(3.236.231.14) 您好!臺灣時間:2021/04/15 06:54
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:林雁秋
研究生(外文):Yan-Chious Lin
論文名稱:慢性腎衰竭患者透析前醫療利用行為之探討
論文名稱(外文):Behaviors of Health Service Utilization for patients with Chronic Renal Failure in Pre-dialysis Stage
指導教授:顏妙芬顏妙芬引用關係
指導教授(外文):Miaofen Yen
學位類別:碩士
校院名稱:國立成功大學
系所名稱:護理學系碩博士班
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:110
中文關鍵詞:慢性腎衰竭透析前醫療利用
外文關鍵詞:chronic renal failurepre-dialysishealth service utilization.
相關次數:
  • 被引用被引用:13
  • 點閱點閱:755
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:148
  • 收藏至我的研究室書目清單書目收藏:8
面對逐年增加的透析病患及龐大健保支出,有學者提出透析前照護來延緩患者接受透析治療的時間及衝擊。因此,了解患者透析前醫療利用行為,作為未來早期介入及處理患者問題的指引已成為當務之急,故引發研究此議題的動機。本研究目的為探討患者透析前醫療利用行為,採回溯性描述研究,以立意取樣,從2003年1月至2003年4月連續選取台南市某醫學中心的初次開始接受透析未超過兩星期的慢性腎衰竭患者共50位。研究工具包括個案基本資料和醫療利用行為自擬問卷,所得資料以質及量兩種方式進行資料分析。
結果顯示50位患者中男女各佔50%,平均年齡55.4歲,過去病史主要為高血壓。僅有23位(46%)患者在病程早期血清肌酸酐(Serum creatinine; Scr)小於或等於3.0 mg/dl時,接受初步腎功能篩檢確知腎功能異常而及早轉介腎臟科醫師,進行透析前照護包括營養指導、接受動靜脈廔管手術或腹膜透析教育等透析前準備。有6位(12%)的患者初次確知已達透析標準;10位患者未持續利用專業西醫療法來處理腎功能問題,其主因為自覺病徵不明顯;延遲轉介腎臟科醫師者共20位(40%);轉介腎臟科時Scr分佈情形以大於或等於6.0 mg/dl時轉介者居多共20位(40%);16位(32%)患者在透析前曾照會營養師,只有5位(10%)患者接受過動靜脈廔管手術或腹膜透析教育等透析前準備。50位患者的初次透析檢驗生化值為Scr 10.9 ± 4.5 mg/dl、BUN 117.6 ± 39.6 mg/dl、Na 136.1 ± 4.3 meq/dl、K 4.6 ± 0.9 meq/dl、HCO3- 19.3 ± 7.2 mmol/L、pH 7.47 ± 1.07 mmol/L、Hb 8.2 ± 2.0 g/dl、Hct 24.3 ± 7.5%、Ccr 4.6 ± 3.4 ml/min。
醫療照顧過程中,有4位(8%)患者嚐試專業中醫療法,18位(36%)患者使用非專業民俗療法(如:中草藥、偏方與成藥),影響原因包括:為避免接受透析、醫療信念及大眾媒體過度宣染。患者也常因對透析治療心存誤解,及恐懼未來無法調適長期透析生活,而常有拖延透析之情形。
研究結果得知普遍患者未依據美國國際健康組織(National Institutes of Health, NIH)轉介時機,在女性患者Scr大於1.5 mg/dl、男性患者Scr大於2.0 mg/dl時,適當轉診給腎臟科醫師,進行整合性透析前照護(黃,2001;Levinseky, 2002)。最後依據研究結果進行以下建議包括:(一)針對慢性腎衰竭高危險群患者,如:糖尿病、高血壓、中老年人等定期進行腎功能篩檢,讓更多患者能即早接受適當的透析前照護;(二)設立腎臟護理師掌握病患治療與追蹤過程,並適時提供相關支持及醫療訊息,以降低患者面對透析治療的恐懼且引導患者坦然面對未來透析生活;(三)藉由衛生教育舉辦加強民眾對腎疾病注意事項的正確觀念;(四)建立明確轉診指標,且針對醫療人員進行透析前照護相關教育,以提昇照護品質。
The progress of chronic renal failure (CRF) is irreversible, and it can lead to the need for dialysis therapy incidence. The annual growth of health insurance reimbursement continues to increase. In order to promote the quality of life for patients with CRF and maintain the reimbursement of health care, many authors had suggested that pre-dialysis care can help delay progression of renal disease and early interventions is necessary. Therefore, the purpose of this retrospective study was to explore the behaviors of health service utilization for patients with CRF in pre-dialysis stage. A total of 50 subjects with CRF who initiated dialysis therapy within two weeks were enrolled into this study from a medical center in Tainan. The data were collected using the demographic data sheet of patients, survey questionnaires for behaviors of health service utilization and personal interviews. Descriptive statistics and quantitative method were applied to analyze the data.
The demographic findings showed that 50% of male and 50% of female, mean age of the group was 55.4 years, and major history was hypertension. Twenty-three patients (46%) with serum creatinine (Scr) less than 3.0 mg/dl were referred to nephrologists and received pre-dialysis care, including nutritional instruction, arteriovenous access fistulae and education of peritoneal dialysis, to prepare dialysis therapy. Six patients (12%) were diagnosed with end-stage renal disease (ESRD) and needed to start dialysis therapy immediately. Ten patients (23%) had not been continuously treated with western medicine. The major reason for discontinuing treatment with western medicine was that patients did not perceive any physiological discomfort. Twenty patients (20%) were delayed referral to nephrologists. Twenty patients (20%) with Scr greater than 6.0 mg/dl transferred to nephrologists. Sixteen patients (32%) consulted nutritionist before initiated dialysis therapy. Only five patients (10%) accepted arteriovenous access fistulae, or education of peritoneal dialysis to prepare dialysis therapy.
The data of the initial dialysis was Scr 10.9 ± 4.5 mg/dl、BUN 117.6 ± 39.6 mg/dl、Na 136.1 ± 4.3 meq/dl、K 4.6 ± 0.9 meq/dl、HCO3- 19.3 ± 7.2 mmol/L、pH 7.47 ± 1.07 mmol/L、Hb 8.2 ± 2.0 g/dl、Hct 24.3 ± 7.5%、Ccr 4.6 ± 3.4 ml/min. Four patients (8%) were treated with Chinese medicine, and eighteen patients (36%) were treated with folk medicine (traditional Chinese herb). The factors of seeking non-western medicine included avoidance dialysis therapy, medicine belief and public medium exaggeratedly announce effect of folk medicine. The reasons of delay of dialysis therapy included the misunderstanding to dialysis therapy, and fear of unable to cope with impact of dialysis therapy in future life.
The findings showed that fewer male patients with Scr greater than 1.5 mg/dl and fewer female patients Scr greater than 2.0 mg/dl had any consultation to nephrologists to accept multidisciplinary pre-dialysis care. In summary, the government should regularly screen high risk population with CRF, and should establish pre-dialysis care in early phase. Nephrology clinical nursing specialists need to evaluate the consequences of multidisciplinary case management for patients, and provide enough information regarding dialysis therapy to reduce the fear of dialysis and help them understand how to live problems in their future life. In order to improve late referral to nephrologists and the quality of care to the dialysis patients, clear definition of early renal insufficiency should be established, and medical specialists should be taught the information about pre-dialysis care.
中文摘要 ---------------------------------------i
英文摘要 -------------------------------------iii
誌謝 -----------------------------------------vi
目錄 - --------------------------------------viii
表目錄 - ------------------------------------xii
圖目錄 -------------------------------------xiii
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 -------------------------------3
第二章 文獻查證 -------------------------------4
第一節 慢性腎衰竭的病程演變 -------------------4
第二節 透析前照護現況 -------------------------7
第三節 透析前照護內容 ------------------------10
第四節 醫療利用行為的定義及測量方式 ----------13
第三章 研究架構與研究問題 --------------------17
第一節研究架構 -- -----------------------17
第二節名詞定義 -------------------------19
第三節研究問題 --- ----------------------20
第四章 研究方法及過程 -------------------21
第一節 研究方法 -----------------------------21
第二節 研究對象 ------------------------------21
第三節 研究工具 -----------------------------22
第四節 編制工具的過程 -----------------------22
第五節 研究過程 -----------------------------25
第六節 資料分析 ------------------------------28
第五章 研究結果 -------------------------30
第一節 人口學屬性分析 ------------------------30
第二節 求醫過程 ------------------------------32
初次確知腎功能異常情況 -----------------------32
專業西醫回診追蹤 - ---------------------------37
轉介腎臟科 -----------------------------------42
接受透析前照護 ------------------------------44
初次透析情形 -------------------------------52
第三節 求醫型態 ------------------------------63
求醫型態與持續時間 ---------------------------63
選擇非西醫療法的原因 -------------------------66
第四節 求醫地點 ------------------------------72
第六章 討論 ------------------------------73
第一節 人口學屬性分析 -------------------------73
第二節 求醫過程 -------------------------------73
初次確知腎功能異常情況 ------------------------73
專業西醫回診追蹤 ------------------------------74
轉介腎臟科 ------------------------------------76
接受透析前照護--------------------------------76
初次透析情形---------------------------------77
第三節 求醫型態 -------------------------------79
第四節 求醫地點 -------------------------------80
第七章 結論與建議 -----------------------------82
第一節 結論----------------------------------82
第二節 建議----------------------------------83
臨床實務-----------------------------------83
初次透析情形---------------------------------87
第八章 研究限制------------------------90
參考資料-----------------------------------91
附錄
(附件一)人體試驗委員會同意-------------------101
(附件二)參與研究同意書 ----------------------102
(附件三)個人基本資料 ------------------------103
(附件四)醫療利用行為問卷初稿----------------104
(附件五)專家效度名單 ------------------------107
(附件六)醫療利用行為問卷 --------------------108


表目錄
表1 CKD分期及盛行率--------------------------5
表2 人口學資料 -------------------------------31
表3-1 初次確知腎功能異常情況 -------------------35
表3-2 初次確知腎功能異常時,血清肌酸酐分佈情形及接受篩檢動機 ------------36
表3-3 專業西醫回診追蹤-----------------------41
表3-4 轉介腎臟科 -------------------------------43
表3-5 轉介腎臟科時,血清肌酸酐分佈情形 ---------43
表3-6 接受透析前照護 ---------------------------51
表3-7 接受初次透析現況-----------------------61
表3-8 延遲轉介與未延遲轉介初次透析情形----------62
表4-1 求醫型態及持續時間----------------------65
表4-2 利用非專業民俗療法患者的延遲轉介及接受透析前照護情形------------65
表5-1 求醫地點 ---------------------------------72

圖目錄
圖一 研究架構----------------------------------18
圖二 研究步驟----------------------------------28
王春葉、林佑樺、許國泰、林耀信(1997)‧影響血液透析病患工作的因素探討,腎臟與透析,9(3),214 - 224。
王瑞廷(1996)‧腎臟內科秘訣‧於王瑞廷編著,內科學答問(pp. 249-264)‧台北:合記。
丘周萍(1987)‧接受血液透析患者的壓力、因應行為與社會支持‧護理雜誌,
34(4),55-61。
朱宗信(1997)‧慢性腎衰竭之診斷與處置,當代醫學,24(12),62 - 65。
朱益宏(1999)‧全民健保長期洗腎病人論人計酬可行性之初探‧未發表的碩士論文,台北:陽明大學醫務管理研究所。
何佩姍(1996)‧影響原住民與非原住民兒童就醫行為相關因素研究‧未發表的碩士論文,高雄:高雄醫學院公衛衛生研究所。
吳佩蓉(2001)‧慢性腎衰竭病患的護理,於台灣腎臟護理學會主辦,腎臟病房護理研習會講義‧嘉義:基督教醫院。
吳就君(1981)‧台灣地區居民社會醫療行為研究‧公共衛生,8(1),25 - 49。
李卓倫(1987)‧民眾尋求與利用健康服務模式的行為研究‧公共衛生,14(1),42 - 60。
李金鳳(1990)‧中西醫門診病患對傳統醫療認知、情意與行為變項之調查研究‧未發表的碩士論文,台北:陽明大學公共衛生研究所。
李重德(2002)‧慢性尿毒症─末期腎病‧於黃建鐘編著,腎臟病診治(pp. 125-135)‧台南:成大醫院腎臟科。
李慧鶯(2001)‧同理的概念探究‧護理雜誌,48(2),70 - 80。
杜異珍(1992)‧文化對女性乳癌病患醫療行為之影響‧榮總護理,9(2),127— 133。
杜詠芬(1992)‧尿毒症患者接受血液透析治療的認知與態度及影響因素‧腎臟與透析,4(2),82 - 90。
周孟穎(1998)‧衛生經濟學‧台北:國立編譯館。
林文香(1992)‧為推展護理本土化奠石─認識民間醫療行為文化‧榮總護理,9(2),110 - 115。
林怡亞(2001)‧血液透析患者如何在死亡焦慮中與疾病共存‧未發表的碩士論文,嘉義:南華大學生死學研究所。
林秋菊、金繼春、梁靜祝、賴永勳(2000)‧尿毒症病患訊息需求量表之建立與測定,護理研究,8(6),641 - 650。
姚友雅(1999)‧台北市國中生求醫行為相關因素研究‧未發表的碩士論文,台北:師範大學衛生教育研究所。
胡幼慧(1988)‧文化、行為與健康‧公共衛生,15(3),293— 301。
胡潔瑩、林秋菊(1999)‧末期腎臟疾病病患面對透析治療方式的抉擇衝突‧腎臟與透析,11(2),106 — 109。
翁慧貞(1994)‧尿毒症患者的社會心理障礙及輔導。腎臟與透析,6(1),51 - 54。
張珣(1981)‧疾病與文化‧台北:稻鄉。
張珣(1983)‧台灣漢人的醫療體系與醫療行為‧中央研究院民族研究集刊,56(3),29 - 58。
張笠雲(1998a)‧生病行為‧於張笠雲編著,醫療與社會:醫療社會學的探索(pp.83 - 113)‧台北:巨流。
張笠雲(1998b)‧逛醫師的邏輯:求醫歷程分析‧台灣社會學刊,21,59-87。
張碧玉(2000)‧影響末期腎臟疾病患者血液透析醫療費用之風險因子探討‧未發表的碩士論文,高雄:高雄醫學院公衛衛生研究所。
梁靜祝(1999)‧中西醫療量表的發展及建立‧護理研究,7(5),445— 458。
陳俊旭(2002)‧腎臟病的常用檢查‧於黃建鐘編著,腎臟病診治(pp. 5-7)‧台南:成大醫院腎臟科。
陳昭吟(1996)‧末期腎疾病透析前的求醫經驗‧未發表的碩士論文,高雄:高雄醫學院護理研究所。
陳漢湘(1999)‧保護剩餘的腎功能‧腎臟與透析,11(2),67 - 68。
黃秀梨、吳佩蓉、許淑蓮、蔡敦仁(1996)‧慢性腎衰竭的疾病認知、態度及自我照顧行為之研究,慈濟護理,8(4),313 - 320。
黃尚志、楊五常、陳秀熙、台灣腎臟醫學會透析評估委員(2000)‧台灣地區八十八至八十九年透析評估工作報告,台灣腎臟醫學會雜誌,14,139 - 228。
黃尚志(2001,2月8日)‧中老年病防治季系列演講:腎臟病對國人康衝擊‧衛生署保健處網‧摘自http://www.doh.gov.tw/todaynews/900208/htm.
黃尚志、楊五常(2002)‧台灣慢性腎衰竭申請健保重大傷病證明之基本條件與審核結果研究 ─ 對慢性腎疾病需長期透析病患重大傷病證明審核制度的檢討與建議‧於台灣腎臟醫學會主辦,九十一年會員大會學術演講會講義‧高雄:榮民總醫院。
楊麗瑛(1995)‧透析患者之衛教方針,腎臟與透析,7(4),268- 271。
楊五常(2001,2月8日)‧中老年病防治季系列演講:台灣腎臟醫學會楊理事
長簡報‧衛生署保健處網站‧摘自http://www.doh.gov.tw/todaynews/900208/htm.
楊文山(1992)‧台灣地區民眾求醫行為之分析‧榮總護理,9(2),121 - 125。
楊長興(1995)‧全民健保實施對於民眾醫療利用率影響之初期評估,臺北市:中央健保局。
雷秀麗(2001)‧台灣地區慢性透析病患醫療利用及死亡率之分析‧未發表的碩士論文,台北:陽明大學公共衛生研究所。
劉鴻興(1999)‧慢性腎衰竭,於劉鴻興編著,當代診斷及治療(pp. 20-21)‧台北:合記。
蔣欣欣、盧孳艷(1996)‧健康與疾病的文化觀及現象分析,護理雜誌,43 ( 4 ),
蔣榮福、陸志平、蔣榮欽(1999)‧中草藥與腎臟‧腎臟與透析,11(3),144-148。
盧瑞芬、謝啟瑞(2000)‧醫療經濟學‧臺北:學富文化。
賴銘南、吳寬墩(1996)‧老人與慢性腎衰竭‧腎臟與透析,8(1),13-18。
謝紅桂(2001)‧血液透析病人生活品質及其相關因素探討‧未發表碩士論文,台南:成大護理研究所。
謝淑美(1981)‧醫療服務與醫療行為之研究‧公共衛生,7(4),373-391。
蕭宏恩 ( 2000 )‧護理照護的根本關懷‧護理雜誌,47(5),71-76。
鍾應欽(2001)‧慢性腎衰竭的臨床症狀、診斷與治療方式,於台灣腎臟護理學會主辦,腎臟病房護理研習會講義‧嘉義:基督教醫院。
簡美玲(1993)‧疾病的文化詮釋:阿美族的醫療體系與家庭健康文化‧未發表的碩士論文,新竹:清華大學社會人類學研究所。
蘇美禎 ( 1999 )‧一位末期腎病患者在面臨洗腎時社會心理障礙的護理經驗,護理雜誌,46 ( 1 ),95 — 100。
Aday, L. A., & Andersen, R. M. (1974). A framework for the study of access to
medical care. Health Services Research, 9, 208-220.
Aday, L. A. (1989). Thinking about topic for health survey: A framework for decision making. .In L. A. Andy (Eds.), Designing and conducting health survey (1st ed., pp. 1-19). San Francisco: Jossey-Bass .
Anger, D. (1975). The psychological stress of chronic renal failure and long-term
hemodialysis. Nurse Clinical North America, 10(3), 449-460.(2), 138-144.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter?Journal of Health Social Behavior, 36(1), 185-194.
Astor, B. C., Eustace, J. A., Powe, R. N., Klag, M. J., Sadler, J. H., Fink, N. E., &
Coresh, J. (2001). Timing of nephrologist referal and arteriovenous access use: the choice study. American Journal of Kidney Disease, 38(6), 1178-1184.
Baker, J. E., & Thomas, A. N. (2001). Progressive renal insufficiency program
planning: a technique for evaluation and improvement. Nephrology Nurse Journal, 28(1), 8-13.
Bates, P., & Lewis, S. L. (1996). Nursing assessment urinary system. In S. M. Lewis, I.C. Collier & M. M. Heitkempter (Eds.), Medical-surgical nursing (4th ed., pp. 1311-1331). New York: Mosby.
Botton, W. K., & Kliger, A. S. (2000). Chronic renal insufficiency: current
understanding and their implications. American Journal of Kidney Disease, 36(6), 4-12。
Burns, N., & Grove, S. K (2001). Sampling. In N. Burns & S. K. G. Grove. (Eds.), The practice of nursing research: conduct, critique, & utilization. (4th ed., pp.365-387). Philadelphia: Saunders.
Cass, A., Cunningham, J., Amold, P. C., Snelling, P., Wang, Z., & Hoy, W. (2002).
Delayed referral to a nephrologist: outcome among patients who survive at least one year on dialysis. Medical Journal of Australia, 177(5), 135-138.
Chiou, C. P. (1999). Ancillary use of complementary therapies by ESRD patients
receving hemodialysis in Taiwan. Nursing Research, 7(5), 398-407.
Cockcroft, D. W., Gault, M. H. (1976). Prediction of creatinine clearance from serum creatinine. Nephron, 16(1), 31-41.
Ellis, P. A., Reddy, V., Bari, N., & Cairns, H, S. (1998). Late refer of end-stage renal
failure. Quarterly journal of medicine,. 91, 727-732.
Fetzer, S. J. ( 2001,7月)‧研究方法論:有關樣本、場所與研究過程,於成功
大學護理學系主辦‧護理研究計劃撰寫研習會講義‧台南:成大護理系。
Frank, J. (1968). The role of hope in psychotherapy. International Journal of Psychiatry, 5(5), 383-395.
Golper, T. (2001). Patient education: can it maximize the success of therapy? Nephrology Dialysis Transplantation, 16(17), 20-4.
Granich, R., Cantwell, M. E., Long, K., Maldonado, Y., & Parsonnet, J. (1999). Patterns of health seeking behavior during episodes of childhood diarrhea: a study of Tzotzil-speaking Mayans in the highlands of Chiapas, Mexico Social Science & Medicine, 48(4), 489-495.
Gurklis, A. J., & Menke, M. E. (1995). Chronic hemodialysis patient’s perception of stress. coping and social support. American Nephrology Nurses’ Association Journal, 22(4), 31-33.
Habert, L. A., Wilmer, W. A., Falkenhain, M. E., Ladson-Wofford, S. E., Nahman, N. S., & Rovin, B. H. (2001). Renoprotection: one or many therapies. Kidney International, 59(4), 1211-1226.
Hagren, B., Pettersen, I., Severinsson, E., Lutzen, K., & Clyne, N. (2001). The hemodialysis machine as a lifeline: experiences of suffering from end-stage renal disease. Journal of Advanced Nursing, 34(2), 199-202.
Harris, L. E., Luft, F. C., Rudy, D. W., Kesterson, J. G., & Tierney, W. E. (1998).
Effect of multidisciplinary case management in patients with renal insufficiency. The American Journal of Medicine, 15, 464-471.
Hayslip, D. M., & Suttle, C. D. (1995). Pre-ESRD patient education: a review of the
literature. Advances in Renal Replacement Therapy, 2(3), 217-226.
Headley, M. C., & Wall, B. (2000). Advanced practice nurse: roles in hemodialysis
unit. Nephrology Nursing Journal, 27(2), 177-186.
Hus, C., & Chertow, G. M. (2000). Chronic renal confusion: insufficiency, failure, dysfuction, or disease. American Journal of Kidney Disease, 36(2), 415-418.
Hsu, C. Y., Chertow, G. M., & Curhan, G. C. (2002). Methodological issues in studying the epidemiology of mild to moderate chronic renal insufficiency. International Society of Nephrology, 61, 1567-1576.
Ifudu, O., Dawood, M., Homel, P., & Friedman, E. A. (1996). Excess morbidity in patients starting uremia therapy without prior care by a nephrologist. American Journal of Kidney Disease, 28(6), 841-845.
Jaraillo, E. (1998). Pulmonary tuberculosis and health-seeking behavior: how to get a delayed diagnosis in Cali, Colombia. Tropical Medicine International Health, 3(2), 138-144.
Johnson, M., & Maas, M. (1997). Health seeking behavior. In M. Johnson & M. Mass (Eds.), Nursing outcome classification ( NOC ): Iowa Outcome Project (1st ed., pp.160-161). St Louis: Mosby.
Jones, C. A., McQuillan, G. M., Kusek, J. W., Eberhardt, M. S., Herman, W. H., Coresh, J., Salive, M., Jones, C. P., & Agodoa, L. Y. (1998). Serum Creatinine levels in the US population: Third National health and nutrition examination survey. American Journal of Kidney Disease, 32(6), 992-999.
Kausz, A. T., Khan, S. S., Abichandani, R., Kazmi, W. H., Obrador, G. T., Ruthazer, R., & Pereira, B. J. (2001). Management of patients with chronic renal insufficiency in the Northeastern United States. American Society of Nephrology, 12, 1510-1507
Kleiman, A. (1975). Medicine and psychiatric anthropology and the study of
traditional forms of medicine in modern Chinese culture. Bulletin of Institute of Ethnology Academia Sincia, 39, 107-123.
Kleiman, A., Eisenberg, L., Good, B., Washington, S., & California, D. (1978). Culture, illness, and care: clinical lessons form anthropologic and cross-culture research. Annals of Internal Medicine, 88, 251-258.
Koo, L. C. (1987). Concepts of disease Causation, Treatment and Prevention among Hong Kong Chinese: Diversity and Eclectiscism. Social Science Medicine, 25, 405-417.
Laski, M. E., Kurtzman, N. A., & Sabatini, S. (2000). Chronic renal failure. In D. W.
Seldin & G. Giebisch (Eds.), The kidney-pathophysiology (3rd ed., pp. 2377- 2409) Philadelphia:Williams & Wilkins.
Levin, A., Lewis, M., Mortiboy, P., Faber, S., Porter, E. C., & Mendelssohn, D. C. (1997). Multidisciplinary predialysis programs: quantification and limitations of their outcomes in the Canadian settings. American Journal of Kidney Diseases, 29(4), 533-440.
Levin, A. (2000). Consequences of late referral on patient outcomes. Nephrology Dialysis Transplantion, 15(3), 8-13.
Levinseky, N. G. (2002). Specialist evaluation in chronic kidney disease: too little, too late. Annals of Internal Medicine, 137(6), 542-543.
Lincoln, Y. S., & Guba, E. G.. (1985). Naturalistic inquiry. London: Stage.
Mackenzie, W. (1998). Assessing renal function from creatinine measurements in adults with chronic renal failure, American Journal of Kidney Disease, 32(1), 23-31.
McCarley, T., & Lewis, S. L. (1996). Nursing Acute and Chronic Renal Failure. In S. M. Lewis ., I.C. Collier & M. M. Heitkempetr (Eds.), Medical-surgical nursing (4th ed., pp. 1371-1412). St Louis: Mosby.
Mendelssohn, D. C., Mullaney, S. R., Jung, B., Bake, P. G., & Mehta, R. (2001). What do American nephrologists think about dialysis modality selection? American Journal of Kidney Disease, 29(4), 533-540.
Muirheab, N. (2001). The rationale for early management of chronic renal
insufficiency . Nephrology Dialysis Transplants, 16(7), 51-61.
Nahman, N. S., & Rovin, B. H. (2001). Renoprotection: one or many therapies. Kidney International, 59(4), 1211-1226.
National Kidney Foundation (2002). Kidney Disease Outcome Quality Initiative (K/DOQI) Advisory Board. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. American Journal of Kidney Disease, 39(2), S1-S124
Nissenson, A. R., Pereira, B. J. G., Collins, A. J., & Steinberg, E. P. (2001).
Prevalence and characteristics of individuals with chronic kidney disease in a large health maintenance organization. American Journal of Kidney Disease, 37(6), 1177-1183.
Peter, W. L., Schoolwerth, A. C., McGowan, T., & McClella, W. M. (2003). Chronic kidney disease: issues and establishing programs and clinics for improved patient outcomes. American Journal of Kidney Disease, 41(5), 903-924.
Parson, T. (1994). Human behavior and community health education. In L. W. Green & J. M. Ottoson (Eds.), Coummunity health (7th ed., pp. 91-116). St Louis: Mosby.
Pierce, P. F., & Hicks, F. D. (2001). Patient decision-making behavior. Nursing
Research, 50(5), 267-274.
Schmidt, R. J., Domico, J. R., Sorkin, M. I., & Hobbs, G. (1998). Early referral and its impact on emergent first dialyses, health care cost, and outcome. American Journal of Kidney Disease, 32(2), 278-283.
Shemesh, O., Golbetz, H., Kriss, J.P., & Myers, B. D. (1985) Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney International, 28(5), 830-388.
Shortell, S. M. ( 1984 ). Suggestions for improving the study of health program implementation. Health Service Research, 19(1), 117-125.
Slowik, M. S. (2001). Early education of patient with chronic renal insufficiency: the healthy start program. Nephrology Nursing Journal, 28(6), 643-646.
Suchman, E. A. (1965). Stage of illness and medical care. Journal of Health and
Social Behavior, 6, 114-128.
Winkelmayer, W. C., Glynn, R. J., Levin, R., Owen, W. F., & Avorn, J. (2001). Determinants of delayed nephrologist referral in patients with chronic kidneys disease. American Journal of Kidney Disease, 38(6), 1178-1184.
連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
1. 吳就君(1981)‧台灣地區居民社會醫療行為研究‧公共衛生,8(1),25 - 49。
2. 朱宗信(1997)‧慢性腎衰竭之診斷與處置,當代醫學,24(12),62 - 65。
3. 丘周萍(1987)‧接受血液透析患者的壓力、因應行為與社會支持‧護理雜誌,
4. 王春葉、林佑樺、許國泰、林耀信(1997)‧影響血液透析病患工作的因素探討,腎臟與透析,9(3),214 - 224。
5. 39.吳秋蓉(2003),2002美國壽險市場概觀,現代保險,172期,p83-84。
6. 28.莊衍松(2003),向Microsoft學客服,新新聞周報,6月5日,p81-90。
7. 李卓倫(1987)‧民眾尋求與利用健康服務模式的行為研究‧公共衛生,14(1),42 - 60。
8. 李慧鶯(2001)‧同理的概念探究‧護理雜誌,48(2),70 - 80。
9. 杜異珍(1992)‧文化對女性乳癌病患醫療行為之影響‧榮總護理,9(2),127— 133。
10. 林文香(1992)‧為推展護理本土化奠石─認識民間醫療行為文化‧榮總護理,9(2),110 - 115。
11. 林秋菊、金繼春、梁靜祝、賴永勳(2000)‧尿毒症病患訊息需求量表之建立與測定,護理研究,8(6),641 - 650。
12. 胡幼慧(1988)‧文化、行為與健康‧公共衛生,15(3),293— 301。
13. 胡潔瑩、林秋菊(1999)‧末期腎臟疾病病患面對透析治療方式的抉擇衝突‧腎臟與透析,11(2),106 — 109。
14. 陳漢湘(1999)‧保護剩餘的腎功能‧腎臟與透析,11(2),67 - 68。
15. 楊文山(1992)‧台灣地區民眾求醫行為之分析‧榮總護理,9(2),121 - 125。
 
系統版面圖檔 系統版面圖檔