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研究生:歐羽珊
研究生(外文):Yu-Shan Ou
論文名稱:探討整合性家庭介入措施對於腦中風病人及其家屬之社會支持與身心健康之成效
論文名稱(外文):Effects of the Integral Family Interventions on Social Support and Physical and Mental Health Among Families with Stroke Patients
指導教授:廖珍娟廖珍娟引用關係
指導教授(外文):Jen-Jiuan Liaw
口試委員:彭家勛楊立華廖珍娟
口試委員(外文):Giia-Sheun PengLuke YangJen-Jiuan Liaw
口試日期:2014-05-23
學位類別:碩士
校院名稱:國防醫學院
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:2014
畢業學年度:102
語文別:中文
論文頁數:177
中文關鍵詞:整合性家庭介入腦中風家庭社會支持健康
外文關鍵詞:Integral family interventionstrokefamilysocial supporthealth
相關次數:
  • 被引用被引用:1
  • 點閱點閱:618
  • 評分評分:
  • 下載下載:61
  • 收藏至我的研究室書目清單書目收藏:4
背景:腦中風是國內成人殘障的主要原因,而中風造成不同程度的失能會影響病人日常活動功能及心理情緒,而中風病人長時間就醫、治療,家屬肩負許多責任與壓力進而影響個人健康,因此將整合性家庭介入措施融入臨床照護,提升家庭社會支持,改善病人及家屬身心健康。
目的:探討「整合性家庭介入措施」對於腦中風病人及其家屬之社會支持與身心健康之影響成效。
方法:本研究採雙組前後測之介入性研究設計,於北部某醫學中心神經內科病房,以成對方式招募100組腦中風病人及其家屬為研究對象,採隨機分派為介入組(50組)及對照組(50組)。介入組接受四階段「整合性家庭介入措施」照護模式,對照組則提供常規照護模式,兩組於介入措施前、出院時、診斷中風後一個月進行施測,病人測量包括中風功能障礙(NIHSS、MRS)、醫院焦慮憂鬱量表、中風衝擊;家屬測量包括社會支持、華人健康量表。病人中風衝擊量表以線性回歸模式比較兩組間差異,病人中風功能障礙、病人焦慮憂鬱、家屬社會支持、家屬身心健康資料以廣義估計方程式進行兩組間及前後測的分析比較。
結果:與對照組相較,整合性家庭介入措施能顯著地降低病人中風功能障礙NIHSS(B= -1.100, p=0.007)、MRS(B= -0.52, p≦0.001)、病人焦慮(B= -5.08, p≦0.001)、病人憂鬱(B= -4.97, p ≦
0.001)、病人中風衝擊(B= 9.228, p=0.002);提升家屬感受醫療人員社會支持(B= 14.212, p≦0.001)、家屬健康(B= -4.011, p≦0.001);然而,家屬感受家人親友社會支持部分,介入組並未顯著高於對照組(B= 3.029, p=0.101)。
結論:整合性家庭介入措施照護模式能改善病人中風功能障礙、焦慮憂鬱、中風衝擊;提升家屬來自醫療人員的社會支持與健康狀態。未來整合性家庭介入照護措施期能做為臨床實務應用之參考。

Background: Stroke is the leading cause of adult disability in Taiwan, and it
could affect patient’s daily physiological and mental activities. Long-term
treatment of stroke patients, result in much responsibility and pressure to
families and affecting their health. My hypothesis is the routine treatments
combined with the integral family interventions can improve the stroke patients and their families’ social support and physical and mental health.
Objective: This study was to evaluate the effects of the integral family
interventions on social support and physical and mental health in stroke patients
and their families.
Methods: The study design used two group pre- and post-test. Stroke patients and their families were recruited from neurology ward at a medical center in Taipei, and randomly assigned to the intervention group (50 groups) and the control group (50 groups). The intervention group received "Integrated family interventions" with four sessions, the control group received routine care. All stroke patients and their families tested at the time of admission day, discharge day, and 1month after diagnosed with stroke. The research instruments included National Institute of Health Stroke Scale (NIHSS), Modified Ranking Scale (MRS), Hospital Anxiety and Depression Scale (HADS) and Stroke Impact Scale (SIS) for patients; Social Support (SS), Chinese Health Questionnaire (CHQ) for families.
Results: As compared with the patients in control group, those in the intervention group significantly decresed the scores of the NIHSS (B= -1.100, p=0.007), MRS (B= -0.52, p≦0.001), Anxiety (B= -5.08, p≦0.001), Depression (B= -4.97, p≦0.001), SIS (B= 9.228, p=0.002). As compared with the families in the control group, those in the intervention group significantly increased the scores of the Social Support come from medical professionals (B= 14.212, p≦0.001), the Chinese Health Questionnaire (B= -4.011, p≦0.001). However, there was no significantly difference between the intervention group and the control group in Social Support from the family members (B= 3.029, p=0.101).
Conclusion: The integral family interventions improved the stroke patients’ dysfunction, anxiety, depression, and the stroke impact scale, and the families’ social support from medical professionals, and the health status of the families.

正文目錄 頁
正文目錄 I
『表』目錄 V
『圖』目錄 VIII
『附錄』目錄 IX
中文摘要 X
英文摘要 XII
第一章 緒論 1
第一節 研究背景、動機 1
第二節 研究目的 5
第二章 文獻查證 6
第一節 腦中風疾病特性 6
壹、腦中風的定義與分類 6
貳、腦中風病因與症狀 8
參、腦中風診斷與治療 9
肆、腦中風障礙評估 11
 伍、腦中風病人焦慮憂慮的相關研究 15 
第二節 腦中風病人的家庭護理 18
壹、家庭護理內涵 18
貳、腦中風家庭的照護及相關研究 20
參、腦中風家庭的照護需求 21
第三節 社會支持與腦中風的關係 32
壹、社會支持定義及相關概念 32
貳、社會支持的來源與類型 33
參、腦中風病人家庭的社會支持探討 35
第四節 腦中風病人家屬的健康 40
壹、健康的定義及相關概念 40
貳、影響健康的因素 42
參、中風對家庭成員健康的影響 45
第三章 研究架構 48
第一節 概念架構 48
第二節 研究架構 49
第三節 名詞界定 50
第四節 研究問題 52
第五節 研究假設 53
第四章 研究方法 54
第一節 研究設計 54
第二節 研究對象及場所 55
第三節 介入措施 57
第四節 研究工具及信效度 61
第五節 資料收集步驟 67
第六節 資料分析方法 70
第七節 倫理考量 71
第五章 研究結果 73
第一節 研究對象之基本屬性 75
第二節 研究對象(病人)中風身體功能障礙NIHSS之分析 83
第三節 研究對象(病人)中風身體功能障礙MRS之分析 89
第四節 研究對象(病人)焦慮之分析 94
第五節 研究對象(病人)憂鬱之分析 98
 第六節 研究對象(病人)中風衝擊量表分析 103
 第七節 研究對象(家屬) 感受來自家人親友的社會支持分析110
 第八節 研究對象(家屬) 感受來自醫療人員的社會支持分析119
 第九節 研究對象(家屬)健康之分析 126
第六章 討論 134
第一節 研究對象之基本屬性 134
 第二節 常規照護合併整合性家庭介入措施對於腦中風病人中風功能障礙之影響成效 136
第三節 常規照護合併整合性家庭介入措施對於腦中風病人焦慮憂鬱之影響成效 139
第四節 常規照護合併整合性家庭介入措施對於腦中風病人中風衝擊之影響成效 142
第五節 常規照護合併整合性家庭介入措施對於腦中風病人家屬社會支持之影響成效 144
 第六節 常規照護合併整合性家庭介入措施對於腦中風病人家屬健康之影響成效 147
第七章 結論與建議 151
 第一節 結論 151
第二節 護理上之應用與建議 153
第三節 研究限制與未來研究之建議 156
參考文獻 158
英文文獻 158
中文文獻 172

『表』目錄 頁
表2-1-1評估腦中風障礙與功能常用量表或工具 14
表2-2-1中風病人家庭照護措施統整表 24
表2-3-1支持腦中風病人及其照顧者之建議 38
表2-3-2支持病人住院期間及出院至社區的建議 39
表4-3-1整合性家庭介入措施 58
表4-6-1推論性統計方法 69
表5-1-1病人基本屬性分析 77
表5-1-2家屬及家庭基本屬性分析 80
表5-1-3以Mann-Whitney U比較兩組家庭功能 82
表5-3-2以Mann-Whitney U比較兩組病人NIHSS、MRS、HADS前後測資料分佈 86
表5-2-2以GEE方式探討影響中風病人NIHSS之單變項分析 87
表5-2-3以GEE方式探討整合性家庭介入措施對於腦中風病人NIHSS影響之分析 88
表5-3-1以GEE方式探討影響中風病人MRS之單變項分析 92
表5-3-2以GEE方式探討整合性家庭介入措施對於腦中風病人MRS影響之分析 93
表5-4-1以GEE方式探討影響中風病人焦慮之單變項分析 96
表5-4-2以GEE方式探討整合性家庭介入措施對於腦中風病人焦慮影響之分析 97
表5-5-1以GEE方式探討影響中風病人憂慮之單變項分析 101
表5-5-2以GEE方式探討整合性家庭介入措施對於腦中風病人憂慮影響之分析 102
表5-6-1使用Mann-Whitney U分析病人中風衝擊分數分布及組別比較 107
表5-6-2以GLM方式探討影響病人中風衝擊量表之單變項分析 108
表5-6-3以GLM方式探討整合性家庭介入措施對於腦中風病人中風衝擊量表影響之分析109
表5-7-1使用Mann-Whitney U比較兩組中風病人家屬感受來自家人親友、醫療人員的社會支持(SS)及健康量表
(CHQ)之前後測資料分佈 113
表5-7-2 以GEE方式探討影響中風病人家屬感受來自家人親友的社會支持之單變項分析114
表5-7-3以GEE方式探討整合性家庭介入措施對於腦中風病人家屬感受家人親友的社會支持影響之分析117
表5-8-1以GEE方式探討影響中風病人家屬感受醫療人員的社會支持之單變項分析 122
表5-8-2以GEE方式探討整合性家庭介入措施對於腦中風病人家屬感受醫療人員的社會支持影響之分析125
表5-9-1 以GEE方式探討影響中風病人家屬健康之單變項分析 130
表5-9-2 以GEE方式探討整合性家庭介入措施對於腦中風病人家屬健康影響之分析 132

『圖』目錄 頁數
圖3-1-1概念架構 48
圖3-2-1研究架構 49
圖4-1-1研究設計圖 54
圖4-5-1整合性家庭介入方式對於腦中風病人及其家屬之社會支持與身心健康之資料收集流程圖 69
圖 5-1研究對象收案流程分布圖 74

『附錄』目錄
附錄一 研究相關問卷
附錄二 人體試驗計畫同意書
附錄三 醫院焦慮憂鬱量表使用同意書
附錄四 腦中風衝擊量表使用同意書
附錄五 社會支持量表使用同意書
附錄六 華人健康量表使用同意書
附錄七 家庭功能量表使用同意書

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1. 呂如分(2005)‧中風病患主要照顧者生活品質及其相關因素之探討‧長期照護雜誌,9(2),152-170。
2. 呂如分(2005)‧中風病患主要照顧者生活品質及其相關因素之探討‧長期照護雜誌,9(2),152-170。
3. 呂如分(2005)‧中風病患主要照顧者生活品質及其相關因素之探討‧長期照護雜誌,9(2),152-170。
4. 李金和、王俊毅、林怡儒(2012)‧慢性腦中風復健門診患者之健康相關生活品質及其相關因素探討‧長期照護雜誌,16(2),143-158。
5. 李金和、王俊毅、林怡儒(2012)‧慢性腦中風復健門診患者之健康相關生活品質及其相關因素探討‧長期照護雜誌,16(2),143-158。
6. 李金和、王俊毅、林怡儒(2012)‧慢性腦中風復健門診患者之健康相關生活品質及其相關因素探討‧長期照護雜誌,16(2),143-158。
7. 邱台生、林靜薇、康平靜、林春梅(2006)‧家屬支持團體介入對腦中風病人主要照顧者生活品質的影響‧榮總護理,23(2),109-117。
8. 邱台生、林靜薇、康平靜、林春梅(2006)‧家屬支持團體介入對腦中風病人主要照顧者生活品質的影響‧榮總護理,23(2),109-117。
9. 邱台生、林靜薇、康平靜、林春梅(2006)‧家屬支持團體介入對腦中風病人主要照顧者生活品質的影響‧榮總護理,23(2),109-117。
10. 邱啟潤、王秀紅(2004)‧以「家庭為中心的照護」本質之思辯‧護理雜誌,51(3)。
11. 邱啟潤、王秀紅(2004)‧以「家庭為中心的照護」本質之思辯‧護理雜誌,51(3)。
12. 邱啟潤、王秀紅(2004)‧以「家庭為中心的照護」本質之思辯‧護理雜誌,51(3)。
13. 邱善筠、曹汶龍、蔡宗益(2014)‧中風病人憂鬱情緒及其相關因素探討-以南台灣某醫院為例‧中華職業醫學雜誌,21(2),73-80。
14. 邱善筠、曹汶龍、蔡宗益(2014)‧中風病人憂鬱情緒及其相關因素探討-以南台灣某醫院為例‧中華職業醫學雜誌,21(2),73-80。
15. 邱善筠、曹汶龍、蔡宗益(2014)‧中風病人憂鬱情緒及其相關因素探討-以南台灣某醫院為例‧中華職業醫學雜誌,21(2),73-80。
 
1. 探討卡加利家庭評估及介入模式對因急性創傷造成骨折病患家庭壓力、壓力因應及家庭韌力之影響
2. 生命意義活動介入對生命末期癌症病人及其家屬生活品質與家庭復原力的影響
3. 以家庭為導向之照護介入措施對憂鬱症狀改善成效之探討
4. 評值以家庭為中心護理對急診病患與家屬在急診過渡期的急性壓力、焦慮憂鬱、因應以及家庭功能之成效
5. 運用多媒體復健護理運動方案改善首次腦中風病人之 身體活動功能、憂鬱症狀、及生活品質的成效
6. 腦瘤患者之復原力與生活品質及其相關因素之探討
7. 長期追蹤懷孕婦女睡眠品質之相關危險及保護因子探討
8. 運用「用心擁抱故事」理論於改善機構老年人之憂鬱、心率變異度、血壓、認知功能、生活品質之成效
9. 腦中風病人吞嚥功能狀態與憂鬱相關性探討
10. 評值癌症家庭過渡期護理計劃對肺癌家庭照顧者之身心健康、壓力掌握與家庭功能成效
11. 腦中風病人主要照顧者不確定感情形及其相關因素之探討
12. 加護病房腦動脈瘤病人住院期間家屬之疾病相關認知需求及其相關因素之探討
13. 頭頸癌患者說話障礙、身體心像、社會適應及憂鬱之相關性探討
14. 互動式個別化飲食護理指導介入措施對血液透析病人之生理指標與復原力的成效
15. 探討急診疼痛病人及家屬之負向情緒相關因素