臺灣博碩士論文加值系統

心導管檢查是ㄧ項診斷心血管疾病極為普遍的侵入性檢查，而焦慮是心導管檢查病人常見的負向情緒，如此不但會增加病人之心臟負擔，且可能影響檢查之進行。故本研究目的旨在比較系統性衛教模式與傳統衛教模式於心導管檢查病人，其焦慮程度與滿意度之差異。
本研究採類實驗研究法，以某財團法人醫學中心經門診入院之初次心導管檢查者為研究對象。病人入選後依入院週次隨機分派至實驗組或控制組。資料收集後以描述性、卡方檢定、獨立樣本t檢定、GEE與Mann-Whitney U檢定進行分析。本研究共收集83人，系統性衛教模式組39人，傳統衛教模式組44人。系統性衛教組個案之平均年齡為57.95 (SD= 7.79)歲，以男性居多(n= 23; 59%)，教育程度在高中職以上者居多(n= 23; 59%)，超過半數之個案無心導管檢查家族史(n= 28; 71.8%)、在住院前曾收集心導管檢查相關訊息(n= 21; 53.8%)，以及接受介入性治療 (n=26; 59.1%)。在傳統衛教組個案方面，其平均年齡為63.91 (SD= 9.70)歲，大多數為男性(n= 33; 75.0%)、具高中職以上教育程度之個案(n= 30; 68.2%)與沒有心導管檢查家族史居多(n= 32; 72.7%)，超過半數個案在住院前曾收集心導管檢查相關訊息(n= 29; 65.9%)，以及接受介入性治療24 (61.5%)。但以上變項除年齡於兩組間有統計上之顯著差異外(p= .00)，其餘變項於兩組間皆無統計上之顯著差異(p> .05)。
以廣義估計函數(GEE)分析後，結果顯示在控制組別、時間與年齡後，兩組個案於衛教前後與檢查前後之焦慮程度，實驗組呈現逐漸下降趨勢，兼具立即與持續性效果，然控制組個案於檢查前則呈現不降反升現象；另外，實驗組個案焦慮程度下降之改變量皆優於傳統衛教組，並達統計上之顯著差異(分別為 z= -3.24, p= .00; z= -5.25, p= .00; z= -3.04, p= .00)。另外，以 Mann-Whitney U 檢定分析發現，系統性衛教組個案對心導管檢查衛教之滿意度高於傳統衛教組(45.55 Vs. 42.59分)，且具統計上之顯著差異(z = -3.51, p= .00)。
本研究結果除可提供臨床護理人員完整與一致性之衛教內容外，亦可提供行政管理者作為提升心導管檢查病人的衛教滿意度，以及改善持續性照護品質之依據。

Title of Thesis:
Applying Systematic Patient Education Model to Improve
Levels of Anxiety and Satisfaction in Patients With Cardiac
Catheterization.
Institution: Graduate Institute of Nursing, Taipei Medical University
Author: Wu, Ka-Lai
Thesis directed by: Chang, Wen-Yin, Professor
Cardiac catheterization is a very common invasive and diagnostic
procedure for patients with cardiovascular diseases. However, anxiety is a
negative response in patients during procedures. The anxiety not only
increases the burden of the patients'' heart, but also affects the processes of
the examination. Therefore, the aims of this study were to compare the
effectiveness of anxiety levels and satisfaction between systematic patient
education model (SPEM) and traditional patient education model for patients
with cardiac catheterization.
This study was a quasi-experimental design. Patients were those who
had first cardiac catheterization at a medical center. For those patients who
met the criteria for inclusion were randomly assigned to SPEM group or
traditional patient education model by alternative week. Data were analyzed
using descriptive statistics, chi-square test, independent sample t-test, GEE
and Mann-Whitney U Test.
There were 83 patients participated in this study, 39 patients in the
SPEM group and 44 patients in the traditional patient model group. The
mean age of the SPEM group was 57.95 (SD = 7.79) years. Of these, most
patients (n = 23; 59%) were males, had above high school degree (n = 23;
V
59%), over half of the patients had no family history of cardiac
catheterization (n= 28; 71.8%), had gathered some relevant information
about cardiac catheterization before hospitalization (n= 21; 53.8%), and
accepted the interventive treatments (n= 26; 59.1%). The mean age was
63.91(SD = 9.70) years in the traditional patient model group. Of these, the
majority of patients were males (n= 33; 75.0%), had above high school
education (n= 30; 68.2%), had no family history of cardiac catheterization
(n= 32; 72.7%), had gathered some relevant information about cardiac
catheterization before hospitalization (n= 29; 65.9%), and accepted the
interventive treatments (n= 24; 61.5%). However, a significant difference
was only found in age between the groups (p= .00), but other variables were
not found statistically significant differences between groups.
After Generalized Estimating Equation (GEE) analysis with adjusting
group, time and age, the results indicated that the anxiety levels of SPEM
group at the time after education, before and after cardiac catheterization
were gradually reduced, and made both immediate and continuing effects.
However, the anxiety levels of traditional group at the time before cardiac
catheterization were not reduced but elevated. Moreover, the degrees of the
anxiety level in SPEM group declined more than the traditional patient
model group with statistically significant differences (z = -3.24, p = .00;
z = -5.25, p = .00; z = -3.04, p = .00; respectively). In addition, after
Mann-Whitney U analysis, the results indicated that the degree of
satisfaction of SPEM group for cardiac catheterization was significantly
higher than did patients in the traditional patient model group (45.55 vs.
42.59 points) with statistically significant difference (z = -3.51, p= .00).
VI
The findings of this study not only provide the clinical nursing
personnel the complete and coherent contents of patient education, but also
provide the administrators how to advance the level of the satisfaction in
patients and improve the continuing quality of nursing care.
Keywords: Cardiac catheterization patients, systematic patient education
model, traditional patient education model, anxiety level, satisfaction

目 錄

頁數
致 謝 ………………………………………………………… I
中文摘要 ………………………………………………………… II
英文摘要 ………………………………………………………… IV
目 錄 ………………………………………………………… VII
圖表目次 ………………………………………………………… X

第一章 緒論
第一節 研究背景與動機 ………………………………… 1
第二節 研究目的 …………………………………………… 4
第三節 研究假設 …………………………………………… 5
第四節 操作型定義 ……………………………………… 6
第二章 文獻查證
第一節 心血管疾病與心導管檢查 ……………………… 9
第二節 心導管檢查病人之焦慮與相關研究 ………………..… 11
第三節 心導管檢查病人之衛教與相關研究 ……………..… 15
第四節 心導管檢查病人之滿意度與相關研究 …………..…… 24
第五節 概念架構 ………………………………………..……… 26
第三章 研究方法
第一節 研究設計 ………………………………….…….… 27
第二節 研究對象 ………………………………….….…… 29
第三節 系統性衛教模式 ………………………….………. 30
第四節 傳統衛教模式 ………………………………….…. 33
第五節 資料收集工具 ……………………………………… 34
第六節 倫理考量 …………………………………….…... 36
第七節 研究步驟 …………………………………………. 37
第八節 資料處理與分析 …………………………………… 41
第四章 研究結果
第一節 心導管檢查病人之基本資料 …………………….. 43
第二節 心導管檢查衛教模式對病人焦慮程度之影響 ….. 49
第三節 心導管檢查衛教模式對病人滿意度之影響 …... 56
第五章 討論
第一節 兩組心導管檢查衛教模式於焦慮程度之差異…... 58
第二節 兩組心導管檢查衛教模式於滿意度之差異 ……… 62
第六章 結論與建議
第一節 結論 ……………………………………………… 65
第二節 研究貢獻 ……………………………….……… 66
第三節 研究限制與未來建議 …………………………… 67
參考資料
中文部份 ………………………………………………………… 69
英文部分 ………………………………………………………… 72

附錄
附錄一 衛教手冊 ……………………………………………… 80
附錄二 衛教手冊之專家內容效度檢定結果 ………………… 89
附錄三 致專家效度鑑定函(DVD) ……………………………… 90
附錄四 衛教DVD之專家內容效度檢定結果 ………………… 91
附錄五 「心導管檢查注意流程」衛教單張 …………………… 92
附錄六 心導管檢查病人基本資料之收集表 ………………… 93
附錄七 情境焦慮問卷調查表 ………………………………… 94
附錄八 情境特質焦慮量表同意使用授權書 ………………… 95
附錄九 心導管檢查衛教滿意度調查表 ……………………… 96
附錄十 內容效度專家名單 …………………………………… 97
附錄十一 致專家效度鑑定函(問卷) ………………………… 98
附錄十二 心導管檢查衛教滿意度量表專家內容效度檢定結果 99
附錄十三 人體試驗委員會通過證明 ………………………… 100
附錄十四 心導管檢查衛教之同意書 ………………………… 101

圖表目次
頁數
圖一 系統性衛教模式改善心導管檢查病人成效之概念架構 26
圖二 資料收集流程圖 ………………………………………… 40
圖三 兩組於四次不同測量時間點之情境焦慮程度比較 …… 55
表一 資料統計分析方法 ……………………………………… 42
表二 兩組病人基本資料與衛教前焦慮程度比較 …………… 46
表三 流失與收案兩組個案之基本資料與衛教前焦慮程度比較 48
表四 兩組病人未校正年齡前之焦慮程度分析比較 ………… 50
表五 兩組病人焦慮程度之GEE分析 …………………………… 53
表六 兩組病人校正年齡後焦慮程度之分佈情形 …………… 54
表七 兩組病人滿意度差異分析比較 ………………………… 57

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