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  • 學位論文

重症單位頭部外傷病人選擇長期照護方案之探討─以南部某區域教學醫院為例

Long-term Care Alternatives Selection for Head Injury Patients in Critical Unite -Experience of South Regional Teaching Hospital

指導教授 : 藍守仁 張李淑女
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摘要


本研究主要目的在於探討影響重症單位頭部外傷病人失能之因子之預測及瞭解其選擇長期照護方式的分佈情形,且進一步瞭解頭部外傷病患在人口學特質、健康照護能力及照護需要因素等方面,在選擇長期照護方式的差異,同時藉由選擇長期照護方式相關預測因子的瞭解,使得醫院在提供出院準備服務時,能儘早幫助出院重症單位部外傷病人得到完善的後續照護。 本研究以Andersen(1995)醫療利用行為模式為研究架構理論基礎,並參考國內外相關文獻,將長期照護方式分為非正式(居家)照護與正式(機構)照護服務二類,並自擬問卷收集初級資料,經由專家的審查與修正,以達內容的可靠與正確。本研究為橫斷性研究,並採立意取樣方式,於2006年7月1日至2008年3月27日期間,由南部地區一家區域教學醫院之資深護理人員,針對該院重症單位頭部外傷住院病人或其家屬,於出院後一個月進行電話訪談收得之頭部外傷病人共115位。 研究結果發現77.4%選擇由家人居家照顧,6.1%選擇請看護(或外勞)在家照顧,16.5%選擇機構照護,主要的第一考量因素是病情程度,佔58.2%,第二考量因素則為家庭中有人照顧,佔46.9%。病患之年齡、意識狀況、日常活動功能嚴重度、特殊醫療照護及併發症、疾病嚴重度、居住情形等與選擇照護方式有相關。利用線性迴歸預測病患失能之因素有年齡、意識狀況、醫療費用等與日常活動功能嚴重度有相關;控制其他變項後,邏輯斯迴歸分析發現,日常活動功能嚴重度、居住情形、籍貫等是病人選擇長期照護方式的重要影響因素。 由於研究顯示頭部外傷病人發生功能障礙後,需要長期照護服務時,主要由家庭承擔大部分的照護責任,而機構式長期照護服務亦有一定比率的需要。另外年齡及意識狀況是失能的主要因子,而日常活動功能更是選擇長期照護方案之重要因子,因此針對此類病患更應儘早介入出院準備服務,而醫院更應建立完善的轉介機制,故本研究建議醫院應加強出院準備服務,提供家屬適切的照護資訊及資源,以提高出院病人對後續照護的可近性,而機構式長期照護服務的影響因素除功能障礙程度外,還有族群及經濟能力之差異,因此在規劃長期照護服務時,應考量不同人口群之需要,提供不同的長期照護服務。

並列摘要


OBJECTIVE:The purpose of this research was to investigate the various choices that head injury patients and their families should have when considering long-term care of the patients. We analyzed the differences and similarities of choices within social demography, the resources required for various health cares, and home care needs. As a result, we were able to predict what factors to impact the disability of the head injury patients and the long-term care decisions of the head injury patients and their families. The research helped ensure that patients receive appropriate care as early as possible by informing the family of the crucial issues they might face when the patients are released from the hospital. METHODS:This research divided long-term care into two kinds: Informal care by family and formal care in an organization. We based our research on Anderson’s theory (1995), a model of health service usage. That is, long -term care is determined by patients’ behavior patterns. We considered the influential factors of using long-term care domestically and abroad to design the questionnaire for this study. The questionnaire was evaluated for good reliability and validity. Basing on cross-section research, from July 1, 2006 to March 27, 2008 and using the questionnaire, senior nurses in one regional teaching hospital in the Southern Taiwan interviewed the head injury patients and their families by telephone for one month after they left the hospitals. At the end, we interviewed 115 patients in total. RESULTS:The results showed that 77.4 % of the patients interviewed chose to be cared by their families; 6.1 % chose to be cared in an organization; and 16.5 % chose to be looked after by nursing persons at their homes. The first factor they considered was their degree of sickness, which accounts for 58.2% of the variance. The second factor was the availability if their family can take care of them, which accounts for 46.9 % of the variance. This is also related to patients’ age, consciousness level, degree of their daily living activities on their own, special medical care they have, complications, their serious degree of sickness, and their living at home. After linear regression analyses, we found that the disability of the head injury patients is also related to patients’ age, consciousness level, the charge for medical treatment. After logistic regression analyses, we found that the important factors which influence long-term care choices were: Patients’ activities of daily living, their living at home, and their birthplaces. CONCLUSION:In the study, we found that the head injury patients who need long-term care would stay at home mainly and some would enter hospital or nursing home. Besides, the main factors were patients’ age, and consciousness level. Patients’ activity of daily living was the important factors that influence long-term care choices. For this reasons, all hospitals ought to interfere in this kind of patients’ discharge plan, and to build a good transfer system between hospitals. Therefore, we suggested all hospitals have to strengthen the discharge plan and to provide the suitable information which the patients’ families need. This is to ensure the patients get continuous care after they left the hospitals. When Policymakers make the health policy should consider the elderly economic ability and ethic subgroup that would affect the institutional long-term care utilization.

參考文獻


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