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研究生:林宜昀
論文名稱:失智症照護者指引衛教方案對主要家屬照顧者之成效探討
論文名稱(外文):The effects of intervention for family caregivers of persons with dementia
指導教授:徐淑芬徐淑芬引用關係
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
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
中文關鍵詞:失智症主要家屬照顧者介入措施
外文關鍵詞:dementiafamily caregiverprotocol of health education
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本研究旨在探討失智症照護者指引衛教方案對主要家屬照顧者負荷、社會支持及失智症相關知識之影響。採實驗組與對照組雙組前後測量之類實驗研究設計方法,以方便取樣的方式收集資料,共收集65對病患及主要家屬照顧者資料,實驗組33對與對照組32對。研究過程共五個階段,第一階段為了解照顧者負荷之情形並確定失智症主要家屬照顧者對衛教內容的需求;第二階段為完成「失智症照護者指引衛教方案」;第三階段為執行衛教方案之前測;第四階段為正式執行衛教方案;第五階段為執行衛教方案之後測。
實驗組與對照組在失智症相關知識達統計上顯著差異(p<.05);在照顧者負荷及社會支持協助情形未達統計上顯著差異,但實驗組在照顧者負荷之“人際關係負荷次量表”上於第一次後測與第二次後測達統計上顯著差異(p<.05);在社會支持之協助情形上前測與第一次後測達顯著統計上之差異(p<.05),其中“資訊性支持”於前測與第一次後測及前測與第二次後測;及“工具性支持”於前測與第一次後測達顯著統計上之差異(p<.05)。實驗組與對照組在第一次後測與第二次後測之社會支持需要程度達統計上顯著差異(p<.05)。
分析失智病患疾病嚴重度(以CDR、記憶行為量表、MMSE測量)、社會支持(分為協助情形與需要程度)及失智症知識與照顧者負荷間之相關性,研究結果發現“CDR分數”、“記憶與行為量表總分”、“社會支持需要程度”與照顧者負荷達統計上顯著直線正相關;而“MMSE分數”與社會及病患依賴負荷達統計上直線負相關。
本研究之失智症照顧者衛教方案,藉由多樣化衛教方式(結合個別口頭衛教、手冊指導及電話諮詢關心),直接提升照顧者知識和維持衛教持續效果,並間接增加照顧者的社會支持與降低照顧者負荷及提升失智病患之居家照護品質。期望此研究有助於做為未來本土化衛教方案之參考。
The purpose of this study was to explore the effects of interventions on caregiver’s burden, social support, and knowledge of dementia. For the convenience of sampling, sixty-five pairs of dementia patients and their primary family caregivers were collected and divided into the experimental group and the control group, thirty-three pairs and thirty-two pairs individually. The study had five stages. First stage was to understand the caregivers’ burden and make sure what’s their need in health education. Second stage was to design and complete the health education protocol family caregivers with for dementia. Third stage was the pre-test to validate the health education protocol. Fourth stage was to perform the intervention of the health education protocol. Final stage was the post-test after performing the health education protocol one week and four weeks.
The results of the study indicated that two groups had no difference in demographic data. There were no significant difference between the experimental group and control group in the scores of the Clinical Dementia Rating (CDR), Mini-mental Status Examination ( MMSE), revised memory and behavior problem checklist (RMBPC), knowledge related dementia, social support , and caregiver burden(p>.05)in the pretest. A significant difference between two groups in the knowledge related dementia(p<.05)was found . The results didn’t show the significant differences between the experimental and control groups in the social support and caregiver burden(p>.05). But the burden in interpersonal relationships in experimental group did have a significant difference between the first and the second post-test(p<.05). There was a significant difference in the being assisted conditions in the social support in the experimental group between the pre-test and the first post-test(p<.05). In the experimental group, “informational support ” had the significant differences between the pre-test and the first post-test and between the first post-test and the second post-test(p<.05); the“ instrumental support ” had a significant difference between the pre-test and the first post-test(p<.05). The results of the need levels in social support in two groups showed the significant difference between the first and the second post-test(p<.05).
The findings of the study indicated that “ CDR”, “ RMBPC“, “ the need levels in social support “ had the positive relationships with the caregiver’s burden, and “MMSE” had the negative relationships with the social burden and patient dependence.
The protocol of health education for primary family caregivers of persons with dementia was performed by multidimensional teaching methods in combining the individual health education, a guide manual, and telephone-calls to directly promote caregivers’ knowledge related dementia and maintain the effect of the health education. In addition, it also indirectly increased caregivers’ social support and improved dementia patients’ quality of care at home. This study will be a helpful reference to develop a local health education protocol in the future.
正文目錄……………………………………………………………………Ⅰ
『表』目錄…………………………………………………………………Ⅳ
『圖』目錄…………………………………………………………………Ⅵ
中文摘要……………………………………………………………………Ⅶ
英文摘要……………………………………………………………………Ⅸ
第一章 緒論
第一節 研究動機……………………………………………………..1
第二節 研究重要性…………………………………………………..3
第三節 研究目的………………………………………………………6
第四節 研究問題………………………………………………………6
第二章 文獻查證
第一節 失智症相關概念………………………………………………7
第二節 照顧者負荷相關概念………………………………………..11
第三節 衛教方案對失智病患主要照顧者之相關概念……………..24
第三章 研究架構
第一節 概念架構……………………………………………………..27
第二節 研究假設……………………………………………………..28
第三節 名詞界定……………………………………………………..29
第四章 研究方法與過程
第一節 研究設計……………………………………………………..30
第二節 研究對象與場所……………………………………………..31
第三節 研究工具……………………………………………………..32
第四節 資料收集步驟………………………………………………..37
第五節 研究倫理考量………………………………………………..39
第六節 資料處理與分析……………………………………………..39
第五章 研究結果
第一節 研究對象基本屬性分佈及差異性分析……………………..40
第二節 比較兩組各量表前測得分狀況及差異性分析……………..50
第三節 比較基本屬性、疾病嚴重度與照顧者負荷
、社會支持及失智症知識前測之差異性分析………………68
第四節 介入措施對照顧者負荷、社會支持及失智症相關知識
之影響………………………………………………………78
第五節 失智病患疾病嚴重度及主要家屬照顧者社會支持及
失智症相關知識與主要家屬照顧者負荷間
之相關性……………………………………………………90
第六章 討論
第一節 比較兩組各量表前測得分狀況及差異性分析…………… 94
第二節 比較兩組基本屬性、疾病嚴重度與照顧者負荷
、社會支持及失智症知識前測之差異性分析……………102
第三節 介入措施對照顧者負荷、社會支持及失智症相關知識
之影響…………………………………………………...109
第四節 失智病患疾病嚴重度及主要家屬照顧者社會支持及
失智症相關知識與主要家屬照顧者負荷間
之相關性…………………………………………………115
第七章 結論與建議
第一節 結論……………………………………………………… 116
第二節 研究限制與建議……………………………………………120
第三節 結果應用與未來研究方向…………………………………122
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1. 鄧光銳(1992)˙癡呆症˙醫學繼續教育,2,686-690。
2. 劉秀枝(1989)˙世紀的悲哀─癡呆症/失智症˙臨床醫學,23(1),1-5。
3. 劉景寬、戴志達、林瑞泰、賴秋蓮(2000)˙台灣失智症的流行病學˙應用心理研究,7,157-169。
4. 萬育維、王春雅(1998)˙政策規劃與需求的落差-失智老人與家屬分析˙社區發展季刊,83,92-114。
5. 溫金成、羅文傑、李俊泰、林健群(1998)˙阿耳滋海默氏症˙國防醫學,26(1),11-14。
6. 湯麗玉、毛家舲、周照芳、陳榮基、劉秀枝(1992)˙癡呆症老人照顧者的負荷及其相關因素之探討˙護理雜誌,39(3),89-98。
7. 許樹珍、曾慶音、崔翔雲(2001)˙精神病患家庭照顧存在性的現象學探討˙護理研究,9(3),259-267。
8. 許敏桃、曾英芬(1998)˙社區精神病患主要照顧者心理衛生教育之需求˙護理研究,6(4),290-303。
9. 張文芸(1996)˙癡呆症老人問題行為的認識˙護理雜誌,43(4),85-91。
10. 唐嘉良(1999)˙失智症˙國防醫學,29(1),7-14。
11. 徐亞瑛(1989)˙對老年癡呆症患者家庭的評估及護理措施˙護理雜誌,36(2),25-33。
12. 韋淑玲、蔡芸芳(2002)˙花蓮地區民眾對於老人失智症相關知識及態度之探討˙慈濟醫學,14(2),97-104。
13. 邱啟潤、許淑敏、吳淑如(2003)˙居家照護病患之主要照顧者綜合性需求調查˙醫護科技學刊,5(1),12-25。
14. 林碧珠、林麗嬋、林金真(1997)˙成人教育理論與老人衛生教育˙護理雜誌,44(2),81-86。
15. 林健群(1998)˙失智症的分類與診斷˙國防醫學,26(1),2-7。