臺灣博碩士論文加值系統

論文名稱：社區糖尿病病患「衛生教育介入」之成效探討---比較藥師和護理師之差異
研究所名稱：台北醫學大學護理學研究所
研究所姓名：李夢英
畢業時間：九十五年第一學期
指導教授：盧美秀教授 台北醫學大學護理學研究所教授
本研究係藉北部某縣市「社區糖尿病醫藥服務」計畫，採藥師及護理師「衛生教育介入」之類實驗性研究，探討護理師與藥師之衛生教育介入對社區糖尿病患的糖尿病知識、照護態度、照護行為、糖尿病生化檢測數值，以及健康照護滿意度之差異，並探討護理師及藥師參與社區糖尿病病患照護的可行性，採隨機分配方式實驗組33人和對照組35人經個案同意後由護理師（實驗組）與藥師（對照組）分別進行居家的家訪、電訪衛生教育介入，並於介入三個月後比較兩組之差異，研究工具以自擬之糖尿病知識、照護態度及照護行為、健康照護滿意度問卷表，專家效度檢定CVI達0.86， Cronbach’α值0.789。利用健康照護系統資料庫之糖尿病病患的人口學資料與其BMI、糖化血色素(HbA1c)、空腹血糖值進行介入前後比較分析。
資料以SPSS 11.0 for Windows套裝軟體進行統計分析，統計方法包括平均數、標準差、次數分配、百分比、獨立樣本t檢定及Paired-t、One-Way ANOVA及ANCOVA分析；二組的人口學資料分析檢定除職業別呈現統計上差異外，其他變項均未達統計上顯著差異。研究結果：
一、衛生教育介入對整體社區糖尿病病患照護頗具成效
經護理師和藥師提供衛生教育介入後對社區糖尿病病患知識程度、照護態度與照護行為及糖化血色素值、空腹血糖值及BMI值有顯著性進步，但在照護態度上並無顯著改變。
二、護理師及藥師之衛生教育介入對糖尿病患均具照護成效
衛生教育介入前、後照護成效的差異比較，於糖尿病知識及照護態度，護理師優於藥師，而生化檢測數值之空腹血糖值則藥師優於護理師。檢定二組改善成效的差異:藥師介入組的空腹血糖值顯著優於護理師；糖尿病照護知能(知識與行為)及生化檢測數值之HbA1c及BMI則無差異；證明藥師、護理師之衛生教育介入對糖尿病患的知識程度、照護行為及血糖控制確有助益。
三、護理師與藥師衛生教育介入對社區糖尿病病患滿意度有顯著差異
病患對護理師衛生教育介入病患的照護滿意程度高於藥師，並以專業人員給予的問題解答感受，呈顯著性差異。
四、人口學因素對護理師與藥師衛生教育介入照護成效的相關影響不一。整體分析得性別與空腹血糖值有關，個人運動習慣、運動頻率與時間影響其照護行為的正向與糖化血色素值的改善，採飲食與運動治療方式者對健康照護滿意度高於以口服降血糖藥治療者。
本研究經比較藥師及護理師三個月衛生教育介入及諮詢服務，證明確能有效提升社區糖尿病患之照護成效，藉此期能建立護理師於社區慢性疾病個案之照護模式，或可成為護理人員執業範疇的擴展與參考依據。
關鍵詞：社區糖尿病病患、衛生教育介入、照護成效

Title of thesis: The Effectiveness of Community Diabetes Mellitus Patient Care After Health Education Program Intervention --Comparison of Pharmacists and Nurses
Institution: Graduate Institute of Nursing, Taipei Taipei Medical University
Author: Li, Mung-Yeng
Thesis director by: Lu, Meei-Shiow, Professor
This research is based on the community diabetes medicine service plan from a northern city，expand its service to include pharmacist and the nurse. This is a qusi-experimental study. Subjects are diabetes patients that were selected from the community by screening. After receive consent from the subject, random assignment was used to assign subjects into experimental group（receiving educational intervention from nurse）and control group（receiving educational intervention from pharmacist）.The valid sample counts 68 people [experiment set 33 people, matched control 35 people].They provide intervention separately through telephone. Measurement tools include self reported measures on diabetes knowledge, care attitude and care behavior, and health care satisfaction questionnaire. Expert validity was showed by Content validity index (CVI) of 0.86, and reliability was demonstrated by Cronbach'' α of0.789.
Data analysis with the SPSS 11.0 for Windows software package carry on the analysis including average , standard deviation, frequency, percentage, Independent-t test and the Paired-t, Pearson correlation, the One Way ANOVA, and ANCOVA. According to analysis, there were no difference between groups on basic demographic information except on occupation. Research findings are listed below :
1. The educational interventions which provided by nurse and pharmacist are effective to the diabetes patient care. There are significant improvements on care knowledge, care behavior, HbA1c level, ex-fasting blood sugar, and BMI values. However, no difference was found on care attitude.
2. According to group difference, subjects from experimental group performed better on care knowledge and care attitude. However, subjects from control group had better result on ex-fasting blood sugar. There were no differences on HbA1c level, and BMI value. Evidences support the effectiveness of this 3 months intervention from nurse and pharmacist on diabetes control in the community.
3. There was significant difference on patients’ satisfaction between groups. Subjects from the experimental group had more satisfaction than subjects from the control group.
4. On demographic variables, gender had relationship with ex-fasting blood sugar. Subjects’ exercise habit, frequency, and duration had positive relationship with care behavior and HbA1c level. Moreover, subjects who used diet and exercise control had more satisfaction with care than subjects who used OHA(Oral Hypoglycemic Agent ).
This research compared the effectiveness of pharmacist and nurse who provided three months of health educational intervention and counseling. The results indicate that hygiene educational intervention benefit on the outcomes of diabetes care. Based on the findings from this study, the care mode of chronic disease patient’s in the community for the nurses could be established or become the basis of expansion and reference for nurse''s professional duty.

Keyword: Community diabetes patient.
The health educational intervention. Effectiveness of care.

目 錄
頁數
致 謝……………………………………………………………….. Ⅰ
中文摘要……………………………………………………………..… Ⅲ
英文摘要………………………………………………………………. Ⅵ
目 錄………………………………………………………………. Ⅸ
附 錄……………………………………………………………..... ⅩⅡ
圖表目次………………………………………………………………. ⅩⅢ
第一章 緒論…………….……………………………….………….… 1
第一節 研究動機及重要性…………….……………………….….. 2
第二節 研究目的…………….. ……………………………………. 5
第三節 研究假設…………………………………………………… 6
第四節 操作型名詞定義…………………………………………… 7
第二章 文獻查證
第一節 關於糖尿病及照護………………………………………… 9
第二節 糖尿病共同照護網………………………………………... 13
第三節 衛生教育介入糖尿病照護之成效與影響…..……………. 14
第四節 糖尿病照護之成效與影響…………………………..……. 17
第五節 概念架構…………………………………………..………. 20
第三章 研究方法
第一節 研究設計………………………………………………….. 22
第二節 研究對象……………………………………………..…… 24
第三節 研究工具………………………………………………….. 25
第四節 研究步驟………………………………………………….. 28
第五節 倫理考量………………………………………………….. 32
第六節 資料處理與方法………………………………………….. 33
第四章 研究結果
第一節 研究對象之人口學基本資料分析……….………………. 35
第二節 衛生教育介入對社區糖尿病患的知識、照護態度與行
為的差異分析…………………………………………… 40
第三節 衛生教育介入對社區糖尿病患的生化檢測數值差異分析
…………………………………………………………… 56
第四節 社區糖尿病病患對二組專業人員衛生教育介入之健康
照護滿意度分析…………………………………..…….. 62
第五節 人口學因素對衛生教育介入前、後社區糖尿病患的知
識、照護態度與行為及生化檢測數值與健康照護滿意
度的差異檢定…………………………………………… 65
第五章 討論………………………………………………………..… 74
第六章 結論與建議
第一節 結論………………………………………..….……..……. 78
第二節 研究貢獻……………………………………………….…. 80
第三節 限制與建議……………………………………….……….. 81
參考資料
中文文獻…………………..…………………………...………….…… 82
英文文獻…………………..…………………………………………… 85

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