慢性阻塞性肺疾病患者的疾病認知、基囑遵從行爲及心理感受之探討

Knowledge, Medical Compliance and Psychological Status of Patients with Chronic Obstructive Pulmonary Disease

曾淑津(Shu-Chin Tseng) ； 黃秀梨(Shiow-Li Hwang)

《護理研究》 5卷4期 (1997/08) Pp. 308-320

https://doi.org/10.7081/NR.199708.0308

摘要

慢性阻塞性肺疾病患者需要足夠的疾病認知、醫囑遵從行爲及正向心理感受來調適疾病，國內有關慢性阻塞性肺疾病患者的疾病認知、醫囑遵從行爲及心理感受的研究到目前爲止尚無文獻探討。本研究的目的在探討慢性阻塞性肺疾病患者的疾病認知、醫囑遵從行爲及心理感受，並了解其影響因素。以某醫學中心之60位慢性阻塞性肺疾病患者爲研究對象，以慢性阻塞性肺疾病知識、攻威嚇性遵從行爲，以及心理感受問卷進行調查。研究結果發現，慢性阻塞性肺疾病患者的疾病認知爲中等程度，以「戒煙」及「日常生活保健」的知識較佳，「氧氣治療」及「藥物治療」的知識較差。醫囑遵從行爲偏低，只有37位病患(61.7%)的「血中theophylline濃度」在治療範圍內，有22位低於治療範圍，1位高於治療範圍；「用藥遵從行爲量表」方面，只有25.9%的病患會完全按照醫師指定，35.0%會使用過量的藥物，64.2%會自行減少藥量，11.7%曾經停止使用藥物，8.3%會另行使用中藥或醫囑以外的藥物；而目前仍有11人(18.3%)持續抽煙；病患有傾於負向的心理感受，尤以對疾病及症狀的控制分項得分最低（得分率43.5%）。患者的性別及服用藥物種類會影響用藥遵從性；肺功能障礙程度會影響心理感受。本研究結果有助於護理人員了解慢性阻塞性肺疾病患者的疾病認知、醫囑遵從行爲、心理感受及其影響因素，並協助病人髮展因應策略，以提昇照護品質。

關鍵字

慢性阻塞性肺疾病 ； 疾病認知 ； 醫囑遵從行爲 ； 心理感受

並列摘要

Patients with chronic obstructive pulmonary disease (COPD) require adequate knowledge of the disease, good compliance to medical regimen and a stable psychology to cope with the chronic disease. However, studies of the knowledge, medical compliance and psychological status of COPD patients have not been reported in Taiwan. The purpose of this study was to evaluate the knowledge, medical compliance and psychological status of COPD patients and to analyze their influencing factors. Sixty COPD patients treated at a medical center were enrolled in the study. Scales of knowledge about COPD, compliance of medication and psychological status of COPD patients developed by the researchers were used to evaluate the patients. The results showed that knowledge about COPD of these patients was in the medium range. Quitting smoking and daily health promotion ranked as the top two items of knowledge of the COPD patients, while knowledge about oxygen and drug therapy were the worst. The medical compliance of COPD patients was poor. The serum theophylline levels of 38% of the patients were outside the therapeutic range. Estimated by drug compliance behavior questionnaire, it was found that only 25.9% of patients took the drugs strictly according to instructions, 35% took more than the required dose, 64.2% took less than the required dose, 11.7% stopped taking the drug on more than one occasion and 8.3% used herbal drugs or other non-physician-prescribed drugs. Eighteen percent of patients were smokers. The psychological status of the patients tended to be distressed, the lowest score (43.5%) was for symptom control, i .e, many patients were anxious or depressed. Gender and types of drugs influenced drug compliance while severity of pulmonary function impairment influenced psychological status of the COPD patients. The findings of this study will help medical personnel understand the knowledge, medical compliance and psychological status of COPD patients, and develope strategies to promote quality of care to them.

並列關鍵字

chronic obstructive pulmonary disease ； knowledge ； medical compliance ； psychological status