轉銜期照護模式對腦中風病患及照顧者之成效

The Effect Of Transitional Care On Stroke Patients And Their Caregivers

林佳淑(Chia-Shu Lin)

指導教授 ： 吳麗珍

長榮大學/健康科學學院/護理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00018

摘要

本研究主要目的是探討「轉銜期照護模式」之介入措施，對腦中風病患及照顧者的影響。採縱貫式類實驗性研究設計法，在南部某醫學中心的神經科病房，以方便取樣的方式，共收集70對腦中風病患及其照顧者資料；其中有36對接受轉銜期照護模式，34對對照組接受醫院常規出院衛教。兩組在年齡的差異為± 5歲，及巴氏量表評分等級相同；測量工具包括巴氏量表、照顧結果量表、照顧者準備度量表、照顧者需求滿足程度量表、及其他照護成效評量項目。
研究結果發現提供轉銜期照護模式措施，對腦中風病患之影響：（1）實驗組「巴氏量表」總分，從出院前至出院後一個月共增加38.75分，高於對照組的32.79分，但兩組無顯著性差異（t值=1.19、p值=0.24）；（2）「照顧結果量表」實驗組總分之差異，高於對照組，且兩組達顯著性差異（t值=-3.00、p值＜0.05）；在「照顧結果量表」的10個項目中，「每日進食的種類及食物調製方式」、「監護或求救之管道」、「病人所需的支持性裝置」、「病人所需的醫療處置」等四個項目，實驗組分數高於對照組，兩組達顯著性差異（p值＜0.05）；（3）實驗組病患非計劃性再住院率為5.56%（2位），高於對照組的0% ；（4）實驗組腦中風病患在出院一個月內，跌倒發生率為0.896‰（1人次），而對照組跌倒發生率為2.846‰（5人次）。
提供轉銜期照護模式措施，對照顧者之影響：（1）實驗組「照顧者準備度量表」總得分，從出院前至出院後一個月共增加了11.25分，高於對照組的9.94分，但兩組比較無顯著性差異（t值=1.37、p值=0.16）；（2）從「照顧者需求滿足程度量表」得知，在「照顧者需求滿足程度量表」的44個項目中，其「關節活動」需求項目，實驗組高於對照組，達到兩組之顯著性差異（t值=2.03、p值=0.048）。
本研究結果發現提供轉銜期照護對中風病人自我照顧能力和功能的改善比對照組多，雖然未達統計顯著水準。對腦中病患照顧結果及增加照顧者出院需求滿足程度則有統計上的顯著成效，因此可做為相關人員幫助中風病人返家復健及家屬照護之參考。

關鍵字

類實驗性研究 ； 轉銜期照護模式 ； 腦中風病患 ； 照顧者

並列摘要

A quasi-experimental design was used in this study to examine the effect of "transitional care" on stroke patients and their primary caregivers. The study subjects included 36 dyads of patients and caregivers in the experimental group who received "transitional care" and 34 dyads in the control group who received the standard discharge education. Transitional care included a hospital visit by a patient care manager three days before discharging from the hospital and home visits three days, two weeks, and three weeks after discharging.
Pre-test data of both groups were collected when the patients were ready to be discharged from the neurology ward of a medical center in southern Taiwan. Post-test data were collected at the patients’ homes one month after discharge from the hospital. Patients in the control group were chosen to match age within 5 years and the Barthel Index score with that of experimental subjects. There were no significant differences in the age, gender, education, or self-reported health of the primary caregiver between the two groups. Outcome measures included the Barthel Index, the Care Outcome Scale, the Caregivers Readiness Scale, the Caregivers Need and Satisfaction Assessment Tool, the unplanned readmission rate, and the rate of falling.
With regard to patients, the post-test showed that the Barthel Index score increased more in the experimental group than in the control group (38.75 vs 32.79), but the difference did not reach statistical significance. The experimental group showed a significantly higher total score in the Care Outcome Scale than the control group (t = 3.00, p<0.01). Among the 11 items of the Care Outcome Scale, the scores of 4 items (daily food selection and preparation, care or assistance service resources, use of supportive devices, and medical care arrangements) were significantly higher in the experimental group than in the control group. The fall incidence of the experimental group (0.896%) was lower than that of the control group (2.846%). There were two unplanned hospital readmissions happened in the experimental group while there were none in the control group.
With regard to the caregiver, the Caregiver Readiness Scale score increased in both groups.There was a higher increase in the experimental group (11.25) than in the control group (9.94), but the difference was not significant. Among the 44 items of the Caregiver Need and Satisfaction Assessment Tool, in only 5 items did more than 10 caregivers from each group indicate that they need help. Only one item (joint exercise) had a significantly higher increase in satisfaction in the experimental group than in the control group (t = 2.03, p <0.05).
This study found that transition care helped stroke patients with self-care and function more than the control group although these differences did not reach statistical significance. However, the effect of transitional care on the patient care outcome and caregiver preparedness was significant. The study results can be used to help health care providers assist with home care for stroke patients and caregivers.

並列關鍵字

quasi-experimental study ； transitional care model ； stroke patients ； caregivers

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