臺灣博碩士論文加值系統

研究背景：壓傷為住院常見的合併症，常增加醫療費用及病人死亡率。病人出院返家若有壓傷情形，其主要照顧者對於壓傷處理的自我效能與行為將成為照護關鍵。過去對於壓傷照護較多以衛教單張的指導方式，本研究將發展創新資訊技術導入智慧手機，做為主要照顧者初次面臨壓傷照護自我效能與行為之介入。
研究目的：本研究探討運用壓傷照護應用程式Mobile Application(APP)衛教軟體於主要照顧者初次面臨壓傷照護自我效能、行為與使用滿意度之成效。
研究設計：本研究採單盲及隨機抽樣試驗。
研究方法：於2018.10.24~2019.10.23期間，以中台灣某教學醫學中心內科病房及高齡病房初次發生1、2級壓傷且即將出院病人的主要照顧者為對象，使用亂碼數分成實驗組及控制組。以「壓傷照護應用程式」作為實驗組介入措施，控制組則為傳統書面衛教措施。所有研究對象於出院前皆完成基本資料、「壓傷照護自我效能」及「壓傷照護行為」前測問卷，之後依據組別進行衛教介入，返家一週後，研究者利用電訪完成「壓傷照護自我效能」及「壓傷照護行為」後測問卷訪查。本研究收案共計102位(實驗組51位、控制組51位)，實驗組排除10位，控制組排除12位，流失率共21.5%，總計實驗組納入41位及控制組納入39位。資料進行編碼，再以SPSS 19.0版進行統計分析。以卡方檢定及獨立T檢定進行敘述性分析，以Wilcoxon配對組符號等級檢定、曼惠特尼U檢定及共變數分析進行推論性分析。
研究結果：兩組在病人基本屬性、疾病特性、主要照顧者基本屬性、「壓傷照護自我效能」總分中位數、「壓傷照護行為」總分中位數之前測資料採用無母數統計均無顯著差異(p＞.05)，顯示兩組同質性高。分析兩組之間其後測的「壓傷照護自我效能」總分中位數，實驗組與控制組分別為49.83 vs.30.69，呈顯著差異(p＜.01)；「壓傷照護行為」則二組無顯著差異(p＞.05)。以Wilcoxon配對組符號等級檢定進行兩組內配對，於「壓傷照護自我效能」及「壓傷照護行為」前、後測總分中位數皆呈顯著差異(p＜.01)；顯示兩組主要照顧者之壓傷照護自我效能及行為均顯著提升。實驗組主要照顧者使用壓傷照護應用程式之滿意度項目多數達95%。
結論：壓傷照護應用程式及傳統書面衛教介入後皆可提升主要照顧者壓傷照護自我效能及行為，觀察研究結果發現壓傷照護應用程式比傳統書面資料進步分數較高，顯示壓傷照護應用程式能讓主要照顧者提升其壓傷照護自我效能且滿意度高，但無法提升照護行為。病人出院後仍需專業人員定期訪查或提供居家服務，然壓傷照護應用程式具有潛在之功能，未來可建構社區健康照顧團隊及服務資源的網絡化，可提供更健全且有效率的社區健康服務。

Bacckground: Pressure injury is a common comorbidity in hospitals that often increases medical costs and patient mortality. After a patient is discharged from the hospital, the self-efficacy and skill of the caregiver are the key to care in the treatment of patients with pressure injury. Traditionally, health providers have used leaflets to provide guidelines for caring for patients with pressure injury before they are discharged. In this study, an innovative mobile application was developed for smart phones to evaluate the effects on the self-efficacy and skill of caregivers for the first time in caring for pressure injury.
Aim: To evaluate the effects of an educational program using a mobile application on the self-efficacy and skill of caregivers for the first time in caring for pressure injury
Design: This study had a single-blinded randomization design.
Methods: The study was conducted in a medical ward and senior ward of a medical center in Taiwan from October 24, 2018, to October 23, 2019. The participants were caregivers who were taking care of patients that had first and second-degree pressure injuries and were about to be discharged. The participants were randomized to divide them into experimental and control groups. The experimental groups used an education program through a mobile application for pressure injury care, and the control groups used routine health education methods. A total of 102 cases were collected. There were 10 cases that were excluded from experimental group, 12 cases were excluded from the control group, and the attrition rate was 21.5%. The experimental group comprised 41 cases, and the control group had 39 cases. Each caregiver completed a pre-test before the patient was discharged. Both groups also completed a post-test within 1 week after the patient was discharged. Data were coded, and statistical analyses were performed using SPSS version 19.0. A descriptive analysis was performed using the chi-squared test and independent t-test, and an inferential analysis was performed using a Wilcoxon paired group symbol level test, Mann Whitney U test, and covariate analysis.
Results: The nonparametric statistics showed that there were no significant differences between the experimental and control groups in regard to the demographic data and disease characteristics of the patients, as well as the caregivers’ demographic data and median total scores on the pre-test. This shows that there was homogeneity between groups. The caregivers’ median total scores on the post-test were 49.83 vs. 30.69 in the experimental and control groups, respectively, which had statistical significance (p＜0.01). The difference in median total scores on the post-test between the groups was not statistically significant (p＞0.05). The Wilcoxon paired group symbol level test was used to perform pairing within the two groups, and there were significant differences in the median total scores from before and after the education for self-efficacy and skill for pressure injury care (p < 0.01). This shows that the self-efficacy and skill were significantly improved in both groups. The satisfaction rate reached 95% for the caregivers in the experimental group.
Conclusions: Both the experimental group and the control group showed improved self-efficacy and behavior in pressure injury care. However, the results showed that the experimental group had a higher improvement score in self-efficacy but not in skill for pressure injury care than the control group. The experimental group was also satisfied with using the pressure injury care application. Patients need regular visits or home services from professionals after discharge. In the future, a network of community healthcare teams and services using technology resources could be constructed to provide more complete and efficient community health services.

第一章 緒論
第一節 研究背景與動機---------------------------------------------------1
第二節 研究目的------------------------------------------------------------5
第三節 研究問題或研究假說---------------------------------------------5
第四節 名詞定義------------------------------------------------------------5
第二章 文獻探討
第一節 壓傷之介紹--------------------------------------------------------7
第二節 預防壓傷照護----------------------------------------------------16
第三節 主要照顧者之壓傷照護現況及困難-------------------------19
第四節 主要照顧者壓傷照護自我效能、行為與壓傷關係 ----------------------------------------------------------------------20
第五節 智慧型手機程式對於居家壓傷照護之運用----------------21
第三章 研究方法
第一節 研究架構----------------------------------------------------------25
第二節 研究對象----------------------------------------------------------26
第三節 研究工具----------------------------------------------------------26
第四節 研究工具的信度及效度----------------------------------------30
第五節 資料收集流程----------------------------------------------------31
第六節 倫理考量----------------------------------------------------------34
第七節 資料分析----------------------------------------------------------35
第四章 研究結果
第一節 壓傷個案的基本資料------------------------------------------37
第二節 主要照顧者基本資料------------------------------------------42
第三節 兩組壓傷風險因素評估---------------------------------------45
第四節 壓傷應用程式介入之成效------------------------------------46
第五節 介入後兩組壓傷之成效---------------------------------------69
第六節 實驗組運用壓傷應用程式滿意度---------------------------70
第五章 討論
第一節 壓傷個案、照顧者基本資料---------------------------------71
第二節 壓傷照護應用程式介入對主要照顧者壓傷照護自我效能
之影響--------------------------------------------------------------73
第三節 壓傷照護應用程式介入對主要照顧者壓傷照護行為之影
響--------------------------------------------------------------------76
第四節 壓傷照護應用程式介入對於壓傷癒合之影響------------78
第六章 結論與建議
第一節 研究結論---------------------------------------------------------79
第二節 研究限制---------------------------------------------------------80
第三節 研究建議---------------------------------------------------------81
參考文獻--------------------------------------------------------------------------83
附錄一 Barbara Braden壓傷風險工具同意書-----------------------------91
附錄二 許美玉護理師使用壓傷分級辨識圖卡同意書-------------------92
附錄三 蔡宜貞督導引用問卷同意書----------------------------------------93
附錄四 壓傷個案基本資料----------------------------------------------------94
附錄五 居家主要照顧人口學-------------------------------------------------95
附錄六 居家照護個案壓傷發生危險因素量表----------------------------96
附錄七 主要照顧者壓傷照護自我效能量表-------------------------------97
附錄八 主要照顧者壓傷照護行為量表-------------------------------------98
附錄九 運用壓傷應用程式衛教軟體滿意度-----------------------------100
附錄十 臨床試驗許可書-----------------------------------------------------101
附錄十一 壓傷應用程式內容-----------------------------------------------102

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