個案管理於慢性腎臟病患者自我照顧與生活品質之成效

The Effectiveness of Case Management on Self-Care andQuality of Life in Chronic Kidney Disease Patients

胡靜文(Ching-Wen Hu) ； 林柏松(Paik-Seong Lim) ； 張彩秀(Tsai-Hsiu Chang)

《醫護科技期刊》 14卷1期 (2012/03) Pp. 13-28

https://doi.org/10.6563/TJHS.2012.14(1).2

摘要

目的：本研究旨在分析個案管理於慢性腎臟病患者自我照顧知識、態度、行為意向與生活品質之成效。方法：採類實驗雙組前、後測設計，方便取樣中部某區域教學醫院腎臟內科門診之慢性腎臟病患者。控制組35人接受門診常規照護，實驗組38人除常規照護外，另接受個案管理提供每4週一次、每次50分鐘包含護理及營養自我照顧個別衛教三次及一次的團體體驗活動，最後並針對自我照顧及生活品質指標進行評值。以自擬結構式問卷收集患者之社會人口學特質、自我照顧知識、態度、行為意向與生活品質。結果：實驗組在「自我照顧知識、態度、行為意向」及生活品質之「整體的生活品質」、「整體的健康狀態」、「生理健康範疇」及「心理健康範疇」的改變顯著優於控制組；但在生活品質之「社會關係範疇」及「環境範疇」未達顯著差異。結論：提供足夠疾病特定知識是提升患者自我照顧能力的先決條件。個案管理中整合強化護理及營養衛生教育的提供，能有效提升慢性腎臟病患者自我照顧知識、態度、行為意向與生活品質，此研究可作為未來照護慢性腎臟病患者介入措施之實證依據。

關鍵字

個案管理 ； 慢性腎臟病 ； 自我照顧 ； 生活品質

並列摘要

Purpose: This study analyzed the effects of case management on improving self-care knowledge, attitudes, behavioral intent and quality of life in chronic kidney disease patients. Methods: Researchers used a quasi-experimental design with two groups for the pre-test/post-test comparison. Convenience sampling was used to select participants from one nephrology outpatient at a regional medical teaching hospital in central Taiwan. Thirty-five participants were assigned to the control group, which received routine health care, and 38 were assigned to the experimental group, which received routine health care plus case management provided for 50 minutes every 4 week period for a total of three sessions. Each session included training on individual self-care nursing and nutrition health education. One session included a group ”hands-on” activity. Differences in pre-test/post-test scores were used to measure level of improvement in self-care and quality of life indicators. Structural questionnaires addressed self-care knowledge, attitudes, behavioral intentions and quality of life. Results: Experimental group participants earned significantly improved mean self-care knowledge, attitude, behavioral intent and quality of life scores, including the domains of global QOL, global health status, physical health domain, and psychological in comparison with their control group peers. There was no significant difference between the two in terms of either social relationship or environment domains. Conclusion: Providing adequate disease-specific knowledge is essential to enhancing patient self care. Strengthening integration of case management in nursing and nutrition education may improve self-care knowledge, attitudes, behavioral intent and quality of life in chronic kidney disease patients. Study findings may help guide evidence-based practice in the future.

並列關鍵字

Chronic kidney disease ； case management ； self-care ； quality of life

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