手部外傷為意外事件中最常見的一種,病患在急性期面臨的生理與心理衝擊,可能影響其對疾病的因應及長程適應,故本研究目的在(1)探討嚴重手部外傷病患的急性創傷後反應特質、疾病不確定感特質、因應策略 (包括問題與情緒因應) 的特質;(2)探討預測問題因應策略的相關因素;(3)探討預測情緒因應策略的相關因素。研究採橫斷式相關設計,以立意取樣的方式於北部某醫學中心針對嚴重手部外傷之住院病患進行資料收集,研究工具包括疼痛強度評估量表、急性創傷後反應量表、Mishel疾病不確定感量表中文版及Jalowiec因應量表中文版,資料主要以描述性統計、Cronbach’s α、因素分析、逐步迴歸方法分析。本研究共收得202位個案,結果顯示:(1)本研究個案感受到中等程度的急性創傷後反應;(2)本研究個案感受到中等程度的疾病不確定感;(3)本研究個案主要是採取以問題為中心的因應策略;(4)疾病不確定感、急性創傷後反應能顯著預測以問題為中心的因應策略 (R2= .08,p < .01);(5)急性創傷後反應、性別、疾病不確定感能顯著預測以情緒為中心的因應策略 (R2= .38,p< .005)。本研究結果建議護理人員在照護嚴重手部外傷病患時,應利用有效的措施以改善創傷後反應的症狀及降低不確定感,以協助病患使用有效的因應策略,使病患有良好的疾病適應,以促進早日重返工作崗位迴歸社會。
Severe hand injury is one of the major accidence in Taiwan. The physiological and psychological impact of severe hand injury patients will influence coping long-term adaptation. The purposes of the study was to explore (1)The characteristic of post-traumatic response、uncertainty and coping strategies in severe hand injury patients.;and (2) the use of coping strategies and their related factors . A cross-sectional descriptive design was used for the study. Eligible subjects were recruited by purposive sampling from an plastic surgery inpatient ward in a medical center in Northern Taiwan. Research instruments included Pain Intensity Scale, Acute Post-traumatic Response Scale , Mishel Uncertainty Scale-Community Chinese Version (MUIS-C) , Jaloweic Coping Scale Chinese Version (JCS). Data were analyzed by descriptive statistics , Cronbach''sα, factor analysis , stepwise regression. Two hundreds and two subjects were recruited from the above setting. In general, all of the research instruments demonstrated satisfactory psychometric properties. Patients had moderate acute post-traumatic responses and moderated uncertainty level. Patients used problem-focus coping strategies more frequently than emotional-focus coping strategies. The regression analyses showed that patients with lower post-traumatic responses and lower uncertainty level used problem-focus coping strategies more frequently than other subjects. Patients with higher acute post-traumatic responses, female, and higher uncertainty level used emotional-focus coping strategies more frequently than other subjects. The results strongly supported that patients uncertainty level and post-traumatic responses will influences their consequent using of coping strategies. Health care professional should therefore actively help patients to decrease their uncertainty and post-traumatic responses to increase their use of effective coping.
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