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研究生:詹佳蓉
研究生(外文):CHAN, CHIA-JUNG
論文名稱:新型冠狀病毒感染症住院病患症狀趨勢與靈性安適之關係探討
論文名稱(外文):Relationship between symptom trends and spiritual well-being in hospitalized patients with Coronavirus disease 2019
指導教授:黃采薇黃采薇引用關係
指導教授(外文):Huang, Tsai-Wei
口試委員:黃采薇莊宇慧黃惠娟
口試委員(外文):Huang, Tsai-WeiChuang, Yeu-HuiHuang, Hui-Chuan
口試日期:2023-06-16
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:2023
畢業學年度:111
語文別:中文
論文頁數:150
中文關鍵詞:新型冠狀病毒感染症症狀困擾靈性安適
外文關鍵詞:Coronavirus disease 2019Symptoms distressSpiritual well-being
ORCID或ResearchGate:orcid.org/0000-0002-2923-4607
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研究背景:2019年末,全球開始面對新興傳染病-新型冠狀病毒感染症,其病毒之傳染力高,全球確診之病人數日日攀升。根據研究,確診新型冠狀病毒感染症病人易有生理及心理症狀困擾,但尚未有研究探討新型冠狀病毒感染症確診者其每日症狀變化及靈性安適狀態變化。因此本研究將探討新型冠狀病毒感染症確診者其每日生理及心理症狀變化及靈性安適狀態變化,瞭解其中相關性及預測因子,做為日後照護參考。
研究目的:探討新型冠狀病毒感染症住院期間生理及心理症狀變化、生理及心理症狀嚴重程度與靈性安適之間關係,並從中探討預測因子。
研究方法:住院期間每天以艾德蒙頓症狀評估量表評估症狀變化,住院當日及出院當日填寫靈性安適量表。主要統計方法包含:描述性統計、成對樣本t檢定、獨立樣本t檢定、卡方檢定、皮爾森積差相關分析、線性迴歸分析及廣義估計方程式。
研究結果:共收案88位,結果發現(一)生理症狀omicron病毒變異株嚴重度顯著較高,心理症狀隨著人口學不同有所差異。(二)靈性安適方面住院病患出院之靈性安適顯著高於入院;女性、經濟狀況為小康或感染omicron病毒變異株靈性安適顯著高於男性、經濟狀況為低收者或感染alpha或delta病毒變異株。(三)住院天數越長、生理症狀改善越多,但心理上憂鬱程度增加。當越憂鬱情況下,也會越焦慮及感到不幸福。慢性病越多,生理症狀嚴重度越高。入院靈性安適越不佳,住院天數越長,食慾也越差,心理上也覺得越憂鬱及不幸福;出院靈性安適越差,食慾也越差,心理上也覺得越憂鬱及不幸福。靈性改變量與住院天數呈低度正相關,與咳嗽症狀呈低度負相關。(四)症狀間預測因子以噁心、疲憊、食慾、呼吸困難、食慾及不幸福感為主。靈性安適受到天數、經濟狀況、病毒變異株、生理症狀(噁心、食慾及咳嗽)及心理狀態(憂鬱、焦慮及不幸福感)等因素影響。
結論:新型冠狀病毒感染症住院病患在臨床治療及照護下,不論哪種變異株,生理症狀皆會隨著時間而改善,心理症狀則不然。對於疾病管制中隔離政策及限制社交活動,導致生活幸福感隨之下降,靈性亦感到不安適。住院照護過程提供正確疾病資訊、鼓勵身體活動或增加與他人的關係及社交支持,對於病患心理症狀及靈性安適有正面影響。

Background: At the end of 2019, the world began facing a novel infectious disease - Coronavirus Disease 2019 (COVID-19). Currently, there is limited research exploring the daily symptom changes and spiritual well-being of confirmed COVID-19 patients. Therefore, this study aims to investigate the daily physiological and psychological symptom variations, as well as changes in spiritual well-being among confirmed COVID-19 patients. By understanding the correlations and predictive factors, this research can serve as a reference for future care and support.
Purpose: Exploring the changes in physiological and psychological symptoms, and their relationship with spiritual well-being during hospitalization for COVID-19: investigating predictive factors.
Methods: During hospitalization, the Edmonton Symptom Assessment Scale (ESAS) and the Spiritual Well-Being Scale are used for evaluation. The main statistical methods included descriptive statistics, paired sample t-tests, independent sample t-tests, chi-square tests, pearson's correlation analysis, linear regression analysis, and generalized estimating equations (GEE).
Results: A total of 88 cases were included in the study, and the results revealed the following findings:
1. Demographic factors and different viral variants had an impact on the severity of physiological and psychological symptoms.
2. In terms of spiritual well-being, patients' scores on the Spiritual Well-Being Scale were significantly higher at the time of discharge compared to admission. Females, individuals with a moderate economic status, or those infected with the Omicron variant had significantly higher levels of spiritual well-being compared to males, individuals with a low income status, or those infected with the Alpha or Delta variants.
3. The longer the hospital stay, the more the physiological symptoms improve. However, there is an increase in psychological depression. As the depression worsens, feelings of anxiety and unhappiness also increase. The severity of physiological symptoms increases with the number of chronic diseases. Poor spiritual well-being at admission and discharge is associated with worsened appetite and increased feelings of depression and unhappiness.
4. Spiritual well-being is influenced by factors such as the length of hospitalization, economic status, virus variant strains, and physiological and psychological conditions.
Conclusion: Hospitalized patients with COVID-19, regardless of the viral variant, experience improvement in physiological symptoms over time under clinical treatment and care. However, psychological symptoms do not show the same pattern of improvement. The isolation policies and restrictions on social activities implemented for disease control have led to a decrease in overall life satisfaction and feelings of spiritual discomfort. The process of hospital care can enhance spiritual well-being by providing accurate disease information, encouraging physical activity, fostering relationships with others, and providing social support.

致謝 I
中文摘要 III
英文摘要 V
表目錄 IX
圖目錄 X
第一章 緒論 1
第一節 研究動機與背景 1
第二節 研究目的 4
第三節 研究問題 5
第四節 研究假設 6
第五節 名詞界定 7
第二章 文獻查證 9
第一節 新型冠狀病毒流行病學 9
第二節 新型冠狀病毒感染症臨床症狀診斷與治療 11
第三節 新型冠狀病毒感染症生理及心理症狀 15
第四節 靈性安適 18
第三章 研究方法 22
第一節 研究架構 22
第二節 研究設計 23
第三節 研究場所及對象 24
第四節 研究步驟 25
第五節 研究工具 26
第六節 資料統計與分析 28
第七節 倫理考量 29
第四章 研究結果 30
第一節 研究對象基本屬性分析 31
第二節 研究對象之生理症狀趨勢及影響因子 35
第三節 研究對象之心理症狀趨勢 57
第四節 研究對象之靈性安適 69
第五節 研究對象基本屬性、生心理與靈性安適相關性 81
第六節 新型冠狀病毒感染住院患者症狀之預測因子 85
第七節 新型冠狀病毒感染住院患者靈性安適之預測因子 93
第五章 討論 96
第一節 總結 96
第二節 新型冠狀病毒感染症住院患者基本屬性 98
第三節 新型冠狀病毒感染症住院患者生、心理症狀 101
第四節 新型冠狀病毒感染症住院患者靈性安適狀態 105
第五節 新型冠狀病毒感染症生、心理症狀與靈性關係 108
第六節 研究限制 111
第六章 結論與建議 112
第一節 研究結論 112
第二節 實務應用與研究建議 115
參考文獻 117
中文部分 117
英文部分 117
附錄 141
附錄一 IRB證明函 141
附錄二 量表授權書 141
附錄三 研究問卷 147
表目錄
TABLE 1收案對象基本屬性分析 (N=88) 32
TABLE 2收案對象藥物治療分析 34
TABLE 3艾德蒙頓症狀評估量表-各種生理症狀 不同病毒株每日平均得分狀況比較 40
TABLE 4收案對象基本屬性與各種生理症狀平均得分狀況比較(N=88) 54
TABLE 5 收案對象基本屬性與各種生理症狀平均得分相關性(N=88) 56
TABLE 6收案對象基本屬性與各種心理症狀平均得分狀況比較(N=88) 60
TABLE 7收案對象基本屬性與各種心理症狀平均得分狀況比較 (N = 88) 66
TABLE 8收案對象基本屬性與各種心理症狀平均得分狀況比較(N = 88) 68
TABLE 9 整體收案對象靈性安適狀況 (N = 88) 72
TABLE 10整體收案對象入院與出院平均分數分析 (N=88) 73
TABLE 11收案對象基本屬性與靈性安適入院及出院平均得分比較 (N=88) 74
TABLE 12 靈性安適量表三構面成對樣本T檢定 (N=88) 79
TABLE 13 出院及入院靈性安適量表三構面與各基本特徵比較 (N = 88) 80
TABLE 14 收案對象症狀嚴重度與靈性安適入院、出院及改變量相關分析(N=88) 84
TABLE 15 新型冠狀病毒感染症住院患者生理症狀之預測因子 89
TABLE 16新型冠狀病毒感染症住院患者心理症狀之預測因子 92
TABLE 17 收案對象基本屬性、生心理症狀與靈性安適廣義估計方程式分析(N=88) 94
圖目錄
FIGURE 1 研究架構圖 22
FIGURE 2 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-疼痛趨勢 41
FIGURE 3 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-疲憊趨勢 42
FIGURE 4 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-睡意趨勢 43
FIGURE 5 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-噁心趨勢 44
FIGURE 6 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-食慾趨勢 45
FIGURE 7 ALPHA或 DELTA病毒變異株與OMICRON病毒變異株生理症狀-呼吸困難趨勢 46
FIGURE 8 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-喪失味覺趨勢 47
FIGURE 9 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-咳嗽趨勢 48
FIGURE 8 ALPHA或DELTA病毒變異株與OMICRON病毒變異株生理症狀-喪失味覺趨勢 48
FIGURE 10 ALPHA或DELTA病毒變異株與OMICRON病毒變異株心理症狀-憂鬱趨勢 61
FIGURE 11 ALPHA或DELTA病毒變異株與OMICRON病毒變異株心理症狀-焦慮趨勢 62
FIGURE 12 ALPHA或DELTA病毒變異株與OMICRON病毒變異株心理症狀-不幸福感趨勢 63
FIGURE 13 歐美國家與臺灣新型冠狀病毒感染症疫情及政策趨勢圖 100
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