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研究生:吳佳慧
研究生(外文):Chia-Hui Wu
論文名稱:間歇性導尿護理指導對脊椎裂學齡患童尿失禁知識及自我照顧行為影響之探討
論文名稱(外文):The effect of nursing intervention of intermittent catheterization on the knowledge of urine incontinence and self-care behavior for school-aged children with spina bifida
指導教授:王如華王如華引用關係黃棣棟黃棣棟引用關係張玉坤張玉坤引用關係
指導教授(外文):Ru-Hua WangTai-Tong WongYue-Chune Chang
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
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:138
中文關鍵詞:間歇性導尿護理指導脊椎裂學齡期尿失禁知識自我照顧行為
外文關鍵詞:nursing intervention of intermittent catheterizationspina bifidaSchool-agedthe knowledge of urine incontinenceself-care behavior
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本研究以探討脊椎裂學齡患童的尿失禁知識及自我照顧行為之影響因素,以及實施間歇性導尿護理指導的成效為目的,遂採類實驗設計,以立意取樣方式,於北部某醫學中心選取30位7-12歲脊椎裂學齡患童為研究對象。研究進行第一階段以家庭訪視方式收集個案前測資料,包括脊椎裂學齡患童及其雙親之基本資料、脊椎裂患童尿失禁知識問卷、間歇性導尿自我照顧評量表等測得之資料,之後隨即實施護理指導。一個月後再作第二次家庭訪視及收集後測資料。所有前後測資料分別以描述性統計、配對t檢定、單因子變異數分析、魏氏帶符號等級檢定、魏氏-曼-惠特尼檢定、克-瓦二氏單因子等級變異數分析及皮爾森積差相關分析等統計方法進行分析。
研究結果發現:(一)脊椎裂學齡患童的疾病資訊93.3%來自父母﹐來自護理人員為30%,對於學校護士提供的幫助僅有13.3%。(二)脊椎裂學齡患童尿失禁知識平均得分為17.33,答對率57.77%,經間歇性導尿護理指導後,尿失禁知識平均得分為25.9,答對率86.30%,有顯著的差異(p=0.00)。(三)雖然50%的脊椎裂學齡患童最常以間歇性導尿處理尿失禁問題,其次常用的仍見包尿布(36.7﹪)及護墊(13.3﹪)方式,間歇性導尿護理指導前80%(24位)患童完全由父母執行導尿,僅有5位(16.7﹪)患童可自行導尿,然而指導後有19位(63.33%)患童能自我導尿,顯見患童能自我完成導尿的人數成3.8倍增加。(四)脊椎裂學齡患童尿失禁自我照顧行為評量部分,前測平均得分為5.03,執行率11.43%,經間歇性導尿護理指導後,尿失禁自我照顧行為經評量得分躍升至23.30,執行率53.64%,呈顯著的差異(p=0.000)。(五)患童、雙親基本屬性及其疾病特徵中,除患童住院經驗、行走功能與尿失禁知識有顯著相關(r=-0.387 、p=0.035,F=5.203、p=0.012)外,其他變項皆與尿失禁知識或自我照顧行為無顯著相關。(六)另,本研究惜未於脊椎裂學齡患童的尿失禁知識與自我照顧行為間發現顯著相關性(r=-0.237,p>0.05),然間歇性導尿護理指導後,對脊椎裂學齡患童的尿失禁知識(t=13.11,p<0.05)與自我照顧行為(z=4.2,p<0.05)均造成顯著的改變。
根據本研究發現間歇性導尿護理指導可增進脊椎裂學齡患童尿失禁知識及提昇自我照顧行為。因此建議及早運用兒童認知發展特質所能接受之資訊指導,建立完整的的間歇性導尿知識與技能標準,製作成教學錄影帶或光碟。將之列入護生臨床兒科實習內容外,尚須定期舉辦護理人員或學校護士照顧脊椎裂患童之繼續教育,方能落實脊椎裂學齡患童尿失禁知識及自我照顧之護理指導,也唯有在護理人員及患童均充分受教及學習之後,才可期盼脊椎裂患童尿失禁問題之醫護處置及其生活自我照顧等各方面品質,得以改善。

Urine incontinence is not a fatal complication of spina bifida but it reduced life quality throughout patient’s life. Established knowledge of incontinence and self-care behavior may be benefit to school age children. Nursing intervention on intermittent catheterization was suspected more effective to establish this knowledge. We designed a quasi-experimental design to purposively enroll thirty subjects, aged 7 to 12, to scale the knowledge of urine incontinence and self-care behavior, then to train the skill of intermittent catheterization by nurses. Further interview to scale the effect was performed one month later. The data was analyzed by the software of SPSS for Window, which includes the descriptive statistics, t-test, one way ANOVA, Wilcoxon Signed-Rank test, Mann-Whitney U test, Kruskal-Wallis one way ANOVA and Pearson correlation.
We found: (1) Most knowledge was established by parent (93.3%), but not nurse (13.3% by school nurse). (2) Effect of nursing intervention (average scale 17.33 to 25.9 and correct rate 57.77 to 86.3%) was statistically significant (p=0.00). (3) Nursing intervention increased the rate of intermittent catheterization by children himself (16.7 to 63.3%) and elevated the average score of self-care from 5.03 to 23.3 (11.43 to 53.64%, implementation rate) statistically significantly (p=0.000). (4) Hospitalization experiences and walk function were statistically significantly correlative to knowledge of urine incontinence (r= -0.387, p=0.035; F=5.203, p=0.012).
The study supported the nursing intervention to improve the knowledge and management of urine incontinence which is caused by spina bifida. Early nursing intervention with multimedia, like teaching video tape or disc, may be more effect. Moreover, for further nursing intervention to improve the life quality of patients and parents, we suggested to modify the continuing education courses of nurses who will care the subjects with spina bifida and students, including the clinical skill of intermittent catheterization and programmed education technique to children.

致謝…………………………………………………………...Ⅰ
摘要…………………………………………………………...Ⅱ
目錄…………………………………………………………...Ⅵ
圖表目錄……………………………………………………...Ⅷ
第一章 緒論………………………………………………….1
第一節 研究動機及重要性…………………………………………1
第二節 研究目的……………………………………………………6
第三節 研究問題……………………………………………………7
第二章 文獻查證與研究架構……………………………….8
第一節 脊椎裂與尿失禁……………………………………………8
第二節 學童與其罹病時之認知發展……………………………..20
第三節 脊椎裂學童自我照顧……………………………………..26
第四節 間歇性導尿護理指導……………………………………..30
第五節 概念架構…………………………………………………..38
第六節 研究假設…………………………………………………..40
第七節 名詞界定…………………………………………………..40
第三章研 研究方法………………………………………...45
第一節 研究設計…………………………………………………..45
第二節 研究對象與場所…………………………………………..46
第三節 研究工具…………………………………………………..47
第四節 資料收集過程……………………………………………..54
第五節 資料處理與分析…………………………………………..57
第四章 研究結果…………………………………………...59
第一節 研究對象之基本資料……………………………………..59
第二節 量表信效度的檢測………………………………………..68
第三節 間歇性導尿護理指導前,脊椎裂學齡患童的尿失禁
知識及自我照顧行為……………………………………..72
第四節 脊椎裂學齡患童的基本屬性、疾病特徵、雙親基本
屬性與尿失禁知識、自我照顧行為的關係………………78
第五節 間歇性導尿護理指導對脊椎裂學齡患童的尿失禁知
識及自我照顧行為的影響………………………………..84
第五章 討論………………………………………………...94
第一節 研究對象之基本資料……………………………………..94
第二節 脊椎裂學齡患童的尿失禁知識及自我照顧行為………..96
第三節 患童基本屬性、疾病特徵、雙親基本屬性與尿失禁
知識及自我照顧行為的關係……………………………..99
第四節 間歇性導尿護理指導對脊椎裂學齡患童尿失禁知識
及自我照顧行為的影響…………………………………102
第六章 結論與建議……………………………………….105
第一節 結論………………………………………………………105
第二節 護理上的應用……………………………………………106
第三節 研究限制與建議…………………………………………108
參考文獻…………………………………………………….111
附件一 同意書………………………………………………………..125
附件二 脊椎裂尿失禁學齡患童基本資料表………………………..126
附件三 脊椎裂尿失禁學齡患童雙親基本資料表…………………..131
附件四 脊椎裂尿失禁知識問卷……………………………………..134
附件五 間歇性清潔導尿自我照顧行為評量表……………………..137
附件六 專家效度名單………………………………………………..138
圖表目錄
頁次
圖二-1 研究概念架構………………………………………………...39
圖四-1 研究對象尿失禁知識前後測情形…………………………...92
圖四-2 研究對象尿失禁自我照顧行為前後測情形………………...92
圖四-3 研究對象尿失禁知識與自我照顧行為前後測差異情形…...93
圖四-4 研究對象尿失禁知識與自我照顧行為兩者間的關係之
前後測比較…………………………………………………..93
表三-1 研究設計……………………………………………………...45
表四-1 研究對象之基本資料………………………………………...63
表四-2 研究對象雙親之基本資料…………………………………...67
表四-3 研究量表之信度……………………………………………...68
表四-4 脊椎裂尿失禁知識問卷之項目分析………………………...69
表四-5 脊椎裂尿失禁知識問卷因素分析正交轉軸之結果………...71
表四-6 脊椎裂尿失禁知識問卷前測各題得分情形………………...74
表四-7 脊椎裂尿失禁知識問卷前測各次因素得分情形…………...75
表四-8 間歇性導尿自我照顧行為評量表前測各次因素
得分情形……………………………………………………..76
表四-9 間歇性導尿自我照顧行為評量表前測各項得分
情形…………………………………………………………..77
表四-10 研究對象基本變項與脊椎裂尿失禁知識、自我
照顧行為之相關…………………………………………..80
表四-11 研究對象基本變項與脊椎裂尿失禁知識、自我
照顧行為之相關…………………………………………..82
表四-12 脊椎裂患童的尿失禁知識與自我照顧行為之相關……….83
表四-13 以GEE分析研究對象基本變項與尿失禁知識情形………83
表四-14 脊椎裂尿失禁知識問卷後測各題得分情形……………….86
表四-15 脊椎裂尿失禁知識問卷後測各次因素得分情形………….87
表四-16 間歇性導尿自我照顧行為評量表後測各次因素
得分情形…………………………………………………..87
表四-17 間歇性導尿自我照顧行為評量表後測各項得分情形…….88
表四-18 脊椎裂學齡患童尿失禁知識前後測的情形……………….90
表四-19 脊椎裂學齡患童尿失禁自我照顧行為前後測的情形…….90
表四-20 以GEE分析研究對象尿失禁知識前後測差異的情形……91
表四-21 以GEE分析研究對象尿失禁自我照顧行為前後測
差異的情形………………………………………………..91
表四-22 患童尿失禁知識及自我照顧行為前後測差異之情形…….91

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楊翠芬(2000)˙脊柱裂患者的復健治療˙臨床醫學,45(6),369-373。
楊惠娟、陳月枝、毛新春、林凱信(2001)˙重型β海洋性貧血青少年疾病知識、社會支持與自我照顧行為之探討˙護理研究,9(2),114-123。
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劉向媛(1999)˙學齡期˙張媚等編,人類發展之概念與實務(pp.160-182)˙台北:華杏。
劉雅文(2001)˙一位高位頸椎損傷學齡期病童之護理經驗˙榮總護理,18(2),113-124。
劉碧玉(1975)˙如何協助住院兒童接受治療˙護理雜誌,22(1),30-35。
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錢大維、劉君恕、魏拙夫(2001)˙神經性膀胱功能異常之治療˙臨床醫學,48(1),10-15。
盧美秀、林秋香(1991)˙比較體衛教和個別性衛教對糖尿病病人的知識、態度、行為和血糖變化的影響˙護理雜誌,38(4),101-112。
顏貴紗(1989)˙住院兒童之衛教與治療性的遊戲˙護理雜誌,36(4),33-39。
顧小明(2001)˙臨床護理處置規範(pp. 381-383)˙台北:藝軒。
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1. 盧美秀、林秋香(1991)˙比較體衛教和個別性衛教對糖尿病病人的知識、態度、行為和血糖變化的影響˙護理雜誌,38(4),101-112。
2. 錢大維、劉君恕、魏拙夫(2001)˙神經性膀胱功能異常之治療˙臨床醫學,48(1),10-15。
3. 劉碧玉(1975)˙如何協助住院兒童接受治療˙護理雜誌,22(1),30-35。
4. 劉雅文(2001)˙一位高位頸椎損傷學齡期病童之護理經驗˙榮總護理,18(2),113-124。
5. 楊惠娟、陳月枝、毛新春、林凱信(2001)˙重型β海洋性貧血青少年疾病知識、社會支持與自我照顧行為之探討˙護理研究,9(2),114-123。
6. 楊翠芬(2000)˙脊柱裂患者的復健治療˙臨床醫學,45(6),369-373。
7. 張維琴(1991)˙認識住院兒童因應壓力之行為反應˙榮總護理,8(1),15-17。
8. 馮容芬(1996)˙神經性膀胱之復健護理˙醫學繼續教育,6(2),168-171。
9. 郭漢崇(1991)˙尿路動態機能檢查之臨床應用(九):兒童排尿障礙之診斷及處理˙慈濟醫學,3,89-94。
10. 陳惠玉(1998)˙一位神經性膀胱功能障礙學齡兒童之護理˙榮總護理,15(2),162-170。
11. 陳世乾(1999)˙小兒的神經性膀胱˙健康世界,158,11-14。
12. 陳偉鵬、林清淵(1992)˙兒童之尿失禁及遺尿˙臨床醫學,30(3)158-162。
13. 陳秋江(1994)˙脊柱裂與脊髓神經管縫合不全˙當代醫學,21(2)93-97。
14. 陳月枝(1976)˙住院學齡兒童對身體器官及其疾病的認識˙護理雜誌,23(2),61-73。
15. 袁素娟、郭憲文、阮玉梅(1991)˙慢病患經衛生教育後認知及行為之影響˙護理雜誌,38(1),77-86。