護理指導介入對慢性阻塞性肺病病人居家自我照顧需求滿足程度影響之探討

The Effect of nursing intervention for the satisfaction of home self care needs level of patients with Chronic Obstructive Pulmonary Disease

莊冠琪(Kuan-Chi Chuang)

指導教授 ： 盧美秀

共同指導教授 ： 林秋芬(Chiou-Fen Lin)

臺北醫學大學/護理學院/護理學研究所/碩士(2008年)

摘要

本研究旨在探討護理指導介入對慢性阻塞性肺病病人居家自我照顧需求滿足程度之影響。採類實驗研究法之單組前後測設計，以方便取樣選取個案，共106位。本研究收集資料之工具為自擬之「慢性阻塞性肺病病人居家自我照顧需求量表」，本量表經專家效度檢定，取內容重要性CVI達.86之項目共六類28題，信度檢定採內在一致性Chronbach’s Alpha值為.803。在護理指導介入前，以「慢性阻塞性肺病居家自我照顧需求量表」調查病人居家自我照顧需求，再依個別性需求給予護理指導，兩星期後依返診日期或電話聯繫方式，再次依原量表進行後測，最後進行護理指導介入前、後病人自我照顧需求程度之差異分析。資料收集後以次數分配、百分比、平均值、標準差、獨立樣本t檢定、配對t檢定與One-Way ANOVA進行分析處理。研究結果：一、護理指導介入前，慢性阻塞性肺病病人居家自我照顧需求總平均得分1.96（SD=0.28），需求總分為57.20分，顯示對護理指導的需求介於「有點需要」與「需要」之間。護理指導介入後，慢性阻塞性肺病病人居家自我照顧需求總平均得分1.04（SD=0.09），需求總分為29.26分，顯示對護理指導的需求傾向於「不需要」。二、護理指導介入對慢性阻塞性肺病病人居家自我照顧需求，呈現統計學上顯著差異，藥物治療需求、氧氣治療需求、營養需求、肺部復健需求、睡眠問題需求、支持需求在護理指導介入後，均有顯著差異，並達統計學上p<. 000的顯著差異。三、病人特性與對居家自我照顧需求之分析結果：有無使用氧氣設備與氧氣治療需求呈現統計學上顯著差異（t= -2.93, p< .036），有使用氧氣設備者對氧氣治療需求較高；使用氧氣設備之種類者不同與氧氣治療需求呈現統計學上顯著差異（F =19.06, p< .000）；疾病嚴重度與氧氣治療需求呈現統計學上顯著差異（F =8.81, p < .000），疾病嚴重度第四級者對氧氣治療需求較高。
本研究結果證明護理指導介入能顯著降低慢性阻塞性肺病病人居家自我照顧需求程度，此結果可作為護理專業人員於臨床護理工作之應用，也可提供學校教學者與醫院臨床護理教育者在教學上之參考。

關鍵字

慢性阻塞性肺病 ； 護理指導 ； 居家自我照顧需求

並列摘要

The aim of this study is to evaluate the effect of nursing intervention for the satisfaction of home self care needs level of patients with Chronic Obstructive Pulmonary Disease (COPD). This study use the pre-post test experimental design in order to collect cases. Total 106 patients were included in this study. We designed a “Questionnaire for the Home Self Care Needs Level in Patients with Chronic Obstructive Pulmonary Disease” This questionnaire was designed and examined by Expert validity. And we choice the 28 questions in 6 gropus which Content validity index (CVI) of .86, and reliability was demonstrated by Cronbach' α of .803. Prior to the nursing intervention, we use the “Questionnaire for the need of Home Self Care Needs Level of Chronic Obstructive Pulmonary Disease Patients” to evaluate need of the patients. Than we gave the individual nursing intervention by their needs. We repeated to fill the same questionnaire 2 weeks after first intervention in order to analyze the variance of the effect of needs satisfaction pre- and post- nursing intervention.
The data was analyzed by frequency, percentage, average, standard deviation, independent-t test, paired-t, and One-Way ANOVA. Results:
1. Before the nursing intervention, the average score of home self care needs in patients with COPD is 1.96（SD=0.28）, the average total score is 57.20. It shows the needs in nursing intervention between “mild need” and “need”. After the nursing intervention, the average score is 1.04（SD=0.09）, the average total score is 29.26. It shows the needs in nursing intervention trend to “not need” .
2. It is significant difference of statistical between pre- and post- nursing intervention. In the patients with COPD before and after the nursing intervention, it showed statistical difference in the needs of medication, oxygen therapy, nutrition, rehabilitation, sleeping disorder, and support etc.
3. To analyze the characters of patients and their needs, it is statistical significant difference between the groups of patients with and without oxygen devices at home（t= -2.93, p< .000）. There is more oxygen need in patients who use oxygen therapy devices at home. The use of devices and equipments in individual patients results in a statistical significant difference of the needs of oxygen therapy.（F =15.76, p < .000）. And the severity of disease and the needs of oxygen shows correlation in statistics（F =8.81, p< .000）.The patients with grade IV disease need more oxygen therapy.
This study showed the nursing intervention may reduce the needs of home self care needs in patients with COPD. The result can be applied in clinical nursing work, and also provide as a reference for the nursing education.

並列關鍵字

COPD ； nursing intervention ； home self care needs level

參考文獻

行政院衛生署（2005）•台灣衛生網•2007年3月5日取自

葉若文、高儷娟（2007）•執行一位慢性阻塞性肺疾病病人肺部復健之照護經驗•馬偕護理雜誌，1（1），90-96。

熊得治、謝文斌（2003）•氣喘及慢性阻塞性肺疾病人者的睡眠•當代醫學，30（8），624-629。

吳敬恆、謝文斌（2001）•營養與慢性阻塞性肺疾的關係•當代醫學，28（10），787-792。

郭益莉、白玉珠（2004）•應用歐式理論照顧一位慢性阻塞性肺疾病人者之護理經驗•慈濟護理雜誌，3（1），98-106。