臺灣博碩士論文加值系統

摘要
本研究的目的是探討「全方位護理方案」對髖骨骨折老人返家一個月、三個月角色執行功能的影響，採縱貫式之實驗研究法，以北臺灣三千八百床之某醫學中心為場所，利用隨機取樣方式，於每次收案前，丟擲銅板正面﹙數字﹚為實驗組，反面﹙人像﹚為控制組，共收集實驗組54人，控制組49人，控制組接受醫院常規治療，實驗組接受常規治療外，對骨折老人執行全方位髖骨骨折老人復健護理方案，內容包括：個案評估及資料收集、手術前後衛教護理、復健運動、復健師及護理師實際執行及評值、提供專業諮詢及持續和個案保持聯繫（出院準備服務），運用ADL及SF-36次量表為測量工具，探討措施介入之成效。
研究結果發現：實施復健護理方案，老人角色執行之操作性行為：即日常生活能力(ADL)中次變項：出院一個月平地上行走、出院三個月平地行走、出院三個月上下樓、出院三個月ADL總分、ADL改變量及上下樓改變量，實驗組比控制好，並有顯著差異。
老人角色執行之操作性行為：即生活品質面向之生理功能(PF)、因生理而情緒角色受限(RP)，出院三個月之PF、RP及PF之改變量上，實驗組比控制好，達統計上顯著意義。
老人角色執行之表達性行為：即生活品質面向之一般心理狀況(MH)分數，於出院一個月時實驗組(MH)的比控制組好，且具有顯著差異。
本研究結果發現老人角色功能獲得改善，希冀此方案能推廣至所有醫療院所之髖骨骨折老人，全面提升這些老人術後返家的角色執行功能，未來研究建議增加選案區域及考量成本分析，使研究結果更趨完整。
關鍵字：髖骨骨折老年病患、角色功能、全方位復健護理方案

Abstract
The purpose of this study was to explore the effectiveness of a comprehensive nursing rehabilitation program (CNRP) on the role function of hip fractured patients during a three-month interval following hospital discharge. This study was conducted using a longitudinal experimental design. A 3800 beds medical center located in northern Taiwan was used as the study site. A total of 103 subjects were selected from the trauma wards and randomly assigned into two groups, 54 subjects were assigned to the experimental group and 49 subjects were assigned to the control group. The control group received standard discharge treatment. The experimental group received a CNRP in addition to standard discharge treatment. The program included data collection, patient education, physical rehabilitation program, implementation and evaluation as well as construction and comprehensive discharge planning. The instruments used to evaluate the effectiveness of the intervention, which included ADL (activities of daily living) scale and the SF-36 (Medical Outcomes Study Short Form-36) subscales- PF (physical function), RP (role limitations due to physical problems), MH (mental health), RE (role limitation due to emotional problems), VT (vitality).
The results showed superiority of the experimental group over the control group. The experimental group appeared to have better walking ability at the 1st and 3rd month, better performance on the overall ADL score, climbing stairs, walking ability at the 3rd month and greater improvement in overall ADL score and climbing stairs from the 1st to 3rd month after discharge. The experimental group also appeared to have significantly better performance on PF, RP at the 3rd month, and greater improvement in PF from the 1st to 3rd month after discharge. The experimental group demonstrated significantly higher scores in MH at the 1st month following discharge.
In conclusion, CNRP has proven to be useful in improving the role function of elderly hip fractured patients. Further study with larger sample for multiple study sites and cost effectiveness analysis is suggested.
Key words: hip fracture, elder patients, role function, comprehensive nursing rehabilitation program, intervention.

第一章 序論
第一節 問題重要性 1
第二節 研究動機 3
第三節 研究目的 5
第四節 研究假設 6
第五節 名詞解釋 7
第二章 文獻查證
第一節 髖關節骨折對老年病患的角色執行功能之操作性行為 8
第二節 髖關節骨折與老年病患的角色執行功能之表達性行為 13
第三節 髖骨骨折復健護理措施成效 15
第三章 研究方法
第一節 概念架構 23
第二節 研究設計 28
第三節 研究變項 35
第四節 研究場所 36
第五節 研究對象 37
第六節 研究工具及信度 38
第七節 研究步驟及資料收集過程 40
第八節 資料分析 43
第九節 倫理考量 45
第四章 研究結果
第一節 研究收案結果 46
第二節 研究對象之基本屬性 48
第三節 出院後1個月、3個月髖骨骨折老年病患接受復健護理方案，角色執行之操作性行為即：日常生活能力(ADL)、生理功能(PF)和因生理功能造成角色受限(RP)對髖骨老人的影響 51
第四節 出院後1個月、3個月髖骨骨折老年病患接受復健護理方案對角色執行之表達性行為即：活力(VT)、因情緒造成角色受限(RE)、一般心理狀況(MH)對髖骨老人的影響 55
第五章 討論
第一節 復健護理方案在髖骨骨折老人在操作性角色行為的影響：日常生活能力(ADL)、生理功能(PF)、因生理功能而角色受限(RP) 68
第二節 復健護理方案對髖骨骨折老人在表達性角色行為的影響：活力(VT)、情緒角色受限(RE)、一般心理狀況(MH) 70
第三節 研究結果之推論性 72
第六章 結果與建議
第一節 結論 74
第二節 護理領域之運用 75
第三節 研究限制與建議 77
參考資料 79
附錄
圖表目錄圖
圖次 頁數
圖1 研究架構 27
圖2 復健護理方案實施流程圖 42
圖3 收案期間研究對象追蹤流失情形 47
圖4 角色執行之操作性行為：日常生活能力(ADL)總分1個月、3個月時間點之得分分布圖 56
圖5 角色執行之操作性行為：生理功能(PF)1個月、3個月時間點之得分分布圖 58
圖6 角色執行之操作性行為：生理功能造成角色受限(RP)1個月、3個月時間點之得分分布圖 59
圖7 角色執行之表達性行為：活力(VT)出院1個月、3個月時間點之得分分布圖 61
圖8 角色執行之表達性行為：情緒角色受限(RE)出院1個月、3個月時間點之得分分布圖 62
圖9 角色執行之表達性行為：一般心理狀況(MH)出院1個月、3個月時間點之得分分布圖 63
表次 頁數
表1 措施文獻比較 21
表2 研究設計 28
表3 復健護理方案內容及病房常規比較 30
表4 PF,RP,VT,RE ,MH之Cronbach’s Alpha值 39
表5 資料分析一覽表 44
表6 髖骨骨折老人之基本及疾病資料 49
表7 髖骨骨折老人出院前與出院後1個月時間點，角色執行之操作性行為中ADL次變項：平地行走、上下樓、ADL總分得分分布比較 52
表8 髖骨骨折老人出院後1個月時間點角色執行之操作性行為PF、RP得分分布比較 53
表9 髖骨骨折老人出院後1個月時間點角色執行之表達性行為得分之分布比較 54
表10 髖骨骨折老人出院後3個月時間點角色執行之操作性行為得分分布比較 66
表11 髖骨骨折老人出院後3個月時間點角色執行之表達性行為PF、RP得分之分布比較 57
表12 髖骨骨折老人出院後3個月時間點表達性行為VT、RE、MH得分之分布比較 60
表13 髖骨骨折老人角色執行之操作性行為：ADL、平地行走、上下樓得分改變量之差異 64
表14 髖骨骨折老人角色執行之操作性行為：PF、RP得分改變量之差異 65
表15 髖骨骨折老人角色執行之表達性行為：VT、RE、RE得分改變量之差異 66
表16 研究對象之基本屬性比較 72
附錄目錄
頁數
附錄一 研究同意書 .86
附錄二 住院期間復健運動紀錄表、返家後復健運動紀錄表 87
附錄三 個案基本資料問卷、簡式智能量表、巴氏量表、SF-36生活品質量表 102

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