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研究生:鍾鳳玲
研究生(外文):Feng-Ling Chung
論文名稱:全人工關節置換術患者之治療決策及其相關因素之探討
論文名稱(外文):Factors Related to Treatment Decision Making in Total Joint Replacement Patients
指導教授:蔡慈儀蔡慈儀引用關係
指導教授(外文):Tzu-I Tsai
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:護理學系暨研究所
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:279
中文關鍵詞:治療決策全人工關節置換術健康識能
外文關鍵詞:Treatment decision makingTotal joint replacementHealth literacy
相關次數:
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決定是否接受手術治療,是攸關生命的重大決策,依醫學觀點而言,接受手術確實對患者有助益,而治療決策是一個錯綜複雜之過程,不同背景文化的主體,其影響因素也不盡相同,近年來國外許多學者發現,健康識能也是一個影響治療決策行進的因素,為了解行為背後的影響關係,本研究運用生態系統理論典範,強調主體與環境間的互動關係,使其更了解患者治療過程的全貌。
本研究目的為探討全人工關節置換術患者治療決策及其相關因素,以綜合性研究方法設計,採立意取樣,以關節骨頭疾病接受全人工關節置換術患者,和患者之主要照護者為研究對象,共選取個案及其家屬各100位;量性研究工具為結構式問卷,質性研究工具為半結構式訪談,兩者皆以面對面訪談方式進行資料收集,量性研究使用SPSS 16.0套裝軟體進行統計分析,質性研究以內容分析法作為分析。量性結果顯示教育程度、健康識能、費力活動受限制、行走時需要他人協助或工具輔助、關節變形、曾經是否有關節手術經驗、手術部位、疾病診斷、嚴重度評估情形、醫療服務探索能力中的醫療院所傳單、需要他人協助閱讀醫療健康訊息與治療決策有相關性並達到統計上顯著意義,經邏輯式迴歸分別控制健康識能之後,教育程度與治療決策仍達顯著關係。質性研究結果經歸納分析後,整理出涵蓋兩個主要範疇:壹、手術的動機:身體上的自我察覺、自身經驗的整合、權衡所關心的事件;貳、準備接受手術的身體:解謎、醫療關係的新視角。
根據研究結果未來提供護理人員對關節置換術患者在治療決策之相關因素之了解,同時提供未來照護之參考。建議未來發展個案管理系統,使患者獲得完整的照護;針對不識字或健康識能不足夠之患者,宜提供簡單易懂的圖片或影音方式,改善患者無法閱讀書面文本的障礙,進而減少病患在行進治療決策時可能會遇到的困惑。
For patients of bone joint disease, decision making of surgical treatment is an importantly decision between life and death. According to the medical point of view, surgery is indeed beneficial for patients but decision making of treatment is a complex process. What is more, affected factors will have rather differences underlying different cultures. In recent years, many foreign scholars have found health literacy is also a factor to affect decision making of treatment process. In order to understand the impact relationship of behavior, models ecological systems theory will be used in this study that emphasizing the relationship of interaction between environments and patients, which could be able to understand more the whole treatment decision process.
The purpose of this study is to explore the related factors and decision making process of total joint replacement patients. In this case, the design of researched method is employed mixed-method, and purposive sampling from patients of joint and bone disease who takes total joint replacement. Furthermore, another main investigative subject is the relationship between patient and caregiver, and therefore, total a hundred of patients and a hundred of caregivers will be investigated in this study. Quantitative research tool is the structured questionnaire, and a qualitative research tool is belonged to semi-structured interview, but both data collection is utilized face-to-face interview; SPSS 16.0 software package statistical analysis is used for quantitative research, and qualitative research is analyzed by the method of content analysis. The results of quantitative analysis show that there are some factors have certain correlation in statistical analysis, the level of education, health literacy, restriction of laborious activities, working aids by helper or tool, joint deformation, experience of joint operation, site of operation, diseased diagnosis, assessment of situation of order of severity, navigation capacity of medical services in hospital leaflets, reading help for medical information and decision making and treatment. Then, by logistic regression to control health literacy, respectively found the education still have significant relationship. The results of qualitative research analysis, Results were organized into the following two dimensions: First of all, it is regarding with the motives of operation, including by self-perceived physical functioning, integration of self-experience, and to weigh the concerns of the event. Secondly, preparing the body for surgery, that is covered riddle and new relation perspective in medical. However, study findings may provide useful information for health carers to understand more about the joint patients on decision making process, and providing for future reference. It might be suggested developing case management system in the future that patients can obtain complete care. For illiterate or low health literacy of the patients, it can be improved illiteracy of obstacle by simple images or multimedia, what could be decreased confusion when decision-making in the treatment of patients.
目錄
論文電子檔著作權授權書
論文審定同意書
致謝 i
中文摘要 ii
英文摘要 iv
目錄 vii
圖目錄 ix
表目錄 ix
第一章 緒論1
第ㄧ節 研究背景及重要性 1
第二節 研究目的與問題 4
第三節 名詞界定 5
第二章 文獻查證與概念架構 6
第一節 關節炎與全人工關節置換術相關研究 6
第二節 治療決策概念與相關研究 15
第三節 健康識能相關研究 30
第四節 生態系統理論 37
第三章 研究方法與設計 42
第一節 研究參考架構 42
 第二節 採用綜合性研究方法的原因 44
第三節 綜合性研究法-研究步驟說明 45
第四節 量性研究法-研究對象與場域研究設計 47
第五節 量性研究法-研究步驟 49
第六節 量性研究法-研究工具 50
第七節 量性研究法-資料處理與統計分析 54
第八節 量性研究法-研究信效度與嚴謹性 59
第九節 質性研究法-研究對象與場域 60
第十節 質性研究法-研究工具 62
第十一節 質性研究法-資料處理分析 63
第十二節 質性研究法-研究信效度與嚴謹性 64
第十三節 研究倫理考量 66
第四章 量性資料研究結果 67
第一節 研究對象的個人因素變項、家庭因素變項、醫療因
素變項之描述性統計 67
第二節 雙變項分析 81
第三節 影響因素之迴歸分析 127
第五章 質性資料研究結果 132
第一節 研究對象基本資料 132
第二節 研究結果綱要 134
第三節 為全人工關節置換術患者之治療決策相關因素 135
第六章 討論 169
第一節 影響治療決策的個人因素 169
第二節 影響治療決策的家庭因素 175
第三節 影響治療決策的醫療因素 178
第四節 影響治療決策的文化因素 180
第五節 生態系統理論運用在治療決策上的討論 182
第七章 結論與建議 184
第一節 結論 184
第二節 研究限制 186
第三節 建議 188
第八章 參考文獻 191
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