探討護理指導對首次急性心肌梗塞上班族自我照顧的認知與自我效能之成效

The Awareness and Self-Efficacy of Self-Care and the Effect of Nurses' education in Salarymem After their First Acute Myocardial Infarction

李靜宜(C-hing-Yi Lee)

指導教授 ： 邱艷芬

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00058

摘要

本研究旨在探討首次發生心肌梗塞之存活者出院後自我照顧的認知與自我效能，並評估護理指導的有效性，以新竹某區域教學醫院首次發生急性心肌梗塞上班族的住院病人，採類實驗性設計，以方便取樣方式收實驗組30人和對照組30人，並以結構式問卷進行資料收集，結構式問卷包括基本資料、健康狀況、心肌梗塞後自我照顧知識、自我效能量表及心肌梗塞後生活品質量表。全體個案於住院時給予常規性衛教，並於出院前進行收集資料，之後實驗組立即進行「急性心肌梗塞病人之自我照顧手冊」介入，對照組則返診後一個月先收集資料，之後進行「急性心肌梗塞病人之自我照顧手冊」介入，兩組皆在門診返診後一週、四週、十二週以自擬之心肌梗塞後自我照護認知量表、Sullivan自我效能量表、Thompson生活品質量表之問卷進行收集資料。
所得結果將採用SPSS for Windows 17.0中文版套裝統計軟體進行統計分析。統計方法包括：獨立性t檢定、卡方檢定、相依樣本t檢定、皮爾森積差相關係數(Pearson’s correlation)及變異數分析(ANO VA)等。研究結果：(1)個案之自我照顧知識分數於出院後三個月最高，實驗組與對照組(分別為10.8±1.3分，9.4±1.9分)，自我照顧知識項目中以危險因子分數明顯增加(p<0.01)。(2)個案之自我照顧知識答對率於出院前最低，在衛教介入後，以出院後三個月自我照顧答對率最高，排序上兩組皆為在危險因子自我照顧知識最高排序，對照組在出院後一個月衛教介入，比較出院後一個月與出院後三個月自我照顧知識答對率，以危險因子及藥物服用答對率有顯著差異(p<0.05)。(3)個案之自我效能分數，實驗組於出院後一個月明顯增加，隨著時間進展，自我效能分數於出院後三個月最高(F=4.79, p< 0.0 1)。(4)個案之自我照顧知識與自我效能，在實驗組於出院後一週至出院後三個月為正相關(p<0.05)。個案之整體生活品質分數，實驗組與對照組在出院後三個月(分別63.6 v.s 82.3)比出院前(分別95.4 v.s 91.8)均明顯有改善(p<0.01)。研究結果可在護理上的運用，提供臨床護理人員對於首次急性心肌梗塞病人在出院前給予系統性護理指導，藉以達到預防疾病再發生，更進一步提昇病人的生活品質。

關鍵字

護理指導 ； 首次急性心肌梗塞 ； 上班族 ； 自我照顧 ； 自我效能

並列摘要

The first time this study was to investigate the survivors of myocardi al infarction after discharge self-care knowledge and self-efficacy, and to assess the effectiveness of nursing instruction to a regional teaching hosp ital in Hsinchu, the first acute myo
cardial infarction patients office worke rs, mining quasi-experimental design, sampling method to facilitate the expe rimental group received 30 and the control group of 30 people, and a structured questionnaire to collect data, structured questionnaire includeingg basic data, health status, knowledge, self-care after myocardial infarction, self-efficacy scale and quality of life questionnaire after myocardial infarction. When all the samples at the hospital to give regular health education and collect information befor e discharge, the experimental group immediately after the "acute myocardial infarcti on patients self-care manual" in tervention in the control group one month after the first return visit to collect data, after "acute myocardial infarction patients self-care manual" intervention, both groups returned to the outpatient clinic one week after four weeks, twelve weeks after myocardial infarction by self of self-care know ledge questionnaire, Sullivan Self-Efficacy Scale, Thompson Quality of Life Products Table of the questionnaire to collect data.
The results will be used SPSS for Windows 17.0 statistical software package Chi nese version of the statistical analysis. Statistical methods include: the independence oft test, chi square test, paired t test, Pearson corr elation coefficients (Pearson's correl ation) and analysis of variance (ANOVA) and so on. Results Results: (1) case of self- care knowledge scores hi ghest in three months after discharge, experimental group and control (1 0.8±1.3 min,9.4±1.9 points), self-care knowledge project to significantly increase the risk factor score (p <0.01). (2) cases of self-care knowledge, the lowest correct response rate before discharge, in the health education intervention, three months after discharge self-care to the highest rate of correct answers, sort the two sets of self -care are all risk factors in the highest sort of knowledge, the control group one month after discharge from hospital health education intervention, one month after discharge compared with three months after discharge rates of self-care knowledge and correct answers to correct risk factors and drug use rates were significantly different (p < 0.05). (3) cases of self-efficacy scores, the experimental group significantly increased one month after discharge, as time progress, self-efficacy scores highest in three months after discharge (F = 4.79, p < 0.01). (4) cases of self-care knowledge and self-efficacy, in the experimental group one week after discharge from hospital in three months after a positive correlation (p <0.05). Cases, the overall quality of life scores, the experimental group and control group three months after discharge (respectively 63.6 vs 82.3) than before discharge (respectively 95.4 vs 91.8) have improved significantly (p <0.01). The results can be used on nursing provides nurses with acute myocardial infarction patients for the first time I n the systematic nursing instruction given before discharge, in order to prevent disease recurrence, further improve patient quality of life.

並列關鍵字

First acute myocardial infarction ； Salarymen ； Self-efficacy ； self care

參考文獻

林敏玲、邱艷芬(2001)。花蓮地區心臟衰竭病患對疾病認知、態度及自我照顧行為相關性之探討。慈濟醫學，13(1)，57-64。

許淑蓮(2000)。初患心肌梗塞病人不確定感與焦慮反應-因應行為效應之探討。護理研究，9(2)，159-171。

葉玫玲、邱艷芬(1998)。心肌梗塞病患住院期間發生不確定感內容及其相關因素之探討。護理研究，6(6)，501-512。

葉美玲、陳興夏、劉碧霞(2004)。髖關節置換術護理指導：多媒體影音光碟與手冊之研發與測試。醫護科技學刊，6(2)，141-152。

羅家儀(2004)。照護年輕心肌梗塞病患之我見。榮總護理，21(3)，268-276。