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研究生:郭麗敏
研究生(外文):Li-min kuo
論文名稱:出院準備服務對中風老人主要照顧者生活品質的影響
論文名稱(外文):The effect of discharge planning on the quality of life of primary caregivers of elderly stroke patients
指導教授:江慧玲江慧玲引用關係
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:2003
畢業學年度:91
語文別:中文
論文頁數:148
中文關鍵詞:出院準備服務計畫中風老人主要照顧者生活品質
外文關鍵詞:discharge planning programstroke elderlycaregiverquality of life
相關次數:
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中文摘要
本研究主要目的是探討「出院準備服務計畫」之介入措施,對於中風老人主要照顧者返家後一、三、及六個月生活品質的影響。採縱貫式類實驗性研究設計法,以便利取樣的方式,總共收案人數為103位,以北台灣某醫學中心之四個同質性高的神經內科病房為研究場所,採用隨機分派的方式,其中控制組有56位、實驗組有47位,控制組只接受醫院常規治療與照護,實驗組除接受醫院常規治療與照護外,還依據徐 (2000) 所發展的出院準備服務計畫,在病患住院期間開始給予介入措施,內容包括(一)住院第三天的照顧需求評估,並依據個別需求於住院期間提供衛教及照護技能指導;(二)出院前三天的諮商、照護技能再加強、及必要時提供轉介;及(三)出院後一、三、及六個月的追蹤訪視這三部分。運用SF-36 (short form-36) 健康生活品質量表為測量工具,主要以獨立樣本t檢定 (unpaired t-test) 及廣義估計方程式 (Generalized Estimating Equation; GEE),以確立出院準備服務計畫的效益。
研究結果發現:(一)在主要照顧者的生活品質概況方面,於返家後一、三、及六個月都是以「身體功能」得分最高,「活力狀況」得分最低,比較兩組生活品質的差異,結果顯示實驗組於六個月的「整體健康感受」較控制組好;(二)在生活品質進步量方面,結果顯示:(1) 一至三個月控制組在「社交功能」及「整體健康感受」的進步量比實驗組多;(2) 一至六個月控制組在「社交功能」的進步量比實驗組多;及 (3) 三至六個月實驗組在「身體功能」的進步量比控制組多;及(三)在出院準備服務對生活品質的效益方面,結果顯示於三個月時主要照顧者「社交功能」及「整體健康感受」之生活品質,在組別間的得分差異會隨著時間的變化而不同;於六個月時「身體功能」及「社交功能」之生活品質,在組別間的得分差異會隨著時間的變化而不同;在控制「時間」因素之後,出院準備服務對主要照顧者返家後的生活品質,並沒有造成組別間的差異;在控制「組別」因素之後,於六個月時「身體疼痛」,會隨著時間的變化,對於生活品質造成負向的影響。
綜合以上的研究結果發現主要照顧者的生活品質,以心理層面的生活品質較差,出院準備服務計畫對主要照顧者生活品質,需要較長久的時間才能獲得較明顯的效益,建議往後的研究除了運用縱貫性的追蹤方式之外,並能增加支持團體與社工師的參與,以促進主要照顧者心理層面之生活品質的提昇。
Abstract
The purpose of this study was to examine the effect of discharge planning on quality of life in primary caregivers of stroke elderly on the first, third, and sixth month after discharge. This study used longitudinal quasi-experimental design. Convenient sampling was used. One hundred and three caregivers from four neurological wards of a medical center located at northern Taiwan were recruited. Random assignment was used. Fifty-six caregivers were in the control group and fourty-seven caregivers were in the experimental group. Caregivers in the control group received regular treatment and care. Caregivers in the experimental group received not only regular treatment and care, but also the discharge planning program in the hospital period, which was developed by doctor Shyu in 2000. The discharge planning program included: (1) assessing the care needs on the third day after admitted to the hospital and providing health education and skill instructions according to the individual needs; (2) consultations, strengthening skills, and referral services as necessary on the third day before discharge; (3) follow-ups on the first, third, and sixth month after discharge. Short form-36 (SF-36) health status was used to measure quality of life. The data were analyzed to evaluate the effectiveness of the discharge planning program by unpaired t-test and generalized estimating equation (GEE).
The results showed that the highest scores of quality of life of primary caregivers were physical function and the lowest were vitality on the first, third, and sixth month after discharge. Comparing the difference of caregivers’ quality of life between two groups, the results indicated that caregivers’ general health was better in the experimental group than in the control group. The results showed that caregivers’ social function and general health had much improvement in the control group than in the experimental group from the first month to third month. Caregivers’ social function had much improvement in the control group than in the experimental group from the first month to sixth month. Caregivers’ physical function had much improvement in the experimental group than in the control group from the third month to sixth month. The results showed that caregivers’ scores of social function and general health were different between two groups on the third month. Caregivers’ scores of physical function and social function were different between two groups on the sixth month. After the ‘time’ factor was controlled, the discharge planning did not have any effect on caregivers’ quality of life between two groups after discharge. After the ‘group’ factor was controlled, the discharge planning had a negative effect on caregivers’ body pain on the sixth month after discharge.
In conclusion, the result showed that caregivers’ mental dimension of quality of life was worse and significant improvement took longer time by the discharge planning program. This study suggested that the discharge planning program should not only involve longitudinal follow-ups, but also support groups and social workers to promote the caregivers’ mental dimension of quality of life.
目錄
章節 頁數
第一章 緒論
第一節 研究的重要性…..………………………………………………….1
第二節 研究的動機………………………………………………………….3
第三節 研究目的..………………………………………………………….6
第四節 研究假設…………………………………………………………….7
第五節 名詞界定…………………………………………………………….8
第二章 文獻查證
第一節 中風之相關概念…………………………………………………..11
第二節 出院準備服務之相關概念………………………………………..18
第三節 生活品質之相關概念…………………………………………....27
第三章 研究方法
第一節 研究架構………………………………………………………....37
第二節 研究設計…………………………………………………………..38
第三節 研究對象……………………………………………………………40
第四節 研究場所…………………………………………………………..43
第五節 倫理考量…………………………………………………………..45
第六節 研究工具…………………………………………………………..46
第七節 研究工具信效度檢定……………………………………………..52
第八節 出院準備服務之內容……………………………………………..54
第九節 資料收集過程……………………………………………………..60
第十節 資料分析…………………………………………………………..63
第四章 研究結果與分析
第一節 中風老人的特性………..…………………………………….……65
第二節 中風老人主要照顧者的特性……………………………………….68
第三節 中風老人主要照顧者生活品質概況……………………………….72
第四節 出院準備服務對於中風老人主要照顧者生活品質的影響……….88
第五章 討論
第一節 中風老人及其主要照顧者特性之分析……………………………102
第二節 中風老人及其主要照顧者返家後六個月內生活品質之分析……107
第三節 出院準備服務對於中風老人主要照顧者生活品質的影響………112
第六章 結論、建議、與限制
第一節 結論………………………………………………………………..116
第二節 建議………………………………………………………………..121
第三節 限制…………………………………………………………………125
參考資料
中文部分…………………………………………………………………….127
英文部分…………………………………………………………………….132
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