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研究生:廖婉婷
研究生(外文):Wan-Ting Liao
論文名稱:台灣家族性高膽固醇病患接受健康促進方案成效之探討
論文名稱(外文):The Effectiveness of Health Promotion Program for Patients with Familial Hypercholesterolemia in Taiwan
指導教授:施富金施富金引用關係
指導教授(外文):Fu-Jin Shih
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床暨社區護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
畢業學年度:97
語文別:中文
論文頁數:203
中文關鍵詞:台灣首次護理研究家族性高膽固醇症自我認知自我態度自我照顧能力健康促進行為健康促進方案質量綜合研究法
外文關鍵詞:Taiwan’s first nursing projectFamilial Hypercholesterolemia (family history of hypercholesterolemia)self-awarenessself-attitudesself-care competencehealth promotion behaviorshealth promotion programappraisal structured-instrumentbetween-method triangulation research method.
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國內外醫學研究一再指出,高血脂症會造成動脈硬化斑塊的產生,而與許多慢性疾病例如腦血管、心血管疾病、糖尿病、高血壓、代謝症候群等有高度相關,是這些疾病群共有的危險因子。近年來由於經濟進步,飲食型態改變,台灣人罹患腦及心血管疾病的發生率大幅提升。此外,患者年齡層的下降,與有家族遺傳史者的醫護療效,都成為醫療界的挑戰。因此,積極推動有家族遺傳史者的高血脂防治及完整的健康促進自我照護計畫已是政府及醫療機構刻不容緩的議題。然而,台灣至今缺乏具信、效度的工具,以評核高血脂家族遺傳史者的健康促進情形及需求。故本研究為台灣首次相關護理研究,有系統的發展結構式問卷、設計「家族性高膽固醇患者健康促進方案」、評値此類患者的健康促進自我照護情形及需求、進而探討此方案之介入成效。
本研究採質量綜合研究法,共包含三個階段。在第一階段,研究者藉由文獻查證及先驅研究結果,再與北部某醫學中心之心臟內科門診之家族性高膽固醇患者面談,了解個案對高血脂症的自我認知、自我態度、自我照顧能力、及健康促進行為等的認知情形。
第二階段,是根據第一階段中質性訪談資料分析結果,設計本研究之介入方案名為「台灣家族性高膽固醇患者健康促進方案」,內容包含飲食治療、運動治療、疾病認知及日常生活自我照顧等四大方面。此外一個評值此介入方案成效的結構式問卷亦發展出來。
第三階段以立意取樣共收案60位,先填寫問卷,再由研究者採一對一方式,輔以衛教手冊說明,向個案逐一說明健康促進方案內容。主要的教學技巧包含講述法、概念澄清、啟發式教學法。藉以提供正確的疾病知識、刺激其思考自身的健康問題與需求、鼓勵可提出問題、澄清其疑慮、尋找解決問題的方法,最後達到提升疾病及自我健康認知的目的。介入措施教導後三個月,再以相同問卷進行後測,藉由前、後測差異,評估介入措施之成效。
本研究以成對t檢定(paired t-test)評値個案接受健康促進方案之介入成效。研究結果顯示,在介入方案實施後,研究對象在自我認知、自我態度、自我照顧能力及健康促進行為得分上,皆較介入方案實施前改善,其中以自我認知層面改善最多,其次為自我照顧能力、自我態度,最後是健康促進行為。經由本研究得知,施行介入方案時,個案的自我認知、自我態度及健康促進行為的三個層面是相互影響的 -自我認知及自我態度會直接影響健康促進行為,自我態度也會因為認知程度增加而改變,態度改變進而間接影響健康促進行為。研究亦發現,衛教介入方案對於個案的疾病認知及行為的改善有幫助,但態度及行為不易透過單次的衛教,得到明顯的改善成效。
本研究建議醫療人員可使用本研究針對家族性高膽固醇症患者所設計之健康促進方案,有系統的評估此類患者之家族對此防治此疾病之認知需求,並繼續協助其對治療準則的遵循。經由對正確的醫護措施的認知,轉化其自我照顧態度,強化其健康促進行為,藉以延緩家族性高膽固醇症患者之發病時程,並有效控制疾病,降低其罹患其他慢性疾病的機率,進而提升其生活品質,並使醫療資源做最合理、有效的利用。
Numerous medical reported that by forming the artery plagues and related complications, hypercholesterolemia serves as the risk factor and contributes to many chronic disease such as cerebral artery disease, cardiovascular (CV) disease, diabetes, hypertension and metabolic disorders and so on. For years, due to improvement in economic status, and changes in diet habit and living styles, the mobility rate of cerebral and CV disease for people in Taiwan has significantly increased. The ineffective control over the tendency of the incidence rate of CV disease in the younger population and the lack of promised caring outcomes for the subjects with family history of hypercholesterolemia (FHHc) has challenged CV health professionals. Therefore, it is urgent for governmental as well as private medical institutes to propagate hygiene education on prevention of FHHc. Nevertheless, until now, there is no reliable instrument for Taiwan’s health professionals to accurately evaluate health needs of FHHc, nor valid comprehensive caring program for them. As such, this nursing research as the first project in Taiwan attempted to systematically investigate this phenomenon by developing a reliable and valid instrument to explore this particular population’s health needs, developing and implementing a “Health Promotion Program for Patients with Familiar Hypercholesterolemia”, and evaluating the effectiveness of this program.
A between-method triangulation research method was employed. Three phases of research process was involved. In the first phase, a critical literature review of CV and FHHc information was practiced. Then, face-to-face interviews by the investigator and the subjects in a leading medical center in the northern Taiwan were conducted in order to collect the data of the subjects’ perceptions of their self-awareness of FHHc, self-care attitudes, self-care competence, and health promotion behaviors. In the second phase, the intervention of this study is titled “The Health Promotion Program for Patients with Familiar Hypercholesterolemia”, which contains four dimensions: dietary treatment, exercise treatment, knowledge of hyperlipidemia, and daily self-care skills, as well as the related appraisal structured-instrument with reliability and validity were developed. In the third phase, a single group pre-and post-test method was applied. In this phase, a purposive sample of 60 subjects was obtained. The one-to-one, face-to-face teaching modes with pamphlet were applied to help coach each of the subjects to learn the contents of health promotion program. Each of the subjects’ questions was clarified, and they were encouraged to learn to take an initiative attitude in managing the health problems. Three months later, subjects were invited to receive post-test by the use of same instrument, and the effectiveness of the intervention by health promotion program was examined.
By the employment of pared t-test, the scores of the outcome variables were significantly higher in the post-test: self-awareness of FHHc, self-care competence, self-care attitudes, and health promotion behaviors, accordingly. Meanwhile, three major constructs of self-care knowledge, attitudes and health promotion behaviors were interrelated: (a) the self-care knowledge and attitudes would directly contribute to health promotion behaviors; (b) self-care attitudes were positively influenced by self-care knowledge; and (c) the self-care attitudes indirectly and positively influence health promotion behaviors. It is also found that the subjects’ self-care attitudes and health promotion behaviors were not significantly improved by the single teaching mode.
It is concluded that the employment of health promotion program was effective for Taiwan’s FHHc. Cardiovascular health professionals were encouraged to continuously apply health promotion program to systematically evaluate FHHc’s health needs and coach them to increase their compliance to caring plans. By learning the accurate medical information and following caring plan, not only the FHHc subject’s disease can early detected and controlled, the complications were also can be more possibly prevented. By doing so, not only their quality of life can be ensured, the limited medical resources can also be better allocated and used
第一章 緒論........................................1
第一節 研究動機與背景..............................4
第二節 研究問題....................................7
第三節 研究目的....................................8
第四節 研究假設....................................9
第五節 名詞界定...................................10
第二章 文獻查證...................................14
第一節 血脂異常的定義及分類.......................14
第二節 台灣地區國人血脂狀況及相關流行病學分析.....17
第三節 家族性高膽固醇症基因突變...................25
第四節 血脂異常的處理原則.........................33
第五節 衛教成效...................................43
第三章 研究方法...................................46
第一節 研究設計...................................46
第二節 研究對象及場所.............................48
第三節 研究工具...................................50
第四節 研究步驟...................................55
第五節 研究概念圖.................................57
第六節 資料處理與統計分析.........................58
第七節 研究倫理考量...............................61
第四章 研究結果...................................62
第一節 研究對象背景資料描述.......................62
第二節 介入前研究對象的自我認知、自我態度、
自我照顧能力、健康促進行為之描述...........72

第三節 介入後研究對象的自我認知、自我態度、
自我照顧能力、健康促進行為之描述...........94
第四節 比較「台灣家族性高膽固醇患者健康促進
方案」之成效..............................116
第五章 討論......................................137
第一節 家族性高膽固醇患者個案之背景探討..........137
第二節 介入措施前後血脂値檢測情形................141
第三節 介入措施前後接受非藥物治療情形............143
第四節 介入措施前後接受藥物治療情形..............145
第五節 「台灣家族性高膽固醇患者健康促進方案」
成效探討..................................146
第六章 結論、建議與限制..........................149
第一節 結論......................................149
第二節 研究限制..................................151
第三節 研究建議..................................153
第七章 參考文獻..................................156
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