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研究生:郭淑娥
研究生(外文):Sue Er Kuo
論文名稱:長期依賴呼吸器病患與家屬之需求及其滿意度探討
論文名稱(外文):Needs and Satisfaction of Prolonged Mechanical Ventilator Patients and Family Members
指導教授:劉雪娥劉雪娥引用關係
指導教授(外文):Hsueh-Erh Liu
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:201
中文關鍵詞:長期依賴呼吸器需求滿意度
外文關鍵詞:Prolonged depend mechanical ventilatorneedssatisfaction
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摘要
本研究目的在探討長期依賴呼吸器的病人與其家屬之需求和滿意度。以簡單隨機抽樣和立意取樣方法。此研究是採探討性、描述性設計之研究,在北部某醫學中心選取符合研究條件的對象為樣本,包括病人12位和家屬78位。採用結構性問卷,由研究者參考文獻和臨床經驗,發展出「家屬需求」量表74題,和「病人需求」量表62題。問卷經由專家效度測試和Cronbach alph信度檢定。資料分析採用描述性統計,包括次數、百分比、平均值;推論性統計有t-test, Mann-Whitney U test, ANOVA, Kruskal-Wallis test, Multiple linear regression, Pearson correlation coefficient.
研究結果如下:(1)病人需要的是病況相關需求,和醫療照顧相關訊息的需求。(2)病人對心理社會支持和環境相關需求的滿意度高。(3)家屬需要的也是病況相關需求,和醫療照顧相關訊息的需求。(4) 家屬也滿意病況相關需求,和醫療照顧相關訊息的需求。(5)家屬需求的顯著因素包括年齡、與病人的關係、自覺疾病的嚴重度、教育程度、經濟狀況、住院經驗、家庭經濟主要來源;疾病特徵包括入院診斷、呼吸器脫離訓練情況、病人住呼吸照護中心日數。(6)住院經驗、是否與病人同住、自覺焦慮程度、訪視次數、家屬教育程度、住院日數、入院診斷、呼吸器脫離訓練情況、病人日常活動功能、病人的住院經驗等,也影響家屬需求滿意度之評估。(7)在不同週數這些因素也影響家屬需求和滿意度量表得分之差異。
影響病人需求得分的顯著因素有:年齡、職業、入院診斷、APACHE II score,和病人肌肉疲乏程度。同時經濟狀況、自覺疾病嚴重度、呼吸器脫離情況,和病人入院診斷是影響病人需求滿意度之顯著因素。
研究結果有益於護理人員更加認識病人和家屬之需求與滿意度,設法達到其需求,改善病人精神上的壓力,以適應呼吸器脫離過程,增加病人成功脫離呼吸器的機會。
關鍵詞:長期依賴呼吸器、需求、滿意度。
Abstract
The purpose of this study was to explore the needs and satisfaction of the prolonged mechanical ventilator patients and their relatives. A total of 78 relatives and 12 patients were selected by simple random sampling and purposive sampling method. An exploratory, descriptive research design was used for this study which took place in a medical center in northern Taiwan. The population consisted of relatives and patients who met the criteria. A structured interview technique was used utilizing a list of 74 ”family needs” and 62 “patient needs”. Statements developed by the investigator through literature review and clinical experiences. The questionnaires were identified to be valid and reliable by expert validity and Cronbach alph reliability test. The data were analyzed by the use of appropriate descriptive statistics, including frequency, percentage, mean, and inferential statistics, including t-test, Mann-Whitney U test, ANOVA, Kruskal-Wallis test, Multiple linear regression, and Pearson correlation coefficient.
The result showed that: (1) patients demand needs which were disease-related and care-related information; (2) patients had high satisfaction with the social mental support and environment-related needs; (3) families demand needs which were disease-related and care-related information; (4) families were satisfied with the disease-related and care-related information needs; (5) significant related factors of the families’ needs included: age, relationship to the patients, severity of illness, education, admission experiences, economic status, main family economic source; and disease characteristics including diagnosis, weaning conditions, length of stay in the respiratory care center; (6)admission experiences, living with the patients, anxiety status, visiting times, education of relatives, length of stay, diagnosis, weaning conditions, daily activity function, admission experiences of the patients etc have influence on the assessment of the families’ satisfaction; (7) those factors had significant difference on the needs and satisfaction score of families in different weeks.
The significant related factors of the patient’s needs included: age, occupation, diagnosis, APACHE II score, and muscle fatigue of patients. The same time, economic status, severity of illness, weaning conditions, and diagnosis of patients were significant factors on the patients’ satisfaction score.
The results of these findings can facilitate nurses to be aware of the needs and satisfaction of the patients and their families by meeting the patients’ demands, improving their psychological stress to cope with weaning process.
Key words: Prolonged depend mechanical ventilator, Need, Satisfaction
第一章 緒論 ..…………………………………………………….. 1
第一節 研究動機 ……………………………………………. 1
第二節 研究重要性 ..…….………………………………….. 4
第三節 研究目的 ……………………………………………. 6
第四節 研究問題 ……………………………………………. 6
第五節 研究假設 ……………………………………………. 7
第六節 名詞解釋 ……………………………………………. 7
第二章 文獻查證 …..…………………………………………….. 9
第一節 呼吸照護中心的特性 ...…………………………….. 9
第二節 病人使用呼吸器之生理因素及其適應症 ..………... 11
第三節 呼吸器脫離訓練病人之反應和需求 ………………. 12
第四節 病人長期依賴呼吸器之原因…………………………20
第五節 呼吸器依賴病人之反應和需求 ……………………. ..21
第六節 病人家屬的需求及滿足需求之重要性 ……………. 22
第七節 住院病人與家屬需求的相關性研究 ………………. 25
第八節 影響住院病人和家屬需求之相關性因素 …………. 33
第三章 研究方法 ..……………………………………………….. 39
第一節 研究架構 …………………………………………… 39
第二節 研究設計 …………………………………………… 40
第三節 研究場所及研究對象 ……………………………… 40
第四節 研究工具之擬定 …………………………………… 41
第五節 研究變項 …………………………………………… 44
第六節 研究工具信、效度測定 …………………………… 44
第七節 資料收集過程 ……………………………………… 47
第八節 資料分析方法 ……………………………………… 48
第四章 研究結果 …..…………………………………………….. 56
第一節 研究對象基本資料描述性統計結果 ……………… 56
第二節 病人的需求和需求滿意度量表得分情形 …………. 72
第三節 家屬的需求和需求滿意度量表得分情形 …………. 78
第四節 影響病人需求與需求滿意度之因素 ………………. 88
第五節 影響家屬需求與需求滿意度之因素 ………………. 90
第六節 家屬之需求與需求滿意度之最佳相關因子………...131
第七節 家屬不同時間點在需求與滿意度之差異 ………… 153
第五章 討論 ……………………………………………………… 169
第一節 研究對象之特性………………………………………169
第二節 病人的需求和需求滿意度 …………………………. 170
第三節 家屬的需求和需求滿意度 ………………………. …174
第四節 影響病人需求與需求滿意度之因素 ………………. 179
第五節 影響家屬需求和需求滿意度之因素 ………………. 182
第六章 結論與建議 ………………………………………………. 193
第一節 結論 …………………………………………………. 193
第二節 護理上的應用 ………………………………………. 197
第三節 研究限制與建議 ……………………………………. 200
參考文獻 ……………………………………………………………. 202
中文部分 ………………………………………………………. 202
英文部分 ………………………………………………………. 207
附錄 .………………………………………………………………… 215
一、中文部分
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吳清平、楊式興、蔡珮漪、彭萬誠、顏鴻欽、江啟輝(2000)‧在醫學中心內新成立的呼吸照護中心使用呼吸器患者一年的預後分析‧Taiwan Critical Care Medicine, 2, 1-14.
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周稚傑、侍台平(1989)‧疾病對家庭的衝擊‧國防醫學,8(5),479-486。
邱德修(1999)‧簡明活用辭典‧台北:五南圖書出版公司。
邱麗珠(1999)‧內科重症病房病人家屬需求及其影響因素探討‧中山醫學院護理研究所碩士論文。
姚如玲、陳敏麗(1999)‧某區域教學醫院燒傷病房家屬探訪需求與滿意度之調查‧長庚護理,10 (2),19-27。
胡慧林(1992)‧台灣某醫學中心加護單位病患獲社會支持及運用壓力調適策略相關性探討‧榮總護理,9(2),195-205。
陳秀玲(1998)‧一位腸阻塞患者住院期間面臨手術的壓力源及因應行為‧長庚護理,9(4),55-61。
陳重華‧(2000,9月)‧呼吸器之脫離‧呼吸衰竭之重症照護研討會‧台北:台灣。
陳敏麗、吳素蘭 ( 1998 )‧某醫學中心手術病人家屬需求之探討‧長庚護理,7 (1),26-36。
葉莉莉(1997)‧呼吸器依賴病患之居家照護‧長期照護,1(2),40-52。
郭素娥(1998)‧老年病患之早期住院壓力:自覺與護士他覺感受之比較‧成功大學學報,33,科技醫學篇,61-73。
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黃芷苓、陳彩鳳(1998)‧某區域醫院推行全面品管下之病患與家屬滿意度之探討‧醫院,31,26-37。
黃珊、陳敏麗、許玲女、林麗滿(2000)‧手術病患家屬於等候中需求及其滿意度之探討‧長庚護理,11(2),31-41。
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黃曉黎(1997)‧老年失智症照顧者在行為處置與其疾病知識、態度及社會支持等相關因素探討‧未發表的碩士論文,桃園龜山,長庚醫學暨工程學院護理研究所。
許國正、翁麗雀(1999) ‧灼傷病童父母之需求‧長庚護理,8(2),1-8。
張淑娟譯(1984)‧減低使用呼吸器病人的心理合併症‧護理雜誌,31(3),25-30。
游金靖(1998)‧音樂治療對心臟手術病患呼吸器脫離時焦慮成效探討‧未發表的碩士論文,台北,國防醫學院護理研究所。
曾春典(1985) ‧ 老人健康與醫療狀況調查‧行政院國科會老人學科技整合研究計劃摘要報告。
張美玉(1994)‧長期呼吸器依賴者脫離呼吸器常見問題與護理措施‧榮總護理,11(1),54-64。
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張黎露(2001, March)‧Assess & care a cancer patient with dyspnea‧癌症病人的呼吸照顧研習會,台北。
張麗玲(1983)‧某醫院內科病房住院病人壓力事件之調查‧護理雜誌,30(4),83-88。
湯麗玉(1991)‧癡呆症老人照顧者的負荷及其相關因素探討‧未發表的碩士論文,台北,台灣大學護理研究所。
楊勤熒(1994)‧台北醫學院附設醫院外科住院老人自覺需要之探討‧未發表。
蔡熒煌(2001) ‧Ventilatory weaning & planned extubation‧氣道處理及呼吸器的應用研習會,台中。
鄭幸宜、戴玉慈、郭壽雄、姚開屏‧成人氣喘患者的壓力、因應策略與生活品質之關係‧護理研究,8 (6),599-612。
劉長安、蘇婉麗 (1998)‧某醫學中心住院患者家屬對醫院的需求及滿意度之探討‧護理雜誌,45 (2),47-58。
劉盈君(1994)‧比較加護病房病人家屬與護理人員對家屬需要之認定‧國防醫學院護理研究所碩士論文。
盧崇正(1995)‧長期使用呼吸器的醫療倫理問題‧臨床醫學,36(6),351-356。
潘靜雲、柯純卿、陳季員、劉雅瑛、曾英芬、金繼春 (1996)‧南部某家醫院病人對醫院服務滿意度的調查‧中華衛誌,15(3),249-257。
劉雪娥(1992)‧影響照顧親人評價之因素的探討‧護理雜誌,39(4),65-74。
戴玉慈(1978)‧病人與護士對護理活動重要性之看法‧護理雜誌,25(1),66-80。
戴玉慈、陳美津、陳惠姿、王祖琪、楊清姿、劉紋妙(1998)‧老人護理學‧台北:國立空中大學。
謝文斌 (1992)‧膿胸:罹病率及死亡率之影響因素‧當代醫學,19(7),597-598。
繆珣 (1994) ‧影響急診病患對急診服務滿意度因素之探討‧榮總護理,11(4),348-359。
魏玲玲、楊勤熒、虞秀紅、賴裕和(2000)‧比較住院老人自覺護理需要與護士認知之差異‧新台北護理期刊,2 (2) ,83-95。
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二、英文部分
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