運用壓傷應用程式於主要照顧者初次面臨壓傷照護自我效能與行為之成效探討

The Effects of Educational Program Using Mobile Application(APP) on Self-efficacy and Skill of Caregivers for the First Time to Care Pressure Injury

蔡昀蓁(Yun-Chen Tsai)

指導教授 ： 李淑杏

中山醫學大學/醫學院/護理學系/碩士(2020年)

https://doi.org/10.6834/CSMU201900277

摘要

研究背景：壓傷為住院常見的合併症，常增加醫療費用及病人死亡率。病人出院返家若有壓傷情形，其主要照顧者對於壓傷處理的自我效能與行為將成為照護關鍵。過去對於壓傷照護較多以衛教單張的指導方式，本研究將發展創新資訊技術導入智慧手機，做為主要照顧者初次面臨壓傷照護自我效能與行為之介入。
研究目的：本研究探討運用壓傷照護應用程式Mobile Application(APP)衛教軟體於主要照顧者初次面臨壓傷照護自我效能、行為與使用滿意度之成效。
研究設計：本研究採單盲及隨機抽樣試驗。
研究方法：於2018.10.24~2019.10.23期間，以中台灣某教學醫學中心內科病房及高齡病房初次發生1、2級壓傷且即將出院病人的主要照顧者為對象，使用亂碼數分成實驗組及控制組。以「壓傷照護應用程式」作為實驗組介入措施，控制組則為傳統書面衛教措施。所有研究對象於出院前皆完成基本資料、「壓傷照護自我效能」及「壓傷照護行為」前測問卷，之後依據組別進行衛教介入，返家一週後，研究者利用電訪完成「壓傷照護自我效能」及「壓傷照護行為」後測問卷訪查。本研究收案共計102位(實驗組51位、控制組51位)，實驗組排除10位，控制組排除12位，流失率共21.5%，總計實驗組納入41位及控制組納入39位。資料進行編碼，再以SPSS 19.0版進行統計分析。以卡方檢定及獨立T檢定進行敘述性分析，以Wilcoxon配對組符號等級檢定、曼惠特尼U檢定及共變數分析進行推論性分析。
研究結果：兩組在病人基本屬性、疾病特性、主要照顧者基本屬性、「壓傷照護自我效能」總分中位數、「壓傷照護行為」總分中位數之前測資料採用無母數統計均無顯著差異(p＞.05)，顯示兩組同質性高。分析兩組之間其後測的「壓傷照護自我效能」總分中位數，實驗組與控制組分別為49.83 vs.30.69，呈顯著差異(p＜.01)；「壓傷照護行為」則二組無顯著差異(p＞.05)。以Wilcoxon配對組符號等級檢定進行兩組內配對，於「壓傷照護自我效能」及「壓傷照護行為」前、後測總分中位數皆呈顯著差異(p＜.01)；顯示兩組主要照顧者之壓傷照護自我效能及行為均顯著提升。實驗組主要照顧者使用壓傷照護應用程式之滿意度項目多數達95%。
結論：壓傷照護應用程式及傳統書面衛教介入後皆可提升主要照顧者壓傷照護自我效能及行為，觀察研究結果發現壓傷照護應用程式比傳統書面資料進步分數較高，顯示壓傷照護應用程式能讓主要照顧者提升其壓傷照護自我效能且滿意度高，但無法提升照護行為。病人出院後仍需專業人員定期訪查或提供居家服務，然壓傷照護應用程式具有潛在之功能，未來可建構社區健康照顧團隊及服務資源的網絡化，可提供更健全且有效率的社區健康服務。

關鍵字

行動醫療應用程式(APP) ； 壓傷照護自我效能 ； 壓傷照護行為

並列摘要

Bacckground: Pressure injury is a common comorbidity in hospitals that often increases medical costs and patient mortality. After a patient is discharged from the hospital, the self-efficacy and skill of the caregiver are the key to care in the treatment of patients with pressure injury. Traditionally, health providers have used leaflets to provide guidelines for caring for patients with pressure injury before they are discharged. In this study, an innovative mobile application was developed for smart phones to evaluate the effects on the self-efficacy and skill of caregivers for the first time in caring for pressure injury.
Aim: To evaluate the effects of an educational program using a mobile application on the self-efficacy and skill of caregivers for the first time in caring for pressure injury
Design: This study had a single-blinded randomization design.
Methods: The study was conducted in a medical ward and senior ward of a medical center in Taiwan from October 24, 2018, to October 23, 2019. The participants were caregivers who were taking care of patients that had first and second-degree pressure injuries and were about to be discharged. The participants were randomized to divide them into experimental and control groups. The experimental groups used an education program through a mobile application for pressure injury care, and the control groups used routine health education methods. A total of 102 cases were collected. There were 10 cases that were excluded from experimental group, 12 cases were excluded from the control group, and the attrition rate was 21.5%. The experimental group comprised 41 cases, and the control group had 39 cases. Each caregiver completed a pre-test before the patient was discharged. Both groups also completed a post-test within 1 week after the patient was discharged. Data were coded, and statistical analyses were performed using SPSS version 19.0. A descriptive analysis was performed using the chi-squared test and independent t-test, and an inferential analysis was performed using a Wilcoxon paired group symbol level test, Mann Whitney U test, and covariate analysis.
Results: The nonparametric statistics showed that there were no significant differences between the experimental and control groups in regard to the demographic data and disease characteristics of the patients, as well as the caregivers’ demographic data and median total scores on the pre-test. This shows that there was homogeneity between groups. The caregivers’ median total scores on the post-test were 49.83 vs. 30.69 in the experimental and control groups, respectively, which had statistical significance (p＜0.01). The difference in median total scores on the post-test between the groups was not statistically significant (p＞0.05). The Wilcoxon paired group symbol level test was used to perform pairing within the two groups, and there were significant differences in the median total scores from before and after the education for self-efficacy and skill for pressure injury care (p < 0.01). This shows that the self-efficacy and skill were significantly improved in both groups. The satisfaction rate reached 95% for the caregivers in the experimental group.
Conclusions: Both the experimental group and the control group showed improved self-efficacy and behavior in pressure injury care. However, the results showed that the experimental group had a higher improvement score in self-efficacy but not in skill for pressure injury care than the control group. The experimental group was also satisfied with using the pressure injury care application. Patients need regular visits or home services from professionals after discharge. In the future, a network of community healthcare teams and services using technology resources could be constructed to provide more complete and efficient community health services.

並列關鍵字

medical mobile applications ； pressure injury care app ； self-efficacy of pressure injury care ； skill in pressure injury care

參考文獻

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Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2), 191.

中文部分

于博芮、李世代、林壽惠(2005)．台灣醫療院所壓瘡風險評估工具之臨床效度．台灣老年醫學雜誌，1(2)．79-88。doi:10.29462/tgg.200511.0004

田沁潔、賴惠玲、許文林、彭逸稘、李茹萍(2007)．護理衛教對頭頸部癌症病人口腔照顧認知，健康信念及自我效能之成效．實證護理，3(3)，215-224。