臺灣博碩士論文加值系統

父母或主照顧者在氣喘兒童的照顧上扮演非常重要角色，若對氣喘照護認知不足，恐影響病情的控制及延遲治療，故唯有提升氣喘照護能力，才能使氣喘病童獲得最好的控制。本研究目的乃運用充能概念並透過整合型氣喘照護模式介入，來探討氣喘兒童主照顧者氣喘處理及兒童健康掌控成效。以「實驗組控制組前、後測設計」中的「不相等組實驗組、控制組」實驗設計，自2010年12月至 2012年8月於北部某教學醫院的門診氣喘兒童（5-14歲，經醫師初次診斷為氣喘，且無其他系統性疾病）及主要照顧者為母群體，採隨機分配為實驗A組，實驗B組與控制組，實驗A組採用現行氣喘照護模式外，另安排四次電訪與個別式指導進行三個月介入，實驗B組採用現行氣喘照護模式外，另給予四次電訪及團體式指導進行三個月介入，控制組則僅採用現行氣喘照護模式。共有130位完成前測（實驗A組有44位，實驗B組有24位，控制組有62位），其中有68位完成第三個月、第六個月、第九個月及第十二個月的追蹤與評價。
研究結果發現，不管是個別或團體式整合型氣喘照護模式介入對氣喘兒童照護是有幫助的。以長時間的變化來看，在第十二個月氣喘兒童主照顧者的氣喘處理改變與變化幅度而言，照護知識方面，實驗A組氣喘照護知識平均得分高於實驗B組與控制組，實驗A、B組改變幅度高於控制組（β=0.30, SE=0.11, p＜0.05；β=0.13, SE=0.12, p＞0.05）；照護態度方面，以實驗A組平均得分最高，實驗A、B組改變幅度高於控制組（β=0.36, SE=0.11, p＜0.05；β=0.01, SE=0.11, p＞0.05）；照護行為方面，以控制組平均得分最低，實驗A、B組改變幅度高於控制組（β=0.67, SE=0.39, p＞0.05；β=0. 29, SE=0.36, p＞0.05）；照護心境方面，三組於介入後的照護心境都有改善，其改變幅度則以實驗A、B組高於控制組（β=-0.43, SE=0.36, p＞0.05；β=-0.62, p＞0.05），以團體式指導者改善效果最好；醫病溝通方面，介入後三組都有較介入前增加，而改變幅度實驗A、B組高於控制組（β=0. 42, SE=0.16, p＜0.05；β=0. 23, SE=0.16, p＞0.05）。
氣喘病童健康掌控在介入後第十二個月的情形，於肺功能變化方面，FVC改變幅度以實驗A、B組高於控制組（β=0.75, SE=0.32, p=0.02；β=1.17, SE=0.39, p＜0.01），而FEV1改變幅度以實驗A、B組高於控制組（β=0.55, SE=0.29, p＞0.05；β=0.89, SE=0.35, p＜0.05）；呼吸道發炎狀況方面，氣喘兒童吐氣一氧化氮（eNO）所偵測結果，經Chi-Square檢定，三組差異並未達統計顯著差異（p＞0.05），不過控制組的呼吸道發炎個數增加，而Methacholine激發試驗的氣道反應所偵測結果，經Chi-Square檢定，三組差異有達統計顯著差異（x2=6.83, p＜0.05）；兒童健康狀態變化方面，就醫改變情形，有7人（23.5%）因氣喘發作而到急診就醫（實驗A組1人、實驗B組2人與控制組4人），經Chi-Square檢定，三組並未達統計上顯著差異（x2=1.68, p＞0.05），而因氣喘發作而住院有4人（13.2%），全發生在控制組，經Chi-Square檢定，三組有達統計上顯著差異（x2=7.31, p=0.03），經McNemar檢定，其結果顯示實驗A組與實驗B組氣喘發作而住院次數有顯著的改變（p＜0.05）；用藥情形方面，經Chi-Square檢定，三組於口服類固醇藥物及欣流咀嚼錠使用上有達顯著差異（p＜0.05），而吸入型類固醇藥物使用上未達顯著差異（p＞0.05）；氣喘兒童整體生活品質改變方面，實驗A、B組的整體生活品質改變幅度高於控制組且達顯著差異（β=1.27, SE=0.46,β=1.21, SE=0.47, p＜0.05），就整體生活品質得分乃以採用團體式指導組之病童生活品質改善效果最好。
本研究引用充能概念於整合型氣喘照護中，藉由對話、傾聽、互動的過程，引導主照顧者反思，以及增進對孩童疾病的洞悉與掌控，結果證實，充能概念引用於整合型氣喘照護模式是有效的。未來我們更應以強化兒童為中心的照護及持續提供整合照護，相信對氣喘兒童主照顧者氣喘處理及兒童健康掌控是有幫助。

Parents or primary caregivers play an important role in care with asthmatic children. Caregivers without adequate knowledge in asthma care may affect the disease control and delay treatment. The purpose of this study was to evaluate the effect of an integrative asthma care model , which in composition with empowerment concept on primary caregivers’ asthma management and children’s health control. The study was conducted from December 2010 to August 2012 in the outpatient department of a medical center in northern Taiwan. The study subjects included asthmatic children (5-14 years of age) with no other systemic diseases, and the primary caregiver for these afflicted children. We randomized all subjects into three groups: Experiment Group A, Experiment Group B and Control Group. During the 3-month care period, subjects in Group A received regular care, four telephone interviews and individual instruction; subjects in Group B received clinical regular care, four telephone interviews and group instruction; and subjects in Control Group received ordinary instructions alone. One hundred and thirty subjects completed the pretest, including 44 in Group A, 24 in Group B and 62 in Control Group. At the end of the study, 68 subjects completed follow-up evaluation at the third month, the sixth month, the ninth month and the twelfth month, including 22 in Group A, 21 in Group B and 25 in Control Group.
We found that either individual or group instruction was helpful in care of asthmatic children and primary caregivers' asthma management improved markedly at the twelfth month. Both Groups A and B improved knowledge of asthma care significantly more than the Control Group (β=0.30, SE=0.11, p＜0.05；β=0.13, SE=0.12, p＞0.05) and the average score of Group A was higher Group B and the Control Group. In the attitude of asthma care, the highest average score was seen in Group A, and there was more improvement in Groups A and B than the Control Group (β=0.36, SE=0.11, p＜0.05；β=0.01, SE=0.11, p＞0.05). Concerning behaviors of asthma care, the lowest average score was found in the Control Group, and the change was much higher in Groups A and B than the Control Group (β=0.67, SE=0.39, p＞0.05；β=0.29, SE=0.36, p＞0.05). In emotions of asthma care, three groups in the post intervention had improved, and there was much more improvement in Group A and B (β= -0.43, SE=0.36, p＞0.05；β=-0.62, p＞0.05). Furthermore, three groups with intervention had significantly increased the Physician-Patient Communication as compared to those with no intervention, and the improvement was more significant in Experimental Groups A and B than the Control Group (β=0. 42, SE=0.16, p＜0.05；β=0.23, SE=0.16, p＞0.05).
To evaluate the Children’s Health Control, we assessed changes in pulmonary function and found that Groups A and B had changed higher than the Control Group in FVC (β=0.75, SE=0.32, p=0.02；β=1.17, SE=0.39, p＜0.01) and FEV1 (β=0.55, SE=0.29, p＞0.05；β=0.89, SE=0.35, p＜0.05). We used exhaled nitric oxide (eNO) to assess airway inflammatory conditions. Although there was no difference among these three groups (p> 0.05, Chi-square test), the number of airway inflammations of the control group increased. Additionally, methacholine challenge test was detected statistically significantly in the three groups (x2=6.83, p<0.05). During the study period, seven subjects (23.5%) went to the emergency room for asthma, Group A had a lower rate of emergency room use, and four subjects (13.2%) of the Control Group were hospitalized. There were significant differences between the three groups in terms of the number of hospital admissions(x2=7.31, p=0.03). In medication use for asthma, we found significant differences in the frequency of the use of oral corticosteroids or Montelukast among the three groups (p<0.05). However, we were unable to detect the difference in inhaled β-agonist use (p>0.05). Subjects in Groups A and B had more improvement in quality of life than the Control Group (β=1.27, SE=0.46, β=1.21, SE=0.47, p＜0.05). Particularly, the group instruction showed the best improvement in the quality of life.
The study quoted that the concept of empowerment in integrative asthma care model, through dialogue, listening and interactive process, guided reflection, and enhanced insight on children and disease control. The present study suggests that applying an integrative care program indeed improved primary caregivers’ management in asthma children and their health. Following this care model, we are able to strengthen children-centered care and provide continued integrity of care. We believe that an integrative asthma care model on primary caregivers’ asthma management and children’s health control is helpful.

指導教授推薦書
口試委員審定書
國家圖書館博碩士論文電子檔上網授權書…………………iii
長庚大學博碩士論文著作授權書………………………………iv
誌謝……………………………………………………………………v
中文摘要……………………………………………………………xii
英文摘要………………………………………………………………x
附錄

第一章 緒論 …………………………………………………………1
第一節 研究背景及問題 …………………………………………1
第二節 研究動機及重要性 ………………………………………3
第三節 研究目的 …………………………………………………6
第二章 文獻查證……………………………………………………7
第一節 兒童氣喘的概述 ………………………………………7
第二節 氣喘病童主照顧者之氣喘照護…………………………21
第三節 充能理論運用及其相關研究……………………………32
第三章 研究架構……………………………………………………41
第一節 研究架構………………………………………………41
第二節 名詞解釋………………………………………………43
第三節 研究問題………………………………………………48
第四節 研究假設………………………………………………49
第四章 研究方法……………………………………………………50
第一節 研究設計…………………………………………………50
第二節 研究對象及場所…………………………………………53
第三節 研究工具…………………………………………………55
第四節 研究工具信效度…………………………………………61
第五節 研究步驟…………………………………………………63
第六節 資料處理與分析…………………………………………69
第七節 研究倫理考量……………………………………………70
第五章 研究結果……………………………………………………72
第一節 研究對象基本資料………………………………………72
第二節 介入前研究對象成效指標之描述與比較………………76
第三節 介入成效評價……………………………………………84
第六章 討論 ………………………………………………………95
第一節 介入措施對主照顧者氣喘處理成效之分析……………95
第二節 介入成效措施對氣喘兒童健康掌控之成效分析……104
第七章 結論與建議………………………………………………111
第一節 結論……………………………………………………111
第二節 研究限制與建議………………………………………115
第三節 臨床的應用……………………………………………119
參考資料 ……………………………………………………………126
中文部份 ………………………………………………………126
英文部份 ………………………………………………………131

附錄
附錄一：氣喘病童門診照護藍圖………………………………172
附錄二：階段式氣喘照護指引方針……………………………173
附錄三：氣喘兒童列管之照護指導登錄表……………………174
附錄四：氣喘嚴重度分類………………………………………175
附錄五：主要照顧者氣喘處理問卷……………………………176
附錄六：氣喘兒童生活品質問卷………………………………185
附錄七：問卷同意書……………………………………………190
附錄八：專家效度名單…………………………………………194
附錄九：人體試驗倫理審查收案同意證明……………………195
附錄十：問卷使用同意證明……………………………………197

表 目 錄
表 4-1-1 研究設計……………………………………………………52
表 4-2-1 文獻中兩組研究對象的自我處理行為平均值與標準差…54
表 4-3-1 各量表預測信度測試結果…………………………………63
表 5-1-1 介入前，三組氣喘兒童主照顧者基本特性分佈情形……148
表 5-1-2 介入前，三組氣喘兒童之基本特性分佈情形………………149
表 5-2-1 介入前，不同組別的主照顧者之氣喘處理差異情形……150
表 5-2-2 介入前，不同組別氣喘兒童健康掌控情形………………151
表 5-2-3 介入前，氣喘兒童健康狀態與主照顧者氣喘處理之關係 152
表 5-3-1 介入後，主照顧者氣喘處理成效之三組於不同時間改善 153
表 5-3-2 介入後，主照顧者氣喘照護知識於不同時間成效比較…154
表 5-3-3 介入後，主照顧者氣喘照護態度於不同時間成效比較…155
表5-3-4介入後，主照顧者氣喘照護行為於不同時間成效比較……156
表5-3-5介入後，主照顧者照護心境於不同時間成效比較…………157
表5-3-6介入後，主照顧者醫病關係於不同時間成效比較…………158
表 5-3-7 介入後第十二個月，不同組別氣喘兒童肺部生理情形…162
表5-3-8介入後，氣喘兒童FVC於不同時間成效比較………………163
表5-3-9 介入後，氣喘兒童FEV1於不同時間成效比較……………164
表5-3-10介入後，氣喘兒童FEV1/FVC於不同時間成效比較………165
表 5-3-11 介入後，氣喘兒童藥物使用三組於四個時間組間改變差異
比較………………………………………………………168
表 5-3-12 介入後，氣喘兒童整體生活品質於不同時間成效比較…169

圖 目 錄
圖 3-1-1 研究架構……………………………………………………42
圖 3-2-1 整合型氣喘照護流程………………………………………46
圖 4-2-1 估算樣本數常態分佈………………………………………54
圖 4-5-1 整合型照護模式進行流程…………………………………68
圖5-1-1 Profile of patient enrollment and assignment………………147
圖 5-3-1 介入後，主照顧者氣喘照護知識於不同時間改變情形…159
圖 5-3-2 介入後，主照顧者氣喘照護態度於不同時間改變情形…159
圖5-3-3介入後，主照顧者氣喘照護行為於不同時間改變情形……160
圖 5-3-4 介入後，主照顧者氣喘照護心境於不同時間改變情形…160
圖5-3-5介入後，醫病關係於不同時間改變情形……………………161
圖5-3-6 介入後，氣喘兒童FVC於不同時間改變情形……………166
圖5-3-7 介入後，氣喘兒童FEV1於不同時間改變情形 ……………166
圖5-3-8 介入後，氣喘兒童FEV1/FVC於不同時間改變情形………167
圖 5-3-9 介入後，氣喘兒童整體生活品質於不同時間改變情形…170
圖5-3-10 介入後，氣喘兒童生理症狀於不同時間改變情形………170
圖5-3-11 介入後，氣喘兒童活動限制於不同時間改變情形………171
圖5-3-12 介入後，氣喘兒童情緒功能於不同時間改變情形………171

中文部份
方俞尹(2009)•全民健康保險氣喘醫療給付改善方案長期影響評估•未發表的碩士論文•台北：國立台灣大學衛生政策與管理研究所。
向雅玲、彭台珠、楊福麟、蘇泉發、李茹萍 (2011)．衛教介入對頭部外傷病人主要照顧者焦慮與疾病知識之影響．新臺北護理期刊， 13(1)，35-44。
石清樺（2004）•家張照護氣喘兒童身體活動相關知能介入實驗研究•未發表的碩士論文•台北：國立台灣師範大學衛生教育研究所。
李怡娟、吳麗瑜、張麗春、陳俞琪(2005) •充能式教育在長期照護機構的應用--以安養護機構中的外籍照護服務員為對象•護理雜誌，52(6)，23-29。
李尹暘、林麗娟 （2008）•醫病信任、結果預期及自我效能於糖尿病患自我照顧應用•北市醫學雜誌，5(3)，304-319。
邱上真（2003）•Bruner 發現式學習理論與教學運用•於張新仁主編，學習與教學新趨勢•台北：心理出版社。
吳清平(2000）•氣喘的分類•國防醫學，31(4)，265-271。
林美玲（2003）•氣喘兒童醫療遵從行為與相關因素之探討•未發表的碩士論文•台北：長庚大學護理研究所。
吳家興、林瑞雄、謝貴雄等（1998）•台灣北部國中學生氣喘盛行率調查•中華衛誌，17(3)，214-225。
高碧霞（2004）•氣喘兒童之症狀評估與處置•護理雜誌，51（6），39-45。
高碧霞（2003）•氣喘家庭照護措施對母親氣喘處置效能、生活品質與兒童健康狀態之影響•未發表的博士論文•台北：國立臺灣大學護理研究所。
翁慧卿（2002）•全民健保連續性完整照護氣喘病患之疾病管理模式先導研究委託報告•行政院衛生署九十一年度委託研究計劃。
許正園（2007，11月3日）•阻塞性氣道疾病(氣喘及慢性阻塞性肺疾)的治療準則．2010，8月13日取自www.tsim.org.tw/article/A90/P053.pdf
郭香雲、黃崇儒（2002）•內在動機、自信心、與狀態焦慮之間的關係•北體學報，10，93-101。
徐世達（2010）•台灣兒童氣喘診療指引2010版對5歲以下兒童氣喘治療策略的建議•台灣兒童過敏氣喘及免疫學會學會通訊，11（3），21-27。
陳家盈(2005)•探討氣喘病童之年齡、症狀嚴重度與其母親角色緊張的關係•未發表的博士論文•台南：國立成功大學醫學院護理研究所。
陳素月、許淑蓮、王東衡、黃明賢（2009）．成人氣喘病患自我效能及自我照顧行為之探討．護理暨健康照護研究，5(1)，31-41。
陳淑賢（2000）•氣喘學童氣喘知識與藥物吸入技巧之相關因素探討•未發表的碩士論文•台北：國立陽明大學社區護理研究所。
陳淑賢、蔡芸芳、黃璟隆、葉國偉（2010）．不同氣喘照護模式對氣喘兒童主照顧者氣喘處置行為、心理症狀困擾及氣喘病嚴重度影響之探討•長庚醫院九十九年度委託研究計劃。
黃璟隆(2009，4月15日)•重視氣喘兒學校照顧•2009年9月15日取自http://www.genesys.tw/life_1_show.asp?top=life&;title_seq=3&;area_seq=12&;seq=1506
黃璟隆（2001）•台灣氣喘衛教的過去、現在與未來•台灣兒科醫學會雜誌，42，29-30。
黃立心、徐世達、翁至德、卓訓德、馬益群、林聖節、吳文秋、吳俊宜（2003）•自主管理計畫對氣喘病童之短期影響•中華民國兒童胸腔醫學會雜誌，5(1)，88-95。
黃淳霞，陳怡如、于漱（2205）•校園慢性病學生的個案管理現況與未來方向•護理雜誌，52(2)，15-20。
彭萬誠（2000）•氣喘之診斷及臨床表徵•國防醫學，31(4)：272-278。
程佩玉（2005）•社區氣喘學童之主要照顧者其氣喘照護行為與健康信念關係之研究•未發表的碩士論文•台北：臺灣大學護理學研究所學位論文。
曾麗琦、金繼春、陳季員（2004）•屏東地區學齡期氣喘學童疾病知識、態度與自我處理行為之探討•護理雜誌，51（5），37-43。
談靜慧（2004）•氣喘青少年自我管理意向之預測因子•未發表的碩士論文•高雄：高雄醫學大學護理學研究所。
曹慧美（2008）•有無網路輔助之個案管理對氣喘兒童照顧者照護成效探討•台南：國立成功大學護理學研究所。
蔣立琦、趙淑員、賴香如（1999）•發展氣喘兒童自我處理教育計劃•護理雜誌，46(4)，15-22。
蔣立琦、黃璟隆、趙淑員（2001）•藉由綜合質量性研究方法建構國內氣喘兒童父母自我處理行為評量表•護理研究，9(1)，87-96。
羅中廷、翁慧卿（2006）•知識、態度、自我照顧行為和疾病嚴重度對氣喘病人生活品質的解釋模式•台灣公共衛生雜誌，25(2)，1-10。
穆佩芬、吳沾、吳克恭、劉育秀（2008）•影響學齡期氣喘病兒童社會適應之家庭資源因素的探討•志為護理-慈濟護理雜誌，7(6)，71-82。
廖士程、李明濱、謝博生、李源德（2005）•醫病關係與醫療滿意度之全國性普查•醫學教育，9(2)，149-161。
鍾玉珠、呂秋華（2007）．血液透析患者主要照顧者的負荷、需求及相關因素之探討，台灣腎臟護理學會雜誌，6(1)，23-36。
盧美秀、林秋芬（1991）．比教團體衛教嚇個別衛教對糖尿病病人知識、態度、行為和血糖變化的影響．護理雜誌，38（4），101-102。
鄭曉璘 (2005)•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•未發表的碩士論文•台北：台北醫學大學醫務管理研究所。
賴香如、黃璟隆、餘坤煌、吳德敏、吳玉萍（2001）•國小學生氣喘篩檢研究-ISAAC錄影帶問卷和書面問卷之比較•衛生教育學報，15，23-43。
謝貴雄（1991）•小兒氣喘的診斷與治療•家庭醫學學會會刊，11(9)，102-104。
謝貴雄（1995）•小兒氣喘病之預防與處理•中華民國小兒科醫學會雜誌，36(B)，9-20。
英文資料
Adams, R. J., Wilson, D., Smith, B. J., &; Ruffin, R. E. (2004). Impact of coping and socioeconomic factors on quality of life in adults with asthma. Respirology, 9(1), 87-95.
Artlich, A., Hagenah, J. U., Jonas, S., Ahrens, P., &; Gortner, L. (1996). Exhaled nitric oxide in childhood asthma. European Journal of Pediatrics, 155, 698-701.
Austin, J. K., Huberty, T. J., Huster, G. A. &; Dunn, D. W. (1998). Academic achievement in children with epilepsy or asthma. Developmental Medicine &; Child Neurology, 40(4), 248-255.
Barry, M. J., Mulley, A. G., Fowler, F. J., &; Wennberg, J. W. (1988). Watchful waiting vs immediate transurethral research for symptomatic prostatism. The importance of patients’ preferences. Journal of American Medical Association, 259(20), 3010-3017.
Barry, M. J., Mulley, A. G., Fowler, F. J., &; Wennberg, J. E. (1995). Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia. Medical Care, 33(8), 771-782.
Barton, C., Clarke, D., Sulaiman, N., &; Abramson, M. (2003). Coping as a mediator of psychosocial impediments to optimal management and control of asthma. Respiratory Medicine, 97(7), 747-761.
Bateman, E., Hurd, S., Barnes, P., Bousquet, J., Drazen, J., FitzGerald, M., et al. (2008). Global strategy for asthma management and prevention: GINA executive summary. European Respiratory Journal, 31(1), 143.
Behrman, R. E., Kliegman, R. M., Nelson, W. E., &; Vaughan, V. C. (1992). Nelson textbook of pediatrics. (14th ed., pp.587-596.). Philadelphia: W. B. Saunders.
Bener, A., Abdulrazzaq, Y. M., Debuse, P., &; Abdin, A. H. (1994). Asthma and wheezing as the case of school absence. Journal of Asthma, 31(2), 93-98.
Bodenheimer, T., Lorig, K., Holman, H., &; Grumbach, K. (2002). Patient self-management of chronic disease in primary care. Journal of the American Medical Association, 288, 2469-2475.
Bousquet, J., Clark, T., Hurd, S., Khaltaev, N., Lenfant, C., O'byrne, P., et al. (2007). GINA guidelines on asthma and beyond. Allergy, 62(2), 102-112.
Brook, U., Weitzman, A., &; Wigal, J. (1991). Parental anxiety associated with a child bronchial. Annaol of Allergy, Asthma &; Immunolly, 5(1), 15-20.
Buchanan, A. E. (2000). Trust in managed care organizations. Kennedy Institute of Ethics Journal, 10(3), 189-212.
Bussing, R., Halfon, N. Bernjamin, B., &; Wells, B. K. (1995). Prevalence of behavior problems in US children with asthma. Archives of Pediatrics &; Adolescent Medicine, 149, 565-572.
Butz, A., Pham, L., Lewis, L. P., Lewis, C., Hill, K., Walker, J., &; Winkelstein, M. (2005). Rural children with asthma: impact of a parent and child asthma education program. Journal of Asthma, 42(10), 813-821.
Cabana, M. D., Slish, K. K., Evans, D., Mellins, R. B., Brown, R. W., Lin, X., et al. (2006). Impact of physician asthma care education on patient outcomes. Pediatrics, 117(6), 2149-2157.
Cadman, D., Boyle, M., Szatmani, P., &; Offord, D. R. (1987). Chronic illness, disability, and mental and social well-being: Findings of the Ontario Child Health Study. Pediatrics, 79, 505-512.
Chen, S. H., Teresa, J. C., &; Huang, J. L. (2002). Exploring of the skills for inhalation therapy in schoolchildren with asthma in Taiwan. Annaol of Allergy, Asthma &; Immunolly, 89, 311-15.
Chen, S. H., Yeh, K. W., Chen, S. H., Yen, D. C., Yin, T. J. C., &; Huang, J. L. (2004). The development and establishment of a care map in children with asthma in Taiwan. Journal of Asthma, 41(8), 855-861.
Chen, S. H., Tsai, Y. F., Huang, J. L., &; Yeh, K. W. (2012). Origin of Stress in caregiver of asthmatic children: A qualitative study. Poster session presented at the 20th International Nursing Research Congress-Creating a Legacy through Nursing Research, Innovation and Global Collaboration, Brisbane, Australia.
Chen, S. H., Tsai, Y. F., Sun, C. Y., Wu, I. W., Lee, C. C., &; Wu, M. S. (2011). The impact of self-management support on the progression of chronic kidney disease—a prospective randomized controlled trial. Nephrology Dialysis Transplantation, 26(11), 3560-3566.
Chiang, L. C., Huang, J. L., Yeh, K. W., &; Lu, C. M. (2004). Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children. Journal of Asthma, 41(2), 205-215.
Clark, N. M., Evans, D., Zimmerman, B. J., Levison, M. J., &; Mellins, R. B. (1994). Patient and family management of asthma: theory-based techniques for the clinician. Journal of Asthma, 31(6), 427-435.
Cohen, S., Kamarck, T., &; Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385-396.
Cohen, L. M., Germain, M. J., &; Poppel, D. M. (2003). Practical considerations in dialysis withdrawal: "To have that option is a blessing". Journal of the American Medical Association, 289(16), 2113-2119.
Cunninggham, M. A., &; Baker, D. (1986). How to teach patients better and faster. RN, 149(9), 50-52.
Davenport, T. H., &; Prusak, L. (2000). Working knowledge: How organizations manage what they know. Boston: Harvard Business School Press.
Dean, K. J. (1986). Lay care in illness. Social Science &; Medicine, 22(2), 275-284.
Deber, R. B., Kraetschmer, N., &; Irvine, J. (1996). What role do patients wish to play in treatment decision making? Archive of Internal Medicine, 156(13), 1414-1420.
Doz, M., Chouaid, C., Com-Ruelle, L., Calvo, E., Brosa, M., Robert, J., et al. (2013). The association between asthma control, health care costs, and quality of life in France and Spain. BMC Pulmonary Medicine, 13(1), 15.
Edward, R., Carter, M. D., Jason, S., Debley, M. D., Gregory. J., &; Redding, M. D. (2005). Changes in asthma prevalence and impact on health and function in seattle middle-school children: 1995 vs 2003. Annals of Allergy, Asthma &; Immunology, 94, 634-639.
Eisner, C., &; Havermans, T. (1992). Mothers’ and fathers’ coping with chronic childhood disease. Journal of Psychology and Health, 7, 249-257.
Ellis-Stoll, C. C., &; Popkess-Vawter, S. (1998). A concept analysis on the process of empowerment. Advances in Nursing Science, 21(2), 62-67.
Englund, A., Rydstrom, I., &; Norberg, A. (2001). Being the parent of a child with asthma. Pediatric Nursing, 27(4), 365.
Fielding, D., &; Duff, A. (1999). Compliance with treatment protocols: interventions for children with chronic illness. British Medical Journal, 80(2), 196.
Fiese, B., Winter, M., Anbar, R., Howell, K., &; Poltrock, S. (2008). Family climate of routine asthma care: associating perceived burden and mother-child interaction patterns to child well-being. Family Process, 47(1), 63-79.
Forero, R., Bauman, A., Young, L., Booth, M., &; Nutbeam, D. (1996). Asthma , health behavior, social adjustment, and psychosomatic symptoms in adolescence. Journal of Asthma, 33(3), 157-164.
Fowler, G. M., Davenport, G. M., &; Garg, R. (1992). School functioning of US children with asthma. Pediatrics, 90(6), 939-944.
Foxall, M., Eckberg, J., &; Griffith, N. (1986). Spousal adjustment to chronic illness. Rehabilitation Nursing, 11(2), 13.
Frankel, K., &; Wamboldt, M. (1998). Chronic childhood illness and maternal mental health-why should we care? Journal of Asthma, 35(8), 621-630.
Friend, A., &; Rapport, D. (1991). Evolution of macro-information systems for sustainable development. Ecological Economics, 3(1), 59-76.
Global Initiative for Asthma. (2009, November 22). Pocket guide for asthma management and prevention. Retrieved May 1, 2010, from http://www.ginasthma.com/docs.html.
Georgiou, A., Buchner, D., Ershoff, D., Blasko, K., Goodman, L., &; Feigin, J. (2003). The impact of a large-scale population-based asthma management program on pediatric asthma patients and their caregivers. Annals of Allergy, Asthma &; Immunology, 90(3), 308-315.
Goldstein, R., &; Hurd, S. (1992). The rising problems of asthma; mechanisms and management. Introduction. Chest, 101(6 Suppl), 355S.
Conger, J., &; Kanungo, R. (1988). The empowerment process: Integrating theory and practice. Academy of Management Review, 13(3), 471-482.
Gutierrez, L. M., Parsons, R. J., &; Cox, E. O. (1998). Empowerment in social work practice: A sourcebook. Pacific Grove, CA: Brooks/Cole.
Hardy, S. G. (1992). Nursing implications of increasing asthma prevalence. British Journal of Nursing, 1(13), 653-659.
Hullmann, S. E., Wolfe-Christensen, C., Ryan, J. L., Fedele, D. A., Rambo, P. L., Chaney, J. M., et al. (2010). Parental overprotection, perceived child vulnerability, and parenting stress: a cross-illness comparison. Journal of Clinical Psychology in Medical Settings, 17(4), 357-365.
Indinnimeo, L., Bonci, E., Capra, L., La Grutta, S., Monaco, F., Paravati, F., et al. (2009). Clinical effects of a long‐term educational program for children with asthma–aironet®. A 1‐yr randomized controlled trial. Pediatric Allergy and Immunology, 20(7), 654-659.
Kao, C. C., See, L. C., Yan, D. C, Ou, L. S., &; Huang, J. L. (2001).Time trends and seasonal variations in hospital admissions for childhood asthma in taiwan from 1990 to 1998. Journal of Allergy and Immunology, 19, 63-68.
Keith, T., Sylvia, T., &; Yvonne, R. (1990). Health education： effectiveness and efficiency. New York：Chapman &; Hall.
Klinnert, M. D., McQuaid, E. L., &; Gavin, L. A. (1997). Assessing the family asthma management system. Journal of Asthma, 34(1), 77-88.
Krauss, W. M. (2000). Family assessment within early intervention programs, in J. P. Shonkoff &; S. Meisels (Eds.), Handbook of Early Childhood Intervention, 290-308, Cambridge: Cambridge University Press.
Kolbe, J., Vamos, M., Fergusson, W., Elkind, G., &; Garrett, J. (1996). Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma. CHEST Journal, 110(6), 1463-1468.
Kwok, M. Y., Walsh-Kelly, C. M., Gorelick, M. H., Grabowski, L., &; Kelly, K. J. (2006). National Asthma Education and Prevention Program severity classification as a measure of disease burden in children with acute asthma. Pediatrics, 117(Supplement 2), S71-S77.
Leichsenring, K. (2004). Developing integrated health and social care services for older. International Journal of Integrated Care, 4(3), 1568-4156.
Lenney, W. (1997). The burden of pediatric asthma. Pediatric Pulmonology, 24(S15), 13-16.
Liu, C., &; Feekery, C. (2001). Can asthma education improve clinical outcomes? An evaluation of a pediatric asthma education program. Journal of Asthma, 38, 269-278.
Magee, J. C., Ritterband, L. M., Thorndike, F. P., Cox, D. J., &; Borowitz, S. M. (2009). Exploring the relationship between parental Worry about their children’s health and usage of an internet intervention for pediatric encopresis. Journal of Pediatric Psychology 34(5), 530-538.
Margolis, H., &; McCabe, P. P. (2004). Self-efficacy: A key to improving the motivation of struggling learners. The Clearing House, 77(6), 241-249.
Martens, R., Burton, D., Vealey, R. Bump, L., &; Smith, D. (1990). Development and validation of the Competitive State Anxiety Inventory-2. In R. Martens, R. Vealey, &; D. Burton (Eds.), Competitive anxiety in sport (pp.117-190). Champaign, IL: Human Kinetics.
Mancuso, C. A., Sayles, W., &; Allegrante, J. P. (2010). Knowledge, attitude, and self-efficacy in asthma self-management and quality of life. Journal of Asthma, 47(8), 883-888.
Meltzer, L. J., &; Mindell, J. A. (2007). Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study. Journal of Family Psychology, 21(1), 67-73.
Mesters, I., van Nunen, M., Crebolder, H., &; Meertens, R. (1995). Education of parents about paediatric asthma: effects of a protocol on medical consumption. Patient Education and Counseling, 25(2), 131-136.
McNeil, B. J., Pauker, S. G., Sox, H. C., &; Tversky, A. A. (1982). On the elicitation of preferences for alternative therapies. The New English Journal of Medicine, 306, 1259-1262.
McCarthy, M., Herbert, R., Brimacombe, M., Hansen, J., Wong, D., &; Zelman, M. (2002). Empowering parents through asthma education. Pediatric Nursing, 28(5), 465-474.
McCollough, M. A., Berry, L. L., &; Yadav, M. S. (2000). An empirical investigation of customer satisfaction after service failure and Recovery. Journal of Service Research, 3(2) 121-37.
Mcwilliam, C. L., Stewart, M., Brown, J. B., Mcnair, S., Desai, K., Patterson, M. L., et al. (1997). Creating empowering meaning: an interactive process of promoting health with chronically ill older Canadians. Health Promotion International, 12(2), 111-123.
Mesters, I., Meertens, M. R., Crebolder, H., &; Parcel G. (1993). Development of a health education program for parents of preschool children with asthma. Health Education Research, 8(1), 53-68.
Mu, P. F., Ma, F. C., Hwang, B., &; Chao, Y. M. (2002). Families of children with cancer: The impact on anxiety experienced by fathers. Cancer Nursing, 25(1), 66-73.
Myo, P. H., Richman, J., &; Harris, H. W. (1990). Results of a program to reduce admissions for adult asthma. Annals of Internal Medicine, 112(11), 864-871.
National Health, Lung, and Blood Institute. (2002, July 1). Guidelines for the diagnosis and management of asthmaupdate on selected topics. Retrieved January 1, 2007, from http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma /Asthma_WhatIs.htm
O’Connor, A. M., Fiset, V., Rostom, A., Tetroe, J. M., Entwistle, V., &; Llewellyn-Thomas, H. A. (1999). Decision aids for patients facing health treatment or screening decisions: systematic review. British Medical Journal, 319(7212), 731-734.
Ordonez, G., Phelan, P., Olinsky, A., &; Robertson, C. (1998). Preventable factors in hospital admissions for asthma. Archives of Disease in Childhood, 78(2), 143.
Partridge, M. R. (1986). Asthma education: More reading or more viewing? Journal of the Royal Society of Medicine, 79(6), 326-328.
Piecoro, L., Potoski, M., Talbert, J., &; Doherty, D. (2001). Asthma prevalence, cost, and adherence with expert guidelines on the utilization of health care services and costs in a state Medicaid population. Health Services Research, 36(2), 357.
Prapphal, N., Laosunthara, N., Deerojanawong, J., &; Sritippayawan, S. (2007). Knowledge of asthma among caregivers of asthmatic children: outcomes of preliminary education. Journal Medical Association of Thailand, 90(4), 748.
Richardson, C. R. (2003). Educational interventions improve outcomes for children with asthma. Journal of Family Practice, 52(10), 764-765.
Riegel, B., Carlson, B., &; Glaser, D. (2000). Development and testing of a clinical tool measuring self-management of heart failure. Heart &; Lung: the Journal of Critical Care, 29(1), 4.
Rockville, M. D. (2002). Impact of cancer-related decision aids. Evidence Report Technology Assessment, 46, 1-4.
Santanello, N., Zhang, J., Seidenberg, B., Seidenberg, B., Reiss, T. F., &; Barber, B. L. (1999).What are minimal important changes for asthma measures in a clinical trial? European Respiratory Journals, 14, 23-27.
Sinclair, D., &; Peters, S. A. (2004). The predictive value of total serum IgE for a positive allergen specific IgE result. Journal Clinical Pathology, 57, 956–959.
Steerenberg, P. A., Janssen, N. A. H., de Meer, G., Fischer, P. H., Nierkens, S., van Loveren, H., et al. (2003). Relationship between exhaled NO, respiratory symptoms, lung function, bronchial hyperresponsiveness, and blood eosinophilia in school children. Thorax, 58(3), 242-245.
Stephan, V., Kueher, J., Seibt, A., Saueressig, H., Zingesm, S., &; Dinh, T. D. (1999). Genetic linkage of HLA-class II locus to mite-specific IgE immune responsiveness. Clinical &; Experimental Allergy, 29, 1049-1154.
Strunk, R. C., Szeer, S. J., &; Phillips, B. R. (2003). Relationship of exhaled nitric oxide to clinical and inammatory markers of persistent asthma in children. Journal of Allergy Clinical Immunology, 112, 883-892.
Steerenberg, P. A., Janssen, N. A., &; de Meer, G. (2003). Relationship between exhaled NO, respiratory symptoms, lung function, bronchial hyperresponsiveness, and blood eosinophilia in school children. Thorax, 58, 242-245.
Svavarsdottir, E. K., &; Rayens, M. K. (2005). Hardiness in families of young children with asthma. Journal of Advanced Nursing, 50(4), 381-390.
Tankel, K. (2001). Therapeutic interactions in a medication education group using the psychopharmacology RACE. Journal of Psychosocial Nursing, 39(6), 23-30.
Terpstra, J. L., Chavez, L. J., &; Ayala, G. X. (2012). An intervention to increase caregiver support for asthma management in middle school-aged youth. Journal of Asthma, 49(3), 267-274.
Tettersell, M. J. (1993). Asthma patients’ knowledge in relation to compliance with drug therapy. Journal of Advanced Nursing, 18(1), 103-113.
Thomas, K., &; Velthouse, B. (1990). Cognitive elements of empowerment: An interpretive model of intrinsic task motivation. Academy of Management Review, 15(4), 666-681.
Tsai, Y. G., Lee, M. Y., Yang, K. D., Chu, D. M., Tuh, Y. S., &; Hung, C. H. (2001). A single dose of nebulized budesonide decreases exhaled nitric oxide in children with acute asthma. Journal of Pediatric, 139(3), 433-437.
Turnbull, A. P., &; Turnbull, H. R. (2001). Families, professionals, and exceptionality: Collaborating for empowerment (4th Ed.). Upper Saddle River, New Jersey: Merrill / Prentic Hall.
Tzeng, L. F., Chiang, L. C., Hsueh, K. C., Ma, W. F., &; Fu, L. S. (2010). A preliminary study to evaluate a patient‐centred asthma education programme on parental control of home environment and asthma signs and symptoms in children with moderate‐to‐severe asthma. Journal of Clinical Nursing, 19(9‐10), 1424-1433.
Vries, M. P., Bemt, L., Thoonen, P. A., Muris, W. M., &; Schayck, C. P. (2006). Relationship between house dust mite (HDM) allergen exposure level and inhaled corticosteroid dosage in HDM-sensitive asthma patients on a self management program. Primary Care Respiratory Journal, 15(2), 110－115.
Wallerstein, N. (2002). Empowerment to reduce health disparities. Scandinavian Journal of Public Health, 59, 72-77.
Wallerstein, N., &; Berntein, E. (1994). Introduction to com¬munity empowerment participatory education and health. Health Education Quarterly, 21(2), 141-148.
Watson, W. T. A., Gillespie, C., Thomas, N., Filuk, S. E., McColm, J., Piwniuk, M. P., et al. (2009). Small-group, interactive education and the effect on asthma control by children and their families. Canadian Medical Association Journal, 181(5), 257-263.
Weinstein, A., &; Cuskey, W. (1985) Theophylline compliance in asthmatic children. Annals of Allergy, 54, 19.
Weiss, M. R., &; Chaumeton, N. (1992). Motivational orientations in sport. In T. S. Horn (Ed.), Advances in sport psychology (pp. 61-99). Champaign, IL: Human Kinetics.
Wiesch, D. G., Meyers, D. A., &; Bleecker, E. R. (1999). Genetics of asthma. Journal Allergy Clinical Immunology, 104, 895-901.
Williams, S., Dilworth-Anderson, P., &; Goodwin, P. (2003). Caregiver role strain: the contribution of multiple roles and available resources in African-American women. Aging &; Mental Health, 7(2), 103-112.