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研究生:吳麗敏
研究生(外文):Li Min Wu
論文名稱:腹膜透析患者疾病不確定感、自我照顧、合併症及透析品質之相關性探討
論文名稱(外文):The relationships among disease uncertainty, self care, complications and dialysis qualityin peritoneal dialysis patients
指導教授:鄭綺鄭綺引用關係
指導教授(外文):鄭綺
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:護理學系碩士暨碩士在職專班
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:2019
畢業學年度:107
語文別:中文
論文頁數:117
中文關鍵詞:腹膜透析、疾病不確定、自我照顧、合併症、透析品質
外文關鍵詞:Peritoneal dialysisUncertaintySelf-careComplicationsDialysis quality
相關次數:
  • 被引用被引用:1
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  • 下載下載:12
  • 收藏至我的研究室書目清單書目收藏:0
本研究旨在探討腹膜透析病患疾病不確定感、自我照顧、合併症及透析品質的相關因素。本研究為描述性,相關性研究,以結構式問卷及訪談方式對研究對象進行橫斷式研究。研究對象以北部兩間區域醫院與 一間醫學中心腹膜透析病人為母群體,共收案95名,研究工具包括「基本資料表」、「疾病與透析治療」,「疾病不確定量表」與「腹膜透析自我照顧量表」。研究資料以SPSS 25統計軟體進行次數,百分比,平均值,標準差等描述性統計,推論統計則以獨立t檢定、單因子變異數分析、皮爾森積差相關值檢定與多變量迴歸進行資料處理與統計分析。研究結果顯示,以疾病不確定感與自我照顧量表探討與合併症及透析品質兩者有關研究結果顯示。
一、腹膜透析患者的疾病不確定感總分為61.97(±5.86)分。
二、腹膜透析自我照顧總分平均為202.0(±22.79)分,因素排序低至高排序,「持守立行的治療計畫」、「調整生活型態」、「處理異常狀況」、「護理導管及導管出口處」。
三、腹膜透析合併症發生率排序,排序高至低「腎性骨病變」、「腹膜炎」、「疝氣」、「導管出口處及隧道感染」、「肋膜腔積水」。
四、腹膜透析品質達成率,依排序別高至低為「血紅素」、「血壓控制」、「尿素氮清除率」、「鈣磷乘積」、「血清白蛋白」。
五、假設一:「不確定感越高,自我照顧越差」研究結果支持假設,分析發現不確定總分與住院次數為預測自我照顧的預測因子。假設二:
「自我照顧越差,合併症發生率越高」研究結果支持假設,分析發現自我照顧及藥水的總治療量為預測合併症發生的預測因子。假設三:「自我照顧越差,透析品質越差」研究結果為部分支持研究假設,分析發現紅血球素生成總量及自我照顧為預測透析品質達成率的預測因子。
經研究結果了解相關影響因素,提供臨床人員照護參考,及早給予適切性護理,降低疾病不確定,進而達到良好自我照顧增進生活品質。
This study aims to explore the factors associated with illness uncertainty, self-care, complications and dialysis quality in peritoneal dialysis patients. The study was descriptive and correlational, and cross-sectional research was conducted on study subjects by means of structured questionnaires and interviews. There was a total of 95 peritoneal dialysis patients from 2 local hospitals and one medical center in northern Taiwan were recruited in the study. The study tools include the general basic information form, illness and dialysis treatment, illness uncertainty scale, and peritoneal dialysis self- care scale.The statistical software SPSS 25 was used for data analysis. In this study, descriptive statistics include frequency, percentage, mean value, standard error. The statistical inference was analyzed through the independent t test, one-way ANOVA, Pearson correlation coefficient test, and multiple regression analysis.
1.The total score of illness uncertainty in peritoneal dialysis patients was
61.97(±5.86).
2.The average total score of peritoneal dialysis self-care was 202.0(±22.79). The four factors of self-care are ordered from low to high as following: persistent treatment plan, adjustment of life style, dealing with abnormal conditions, catheter and catheter outlet port care.
3.The occurrence of peritoneal dialysis complications was arranged in descending order: renal osteodystrophy, peritonitis, hernia, catheter outlet port and catheter infection, pleural effusion.
4.The quality achievement rate for peritoneal dialysis was arranged in descending order. hemoglobin, blood pressure control, clearance rate of urea nitrogen, calcium and phosphorus, serum albumin.
5.The first hypothesis in this study was that the higher the uncertainty, the worse the self-care, which was supported. In addition, further regression analysis found that the total score of uncertainty, and frequency of admission are significant predictors. The second hypothesis was that the worse the self-care, the higher the incidence of complications, which was supported. Further regression analysis found that the self-care and total amount of peritoneal dialysis syrup are significant predictors. The third hypothesis was that the worse the self-care, the worse the dialysis quality. The third hypothesis was partially supported. The Total amount of erythropoietin and self-care are significant predictors.
The study results provide care reference for clinical medical personnel, so as to detect problems early and provide proper care, which will reduce illness uncertainty, achieve good self-care and improve the life quality.
致 謝 ....................................Ⅰ
中文摘要 ............................................Ⅱ
英文摘要 ............................................Ⅳ
目 錄 ...................................VI

圖表目次 ............................................X

圖目次 ................................................... X

表目次 ............................................XI

第一章緒論 1
第一節 研究背景與動機 1
第二節研究目的 3
第三節研究假設 3
第四節名詞界定 3
第二章 文獻探討 5
第一節 腹膜透析治療 5
第二節腹膜透析合併症 6
第三節 透析品質 11
第四節 疾病不確定感 14
第五節 自我照顧對疾病控制的影響 16
第三章研究方法 19
第一節 研究設計 19
第二節 研究對象與取樣 19
第三節 研究架構 21
第四節 研究工具及信效度 22
第五節 資料收集過程 26
第六節 研究倫理考量 26
第七節 資料處理與分析 27
第四章 研究結果 28
第一節 研究對象基本資料 28
第二節 腹膜透析患者疾病不確定感 32
第三節 腹膜透析患者自我照顧 34
第四節 腹膜透析合併症 38
第五節 腹膜透析透析品質 40
第六節 基本屬性資料在各研究變項上之影響 42
第七節 不確定感及自我照顧、透析品質、合併症相關性 71
第八節 不確定感及自我照顧、透析品質、合併症的預測因子73
第五章 討論 75
第一節 不確定感程度 75
第二節 自我照顧程度 76
第三節 合併症程度 77
第四節 透析品質程度 80
第五節 研究假設的驗證 83
第六章 結論及建議 85
第一節 結論 85
第三節 研究限制 88
第三節 應用建議 89
參考文獻 92
一、中文文獻 92
二、英文文獻 96
附錄 102
附錄一、病患基本資料調查表 102
附錄二、疾病不確定量表 104
附錄三、腹膜透析自我照護量表 106
附錄四、腹膜透析合併症 110
附錄五、腹膜透析品質 111
附錄六、專家鑑定函 112
附錄七、專家意見 114
附錄八、腹膜透析合併症發生率 115
附錄九、問卷使用授權書 116
附錄十、研究通過證明函 117
圖目次
圖一 研究概念架構.......................... 21
表目次
表一 個人基本屬性資料表................... 30
表二 疾病與透析治療資料表......................31
表三 疾病不確定感之描述性分析..................33
表四 自我照顧之描述性分析..................... 35
表五 腹膜透析半年內各項合併症之發生率...........39
表六 腹膜透析半年內各項透析品質標之達成率.......41
表七 個人基本屬性及對不確定感的影響............ 43
表八 疾病與透析治療及不確定感的影響........... 45
表九 個人基本屬性及疾病與透析治療不確定感相關性的影響47
表十 個人基本屬性及自我照顧................. 49
表十一 疾病與透析治療及自我照顧............. 51
表十二 個人基本屬性及疾病與透析治療自我照顧相關性.. 53
表十三 個人基本屬性及合併症發生的影響............ 56
表十四 疾病與透析治療及合併症發生的影響.............. 59
表十五 疾病與透析治療及合併症發生的影響................63
表十六 疾病與透析治療及合併症發生的影響................66
表十七 不確定感及自我照顧、透析品質、合併症之間相關性分析70
表十八 影響不確定感及自我照顧迴歸係數之分析........72
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