出院前衛生教育方案對心臟衰竭病患自我照顧、生活品質及再住院之成效

心臟衰竭是一種複雜的臨床症候群，需要病患長期執行自我照顧以穩定症狀，但臨床及研究發現病患的自我照顧不佳。病患之衛生教育是促進病人的自我保健行為，維護個人生活品質的重要關鍵。本研究目的為探討出院前衛生教育計劃對出院後二個月自我照顧、生活品質及再入院的成效。本研究採用類實驗研究設計，於台灣南部某醫學中心心臟血管病房招募個案，依據收案先後次序，前35位分派為對照組，後25位為實驗組。收案對象條件包括：1)紐約心臟協會功能性分類為第二、三級之心臟衰竭住院病患（國際疾病分類代碼ICD 428）；2)意識清醒，可以國台語溝通，無使用呼吸器者；3)可自行活動者及執行自我照顧者；4)同意參與研究並填寫同意書者。對照組的個案只接受醫院常規護理，實驗組則接受常規護理和研究者所發展之「心臟衰竭自我照顧手冊」進行一對一衛生教育。於個案住院第二天收集前測資料，出院前一天或當天進行第一次後測，出院後二個月進行第二次後測，研究工具包括基本屬性與疾病特性資料、荷蘭心臟衰竭知識問卷、心臟衰竭自我照顧指標、明尼蘇達生活品質問卷及出院後二個月之再入院次數。資料收集期間為100年7月1日至101年6月14日。本研究結果顯示，對照組之平均年齡為71.39歲，實驗組為66.75歲，二組在基本屬性與疾病因素變項均無顯著差異。以重複測量法分析二組在各變項改變狀況，二組在心臟衰竭知識、三個自我照顧變項及生活品質均有顯著性改善，但實驗組的改善更為明顯。在二組比較方面，二組之心臟衰竭知識、自我照顧維持、自我照顧管理、自我照顧自信與生活品質前測均無顯著差異。二組之第一次後測的心臟衰竭知識及三個自我照顧變項呈顯著差異 (p<.05)，生活品質得分則無顯著不同。在第二次後測，二組之心臟衰竭知識得分、三個自我照顧變項及生活品質均呈顯著不同 (all p< .001)。對照組在二個月內有9人次的再入院及二人死亡，實驗組在二個月內有1人次再入院，死亡人數一人。總結本研究結果，出院前之衛生教育介入能提升心臟衰竭病患之疾病知識、自我照顧及改善生活品質，相較於對照組，實驗組也有較少的再入院情形。本研究可提供臨床健康照護者在設計衛教心臟衰竭介入方案以提升自我照顧及生活品質的參考。

關鍵字

心臟衰竭；衛生教育介入；自我照顧；生活品質

並列摘要

Heart failure is a complex clinical syndrome. Patients with heart failure are required to engage in long-term self-care practices to stabilize symptoms. However, clinical observations and studies have shown that HF patients have poor self-care behaviors. Patient education is the key to promote of patients self-care behaviors and quality of life. The purpose of this study was to investigate the effectiveness of a pre-discharge education program on self-care, quality of life, and readmission 2 months after discharge from hospital in patients with heart failure. A quasi-experimental research design with a non-probability sampling was used. Participants were recruited from the inpatient cardiology unit of a medical center located in southern Taiwan. Participants were assigned into either the control group (n = 35) or the experimental group (n = 25) based on the order of their enrollment into this study. Inclusion criteria were as follows: (1) having a diagnosis of heart failure (International Classification of Diseases code 428) with a class of New York Heart Association II or III, (2) conscious and able to communicate in Mandarin or Taiwanese, and without ventilator use, (3) able to move and perform self-care behaviors by him/herself, and (4) willing to participate in this study and sign the informed consent form. Participants in the control group only received regular pre-discharge care, while those in the experimental group received both regular pre-discharge care and a one-on-one health education program developed by the researchers. The two groups completed a pretest on the 2nd day of hospitalization and posttests on the day before discharge or at discharge and 2 months after discharge. The instruments included the demographic and disease characteristics questionnaire, the Dutch Heart Failure Knowledge Scale (DHFKS), the Self-Care Heart Failure Index (SCHFI), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and number of times rehospitalization, heart failure knowledge, three self-care variables, and quality of life two months after discharge. Data were collected from July 1, 2011 to June 14, 2012. The results showed that the mean age was 71.39 years for the control group and 66.75 years for the experimental group. There were no significant differences in demographics and disease factors between the two groups. Using repeated measures analysis to analyze the changes in the major variables over the study period, the finding showed that both the two groups had significant improvements in HF knowledge, three self-care variables, and quality of life. For the baseline measure, no significant differences were found between the two groups in the scores of the DHFKS , self-care maintenance, self-care management, self-care confidence, and MLHFQ . The first posttest between the two groups showed significant differences in the scores of DHFKS and three self-care variables (p < .05) but no significant differences in the MLHFQ score. The second posttest showed significant differences in the DHFKS, SCHFI, and MLHFQ scores between the two groups (all p < .001). In addition, there were 9 readmissions and two deaths in the control group, while there was 1 readmission and one death in the experimental group during the two-month follow-up period. In sum, the pre-discharge education program can improve the disease knowledge, self-care, and quality of life in patients with heart failure. The experimental group had fewer readmissions as compared to the control group. This study can serve as a reference for clinical healthcare providers in designing health education programs on improving self-care abilities and quality of life in patients with heart failure.