本研究旨在探討現行「論病例計酬」健保給付下,乳癌手術病人於出院前之身體症狀困擾、疾病不確定感和出院護理指導需求,及其影響因素。採橫斷式相關性研究設計,以結構式問卷訪談北部某醫學中心50名乳癌手術病人。研究工具含個人屬性、術後身體症狀困擾、疾病不確定感及出院護理指導需求,統計方法有描述性統計、單因子變異數分析、及簡單線性回歸。研究結果:一、乳癌手術病人有輕度的術後身體症狀困擾(平均=1.11~2.78),輕至中度的疾病不確定感(平均=2.42~3.04),高度的出院護理指導需求(平均=3.48~4.14)。二、信奉佛教、民間宗教及道教者「複雜性」的疾病不確定感顯著高於基督教和天主教。疾病瞭解程度較不清楚者疾病不確定感均顯著高於非常清楚者。一般術後身體症狀困擾愈強,其疾病不確定感也愈高。三、年齡較輕者對「提昇生活品質」之出院護理指導需求較高。而自認疾病嚴重者對「治療和併發症」之出院護理指導需求也較高。四、疾病不確定感得分越高,出院護理指導需求也越高。這結果可幫助護理人員瞭解現行健保制度下乳癌手術病人的護理需求,進而提供病人更合適的護理照護。
The purpose of this study was to determine the association of post surgery physical symptom distress, sense of uncertainty in illness, and patient education need before discharge among breast cancer patients who received Modified Radical Mastectomy (MRM) under the ”case payment” reimbursement policy of NHI program in Taiwan. A cross-sectional correlational study was conducted by interviewing 50 patients with structured questionnaire in a medical center in northern Taiwan. Descriptive statistics, one-way ANOVA, and simple linear regression methods were used to analyze the collected data. The results were 1. Mild degree of post surgery physical symptom distress (mean=1.11~2.78), mild to intermediate degree of sense of uncertainty in illness (mean=2.42~3.04), and high degree of patient education need before discharge (mean=3.48~4.14) were found in those patients. 2. Patients' religion was Buddhism, Taoism or others had a higher degree of sense of uncertainty in facing sophisticated illness than those religion was Christianity. Furthermore, the better the patients understand the illness, the less degree of sense of uncertainty the patients have. 3. The younger patients had a higher degree of needs in health education in improving quality of life. Meanwhile, patients were more sensitive in the severity of illness had a higher degree of health education need in treatment and complication. 4. Sense of uncertainty in illness was positively associated with patient education need before discharge. The results of this study might assist the clinical nurses in understanding the needs of patients who undergo MRM surgery in order to provide more adequate nursing care under the current NHI reimbursement policy.
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