臺灣博碩士論文加值系統

摘要
心臟衰竭是一個慢性、失能性疾病，也是住院病患常見的診斷之一，由於受限於疾病的進展會逐漸惡化，導致代償機能減退、日常生活功能障礙因而影響其生活品質。本研究目的在探討自我管理計劃於心衰竭患者之成效。採類實驗型前測和後測重覆測量設計，在中區某區域教學醫院心臟內科門診收集資料，研究對象為經診斷為心衰竭患者，採方便取樣，共收集實驗組40位及對照組42位。實驗組接受護理常規照護及自我管理計劃介入措施，包括提供心臟衰竭自我管理手冊、個別性衛教指導及電話追蹤，對照組接受護理常規照護。兩組研究對象均於收案當週，第四週及第八週施行量表檢測。。研究測量包括心衰竭自我管理問卷、日常活動自我效能量表及明尼蘇達心衰竭問卷。廣義估計方程式模式（Generalized Estimating Equation,GEE），檢驗自我管理計劃之成效。
研究結果顯示自我管理計劃可提升心衰竭患者自我管理之自我遵循、自我管理及生活品質。本研究結果可提供護理人員照護心衰竭患者之重要依據進而提升照護品質。



關鍵字：心臟衰竭、自我管理、身體活動、生活品質

ABSTRACT
The purpose of this study was to investigate the efficacy of Self-Management Program on self-management, physical activity and the quality of life in patients with heart failure. The study is a repeated measure quasi-experimental design. Data were collected from a cardiac clinic of local hospital in Taichung, Taiwan. The sampling criteria included diagnosed heart failure according to International Classification of Disease code. A total of eighty-two qualified participants were enrolled and convenient assigned to an interventional group (n = 40) or a control group (n = 42). Data were obtained at three time points: baseline; four weeks after and eight weeks after the intervention. Patients in an intervention group received the usual nursing care plus Self-Management Program. Patients in the control group received the usual nursing care only. Outcome measures included Self-care of Heart Failure Index (SCHFI), Duke Activity Status Index (DASI) and Minnesota Living with Heart Failure Questionnaire. Generalized estimation equations (GEE) were used to compare changes of scores over time among groups for the outcomes.
This study found Self-Management Program is effective in improving self-care maintenance, self-care management and quality of life among participants of the intervention group. The findings of this study provided a health care intervention for nurses who are taking care patients with heart failure.



Keywords: Heart failure；Self-management；Physical activity；Quality of life
 

第一章緒論
第一節研究背景與動機………………………………………………………1
第二節研究目的………………………………………………………………3
第二章文獻探討
第一節心臟衰竭的流病學……………………………………………………4
第二節自我管理………………………………………………………………9
第三節身體活動………………………………………………………………15
第四節生活品質………………………………………………………………18
第五節自我管理、身體活動與生活品質的相關性………………….....20
第三章研究方法
第一節研究架構………………………………………………………………22
第二節研究設計………………………………………………………………23
第三節研究對象與場所………………………………………………………24
第四節研究樣本………………………………………………………………25
第五節研究介入措施…………………………………………………………25
第六節研究工具………………………………………………………………28
第七節資料收集過程…………………………………………………………32
第八節研究倫理考量…………………………………………………………34
第九節資料處理與分析………………………………………………………34
第四章研究結果
第一節研究對象基本屬性與疾病特性………………………………………36
第二節心臟衰竭病患之自我管理……………………………………………46
第三節心臟衰竭病患之身體活動……………………………………………59
第四節心臟衰竭病患之生活品質……………………………………………62

第五章討論
第一節研究對象基本屬性與疾病特性………………………………………71
第二節心臟衰竭病患之自我管理……………………………………………72
第三節心臟衰竭病患之身體活動……………………………………………73
第四節心臟衰竭病患之生活品質……………………………………………74
第六章結論
第一節結論……………………………………………………………………76
第二節研究限制………………………………………………………………77
第三節建議……………………………………………………………………78
參考資料
中文資料………………………………………………………………………80
英文資料………………………………………………………………………82
附件
附件一 研究受訪者同意書………………………………………………93
附件二 病患基本資料表…………………………………………………96
附件三 心臟衰竭自我管理量表…………………………………………99
附件四 日常活動自我效能量表…………………………………………101
附件五 美國明尼蘇達心衰竭量表………………………………………104
附件六 畫鐘試驗表………………………………………………………105
附件七 研究倫理審議證明書……………………………………………106
附件八 醫院人體試驗委員會審查證明書………………………………107
附件九 心臟衰竭自我管理量表授權書（英文）………………………108
附件十 日常活動自我效能量表授權書（英文）………………………109
附件十一 日常活動自我效能量表授權書（中文）………………………110
附件十二 美國明尼蘇達心衰竭量表授權書（英文）……………………111
附件十三 美國明尼蘇達心衰竭量表授權書（中文）……………………112
附件十四 心臟衰竭自我管理指導手冊之專家效度評分表………………113
附件十五 心臟衰竭自我管理問卷量表之專家效度評分表………………114
附件十六 心臟衰竭衛教單張………………………………………………116

表次
表1 自我管理計劃介入措施內容………………………………………………26
表4-1 研究對象基本資料…………………………………………………………37
表4-2 心臟衰竭疾病特性…………………………………………………………41
表4-3 慢性病分佈情形……………………………………………………………42
表4-4 引起心衰竭病因……………………………………………………………43
表4-5 藥物使用情形………………………………………………………………44
表4-6 運動行為……………………………………………………………………45
表4-7 運動種類……………………………………………………………………45
表4-8 自我管理之自我遵循兩組前後測之比較…………………………………48
表4-9 自我管理之自我管理兩組前後測之比較…………………………………51
表4-10 自我管理之自信兩組前後測之比較………………………………………53
表4-11 自我管理兩組前後測之比較………………………………………………54
表4-12 自我管理量表之廣義估計方程式模式表…………………………………55
表4-13 身體活動兩組前後側之比較………………………………………………60
表4-14 身體活動量表之廣義估計方程式模式表…………………………………60
表4-15 生活品質兩組前後測之比較………………………………………………65
表4-16 生活品質量表之廣義估計方程式模式表…………………………………66

圖次
圖一 研究架構圖…………………………………………………………………22
圖二 為心臟衰竭患者接受自我管理計劃之資料收集過程……………………33
圖4-1 調整前自我管理自我遵循量表……………………………………………56
圖4-2 調整後自我管理自我遵循量表……………………………………………56
圖4-3 調整前自我管理之自我管理………………………………………………57
圖4-4 調整後自我管理之自我管理………………………………………………57
圖4-5 調整前自我管理量表之自信………………………………………………58
圖4-6 調整後自我管理量表之自信………………………………………………58
圖4-7 調整前身體活動兩組前後側之比較………………………………………61
圖4-8 調整後身體活動兩組前後側之比較………………………………………61
圖4-9 調整前整體生活品質………………………………………………………67
圖4-10 調整後整體生活品質………………………………………………………67
圖4-11 調整前生理生活品質………………………………………………………68
圖4-12 調整後生理生活品質………………………………………………………68
圖4-13 調整前情緒生活品質量表…………………………………………………69
圖4-14 調整後情緒生活品質量表…………………………………………………69
圖4-15 調整前社交生活品質量表…………………………………………………70
圖4-16 調整後社交生活品質量表…………………………………………………70

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