應用過渡理論模式於肝癌病患出院準備度及出院適應情形之相關性研究

Application of transition theory to Perceived Readiness and Post-Discharge Coping Difficulty of patient with Hepatocellular Carcinoma

紀媚慈(Mei-Tzu Chi)

指導教授 ： 周汎澔

高雄醫學大學/護理學院/護理學系研究所/碩士(2012年)

摘要

本研究旨在探討肝癌病患出院準備度及出院後適應情形之相關因素，研究目的為：(1)探討肝癌病患人口學特性、住院因子與出院準備度之相關性;(2)探討肝癌病患人口學特性、住院因子與出院後適應之相關性;(3)分析肝癌病患出院準備度與出院後適應情形之相關性;(4)探討肝癌病患出院準備度之預測因子;(5)探討肝癌病患出院後適應情況之預測因子。採橫斷性之描述性、相關性研究設計，並以結構式問卷收集資料。以立意取樣，於南部某區域教學醫院之肝膽腸胃內、外科病房進行收案，選取年滿二十歲，經專科醫師診斷為肝癌之患者為研究對象，共140人。將所得資料以SPSS 14.0套裝軟體進行統計分析，以描述性統計分析人口學特性資料;本研究因資料呈現非常態分佈，在推論性統計方面採無母數分析：Mann-Whitney U test、克-瓦(Kruskall Waiiis)二氏單因子等級變異數分析、斯皮爾曼等級分析，並以逐步複迴歸分析檢定影響出院準備度、出院後適應的重要因素。
研究結果發現：(1)人口學特性與整體出院準備度在「獨居」呈現顯著差異;(2)人口學特性與出院後適應量表中「獨居」呈現顯著性差異;(3)住院因子與出院準備度在「住院天數」、「計畫性入院」、「曾住院」、皆呈現顯著性差異;(4)住院因子與出院後適應量表中「計畫性入院」呈現顯著性差異;(5)出院準備度與出院後適應呈現顯著負相關;(6)出院準備度之預測因子為計劃性入院、是否曾住院、教育程度、職業與否，可解釋25.7%之總變異量;(7)出院後適應之預測因子為出院準備度婚姻狀況及計劃性入院者，可解釋35.3%之總變異量。
運用過渡理論模式來探討肝癌病患出院準備度及出院後適應情形，能確實印證此理論架構的關聯性，並能從此理論與研究結合中更能評估病患的個別性及需求，提供臨床上更具實證的護理指導。

關鍵字

過渡理論 ； 準備度 ； 適應

並列摘要

This research was to explore the application of transition theory to Perceived Readiness and Post-Discharge Coping Difficulty of patient with Hepatocellular Carcinoma.The purpose of this study were to:(1)explore the demographic characteristics of HCC patients, hospital stay and discharge readiness of the correlation factor; (2) investigate the liver cancer patient demographic characteristics, hospital factors and adaptation after discharge; (3) analysis of liver cancerpatients discharged from hospital ready to adapt to the circumstances of the degree and after discharge; (4) explore predictors of liver cancer patient discharge readiness; (5) explore the predictors of adaptation in HCC patients after discharge.
Cross-sectional descriptive, correlational research design, and a structured questionnaire to collect data. Surgical ward were enrolled in a regional teaching hospital of Gastroenterology, Hepatology, purposive sampling, select at least 20-year-old, were diagnosed with liver cancer patients, a total of 140 people. In this study, abnormal distribution of data presentation adopted in inferential statistics, nonparametric analysis: Mann-Whitney U test, Kruskall Waiiis two's single-factor rating analysis of variance, Spearman rank analysis, andStepwise multiple regression analysis to test the impact of discharge readiness, an important factor in adaptation after discharge.
The results showed that: Readiness and discharged from hospital discharge to adapt to the significantly negative correlation; (1)discharged predictors of readiness for the planned admission, whether the hospitalization, education level, occupation or not, accounted for 25.7% of the total variance; discharged (2)predictors of adjustment after discharge readiness marital status and planned admissions, which explained 35.3% of total variance.
Use the transition theoretical model of hepatoma patients discharged from hospital readiness and adapt to the situation after discharge can actually prove the relevance of this theoretical framework, and from this theory and the combination of better assessment of individual patients and demand, provide clinicalmore empirical care guidance.

並列關鍵字

Transition theory ； Perceived Readiness ； Coping

參考文獻

李碧月、柯成國、李來涼、應純哲(2005)•衛生教育對肝癌化療病患心理社會調適之影響•福爾摩莎醫務管理雜誌，1(1)，45-54。

中文文獻

行政院衛生署國民健康局(2010)•中華民國96年癌症登記報告•統計資料網．2010年6月25日取自 htpp://www.doh.gov.tw//statistic/data/死因摘要/94y/表8.xls。

牟聯瑞(2009)•射頻電燒術(RFA)在肝癌的應用•秀傳季刊，24(3)，17。

李麗傳(2001)•應用個案管理提升出院準備服務•護理雜誌，48(3)，19-23。