慢性阻塞性肺疾病患主要照顧者負荷及其相關因素之探討

Caregivers’ Burden and Its Related Factors in Patients With Chronic Obstructive Pulmonary Disease

莊文齡(Wen-Ling Chuang)

指導教授 ： 蔡仁貞

臺北醫學大學/護理學院/護理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00134

摘要

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）在世界各地不論是發生率或死亡率都有增加的趨勢，而其所帶來的醫療及社會負擔也十分重大。基於COPD的特性及其症狀，患者會經歷到漸進性的功能狀態退化，活動執行能力降低，對生活品質也造成很大的衝擊，就家庭主要照顧者而言，隨著患者病程的進展導致身體功能的改變及自我照顧能力降低，會影響到主要照顧者的生活型態及個人情緒，在照護過程中同時會面臨許多負荷與壓力。
目前國內針對COPD病患主要照顧者負荷之相關研究較為欠缺。本研究以橫斷式研究設計，針對台北市某教學醫院及某醫學中心門診之COPD病患主要照顧者探討其照顧負荷。共收集101對研究對象，資料包括病患人口學特質、疾病特性和呼吸困難程度，以及主要照顧者人口學特質、照顧狀況、自覺健康狀況、社會支持和照顧者負荷程度。研究工具包括：基礎呼吸困難指標（BDI）、功能性社會支持量表、主要照顧者負荷量表。資料分析方法包括：描述性統計、曼-惠特尼U檢定、克-瓦二氏單因子等級變異數分析、斯皮爾曼等級相關係數與逐步迴歸分析。
研究結果如下：（1）主要照顧者負荷程度為輕度負荷，各項負荷得分高低依序為心理負荷、生理負荷、財務負荷、社會負荷。（2）不同病患性別、職業狀況，其主要照顧者負荷有顯著差異；基礎呼吸困難指標與主要照顧者負荷呈現負相關。（3）主要照顧者負荷會因為主要照顧者與病患親屬關係、與病患關係程度、是否有親友協助共同照顧及每天照顧病患時數不同而有所差異，主要照顧者自覺健康狀況及社會支持與主要照顧者負荷有顯著相關性。（4）主要照顧者負荷的預測因子為社會支持需要程度、社會支持協助情形、病患基礎呼吸困難指標及主要照顧者自覺健康狀況及與病患親屬關係（媳婦），此五個變項可解釋主要照顧者負荷總變異量為47%。
本研究結果發現，病患基礎呼吸困難指標與主要照顧者負荷有相關性，因此醫護人員應更加重視病患疾病症狀處置，也要主動關心主要照顧者的身心健康狀況，並評估主要照顧者個別需求及提供所需資源，例如提供適當的照顧資訊、社會支持或心理支持。在整體性的評估下並提供照顧者適當的照顧措施後，以協助降低主要照顧者之負荷。

關鍵字

慢性阻塞性肺疾病患 ； 主要照顧者 ； 照顧負荷 ； 社會支持。

並列摘要

The trend of chronic obstructive pulmonary disease (COPD) has been rising in both incident and mortality all over the world, and it also generates the tremendous burden on different perspectives. Based on the characteristics and symptoms of COPD, the patients would undergo the gradual degeneracy in physiological mechanism and suffer the decreasing ability, this would lead to varies immeasurable impacts on the quality of life as well. For the caregivers, their acceptable burden or stress would be affected while the course of this disease has been in progress, like the change of physical functions and the drop of self-care ability in patients.
Nowadays, the domestic research in the burden of caregivers and their correlation in the patients with COPD are deficient. This cross-sectional study is designed to investigate the burden of the COPD’s caregivers from a teaching hospital and a medical center in Taipei city. In this research, data were collected from 101 patients and their caregivers. In the patients’ part, the demographic features, the characteristics of the disease and dyspnea levels were collected. In caregivers’ part, the demographic features, care status, self-perceived health status, social support and the level of caregivers’ burden were included. In this study, the structured questionnaires were introduced, which include the Baseline Dyspnea Index (BDI), Appraisal of Informal
Social Support Questionnaire and Caregiver Burden Questionnaire. The data analyses were implemented by descriptive statistic, Mann-Whitney U Test, Kruskal-Wallis H test, Spearman’s correlation and stepwise regression.
The results of this study were shown as follows: (1) The level of primary caregivers’ burden was mild, and the severity was psychological burden, physical burden, financial burden and social burden in sequence. (2) The difference of primary caregivers’ burden was significant based on patients’ gender and occupation; moreover, the Baseline Dyspnea Index had a negative correlation with caregivers’ burden. (3) There were significant difference in primary caregivers’ burden based on the relation and relationship between patients and their primary caregivers, receiving extra assistance from others or not, and the caring hours per day. Furthermore, the self-perceived health status and social support would also have a significant correlation of primary caregivers’ burden. (4) The important factors of primary caregivers’ burden were: the necessity of social support, the assistance of social support, Baseline Dyspnea Index, self-perceived health status and the relation between caregivers and patients. The explainable variance is 47%.
The research has shown the burden of primary caregivers have a significant correlation with Baseline Dyspnea Index. Therefore, medical professionals should put more emphasis on patient's symptom management and concerning the physical and mental health of caregivers voluntarily. Furthermore, in order to decrease the caregivers’ burden, the medical professionals need to evaluate each individual’s demands and provide the resources, such as appropriate care information, social support and mental support to primary caregivers of the patients.

並列關鍵字

Chronic Obstructive Pulmonary Disease patient ； Primary caregiver ； Caregiving burden ； Social support.

參考文獻

張文（2000）•建立慢性阻塞性肺疾病患者日常活動耗氧量之標準並分

李雅欣、楊嘉禎、王桂芸、湯玉英（2005）•呼吸困難之概念分析•腫瘤護理雜誌，5（2），43-50。

邱啟潤、許淑敏、吳淑如（2003a）•居家照護病患之主要照顧者綜合性需求調查•醫護科技學刊，5（1），12-25。

邱啟潤、許淑敏、吳瓊滿（2002）•主要照顧者負荷、壓力與因應之國內研究文獻回顧•醫護科技學刊，4（4），273-289。

陳貞吟、陳楚杰、蔡明足、沈玉卿、周歆凱、翁林仲（2008）•影響居家長期照護病患主要照顧者生活品質因素之研究•長期照護雜誌，12（3），267-283。