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系統識別號 U0026-2507201611501600
論文名稱(中文) 重要關鍵人幫忙關係策略對慢性腎臟病患者健康生活型態之成效
論文名稱(英文) Effects of Strategies of Promoting Helping Relationships from Significant Others on Healthy Lifestyle among Patients with Chronic Kidney Disease
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 104
學期 2
出版年 105
研究生(中文) 李佩玉
研究生(英文) PEI-YU LEE
電子信箱 crab228@gmail.com
學號 T26031068
學位類別 碩士
語文別 中文
論文頁數 93頁
口試委員 指導教授-顏妙芬
口試委員-宋俊明
召集委員-林秋菊
中文關鍵字 幫忙關係  健康促進生活型態  慢性腎臟病 
英文關鍵字 helping relationships  healthy lifestyle  chronic kidney disease 
學科別分類
中文摘要 慢性腎臟病因初期症狀不明顯,使得國人警覺性偏低,對於可以延緩疾病惡化的預防措施,像是生活型態的改變、定時返診追蹤、按時服藥…等等,往往遵從性低,但若能藉由重要關鍵人所提供的幫忙關係,時時協助甚至陪伴個案共同執行健康行為,將有助於促進健康生活型態並延緩疾病的惡化。因此,本研究目的為瞭解重要關鍵人所提供的幫忙關係策略對於慢性腎病患者健康生活型態之影響。
本研究為實驗性設計法,採雙組前後測設計。以立意取樣針對南部地區區域或醫學中心腎臟科門診之慢性腎臟病病患為研究對象共120名,並隨機分配為實驗組及控制組。兩組皆於介入時給予結構式問卷前測,實驗組提供個案及重要關鍵人完整的幫忙關係策略介入措施,包括提醒機制、協助設立目標、鼓勵支持、回饋,期間包含一對一策略指導及電話追蹤,控制組則採一般常規照護,並於介入後三個月進行結構式問卷後測。研究工具之結構式問卷包含重要關鍵人幫忙關係量表、健康促進生活型態量表、國際身體活動量表。將所得的資料以描述性統計、獨立t 檢定、差異中之差異法進行資料處理及分析。
研究結果顯示,實驗組的健康促進生活型態、身體活動量、幫忙關係程度在介入措施前均顯著的低於控制組,經過三個月的幫忙關係策略介入後,實驗組的健康促進生活型態及所感受到的幫忙程度皆有進步,控制組則有退步,兩組進步幅度達顯著差異;實驗組的身體活動量有進步,控制組則為退步,兩組進步幅度未達顯著差異。建議臨床個案管理可納入對個案具有影響力的家人或朋友共同參與照護計畫,使幫忙關係從醫療院所拓展到社區及居家,共同營造健康促進之環境。
英文摘要 SUMMARY
Continuous assistance from significant others may promote a healthy lifestyle and prevent disease progression. The objective of this study was to understand the effects of helping relationship strategies on healthy lifestyle among patients with CKD. This study was an experimental two-group pretest–posttest design study. A total of 120 patients with CKD were randomly assigned to the experimental or control group. Subjects in the experimental group were provided with helping relationship strategies and monthly follow-up by phone. Strategies of improving helping relationship included warning mechanisms, target setting, encouragement, and feedback. In contrast, the subjects in the control group received regular care and monthly follow-up by phone. There were 72% male in this study. The mean age of the subjects was 63.14 years. We used the mean of difference to compare the effect of posttest between the two groups. Significant differences in helping relationship (t = −2.15, p < .05) and health-promoting lifestyle (t = 3.12, p < .05) were found between the two groups. No significant differences in physical activity (t = 1.62, p > .05) were found between the two groups. Appropriate helping relationship strategies may improve the helping relationship between significant others and patients with CKD for promoting a healthy lifestyle.
Key words: helping relationships, healthy lifestyle, chronic kidney disease

INTRODUCTION
People are less aware of chronic kidney disease (CKD) because of its mild early symptoms. It is difficult for them to adhere to lifestyle changes, regular clinic visits, and timely medication administration. However, continuous assistance from significant others may promote a healthy lifestyle and prevent disease progress. The necessary characteristics of significant others should include dependability, credibility, and positivity. Significant others may use understanding, caring, faith, and honesty to help patients deal with CKD and improve their self-care efficacy. Four teaching strategies, warning mechanisms, target setting, encouragement, and feedback, were developed to improve the helping relationship with significant others. The objective of this study was to understand the effects of helping relationship strategies on healthy lifestyle among patients with CKD.
MATERIALS AND METHODS
This study was an experimental two-group pretest–posttest design study. A total of 120 patients with CKD were selected from nephrology outpatient clinics from a regional hospital and a national medical center in southern Taiwan. Study subjects were randomly assigned to the experimental or control group. The inclusion criteria of the subjects were: (1) age >20 years, (2) diagnosis of CKD stages 1–4, (3) having significant others, and (4) with clear consciousness. The exclusion criteria were with: (1) good healthy lifestyle and (2) a psychiatric history. Power analysis calculation indicated that for an effect size of 0.5, power of 0.8, and 20% loss rate, 120 participants would be required. Before starting the interventions, all patients completed a structured questionnaire as a pretest. Subjects in the experimental group were provided with helping relationship strategies and monthly follow-up by phone. Strategies of improving helping relationship included warning mechanisms, target setting, encouragement, and feedback. In contrast, the subjects in the control group received regular care and monthly follow-up by phone. Three months later, all subjects completed a structured questionnaire as a posttest. The structured questionnaire included helping relationships scale, health-promoting lifestyle profile, and International physical activity questionnaire. Descriptive statistical analyses were used to describe variable distributions using means, standard deviations, frequencies, and percentages. The chi-square test was used to examine differences between groups in terms of demographic variables. The t-test was used to assess differences between the experimental and control groups for pretest. Difference in differences was used to assess differences between experimental and control groups for posttest.
RESULTS AND DISCUSSION
A total of 120 subjects diagnosed with CKD were recruited. Four subjects (one in control group and three in experimental group) did dropped out at first month; Valid data from 116 subjects (57 in experimental group and 59 in control group) were included. Among the subjects, 72% were males and mean age was 63.14 years. The percentage of subjects with stage 1, 2, 3, and 4 of CKD were 3.4%, 9.5%, 57.8%, and 29.3%, respectively. There were no significant different between the two groups in terms of demographic variables. In the baseline data, the mean of helping relationship score was 68.04 (SD = 13.56) in the experimental group and 72.85 (SD = 10.37) in the control group. The mean of health-promoting lifestyle score was 129.23 (SD = 19.64) in the experimental group and 143.37 (SD = 19.84) in the control group. The mean of physical activity scores was 1767.28 (SD = 1605.92) in the experimental group and 3369.01 (SD = 3286) in the control group. Significant differences were found in helping relationship (t = −2.15, p < .05), International Physical Activity Score (t = −3.27, p < .05), and health-promoting lifestyle (t = −3.85, p < .05) between the two groups. We used the mean of difference to compare the effect of posttest between the two groups. The mean difference of helping relationship score was 3.05 (SD = 15.22) in the experimental group and −5.05 (SD = 12.61) in the control group. The mean difference of health-promoting lifestyle score was 0.18 (SD = 0.35) in the experimental group and −0.06 (SD = 0.35) in the control group. The mean difference of physical activity scores was 33.59 (SD = 1580.87) in the experimental group and −674.7 (SD = 1.62) in the control group. Significant differences in helping relationship (t = −2.15, p < .05) and health-promoting lifestyle (t = 3.12, p < .05) were found between the two groups. No significant differences in physical activity (t = 1.62, p > .05) were found between the two groups.
CONCLUSION
Appropriate helping relationship strategies may improve the helping relationship between significant others and patients with CKD for promoting a healthy lifestyle. We recommend that significant others, such as families and friends, should be included in the care plan as part of clinical case management; therefore, helping relationships can be expanded from medical centers to communities, and everyone can contribute in building a health-promoting environment. Because of time and human resource limitations, the study was performed only for 3 months. It is suggested that longitudinal studies can be implemented to understand the long-term effects of helping relationships from significant others among patients with CKD.
論文目次 中文摘要 I
英文摘要 II
致謝 V
目錄 VII
圖目錄 X
表目錄 X
第一章 緒論 1
第一節 研究重要性及動機 1
第二節 研究目的與問題 3
第二章 文獻查證 4
第一節 慢性腎臟病與健康生活型態 4
第二節 影響健康生活型態相關因素 14
第三節 重要關鍵人之幫忙關係 16
第四節 重要關鍵人幫忙關係策略 22
第三章 研究方法與過程 29
第一節 研究架構 29
第二節 名詞界定 30
第三節 研究設計 32
第四節 研究對象 36
第五節 研究工具 37
第六節 倫理考量 39
第七節 資料搜集策略 40
第八節 資料分析與解釋 43
第四章 研究結果 44
第一節 研究對象人口學基本資料 45
第二節 介入措施前,研究對象之健康促進生活型態、身體活動量、重要關鍵人幫忙關係之現況及比較 50
第三節 幫忙關係策略對慢性腎臟病患者健康促進生活型態之影響 56
第四節 幫忙關係策略對慢性腎臟病患者身體活動量之影響 59
第五節 幫忙關係策略對慢性腎臟病患者幫忙關係程度之影響 63
第五章 討論 66
第一節 研究對象人口學基本資料 66
第二節 研究對象健康促進生活型態、身體活動量及幫忙關係之現況 68
第三節 幫忙關係策略對慢性腎臟病患者健康促進生活型態之影響 70
第四節 幫忙關係策略對慢性腎臟病患者身體活動量之影響 72
第五節 介入措施對於提升慢性腎臟病患者幫忙關係之成效 74
第六章 結論 76
第一節 結論 76
第二節 應用與建議 77
第三節 研究限制 80
參考文獻 81
中文部分 81
英文部分 84

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