臺灣博碩士論文加值系統

本研究目的為發展一份適用於臨床護理人員評估精神病患過度飲水現象之量表，並測試此精神病患過度飲水評估量表之信度與效度。本量表係依據廣泛的文獻查證、參考相關量表為基礎，擬定而成，經專家內容效度檢測，CVI值達.89。之後，採橫斷式研究調查法，於桃園地區某精神專科醫院，以立意取樣方式於五個復健病房，選取符合能以國台語溝通、住院復健病房超過一月以上、年齡在20-65歲、以及依據國際疾病分類編碼(ICD)前三碼為295(精神分裂症)或296(情感型疾患)之收案條件者，進行施測，共有121位的慢性精神病患同意參加。檢測方式是由研究護理師測量7am以及 4pm的體重，並執行下午之抽血及驗尿，再以精神病患過度飲水評估量表進行評估。此精神病患過度飲水評估量表是以因素分析檢測量表的內在結構以建立建構效度；以內在一致性(KR-20)及再測信度檢測量表之信度。結果發現，量表效度部份：經主成分因素分析法得到五個因素，其分別命名為「生理變化」、「精神症狀」、「藥物副作用 」、「行為表徵」、「生活環境」，共有20個題項解釋變異量為65.61％，顯示本量表具有良好的建構效度。信度的部份：內在一致性KR-20為.88，各因素之内在一致性則介於.73~86之間，達可信範圍。而在兩週後，再測信度r＝.86 (p＜.001)，可知此量表具有穩定性。ROC曲線分析方面，確診過度飲水之切截點≧4分，量表之敏感度為100%及特異度78.95%。而水中毒≧7分，量表之敏感度為93.75%及特異度95.24%，顯示本量表對於精神病患過度飲水及水中毒之檢測，其準確性佳。由於本研究發展之「精神病患過度飲水評估量表」具有良好的信度及效度，應可做為未來研究和實務上應用的測量工具。

This study aimed to develop a scale that would be useful for clinical nurses to assess the issue of polydipsia among psychiatric patients, and to test the reliability and validity of this Polydipsia Assessment Scale for Psychiatric Patients (PASPP). The PASPP was based on extensively validated publications and other applicable reference scales and tested with regard to its content validity. Its CVI value was 0.89. Subsequently, a cross-sectional survey approach was developed for this study. The enrollment site was a psychiatric hospital located in Taoyuan, Taiwan. Purposive sampling yielded a total of 121 chronic psychiatric patients from five rehabilitation patient wards consenting to participating in the study. These patients met the enrollment criteria, including the ability to communicate in Mandarin and Taiwanese, having stayed in the rehabilitation patient ward for more than a month, being aged 20 to 65, and the first three digits of their condition being 295 (schizophrenia) or 296 (mood disorders) according to the International Classification of Diseases (ICD). The test was carried out by study nurses that measured psychiatric patients' weights at 7am and 4pm, and collected blood samples and performed urinalysis in the afternoon before the PASPP was completed. The PASPP was examined through factor analysis for its internal structure in order to establish structural validity. The reliability of the PASPP was examined by means of internal consistency (KR-20) and test-retest reliability. It was found that in terms of scale validity, the principal component analysis yielded five factors, which were given the names of physiological changes, psychiatric symptoms, drug-associated side effects, behavioral presentation, and living environment, consisting of 20 items. The explained variance was 65.61%, meaning that the PASPP had optimal structural validity. As far as reliability is concerned, the internal consistency (KR-20) was 0.88. The internal consistency of each of the factors, on the other hand, was between 0.73 and 0.86 and fell within the reliable range. The test-retest reliability (r value) over two-week was .86 (p＜.001), showing acceptable stability of the PASPP. In terms of the ROC curve analysis, the cutoff point for confirmed polydipsia was ≧ 4 points, with the scale sensitivity being 100% and specificity being 78.95%. Water intoxication, on the other hand, was ≧ 7 points, with the scale sensitivity being 93.75% and specificity being 95.24%, indicating that the PASPP has favorable accuracy when used to test polydipsia and water intoxication in psychiatric patients. The PASPP has optimal reliability and validity and should be a useful measurement tool in future studies and practice.

指導教授推薦書……………………………………………………
口試委員會審定書…………………………………………………
授權書……………………………………………………………
誌謝…………………………………………………………………Ⅳ
中文摘要……………………………………………………………Ⅴ
英文摘要……………………………………………………………Ⅶ
目錄…………………………………………………………………Ⅹ

第一章 緒論……………………………………………………… 1
第一節 研究動機與重要性 ………………………………… 1
第二節 研究目的 …………………………………………… 2
第二章 文獻探討 …………………………………………… 3
第一節 流行病學研究 ……………………………………… 3
第二節 過度飲水的定義 …………………………………… 4
第三節 確認過度飲水個案之方法 ………………………… 5
第四節 精神疾患過度飲水之臨床表徵 …………………… 7
第五節 過度飲水的相關因素 ……………………………… 8
第六節 國外過度飲水量表介紹 ……………………………15
第七節 總結 …………………………………………………17
第三章 研究方法 ……………………………………………18
第一節 研究設計 ……………………………………………18
第二節 研究對象與場所 ……………………………………19
第三節 研究工具 ……………………………………………20
第四節 研究工具之信度、效度檢定 ………………………26
第五節 倫理考量 ……………………………………………27
第六節 資料收集步驟 ………………………………………27
第七節 資料分析 ……………………………………………29
第八節 前趨研究結果 ………………………………………31
第四章 研究結果 ………………………………………………36
第一節 研究對象基本屬性 …………………………………36
第二節 量表項目分析結果 …………………………………39
第三節 效度結果 ……………………………………………40
第四節 信度結果 ……………………………………………44
第五節 ROC曲線分析結果 …………………………………45
第六節 基本資料與是否過度飲水之差異比較 ……………46
第五章 討論 ……………………………………………………48
第一節 量表之項目分析 ……………………………………48
第二節 量表之效度分析 ……………………………………49
第三節 量表之信度分析 ……………………………………51
第四節 ROC曲線分析 ………………………………………53
第五節 基本資料變項與是否過度飲水之比較分析 ………55
第六章 結論與建議 …………………………………………58
第一節 結論……………………………………………………58
第二節 護理上的應用…………………………………………59
第三節 研究限制………………………………………………60
第四節 建議……………………………………………………61
參考資料 …………………………………………………………63
中文部分 ………………………………………………………63
英文部分 ………………………………………………………65
附錄
附錄一 基本資料表………………………………………………96
附錄二 精神病患過度飲水評估量表……………………………97
附錄三 專家效度之專家名單……………………………………98
附錄四 專家效度評分……………………………………………99
附錄五 專家效度分析……………………………………………103
附錄六 專家修改題目之內容……………………………………108
附錄七 受試者同意書……………………………………………117
附錄八 人體試驗倫理委員會同意臨床試驗證明書……………122


圖目錄
圖1 因素分析特徵值之陡坡圖……………………………………83
圖2 過度飲水之ROC曲線…………………………………………88
圖3 水中毒之ROC曲線……………………………………………88

表目錄
表1 過度飲水現象相關因素及危險因子之研究 …………………14
表2 量表的架構 ……………………………………………………23
表3 量表內容與操作型定義 ………………………………………24
表4 不同設定之估算樣本數 ………………………………………34
表5 基本資料分析 …………………………………………………75
表6 量表之項目分析結果.…………………………………………79
表7 探索性因素分析(第一次) ……………………………………80
表8 探索性因素分析(第二次)……………………………………87
表9 量表之因素變異量……………………………………………82
表10量表之構面命名 ……………………………………………84
表11量表之信度分析 ……………………………………………85
表12量表各構面間之相關分析結果 ……………………………86
表13量表之再測信度分析結果 …………………………………87
表14精神病患基本資料與是否過度飲水之差異比較 …………89
表15各項檢驗值與評估量表間之相關分析結果 ………………93
表16精神病患過度飲水評估量表與過度飲水篩檢量表的比較 94
表17如何從體重的增加來估計血鈉的變化 ……………………95

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