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  • 學位論文

以系統性衛教模式改善心導管檢查病人之焦慮程度與滿意程度

Applying Systematic Patient Education Model to Improve Levels of Anxiety and Satisfaction in Patients With Cardiac Catheterization

指導教授 : 張文英

摘要


心導管檢查是ㄧ項診斷心血管疾病極為普遍的侵入性檢查,而焦慮是心導管檢查病人常見的負向情緒,如此不但會增加病人之心臟負擔,且可能影響檢查之進行。故本研究目的旨在比較系統性衛教模式與傳統衛教模式於心導管檢查病人,其焦慮程度與滿意度之差異。 本研究採類實驗研究法,以某財團法人醫學中心經門診入院之初次心導管檢查者為研究對象。病人入選後依入院週次隨機分派至實驗組或控制組。資料收集後以描述性、卡方檢定、獨立樣本t檢定、GEE與Mann-Whitney U檢定進行分析。本研究共收集83人,系統性衛教模式組39人,傳統衛教模式組44人。系統性衛教組個案之平均年齡為57.95 (SD= 7.79)歲,以男性居多(n= 23; 59%),教育程度在高中職以上者居多(n= 23; 59%),超過半數之個案無心導管檢查家族史(n= 28; 71.8%)、在住院前曾收集心導管檢查相關訊息(n= 21; 53.8%),以及接受介入性治療 (n=26; 59.1%)。在傳統衛教組個案方面,其平均年齡為63.91 (SD= 9.70)歲,大多數為男性(n= 33; 75.0%)、具高中職以上教育程度之個案(n= 30; 68.2%)與沒有心導管檢查家族史居多(n= 32; 72.7%),超過半數個案在住院前曾收集心導管檢查相關訊息(n= 29; 65.9%),以及接受介入性治療24 (61.5%)。但以上變項除年齡於兩組間有統計上之顯著差異外(p= .00),其餘變項於兩組間皆無統計上之顯著差異(p> .05)。 以廣義估計函數(GEE)分析後,結果顯示在控制組別、時間與年齡後,兩組個案於衛教前後與檢查前後之焦慮程度,實驗組呈現逐漸下降趨勢,兼具立即與持續性效果,然控制組個案於檢查前則呈現不降反升現象;另外,實驗組個案焦慮程度下降之改變量皆優於傳統衛教組,並達統計上之顯著差異(分別為 z= -3.24, p= .00; z= -5.25, p= .00; z= -3.04, p= .00)。另外,以 Mann-Whitney U 檢定分析發現,系統性衛教組個案對心導管檢查衛教之滿意度高於傳統衛教組(45.55 Vs. 42.59分),且具統計上之顯著差異(z = -3.51, p= .00)。 本研究結果除可提供臨床護理人員完整與一致性之衛教內容外,亦可提供行政管理者作為提升心導管檢查病人的衛教滿意度,以及改善持續性照護品質之依據。

並列摘要


Title of Thesis: Applying Systematic Patient Education Model to Improve Levels of Anxiety and Satisfaction in Patients With Cardiac Catheterization. Institution: Graduate Institute of Nursing, Taipei Medical University Author: Wu, Ka-Lai Thesis directed by: Chang, Wen-Yin, Professor Cardiac catheterization is a very common invasive and diagnostic procedure for patients with cardiovascular diseases. However, anxiety is a negative response in patients during procedures. The anxiety not only increases the burden of the patients' heart, but also affects the processes of the examination. Therefore, the aims of this study were to compare the effectiveness of anxiety levels and satisfaction between systematic patient education model (SPEM) and traditional patient education model for patients with cardiac catheterization. This study was a quasi-experimental design. Patients were those who had first cardiac catheterization at a medical center. For those patients who met the criteria for inclusion were randomly assigned to SPEM group or traditional patient education model by alternative week. Data were analyzed using descriptive statistics, chi-square test, independent sample t-test, GEE and Mann-Whitney U Test. There were 83 patients participated in this study, 39 patients in the SPEM group and 44 patients in the traditional patient model group. The mean age of the SPEM group was 57.95 (SD = 7.79) years. Of these, most patients (n = 23; 59%) were males, had above high school degree (n = 23; V 59%), over half of the patients had no family history of cardiac catheterization (n= 28; 71.8%), had gathered some relevant information about cardiac catheterization before hospitalization (n= 21; 53.8%), and accepted the interventive treatments (n= 26; 59.1%). The mean age was 63.91(SD = 9.70) years in the traditional patient model group. Of these, the majority of patients were males (n= 33; 75.0%), had above high school education (n= 30; 68.2%), had no family history of cardiac catheterization (n= 32; 72.7%), had gathered some relevant information about cardiac catheterization before hospitalization (n= 29; 65.9%), and accepted the interventive treatments (n= 24; 61.5%). However, a significant difference was only found in age between the groups (p= .00), but other variables were not found statistically significant differences between groups. After Generalized Estimating Equation (GEE) analysis with adjusting group, time and age, the results indicated that the anxiety levels of SPEM group at the time after education, before and after cardiac catheterization were gradually reduced, and made both immediate and continuing effects. However, the anxiety levels of traditional group at the time before cardiac catheterization were not reduced but elevated. Moreover, the degrees of the anxiety level in SPEM group declined more than the traditional patient model group with statistically significant differences (z = -3.24, p = .00; z = -5.25, p = .00; z = -3.04, p = .00; respectively). In addition, after Mann-Whitney U analysis, the results indicated that the degree of satisfaction of SPEM group for cardiac catheterization was significantly higher than did patients in the traditional patient model group (45.55 vs. 42.59 points) with statistically significant difference (z = -3.51, p= .00). VI The findings of this study not only provide the clinical nursing personnel the complete and coherent contents of patient education, but also provide the administrators how to advance the level of the satisfaction in patients and improve the continuing quality of nursing care. Keywords: Cardiac catheterization patients, systematic patient education model, traditional patient education model, anxiety level, satisfaction

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