Improving Toileting Abilities of Elders 200 文獻查證 White 959effectance Bandura 977 social cognitive theory mastery experiences vicarious experiences ver

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1 提升長期照顧機構長者如廁能力之研究 2 3* 2 3 背景 : 如廁是一個複雜的活動, 如廁能力會影響個體的身心健康及生活品質 然而, 目前機構照顧人員缺乏理論為基礎的照護模式, 來促進機構長者的如廁能力 目的 : 探討以理論為基礎之自我照護及運動自我效能活動, 提升如廁能力之成效 方法 : 採實驗性 雙組 追蹤性研究設計 資料收集時間共有 4 次 : 基本資料收集 介入措施執行後 2 個月 4 個月 6 個月 實驗組住民接受由機構工作人員提供的活動指導, 採用 Bandura 的社會認知理論為基礎所設計的自我照顧及運動自我效能促進課程活動 結果 : 本研究共有 274 位機構長者參與 ( 實驗組 20 位 ; 對照組 54 位 ) 在介入措施執行半年後, 實驗組個案在下半身強度 左右髖關節及膝關節屈曲與伸展角度, 均有顯著性改變 對照組個案只有左右膝關節伸展角度有顯著性改變 也發現如廁能力之預測因子項目中, 功能能力自我效能 下半身強度 疼痛感 及右膝關節伸展度, 可解釋的總變異量達 52.3% 實驗組個案在如廁能力有進步, 但統計上無顯著改變 對照組如廁行為能力也出現無統計上顯著改變, 然其變化較呈現不穩定狀態 結論 / 實務應用 : 提供長照機構工作人員, 運用以理論為基礎的自我照顧及運動自我效能促進課程, 來維持老年人之如廁功能 關鍵詞 : 如廁能力 長期照顧機構 長者 前言 % % , disuse 2009 activity of daily living, ADL suhsian@yahoo.com % 2007 doi:0.6225/jnhr 護理暨健康照護研究

2 Improving Toileting Abilities of Elders 200 文獻查證 White 959effectance Bandura 977 social cognitive theory mastery experiences vicarious experiences verbal persuasion Bandura Chen & Wang, % upper and lower body muscular strength aerobic endurance upper and lower body flexibility agility/dynamic balance; Chen, Lin, & Yu, 2009; Rikli & Jones, Journal of Nursing and Healthcare Research September 202 Vol. 8, No. 3

3 方法 一 研究設計與對象 geriatric depression scale short form 二 介入措施 self-care and exercise self-efficacy enhancement program, SCESEEP Bandura SCESEEP 4 SCESEEP 34SCESEEP SCESEEP SCESEEP SCESEEP SCESEEP SCESEEP 三 研究工具㈠ ㈡Tappen Tappen s refined activities of daily living Tappen 995 老 量 5 行 行 29 護理暨健康照護研究

4 Improving Toileting Abilities of Elders 2 6 不 數 力 行 量 度 5 度.89 to.96 Tappen, 995 ㈢ self-efficacy for function ability Resnick 數 力 行 r =.92 the apathy evaluation scale function performance r =.49 r =.88 ㈣ outcome expectation for function scale Resnick 數 r =.92 function performance r =.80 ㈤ physical fitness assessment scale 四 資料分析 SPSS for Windows 6.0 tχ 2 linear regressionanalysis of covariance, ANCOVA 結 一 研究對象基本資料 果 n = 42n = SD = p >.052 二 SCESEEP 活動介入對體適能的影響 6 SCESEEP p <.05 p >.05 6 p <.05 p >.05 三 SCESEEP 活動介入對如廁能力的影響 F = 7.009, p < % R 2 =.52 SCES- EEP F = 0.873, df = 3, p >.05 M = 72.08, SD = M = 68.0, SD = M = 70.58, SD = M = 77.0, SD = F = 0.325, df = 3, p >.05 24M = 77.23, SD = M = 75.63; SD = Journal of Nursing and Healthcare Research September 202 Vol. 8, No. 3

5 表一實驗組與對照組之基本資料及比較 (N = 274) 實驗組 對照組 變項 n M ± SD n M ± SD t-test/χ 2 p 值 性別 婚姻狀態 教育程度 6 < 6 經濟來源 年齡 77.2 ± ± 入住機構月數 ± ± 功能能力自我效能 4.84 ± ± 功能能力結果期待 0.95 ± ± 基本如廁能力 ± ± 表二 SCESEEP 活動介入後對體適能狀態之變化 討 論 變項實驗組 (F 值 ) 對照組 (F 值 ) ** ** ** ** ** ** ** ** 4.424** 2.840** 4.342** SCESEEP: self-care and excercise self-efficacy an hancement program; *p <.05. **p <.0. M = 74.92, SD = M = 72., SD = Chen et al., 護理暨健康照護研究

6 Improving Toileting Abilities of Elders 表三控制干擾因子後研究對象如廁能力之改變 變項 correlated model intercept error total corrected total 實驗組 對照組 Type III SS df MS F Type III SS df MS F a ** 04.8** 7.08** ** 9.342** b ** 2.36** 5.36** 92.69** 2.95** 3.85** 0.63 a R 2 =.653 adjusted R 2 =.647 b R 2 =.549 adjusted R 2 =.543 *p <.05. **p <.0. 表四體適能檢測 功能能力自我效能及結果期待及如廁能力之變化 變項 實驗組 M(SD) 對照組 M(SD) Time Time2 Time3 Time4 Time Time2 Time3 Time SCESEEP Journal of Nursing and Healthcare Research September 202 Vol. 8, No. 3

7 SCESEEP SCESEEP 研究限制 SCESEEP SCESEEP SCESEEP SCESEEP 結論 Bandura SCESEEP SCESEEP SCESEEP 誌謝 NSC B 參考文獻 [Wang, H. P. (2003). Disease, functional status, and self-rated health in Taiwan elderly: Taiwanese Journal of Social Welfare, 3, ] [Department of Social Affairs, Taiwan, ROC. (202, January 5). Allocation of resources by senior citizen social welfare organizations nationwide. Retrieved from 護理暨健康照護研究

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10 Improving Toileting Abilities of Elders Improving Toileting Abilities in Elders Living in Long-Term Care Facilities Shih-Ling Kuo Ching-Len Yu 2 Su-Hsien Chang 3 * MS, RN, Clinical Instructor, Department of Nursing, National Tainan Institute of Nursing; 2 PhD, Assistant Professor, Department of Environmental Engineering, Kun Shan University; 3 PhD, RN, Associate Professor, Department of Eldercare, National Tainan Institute of Nursing. Background: Self-toileting is a complicated and complex activity. Inability to perform such can impact negatively upon the physical health, psychological health, and quality of life of affected individuals. Staff caregivers in longterm care facilities lack a theory-based intervention to improve toileting abilities in elders who live in long-term care facilities. Purpose: This study tested the effectiveness of a theory-based intervention program on improving the toileting abilities of elders living in long-term care facilities. Methods: This study used a research design that was experimental, two-group, and longitudinal. Data was collected four times, respectively, at baseline and at 2 months, 4 months, and 6 months post-intervention. Care facility staff administered a theory-based intervention designed on Bandura s social cognitive theory to subjects in the experimental group. Results: A total of 274 subjects participated in the study, with 20 assigned to the experimental group and 54 assigned to the comparison group. The experimental group recorded statistically significant changes in lower-body strength and flexion and extension in both hips and knees. The comparison group recorded statistically significant changes in knee extension degrees only. Results showed lower body strength, perception of pain, and degree of right knee extension to be significant predictors of self-toileting abilities (R 2 =.53). Although toileting ability improved in the experimental group, the change was not statistically significant. The comparison group further showed no statistical changes in toileting behavior, and these changes present unstable state. Conclusions / Implications for Practice: This study provides valuable information that staff caregivers can apply in theory-based interventions focused on enhancing elder self-care abilities and self-efficacy in order to sustain the self-toileting abilities of elders living in long-term care facilities in Taiwan. Key Words: toileting ability, long-term care facilities, elders. Accepted for publication: June 23, 202 *Address correspondence to: Su-Hsien Chang, No. 78, Minzu Rd. Sec. 2, Tainan City 70043, Taiwan, ROC. Tel: +886 (6) ; suhsian@yahoo.com 78 Journal of Nursing and Healthcare Research September 202 Vol. 8, No. 3