習得智謀方案介入於失能者之高齡家庭照顧者習得智謀、照顧負荷及生活品質成效探討

The Effectiveness of a Learned Resourcefulness Intervention on Learned Resourcefulness, Caregiver Burden, and Quality of Life for Older Family Caregivers of the Disabled Adults

陳孟君(Meng-Chun Chen)

指導教授 ： 林淑媛

高雄醫學大學/護理學院/護理學系博士班/博士(2020年)

摘要

研究背景：失能者的照顧趨向多重及複雜，易使高齡家庭照顧者出現不同程度照顧負荷，長期處於沉重的照顧負荷，生活品質會受到影響，提供習得智謀介入策略幫助高齡家庭照顧者發展適應性行為，可能可以降低照顧負荷，增加生活品質。
研究目的：本研究在探討習得智謀方案介入於失能者之高齡家庭照顧者在習得智謀、照顧負荷及生活品質的成效。比較實驗組與對照組在習得智謀方案介入前、介入後第5週及第9週在習得智謀、照顧負荷及生活品質之差異。
研究方法：採類實驗性研究(Quasi-experimental study)重複性測量設計，以方便取樣，於台灣南部某區域教學醫院門診、居家護理所及三個社區收案94位60歲以上高齡家庭照顧者。並依其意願分派為實驗組(n=46)，接受習得智謀方案，或對照組(n=48)維持原有居家照護模式。共有實驗組44人、對照組41人完成本研究，實驗組接受為期4週的習得智謀方案，內容包括一次面對面衛教指導及三次每週電話追蹤。兩組均接受自我控制量表、家庭照顧者照顧負荷量表及歐洲生活品質評估量表EQ-5D之前測，分別於第5週及第9週再進行後測。採SPSS 22.0統計軟體以描述性統計、獨立樣本t檢定、卡方檢定及一般廣義估計方程式進行分析。
研究結果：家庭照顧者平均年齡為69.34± 6.66歲；多數為女性( n = 63; 67.02%)、國小教育程度( n = 33; 35.11%)。經由廣義估計方程式分析結果呈現：在習得智謀方面，實驗組的習得智謀改變優於對照組具有組間顯著差異；相較於對照組，實驗組於第5週( p < .001)及第9週( p < .001)在習得智謀的組別與時間交互作用有顯著差異；在照顧負荷方面，實驗組的照顧負荷改變優於對照組有組間顯著差異；實驗組於第5週(p = .001)及第9週( p < .001)在組別與時間交互作用亦有顯著差異；在生活品質方面，實驗組的生活品質改變優於對照組有組間顯著差異；而生活品質程度僅在介入措施後第9週的組別與時間交互作用達顯著差異( p = .025)。
結論與實務應用：本研究支持四週的「習得智謀方案」可提升高齡家庭照顧者的習得智謀與生活品質，減輕照顧負荷。未來可作為長照機構、社區與居家護理人員推展改善高齡家庭照顧者照顧負荷，提升生活品質方案之參考。

關鍵字

習得智謀方案 ； 失能者 ； 家庭照顧者 ； 照顧負荷 ； 生活品質

並列摘要

Background: The multiplicity and complexity of care for people with disabilities impose a substantial burden on older family caregivers, which in turn reduces caregivers’ quality of life. Applying a learned resourcefulness intervention to older family caregivers to develop adaptive behaviors may reduce their caregiving burden and improve their quality of life.
Objectives: The purposes of this study were: (1) to determine the effectiveness of a learned resourcefulness intervention on learned resourcefulness, caregiver burden, and quality of life for older family caregivers of the disabled adults; (2) to compared the learned resourcefulness, caregiving burden, and quality of life of experimental and control groups of participants before implementing a learned resourcefulness intervention and at the 5th and 9th weeks after implementing the intervention. The SPSS 22.0 statistical package was used to collect and analyze data, which were analyzed using descriptive statistics, independent-samples t test, chi-squared test, and a generalized estimating equation (GEE) model.
Methods: A total of 94 older family caregivers aged 60 years or older were recruited from outpatient clinics, home care centers, and three communities. The study assigned the participants to an experimental group (n=46), which received the learned resourcefulness intervention, or a control group (n=48), which applied the existing home care model, according to their preference. A total of 85 family caregivers (experimental group n = 44; control group n = 41) completed this study. The intervention in the experimental group lasted 4 weeks and included one face-to-face health education instruction and three weekly telephone follow-ups. A pretest including the Rosenbaum’s Self-Control Schedule (SCS), the Care Burden Scale (CBS), and the European Quality of Life-5 Dimension (EQ-5D) instrument was administered on both groups; two groups received posttests at the 5th and 9th weeks after implementing the intervention.
Results: The mean age of the family caregivers was 69.34± 6.66 years. Over half of caregivers were femeral (n = 63; 67.02%) and over one-third of caregivers had elementary education (n = 33; 35.11%). Generalized estimating equation analyses showed that a significant group–time interaction effect on learned resourcefulness and caregiver burden in the experimental group at the 5th week (p < .001) and the 9th week (p < .001) as compared with the control group; the interaction effect on quality of life was significant only at the 9th week (p = .025).
Conclustions / Implications for practice: The results indicated that the 4-week learned resourcefulness intervention improved the learned resourcefulness, quality of life, and reduced the caregiving burden on family caregivers. This study results may be serve as a reference for long-term care facilities, communities, and home care nurses in reducing the caregiving burden on and improving the quality of life of older family caregivers.

並列關鍵字

learned resourcefulness program ； disabled ； family caregivers ； caregiver burden ； quality of life

參考文獻

Zauszniewski, J. A. (1995). Learned resourcefulness: A conceptual analysis. Issues in Mental Health Nursing, 16(1), 13-31. doi:10.3109/01612849509042960

一、中文部份

王士華、戎瑾如、陳喬琪、魏秀靜、林寬佳(2007)‧青少年精神分裂症病患主要照顧者相關壓力、習得智謀與照顧負荷之研究‧護理雜誌，54(5)，37-47。doi: 10.6224/JN.54.5.37

王春葉、林佑樺、李憶農、陳靖博、林耀信(2002)‧血液透析病患主要照顧者的負荷及其相關因素之探討‧台灣腎臟護理學會雜誌，1(1)，31-46。

王俐潔、陳威宇、張書展、黃安年、洪榮駿、王瑞霞(2011)‧消化道末期癌症病患居家主要照顧者之照顧負荷與相關性因素探討‧護理雜誌，58(6)，54-64。doi: 10.6224/JN.58.6.53