透過您的圖書館登入
IP:3.235.243.45
  • 學位論文

出院燒傷病人生活品質及其相關因素之探討-以某復健機構服務之病人為例

Discharged Burn Patients Quality of Life and Related Factors: Survey at Rehabilitation Institution

指導教授 : 張媚

摘要


燒傷是一種創傷性的損傷,燒傷病人除了需要承受住院時的生理煎熬及心理上的衝擊,出院後還須面對傷口的後續照護、疤痕增生、肢體攣縮及變形、復健治療等後續照護問題,外觀及日常生活的改變,更影響到生活品質。本研究目的在探討接受復健機構服務之出院燒傷病人生活品質及其相關影響因素。採橫斷式描述性設計,以立意取樣選取於陽光社會福利基金會接受復健與照顧之32位燒傷病人為研究對象。研究測量工具為結構式問卷,包括個人基本屬性、疾病特性、日常生活活動功能量表及世界衛生組織生活品質問卷台灣簡明版等四部分。統計方法包括將差異性者進行曼惠特尼U考驗(Mann-Whitney U test)與克-瓦二氏單因子等級變異數分析(Kruskal-Wallis One-Way ANOVA)執行檢定,關聯性者將以史皮爾曼等級相關分析(Spearman Rank Correlation)進行檢定,以多元迴歸分析(Multiple Regression)發現生活品質之預測因子。 研究結果顯示(一)本研究機構內燒傷病人的整體生活品質平均得分為48.44,低於一般民眾及其他慢性病病人。(二)個人基本屬性與「整體生活品質」的生活品質感受並無顯著關係。僅宗教信仰與社會範疇的生活品質有顯著關係,有宗教信仰病人在社會範疇的生活品質感受優於無宗教信仰者。(三)大部分的疾病特性與生活品質皆無明顯的關聯性存在,僅疾病特性(燒傷面積、燒傷部位數、疤痕攣縮部位數、疤痕影響關節部位數)與社會範疇的生活品質有顯著關係,疤痕攣縮部位數亦與整體生活品質有顯著的正相關。(四)日常生活活動功能與生活品質無顯著相關,可能因研究樣本在「日常生活活動功能」指數的差異程度不大。(五)燒傷病人生活品質之預測因子:「燒傷面積」為「生理範疇」生活品質之預測因子,解釋力為23.8%,面積>25%之重度燒傷者較面積<15%之輕度燒傷者差。接受機構服務項目數是「心理範疇」生活品質之預測因子,解釋力為15.8%,接受機構服務項目越多者,越佳。疤痕攣縮部位數、宗教信仰及教育程度是「社會範疇」生活品質之預測因子,三者解釋力共43.0%,疤痕攣縮部位數越多、有宗教信仰者,「社會範疇」生活品質越好;大學以上畢業者較高中職以下畢業者有較差的「社會範疇」生活品質。燒傷面積及婚姻是「環境範疇」生活品質之預測因子,解釋力共28.7%。燒傷面積>25%優於面積<15%者及已婚者優於未婚者。燒傷面積亦為整體生活品質之預測因子,解釋力為17.1%,面積>25%者優於面積<15%者。

並列摘要


Burns is a traumatic injury. In addition to suffering the physiological and psychological impact during hospitalization, burn patients had to face the subsequent wound care, hypertrophic scars, scar contractures, deformed limbs, rehabilitation therapy, other follow-up care issues, and change in appearance and daily life after discharge. All of above affect their quality of life. The purpose of this study was to investigate the correlation between quality of life and burn-related factors for discharged burn patients who assisted by a rehabilitation institution. We adopted cross-sectional descriptive correlation design and purposive sampling in 32 burn patients who were rehabilitated and taken care of by Sunshine Social Welfare Foundation. Research tools were questionnaires which included four parts as below: basic personal attributes scale, disease characteristics scale, Activities of Daily Life(ADL) scale, and World Health Organization Quality of Life-BREF(WHOQOL-BREF). Inferential statistical methods included testing the differences by using the statistical tests, "Mann Whitney U test" and "Kruskal-Wallis One-Way ANOVA" testing the relevance by using "Spearman Rank Correlation analysis" and found the predict factor of life quality by using "Multiple Regression" . The results showed that: (1) The average score of quality of life for burn patients in this research was 48.44 which was lower than general population and patients with other chronic diseases. (2) There was no direct correlation existed between basic personal attributes and "overall quality of life". The only related variable with quality of life was religion. The result showed that patients with religion achieved better quality of life than non-believers. (3) In the summary of correlation analysis of disease characteristics and quality of life, there was no obvious correlation between the majority of disease characteristics and quality of life. The social relationship domain was the only variable related to more disease characteristics (burn surface area, figures of burn areas, figures of scar contractures, and figures of joints affected by scars) in quality of life category. The overall quality of life had significantly positive correlation with the number of scar contractures. (4) Daily life functions and quality of life relevance: Because there was no big difference in the variable of daily life functions index for burn patients, it was difficult to predict the correlation between "daily life functions" and "quality of life". (5)The predictive factors of quality of life in burn patients: "Total burn surface area (TBSA)" was the predictive factor to determine the quality of life in "physical domain". The explanatory power was 23.8%(R2 = .238). Severe burn patients with TBSA > 25% were worse than those mild burn patients with TBSA<15%. The item number of acceptance service was the predictive factor to determine the quality of life in "psychological domain". R2 =0.158. The more service item person accepted, the better was his quality of life. Figures of scar contractures, religion, and education were the predictive factors to determine quality of life in "social relationship domain". Total R2 of these three items was 0.430. The person who had religion and more scar contractures had better quality of life in social relationship domain. The person with bachelor degree or higher had worse quality of life in social relationship domain than those with high school diploma or lower. TBSA and marriage were the predictive factors to determine the quality of life in environment domain. R2=0.287. The person with TBSA>25% was better than the TBSA<15%. Married person was better than those unmarried. TBSA was the predictive factor as well to determine the overall quality of life. R2=0.171. The person with TBSA>25% was better than the TBSA<15% in overall quality of life.

參考文獻


李明濱、吳其炘(2004)•燒傷之心身醫學觀•北市醫學雜誌,1(3),252-260。
姚開屏(2002b)•健康相關生活品質概念與測量原理之簡介•台灣醫學,6(2),183-192。
台灣版世界衛生組織生活品質問卷發展小組(2005)•台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊(第二修訂版)•台北:台灣簡明版世界衛生組織生活品質發展小組。
姚開屏(2002a)•台灣版世界衛生組織生活品質問卷之發展與應用•台灣醫學,6(3),193-200。
李德芬、林欣潔、吳佳玟、吳嘉純、林美珍(2004)•燒燙傷病患的疼痛處置・疼痛醫學雜誌,14(2),74-85。

被引用紀錄


周彥慈(2017)。復原期燒傷病患之身體心像、自尊與社交焦慮〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0003-2307201722132900

延伸閱讀