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研究生:蔡宜貞
研究生(外文):Ti-Chen Tsai
論文名稱:居家照護個案壓瘡發生相關因子之探討
論文名稱(外文):Factors associated with occurrence of pressure ulcers among Home-Care clients.
指導教授:王瑞霞王瑞霞引用關係
指導教授(外文):Ruey-Hsia Wang
學位類別:碩士
校院名稱:高雄醫學大學
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:2010
畢業學年度:98
語文別:中文
論文頁數:179
中文關鍵詞:壓瘡居家照護主要照顧者負荷皮膚照護行為皮膚照護自我效能
外文關鍵詞:pressure ulcershome carecaregiver burdenskin care behaviorskin care self-efficacy
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本研究目的為(1)探討居家照護個案的人口學及疾病特性、主要照顧者人口學及照顧特性與居家照護個案壓瘡發生關係, (2)探討居家照護個案的壓瘡發生危險因素、主要照顧者負荷、皮膚照護自我效能、皮膚照護行為與居家照護個案壓瘡發生關係,(3)探討居家照護個案壓瘡發生之重要解釋因子。
採橫斷性研究設計,採立意取樣,以年滿18歲以上,照顧出院4至6週且接受居家照護的個案至少一個月以上之主要照顧者為研究對象。收集南部五家醫院附設居家護理所的220位主要照顧者,去除12位在住院時發生壓瘡,及40位住院前即發生壓瘡的居家照護個案,共收集168位主要照顧者之資料。採結構式問卷調查方式,問卷內容包括居家照護個案人口學及疾病特性、主要照顧者人口學及照顧特性、居家照護個案壓瘡發生危險因素、主要照顧者負荷、皮膚照護自我效能、皮膚照顧行為及居家照護個案皮膚損傷狀態等量表。量表經信度及效度檢定,包含內在一致性、再測信度、專家效度與表面效度。研究資料以百分比、平均值、標準差、雙樣本t檢定、卡方檢定及逐步對數複廻歸分析進行分析。
研究結果發現(1)居家照護個案出院後4至6週,壓瘡發生率為10.9%,壓瘡盛行率為34.5%(2)居家照護個案罹患泌尿道感染、存有留置尿管、曾發生過壓瘡、未使用減壓輔具及未使用氣墊床者其壓瘡發生率較高,近於顯著關係。(3)主要照顧者無人協助替換照顧及住院時護理人員無指導壓瘡預防技能者其居家照護個案的壓瘡發生率較高,且近於顯著意義。(4)居家照護個案的壓瘡風險評估平均總分為12.85分,具有中等程度的壓瘡發生危險。(5)主要照顧者呈現中度負荷感受,標準化得分為60.50。(6)主要照顧者呈現中上程度皮膚照護自我效能,標準化得分為88.41。(7)主要照顧者呈現中上程度皮膚照護行為,標準化得分為83.25。(8)有壓瘡者的主要照顧者負荷無顯著高於無壓瘡者 (9)無壓瘡者的主要照顧者皮膚照護自我效能及皮膚照護行為顯著優於有壓瘡者。(10) 主要照顧者有人輪流替換照顧及皮膚照護行為是居家照護個案壓瘡發生重要的解釋因子,可解釋10.4%至18.7%之解釋變異數。
本研究結果建議居家護理師在居家照護時,需追蹤主要照顧者的皮膚照護行為及了解是否有人協助替換照顧,進行適當的介入與指導,以降低居家照護個案壓瘡之發生。
The purposes of this study were (1) to explore the relationships of demographic and disease characteristics of home-care clients and demographic and caregiving characteristics of caregivers, to occurrence of pressure ulcers in home-care clients; (2) to explore the relationship of risk factors for pressure ulcers, caregiver burden, skin care self-efficacy, skin care behavior to the occurrence of pressure ulcers in home-care clients; (3) to explore the significant explanatory factors for the occurrence of pressure ulcers in home-care clients.
The study adopted a cross-sectional design with a purposive sampling of caregivers who were aged 18 or above, and who cared for over a one-month period for home-care clients who had been discharged from hospitals for 4-6 weeks. We recruited 220 caregivers from hospital-based home care units in southern Taiwan and then excluded 12 and 40 caregivers of patients who had pressure ulcers during and before hospitalizations respectively. Finally, data of 168 caregivers were collected. Structured questionnaires, including demographic and disease characteristics of home-care clients, demographic and caregiving characteristics of caregivers, risk factors for pressure ulcer occurrence, caregiver burden, skin care self-efficacy, skin care behavior, and skin conditions of home-care clients were used to collect data. Internal consistency, test-retest reliability, content validity, and surface validity were examined to verify the reliability and validity of all questionnaires. Data were analyzed using percentage, mean, standard deviation, two-sample t-test, chi-square test and stepwise logistic regression analysis.
Results showed that (1) the incidence and prevalence rates of pressure ulcer occurrence in home-care clients at 4 to 6 weeks after discharge were 10.9% and 34.5% respectively; (2) home-care clients with urinary tract infection, urinary catheters, history of pressure ulcers and clients without using assistive devices or air cushion beds for pressure relief had significantly high incidence rate of pressure ulcers in clients; (3) caregivers without help of substitute caregivers and without guidance for pressure ulcer prevention by nursing staff during hospitalization showed significantly high incidence rate of pressure ulcers in clients; (4) the mean total score of pressure ulcer risk assessment in home-care clients was 12.85, indicating a medium level risk of pressure ulcer occurrence; (5) the standardized score in caregiver burden was 60.50, indicating a medium level of burden; (6) the standardized score in skin care self-efficacy of caregivers was 88.41, indicating an above medium level of skin care self-efficacy; (7) the standardized score in skin care behavior of caregivers was 83.25, indicating an above medium level of skin care behavior; (8) no significant difference existed in caregiver burden among caregivers of home-care clients with or without pressure ulcers; (9) caregivers of home-care clients without pressure ulcers were significantly better in both skin care self-efficacy and skin care behavior than those of clients with pressure ulcers; (10) with substitute caregivers and skin care behavior were the most significant explanatory factors for pressure ulcers, which explained 8% to 14.4% of the variation.
The results of the study suggest home care nurses should follow up both caregivers’ skin care behavior and their need for substitute caregivers, and then provide further intervention to reduce the occurrence of pressure ulcers in home-care clients.
第一章 緒論…………………………………………………………… 1
第一節 研究動機與重要性……………………………………… 1
第二節 研究目的………………………………………………… 4
第二章 文獻查證.………………………………………………………5
第一節 居家照護個案壓瘡評估………………………………… 5
一、 壓瘡的定義及分級 ……………………………………5
二、 壓瘡之發生率與盛行率 ………………………………9
三、 壓瘡發生之危險因素 ………………………………10
四、 壓瘡的高危險因素評估………………………………15
第二節 預防壓瘡皮膚照護行為…………………………………18
一、 翻身擺位………………………………………………18
二、 保持皮膚適度濕潤及乾燥……………………………20
三、 避免剪力、摩擦力… …………………………………21
四、 適當使用輔具來預防壓瘡 ……………………………21
五、 維持足夠的營養及水分攝取… ………………………22
六、 避免尿液、糞便侵蝕皮膚 ……………………………23
七、 評估個案疼痛情形 ……………………………………24

第三節主要照顧者負荷與壓瘡關係………………………………25
一、 主要照顧者負荷概念…………………………………25
二、 主要照顧者負荷與壓瘡之關係………………………27
第四節 主要照顧者自我效能與壓瘡關係 ………………………30
第五節 居家照護個案人口學與疾病特性與壓瘡關係 …………33
第六節 主要照顧者人口學與照顧特性與壓瘡關係 ……………37
第三章 研究架構與假設………………………………………………43
第一節 研究架構…………………………………………………43
第二節 研究假設…………………………………………………44
第三節 名詞界定…………………………………………………45
第四章 研究方法………………………………………………………47
第一節 研究對象…………………………………………………47
第二節 研究工具…………………………………………………49
第三節 研究工具的信度及效度…………………………………55
第四節 研究進行步驟……………………………………………58
第五節 倫理考量…………………………………………………59
第六節 資料分析…………………………………………………60
第五章 研究結果………………………………………………………62
第一節、研究變項之描述……………………………………… 62
一、 居家照護個案的人口學與疾病特性 …………………62
二、 主要照顧者的人口學與照顧特性 ……………………66
三、 居家照護個案皮膚狀態 ………………………………69
四、 居家照護個案壓瘡發生危險因素評估情形 …………71
五、 主要照顧者負荷狀態… ………………………………73
六、 主要照顧者皮膚照護自我效能 ………………………76
七、 主要照顧者皮膚照護行為 ……………………………78
第二節、各研究變項與壓瘡之關係 ……………………………81
一、 居家照護個案人口學與疾病特性與壓瘡發生關係 …81
二、 主要照顧者人口學因素與照顧特性與壓瘡發生關係…85
三、 居家照護個案壓瘡發生危險因素與壓瘡發生差異 …88
四、 居家主要照顧者負荷與壓瘡發生之差異 ……………90
五、 居家照護個案壓瘡發生危險因素、主要照顧者負荷、皮膚照護自我效能、皮膚照護行為與壓瘡發生之關係 …91
第三節、居家照護個案壓瘡發生之解釋因子 …………………93
第六章 討論…………………………………………………………98
第一節 居家照護個案人口學與疾病特性……………………98
第二節 主要照顧者的人口學與照顧特性……………………101
第三節 居家照護個案皮膚狀態………………………………103
第四節 居家照護個案的壓瘡發生危險因素 …………………107
第五節 主要照顧者負荷狀態 …………………………………109
第六節 主要照顧者的皮膚照護自我效能與皮膚照護行為 …111
第七節 居家照護個案人口學與疾病特性與其壓瘡發生之關係 ……………………………………………………113
第八節 主要照顧者的人口學與照顧特性與居家照護個案壓瘡發生之關係 ………………………………………………116
第九節 壓瘡風險評估工具與預測接受居家照護個案壓瘡發生之關係 ……………………………………………………120
第十節 主要照顧者負荷、皮膚照護自我效能及皮膚照護行為與居家照護個案壓瘡發生之關係 ………………………121
第十一節 居家照護個案壓瘡發生之重要解釋因子 …………122
第七章 研究結論及建議 ……………………………………………125
第一節 結論………………………………………………………125
第二節 建議………………………………………………………127
第三節 研究限制…………………………………………………130
參考文獻………………………………………………………………131
中文文獻 …………………………………………………………131
英文文獻 …………………………………………………………138
附錄一:研究收案之居家護理所名單
附錄二:人體試驗委員會同意函
附錄三: 研究工具同意書
附錄四:專家效度名單
附錄五: 正式研究問卷
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