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研究生:徐清樺
研究生(外文):Hsu, Ching-Hwa
論文名稱:衰弱、尊嚴、韌力與生活品質於心臟疾病患者之探討 - 質量性研究
論文名稱(外文):Frailty, Dignity, Resilience, and Quality of Life in Patients with Heart Disease: A Mixed Methods Research
指導教授:童恒新童恒新引用關係
指導教授(外文):Tung, Heng-Hsin
口試日期:2022-01-25
學位類別:博士
校院名稱:國立陽明交通大學
系所名稱:護理學系
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:243
中文關鍵詞:心臟疾病衰弱尊嚴韌力生活品質質量性研究法
外文關鍵詞:Heart diseaseFrailtyDignityResilienceQuality of Lifemixed methods research
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目的:探討心臟疾病患者衰弱、尊嚴、韌力與生活品質之相關性,以及心臟疾病患者的罹病過程經歷與生活經驗。
方法:本研究為質量混合型研究設計。量性部分採方便取樣於北部某區域醫院心臟內科門診與病房進行樣本收集共101位病人,使用結構式問卷包括:基本屬性、疾病特徵、中文版介護風險評估篩檢量表(Kihon Checklist - Chinese)、中文版病人尊嚴量表(Patient Dignity Inventory - Mandarin version)、心理韌性量表中文版(Chinese version of Resilience Scale)、及歐洲生活品質五面項量表(EuroQol 5-dimension questionnaire)為研究工具,資料收集後透過SPSS 20.0版電腦套裝統計軟體進行頻次、百分比、平均數、標準差、最大/最小值、獨立樣本t檢定、單因子變異數分析、卡方檢定、皮爾森積差相關及階層迴歸進行統計分析,另使用SAS 9.4版電腦套裝統計軟體以潛在類別模式對低生活品質之樣本進行潛在類別分析。質性部分採立意取樣自問卷調查中的101位受訪者選取訊息豐富且可清楚描述之個案共10位進行訪談,以胡賽爾的現象學觀點藉由半結構式訪談大綱引導進行訪談,訪談文本使用內容分析法進行分析。
結果:本研究結果顯示心臟疾病患者的生活品質會受到年齡、教育程度、職業狀態、經濟來源、主要照顧者,以及疾病種類的影響,且衰弱、尊嚴、韌力都是生活品質的預測因子。無配偶、有菸酒習慣、經濟來源、合併有慢性腎病變或周邊動脈硬化等基本屬性與疾病屬性是低生活品質的潛在類別。心臟疾病患者的罹病過程歷程包含衝擊、調適、及重生三個主題,從對生命失去期待,到感受與接受外界環境支持以調整面對疾病的態度,到思想昇華及生命重啟等階段。
結論:本研究可瞭解心臟疾病患者衰弱、尊嚴、韌力與生活品質之相關性,生活品質之預測因子,及罹病過程經歷與生活經驗。研究結果可提醒臨床照護人員對患者尊嚴、韌力之觀察,辨識低生活品質之潛在患者,並適時介入輔導,以維護患者的生活品質。
Aim:The purpose of this study was to discuss the relationship between frailty, dignity, resilience, and quality of life in patients with heart disease, also explore the experience of heart disease patients when dealing with the disease.
Design and Methods: The study was conducted with a mixed methods research study design. 101 participants were recruited by convenience sampling from a general hospital in northern Taiwan. Four structured questionnaires, namely the Kihon Checklist - Chinese (KCL-C), the Patient Dignity Inventory - Mandarin version (PDI-MV), the Chinese version of Resilience Scale (CRS), and the EuroQol 5-dimension questionnaire (EQ-5D), were used to assess frailty, dignity, resilience, and life quality. Hierarchical regression was applied to determine the predictors of quality of life, and latent class analysis was used to classify possible demographic characteristic which was related to low quality of life. The phenomenology interview was applied for qualitative inquiry, 10 interviewees were selected by purposive sampling from the quantitative part. Whom were information-rich people and could describe clearly about the experience of facing and managing the heart disease period. Content analysis was applied to analyze data.
Results: The results demonstrated that age, education level, employee status, financial resources, primary care provider, disease types, frailty, dignity, and resilience were associated with quality of life. Besides, patients who did not have spouse, having habit of smoking and alcohol drinking, financial resources from others, combined with renal disease or peripheral arterial disease were classified with low quality of life. While experiencing heart disease, interviewees had to deal with shock, awake from the darkness, and rebirth to a new life.
Conclusions: Some demographic characteristics, frailty, dignity, and resilience were found correlated with quality of life and among them were identified as predictors. The results from both quantitative and qualitative part could make an awareness of observation on patient’s dignity, resilience, and identify possible demographic characteristic that is potentially related to low quality of life.
目錄
中文摘要 i
英文摘要 ii
目錄 iv
圖目錄 vii
表目錄 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第二章 文獻探討 7
第一節 心臟病與衰弱 7
第二節 尊嚴 12
第三節 韌力 18
第四節 生活品質 22
第五節 尊嚴、韌力與生活品質 28
第三章 研究方法 31
第一節 研究概念架構 31
第二節 研究問題 32
第三節 名詞解釋與界定 33
第四節 研究設計 35
第五節 研究對象與場所 37
第六節 研究工具及其信效度與嚴謹度 39
第七節 資料收集過程 44
第八節 資料處理與分析 46
第九節 研究倫理考量 50
第四章 研究結果 51
第一節 心臟疾病患者之基本屬性、衰弱、尊嚴、韌力與生活品質情形 51
第二節 心臟疾病患者基本屬性對衰弱、尊嚴、韌力與生活品質之相關 59
第三節 心臟疾病患者衰弱、尊嚴、韌力與生活品質之相關 67
第四節 心臟疾病患者衰弱對尊嚴、韌力與生活品質之影響 69
第五節 心臟疾病患者生活品質之預測因子 70
第六節 低生活品質心臟疾病患者基本屬性之潛在類別分析 79
第七節 質性訪談研究對象基本屬性描述 84
第八節 心臟疾病患者面對疾病之經驗、調適過程以及身心靈感受 86
第五章 結果討論 126
第一節 心臟疾病患者基本屬性、衰弱、尊嚴、韌力與生活品質之現況 126
第二節 心臟疾病患者基本屬性、衰弱、尊嚴、韌力與生活品質之關係 132
第三節 衰弱對心臟疾病患者尊嚴、韌力與生活品質之影響 140
第四節 心臟疾病患者生活品質之預測因子 142
第五節 低生活品質心臟疾病患者之潛在類別特性 144
第六節 心臟疾病患者經歷衝擊、調適、重生之經驗 151
第六章 結論與建議 166
第一節 研究結果 166
第二節 研究限制 168
第三節 研究建議 170
參考資料 173
附錄 225
附錄一 研究問卷 225
附錄二 研究問卷使用授權同意書 235
附錄三 受試者同意書 238
附錄四 人體試驗委員會通過證明書 242

圖目錄
圖1 Wilson & Cleary健康相關生活品質模式 25
圖2 研究架構 32
圖3 樣本計算圖 38
圖4 收案流程圖 45

表目錄
表1 研究問題統計方法分析綜整 47
表2 心臟疾病患者之基本屬性資料分析 53
表3 心臟疾病患者疾病特徵資料分析 56
表4 心臟疾病患者衰弱、尊嚴、韌力、生活品質之情形 58
表5 心臟疾病患者衰弱各項因子之人次統計 59
表6 心臟疾病患者基本屬性、衰弱、尊嚴、韌力、生活品質之相關性 64
表7 心臟疾病患者衰弱、尊嚴、韌力、生活品質之相關 68
表8 心臟疾病患者衰弱與否對尊嚴、韌力與生活品質之影響 69
表9 心臟疾病患者基本屬性、衰弱、尊嚴、韌力對生活品質整體評價之階
層迴歸係數分析表 73
表10 心臟疾病患者生活品質整體評價之自變項共線性診斷 75
表11 心臟疾病患者基本屬性、衰弱、尊嚴、韌力對自覺健康相關生活品質
之階層迴歸係數分析表 78
表12 心臟疾病患者自覺健康相關生活品質之自變項共線性診斷 79
表13 心臟疾病患者低生活品質整體評價與基本屬性之類別模式適合度檢定
80
表14 心臟疾病患者低生活品質整體評價基本屬性之潛在類別與機率分布81
表15 心臟疾病患者低自覺健康相關生活品質之類別模式適合度檢定 82
表16 心臟疾病患者低自覺健康相關生活品質基本屬性之潛在類別與機率分
布 83
表17 訪談對象基本資料 85
表18 心臟疾病患者罹病歷程之主題及次主題 87
表19 心臟疾病患者罹病歷程之次主題、類別與編碼 88
表20 過去探討心臟疾病患者相關變項之統計方法 145
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