臺灣博碩士論文加值系統

台灣末期腎臟病發生率與盛行率在2015年均已排名世界第一，2015年台灣總透析人數為77,920人，該年新增透析發生數為11179人，末期腎臟病人需透過血液透析、腹膜透析得以持續延長生命，而病人在生活上及自我照護上的重大改變，是否因不同透析病人的控握信念與自我照顧影響著病人的生品質，本研究的目的將探討不同透析病人間控握信念、自我照顧及生活品質的差異與影響的因素。
本研究採橫斷研究，研究對象取自台灣北部一家醫學中心及一家區域教學醫院的門診血液透析及腹膜透析病人，收案條件為20歲以上、意識清楚，正接受血液或腹膜透析治療之尿毒症患者；排除正接受化療、經醫師通告病情危急、曾轉換不同透析方式、截肢者及有精神科病史者。研究工具包括基本人口學資料、腎臟疾病生活品質量表(KDQOL-SF)、多層面健康量表(MHLC)、自我照顧量表(ESCA)，採自填問卷方式填答，收案期間為109年6月21日至110年6月20日，共收案200位病人，其中血液透析病人共106人，腹膜透析病人94人。運用SPSS軟體22版次進行統計資料，結果顯示透析病人的生活品質得分各層面依序為: ｢症狀問題｣72.8分、｢腎病影響｣68.6分、｢心理層面｣44.7分、｢生理層面｣37.6分、｢腎臟負擔｣31.9分；比較不同透析病人生活品質，在｢症狀問題｣、｢腎病影響｣ 層面，腹膜透析病人優於血液透析病人，達顯著差異(t值分別是t=-3.269及-6.568，p＜.05)；影響生活品質的因素在｢症狀問題｣層面，以未婚、全職、合併症0~1項以下者有較佳的生活品質感受；｢腎病影響｣層面以腹膜透析病人透析1~3年感受較好。控握信念在血液透析與腹膜透析的病人之間未有差異，排序為醫師控握、內在控握、機運控握、他人控握；自我照顧狀況為血液透析病人照顧優於腹膜透析病人(t=5.76，p <.001)。
依本研究結果建議在照護上應更協助血液透析病人減輕腎病症狀問題的困擾，強化病人的衛教進而改變病人控握由外在、醫師傾向轉變成內在，以增強健康照護行為，衛教納入配偶以提升病人的自我照顧能力。

The incidence and prevalence of end-stage renal disease in Taiwan ranked first in the world in 2015. In 2015, the total number of dialysis patients in Taiwan was 77,920, and the number of new dialysis cases in that year was 11,179. End-stage renal disease patients require hemodialysis and peritoneal dialysis. The purpose of this study is to explore different dialysis patients' control beliefs, Self-care and quality of life differences and influencing factors.
This study was a cross-sectional study. The subjects were selected from outpatient hemodialysis and peritoneal dialysis patients from northern Taiwan. The including criteras were over 20 years old, conscious, and uremic patients undergoing blood or peritoneal dialysis treatment. The research tools include basic demographic data, Kidney Disease Quality of Life Scale (KDQOL-SF), Multidimensional Health Scale (MHLC), Self-Care Scale (ESCA). Using SPSS software version 22 to conduct statistical data. A total of 200 patients were received, including 106 hemodialysis patients and 94 peritoneal dialysis patients. The results show that peritoneal dialysis patients were better than hemodialysis patients in terms of “symptom problems” and “nephropathy impact” (t=-3.269, -6.568，p＜.05); the factors affecting the quality of life are at the level of "symptom problems", those who are unmarried, full-time, and those with comorbidities less than 0 to 1 have a better quality of life experience. The ranking was physician control, internal control, machine control, and others control; self-care status was that the care of hemodialysis patients was better than that of peritoneal dialysis patients (t=5.76，p <.001).
The results of this study are suggested to assist hemodialysis patients to alleviate the troubles of kidney disease symptoms in nursing care, strengthen the patient's health education and include spouses or family members, so as to change the patient's control from the external, the doctor's tendency to the internal, in order to strengthen the Self-care ability, improve health care behavior.

目次
中文摘要 ……………………………………………………………… i
英文摘要 ……………………………………………………………… ii
目次…………………………………………………………………… iii
表次…………………………………………………………………… iv
圖次…………………………………………………………………… v
第一章 緒論
第一節 研究背景與動機…………………………………………… 1
第二節 研究目的…………………………………………………… 3
第三節 研究問題…………………………………………………… 3
第四節 研究假設…………………………………………………… 3
第五節 名詞界定…………………………………………………… 4
第二章 文獻探討……………………………………………………… 7
第一節 慢性腎衰竭及治療………………………………………… 7
第二節 透析病人生活品質………………………………………… 9
第三節 自我照顧………………………………………………… 12
第四節 控握信念Locus of Control……………………………… 15
第三章 研究方法…………………………………………………… 18
第一節 研究架構………………………………………………… 18
第二節 研究設計………………………………………………… 18
第三節 研究對象及場所………………………………………… 18
第四節 研究工具與信效度檢定………………………………… 19
第四章 研究結果…………………………………………………… 22
第一節 透析病人的基本屬性分析……………………………… 22
第二節 透析病人之控握信念…………………………………… 24
第三節 透析病人的自我照顧…………………………………… 32
第四節 透析病人的生活品質…………………………………… 37
第五節 透析病人控握信念、自我照顧與生活品質之相關…… 45
第六節 透析病人生活品質的之重要預測因子…………………… 48
第五章 討論 51
第一節 透析病人的控握信念探討 ………………………… 51
第二節 透析病人的自我照顧探討 ………………………… 52
第三節 透析病人的生活品質探討…………………………… 53
第六章結論與建議…………………………………………………… 56
第一節 結論……………………………………………………… 56
第二節 建議與限制……………………………………………… 57
參考文獻
中文部分…………………………………………………………… 59
英文部分…………………………………………………………… 61
附件………………………………………………………………… 67
附件一G power 計算人數…………………………………… 66
附件二KDQOL-36問卷……………………………………… 67
附件三多層次控握信念量表…………………………………. 70
附件四控握信念量表同意書…………………………………. 72
附件五自我照顧能力量表…………………………………… 73
附件六自我照顧量表同意書………………………………… 74
附件七正式問卷……………………………………………… 75
附件八IRB 證明……………………………………………… 81
 
表 次
表4-1基本屬性之描述性分析………………………………………………….. 23
表4-2控握信念病人的平均數±標準差/得分範圍………………………………24
表4-3透析病人控握分佈………………………………………………………...25
表4-4 基本屬性與內在控握信念之差異性……………………………………. 28
表4-5基本屬性與他人控握與醫師控握之差異性………………………….......30
表4-6自我照顧量表之平均數、標準差……………………………………… ...33
表4-8基本屬性、自我照顧之相關性分析………………………………………36
表4-9 透析病人生活品質各層面量表分數分佈………………………………...37
表4-10影響生活品質之基本屬性分析…………………………………….…….39
表4-11透析病人控握信念、自我照顧與生活品質的相關分析………………..46
表4-12血液透析病人控握信念、自我照顧與生活品質的相關分析………….46
表4-13腹膜透析病人控握信念、自我照顧與生活品質的相關分……….……47
表4-14透析病人生活品質預測因子分析……………………………………….49
表4-15血液透析病人生活品質預測因子分析………………………………….50
表4-16腹膜透析病人生活品質預測因子分析………………………………….50
 
圖 次
圖一、研究架構..........................................18

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