接受胃切除胃癌病人的症狀嚴重度、不確定感與希望狀態之探討

Perceived Symptom Severity, Uncertainty and Hope in Patients with Gastric Cancer Undergoing Gastrectomy

高翡勵(Fei-Li Kao)

指導教授 ： 賴裕和

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

胃癌是台灣常見的癌症，手術是主要的治療方法，然而外科病房中的護理人員由於缺乏研究為基礎的資料，常未加以注意胃癌病人手術前後即刻身心變化的情形，而無法給予病人更即時的評估與護理。故本研究的目的針對胃切除癌症病人探討其在手術前後症狀嚴重度、不確定感、希望狀態的差異情形，以及三者間的相關性。研究採縱貫性相關性研究方法，於台北市某醫學中心一般外科病房，以接受胃切除癌症病人為收案對象，採立意取樣方式利用量表，於手術前一到兩天、術後一星期及術後十到十二天共九個時間點進行資料的收集，研究工具包括症狀嚴重度量表、Mishel疾病不確定感量表社區版、赫氏希望指標。收集的資料以描述性統計、重複測量、皮爾森基差相關等方法分析。其結果發現胃癌病人症狀嚴重度以術後第一、四及第五天較高，其不確定感手術前為最高，經手術治療後顯著降低，且手術前後之不明確性感受分數皆比複雜性感受高，可知不確定感的來源為對疾病狀態、手術結果不明確、不清楚的感受明顯高於相關治療與照顧系統的複雜與變化的感受，病人的希望狀態於手術前後皆處於中等程度的希望狀態。病人手術前後的不確定感越低則希望狀態越高，大部分所感受的疼痛程度、疲憊程度會影響到病人的不確定感，呈現顯著正相關。本研究結果可得知手術前後不確定感及希望狀態的改變情形，並可提供臨床護理人員一個實證性的資料來瞭解病人所經歷的不適症狀之變化趨勢，藉此結果可做為臨床的護理人員提供相關措施降低症狀嚴重度、不確定感，進而提升病人希望狀態之依據。

關鍵字

胃癌 ； 胃切除術 ； 症狀嚴重度 ； 疾病不確定感 ； 希望狀態

並列摘要

Gastric cancer is one of the major cancers in Taiwan. Surgery is the major treatment modality. However, due to lack of sufficient attention on patients’ post-operation experiences clinically, we did not know how patients’ experiences during early stage of gastrectomy. The purposes of this longitudinal study were to investigate the changes of symptom severity, uncertainty, hope, and their relationship among patients with gastric cancer before and after gastrectomy. Eligible subjects were recruited by purposive sampling from general surgery inpatient wards in a medical center in Taipei. Data were collected one to two days before surgery (T 1), each day in the first week post-surgery (T 2-8), and either day during 10 to 12 (T 9), with total 9 data collection points. Data were collected by using Basic Information Form, Numerical Rating Scale of Symptom Severity, Mishel Uncertainty in Illness Scale for Community (MUIS-C), and Herth Hope Index (HHI). Data were analyzed by using descriptive statistics, repeated measured ANOVA, and Pearson’s correlation. The results showed that: (1) The levels of symptom severity were higher in the first, fourth and fifth day after surgery. (2) Uncertainty was greatest before surgery and it declined over the course of treatment. Scores for ambiguity were higher than scores for complexity in pre- and post-surgery. (3) The levels of hope were both medium before and after operation. (4) Uncertainty were negatively related to hope, but positively correlated with pain intensity in average and levels of fatigue intensity during gastrectomy. The evidence-based results can help nurses better understanding the changes of symptom severity, uncertainty and hope among patients receiving gastrectomy, and to develop interventions to enhance better care for these patients.

並列關鍵字

gastric cancer ； gastrectomy ； symptom severity ； uncertainty ； hope

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