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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張媚 | |
| dc.contributor.author | Fei-Ling Wu | en |
| dc.contributor.author | 巫菲翎 | zh_TW |
| dc.date.accessioned | 2021-06-17T00:39:20Z | - |
| dc.date.available | 2015-03-02 | |
| dc.date.copyright | 2012-03-02 | |
| dc.date.issued | 2012 | |
| dc.date.submitted | 2012-01-23 | |
| dc.identifier.citation | 中文參考文獻
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Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 352, 837-853. Waltz, C. F., Strickland, O. L., & Lenz, E. R. (2005). Measurement in nursing research. (3rd ed.) Philadelphia: Lippincott. Wearden, A. J., Hynd, K., Smith, H., Davies, R., & Tarrier, N. (2006). Idiosyncratic personal explanations for blood glucose events are associated with poorer self-management and glycemic control in adult patients with long-standing type 1 diabetes. Diabetes Care, 29(6), 1208-1213. Weber RP (1990) Basic content analysis. (2nd ed.). CA: Sage. Wredling R., Theorell, P. G., Roll, H. M., Lins, P. E., & Adamson, U. K. (1992). Psychosocial state of patients with IDDM prone to recurrent episodes of severe hypoglycemia. Diabetes Care, 15(4), 518-521. Wu, F. L., Juang, J. H., & Yeh Chang, M. (2011). The dilemma of diabetic patients living with hypoglycaemia. Journal of Clinical Nursing, 20 (16), 2277-2285. Yeung, S., Lui, M. H., Ross, F., & Murrells, T. (2007). Family carers in stroke care: examining the relationship between problem-solving, depression and general health. Journal of Clinical Nursing, 16 (2), 344-352. Zoffmann, V., & Kirkevold, M. (2005). Life versus disease in difficult diabetes care: conflicting perspectives disempower patients and professionals in problem solving. Qualitative Health Research, 15(6), 750-765 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/66501 | - |
| dc.description.abstract | 【背景與目的】
糖尿病患者的治療以追求理想血糖控制為目標，然而對施打胰島素的患者而言，低血糖成為糖尿病患者在血糖管理的重要限制因素。患者學習與疾病共處的過程中，往往陷入兩難的困境，一方面害怕經歷低血糖事件，同時也擔心處理低血糖症狀導致血糖過高，因而導致血糖控制不佳與情緒困擾。「問題解決」被認為是糖尿病自我管理重要的核心內涵。有效的問題解決可以協助糖尿病患者處理與疾病相關的照護問題，患者藉由問題解決的技巧，主動確認及尋求各種可能策略來處理自己的問題，促進及維持行為改變且朝向自我管理的目標。因此，本研究目的在探討糖尿病患者面對低血糖問題之解決過程。 【方法】 本研究採用橫斷式問卷調查法，以立意取樣方式，自99年6月至100年6月以北台灣醫學中心及區域醫院的新陳代謝科門診為收案場所，樣本為年滿18歲；經醫師診斷第一型或第二型之糖尿病患者至少一年；接受胰島素注射治療；且半年內，曾經發生至少1次低血糖事件者，共計230位研究樣本。主要測量工具有「糖尿病患者低血糖問題解決量表」以及「疾病負向情緒量表」進行資料收集，以SPSS Window 16.0版套裝軟體進行統計分析，資料方法有描述性統計、Mann-Whitney U test、Kruskal-Wallis test、皮爾森積差相關分析、卜瓦松迴歸以及多元迴歸分析。 【結果】 本研究230位研究對象以男性、已婚、非獨居、無職業者以及第二型糖尿病患居多；教育程度在高中以上有53.9%，平均年齡48.62歲(SD=17.50)，胰島素治療的平均時間為7.53年(SD=7.13)，平均糖化血色素值為8.64(SD=1.88)，半年內發生低血糖的總次數多達3,999次(每個月平均低血糖次數665.5次)。重要的研究發現為: 男性、非獨居者、未婚、教育程度愈低、有職業、第一型糖尿病患者、胰島素治療時間愈長、使用胰島素治療以及糖化血色素值愈低等九項因素是低血糖發生次數增加的重要預測因子。整體問題解決能力平均得分在中上程度，低血糖問題解決的三個量表得分最高為「問題定向」，最低的是「立即反應」量表；單題平均得分在「問題解決技巧」量表之「執行」與「可供選擇的方案」分量表得分最低。糖尿病患者的低血糖問題解決能力，低負向情緒組明顯優於高負向情緒組。低血糖問題解決過程之立即反應、問題定向與問題解決技巧呈現正向的顯著關係。教育程度、接受藥物治療方式、發生低血糖次數以及疾病情緒適應是糖尿病患者低血糖問題解決能力之重要影響因素，共可解釋27%的總變異量。 【結論】 本研究以社會問題解決理論為基礎，勾勒出糖尿病患者低血糖問題解決模式，研究結果支持低血糖問題解決過程之「問題定向」、「立即反應」與「問題解決技巧」之間有顯著的關係，可作為低血糖自我管理的參考依據。「低血糖問題解決量表」的測量工具，未來可以提供臨床醫護人員快速檢視患者的低血糖問題解決能力，且經由此區辨特別需要協助問題定向與問題解決技能的患者，給予適當問題解決的培訓。未來研究能以縱貫式研究法來進行，擴大研究群體(如:各類型醫療院所、其他區域以及增加國中、國小不同教育程度的研究對象等)，以增加不同代表性的參與樣本，繼續強化研究結果的推論性。 | zh_TW |
| dc.description.provenance | Made available in DSpace on 2021-06-17T00:39:20Z (GMT). No. of bitstreams: 1 ntu-101-D94426001-1.pdf: 2366914 bytes, checksum: 242c4e58de19211d9d0464caf44aa6db (MD5) Previous issue date: 2012 | en |
| dc.description.tableofcontents | 目 錄
誌謝 Ⅰ 中文摘要 Ⅲ 英文摘要 Ⅴ 目錄 Ⅶ 圖表目錄 ⅩⅡ 第一章 緒論 1 第一節 研究背景 1 第二節 研究的重要性 3 第三節 研究目的 6 第四節 研究問題 6 第二章 文獻探討 7 第一節 糖尿病患者的低血糖現象 7 一、低血糖的定義與症狀 7 二、低血糖的原因 8 三、患者面對低血糖的經驗感受 9 第二節 問題解決模式 12 一、問題解決的定義 12 二、問題解決的理論依據 14 三、問題解決之測量 19 第三節 問題解決模式之相關性研究 22 一、問題解決與健康照護的關係 22 二、問題解決與一般性研究的關係 25 第四節 糖尿病問題解決之相關研究 27 一、糖尿病問題解決的定義 27 二、糖尿病問題解決的測量 28 三、問題解決於糖尿病照護的研究 34 第五節 糖尿病的情緒適應 38 一、糖尿病之情緒反應 38 二、糖尿病之情緒適應與問題解決的關係 40 第三章 前趨研究與研究架構 43 第一節 糖尿病患者低血糖問題解決之前趨研究 43 一、取樣方法與參與者基本資料 43 二、資料分析的步驟 44 三、問題解決過程分析的結果 54 四、問題解決於糖尿病患低血糖自我管理的關係 56 第二節 研究概念架構 57 第三節 研究理念 59 第四節 研究假設 61 第五節 名詞界定 62 第四章 研究方法 64 第一節 研究設計 64 第二節 研究對象 65 一、研究樣本 65 二、樣本數 65 第三節 研究工具 66 一、糖尿病患者低血糖問題解決量表 (Hypoglycemic Problem Solving Inventory for Diabetes) 66 (一) 社會問題解決量表介紹 66 (二) 糖尿病患者低血糖問題解決量表之編製 69 (三) 專家效度檢定 71 (四) 問題的前驅測試 74 二、疾病負向情緒量表 83 三、基本資料 83 第四節 研究進行步驟與過程 84 第五節 資料處理與分析 86 第六節 研究倫理考量 88 第五章 研究結果 89 第一節 研究變項之描述與分析結果 89 一、研究樣本之基本特性 89 二、疾病情緒適應情形 95 三、低血糖問題解決之狀況 97 第二節 低血糖問題解決之過程及研究變項間之關係 106 一、低血糖問題解決過程之內涵 106 二、個人因素、疾病情緒調適與低血糖問題解決之分析 110 第三節 影響糖尿病患者低血糖問題解決之因素 117 第六章 討論 121 第一節 基本資料特性與低血糖事件之關係 121 第二節 糖尿病患者之低血糖問題解決 125 一、糖尿病患者之低血糖問題解決能力 125 二、低血糖問題解決變項之間的關係 130 第三節 研究對象之疾病情緒調適與低血糖問題解決 135 第四節 個人因素、疾病情緒調適對低血糖問題解決的影響 138 第七章 結論與建議 142 第一節 結論 142 第二節 研究限制與建議 144 第三節 未來護理的應用 147 參考資料 151 中文部份 151 西文部份 153 附錄 165 | |
| dc.language.iso | zh-TW | |
| dc.title | 糖尿病患者低血糖問題解決過程之探討 | zh_TW |
| dc.title | A Problem-Solving Process for Diabetics with Hypoglycemia | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 100-1 | |
| dc.description.degree | 博士 | |
| dc.contributor.oralexamcommittee | 吳英璋,胡文郁,莊峻鍠,張玉坤 | |
| dc.subject.keyword | 糖尿病,低血糖,社會問題解決,自我管理,情緒適應, | zh_TW |
| dc.subject.keyword | Diabetes,hypoglycemia,social problem-solving,self-management,emotional adaptation, | en |
| dc.relation.page | 196 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2012-01-30 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 護理學研究所 | zh_TW |
| 顯示於系所單位： | 護理學系所 | |
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