臺灣博碩士論文加值系統

目的：本研究之目的在於了解冠狀動脈繞道手術後糖尿病患者其健康需求，探討此族群自主管理、自我效能與治療遵從性之情形與其相關性，以及自主管理的預測因子，並了解自主管理預測因子間之中介效應。
背景：心血管病是全球死因之首，佔所有死亡人口之29％，冠狀動脈心臟疾病，高居國人心臟血管疾病的第二位，冠狀動脈繞道手術後之糖尿病患者易發生合併症且癒後較差，控制相關因子可以減少合併症發生，了解其疾病自主管理對於此類患者之長期控制與照護而言，是非常需要關切的議題，而國內外尚無此族群病人同時針對自主管理、自我效能與治療遵從性關係進行分析探討之研究。
方法：本研究以整合式橫斷性研究方法，採方便取樣方式進行調查，以北部兩家醫學中心及一家區域教學醫院門診之166位冠狀動脈繞道手術糖尿病患者為對象，量性部分:運用基本資料表、自主管理量表、自我效能量表及治療遵從性量表作為研究工具，質性部分:以半結構式訪談其中7位病患最關切之健康問題及健康需求。質性資料採內容分析法，量性資料以描述性統計說明病患之基本屬性與自主管理、自我效能、治療遵從性情形，以皮爾森積差相關、獨立樣本T檢定、單因子變異性分析，檢視探討此族群自主管理、自我效能與治療遵從性之相關性，以回歸分析進行自主管理的預測因子之分析，另以Multiple mediation script檢測各變項之中介影響力。
結果：本研究結果發現病患平均值為67.5歲，以男性居多佔80.1%，病患之年齡、性別、教育程度等人口學變項與自主管理、自我效能或治療遵從性上達到統計顯著意義；而自我效能和治療遵從性與自主管理呈現顯著負相關(r＝-.618, p=＜.001；r＝-.549, p=＜.001)，以逐步迴歸分析，結果顯示年齡、教育程度、照顧者、職業層級、抽菸、藥物副作用、有無其他疾病、收縮血壓，以及自我效能及治療遵從性，皆為自主管理重要之預測因子，整體可解釋自主管理67.4%之變異量，而中介效應影響力上，僅於自我效能對自主管理的解釋力受治療遵從性影響18.5%達統計上顯著意義(95%CI= -.0472~ -.0115)，其餘變項皆未達統計上顯著意義；質性訪談分析結果發現，病患最關切之健康問題與需求，可能造成病患自主管理、自我效能及治療遵從性的影響。
結論：研究顯示本研究之結果可提供護理人員了解冠狀動脈繞道手術後糖尿病患者的自主管理、自我效能、治療遵從性的情形，以及彼此之間的連續性，以進一步做為提升病患之自主管理、自我效能及治療遵從性，以加強持續相關的健康行為，來控制相關因子並減少合併症發生，提升長期之生活品質。

Objectives：The purpose of this study is to understand the diabetes after coronary artery bypass graf and view their health needs to enhance self-management, Self-efficacy and treatment Compliance of associated with impact predictors factor. and to understandof self-management factor between Mediation effect.
Background：Cardiovascular disease is the first cause of death worldwide, accounting for 29% of all deaths. Coronary artery heart disease is the second leading of cardiovascular disease in Taiwan. Diabetes after coronary artery bypass graf patients prone to complications and poor prognosis, control Related factors can reduce complications, to understand their disease self-management for control of such long-term care patients is important issues. However, no researches for self-management, self-efficacy and treatment compliance analysis of the relationship in diabetes after coronary artery bypass graf.
Study Design：A Integrated cross-sectional study method and convenience sampling in the study. Quantitative component:Three instrument were self-management scale, self-efficacy scale and the treatment compliance scale related investigations, and a demographic questionnaire,. Investigate the two medical centers, one regional teaching hospital in northern, 166 patient diabetic coronary artery bypass graf surgery. Qualitative component :semi-structured interviews in which seven patients with the most concerned about health problems and health needs. The data analyzed by Content analysis for group of health problems and needs, Quantitative parts by descriptive statistics shows the basic attributes and patient self-management, self-efficacy, Treatment compliance situation, using the Pearson correlation, independent samples T test, one way ANOVA analyzed of relevance, Regression analysis for predictors of self-management , and the Multiple mediation script to detect the variables mediating influence.
Findings：The results showed that patients with an average of 67.5 years, and 80.1% males, patient age, gender and education et al variables are reaches significant meaning with self-management, self-efficacy or treatment compliance. self-efficacy and treatment compliance showed a significant negative correlation in self-management (r =-. 618, p = <.001; r =-. 549, p = <.001), the stepwise regression analysis showed that age, education, carers, professional level, smoking, drug side effects, other diseases, systolic blood pressure, and self-efficacy and treatment compliance have 67.4% explained, are important predictors factors of self-management, while the mediating effect, treatment compliance was statistically significant 18.5% significance (95% CI = -. 0472 ~ -. 0115) in self-efficacy on the explanatory power of self-management. Qualitative analysis found that patients with health problems and needs, may affect in self-management, self-efficacy and compliance of treatment.
Conclusion：The results of this study can provide nurses to understand patients with diabetes after coronary artery bypass graft in the self-management, Self-efficacy and treatment compliance of the case, as well as the continuity between them, in order to enhance the patients discharged as a self-management, self-efficacy and treatment compliance, to enhance the continued relevance of health behavior and control the disease relevant factors and reduce the complication, improve long-term quality of life.

目 錄 頁次
致 謝 I
中文摘要 II
英文摘要 IV
內容目次 VI
附 件 IX
圖表目錄 X

內容目次
第一章 緒論 1

第二章 文獻探討 3

第一節 冠狀動脈疾病與冠狀動脈繞道手術 3
第二節 冠狀動脈疾病與糖尿病 4
第三節 自主管理 7
第四節 自我效能 10
第五節 治療遵從性 12
第六節 自主管理、自我效能及治療遵從性 15
第七節 冠狀動脈繞道手術後糖尿病患者之健康需求 17

第三章 研究方法 19

第一節 研究概念架構 19
第二節 研究問題 19
第三節 名詞界定 20
ㄧ、冠狀動脈繞道手術 20
二、糖尿病 20
三、自主管理 21
四、自我效能 21
五、治療遵從性 21
第四節 研究設計 21
ㄧ、研究場所 21
二、研究對象 22
三、研究樣本數 22
第五節 研究步驟 23
第六節 倫理考量 24
第七節 研究工具 25
ㄧ、個人基本資料和疾病資料表 25
二、自主管理量表 25
三、慢性病自我效能量表 26
四、心血管糖尿病治療遵從量表 27
第八節 研究工具之效度 27
第九節 研究工具之信度 28
第十節 統計分析 29

第四章 研究結果 31

第一節 冠狀動脈繞道手術後糖尿病病患之基本屬性 31
第二節 冠狀動脈繞道手術後糖尿病病患之自主管理、自我效能、
治療遵從性 40
一、冠狀動脈繞道手術後糖尿病病患之自主管理 40
二、冠狀動脈繞道手術後糖尿病病患之自我效能 40
三、冠狀動脈繞道手術後糖尿病病患之治療遵從性 41
第三節 冠狀動脈繞道手術後糖尿病病患之基本屬性與自主管理、
治療遵從性、自我效能之相關 49
一、冠狀動脈繞道手術後糖尿病病患之基本屬性與自主管理之相關 49
二、冠狀動脈繞道手術後糖尿病病患之基本屬性與自我效能之相關 50
三、冠狀動脈繞道手術後糖尿病病患之基本屬性與治療遵從性之相關 50
四、冠狀動脈繞道手術後糖尿病病患自主管理、自我效能、
治療遵從性之相關 51
第四節 冠狀動脈繞道手術後糖尿病病患之基本屬性與自我效能
、治療遵從性、自主管理之關係 55
一、冠狀動脈繞道手術後糖尿病病患之基本屬性與自我效能 55
二、冠狀動脈繞道手術後糖尿病病患之基本屬性與治療遵從性 58
三、冠狀動脈繞道手術後糖尿病病患之自主管理 60
四、冠狀動脈繞道手術後糖尿病病患與自主管理顯著變項之間之相關性 62
第五節 冠狀動脈繞道手術後糖尿病病患之基本屬性、
自我效能、治療遵從性與自主管理之關係 70


第六節 冠狀動脈繞道手術後糖尿病患最關切之健康問題與需求 72

第五章 討 論 78

第一節 冠狀動脈繞道手術後糖尿病病患之基本屬性與自主管理
、治療遵從性、自我效能 78
ㄧ、冠狀動脈繞道手術後糖尿病病患之基本屬性 78
二、冠狀動脈繞道手術後糖尿病病患之自我效能 80
三、冠狀動脈繞道手術後糖尿病病患之治療遵從性 80
四、冠狀動脈繞道手術後糖尿病病患之自主管理 81
第三節 冠狀動脈繞道手術後糖尿病病患之基本屬性與自主管理、
治療遵從性、自我效能之相關性探討 80
一、冠狀動脈繞道手術後糖尿病病患之基本屬性與自我效能相關性探討...……82
二、冠狀動脈繞道手術後糖尿病病患之基本屬性與治療遵從性相關性探討 83
三、 冠狀動脈繞道手術後糖尿病病患之基本屬性與自主管理相關性探討 84
四、冠狀動脈繞道手術後糖尿病病患之自主管理、治療遵從性、自我效能
之相關性探討 85
五、冠狀動脈繞道手術後糖尿病病患之健康問題與需求與自主管理、
治療遵從性、自我效能之相關性探討 86
第四節 冠狀動脈繞道手術後糖尿病病患自主管理之相關預測因子 88

第六章 結論與建議 89

第一節 研究結論與建議 89
第二節 研究限制 92

參考文獻 93

中文文獻 93
英文文獻 96

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