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研究生:洪語蔓
研究生(外文):HONG,YU-MAN
論文名稱:慢性阻塞性肺病病人社會支持與自我管理之關係:直接效應或間接效應
論文名稱(外文):The Relationship Between Social Support And Self-Management In Chronic Obstructive Pulmonary Disease Patients:The Direct Effect Or Indirect Effect.
指導教授:王桂芸
指導教授(外文):WANG, KWUA-YUN
口試委員:林寬佳陽光耀王桂芸
口試委員(外文):LIN,KUAN-CHIAYANG,KUANG-YAOWANG, KWUA-YUN
口試日期:2017-05-04
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:2017
畢業學年度:105
語文別:中文
論文頁數:147
中文關鍵詞:慢性阻塞性肺部疾病社會支持自我管理中介因子疾病分類PROCESS迴歸分析
外文關鍵詞:Chronic Obstructive Pulmonary Diseasesocial supportself managementmediationindirect effectPROCESS regression
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背景與目的:慢性阻塞性肺疾病(COPD) 為不完全可逆且反覆急性發作的慢性疾病,症狀出現已是疾病嚴重度中度或更為嚴重,因此病人所經歷的痛苦是疾病逐步對日常生活產生困擾而非死亡。因此,除病人醫療處置所需外,首重提供後續慢性病的自我管理,若能藉社會支持的輔佐作用,更能加強、維持病人的自我管理。本研究目的探討自我效能對COPD病人社會支持與自我管理關係之影響。
研究方法:本研究為橫斷研究設計,方便取樣方法,結構式問卷進行資料收集,包含基本屬性、社會支持(ISEL)、自我效能(GSES)及自我管理量表(PIH 2010 scale)為資料收集之工具。收案期間自2016年11月21日至2017年2月06日,選取79位臺灣北部某醫學中心胸腔內科門診COPD病人做研究樣本,以最新GOLD 2017版本作為疾病分類為依據,其資料以描述性統計、獨立t檢定、變異數分析(ANOVA)、皮爾森相關係數及PROCESS迴歸分析等方式進行分析。
研究結果:(一)參與此研究病人年齡平均為76.89歲,以男性、國中至高中職、已婚者、與家人同住、有宗教信仰、月收入低於2 萬元居多。此外,平均患病年數為 8.69年,疾病分類為Level II(B、C、D組)、FEV1以≤65% 及COPD相關用藥以服用兩種藥物者佔多數。(二)自我效能總分平均值為35.8(SD=7.7),社會支持總分平均值為37.39(SD=10.3),自我管理量表結果為總分平均值為83.5,三者之間呈高度的正相關。(三)社會支持與自我管理之關係為間接效應,自我效能可作為部分中介因子,但於不同疾病分類其自我效能扮演之中介因子會有所差異,Level I(GOLD A)病人自我效能為完全中介因子,Level II自我效能為部分中介因子。
結論與建議:較無呼吸困難症狀(mMRC≤1)及低急性惡化風(過去一年無急性惡化住院)之Level I病人,提升其自我管理應著重於病人對自身健康想法與信念的變化,其自我效能高低決定自我管理之成果。而有較多呼吸困難情形(mMRC≥2)或有較高急性惡化風險(因急性惡化住院≥1次)Level II病人自我管理主要受到社會支持的影響,因此提升此組病人之自我管理首重給予病人良好之社會支持。
Background and aim: Chronic Obstructive Pulmonary Disease is a type of chronic diseases with incomplete reversibility and repeated acute attacks. Often, the occurrence of symptoms signifies that the disease has turned into moderate severity or even severe severity; as a result, the patients mainly suffer from pain caused by the disease’s gradual disturbance to their daily life instead of threat of death. In this sense, in addition to medical treatment for the patients, self-management for the subsequent chronic disease treatment is the focus. In the meanwhile, with adjuvant action of social support and self-efficacy, the patients’ self-management can be further enhanced and maintained. Therefore, in this research, we aimed to explore self-efficacy’s influence on the relationship of COPD patients’ social support and self-management.
Methods: In this research, cross-sectional survey, convenience sampling, and structured questionnaire were adopted for data collection, and the research tools included demographic and disease characteristics, ISEL, GSES, and PIH 2010 scale. The case acceptance period ranged from November 21, 2016, to February 6, 2017, with 79 COPD patients in the outpatient service in the Chest Medicine Dept. in a Medical Center in northern Taiwan as the research sample. Based on the latest GOLD 2017 as the disease classification, the collected data was analyzed by descriptive statistics, independent t-test, analysis of variance, Pearson correlation coefficient, and PROCESS.
Result: The average age of the patients who participated in this research was 76.89 years old. Most of them were mostly male, married, and with educational background of junior to senior/vocational high school. Besides, most of them had a religious belief, and earned monthly salary lower than 20,000 NTD. On the other hand, the patients’ average number of years of illness was 8.69 years, while most patients’ disease classification was Level II, FEV1 ≤65%, and took two COPD related drugs.
The average value of the total score in respect with self-efficacy was 35.8 (SD=7.7), the average value of the total score in respect with social support was 37.39 (SD=10.3), and the average value of the total score of self-management scale was 83.5—the three items show significantly positive correlation. The relationship between social support and self-management had indirect effect. In addition, self-efficacy could function as partial mediation. However, since Level I patients’ self-efficacy was complete mediation, Level II patients’ self-efficacy was partial mediation.
Conclusion: For Level I patients (mMRC≤1 and and no admitted with an acute exacerbation), their self-management enhancement should target at raising self-efficacy, which can determine the performance outcome of self-management. Otherwise, for Level II patients (mMRC≥2 or be hospitalized due to acute exacerbation ≥1 ), self-management is primarily influenced by social support; therefore, providing sound social support can serve as the buffer factor of the disease.
第一章 緒論
第一節 研究動機及重要性
第二節 研究目的
第三節 研究假設
第四節 研究問題
第二章 文獻探討
第一節 慢性阻塞性肺疾病之相關概念
第二節自我管理之相關概念
第三節 自我管理之影響因素及其相關研究
第三章 研究方法
第一節 研究架構
第二節 名詞界定
第三節 研究場所及研究對象
第四節 研究工具
第五節 研究步驟
第六節 資料分析
第七節 研究倫理與考量
第四章 研究結果
第一節 COPD病人基本屬性之現況分佈
第二節 COPD病人社會支持、自我效能、自我管理得分情形
第三節 病人基本屬性與自我管理之關係
第四節 自我效能對社會支持與自我管理關係之影響
第五章 討論
第一節 COPD病人基本屬性之概況
第二節 自我效能、社會支持與自我管理之概況
第三節 自我效能在社會支持與自我管理之間的中介關係
第六章 結論與建議
第一節 研究結論
第二節 研究建議
第三節 研究限制
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