肝硬化病人不確定感與因應行為之研究

The Uncertainty and Coping Behaviors of Patients With Liver Cirrhosis

林婉如(Wanu-Ju Lin)

指導教授 ： 黃惠滿

長榮大學/健康科學學院/護理學系(所)/碩士(2015年)

https://doi.org/10.6833/CJCU.2015.00166

摘要

肝硬化病人若對病程進展、治療決定的參與、身體不適症狀的改善、醫療訊息的獲得缺乏控制感時，易生不確定感，且會降低其澄清問題及尋求資源的能力，進而影響因應行為及對疾病的適應。本研究目的在探討肝硬化病人之不確定感及因應行為，並了解因應行為取向的預測因子。採橫斷式、量性研究設計，以方便取樣方式選取南部某醫院76位肝硬化病人為研究對象，以三份結構式問卷收集資料，結果呈現：肝硬化病人：(1)不確定感為中等程度以上；因應行為使用頻率以問題取向因應行為為主；(2)無宗教信仰、疾病嚴重度高和有疲憊感受者有較高的不確定感；(3)離婚、無工作、喝酒頻率為「天天喝」和「經常喝」者、疾病嚴重度高和有疲憊感受者較常使用情緒取向因應行為；喝酒頻率、疾病嚴重度與情緒取向因應行為呈正相關；(4)無工作、喝酒頻率為「經常喝」的肝硬化病人較常使用問題取向因應行為；教育程度、喝酒頻率與問題取向因應行為呈正相關；(5)肝硬化病人的整體不確定感分別與情緒取向因應行為、問題取向因應行為間呈正相關；(6)工作狀況、喝酒頻率、整體不確定感是情緒取向因應行為的預測因子，可解釋總變異量之40.0 %；(7)教育程度、喝酒頻率、整體不確定感是問題取向因應行為的預測因子，可解釋總變異量之33.4%。
本研究結果可供護理人員照護肝硬化病人時評估不確定感、因應行為，進而提供個別性的護理措施之參考。當病人不確定感程度高並採取情緒取向因應行為時，建議護理人員多傾聽及鼓勵病人表達情緒及問題，以提早介入改善病人負面情緒，當病人因負面情緒影響而採取情緒取向因應行為時，護理人員應接受其行為、傾聽及鼓勵病人表達情緒及問題，並協助引導病人採用問題取向因應行為；若病人不確定感程度高同時使用問題取向因應行為時，可主動提供疾病相關資訊、社會資源，以協助病人適應病程。

關鍵字

肝硬化病人 ； 不確定感 ； 因應行為

並列摘要

Patients with liver cirrhosis tend to develop a sense of uncertainty when they lack control over the progress of the disease, treatment decision making, physical discomforts, the acquisition of medical information, and the ability to plan their future. The sense of uncertainty that liver cirrhotic patients develop when facing their disease or treatment may elicit physical and psychological distress which can influence the patients’ cognition, evaluation capacity, and coping behaviors. This study investigated actual liver cirrhotic patients’ sense of uncertainty and coping behaviors. A cross-sectional, quantitative research design was used with convenience sampling being performed to select 76 liver cirrhotic inpatients in the division of gastroenterology at a hospital in Southern Taiwan. Three structured questionnaires were used for data collection, yielding the following results:；(a) Liver cirrhotic patients perceived a moderate or increased level of uncertainty and problem-oriented coping behaviors were the most frequently used coping behaviors. (b) Patients who had no religion, who were unemployed, or who had severe disease conditions or fatigue exhibited comparatively high levels of uncertainty. (c) Patients who were divorced or unemployed, or fatigue often showed affective-oriented coping behaviors.Consuming alcohol frequency, illness severity was positively correlated with affective-oriented coping behaviors. (d) Patients who were unemployed often exhibited problem-oriented coping behaviors. Educational level andconsuming alcohol frequency were positively correlated with problem-oriented coping behaviors.(e) Patients’ uncertainty was positively correlated with affective- and problem-oriented coping behaviors.(f) The employment status, consuming alcohol frequency, and uncertainty were the predictors of affective-oriented coping behaviors and explained 40.0% of the total variance. (g) The education level, consuming alcohol frequency, and uncertainty were the predictors of problem-oriented coping behaviors and explained 33.4% of the total variance.
These results can assist nurses in identifying the level of uncertainty in liver cirrhotic patients and detecting their psychological problems to mitigate the patients’ negative emotions through early interventions. Since liver cirrhotic patients frequently exhibit affective-oriented coping behaviors because of their negative emotions, nurses should accept their behaviors, encourage them to express their emotions and problems, and listen to them patiently. Nurses should also guide the patients in adopting problem-oriented coping behaviors. If patients were high levels of uncertainty, frequently exhibit problem-oriented coping behaviors, by spontaneously providing disease-related information and social support, they can readily adopt to their disease conditions.

並列關鍵字

Liver cirrhotic patients ； uncertainty ； coping behaviors

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