居家呼吸器依賴病患與主要照顧者負荷之初探

A Descriptive Study on Primary Caregiver Burden for Home Ventilator-Dependent Care

黃卓禕(Cho-Yi Huang) ； 李世代(Shyh-Dye Lee) ； 張宏哲(Hong-Jer Chang) ； 江玲玲(Ling-Ling Chiang) ； 李俊年(Chun-Nin Lee)

《呼吸治療》 7卷1期 (2008/01) Pp. 1-14

https://doi.org/10.6269/JRT.2008.7.1.01

摘要

由於我國呼吸治療之居家照護發展較先進國家緩慢，在中央健保局的補助，以及呼吸治療師推廣下，主要照顧者有意願選擇回家照護呼吸器依賴的病患也逐漸增加，然而實際在家中照護病患的照顧者，所承受的各種負荷常易被忽略。因此本篇研究主要了解目前居家呼吸照護的病患特質和照顧者負荷情形，及其彼此間的相關性。研究採橫斷式研究設計，以結構式問卷進行研究資料的收集，內容包括呼吸器依賴個案基本資料及主要照顧者負荷量表。以立意取樣的方式選取台灣中部至北部居家呼吸照護機構所提供的居家呼吸治療個案及其主要照顧者爲研究對象。研究結果發現：(1)呼吸器依賴病患以男性略多於女性，近六成個案並無任何社會資源的補助；個案住院大於3次以上及意識清醒者高達近八成，罹病情形仍以肺部疾病或疾患爲主。在呼吸器使用上，使用超過3年以上者佔約四成半，六到七成個案每日使用19~24小時，並採行ACMV mode，氧氣濃度以0~2L/min居多。(2)呼吸器依賴病患主要照顧者的負荷，以財務負荷最明顯，其次是生理、社會、心理之負荷。(3)呼吸器依賴個案在生病之前未有職業、年齡層愈低、依賴程度越高、以及使用氧氣濃度愈低者，其主要照顧者的總負荷也愈大。因此，本研究除提供相關專業人員於實際工作中洞悉個案及主要照顧者的情況之外，亦期望政策擬訂者在制定居家呼吸照護服務政策與措施的同時，能考量到照顧者之負荷，並做到全人全家照護之整體性評估。

關鍵字

居家呼吸器依賴照護 ； 主要照顧者 ； 負荷

並列摘要

Home respiratory care in Taiwan has usually lagged behind advanced countries for years. Under the encouragement of National Health Insurance Program (NHIP), and the popularizing efforts of respiratory therapists, more and more primary caregivers tend to take a care for the ventilator-dependent patients at home. Actually, the primary caregivers usually suffered from heavy burdens without corresponding and pertinent concerns. This study intend to workup on the burden of primary caregivers for home ventilator-dependent patients and the relationships between the burden and their demographic characteristics. The study was designed using a cross-sectional scheme to collect the necessary information by the organized structural questionnaires, including personal demographic information of home ventilator-dependent care, and Caregiver Burden Scale with the permission of the original author. The subjects were collected by purposive sampling from Home Respiratory Care Facilities in central and northern Taiwan. The results of the study showed as follows：(1) The male home ventilator-dependent patients were a little more than females. About 60% patients did not gain any subvention from the government. 80% patients, with good consciousness level, have been hospitalized for more than three times. Certainly, the most prevalent morbid condition of the subjects was pulmonary disease/disorder. Most subjects used assist control mandatory ventilation (ACMV) mode and oxygen flow by 0~2 liter per minute by their ventilator setting. 45% patients had been using ventilators for more than three years, 60% to 70% of them used ventilators up to 19~24 hours per day. (2) Main burden of primary caregivers caring for home ventilator-dependent patients belonged to the financial part, and the others were physiological, social, and psychological counterparts. (3) All burdens of primary caregivers' tend to be more remarkable, when home ventilator-dependent patients didn't work before their current morbidity, younger age, more dependency on primary caregiver, and using lower oxygen flow. Hence, the study can provide the professional therapists engaged in home respiratory care to realize the peculiar situation about care recipients and care givers. We also hoped the study results can provide the basis for the related policymaking and gain access to a holistic and whole family approach to the patients.

並列關鍵字

home ventilator-dependent care ； primary caregiver ； burden