臺灣博碩士論文加值系統

近年來心血管疾病已位居國人十大死因的第二位，若內科治療的方式無效時，則以外科手術的方式可以提高心臟病患的存活率與生活品質。
本研究的主要目的在探討心臟手術病患於手術前、手術後及出院返家後之持續照護的需求，即心臟手術病患的個案管理需求。以描述相關性與縱貫性的研究方式，針對北部某醫學中心接受心臟手術的病患，以立意取樣的方式共收案70名。研究工具採用＂心臟手術病患個案管理需求量表＂進行資料收集，所得資料以描述性統計、t檢定、單因子變異數分析、皮爾森績差相關及複迴歸分析等方法進行資料分析。
研究結果發現：(1)心臟手術病患在手術前照護需求的重要程度依序為生理照護需求、訊息需求、心理社會需求；手術後及出院返家後的照護需求程度依序為訊息需求、心理社會需求、生理照護需求。(2)心臟手術病患在手術前的照護需求滿足程度依序為心理社會需求、訊息需求、生理照護需求，手術後及出院返家後的照護需求滿足程度依序為訊息需求、心理社會需求、生理照護需求。(3)影響照護需求程度的相關因素，在手術前為年齡、教育程度、職業狀況、經濟狀況及有無家庭照顧者。手術後則是與年齡及有無慢性病有關，出院返家後則是與年齡、教育程度、經濟狀況有關。(4) 影響照護需求滿足程度的相關因素，在手術前為職業狀況、經濟狀況及有無家庭照顧者。手術後則是與職業狀況有關。出院返家後則是與職業狀況、婚姻狀況及經濟狀況有關。(5)整體照護需求重要程度的影響因子，在手術前為性別、年齡及有無慢性病。(6) 整體照護需求滿足的重要程度影響因子，在手術後為術後住院天數及有無慢性病。
本研究結果期望未來作為制定心臟手術病患個案管理介入模式及相關研究的參考。

In recent years, cardiovascular disease is the second leading cause of death in Taiwan. At present, there have proposed numerous approaches in cardiovascular disease treatment and prevention methods. However, if cardiology treatments cannot be applied then surgery is the only effective treatment. This study is aimed to investigate and analyze patients before, after and post surgery home care of a cardiovascular disease surgery in order to optimize special care needs, and health management.
A longitudinal, correlational study was conducted study at a medical center located in northern Taiwan. The sample data were collected from 70 patients who underwent cardiac surgery. The sample data was further analyzed by descriptive statistics, t-test, one-way ANOVA, Pearson correlation and multiple regression analysis.
There are major findings from this study:
(1) The findings suggested that patients required special attentive needs before surgery(listed in descending order of priority): physiological care .information regarding the surgery and psychosocial needs; in addition, the findings indicated the importance post-surgery care (listed in descending order of priority): information on post-surgery, psychosocial needs, and physical recovery help. (2) The satisfaction of care needed before the surgery(listed in descending order of priority): psychosocial needs, information regarding the surgery and physiological needs; the satisfaction of post-surgery care (listed in descending order of priority): Information on post-surgery, psychosocial needs and physiological care. (3) Factors which impacts the level of care need surgery (listed in descending order of priority): age, education, occupation, income and family caregiver ; factors which impacts the level of care need post surgery(listed in descending order of priority): age and chronic diseases; factors which impacts the level of care after retuning home from surgery (listed in descending order of priority): age, education and income. (4) Factors that influences the level of care before surgery (listed in descending order of priority): occupation, income and family caregiver; factors that influence the level of care met post surgery: occupation; factors that influences the level of care met after returning home from surgery (listed in descending order of priority): occupation, marriage and income. (5) The overall factors that influences a patient’s need before surgery (listed in descending order of priority): gender, age and chronic diseases. (6)The overall factors that influences satisfaction post surgery: length of hospital stay after surgery and chronic diseases.
In conclusion, the results from this study can serve as a source to develop a health management program for cardiac surgery patients and others of related research.

中文摘要 I
英文摘要 III
目錄 V
表目錄 VII
圖目錄 IX
第一章 緒論 1
第一節 研究背景﹅動機及重要性 1
第二節 研究目的 3
第三節 名詞界定 3
第二章 文獻查證 5
第一節 心臟手術對個案的影響 5
第二節 心臟手術個案的照護需求 9
第三章 研究方法 13
第一節 研究設計 13
第二節 研究對象 15
第三節 研究工具 15
第四節 研究倫理 17
第五節 資料收集過程 17
第六節 資料處理與分析 19
第四章 研究結果 21
第一節 個案基本資料與疾病特性之分布情形 23
第二節 個案對於照護需求及需求滿足程度之現況 27
第三節 個案基本資料、疾病特性與照護需求之關聯性 33
第四節 個案基本資料、疾病特性與照護需求滿足之關聯性 47
第五節 個案照護需求及需求滿足程度之影響因子 61
第五章 討論 77
第一節 研究對象基本人口學變項探討 77
第二節 研究對象疾病特性探討 77
第三節 心臟手術個案照護需求程度及滿足情形之現況 79
第四節 影響照護需求程度的相關因素探討 81
第五節 影響照護需求滿足的相關因素探討 83
第六節 照護需求重要程度的影響因子 87
第七節 照護需求滿足程度的影響因子 89
第六章 結論與建議 91
第一節 結論 91
第二節 建議 93
第三節 研究限制 95
參考文獻 97
中文部分 97
英文部分 103
附錄一 人體試驗委員會同意臨床試驗證明書 107
附錄二 個案基本資料 111
附錄三 問卷 113
附錄四 量表授權同意書 119

中文部分

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林璟淑、廖彥琦(2003)．肌肉鬆弛訓練技巧對心臟手術後病患疲憊程度改善成效之探討．慈濟護理雜誌，2(4)，46-54。[Lin, J. S., & Liao, Y. C. (2003). The effects of muscle relaxation in improving fatigue reduction among cardiac surgery patients. Tzu Chi Nursing Journal, 2(4), 46- 54.]
紀乃新、王水深(2012)．微創心臟手術．台北市醫師公會會刊，56(10)，21-24。[ Ji, N. X., & Wang, S. S. (2012). Minimally invasive cardiac surgical procedures . The Journal of Taipei Medical Association, 56(10), 21-22.]
周美錱(2010)．手術前訪視的重要性，品質月刊．46(8)，17-20。[Chou, M. C. (2010). The important of pre-operative visiting. Quality Magazine．Chinese Society for Quality, 46(8), 17-20.]
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陳詠真(2011)．使用衛教光碟衛教心臟手術病患及家屬對降低術前焦慮之探討．桃園市：長庚大學護理學系碩士班。[ Chen, Y. C. (2011). Using videodisc intervention to reduce pre-operative anxiety of the patient and family toward cardiac surgery. Chang Gung University, Taoyuan City, Taiwan, ROC.]
陳雅鈴、張碧容(2004)‧一位行冠狀動脈繞道手術患者術後之護理經驗‧護理雜誌，51(6)，80-86。[ Chen,Y. L., & Chang, P. R. (2004). Nursing care for a post coronary artery bypass graft atient. The Journal of Nursing, 51(6), 80-86.] doi：10.6224/JN.51.6.80
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郭斐如(2005)．冠狀動脈繞道手術出院病患健康照護需求及其相關因素之探討．臺北市：國防醫學院護理研究。[ Kuo, F. J. (2005). The health care needs and related factors in discharged patients with coronary artery bypass graft surgery. National Defense University, Taipei City, Taiwan, ROC.]
郭雯芳(2011)．探討冠狀動脈繞道手術後病患身體功能的改變．台北市：台灣大學護理學研究所。[ Kuo, W. F. (2011). Changes of physical function in patients undergoing coronary artery bypass graft surgery. National Taiwan University, Taipei City, Taiwan, ROC.]
黃正雄（2004)．冠狀動脈阻塞心臟病外科手術治療之近況．台北市醫師公會會刊，48（10），64－66。[ Hwang, C. S. (2004). The new trends of surgical treatment for coronary artery heart disease. The Journal of Taipei Medical Association, 48(10), 64-66]
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黃秀梨、許淑蓮、鄭靜瑜、廖玟君、張瑛、黃慧芬、吳佩蓉．．．林碧珠(1996) ．心臟手術病人居家期間壓力感受追蹤研究．慈濟醫學雜誌，8(3)，223–229。[ Hwang, S. L.,Sheu, S. L., Cheng, C. Y., Liao, W. C., Chang, Y., Hwang, H. F., Wu, P. J., … Lin, B. J. (1996). Perception of open heart surgery patients stress after discharge–a follow-up study. Tzu Chi Nursing Journal, 8(3), 223–229.]
黃秀梨、張瑛、黃嗣棻、吳佩蓉、廖玟君(1997)．心臟手術病人於加護期間壓力感受及其影響因素之探討．慈濟醫學雜誌，9(4)，285 - 294。[ Hwang, S. L., Chang, Y., Hwang, S. F., Wu, P. J., & Liao, W. C. (1997). Stress perception of post-heart surgery patients in the Intensive care unit. Tzu Chi Medical Journal, 9(4), 2 85–294.]
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[Hwang, S. L., Liao, W. C., Cheng, C. Y., Hwang, S . F., Chang, Y., & Hwang, T. Y. (1997) . Coping with the stress before and after heart surgery - a follow-up study. Tzu Chi Medical Journal, 9(1), 53–61.]
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黃麗萍(2006)．冠狀動脈繞道手術術後住院病患疲憊感及其相關因素．台北市：國防醫學院護理研究所。[Huang, L. P. (2006). The fatigue and related factors in hospitalized patients with coronary artery bypass graft surgery. National Defense University. Taipei City, Taiwan, ROC.]
游千代、馮明珠、柯乃熒(2007)．個案管理之概念分析．護理雜誌，60(4)，99-104。[ Yu, C. T., Feng, M. C., & Ko, N. Y. (2007). Case management: a concept analysis. The Journal of Nursing, 60(4), 99-104.] doi：10.6224/JN.60.4.99
張瑀玲(2006)．加護病房心臟術後譫妄盛行率及危險因子之探討．桃園市：長庚大學護理學碩士班。[Chang, Y. L. (2006). Prevalence and risk factors for delirium after cardiac surgery in an intensive care unit. Chang Gung University, Taoyuan City, Taiwan, ROC.]
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張孝瑛(2007)．系統性護理指導對冠狀動脈繞道手術後出院病患健康照護需求、身體活動功能及生活品之成效探討．台北市：國防醫學院護理研究所。[Chang , H. Y. (2007). The effects of systemic nursing instruction on health care needs , Function of physical activities and quality of life in discharged patients after coronary artery bypass graft surgery. National Defense University, Taipei City, Taiwan, ROC.]
雍允雯(2003)．心臟手術後患者呼吸器脫離影響因素與成功脫離之相關探討．台北市：臺北醫學大學。[Yun, Y. W. (2003). The relationship between related factors of ventilatory weaning and the successful weaning in patients undergone cardiac surgery. Taipei Medical Unversity, Taipei City, Taiwan, ROC ]．
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[Liao, W. C., Cheng, C. Y., Hwang, S. F., Chang, Y., & Hwang, S. L. (1998). Coping behaviors of heart surgery patients after discharge - a follow-p study, Tzu Chi Medical Journal, 10(3), 221-229.]
廖玟君、黃正宜、黃翠媛、黃秀梨(2011)．開心手術後病人睡眠型態與睡眠干擾因素之系統性文獻回顧．護理研究，19(4)，275–288。[Liao, W. C., Huang, C. Y., Huang, T. Y., & Hwang, S. L . (2011). A systematic review of sleep patterns and factors that disturb sleep after heart surgery. The Journal of Nursing Research, (19)4, 275–288.]doi：10.1097/JNR.0b013e318236cf68
葉雅惠、江慧玲、林麗英、許凰珠（2010）．多媒體光碟於脊推手術病患術前焦慮之成效•護理暨健康照護研究，6(4)，299−307。[Yah, Y. H., Chiang, H. L., Lin, L. Y., & Hsu, H. C. (2010). Efficacy of using multimedia videos to reduce preoperative anxiety in patients scheduled for spinal surgery. Journal of Nursing and Healthcare Research, 6(4), 299−307.] doi:10.6225/JNHR.6.4.299
劉慧玲、洪美英、鍾貴春、陳堉玫、徐南麗(2004)．冠狀動脈繞道手術病患出院後自覺健康問題及護理指導需求．慈濟護理雜誌，3(1)，61-71。[ Liou, H. L., Hung, M. Y., Chung, K.C., Chen, Y. M., & Hsu, N.T. (2004). The perceived health problems and needs for nursing instruction in patients undergoing coronary artery bypass grafting surgery after discharge. Tzu Chi Nursing Journal, 3(1), 61-71]
劉怡伶、蔡仁貞、鄭綺(2007)．冠狀動脈繞道術後病患身體症狀困擾、身體活動功能及其自我效能相關之探討．實證護理，3(1)，73-82。[ Liou, Y. L., Tsai, J. C., & Jeng, C. (2007). Physical symptom distress, physical function and self-efficacy in patients who had undergone coronary artery bypass grafting surgery. Journa l of Evidence-Based Nursing, 3(1), 73-82] doi:10.6225/JNHR.5.4.302
劉鼎浩、陳怡蓁、洪素鶯、周正亮(2013)．接受冠狀動脈繞道手術或心臟瓣膜手術患者第一期心肺復健-某醫學中心之經驗．台灣復健醫誌，41(3)，181 -188。[Liu, D. H., Chen, Y. C., Hung, S. Y., & Chou, C. L. (2013). Cardiac rehabilitation after coronary artery bypass graft or heart valve replacement surgery-experience of a medical center. Taiwan Journal of Physical Medicine and Rehabilitation, 41(3), 181-188.]
蔡雨純、顏淑華、施惠玲(2009)．從縱貫面探討一位行冠狀動脈繞道手術病人之護理經驗．源遠護理，3(1)，51-60。[Tsai, Y. C., Yen, S. H., & Shi, H. L. (2009). Case study on the nursing care of a patient post coronary artery bypass graft surgery. Yuan Yuan Nursing, 3(1), 51-60.]　
歐乃欣、黃姿倩、郭雯芳、蔡旻璇、陳佳慧 (2013)．老年病患心臟術後的預後．台灣老年醫學暨老年雜誌，8(3)，135-145。[Ou, N. H., Huang , T. C., Kuo , W. F., Tsai , M. H., & Chen, C. H. (2013). Functional outcomes in older cardiac surgery patients. Taiwan Geriatr Gerontol, 8(2), 135-145.]
歐淑華(2012)．心臟手術病人活動耐力及其相關因素之探討．台北市：國防醫學院護理研究所。[Ou, S. H. (2012) . Activity tolerance and related factors in patients undergoing cardiac surgery. National Defense University. Taipei City, Taiwan, ROC.]
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