探討腸造口病人家庭照顧者之照顧者負荷及其相關性探討

Burden in family caregivers of patient with ostomy and Its Correlation

康雯茹(Wen-Ju Kang)

指導教授 ： 黃正宜

中山醫學大學/醫學院/護理學系碩士班/碩士(2017年)

摘要

腸造口建置在病人生理功能方面，失去可自己意志控制的肛門括約肌的解便能力，並且需學習傷口清潔照護與生活模式的調整改變等照護負擔。病人面對疾病過程的壓力事件，家人是其身心社會支持的主要來源，對於病人預後復健有潛在的影響。
本研究採橫斷式相關性研究設計，以方便取樣於中部某醫學中心進行收案，共收案 96位造口病人及其家庭照顧者。採結構式問卷收取資料，包括：病人人口學特性與疾病特質、家庭照顧者之人口學特性與照顧特質，照顧者反應量表（CRA）評估工具。研究資料以SPSS Windows20.0軟體進行描述性及推論性統計分析。
病人之人口學特性、疾病特質與家庭照顧者負荷之關係，研究結果顯示：（1）照顧對象有配偶者、暫時性造口其家庭照顧者之自尊感受較高；（2）照顧對象為男性、尚有配偶者，家庭照顧者之時間安排負荷較重；（3）時間安排負荷與病人年齡呈正相關；（4）照顧對象為男性者，家庭照顧者之健康負荷較高。
家庭照顧者之人口學特性、照顧特質與家庭照顧者負荷之關係，研究結果顯示：（1）自尊感受與每週照顧天數呈正相關；（2）家人支持負荷會因家庭經濟狀況不同而呈顯著差異；（3）獨立照顧之家庭照顧者家人支持負荷與時間負荷程度較高；（4）總照顧週數越長，家人支持負荷越重；（5）女性家庭照顧者之時間安排負荷較男性高；（6）辭去工作之家庭照顧者的時間安排負荷較高；（7）照顧時間越長，時間安排負荷越重。
家庭照顧者負荷的預測因素，研究結果顯示：（1）自尊感受的重要因子為病人婚姻狀況及造口留置時間，可解釋自尊感受之變異量為10.7%（p=.005）；（2）家人支持負荷的重要因子為照顧型態，可解釋家人支持負荷之變異量為16.3%（p=.004）；（3）時間安排負荷的重要因子，為每天照顧時數、家庭照顧者職業狀況及照顧型態，可解釋時間安排負荷之變異量為34.7%（p=.000）；（4）健康負荷的重要因子為病人性別，可解釋健康負荷之變異量為9.5.%（p=.002）。
本研究結果建立台灣本土化腸造口病人之家庭照顧者於術後的照顧者負荷資料，建議未來照護過程提供喘息時間安排，讓照顧者擁有自我的角色，減輕照顧負荷，於未來研究採縱貫式研究方法，從病人入院時開始收案，定期追蹤，了解在病人不同時期與家庭照顧者負荷的變化。

關鍵字

腸造口 ； 家庭照顧者 ； 照顧者負荷

並列摘要

Individuals living with an ostomy may suffer from a variety of stressor related to lose of control of anal sphincter, increased burden on learning wound care and change of lifestyle. Family caregivers are the main source of support for patients while facing the stress during disease process.
The study adopted a cross-sectional study design with purpose sampling from on medical center in central Taiwan. Ninety-six pairs of eligible patients and their primary family caregiver were recruited. Data collection included patient and caregiver’s demographics, disease-related information, care pattern, and the caregiver’s burden (measured with the Caregiver Reaction Assessment, CRA). Data were analyzed using SPSS Windows 20.0 software.
In terms of correlation among patient demographics, disease-related, and family caregiver’s burden, the study showed the following results: (1) The type of ostomy and patient’s marital status are the factors to family caregivers’ self-esteem. (2) Patient’s gender and marital status were related with family caregiver’s disrupted schedule. (3) Patient’s age was positively associated with disrupted schedule (4) Patient’s gender was related with family caregiver’s loss of physical strength.
According to the correlation among family caregiver demographic, care pattern and family caregiver burden, the results of the study showed that: (1) The days of caregiving per week was positively correlated with caregiver’s self-esteem. (2) Family income status was related with family caregiver’s lack of family support. (3) Care pattern was related with caregiver’s lack of family support and disrupted schedule. (4) The days of caregiving was positively correlated with caregiver’s lack of family support the burden of the family. (5) Female caregivers would suffer from higher level of disrupted schedule then male. (6) Caregiver’s occupation status was related with family caregiver’s disrupted schedule; (7) the hours of caregiving per day was positively correlated with caregiver’s disrupted schedule.
As for the predictors to a family caregiver burden, the result of the study showed that: (1) The main predictors of self-esteem were the patient’s marital status and the type of ostomy, 10.7%(p= .005) of variances could be explained; (2)The main predictors of lack of family support was care pattern, 16.3% (p= .004) of variances could be explained; (3) The main predictors of disrupted schedule were the number of hours of caregiving per day, caregiver’s occupation status, and the care pattern, up to 34.7% (p=.000) of variances could be explained; (4) The main predictors of caregivers’ physical health status was the patient’s gender, 9.5.% (p=.002) of variances could be explained.
The result of the present study can provide information which based on caregiver burden of Taiwan ostomy patient in postoperative care. It is suggested that we should provide a respite schedule to let the caregiver have a self-role and reduce burden during future care process. In the future, it is recommended to adopt longitudinal research methods which following up the patient from hospitalizing in the beginning to understand family caregiver’s burden in different stages of the case.

並列關鍵字

ostomy ； family caregiver ； caregiver burden

參考文獻

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[Literature Review of Primary Caregivers' Burden, Stress and Coping in Taiwan

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