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研究生:蔡月娥
研究生(外文):Yueh-O
論文名稱:冠狀動脈疾患對出院準備服務之成效及其滿意度探討
論文名稱(外文):To examine the efficiency and satisfaction of discharge planning in the patients with coronary artery disease
指導教授:廖玟君廖玟君引用關係
指導教授(外文):Wen-Chun Liao
學位類別:碩士
校院名稱:中山醫學大學
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:2009
畢業學年度:97
語文別:中文
論文頁數:141
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本研究目的旨在探討冠狀動脈疾病(Coronary artery disease)患者對出院準備服務(Discharge Planning)的滿意度及其成效指標,本研究採前測-後測橫斷式描述性設計,以立意取樣方式,以2008年7月至2008年10月間,經心臟專科醫師診斷為冠狀動脈疾患而且行氣球擴張術(PTCA)或置放支架(Stent)之治療者為研究對象。研究方法是針對收案患者,給予出院準備服務計劃的介入措施;主要研究工具為「出院準備服務病患滿意度調查問卷」,評值病患對出院準備服務的滿意度,並以電訪的過程記錄及月報表評值出院後十四天再急診之不當再急診率、出院後十四天再住院之不當再住院率、與滯院日數之滯院率,來評估出院準備服務的成效。資料收集後,以描述性統計及推論性統計包括百分比、個案數、平均值、標準差、獨立樣本t檢定、卡方檢定及成對t檢定進行分析,以比較前、後測兩組病患對出院準備服務的滿意度與出院後十四天再急診的不當再急診率、出院後十四天再住院的不當再住院率、與滯院日數之滯院率之差異。本研究共施行出院準備服介入措施之對象共170人,寄出問卷只有68人回函(回函率40%),是以做為後測分析的資料,以去年同時期病患63人做為前測的比較資料。比較前、後測兩組危險因子分佈結果:兩組研究對象基本屬性多無顯著差異(p > .05),唯後測組教育程度(大專以上居多)較前測組不同(p<.05)外,其他基本人口學變項皆具同質性。在出院準備服務介入措施後病患滿意度平均分數由前測的2.3分(SD=0.5)提升到2.8分(SD=0.4),兩組在統計上有顯著之差異(p < .05)。出院後十四天再急診的不當再急診率、出院後十四天再住院的不當再住院率、與滯院日數之滯院率方面,由前測之出院後十四天再急診的不當再急診率15人(23.8%)、出院後十四天再住院的不當再住院率2人(3.2%)、及滯院日數之滯院率8人(12.7%),降到後測的出院後十四天再急診的不當再急診率1人(1.5%)、出院後十四天再住院的不當再住院率1人(1.5%)、及滯院日數之滯院率1人(1.5%),統計上顯示其頻次均有下降的趨勢,而且具有統計上的意義。總結本研究之冠狀動脈疾患經由出院準備服務介入措施後,確實可以提升病患滿意度,降低出院後十四天再急診之不當再急診率、十四天再住院之不當再住院率、與滯院日數之滯院率。其結果亦可做為其他疾病行出院準備服務之參考,及作為出院準備服務相關研究的依據。
關鍵詞:冠狀動脈疾患、出院準備服務、成效、病患滿意度


The purpose of this study was to examine the efficiency and satisfaction of discharge planning in the patients with coronary artery disease. A pretest-posttest cross-sectional design with a descriptive correlation approach is used in this study. Data were collected from July of 2008 to October of 2008. Subjects who were diagnosed as coronary artery disease by a cardiologist and underwent a PTCA (Percutaneous Transluminal Coronary Angioplasty) or a Stent deployment were recruited from a cardiac vascular ward. Research instruments in this study included a demographic sheet and structured questionnaires of satisfaction on discharge planning. Questionnaires were mailed to 170 subjects after discharge planning intervention. Response rates were 36.4% (n=63) and 40.0% (n=68) in the pretest and posttest groups, respectively. There were no significant differences between these two groups in personal attributes. Descriptive statistics and inferential statistics including independent t-test, χ2, and paired t-test were used to compare the differences between the pretest and posttest groups on the patient satisfaction, the fourteen days post-discharge readmission, the fourteen days post-discharge with an emergency treatment, and the hospital length of stay (LOS). Results showed that the mean score of patient satisfaction was significantly increased from 2.3 (pretest group) to 2.8(posttest group). The fourteen days post-discharge readmission, the fourteen days post-discharge with an emergency treatment, and the hospital length of stay were significantly reduced in the posttest group. The findings of this study demonstrate positive outcomes in the discharge planning intervation and provide information for the hospital managers to develop other disease discharge planning.
Key words: coronary artery disease, discharge planning,
efficiency, patient satisfaction.



目錄 頁碼
致謝…………………………………………………………………Ⅰ
中文摘要……………………………………………………………Ⅱ
英文摘要……………………………………………………………Ⅳ
論文目錄……………………………………………………………Ⅵ
圖表目次 ……………………………………………………………X
第一章 緒論…………………………………………………………1
第一節 研究動機與背景………………………………………1
第二節 研究之重要性及完整性研究目的……………………3
第三節 研究目的………………………………………………4
第四節 研究假設………………………………………………4
第五節 名詞解釋………………………………………………5
第六節 研究架構………………………………………………7
第二章 文獻查證……………………………………………………8
第一節 冠狀動脈疾病危險因子………………………………8
第二節 冠狀動脈疾患出院後的照護需求 …………………20
第三節 出院準備服務提供的內容及特性 …………………23
第四節 出院準備服務病患滿意度 …………………………29
第五節 出院準備服務的成效 ………………………………32
第三章 研究方法 …………………………………………………36
第一節 研究設計與對象 ……………………………………36
第二節 推估樣本數 …………………………………………37
第三節 研究場所 ……………………………………………37
第四節 研究工具 ……………………………………………38
第五節 研究介入措施 ………………………………………43
第六節 資料收集流程 ………………………………………48
第七節 資料分析方法 ………………………………………49
第四章 研究結果 …………………………………………………51
第一節 研究對象社會人口學變項現況描述………………51
第二節 病患滿意度問卷調查之成效………………………57
第三節 病患再急診、再住院及滯院天數之成效…………60
第四節 手冊合併電CGH諮詢介入措施之成效 ……………64
第五章 討論 ………………………………………………………65
第一節 病患滿意度、再急診、再住院及滯院天數之成 …65
第二節 衛教手冊合併電話護理諮詢介入措施之成效 ……66
第三節 病患社會人口學特質對滿意度之成效影響 ………68
第六章 結論與建議 ………………………………………………72
第一節 結論 …………………………………………………72
第二節 建議 …………………………………………………73
第三節 研究限制 ……………………………………………75
參考資料……………………………………………………………76
中文部分………………………………………………………76
英文部分………………………………………………………81
附錄…………………………………………………………………95
附錄一 佛來明罕危險分數(Framingham Risk Score) ………95
附錄二 戒菸知多少………………………………………………100
附錄三 心臟復健居家運動計畫活動漸進式進度表……………103
附錄四 復健運動走路計畫(建議範例)…………………………104
附錄五 復健運動自覺用力指數量表……………………………105
附錄六 冠狀動脈疾患復健運動指導……………………………106
附錄七 冠狀動脈疾患出院需求評估紀錄單及評分單…………110
附錄八 冠狀動脈疾患相關之危險因子評估紀錄單……………111
附錄九 冠狀動脈疾患健康指導手冊……………………………113
附錄十 出院準備服務電訪紀錄單………………………………119
附錄十ㄧ 出院準備服務後之病患滿意度問卷調查……………121
附錄十二 冠狀動脈疾患健康指導手冊內容效度專家名冊……122
附錄十三 CVI專家內容效度評分內容及標準 …………………123
附錄十四 CVI評分表專家內容效度評分表 ……………………124
附錄十五 專家內容效度檢定CVI結果 …………………………125
附錄十六 人體試驗研究計畫許可書……………………………133
附錄十七 人體試驗研究計畫受試者同意書……………………134
附錄十八 電話訪問常見的問題內容……………………………137
圖表目次
圖目錄
圖一 研究之架構圖 ………………………………………………7
圖二 後續照護需求圖……………………………………………22
圖三 Tantipoon -winai 病患滿意度之架構 …………………31
圖四 本研究之出院準備服務之概念性模式……………………45
圖五 研究流程圖各專業團隊的角色功能介入之模式…………48
表目錄
表一 國家膽固醇教育計劃書之建議……………………………12
表二 高血壓的分類………………………………………………13
表三 行政院衛生署建議國人的BMI標準 ………………………15
表四 運動時心跳次數增加的標準建議…………………………17
表五 資料整理:出院準備服務的定義整理 ……………………25
表六 資料整理:出院準備服務的特性 …………………………27
表七 研究設計……………………………………………………36
表八 出院準備服務新增措施模式與例行的照護模式比較……37
表九 出院準備服務後之病患滿意度問卷調查表之因素分析…42
表十 資料分析方法………………………………………………50
表十ㄧ 出院準備服務介入措施前、後測基本資料分析比較 …54
表十二 出院準備服務介入措施前、後測基本資料分析比較 …56
表十三 介入措施後滿意度分項答數人次及百分比 ……………58
表十四 出院準備服務介入措施前、後測滿意度分析比較 ……59
表十五 前後測再急診再住院滯院日數之人次百分比之比較 …62
表十六 前後測再急診再住院滯院日數之人次疾原因 …………63
表十七 介入措施前、後電訪時間分析比較 ……………………64

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