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研究生:簡惠慧
研究生(外文):Hui-Hui Chien
論文名稱:國際健康功能與身心障礙分類系統(ICF)與護理四大概念在腦中風護理照護之連結
論文名稱(外文):The Linkage between the International Classification Of Functioning, Disability And Health (ICF) and the Four Core Concepts Of Nursing on Stroke Nursing Care
指導教授:賴甫誌賴甫誌引用關係
指導教授(外文):Fu-Chih Lai
口試委員:李世代劉燦宏
口試委員(外文):Shyh-Dye LeeTsan-Hon Liou
口試日期:2014-12-23
學位類別:碩士
校院名稱:臺北醫學大學
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:2015
畢業學年度:103
語文別:中文
論文頁數:175
中文關鍵詞:ICF護理四大概念結構方程式腦中風照護長照機構
外文關鍵詞:ICFthe Four Core Concepts of NursingStructural equation modelingSEMstroke carelong-term facilities
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腦中風是成人目前身心障礙及死亡的主要原因之一,身體活動功能障礙是最常見的後遺症,其恢復後的長期照護問題成為健康重要議題,中風患者護理評估及實務照護上更面臨許多困難與問題。世界衛生組織於2001年公佈了國際健康功能與身心障礙分類系統(International Classification of Functioning , Disability and Health, ICF),ICF除了身體功能和構造、活動和社會參與因子外,更將環境和個人因素納入,認為疾病、功能、個人和環境間為互動而形成,考量到活動參與及環境因素作為身心健康之需求評估,重視所處環境對個人活動參與和健康的影響,以提供腦中風病患所需之照護需求及健康促進。
本研究目的為以護理四大概念探討國際健康功能與身心障礙分類系統ICF在腦中風護理模式之建構。研究方法:描述性研究,立意取樣長照機構之腦中風148位個案為研究對象,經由歸納及整理相關文獻擬出「腦中風病患國際健康功能與身心障礙分類系統ICF分類碼之健康失能狀況表」之問卷,進行觀察、訪談病患或主要照護者進行資料收集,以護理四大概念為架構,以SPSS 19版及AMOS 22版統計軟體進行資料分析和腦中風病患整體模式之建構。研究結果:以皮爾森相關係數分析整體ICF核心分類碼之間的相關聯性,整體身體功能b碼與活動參與d碼、環境e碼及s碼均有顯著相關(r=.18~774, p<.05~.001);進一步分析ICF架構(健康及環境)與護理照護(巴氏量表、IADL量表)之間整體模式關係性,健康-環境(r=.99, p<.001);健康-護理(r=.91, p<.001);環境-護理(r=.97, p<.001),腦中風病患照護整體模式建構成立。結論:護理四大概念在研究對象基本屬性對健康、環境、護理構面有相關顯著影響,整體模型發現健康、環境、護理三大構面間具有高度顯著關係,證實了環境的差異對健康產生不同的影響,更凸顯出ICF架構中身體功能、活動參與及環境評估的重要性。建議未來研究可擴展至ICF架構可將核心分類碼部分作為其他急性或慢性疾病的預後、功能維持與健康相關之生活品質的評量工具之相關研究,以提供日後長照機構評估與照護品質指標追蹤監測的實證參考。
Stroke is the major cause of disabilities and death for adult. The most common sequelae of stroke is physical and functional disable. Therefore, health and care challenges the stroke patients encountered are long-term care need, assessment, and clinical practice. The world Health Organization (WHO) launched the International Classification of Functioning, Disability and Health (ICF) in 2001 that integrated body function, structures, activities and participation in social factors along with the environmental and personal into the interactions among the disease, functional, personal and environmental. Active participation and environmental aspects are taken into account of assessing the environmental impact on individual’s active participations and health that to provide the quality care and life for stroke patients.
This quantitative descriptive study aimed to explore the linkage of between ICF core sets with four core concepts of nursing on stroke care with purposive sampling of 148 long-term care facility stroke residents. Research instruments used in this study were developed with induction and literature reviews. Data was collected from the observation of participants and interviews with main care provider. The linkage between ICF and four nursing concepts framework is delineated with statistical analysis of SPSS 19 and AMOS that descriptive and inferential data of model construction are carried out.
The Pearson correlation coefficient has shown the categories of ICF core set for the stroke: the whole body function b code, participation d code, environment e code & body structure s code were significantly related(r=.18~.774, p<.05~.001).The whole model of stroke patients was well construction on the domains of health-environment(r=.99, p<.001), health-nursing (r=.91, p<.001), environment-nursing (r=.97, p<.001).
Conclusion: Application of four core concepts of nursing on stroke nursing care, the significant founds were between the participants’ attribute and health, environment, nursing domain. The whole model represented these three domians( health, environment, nursing) were high correlation coefficient. Hence, it was confirmed that different environment was effect on health. In other words, it was important that body activities, participation & environment were assessed in ICF.
Recommendations of the study will be expanded to ICF architecture as part of the core classification code other acute or chronic disease prognosis, functional sustain future research and health-related quality of life assessment of the amount of tools to provide a future long-term care institutions to assess the quality of care indicators track empirical reference monitor.
目 錄
頁 數
致謝........................................................................................................... I
中文摘要................................................................................................... II
英文摘要................................................................................................... IV
論文目錄................................................................................................... VI
圖表目次................................................................................................... X
第一章 緒論
第一節 研究背景與重要性......................................................... 1
第二節 研究動機.......................................................................... 9
第三節 研究目的.......................................................................... 13
第四節 研究問題.......................................................................... 14
第五節 名詞界定.......................................................................... 15
第二章 文獻探討
第一節 腦中風之概述................................................................... 21
第二節 腦中風失能者需求評估工具........................................... 30
第三節 護理四大概念與國際健康功能與身心障礙分類系統
ICF之概述........................................................................ 38
第四節 國際健康功能與身心障礙分類系統ICF之運用............ 54
第三章 研究方法
第一節 研究設計.......................................................................... 59
第二節 研究對象.......................................................................... 60
第三節 研究架構.......................................................................... 61
第四節 研究工具信效度及預試................................................... 64
第五節 資料收集流程與方法....................................................... 69
第六節 統計分析方法................................................................... 72
第七節 倫理考量.......................................................................... 73
第四章 研究結果
第一節 研究對象基本屬性之現況............................................... 74
第二節 研究對象ICF核心分類碼之現況................................... 80
第三節 護理四大概念健康、環境與護理在ICF核心分類碼
與巴氏量表、IADL量表間之各構面分析..................... 86
第四節 研究對象基本屬性對護理四大概念在健康與環境構
面之相關影響................................................................... 93
第五節 研究對象基本屬性對護理四大概念在護理構面之相
關影響.............................................................................. 98
第六節 護理四大概念研究對象基本屬性、健康、環境、護
理間之相關性分析........................................................... 102
第七節 ICF架構與護理照護模式的建構.................................... 107
第五章 討論
第一節 研究對象基本屬性........................................................... 115
第二節 研究對象ICF核心分類碼之相關…................................ 118
第三節 護理四大概念健康、環境、護理與ICF核心分類碼與
巴氏量表、IADL構面間之相對應….............................. 121
第四節 研究對象基本屬性對護理四大概念在健康、環境、
護理構面之相關影響....................................................... 124
第五節 ICF架構與護理照護模式的建構.................................... 128
第六章 結論與建議
第一節 結論與建議...................................................................... 131
第二節 研究限制............................................................................ 138
參考文獻
中文部分........................................................................................... 139
英文部分........................................................................................... 156
附錄
附錄一 巴氏量表 Barthel Index................................................... 167
附錄二 Instrumental Activities of Daily Living (IADL) ............... 169
附錄三 問卷................................................................................... 171
圖一 護理四大概念架構............................................................ 43
圖二 國際功能、失能和健康分類(ICF)理論架構圖................ 47
圖三 研究理論架構................................................................ 62
圖四 研究架構.................................................................... 63
圖五 資料收集流程.................................................................... 70
圖六 整體模式............................................................................ 110
表一 研究對象基本資料............................................................. 76
表二 研究對象身心障礙級別..................................................... 80
表三 ICF核心分類碼現況......................................................... 83
表四 整體ICF碼相關性............................................................ 86
表五 健康構面各面向因素負荷量............................................. 90
表六 環境構面各面向因素負荷量............................................. 91
表七 健康、環境與護理各面向相關性..................................... 92
表八 基本屬性對健康與環境構面之影響................................. 96
表九 基本屬性對巴氏量表與IADL之影響............................. 100
表十 研究對象基本屬性和ICF核心碼對巴氏量表多元逐步迴歸分析........ 105
表十一 研究對象基本屬性和ICF核心碼對IADL多元逐步迴歸分析....... 106
表十二 模型適配度檢定............................................................ 112
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