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  • 學位論文

教學光碟飲食指導對血液透析病人飲食控制的成效

The effectiveness of dietary teaching CD on diet control in hemodialysis patients

指導教授 : 丘周萍

摘要


慢性腎衰竭疾病為國人十大死因之一,由於器官移植不易取得,多數的腎病患者皆以血液透析治療來維繫生命。目前的護理衛教仍多以單張的使用為主,但資料顯示多媒體的視覺效果有助於學習。因此,本研究目的是針對血液透析患者設計一套「末期腎病血液透析患者飲食控制護理指導」之互動式影音光碟,測試此衛教工具對血液透析患者飲食控制知識、行為與護理指導之成效,以做為臨床護理指導之參考依據。 本研究採類實驗性研究設計(quasi-experimental design),分析兩組前後測之研究;研究對象來自南部兩所血液透析中心患者,將符合收案條件並同意參與的研究者分為實驗組60人與控制組60人,共收案120人,實驗組共接受為期4週,每週三次、共計12次,每次約10分鐘的光碟飲食護理指導介入措施;控制組僅院所提供之一般常規護理衛教。本研究以立意取樣方式,採結構式問卷進行資料收集,問卷內容包括基本資料、高血鉀、高血磷與水分控制的知識量表與行為量表;依據院所與研究對象同意所提供血清鉀、血清磷,兩次透析間距體重測量作資料比較分析,於措施介入前及光碟飲食護理指導介入進行4 週後之後測;並以敘述性統計、次數分配表、卡方檢定、描述性統計量以及無母數的曼-惠特尼 優(Mann-Whitney U)差異性檢定分析。 研究結果發現實驗組經教學光碟飲食護理指導介入後,在生化值血清鉀、血清磷及兩次透析間距體重方面皆較控制組為佳(p<0.05),高鉀飲食、高磷飲食以及限水飲食控制的認知與控制行為情形,實驗組也較控制組為佳(p<0.001),而經飲食護理指導後滿意度,亦是實驗組較佳(p<0.001)。因此,本研究支持使用教學光碟飲食護理指導能有效改善血液透析病患在飲食控制的知識與行為的提升,可增加血液透析室飲食衛教的整體滿意度,本研究衛教方式可應用於血液透析中心病患之護理照護參考。

並列摘要


Chronic renal disease is one of the 10 leading causes of death in our country. Organ transplantation is difficult, and donors are not easily available; therefore, most Chronic renal disease patients depend on hemodialysis treatment for survival. The current health care guide is based on paper materials; however, studies have reported the advantages of using multimedia-based visual effects for learning. Therefore,this study aimed to design interactive visual disks (DVDs) on diet control and feeding guidance for hemodialysis patients.We examined the influence of health education tools on the knowledge and behavior of patients. Furthermore,we examined the efficiency of the health education tools in improving diet control and serving as a clinical care reference for patients. This study adopted a quasi-experimental design. Patients who met the inclusion criteria and agreed to participate in the study were divided into two groups: control and experimental groups (60 persons in each group). Blood samples for analysis were obtained from two hemodialysis centers in Southern Taiwan. We analyzed the data in the two groups before and after watching the DVDs. The experimental group received diet care intervention on DVD for 4 weeks, three times a week, in 10-minute sessions. The control group received routine health diet education. In this study, a purposive sampling approach was adopted, and we collected data using a structural formula questionnaire. The questionnaire comprised basic patient information; knowledge scales; and behavior scales for hyperkalemia, hyperphosphatemia, and water control. We performed comparative analysis of the serum phosphorus and potassium levels and the weight gain of the patients in the two groups. The effects of the dietary and care intervention DVDs on patients were measured after 4 weeks. Descriptive statistics, frequency allocation, the chi-square test, nonparametric Mann-Whitney U test, and various assays were used for data analysis. The DVD diet care intervention improved the performance of the experimental group. The results of biochemical analysis (serum potassium and phosphorus levels and interdialysis weight gain) were more improved in the experimental group than in the control group (p < 0.05). Furthermore, the questionnaire scores on cognition and behavior for high- potassium and -phosphorus diets and water control were higher in the experimental group than in the control group (p < 0.001). The satisfaction levels with the DVD intervention were higher in the experimental group than in the control group (p < 0.001). Therefore,using DVDs can improve the diet knowledge and behavior of hemodialysis patients and facilitate their care. Patient satisfaction regarding the hemodialysis unit of health education is increasing. The health education approach used in this study can be applied to patient care and nursing at hemodialysis centers.

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