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系統識別號 U0026-0102201017434700
論文名稱(中文) 預防譫妄措施於加護病房轉出老年病人之成效探討
論文名稱(英文) Effects of delirium prevention intervention for the post intensive care elderly
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 98
學期 1
出版年 99
研究生(中文) 王首文
研究生(英文) Shou-Wen Wang
學號 t2694401
學位類別 碩士
語文別 中文
論文頁數 63頁
口試委員 指導教授-陳清惠
口試委員-王靜枝
口試委員-張家銘
中文關鍵字 預防譫妄措施  老人  急性混亂  譫妄 
英文關鍵字 prevent delirium intervention  the elderly  acute confusion 
學科別分類
中文摘要 譫妄為住院老人常見臨床合併症,不僅造成跌倒、自拔管路等意外傷害,使住院天數增加,亦提高死亡率。本研究探討由加護病房轉出住院老人譫妄發生率及預防譫妄措施之成效,採實驗性研究設計,以南部某醫學中心,65歲以上為收案對象,樣本數各30位。措施為利用輔助用具,協助個案出病室外,到院內固定公共場所,並與個案討論家人、住院主要照顧者及相關醫護人員姓名、稱謂、關係、日期、時間點、天氣狀況、所在處、此次就醫過程及當天時事,每次30分鐘以上,以促進定向感等認知能力,持續至轉出後第14天。
結果顯示譫妄發生個案有29位 (介入組15位/控制組14位),譫妄發生率為48.3%。介入組持續發生天數顯著低於控制組(2.13vs 3.29,t= -2.74, p=.011) ,譫妄持續發生天數<2天個案,介入組顯著多於控制組,X2=5.855( p=.016)。大多數在轉出當天就發生譫妄(96.9%),多數持續時間2天 (44.8%, 13/29),最長為7天(控制組),兩組皆無新增譫妄個案,無法推論預防譫妄措施是否更能降低由加護病房轉出老年病人譫妄發生率。兩組皆無重複個案發生。再回轉加護病房方面,二組各有4人,皆因疾病因素導致,無統計顯著差異。
臨床應持續評估及執行認知訓練,並幫助老年病人到公共區域活動,增加與外界接觸及環境刺激,以降低譫妄持續發生天數。
英文摘要 Delirium is a common complication among hospitalized elderly. Delirium may not only lead to the accident of falling or self-extubation, but also increase the length of stay and mortality rate. The purpose of study was to investigate the incidence of delirium and to test the effects of a prevent delirium intervention in elderly during post-intensive care. Elderly who were older than 65 years and transferred from intensive care unit (ICU) to the general wards were randomly assigned to experimental and control group. The experimental group (n= 30) was provided aids enable to move to public place and to enhance cognition training (introduction of care-team members or caregiver, and discussion daily schedule and current events, reorient the surrounding) 30 minutes per day for14 days. The control group (n= 30) was provided the routine care.
The overall incidence of delirium was 48.3 % (intervention group n=15, control group n=14). Almost of them were diagnosed on the day transferred (96.6%). Most delirium duration was 2 days (44.8%, 13/29); the longest duration was 7days (control group). The duration of delirium was significantly lower in the intervention group, compared to controls (2.13 vs. 3.29days, respectively, P=.011).
The findings of study suggest that nursing intervention is effective to decrease duration of delirium among the elderly in post-intensive care.
論文目次 中文摘要I
英文摘要II
致謝III
表目錄VII
圖目錄VII
附件目錄VII
第一章 緒論1
第一節 背景與重要性1
第二節 研究目的2
第二章 文獻查證3
第一節 譫妄的定義及分類3
第二節 評估測量譫妄的工具4
第三節 影響住院老人發生譫妄的相關因素8
第四節 預防及處置住院老人譫妄發生措施11
第三章 研究架構與研究問題20
第一節 研究架構20
第二節 研究問題21
第四章 研究方法與過程22
第一節 名詞界定22
第二節 研究設計24
第三節 研究場所與對象24
第四節 介入措施與施行方法26
第五節 研究工具27
第六節 倫理考量27
第七節 資料分析與處理28
第五章 研究結果30
第一節 研究對象人口學屬性30
第二節 與加護病房轉出老人瞻望發生之相關因素34
第三節 預防譫妄措施對譫妄發生之影響36
第六章 討論38
第一節 人口學屬性對研究結果影響之探討38
第二節 認知訓練活動對譫妄發生成效之探討38
第七章 結論、限制與建議41
第一節 結論41
第二節 限制41
第三節 研究結果之應用與建議42
參考文獻43
中文部份43
英文部份44
表目錄
表4-1描述性統計29
表5-1人口學變項(等比變項)30
表5-2 人口學變項-1(類別變項)31
表5-3人口學變項-2(類別變項)32
表5-4類別變項與加護病房轉出之老人譫妄發生之相關34
表 5-5等比變項與由加護病房轉出之老人譫妄發生之相關35
表5-6 譫妄發生率、發生時間點、結案原因及組間比較36
表5-7發生譫妄個案持續天數、譫妄型態及組間比較37
圖目錄
圖3-1 研究架構20
附件目錄
附件一 研究流程圖51
附件二 受試者同意書及譫妄相關說明52
附件三 個案基本資料表55
附件四 中文版譫妄評估量表(CAM)56
附件五 中文版加護病房譫妄評估(CAM-ICU)60
附件六 每日譫妄篩檢與相關因素趨勢紀錄表61
附件七 成大醫院人體試驗委員會審查同意書62
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