臺灣博碩士論文加值系統

本研究目的旨在探討提供指導手冊及輔助光碟的護理措施，對髖關節置換術患者的自我效能、功能性活動與住院天數之成效。採準實驗型之研究設計，以北部某一醫學中心66名病人為研究對象，有實驗組33名及對照組33名。實驗組於住院前接受第一項護理措施─提供指導手冊與光碟，入院後接受第二項護理措施─討論或教導，及手術後接受第三項護理措施─探視與再教導。對照組則接受一般門診及病房常規照護。研究工具包括基本資料表、自我效能量表、Iowa Level of Assistance Scale及Shorten Functional Status Index、認知量表及評價量表。所得資料以SPSS10.0版套裝軟體進行編碼及分析，統計方法包含次數分配、百分比、全距、平均值、標準差、卡方檢定、獨立樣本t 檢定、配對樣本t 檢定、皮爾森積差相關、單因子共變數等進行分析。本研究結果顯示︰(1)兩組在基本資料上無統計顯著差異。(2)實驗組的自我效能、功能性活動與住院天數均比對照組顯著改善。(3)自我效能與功能性活動有顯著相關，與人口學特質、疾病特質、住院天數沒有顯著相關。(4)功能性活動與基本資料、住院天數均達顯著相關。根據本研究結果，建議使用手冊及輔助光碟於髖關節置換術患者入院前及住院後的教育，而未來研究方向則可以延長研究時間以了解教育措施的持續成效。

The purpose of this study was to evaluate the effects of the nursing intervention, including teaching, booklet and videodisc, to improve self-efficacy, functional activities, and length of stay for hip replacement patients. A quasi-experimental research design was used for this study. Totally, 66 subjects obtained from one medical center were non-randomly assigned into either the experimental group (n=33) or the control group (n=33). The experimental group received the first nursing instruction with the guide booklet and videodisc before hospitalization. The second nursing instruction with discussion and teaching was provided in hospital before surgery. After surgery, the third nursing instruction by visiting and guiding. The control group only received regular outpatient service and ward routine care. The research instruments include Patient’s Essential Data List, Self-Efficacy Scale, Iowa level of assistance Scale and Shorten Functional Status Index, knowledge Questionnaire, and Evaluation Questionnaire. SPSS10.0 version software was used for coding and data analysis. Statistic methods included frequency, percentile, range, mean, standard deviation, chi-square, independent sample t-test, paired sample t-test, pearson’s-r, and ANCOVA.
The result of this study showed no significant difference in Patient’s Essential Data List between two groups. The experimental group has significant improvement in self-efficacy, functional activities, and length of stay comparing with control group. There was a significant relationship between self-efficacy and functional activities, but no significant relationships between self-efficacy, and patient’s essential data, length of stay. There were significant relationships between functional activities, and patient’s essential data, length of stay.
Using booklet and videodisc in pre-hospital and in-hospital education for hip replacement patients is recommended. The further research on investigation of the maintenance effects of education intervention is suggested.

目 次 頁數
誌謝．．．．．．．．．．．．．．．．．．．．．．．．．I
中文摘要．．．．．．．．．．．．．．．．．．． ．．．III
英文摘要．．．．．．．．．．．．．．．．．．．．．．．V
目 錄．．．．．．．．．．．．．．．．．．．．．．．VII
圖表目次．．．．．．．．．．．．．．．．．．．．．．．IX
第一章 緒論
第一節 研究動機及重要性．．．．．．．．．．．．．．．．1
第二節 研究目的．．．．．．．．．．．．．．．．．．．．3
第三節 研究問題．．．．．．．．．．．．．．．．．．．．3
第四節 研究假設．．．．．．．．．．．．．．．．．．．．4
第二章 文獻查證
第一節 髖關節置換術．．．．．．．．．．．．．．．．．．5
第二節 髖關節置換術患者的護理措施．．．．．．．．．．．8
第三節 自我效能．．．．．．．．．．．．．．．．．．．．11
第四節 功能性活動．．．．．．．．．．．．．．．．．．．14
第五節 自我效能與功能性活動．．．．．．．．．．．．．．15
第六節 住院天數．．．．．．．．．．．．．．．．．．．．16
第七節 自我效能、功能性活動、住院天數與基本資料之間的相關性17
第三章 概念架構及名詞解釋
第一節 概念架構．．．．．．．．．．．．．．．．．．．．20
第二節 名詞界定．．．．．．．．．．．．．．．．．．．．21
第四章 研究方法
第一節 研究設計．．．．．．．．．．．．．．．．．．．．23
第二節 研究場所及對象．．．．．．．．．．．．．．．．．24
第三節 研究工具及信效度．．．．．．．．．．．．．．．．24
第四節 資料收集過程．．．．．．．．．．．．．．．．．．28
第五節 資料處理與分析．．．．．．．．．．．．．．．．．31
第五章 研究結果
第一節 個案的基本資料與住院天數．．．．．．．．．．．．32
第二節 護理措施對患者自我效能的成效．．．．．．．．．．39
第三節 護理措施對患者功能性活動的成效．．．．．．．．．42
第四節 自我效能、功能性活動、住院天數與基本資料之間的相關性 46
第五節 護理指導手冊及光碟的評價．．．．．．． ．．．．48
第六章 討論
第一節 護理措施對患者自我效能的成效．．．．．．．．．．53
第二節 護理措施對患者功能性活動的成效．．．．．．．．．56
第三節自我效能、功能性活動、住院天數與基本資料之間的相關性 59
第四節 護理措施與護理指導手冊及光碟的評價．．．．．． 63
第七章 結論與建議
第一節 結論．．．．．．．．．．．．．．．．．．．．．．68
第二節 護理上的應用．．．．．．．．．．．．．．．．． 69
第三節 研究限制與未來研究建議．．．．．．．．．．．． 71
參考資料
中文部份．．．．．．．．．．．．．．．．．．．．．．． 73
英文部份．．．．．．．．．．．．．． ．．．．．．．． 75
附錄一 研究同意書．．．．．．．．．．．．．．．．．83
附錄二之一 人口學特質量表．．．．．．．．．．．．．．．84
附錄二之二 疾病特質量表．．．．．．．．．．．．．．．．85
附錄三 申請骨科自我效能量表使用及翻譯信函．．．．．86
附錄四 骨科自我效能量表使用及翻譯同意書．．．．．．87
附錄五 申請活動能力量表使用與翻譯信函及同意書．．．88
附錄六 申請日常活動功能量表使用與翻譯信函及同意書．89
附錄七 護理指導手冊及光碟評價表．．． ．．．．．． 90
附錄八 認知量表．．．．．．．．．．．． ．．．．． 94
附錄九 專家效度名單．．．．．．．．．．．．．．．．95
附錄十 專家效度鑑定信函．．．．．．．．．． ．．． 96
附錄十一 授權同意書．．．．．．．．．．．．．．．．．97
附錄十二 拍照同意書．．．．．．．．．．．．．．．．．98
附錄十三 攝錄同意書．．．．．．．．．．．．．．．．．99
圖 表 目 次 頁數
圖3-1 研究架構．．．．． ．．．．．．．．．．．．．．19
圖4-1 資料收集流程．．．．．．．．．．．． ．．．．．30
圖5-1 實驗組個案的認知得分比率分布情形．．．．．． ．49
表4-1 類實驗型研究設計．．．．．．．．．．． ．．．．23
表5-1 人口學特質的分布．．．．．．．．．．．．． ．．35
表5-2 疾病特質的分布．．．．．．．．．． ．．．．．．38
表5-3 實驗組與對照組不同階段自我效能之差異．．．． ．40
表5-4 實驗組與對照組自我效能各題項的得分及差異情形 ．41
表5-5 實驗組與對照組活動能力分布及差異情形．．．．． 43
表5-6 實驗組與對照組日常活動功能差異情形．．．．．． 44
表5-7 實驗組與對照組在日常活動功能的「困難程度」
回歸係數同質性考驗．．．．．．．．．． ．．．．45
表5-8 實驗組與對照組在日常活動功能的「困難程度」
共變數分析摘要表．．．．．．．．．．． ．．．．45
表5-9 實驗組與對照組在日常活動功能的「協助程度」
回歸係數同質性考驗．．．．．．．．．．．．．． 46
表5-10 實驗組與對照組在日常活動功能的「協助程度」
共變數分析摘要表．．．．．． ．．．．．．．．．46
表5-11 自我效能、功能性活動、住院天數與基本資料之間的
相關性．．．．．．． ．．．．．．．．．．．．．48
表5-12 實驗組個案的認知項目得分的分布．．．．．． ．．49
表5-13 手冊與光碟評價的得分情形．．．．． ．．．．．．50

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