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研究生:葉秀珍
研究生(外文):Shiu- Chen Yeh
論文名稱:心臟衰竭病患出院過渡期疾病歷程管理
論文名稱(外文):Illness Trajectory Management of Patients with Heart Failure During Discharge Transition
指導教授:徐亞瑛徐亞瑛引用關係
指導教授(外文):Yea-Ing Shyu
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:2002
畢業學年度:90
語文別:中文
論文頁數:149
中文關鍵詞:心臟衰竭出院過渡期疾病歷程
外文關鍵詞:heart failuredischarge transitionillness trajectory
相關次數:
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本研究係以質性研究法探討心臟衰竭病患之疾病歷程管理及相關因素,共訪談11位個案。以質性資料分析軟體(NUDIST)及Miles & Huberman(1994)的資料分析法進行資料整理與歸納,並請其中三位參與者針對研究結果進行成員檢視。
研究結果發現,心臟衰竭病患全面性歷程管理包含察覺、自我解釋、判斷是否採取行動策略以及評值照顧結果四個階段,是一個流動性、循環性、非線性的過程,每個階段都會影響疾病歷程管理最終的結果。個案採取兩大類的自我照顧行動,其一是症狀緩解策略,包括減少體力透支、身體能量恢復、安全保護、靈性救助四個類組,另一類是全面性疾病管理策略,包括飲食管理策略、藥物管理策略、活動策略以及心靈照護策略五個類組。
很多因素會影響心臟衰竭病患的歷程管理,包括個人因素、疾病歷程階段、社會網絡、治療相關因素、心理以及靈性因素六個類組。個案在不穩定期或是仍有身體症狀時,其自我照顧活動會增加,但是健康狀況日益好轉時,採取的自我照顧策略趨於簡單、鬆緩。心臟衰竭病患全面性歷程管理不完全是單一進行的方向,除了疾病特質不可控的因素之外,操弄可控的影響因素,例如改變生活習慣、增加自我照顧知識、增加個人內、外在資源、增加症狀辨識以及處理的技巧、自我照顧能力等,通常可以改變疾病歷程方向、延長穩定期以及延緩病情惡化的速度。較善於疾病管理的個案,較能夠降低身體所帶來的限制,學習與疾病共存的哲學,採取全面性的歷程管理,其疾病歷程也趨於穩定;相反的,較不善於疾病管理的個案,其疾病歷程變化性較大,並且可能不斷的經歷病情惡化的循環。
出院後一個月之過渡期是屬於一個高再入院的時期,藉由本研究的研究結果可以對心臟衰竭病患疾病歷程管理及其影響因素有更深入的瞭解,有助於提供護理措施以及發展出院計劃或是過渡期照護的前提,進而提昇照護品質。
關鍵字:心臟衰竭、出院過渡期、疾病歷程
Abstract
A qualitative study was utilized in this study to explore illness trajectory management and related attributes of clients with heart failure. Eleven clients were interviewed. Data were analyzed inductively by following guidelines provided by Miles & Huberman (1994) with software NUDIST. Three of the participants were asked to do member checks on the findings.
This study found that the overall trajectory management of clients with heart failure was a floating, circulating, non-linear process which involved four stages: Perception, Self-interpretation, Judgment and Evaluation. Clients who participated in this study adopt two kinds of self-care actions. One was symptom release strategy that included avoiding energy exhaustion, recovering energy, protecting security and looking for spiritual help. The other was a general illness management strategy that included diet management, medicine management, activities management and spiritual care.
Many attributes influenced the trajectory management of clients with heart failure that were personal factors, illness trajectory phases, social networks, therapy-related factors, psychological and spiritual factors. The attributes which affected trajectory management and strategies adopted by clients were also influenced by different illness trajectory stages. Self-care activities would increase when symptoms occurred; on the other hand, self-care strategies became simple and loose when physical conditions improved. Overall, the trajectory management of clients with heart failure did not exactly display in a single pattern. The controllable attributes and properly-supplied trajectory management strategies usually could change illness trajectory directions, extending time period of stability or postpone deteriorating rate. The transitional period within one month after hospital discharge, were most likely to be rehospitalized.
The findings are able to provide a reference for development of nursing interventions and discharging planning services in order to improve the quality of nursing care for patients with heart failure.
Keyword: heart failure, discharge transition, illness trajectory
目錄 v
圖表目錄 vii
中文摘要 viii
英文摘要 x
第一章 緒論 1
第一節 研究的重要性 1
第二節 研究動機 3
第三節 研究目的 6
第四節 解釋名詞 …………………………………… … 6
第二章 文獻查證 ……………………………… …………………..7
第一節 疾病歷程概論 7
第二節 心臟衰竭疾病管理相關研究 10
第三節 影響疾病歷程管理因素相關研究 21
第四節 質性研究法 35
第三章 研究方法 40
第一節 研究設計 40
第二節 研究場所 40
第三節 研究對象 41
第四節 研究工具 …………… ………………………… 44
第五節 研究過程 45
第六節 資料分析的過程 48
第七節 質性資料分析的可靠度 52
第八節 研究對象權利保護 57
第九節 研究者的角色 59
第四章 研究結果 61
第一節 心臟衰竭病患全面性疾病歷程管理 61
第二節 機器的日常保養─全面性疾病管理策略 68
第三節 馬達沒力了怎麼辦?-症狀緩解策略 83
第四節 影響心臟衰竭病患全面性疾病歷程管理之因素 92
第五節 疾病歷程管理的結果 104
第五章 討論 110
第一節 疾病歷程管理過程之相關文獻比較 110
第二節 疾病歷程管理策略相關文獻比較 112
第三節 疾病歷程相關的影響因素文獻比較 117
第四節 研究限制 121
第六章 結論與建議 122
第一節 結論 122
第二節 護理上的應用 123
參考資料 127
中文部分 127
英文部分 128
附錄 143
圖表目錄
表3-1 研究對象基本資料表 43
表3-2 心臟衰竭病患疾病管理之初步編碼表 50
表4-1 機器的日常保養-全面性疾病管理策略的類組/編碼、定義及舉例 76
表4-2 馬達沒力了怎麼辦?-症狀緩解策略的類組/編碼、定義及舉例 87
表4-3 馬達無力了怎麼辦?-症狀緩解策略的效用 91
表4-4 身體症狀之緩解策略 91
表4-5 影響歷程管理之因素的類組/編碼、定義及舉例 97
圖4-1 心臟衰竭病患疾病歷程管理 67
圖4-2 機器的日常保養-全面性疾病管理策略 69
圖4-3 馬達沒力了怎麼辦─症狀緩解策略 83
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