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研究生:楊雅晴
研究生(外文):YANG,YA-QING
論文名稱:肝臟移植術後病人自我效能與生活品質相關因素之探討
論文名稱(外文):Factors associated with self-efficacy and quality of life of liver transplant recipients
指導教授:曾雯琦曾雯琦引用關係
指導教授(外文):TZENG, WEN-CHII
口試委員:周雨青李威震
口試委員(外文):ZHOU, YU-CHINGLI, WEI-CHEN
口試日期:2022-05-09
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:2022
畢業學年度:110
語文別:中文
論文頁數:207
中文關鍵詞:肝臟移植自我效能生活品質
外文關鍵詞:Liver transplantSelf-efficacyQuality of life
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背景:肝臟移植是治療末期肝病病人的有效方法,隨著醫療技術的進步與免疫抑制劑的發展,移植後病人的存活率也明顯提高,身為前線醫療人員,除了改善病人在醫院時身體的不適之外,也需關心病人返家後續的生活品質。
目的:本研究欲了解接受肝臟移植手術後病人的自我效能與生活品質及其影響因素,並探討病人在術後的疾病認知、心理困擾、自我效能與其生活品質之變化,為提供臨床照護、出院準備、個別化衛教、門診追蹤及未來研究的參考。
研究方法:本研究為縱貫式研究,為藉結構式問卷進行資料收集,調查工具使用「肝臟移植病人基本資料表」、「簡短疾病認知量表」、「管理慢性病之自我效能量表」、「醫院焦慮與憂鬱量表」及「SF-36生活品質量表」。研究場所為北部某醫學中心胃腸肝膽科一般外科病房及門診進行,自 2020 年 12 月至 2022 年 5 月期間進行收案。收案時間分別在肝臟移植手術當次住院的出院前一天填寫第一次的問卷,共收案 64 人,在第六個月的定期回診時或因膽道相關併發症的第一次住院者填寫第二次問卷,共收案 43 人,而其中有 20 位病人為再度入院治療。納入條件為(一)
年滿 20 歲(含)以上、(二)此次住院接受肝臟移植手術、(三)意識清楚,能以國、台語溝通者、(四)同意參與本研究,排除條件為(一)境外接受肝臟移植、(二)經醫師評估為病危病人。搜集資料以 SPSS 27.0 for mac套裝軟體建檔與處理,採用描述性統計分析及獨立樣本 t 檢定、One-Way ANOVA、Pearson’s 卡方檢定、皮爾森相關係數進行推論性統計分析。
研究結果:肝臟移植病人術後生活品質得分範圍為 17.97-66.36,得分最高的次量表為「心理健康, MH」,得分最低的為「因生理問題導致角色受限,RP」,影響生活品質的因素有性別、教育程度及術前 MELD 分數。與一年內再次入院的相關因子為生理指數的肝功能 AST/ALT。依據研究結果建議臨床醫療人員可透過常規篩檢評估病人的心理情緒狀態,由於肝功能為再度入院之相關因子,臨床實務也需定期監測生理指數,給予相關醫療措施,早期介入護理衛教與護理諮詢,以提升病人返家後的生活品質。
Background: Liver transplantation is the curative intervention for terminal liver disease. With advances in surgical techniques and emerging immunosuppressive therapy has resulted in significant improvements in post transplantation survival. While the patients recover from the operation, medical staff should be concerned about the quality of life after discharge.

Aim: This study aims to understand the factors affecting self-efficacy and quality of life of patients after liver transplantation, exploring the changes about patients’ illness perception, psychological distress, self-efficacy and quality of life. To provide reference for clinical care, discharge preparation, individualized health education, outpatient follow-up and future research.

Methods: A longitudinal study design is used with data collected by self administered questionnaires including “Information Sheet for Liver Transplant Patients”, “Brief Illness Perception Questionnaire(BIPQ)”, “Self-efficacy Management of Chronic Disease”, “Hospital Anxiety and Depression” and “Medical Outcomes Study Short Form 36(SF-36)”. From December 2020 to May 2022, the first questionnaire was completed on the day before discharge from the hospital then the liver transplant, 64 adult liver transplant recipients were recruited by purposive sampling. A second questionnaire was completed at the sixth month of regular visits OPD or for the first hospitalization for biliary related complications, 43 adult liver transplant recipients were recruited and 20 of them were readmitted. All sampling be recruited from the Gastroenterology and Hepatobiliary General Surgery division ward and OPD in a medical center located in north Taiwan. The participants inclusion criteria were: (1) the patients who above 20 years old, (2) Hospitalized for liver transplantation, (3) clearly conscious and able to communicate in Mandarin and/or Taiwanese, and (4) Consent to participate in this study. Exclusion criteria were: (1) Taiwan over-seas liver transplant recipients and (2) liver transplant recipients evaluated by physicians as critical condition. Data is managed by SPSS version 27.0 for mac; descriptive statistics, independent sample t test, one-way ANOVA, Pearson’s chi square test, and Pearson’s correlation were performed for data analysis.

Results: The liver transplant recipients had SF-36 scores ranging from 17.97 to 66.36 of quality of life. Among the 8 subscales, find the “Mental health” score was the best and the “Role physical” was poorest. The factors affecting quality of life included gender, education and pre-operative MELD score.The correlate of readmission within one year was the physiological index of liver function. Based on the results of the study, it is recommended that clinical staff can assess psychological and emotional status through routine screening, and since liver function is a correlate of readmission, clinical practice should also regularly monitor physiological indices, provide medical measures, and intervene early with nursing health education, care consultation to improve patients' quality of life after returning home.
正文目錄II
『表』目錄VI
『圖』目錄VIII
『附錄』目錄VIII
中文摘要X
英文摘要XII

正文目錄
第一章 緒論1
第一節 研究動機1
第二節 研究重要性4
第三節 研究目的5
第二章 文獻查證6
第一節 肝臟移植及膽道併發症簡介6
第二節 肝臟移植病人之自我效能及其影響因素12
第三節 肝臟移植病人之疾病認知與心理困擾及其影響因素14
第四節 肝臟移植病人生活品質及其影響因素16
第三章 研究架構18
第一節 研究架構18
第二節 名詞解釋及定義19
第三節 研究假設22
第四章 研究方法23
第一節 研究設計23
第二節 取樣條件及樣本數24
第三節 研究工具25
第四節 資料收集過程32
第五節 資料處理與分析34
第六節 研究倫理考量36
第五章 研究結果37
第一節 肝臟移植病人基本資料之描述性分析38
第二節 肝臟移植病人之簡易疾病認知量表得分、醫院焦慮與憂鬱量表得分、自我效能量表得分及
SF-36 健康量表得分之描述性分析44
第三節 肝臟移植病人疾病認知、心理困擾、自我效能與健康生活品質之相關性分析54
第四節 肝臟移植後病人人口學屬性對疾病認知、心理困擾、自我效能及健康生活品質之推論性分
析57
第五節 肝臟移植病人疾病認知、心理困擾、自我效能與 SF-36 健康生活品質之追蹤調查96
第六章 討論129
第一節 肝臟移植病人之基本資料、疾病認知、心理困擾、自我效能及生活品質130
第二節 肝臟移植病人人口學屬性、疾病特性、疾病認知、心理困擾、自我效能與生活品質之相關
性136
第三節 追蹤肝臟移植病人再度入院及其相關因素139
第七節 結論與建議140
第一節 結論140
第二節 研究結果臨床應用141
第三節 研究限制與未來研究建議142
參考文獻143
英文文獻143
中文文獻172

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