尿毒症患者對疾病與治療的知識、態度、自我照顧行為及其相關因素之探討

摘 要 本研究目的為 瞭解尿毒症患者對疾病與治療的知識、態度與自我照顧 行為，並探討患 者基本資料、焦慮狀態、獲悉疾病嚴重程度對疾病與治療的 的知識、態 度與自我照顧行為影響之程度。本研究為描述相關性研究，採立 意取樣 方式調查中部地區某區域教學醫院之血液透析中心門診患者，自民國 85年11月25日至86年1月31日間，以患者基本資料、焦慮狀態、獲悉疾病 嚴 重程度以及對疾病、治療的知識、態度與自我照顧行為量表為研究工 具，共 取得有效問卷41份，研究結果以t-test、one-way ANOVA、 Pearson correlation 、stepwise regression等統計方法分析所得資 料。研究重要 結果歸納如下: 尿毒症患者對疾病與治療知識的瞭 解尚理想，平均值為0.78分，以『性 問題』、『尿毒症病因』方面的知 識較差。對疾病與治療所抱持的態度，則 傾向於正向態度，平均值 為3.77分，以對『覺得身患尿毒症後應減少夫妻間 的性生活』、『覺得 患病後，生活方式受限制，無生活品質可言』所抱持態 度較負向。在自 我報告的自我照顧行為方面，平均值為3.66分，以『尋求相 關知識與訊 息』及『水份控制』較差。 尿毒症患者以年齡較輕、已婚和未婚、 有工作以及覺得疾病預後越嚴重 的患者，其對疾病與治療的知識較瞭解 。以有工作、經濟狀況有盈餘以及焦 慮程度越低者其態度較正向。教育 程度以高中程度及以上的患者，其自我報 告之自我照顧行為較好。 尿毒症患者『年齡』、『教育程度』以及『獲悉疾病嚴重程度』是影響 知識的重要因素，可解釋知識得分的64%(R2=64%)，尤其年齡因素解釋 了47% 的變異量。而『工作狀況』及『焦慮狀態』，可解釋態度得分 的25%(R2=25%) 。至於自我照顧行為則沒有變項可顯著地加以預測。而 尿毒症患者對疾病與 治療的知識、態度及自我照顧行為三者間呈正相關 性，彼此互相影響。 依據研究結果建議，護理人員在照顧尿毒症患 者時，應整體性評估患者 對疾病與治療的知識、態度與自我照顧行為， 且在執行護理指導時應考慮到 患者不同年齡、教育程度上的個別差異， 及患者的焦慮情緒，以提升尿毒症 患者的照顧品質。 關鍵字 : 尿毒 症、知識、態度、自我照顧行為

ABSTRACT This study was conducted (1) to investigate the disease- and management-related knowledge , attitudes , and self-care behavior ; (2) and to explore their relationships with demographic data , state anxiety , and the degree of understanding severity of disease of patients with uremia .Using a descriptive correlational design and applying purposive sampling , a total of 41 valid cases were recruited from outpatients for hemodialysis in a regional teaching hospital in Taichung , from November 25 1996 to January 31 1997 . And five instruments were used here: "state anxiety " , " the severity of the disease" , "the disease- and management- related knowledge , attitudes and the self-care behavior" In this study , t-test , one-way analysis of variance , Pearson correlation , stepwise regression were applied to analyze the data. The important results were indicated as follows: (1)Uremic patients had a better understanding in disease- and management-related knowledge whose mean was 0.78 than in "sexual problem" and "pathogenesis of uremia". As regards the attitude towards the disease and management , it tended to be positive . The mean was 3.77 . However it tended to be negative with regard to the attitude toward "Uremic patients should decreased sexual activities between couples " and "Uremic patients would lead a life with restriction which brought no life quality " . Moreover , the mean of self-care behavior in self-reports was 3.66 . And it tended to be worse with regard to "related knowledge and information search" and "water control". (2)Uremic patients of younger age , married or single , working , and with the feelings of their serious disease will understand more about the disease and management . The attitudes of those patients who had work , surplus in earnings , less anxiety tended to be more positive . As regards the education level , the self-care behavior of those patients graduated from or above high school was better in their self-reports . (3)Patient''s age , education level , and understanding of the severity of the disease were the most significant predictios of disease- and management-related knowledge . They may explained 64% of the variance for the knowledge , especially the factor of age which accounted to 47% . As far as "working condition" and "state anxiety" were concerned , they may explained 25% of variance for the attitudes . But we didn''t find any variables to predict the self-care behavior . Generally speaking , there was a positive correlation between the disease- and management-related knowledge , attitudes , and self-care behavior of patients with uremia. From this study , it is suggested that in order to improve the care quality , nurses should have to make an integrated evaluation on the disease- and management-related knowledge , attitudes , and self-care behavior of uremic patients . Besides , they also have to consider the age , education level , and state anxiety of patients when conducting health teaching . Key words : uremia , knowledge, attitude , self-care behavior