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研究生:王妍惠
研究生(外文):Wang Yen Hui
論文名稱:心臟衰竭病患症狀經驗量表之發展及其影響因素探討
論文名稱(外文):Development of The Congestive Heart Failure Symptom Distress Experience Scale in Taiwan
指導教授:劉雪娥劉雪娥引用關係
指導教授(外文):Liu Hsueh Erh
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:128
中文關鍵詞:心臟衰竭症狀經驗症狀發生症狀處理症狀困擾
外文關鍵詞:Congestive Heart FailureSymptom ExperienceSymptom OccurrenceSymptom DisposeSymptom Distress
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本研究針對臨床心臟衰竭病患,發展適合於評估其患病過程的症狀經驗之量表,並探討其在疾病經驗中影響症狀困擾的因素。
研究過程於北部某醫學中心,立意取樣收集門診及住院病患共150位樣本。進行「心臟衰竭病患症狀經驗量表」之信效度檢測。並加入「巴氏量表」、「疲憊/活力量表」以及「無力定義性特徵量表」一併探討影響病患症狀困擾之因素。
研究結果顯示信度方面,量表之症狀發生層面值為0.53、症狀發生嚴重度值為0.52、自我處理情形值為0.78、症狀困擾值為0.45。效度方面,建構效度之因素分析結果修正量表共為23題,並將症狀分為「虛弱倦怠」、「體液鬱積」、「血液循環不良」、「疼痛反應」以及「日常生活」五個類別。而在效標關聯效度方面,「巴氏量表」與「日常生活」因素之相關係數值為-0.51(p < 0.01)。「疲憊/活力量表」與「虛弱倦怠」因素之相關係數值為0.50(p < 0.01)。顯示心臟衰竭症狀經驗量表在因素五及因素一,具備效標關聯效度。
以整體量表來看,當病患症狀發生頻率越高,或是症狀嚴重度越高,或是自覺症狀處理情形越差時,就會有較高之症狀困擾。病患無力感較高者、有較高之疲憊感受、或較差之日常活動功能,病患的症狀困擾均很高。另外,症狀困擾並不會因為研究中人口學所探討的變項所影響。而在樣本疾病狀況方面,住院病患比起門診病患有較高之症狀困擾。心臟功能較差者也有較高的症狀困擾。合併患有糖尿病、其他心臟疾病者、以及其他系統疾病的病患亦有較高的症狀困擾情形。這些結果,將可提供臨床人員做為照護上的依據。
The purpose of this study is to develop an instrument to measure the experiences of symptom distress in patients diagnosed as Congestive Heart Failure. The associated factors will also be identified at the same time.
Using purposive sampling, a total of 150 samples are collected from both the OPD and wards in a medical center in northern part of Taiwan. Several instruments are selected for data collection. These are: 「The Congestive Heart Failure Symptom Distress Scale」,「Barthel’s Scale」,「Fatigue/ Stamina Scale」, and「Defining Characteristics of Powerlessness Scale」.
Results show that the reliability (alpha) of the frequency dimension, severity dimension, symptom dispose dimension, and symptom distress dimension is 0.53, 0.52, 0.78, and 0.45 respectively. The results of factor analysis indicate that 23 items are included in the final version of The Congestive Heart Failure Symptom Distress Scale. It includes 5 factors which are named as:「frail and tired」、「fluid congestion」、「poor circulation」、「pain reaction」、and「daily life」. Results show that the reliability (alpha) of the frequency dimension, severity dimension, symptom dispose dimension, and symptom distress dimension is 0.53, 0.52, 0.78, and 0.45 respectively. The results of factor analysis indicate that 23 items are included in the final version of The Congestive Heart Failure Symptom Distress Scale. It includes 5 factors which are named as:「frail and tired」、「fluid congestion」、「poor circulation」、「pain reaction」、and「daily life」. Criterion-related Validity shows that「Barthel Scale」is highly related with the 「daily life」 factor (r = -0.51, p < 0.01) and 「Fatigue/Stamina Scale」 is correlated with the 「frail and tired」factor of this new instrument (r = -0.50, p < 0.01).
In general, patients with higher frequency of symptom occurrence, higher severity, or less symptom dispose function report stronger symptom distress. Patients with more powerlessness, more fatigue, or worse daily activity function experience stronger symptom distress. Furthermore, the demographic variables selected in present study have no impact on symptom distress. The OPD patients report more symptom distress than patients from the ward. Those with worse cardiac-function, combined with Diabetes Mellitus, or other cardiac or other disease report more symptom distress. These results are the guidelines for clinical cardiovascular nursing care.
指導教授推薦書 …………………………………………………… i
口試委員會審定書 ………………………………………………… ii
授權書 ……………………………………………………………… iii
誌謝 ………………………………………………………………… v
中文摘要 …………………………………………………………… vii
英文摘要 …………………………………………………………… viii
目錄 ………………………………………………………………… ix
圖表目錄 …………………………………………………………… xi
附錄目錄 …………………………………………………………… xiii
第一章 緒論
第一節 研究動機 …………………………………………… 1
第二節 研究之重要性 ……………………………………… 3
第三節 研究目的 …………………………………………… 5
第四節 研究問題 …………………………………………… 5
第五節 研究假設 …………………………………………… 6
第六節 名詞定義 …………………………………………… 6
第二章 文獻查證
第一節 心臟衰竭病患之疾病特性 ………………………… 9
第二節 心臟衰竭病患之症狀經驗 ………………………… 11
第三節 心臟衰竭病患之症狀處理 ………………………… 17
第四節 心臟衰竭病患症狀困擾之相關因素 ……………… 18
第三章 研究方法
第一節 研究設計 …………………………………………… 23
第二節 研究架構 …………………………………………… 24
第三節 研究對象 …………………………………………… 25
第四節 研究工具 …………………………………………… 26
第五節 工具發展過程與信效度 …………………………… 29
第六節 資料收集過程 ……………………………………… 33
第七節 資料分析方法 ……………………………………… 35
第四章 研究結果
第一節 研究對象之基本屬性 ……………………………… 37
第二節 心臟衰竭症狀經驗量表之臨床信度與效度 ……… 40
第三節 症狀經驗量表之測量結果 ………………………… 56
第四節 影響症狀困擾之因素 ……………………………… 63
第五節 影響因素對症狀困擾之預測力 …………………… 70
第五章 討論
第一節 心臟衰竭症狀經驗量表之信效度 ………………… 82
第二節 心臟衰竭病患之症狀經驗 ………………………… 85
第三節 心臟衰竭症狀經驗各層面間彼此的相關性及預測力 89
第四節 症狀困擾之影響因素與症狀困擾間之相關及預測力 90
第六章 結論
第一節 總結 ………………………………………………… 98
第二節 研究結果於護理臨床上的應用 …………………… 100
第三節 研究限制與建議 …………………………………… 101
參考資料
中文部分 ……………………………………………………… 102
英文部分 ……………………………………………………… 105
附錄 …………………………………………………………… 116
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