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  • 學位論文

血液透析與腹膜透析患者健康促進生活型態之比較

The comparision of health promoting lifestyle between hemodialysis and peritoneal dialysis patients

指導教授 : 葉德豐
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摘要


隨著平均壽命延長,人口結構老化,疾病型態逐漸轉變成以慢性病為主,因此醫療體系從過去只重視急性醫療的觀念逐步轉為著重疾病預防和健康促進。生活型態是影響健康最重要的因素,慢性病的照護首要工作是建立良好的生活型態。2009年台灣的末期腎病發生率及盛行率世界排名分別第一及第四,截至2011年9月台灣地區慢性腎衰竭(尿毒症)必須定期透析治療者共有63,464人,除了腎臟移植外,這些患者必須定期接受透析治療以維持生命,為了維持患者長期的健康,必須以健康促進活動來改變患者的生活型態,進而提升患者的生活品質與減少疾病的死亡率。 本研究以中部某醫學中心定期接受血液透析與腹膜透析之患者為對象,探討血液透析與腹膜透析患者間健康促進生活型態之差異與相關影響因素。本研究採用自填結構式問卷與病歷回顧;自填結構式問卷內容包括患者個人特性、健康狀態、自我照顧自我效能與健康促進生活型態等部分;病歷回顧則包含透析品質與檢驗指標。統計方法以SPSS 17.0版套裝軟體分析。 根據本研究結果顯示,透析方式並不會影響健康促進生活型態的施行;健康促進生活型態施行較佳的族群分別為:年齡在50-64歲、學歷高中以上、未婚、每周運動3次(含以上)者、身體質量正常、自覺健康良好、自覺快樂者、經濟獨立自主者、有工作者及無糖尿病與紅斑性狼瘡共病疾病者;自我照顧自我效能施行較佳的族群分別為:學歷高中以上、自覺健康狀態好的或還好、透析年資一年以下、自覺快樂者、經濟獨立自主者、有工作者及無心臟病共病疾病者;自我照顧自我效能則與健康促進生活型態的施行呈顯著正相關。 根據本研究結果建議:(1)教育程度為國中以下者執行健康促進生活型態及自我照顧自我效能方面較差,應提供簡單易懂且方便執行的衛教內容。(2)在自覺健康狀況差、自覺不快樂、無工作及經濟依賴者,執行健康促進生活型態及自我照顧自我效能方面較差,應適時評估其身、心理的狀態,多給予鼓勵、陪伴與傾聽;在經濟方面若有困難,可協助轉介社福團體以解決其問題。(3)醫護人員應特別注意病人有無共病疾病以加強衛教內容。(4)提升護理人員溝通的方法及學習健康促進衛教的技巧。

並列摘要


With the prolong of life expectancy, the aging of the population structure, diseases are gradually transformed into chronic patterns, the healthcare systems are also transformed from acute care into disease prevention and health promotion. Lifestyle is the most important factor that affects the health status, the first and foremost task for chronic disease care is to establish a satisfactory lifestyle. The incidence and prevalence of End stage renal disease (ESRD) ranked first and fourth respectively in the world, a total of 63,464 ESRD patients that needed regular dialysis treatment as of September 2011 in Taiwan. In addition to kidney transplants, these patients must often followed by long-term dialysis treatment to sustain life. In order to maintain long-term health of patients, health promotion activities are necessary to change the patient''s lifestyle, and thus improve the quality of life of patients and reduce the mortality of the disease. In this study, hemodialysis and peritoneal dialysis patients in a medical center were selected to explore the differences of health promotion lifestyle between two patients groups and their associated factors. Self-administered structured questionnaire and medical record review were used in this study. Self-administered structured questionnaire contained individual patient characteristics, self-reported health status, self-care self-efficacy and health promoting lifestyle. Medical record review contained the dialysis quality indicators and the laboratory tests. Statistical analysis was use SPSS 17.0 software package. According to the results, there was no difference in health promoting lifestyle between hemodialysis and peritoneal dialysis patients. Those who had better health promoting lifestyle were 50-64 years old, educated above high school, unmarried, exercising three times or more in a week , normal body mass index, good perceived health status, feeling happy, economic independence, having job currently, and without comorbidity in diabetes and lupus erythematosus. Those who had better self-care self-efficacy were educated above high school, perceived good or general health status, less than one year started dialysis , feeling happy, economic independence, having job currently, and without comorbidity in cardiac diseases. There was positive association between health promoting lifestyle and self-care self-efficacy. According to the results of this study, we suggest as following: (1) As the worse of health promoting lifestyle and self-care self-efficacy, we suggest that provide easy to understand and implement health education contains for those lower education level patients. (2) As the worse of health promoting lifestyle and self-care self-efficacy, we suggest that assess phisological and psychological status timingly, provide encouragement, escort and listening, and refer to social welfare organizations for those who perceived poor health status, feeling unhappy, no jobs currently and economy resulting to worse of health promoting lifestyle and self-care self-efficacy. (3) The health professionals should pay special attention to patients with or without comorbidity diseases in order to strengthen health education contains. (4) Nursing staffs should learn to improve communication technique and health education skills for health promotion.

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