健康照護需求之定義......................................................15
二、接受前十字韌帶重建術病患之健康照護需求..............15
三、影響健康照護需求的相關因素………………………..19
第六節 健康信念、自我照顧自我效能與健康照護需求之關
係的實徵研究....................................................................21
第參章 研究架構....................................................................................25
第一節 研究架構............................................................................25
第二節 名詞界定............................................................................26
第三節 研究問題............................................................................27
第肆章 研究方法....................................................................................28
第一節 研究設計............................................................................28
第二節 研究對象及研究場所........................................................28
第三節 研究工具............................................................................29
第四節 資料收集過程....................................................................35
第五節 資料處理與分析................................................................36
第六節 倫理考量............................................................................38
第伍章 研究結果....................................................................................39
第一節 研究對象之基本資料........................................................39
一、研究對象之人口學特性..................................................39
二、研究對象之疾病特性..................................................40
第二節 健康信念………………………………………………...43
一、接受重建術術前及術後之健康信念………………….43
二、接受重建術術前及術後健康信念之差異情形……….43
第三節 自我照顧自我效能………………………………………47
一、接受重建術前及術後之自我照顧自我效能…………..47
二、接受重建術術前及術後自我照顧自我效能之差異情形
第四節 健康照護需求……………………………………………51
一、接受重建術前及術後之健康照護需求………………..51
二、接受重建術術前及術後健康照護需求之差異情形…..52
(一)整體健康照護需求方面…………………………...52
(二)訊息需求方面……………………………………...55
(三)生理照護需求方面………………………………...58
(四)心理社會需求方面………………………………...61
第五節 健康信念、自我照顧自我效能與健康照護需求之相關性…………………………………………………………65
一、健康信念、自我照顧自我效能與整體健康照護需求之相關性……………………………………………………..65
二、健康信念、自我照顧自我效能與訊息需求之相關性..67
三、健康信念、自我照顧自我效能與生理照護需求之相
關性…………………………………………………….69
四、健康信念、自我照顧自我效能與心理社會需求之相
關性……………………………………………………..71
五、健康信念與自我照顧自我效能之相關性……………..73
第陸章 討論……………………………………………………………74
第一節 研究樣本基本資料探討....................................................74
第二節 健康照護需求……………………………………………75
一、接受重建術術前及術後之健康照護需求……………..75
二、影響健康照護需求的相關因素………………………..78
第三節 健康信念…………………………………………………81
第四節 自我照顧自我效能………………………………………82
第五節 健康信念、自我照顧自我效能與健康照護需求之相關性…………………………………………………………84
第柒章 結論與建議……………………………………………………88
第一節 結論....................................................................................88
第二節 研究限制............................................................................90
第三節 應用與建議........................................................................92
參考資料………………………………………………………………..95
中文部分..........................................................................................95
英文部分..........................................................................................97

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