國際健康功能與身心障礙分類系統(ICF)與護理四大概念在腦中風護理照護之連結

The Linkage between the International Classification Of Functioning, Disability And Health (ICF) and the Four Core Concepts Of Nursing on Stroke Nursing Care

簡惠慧(Hui-Hui Chien)

指導教授 ： 賴甫誌

臺北醫學大學/護理學院/護理學研究所/碩士(2015年)

https://doi.org/10.6831/TMU.2015.00032

摘要

腦中風是成人目前身心障礙及死亡的主要原因之一，身體活動功能障礙是最常見的後遺症，其恢復後的長期照護問題成為健康重要議題，中風患者護理評估及實務照護上更面臨許多困難與問題。世界衛生組織於2001年公佈了國際健康功能與身心障礙分類系統（International Classification of Functioning , Disability and Health, ICF），ICF除了身體功能和構造、活動和社會參與因子外，更將環境和個人因素納入，認為疾病、功能、個人和環境間為互動而形成，考量到活動參與及環境因素作為身心健康之需求評估，重視所處環境對個人活動參與和健康的影響，以提供腦中風病患所需之照護需求及健康促進。
本研究目的為以護理四大概念探討國際健康功能與身心障礙分類系統ICF在腦中風護理模式之建構。研究方法：描述性研究，立意取樣長照機構之腦中風148位個案為研究對象，經由歸納及整理相關文獻擬出「腦中風病患國際健康功能與身心障礙分類系統ICF分類碼之健康失能狀況表」之問卷，進行觀察、訪談病患或主要照護者進行資料收集，以護理四大概念為架構，以SPSS 19版及AMOS 22版統計軟體進行資料分析和腦中風病患整體模式之建構。研究結果：以皮爾森相關係數分析整體ICF核心分類碼之間的相關聯性，整體身體功能b碼與活動參與d碼、環境e碼及s碼均有顯著相關(r=.18~774, p<.05~.001)；進一步分析ICF架構(健康及環境)與護理照護(巴氏量表、IADL量表)之間整體模式關係性，健康-環境(r=.99, p<.001)；健康-護理(r=.91, p<.001)；環境-護理(r=.97, p<.001)，腦中風病患照護整體模式建構成立。結論：護理四大概念在研究對象基本屬性對健康、環境、護理構面有相關顯著影響，整體模型發現健康、環境、護理三大構面間具有高度顯著關係，證實了環境的差異對健康產生不同的影響，更凸顯出ICF架構中身體功能、活動參與及環境評估的重要性。建議未來研究可擴展至ICF架構可將核心分類碼部分作為其他急性或慢性疾病的預後、功能維持與健康相關之生活品質的評量工具之相關研究，以提供日後長照機構評估與照護品質指標追蹤監測的實證參考。

關鍵字

ICF ； 護理四大概念 ； 結構方程式 ； 腦中風照護 ； 長照機構

並列摘要

Stroke is the major cause of disabilities and death for adult. The most common sequelae of stroke is physical and functional disable. Therefore, health and care challenges the stroke patients encountered are long-term care need, assessment, and clinical practice. The world Health Organization (WHO) launched the International Classification of Functioning, Disability and Health (ICF) in 2001 that integrated body function, structures, activities and participation in social factors along with the environmental and personal into the interactions among the disease, functional, personal and environmental. Active participation and environmental aspects are taken into account of assessing the environmental impact on individual’s active participations and health that to provide the quality care and life for stroke patients.
This quantitative descriptive study aimed to explore the linkage of between ICF core sets with four core concepts of nursing on stroke care with purposive sampling of 148 long-term care facility stroke residents. Research instruments used in this study were developed with induction and literature reviews. Data was collected from the observation of participants and interviews with main care provider. The linkage between ICF and four nursing concepts framework is delineated with statistical analysis of SPSS 19 and AMOS that descriptive and inferential data of model construction are carried out.
The Pearson correlation coefficient has shown the categories of ICF core set for the stroke: the whole body function b code, participation d code, environment e code & body structure s code were significantly related(r=.18~.774, p<.05~.001).The whole model of stroke patients was well construction on the domains of health-environment(r=.99, p<.001), health-nursing (r=.91, p<.001), environment-nursing (r=.97, p<.001).
Conclusion: Application of four core concepts of nursing on stroke nursing care, the significant founds were between the participants’ attribute and health, environment, nursing domain. The whole model represented these three domians( health, environment, nursing) were high correlation coefficient. Hence, it was confirmed that different environment was effect on health. In other words, it was important that body activities, participation & environment were assessed in ICF.
Recommendations of the study will be expanded to ICF architecture as part of the core classification code other acute or chronic disease prognosis, functional sustain future research and health-related quality of life assessment of the amount of tools to provide a future long-term care institutions to assess the quality of care indicators track empirical reference monitor.

並列關鍵字

ICF ； the Four Core Concepts of Nursing ； Structural equation modeling ； SEM ； stroke care ； long-term facilities

參考文獻

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