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研究生:彭秀榮
研究生(外文):Peng, Hsiurang
論文名稱:全身性紅斑性狼瘡患者的症狀困擾、不確定感、復原力、社會支持與健康生活品質之關係探討
論文名稱(外文):The Relationships among Symptom distress, Uncertainty, Resilience, Social Support and Health-Related Quality of Life of Systemic Lupus Erythematosus Patients
指導教授:楊瑞珍楊瑞珍引用關係
指導教授(外文):Yang, Reajeng
口試委員:林寬佳周幸生
口試委員(外文):Lin, KuanchiaChou, Shinshang
口試日期:2012-06-29
學位類別:碩士
校院名稱:國立臺北護理健康大學
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:2012
畢業學年度:100
語文別:中文
論文頁數:121
中文關鍵詞:全身性紅斑性狼瘡健康生活品質症狀困擾疾病不確定感復原力中介作用
外文關鍵詞:Systemic lupus erythematosusHealth-Related Quality of LifeSymptom distressUncertaintyResilienceSobel Test
相關次數:
  • 被引用被引用:9
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全身性紅斑性狼瘡易侵犯多種身體器官,常處於疾病活性期或緩解期交替的慢性疾病,本研究目的旨在檢視全身性紅斑性狼瘡患者的身體症狀困擾、疾病不確定感、社會支持、復原力與健康生活品質間的關係。本研究為橫斷性研究,採立意取樣法選取北部某醫學中心醫院之255位符合選樣條件的全身性紅斑性狼瘡患者為對象。研究工具有:身體症狀困擾量表、疾病不確定感量表、社會支持量表、復原力量表、健康生活品質量表及基本人口資料。以自我填答方式收集資料後利用SPSS 17.0及SAS 9.2 套裝軟體進行資料整理。假設檢定使用 Tobit regression model及Sobel test。本研究結果發現: SLE患者在過去30天中身體與心理不健康的天數分別是10.1±9.9天、8.8±8.6天,因上述影響導致妨礙生活的天數6.6±8.3天。部分假設已獲得證實,意即健康生活品質明顯受到身體症狀困擾、疾病不確定感、社會支持或復原力的影響;尤其是復原力在身體症狀困擾或疾病不確定感與健康生活品質間具有中介作用;然而,社會支持的中介作用則不明顯。本研究結果能協助醫護人員了解SLE 患者的健康生活品質,進而提供合適的護理措施,以提升照護品質。
Systemic lupus erythematosus (SLE) is frequent involvement variety of body organs, usually in alternating of disease activity or remission in chronic diseases. The purpose of the present study were to evaluate the relationships among physical symptom distress, uncertainty in illness, social support, resilience and health-related quality of life (HRQOL) for SLE patients. A cross-sectional design was used to guide the study. Two hundred and fifty-five subjects who met the selection criteria were selected from a medical center of Taipei by purposive sampling. The questionnaires included Physical Symptom Distress Scale, Uncertainty in Illness Scale, Social Support Scale, Resilience Scale, HRQOL-4 and demographic data. Data were collected by self-administrated questionnaire. Data was processed by SPSS 17.0 and SAS 9.2. Tobit regression model and Sobel test were used to test the hypothesis. The results of this study showed: SLE participants with physically and mentally unhealthy days were 10.1 ± 9.9 days and 8.8 ± 8.6 days respectively during the previous 30 days; in addition, 6.6 ± 8.3 days of activity limitation due to above poor physical and mental health. Some of hypotheses were supported, that is HRQOL was significantly influenced by the physical symptom distress, uncertainty in illness, resilience, and social support. Especially, resilience mediated the effect of physical symptom distress or uncertainty in illness on HRQOL. However, the mediating effect of social support was not found. The findings of this study could be used as a reference for health providers to better understand the health related quality of life in patients with SLE, to provide suitable nursing intervention, and promote the quality of care.
目  次

中文摘要 …………………………………………………………………………… i
英文摘要 …………………………………………………………………………… ii
目次 ………………………………………………………………………………… iii
表次 ………………………………………………………………………………… v
圖次 ………………………………………………………………………………… vii
第一章 緒論………………………………………………………………………… 1
第一節 研究背景與動機 ………………………………………………………… 1
第二節 研究目的 ………………………………………………………………… 2
第二章 文獻探討…………………………………………………………………… 3
第一節 全身性紅斑性狼瘡疾病對生活品質影響……………………………… 3
第二節 身體症狀困擾、不確定感、復原力、社會支持等的意涵與生活品質的
關係…………………………………………………………………… 5
第三節 全身性紅斑性狼瘡病患健康生活品質的相關因子…………………… 10
第三章 研究方法…………………………………………………………………… 13
第一節 研究設計與研究架構…………………………………………………… 13
第二節 研究場所與對象………………………………………………………… 14
第三節 研究步驟 ………………………………………………………………… 15
第四節 研究工具及信效度檢測 ………………………………………………… 15
第五節 資料分析方法 ………………………………………………………… 20
第六節 研究倫理考量 ………………………………………………………… 21
第四章 研究結果…………………………………………………………………… 22
第一節 個人背景因素、身體症狀困擾、不確定感、社會支持、復原力及健康 22
日之分佈情形 ……………………………………………………………
第二節 個人背景因素與健康生活品質差異性分析…………………………… 42
第三節 個人背景因素與疾病不確定感、社會支持、復原力、身體症狀困擾差
異性分析………………………………………………………………… 48
第四節 身體症狀困擾、疾病不確定感、社會支持、復原力與健康生活品質之
相關性分析…………………………………………………………… 53
第五節 身體症狀困擾、社會支持、復原力與疾病不確定感之相關性分
析……………………………………………………………………… 55
第六節 影響健康生活品質的預測因子………………………………………… 57
第七節 影響健康生活品質的中介變因 ………………………………………… 69
第五章 討論 ……………………………………………………………………… 74
第一節 受試者特徵、身體症狀困擾、疾病不確定感、社會支持、復原力
與健康生活品質的分佈情形………………………………………… 74
第二節 受試者特徵與健康生活品質的差異性探討………………………… 78
第三節 身體症狀困擾、疾病不確定感、社會支持、復原力與健康生活品質之
相關……………………………………………………………… 80
第四節 SLE病患健康生活品質的預測因子…………………………………… 81
第五節 中介變項對全身性紅斑性狼瘡健康生活品質的作用………………… 82
第六節 身體症狀困擾、疾病不確定感、社會支持與復原力的高危險群
特徵……………………………………………………………………… 83
第六章 結論與建議……………………………………………………………… 85
第一節 結論 …………………………………………………………………… 85
第二節 研究限制與困難……………………………………………………… 88
第三節 應用與建議 …………………………………………………………… 88
參考文獻 ………………………………………………………………………… 89
中文部分 ………………………………………………………………………… 89
外文部分 ………………………………………………………………………… 90
附錄
附錄一 本研究六種問卷內容…………………………………………………… 99
附錄二 研究問卷量表使用同意書……………………………………………… 105


表  次
表4-1 研究對象之背景資料分佈狀況 ……………………………………… 24
表4-2 不健康生活品質天數分佈狀況 ……………………………………… 27
表4-3a 研究對象之身體症狀困擾分布狀況 ………………………………… 29
表4-3b 研究對象之身體症狀困擾分布狀況………………………………… 30
表4-4 疾病不確定感分布狀況 ……………………………………………… 31
表4-5a 疾病不確定感之不明確性的不確定感分布狀況 …………………… 33
表4-5b 疾病不確定感之複雜性的不確定感分布狀況……………………… 33
表4-6a 社會支持分布狀況 ………………………………………………… 35
表4-6b 社會支持分布狀況 ………………………………………………… 36
表4-7 社會支持來源各分布狀況 ………………………………………… 36
表4-8a 復原力分布狀況 ………………………………………………… 37
表4-8b 復原力分布狀況 ………………………………………………… 38
表4-9 個人背景資料與健康生活品質分布狀況 ………………………… 44
表4-10 個人背景資料與疾病不確定感、社會支持、復原力、身體症狀困擾分
布狀況………………………………………………………………… 49
表4-11疾病不確定感、社會支持、復原力、身體症狀困擾與健康生活品質之
皮爾森積差相關分析…………………………………………………… 54
表4-12 身體症狀困擾、社會支持、復原力、疾病不確定感之皮爾森積差相關分
析表 …………………………………………………………………… 56
表4-13 健康生活品質常態檢定表 ………………………………………… 58
表4-14 人口學資料、疾病不確定感、身體症狀困擾、社會支持、復原力與自評
健康狀況之預測重複檢驗分析表 …………………………………… 65
表4-15 人口學資料、疾病不確定感、身體症狀困擾、社會支持、復原力與身體
不健康天數之重複檢驗分預測分析表 ……………………………… 66
表4-16 人口學資料、疾病不確定感、身體症狀困擾、社會支持、復原力與心理
不健康天數之重複檢驗分預測分析表 ……………………………… 67
表4-17 人口學資料、疾病不確定感、身體症狀困擾、社會支持、復原力與妨礙
日常生活天數之重複檢驗分預測分析表 …………………………… 68
表4-18 社會支持系統、復原力對身體症狀困擾影響自評整體健康狀況的中介
作用…………………………………………………………………… 70
表4-19 復原力分量表對身體症狀困擾影響自評整體健康狀況的中介作用… 70
表4-20 社會支持系統、復原力對疾病不確定感影響自評整體健康狀況的中介
作用 …………………………………………………………………… 71
表4-21 復原力分量表對疾病不確定感影響自評整體健康狀況的中介作用… 71
表4-22 復原力對身體症狀困擾影響心理不健康天數的中介作用………… 72
表4-23 復原力對疾病不確定感影響心理不健康天數的中介作用………… 73
表4-24 復原力分量表對疾病不確定感影響心理不健康天數的中介作用… 73
表6-1 研究假設彙整總表 …………………………………………………… 87
圖  次
圖3-1 研究架構圖 ……………………………………………………………… 13
圖4-1 自評整體健康分佈圖…………………………………………………… 58
圖4-2 自評整體健康Q-Q Plot 圖……………………………………………… 58
圖4-3 身體不健康天數健康分佈圖……………………………………………… 59
圖4-4 身體不健康天數Q-Q Plot 圖 …………………………………………… 59
圖4-5 心理不健康天數分佈圖 ………………………………………………… 60
圖4-6 心理不健康天數Q-Q Plot 圖 ………………………………………… 60
圖4-7 妨礙日常生活天數分佈圖 …………………………………………… 61
圖4-8 妨礙日常生活天數Q-Q Plot 圖………………………………………… 61
圖4-9 中介變項路徑圖…………………………………………………………… 69
圖4-10 復原力對身體症狀困擾與整體自評健康之中介效果圖………………… 71
圖4-11 復原力對疾病不確定感與整體自評健康之中介效果圖………………… 72
圖4-12 復原力對疾病不確定感與心理不健康天數之中介效果圖……………… 73

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