多媒體護理指導對乳癌病患術後復健成效探討

研究背景:乳癌病患術後的復健運動不僅可降低術後淋巴水腫、肩頸活動障礙、軟組織沾黏等合併症的發生，更可以儘快的恢復其身體功能，降低疾病造成的衝擊，因此如何提供有效的護理指導來提升術後復健運動的執行更顯重要。於臨床工作發現，術後病患常因復健運動的執行錯誤導致疼痛、不知執行時機、不知執行的重要性而未執行術後復健運動操，造成合併症的發生。本研究的目的欲探討多媒體護理指導對乳癌病患術後復健成效。研究方法:本研究採單盲實驗性設計，以中部某一家醫學中心外科病房進行收案，以區段式隨機分派為實驗組與控制組，每組各32位。實驗組接受多媒體運動護理指導光碟，控制組接受傳統護理指導單張，比較多媒體光碟與單張護理指導之差異，資料收集建檔後以SPSS 20統計軟體分析其成效。成效指標包含乳癌復健運動知識得分、技能評分及實際執行情形。研究結果:研究結果發現兩組研究對象在不同護理指導方式介入前，基本資料屬性與乳癌復健運動先備知識前測平均得分對照組與實驗組未達顯著差異，顯示兩組研究對象達同質性。前、後測平均得分比較，實驗組高於對照組，達顯著差異，對照組平均進步得分為8.19±.05，實驗組平均進步得分為11.21±.06，實驗組介入多媒體光碟後平均得分由0.59±.71進步到11.80±.42，多於對照組，達顯著差異。在技能方面，立即、第二次平均得分比較，對照組立即平均得分12.90±1.68，第二次平均得分15.10±2.60，實驗組立即平均得分16.90±1.20，第二次平均得分17.20±.84，實驗組高於對照組，達顯著差異。在實際操作方面，實驗組全部達成人數多於對照組，結果發現對照組與實驗組在實際操作方面未達顯著差異，分析其原因可能與多媒體護理指導光碟閱讀較不便利及研究場所未設有行動衛教設備有關；建議可以將行動護理資訊車或床邊資訊系統匯入多媒體護理指導，以提高護理人員及病患使用的方便性。結論: 研究結果顯示多媒體光碟護理指導對乳癌患者的復健運動有顯著成效，建議未來臨床單位能充實撥放設備，提供個案復健運動指引並落實於乳癌術後復健病患身上，將嘉惠更多病患，使其返家後能正確落實且持之以恆。

關鍵字

乳癌病患；運動操；復健

並列摘要

Background:Rehabilitation among postoperative patients with breast cancer not only decreases the side effect of lymphedema of limbs and rigidity of cervicobrachial activity or soft tissue, but also helps rapid recover of the physical performance. Therefore to provide the effective nursing care for promotion of the exercise on rehabilitation after operation is very important. During daily practice, patients maybe result in pain or other complication due to the malpractice of exercise on rehabilitation, inappropriate times or do not care the importance of the exercise on rehabilitation then not perform those exercises, The aim of study was analysize to analysis the effects of exercise on rehabilitation among postoperative patients with breast cancer. Method:This research design was a single blind study. Participants were the and there were randomly assigned to experiment and control group. Patients after operation in one medical center, which random assignment divide to experiment and control group.Each group included 32 patients. Experiment group patients received the nursing education of the compact disc of exercise on rehabilitation and control group received the traditional nursing education. Compare with the difference, including which the knowledge points of exercise on rehabilitation, the score of skills, and the actualtimes of operating. Statistical data was analyzed with SPSS 22.0 software. Result:This study revealed that the score of knowledge, basic characteristic, pre-test of knowledge, were not significant among these two groups before different nursing intervention. The average score between pre- and post-test knowledge test on the experiment group was higher than control group and revealed significance, which the average score of the control group increased to 8.19 + .05, and the experiment group increased to 11.21 + .06. The mean score in experiment group was higher than control group increases from 0.59 + .71 to 11.8 + .42 and revealed significance more than the controlgroup. In skill performance which compared with the first and second test, the score of the first test in control group was 12.90 + 1.68, and the score of the second test was 15.10 + 2.60. Then the score of the first test in experiment group was 16.90 + 1.20, and the score of the second test was 17.20 + .84. The experiment group was higher than control group in first and second tests and revealed significance. The data of the experiment group was higher than control group in the actual times of operating but statistical data revealed no significance which maybe related that not convenient for reading compact disc of exercise on rehabilitation and no teaching portal machine during health education. We suggest that maybe preparethe compact disc of exercise on rehabilitation to portal nursing machine or bedside information system, then increase the convenience of nurses or patient. Conclusion:Our statistical data revealed compact disc has more efficiency for exercise on rehabilitation. We suggest that maybe enrichment of machine in clinical station, provide the guideline of exercise on rehabilitation for further actual and persistent operating in postoperative patients with breast cancer after discharge during daily life.