影響慢性阻塞性肺疾病患者自我照顧行為因素之探討

Abstract

本研究主要是以Becker(1974)的健康信念模式去探討慢性阻塞性肺疾病患者之自我照顧行為之現況，及影響自我照顧行為的重要因素，以北市某醫學中心門診病人經胸腔專科醫師確診為慢性阻塞性肺疾病一年以上，符合收案條件者作為研究對象，研究工具採結構式問卷，包括基本資料、自我照顧行為量表、健康信念量表、醫療人員指導項目及憂鬱量表，採一對一訪談方式，共收集135份有效問卷，研究結果如下： (1).本研究之自我照顧行為介於有時與經常之間，以服藥及回診行為最佳，胸腔復原運動最差。 (2).皮爾遜積差相關分析顯示罹病年數越長、憂鬱程度越重、自覺嚴重性越大、自覺罹患性越大、自覺行動利益越大、自覺行動障礙越低、醫療人員指導項目數目越多者，其自我照顧行為越佳，由逐步複迴歸分析得知，COPD自我照顧行為之預測因子包括「自覺行動利益」、抽菸史「現在仍抽菸者與從未抽菸者的對比」、罹病年數「3年以下與10年以上的對比」、「醫療人員指導項目數量」、「憂鬱」等變項能解釋自我照顧行為之變異量67.6%，其中自覺行動利益對慢性阻塞性肺疾病患者之自我照顧行為預測解釋力為45.5%。 護理應用：(1)針對沒有執行胸腔復原運動者，透過加強行動利益，來鼓勵病人執行；(2)針對罹病時間較短及目前還在抽菸者，強化其自我照顧行為的指導；(3)加強醫護人員COPD肺部復健相關知識的在職教育；(4)護理人員應注意COPD病人心理調適的問題。 關鍵字：健康信念、醫療人員指導項目、憂鬱、慢性阻塞性肺疾病自我照顧行為

The purpose of this study is to apply Becker’s health belief model to explore the self-care behavior of clients with chronic obstructive pulmonary disease (COPD).The researcher recruited 135 outpatients in a northern medical center. Data was collected through on by one interview according a structured questionnaire included demographic data；health belief scale；depression scale；COPD self care behavior scale and numbers of self care advice suggested by medical staff. The results indicate that: (1) the highest score of COPD self care behavior was medication behavior, and the lowest score was pulmonary exercise. (2)Pearson correlation found that the longer duration of illness,the even worse depression,the lower perceived barrier to action,the higher perceived benefits to action,the higher numbers of self care advice suggested by medical staff，the self care behavior of COPD is better；using Stepwise Multiple Regression found that subjects' self-care behaviors can be predicted by perceived benefits to action,smoking history, duration of illness, numbers of self care advice being suggested by medical staff, and depression. The model explains 67.6% of the total variances of self-care behaviors and perceived benefits to action was the most impotant precdictor. Recommendations:(1)Nurses should emphasize perceived benefits to action for pulmonary exercise；(2)Nurses should design education program according to smoking history and duration of illness；(3)To strenghern pulmonary rehabilitation continuing education for medical staff ；(4)Nurses should be aware of psychological adjustment of COPD patients.