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研究生:陳瑞芬
研究生(外文):Jui-Fen Chen
論文名稱:記憶門診中提供失智者家屬照顧指導與支持方案之成效
論文名稱(外文):The effects of a nurse education and support program for caregivers of patients with dementia in a memory clinic
指導教授:戴玉慈戴玉慈引用關係
指導教授(外文):Yu-Tzu Dai
學位類別:碩士
校院名稱:國立臺灣大學
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:2004
畢業學年度:92
語文別:中文
論文頁數:163
中文關鍵詞:失智症照顧者記憶門診
外文關鍵詞:dementiacaregiversmemory clinic
相關次數:
  • 被引用被引用:2
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本研究目的為探討在記憶門診中提供「照顧指導與支持方案」對於失智者家屬的知識與態度、照顧負荷、生活品質之成效。採實驗性研究設計,於台北市某醫學中心神經部門診選取失智症照顧者,提供18位記憶門診組照顧者「照顧指導與支持方案」,三個月內完成3次診後會談、2次電訪及1次家訪,21位一般門診組照顧者維持一般門診照護。採結構式問卷測量方案成效,包括:知識態度量表、照顧負荷量表、生活品質量表SF-36。以SPSS10.0 for Windows之無母數統計方法進行兩組間及單組前後測資料分析與比較。研究結果發現,提供「照顧指導與支持方案」的效果為:
一、整體失智症疾病知識及態度無影響,但照顧者可了解失智者的行為不是故意的。記憶門診組能學習到藉由控制環境因子與作息時間可避免失智者混亂或不安,且能接受失智症是一種疾病,一般門診組會有失智症是罕見疾病的錯誤概念的趨勢。
二、對整體照顧負荷無影響,但在「害怕失智者的未來」、「應該為失智者再多作一些」、「照顧失智者方面能做得更好」三項照顧負荷感受有增加,「照顧失智者影響自身健康」、「為了照顧失智者而犧牲社交生活」的照顧負荷感受有減輕的趨勢。
三、「社會功能SF」生活品質有下降的趨勢,記憶門診組同時有「因情緒問題造成角色扮演受限RE」生活品質下降的情形,而一般門診組在「生理功能PF」生活品質下降了。
建議未來應透過長期追蹤評價與增加個案數,來瞭解此方案之整體效益。整體而言,雖然本研究未達到預期的目的,但照顧者感謝專業人員提供失智者照護知識與關心,讓照顧者覺得更有信心與能力繼續照顧失智者,此研究結果可作為未來提供失智者及照顧者照護時的參考。
關鍵詞:失智症、照顧者、記憶門診。
The purpose of this study was to evaluate the effects of a nurse education and support program for caregivers of patients with dementia in a memory clinic. The nurse education and support program was designed to help the caregivers of patients with dementia to correct their knowledge and attitude, reduce their stress and burden, and improve their quality of life. The randomized controlled design and single-blind were used in this study. The subjects were recruited from a neurological clinic at a medical center in Taipei and assigned randomly into a memory clinic group (experimental group, n=18) and a usual clinic group (control group, n=21). For three months, the memory clinic group participated in the nurse education and support program. Each member of the group received individualized health education and emotional support. A total of six occasions, which included three interviews following visits to the doctor, two follow-up telephone interview and a personal home visit by the nurse. Data collection was performed by an assistant by face to face interview with structured questionnaires: (1) Knowledge and Attitude scale (1991); (2) Zarit Burden Interview (1980); (3) The MOS 36-Item Short-Form Health Survey (SF-36, 1992). The data was recorded and analyzed with SPSS 10.0 for Windows. The study findings were as follows:
1.There was no significant effect on knowledge and attitude improvement between groups, but there was a positive trend that caregivers were able to realize the behavioral problems of patients with dementia are not caused on purpose. In the memory clinic group, caregivers were able to accept the concept that dementia is a disease and could better understand that by controlling the environment and daily schedule, patient disturbance or confusion can be decreased. In usual clinic group, caregivers had the misunderstanding that dementia is a rare disorder.
2.There was no significant effect on reducing caregiver’s burden between groups, but there were significant effects on increasing the caregiver’s burden that “be fear of the future of the patients with dementia”, “have the confidence to do more for the patients with dementia”, and “have the confidence to do better for the patients with dementia.” There was a trend towards down that “caregivers’ health were affected after caring the patients with dementia” and “caregivers sacrificed their social life after caring the patients with dementia”.
3.There was a decreasing trend in the “Social Functioning” score between groups. Besides, “Role-Emotional” score was decreasing significantly in memory clinic group. ”Physical Functioning” score was decreasing in usual clinic group.
The longitudinal effects of the nurse education and support program need to be further examined. The results could serve as a reference to related studied and interventions on the patients with dementia and their caregivers.
(Key words: dementia, caregivers, memory clinic)
內容目錄
致謝-----------Ⅰ
論文摘要-------Ⅱ
內容目錄-------Ⅵ
圖表目次-------Ⅷ
第一章 緒論
第一節 研究動機----------------1
第二節 研究目的----------------4
第三節 研究問題----------------5
第四節 名詞界定----------------5
第二章 文獻查證
第一節 失智症概論--------------8
第二節 居家照顧問題與策略------20
第三節 知識及態度--------------27
第四節 照顧負荷----------------30
第五節 生活品質----------------35
第六節 相關介入措施及成效------39
第三章 研究方法與過程
第一節 概念架構----------------54
第二節 研究假設----------------54
第三節 研究設計----------------55
第四節 研究對象----------------56
第五節 研究工具----------------56
第六節 研究工具信度測試--------68
第七節 資料收集過程------------70
第八節 資料處理及分析方法------75
第九節 倫理考量----------------75
第四章 研究結果
第一節 基準點之評估結果--------77
第二節 方案之效果評估----------91
第五章 討論
第一節 失智者與照顧者基本資料--103
第二節 方案對知識與態度之效果--106
第三節 方案對照顧負荷之效果----112
第四節 方案對生活品質之效果----117
第五節 和相關研究比較----------120
第六章 結論與建議
第一節 結論--------------------125
第二節 建議--------------------128
第三節 研究限制----------------129
參考資料-----------------------132

圖表目次
表2-1 阿茲海默症用藥比較表-------------------------16
表2-2 與膽鹼脂酶抑制劑產生交互作用之藥物及效應表---19
表2-3 國外失智症相關介入措施研究比較---------------49
表2-4 國內失智症相關介入措施研究比較---------------51
圖3-1 概念架構-------------------------------------54
表3-1 研究設計-------------------------------------55
圖3-2 CDR分數判斷規則流程圖------------------------59
表3-2 SF-36量表內容--------------------------------66
表3-3 SF-36量表重新計分之題目與分數----------------67
表3-4 SF-36量表各面向最高得分、最低得分、間距------68
表3-5 量表信度檢定---------------------------------69
圖3-3 資料收集流程圖-------------------------------73
圖3-4 「照顧指導與支持方案」執行內容及流程---------74
表3-6 資料分析目的與統計方法-----------------------75
表4-1 研究個案數及收案各時段個案流失原因表---------77
表4-2 失智者基本資料分布表-------------------------79
表4-3 照顧者基本資料分布表-------------------------82
表4-4 失智者性別與照顧者的關係分佈表---------------83
表4-5 失智症知識評量前測平均得分與排序表-----------85
表4-6 失智症態度評量前測平均得分與排序表-----------87
表4-7 「照顧負荷量表」前測平均得分與排序表---------89
表4-8 「生活品質量表」前測平均得分與排序表---------91
表4-9 單組知識前後測分數比較-----------------------92
表4-10 兩組間知識前後測分數改變量之比較------------93
表4-11 單組態度前後測分數比較----------------------94
表4-12 兩組間態度前後測分數改變量之比較------------95
表4-13 單組照顧負荷前後測分數比較------------------97
表4-14 兩組間照顧負荷前後測分數改變量之比較--------99
表4-15 單組生活品質前後測分數比較------------------101
表4-16 兩組間生活品質前後測分數改變量之比較--------102

附錄一 「個別照顧指導與支持方案」內----------------142
附錄二 量表使用同意書------------------------------148
附錄三 問卷內容------------------------------------149
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