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系統識別號 U0026-1408201000310400
論文名稱(中文) 跌倒預防門診之計畫評值
論文名稱(英文) Program evaluation of the “ Falls prevention Outpatient Department”
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 2
出版年 99
研究生(中文) 陳仕瑜
研究生(英文) Shih-Yu Chen
學號 t2697108
學位類別 碩士
語文別 中文
論文頁數 129頁
口試委員 指導教授-陳清惠
召集委員-楊宜青
口試委員-林桑伊
中文關鍵字 老人  跌倒  預防  評值 
英文關鍵字 elderly  falls  prevention  assessment 
學科別分類
中文摘要 台灣地區老年人口占總人口比率之10.4%,每五位老年人當中,每年至少有一位發生跌倒意外。老年人口之跌倒預防一直是全球老人保健之重要議題。跌倒預防門診為跌倒預防措施常見的方法之一,運用周全性評估與整合性多重因子介入措施,以有效防範社區老人跌倒之發生。國立成功大學醫學院附設醫院自民國97年5月成立跨科部老人跌倒預防團隊並試辦跌倒預防門診,目前已服務73位病人,本研究目的即在瞭解該項服務之成效,並做為進一步改進之參考。本研究運用Donabedian所提出的健康照護品質架構針對門診醫療模式進行評值。研究對象包含門診團隊成員與在本門診看診滿六個月以上之病人或其家屬,針對本門診之結構、過程、結果面進行評值。
結果顯示,本門診團隊涵蓋多學科成員且具有周全的評估模式。給予病人的建議種類中,以運動建議比率最高。病人參與跌倒預防門診後其跌倒次數、跌倒傷害次數其呈現改善趨勢;起走測試呈顯著改善;日常生活活動功能呈現顯著下降;跌倒害怕程度、單腳站立平衡、前伸測試、下肢肌力則無顯著差異。依其遵從性來看,運動、藥物、環境建議多數無法遵從,整體之遵從性尚須加強。本門診之病人與照顧者對跌倒相關已有部分基礎之了解,但於跌倒預防行為之執行上尚有落差。整體而言,對門診之滿意度為滿意。此研究結果可提供老人跌倒醫療照護與防治之參考。
英文摘要 The elderly in Taiwan accounts for 10.4% of the total population. Annually, one fifth of all elderly will experience a fall accident. Fall prevention in the elderly is an important global issue in field of geriatric health care. Establishing falls clinic is one of the common approaches to prevent fall in community elders. The falls clinic, which is a multidisciplinary fall-prevention program in the National Cheng Kung University Hospital, was setup on May, 2008. Currently, the clinic has served 73 patients. The study utilized the health care quality structure developed by Donabedian to assess the quality of medical care and to examine the effectiveness of the clinic in fall prevention. The purpose of the study allows a greater understanding regarding the program outcomes. Study participants included team members from the falls clinic and outpatients who have had at least a six month follow-up.
The result shows that the clinic has members from multidisciplinary fields and has a complete assessment model. The most frequent suggestion given to patients was recommending them to exercise. After patients participated in the clinic, improvements were observed in falls, fall injuries and the Time up and go test, but the activities of daily living decline. Others measurements have no significant difference, such as fear of falling, one-leg standing test, forward reach test and leg muscle strength. According to the adherence, exercise, medicine, and environment were less adhered. In order to improve adherence, multifactorial fall prevention interventions need to adjust for suitableness. Patients and caregivers understand a majority of the fall-related knowledge, but fall-prevention efforts were not fully executed, and improvement is needed. As a whole, the degree of clinic satisfaction is satisfactory. The study results can serve as a reference for further improvements in geriatric health care services.
論文目次 摘要.....................................................I
致謝....................................................IV
目錄.................................................... V
表目錄.................................................VII
圖目錄..................................................IX
附件目錄................................................IX
第一章 緒論.............................................1
第一節 研究動機與重要性...................................1
第二節 研究目的..........................................3
第二章 文獻查證..........................................4
第一節 跌倒預防措施.......................................4
第二節 健康照護品質評估計畫...............................11
第三節 跌倒預防門診.....................................13
第三章 研究問題與研究架構 ................................19
第一節 研究問題.........................................19
第二節 研究架構.........................................19
第四章 研究方法與過程....................................20
第一節 國立成功大學醫學院附設醫院試辦之跌倒預防門診............20
第二節 名詞界定.........................................24
第三節 研究設計與對象....................................27
第四節 研究工具的測量與信效度.............................28
第五節 研究過程.........................................36
第六節 研究對象之倫理考量.................................37
第七節 資料分析與解釋....................................38
第五章 研究結果.........................................39
第一節 跌倒預防門診病人之人口學屬性與跌倒危險因子............41
第二節 跌倒預防門診之結構面...............................44
第三節 跌倒預防門診之過程面...............................46
第四節 跌倒預防門診之結果面...............................53
第六章 討論.............................................68
第一節 跌倒預防門診之結構面...............................68
第二節 跌倒預防門診之過程面...............................69
第三節 跌倒預防門診之結果面...............................73
第七章 結論與建議........................................76
第一節 結論.............................................76
第二節 研究結果運用與建議 .................................77
第三節 研究限制及未來研究建議.............................79
參考文獻 ................................................81

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