臺灣博碩士論文加值系統

本研究旨在探討因應技能訓練對住院心臟衰竭病患壓力感受、憂鬱情緒、自我照顧自我效能及生活品質之成效。研究採實驗性設計，以方便取樣方式選取南部地區兩所區域醫院心臟內科病房之40位心臟衰竭病患為研究對象，研究對象以簡單隨機方式分派至實驗組及對照組各20人；實驗組個案於住院期間接受研究者自行設計一套六次的心臟衰竭病患個別性因應技能訓練課程，每次60分鐘，對照組個案則僅接受一般病房處置。因應技能訓練內容包括：心臟衰竭病患的疾病症狀及藥物副作用之自我照顧策略、飲食控制策略、運動復健策略、壓力處置策略及情緒因應策略。問卷內容包括視覺類比量表(壓力)、貝氏憂鬱量表、健康促進策略量表及生活品質量表(SF-36)。於病房內以訪談方式收集個案的前測資料，病患出院一週後於門診回診時再收集後測資料，分析方式以SPSS 10. 0套裝軟體，採描述性統計、卡方統計及T檢定等方法進行資料分析。
研究結果顯示實驗組病患完成因應技能訓練一週後，在自我照顧自我效能之得分顯著高於對照組(t＝5.27, p＝.00)，而在壓力感受、憂鬱情緒及生活品質之得分則無顯著差異。本研究提供護理人員照護心臟衰竭病患之參考。

The purpose of this study is to evaluate the effectiveness of a coping skills training program on the perceived stress, self-care self-efficacy, depression and quality of life among hospitalized heart failure patients. The study is an experimental design. Forty heart failure patients who meet the inclusion criteria were randomized assign into comparison group (20 patients) or experimental group (40 patients) in two regional hospitals. Participants in the experimental group were received the coping training program, while the comparison group patients were only received routine hospital care. The coping skills training program includes an educational component, stress management, and disease specific problem solving strategies. The questionnaires include Visual Analogue Scale (VAS-stress), Beck Depression Inventory (BDI), Strategies Used by People to Promote Health (SUPPH), and Short-Form Health Survey (SF-36). Data were collected by interview for pretest and one week following the intervention. Main statistical analysis includes descriptive statistics, chi-square test, and t- test, by using SPSS 10.0. Window version. The result showed after coping skills training program, the experimental group improved their scores for self-care self-efficacy (t＝5.27, p＝.00) than comparison group, but weren’t different on the perceived stress, depression and quality of life. The findings of this study provide important information for nurses in caring patients with heart failure.

誌 謝………………………………………………………………………I
中文摘要……………………………………………………………………II
英文摘要……………………………………………………………………IV
目 錄……………………………………………………………………VI
圖表目次……………………………………………………………………IX
第一章 緒論
第一節 研究動機………………………………………………………1
第二節 研究之重要性…………………………………………………1
第三節 研究目的………………………………………………………2
第二章 文獻探討
第一節 心臟衰竭…………………………………………………………3
第二節 壓力………………………………………………………………5
第三節 因應………………………………………………………………8
第四節 憂鬱………………………………………………………………18
第五節 自我照顧自我效能………………………………………………21
第六節 生活品質…………………………………………………………25
第七節 文獻總結…………………………………………………………30
第三章 研究架構與假設
第一節 研究架構 ………………………………………………………32
第二節 名詞定義…………………………………………………………33
第三節 研究問題與研究假設……………………………………………34
第四章 研究設計與方法
第一節 研究對象及場所…………………………………………………36
第二節 實驗處置…………………………………………………………36
第三節 研究工具…………………………………………………………37
第四節 研究步驟…………………………………………………………45
第五節 研究設計…………………………………………………………47
第六節 資料分析…………………………………………………………48
第五章 研究結果
第一節 個案背景資料之描述……………………………………………49
第二節 心臟衰竭病患之壓力感受、憂鬱情緒、自我照顧自我效能及生
活品質狀態之描述………………………………………………54
第三節 因應技能訓練對心臟衰竭病患壓力感受、憂鬱情緒、自我照顧
自我效能及生活品質之成效探討………………………………58
第四節 心臟衰病患因應技能訓練課程評值與成效之探討……………66
第六章 討論
第一節 研究對象背景資料之描述………………………………………69
第二節 心臟衰竭病患之壓力感受、憂鬱情緒、自我照顧自我效能及生
活品質狀態………………………………………………………70
第三節 因應技能訓練對心臟衰竭病患壓力感受、憂鬱情緒、自我照顧
自我效能及生活品質之成效……………………………………72
第四節 心臟衰病患因應技能訓練課程之評值與成效………………75
第七章 結論與建議
第一節 結論………………………………………………………………77
第二節 建議………………………………………………………………78
參考資料
中文部分……………………………………………………………………80
英文部分……………………………………………………………………83
附錄
附錄一 健康促進策略量表(SUPPH)同意…………………………………94
附錄二 健康促進策略量表(SUPPH)中文版同意書………………………95
附錄三 生活品質量表(SF-36))中文版同意書…………………………96
附錄四 參與研究同意書…………………………………………………97
附錄五 心臟衰竭病患的因應技能訓練課程表…………………………98
附錄六 心臟衰竭病患的因應技能訓練教學活動設計(一) …………100
附錄七 心臟衰竭病患的因應技能訓練教學活動設計(二) …………101
附錄八 心臟衰竭病患的因應技能訓練教學活動設計(三) …………102
附錄九 心臟衰竭病患的因應技能訓練教學活動設計(四) …………103
附錄十 心臟衰竭病患的因應技能訓練教學活動設計(五) …………104
附錄十一心臟衰竭病患的因應技能訓練教學活動設計(六) …………105
附錄十二心臟衰竭病患基本資料問卷表………………………………106
附錄十三壓力視覺類比量表 ……………………………………………107附錄十四貝氏憂鬱量表…………………………………………………108
附錄十五健康促進策略量表(SUPPH)……………………………………111
附錄十六生活品質量表(SF-36)…………………………………………113
附錄十七心臟衰竭病患因應技能訓練課程評值表………………………117
附錄十八專家效度名單……………………………………………………118
附錄十九心臟衰竭病患因應技能訓練手冊………………………………119

一、中文部分
行政院衛生署（民　９１）・臺灣地區主要死亡原因──民國九十年。
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　　王秀紅（２０００）・自我照顧的概念及其在國內護理研究應用之評析・護理雜誌，４７（２），６４－７０。
王曼溪（１９９９）・住院老年人生活品質之探討・榮總護理，１６（４），４１１－４１７。
王蕙玲（１９９７）・壓力與因應之策・航空醫學會會刊，１１（１），７９－８３。
史曉寧、林麗嬋、宋琇鈺（２０００）・評價衛教對老年充血性心衰竭知識與順從性之效果・慈濟醫學，１２（１），４９－５７。
丘周萍（１９８７）・接受血液透析治療患者的壓力、因應行為與社會支持・護理雜誌，３４（４），５５－６１。
　　李昱（２０００）・台灣人憂鬱問卷之發展・長庚醫學，２３（１１），６８８－６９４。
李啟明（１９９８）・心臟衰竭的診斷與治療・當代醫學，２５（５），３５２－３５６。
　　吳英璋（２００１）・減輕壓力５１妙招・台北：新自然主義。
林青蓉（２０００）・憂鬱及其他情感性疾患。於藍菊梅等合譯，心理衛生護理・pp.21-1─21-23・台北：華騰。
林雅蘋（１９９９）・護理介入對心臟衰竭患者疾病知識、態度及自我照顧行為之影響・未發表之碩士論文，花蓮：慈濟醫學暨人文社會學院。
林敏玲（１９９７）・花蓮地區心臟衰竭病患對疾病認知、態度及自我照顧行為相關性之探討・未發表之碩士論文，花蓮：慈濟醫學院。
胡文郁（１９９８）・對壓力源之適應與不適應反應・於劉雪娥・成人內外科護理學・（pp.30-36）・台北：匯華。
柯慧貞、黃梗妍、李毅達、莊麗珍（１９９６）・貝氏憂鬱量表應用於國人周產期憂鬱症篩選之適用性 ・中華民國衛生雜誌，１５（３），２０８－２１８。
柯慧貞、陸汝斌、柯永河（１９９５）・生活壓力、年齡、迪皮質醇壓制測試異常反應與憂鬱症亞型之關係 ・中華精神醫學，９（４），２２３－２３０。
　　胡月娟（１９９４）・慢性病患所承受的衝擊與因應行為・護理研究，２（２），１４０－１５２。
柯慧貞（１９８８）・內因性憂鬱症與非內因性憂鬱症在腎上腺皮質素抑制反應、認知偏差及生活壓力之比較・未發表之博士論文，台北：臺灣大學。
　　高紀惠（１９９２）・心臟復健運動對活動耐力進展效應之探討・護理雜誌，３９（３），６３－7５。
許淑蓮（２００１）・初患心肌梗塞病人不確定感與焦慮反應－－因應行為效應之探討・護理研究，９（２），１５９－１7１。
　　梁繼權、呂碧鴻、李明濱、湯麗玉（１９９８）・成年人慢性病壓力與憂鬱相關之探討・中華民國家庭醫學雜誌，８（３），１２４－１３３。
陳宏、馮榕(１９９８)・綜觀身體疾病患者之憂鬱現象・國防醫學，7，（2），１３５－１４１。
陳綱華、顧乃平（１９９７）・心臟移植後患者的壓力源、因應行為及生活滿意度之關係・護理研究，５（１），４１－５１。
傅中玲（２０００）・頭痛病人的生活品質評估・臨床醫學，４５（３），１４３－１４９。
廖如文、顧乃平（２０００）・等待心臟移植患者的壓力源、因應行為及相關影響因素・護理研究，８（１），８５－９５。
　　潘正德（２００１）・壓力管理・台北：華騰。
賴佑銘（２０００）・情緒反應及情感性疾患。於王美業等合譯，精神科護理概論・pp.１２－１─－１２－２１・台北：華騰。
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