302 The Care Needs of Caregivers 探討居家呼吸器依賴患者其主要照顧者之 照顧需求及相關因素 郭文芳簡姿娟 * 隨著我國健保局推行的呼吸器依賴患者整合性照護計劃, 居家照顧將成為呼吸器依賴患者之主要照顧重點, 而照顧者將會面臨許多壓力與責任, 因此須進一步探討照顧者需要協助之問題, 以作為護理人員提供照顧之參考 探討居家呼吸器依賴患者主要照顧者的照顧需求情形及相關因素 採橫斷式相關性研究設計, 以方便取樣方式選取中部地區居家照顧之呼吸器依賴患者的主要照顧者, 以結構性問卷收集資料, 有效問卷共 138 份 ⑴ 照顧相關知識 為最重要的需求項目,⑵ 主要照顧者之照顧需求與患者之診斷與疾病情況有顯著相關,⑶ 主要照顧者每日照顧的時間與照顧相關技能及照顧相關服務需求呈現顯著正相關 由於主要照顧者對於 照顧相關知識 有高度的需求, 故建議制定完整的居家照顧指引, 包括 : 症狀評估 疾病監測及處置 藥物 營養及復健等內容, 減少因知識不足帶來的壓力與傷害 關鍵詞 : 居家呼吸器依賴患者 主要照顧者 照顧需求 2005 1998 2008 2005 ㈠ 2003 2835 320 * 98 6 11 98 9 1 98 10 13 43302 34 04 26318652 3074 5 卷 4 期 中華民國 98 年 12 月
303 Farré et al., 2005; MacIntyre et al., 2005 2000 30 320 11.3% 67.5% 2003 2005 2000 12 83.3% 91.7% 24 2004 ㈡ 200014 78 12 2000 2004120 Exel, Koopmanschap, Berg, Brouwer, Bos, 2005 Morimoto, Schreiner, & Asano, 2003 ㈢ 2000 2004 489 77.3% 94.1% Leff et al., 2006 30 2002 2001 2003 Farré, Giró, Casolivé, Navajas, & Escarrabill, 2003; Warren et al., 2004 5 卷 4 期 中華民國 98 年 12 月
304 The Care Needs of Caregivers Simonds, 2006 18 96 9 270~290 30~60 150 13896 12 10 97 1 30 ㈠ 1. 2. ㈡ 1999 37 0.91~0.92.90 SPSS10.0 t one-way ANOVAPearson s productmoment correlation p <.05 5 卷 4 期 中華民國 98 年 12 月
305 83 60.1% 55 39.9% 62 44.9% 56 40.6% 87 63.0% 51 37.0%88 63.8%47 34.1% 96 69.6% 88 63.8% 55 39.9% 14 10.1% 11 8.0% 51 37.0%42 30.4% 45 32.6% 0 8518.7 26.0 92 66.7% 10 7.3% 99 71.7% 52 37.7% 70 50.7% n % 83 60.1 55 39.9 56 40.6 62 44.9 20 14.5 87 63.0 51 37.0 88 63.8 47 34.1 21 15.2 30 21.7 14 10.1 35 25.4 N = 138 n % 42 30.4 36 26.1 60 43.5 8 51 37.0 9~12 42 30.4 13~15 45 32.6 0~20 92 66.7 21~40 13 9.4 41~60 23 16.7 61~100 10 7.3 39 28.3 99 71.7 70 50.7 57 41.3 11 8.0 52 37.7 37 26.8 30 21.7 13 9.4 6 4.4 42 30.4 96 69.6 115 83.3 63 45.7 64 46.4 8 5.8 123 89.1 83 60.1 80 58.0 109 79.0 93 67.4 83 60.1 80 58.0 84 60.9 89 64.5 8 5.8 5 卷 4 期 中華民國 98 年 12 月
306 The Care Needs of Caregivers 25 50 75 N = 138 58.0 25.8 3.0 40.0 67.5 78.0 97.0 34.4 35.5 1.0 11.0 22.0 48.3 192.0 18.4 6.2 8.0 12.0 23.0 24.0 24.0 50.5 14.0 18.8 41.0 50.0 61.0 84.0 54.7 47.4 3.0 18.8 42.0 73.0 248.0 17.6 6.9 4.0 10.0 20.0 24.0 24.0 57 41.3% 11 8.0% 96 69.6% 115 83.3% 64 46.4%63 45.7% 123 89.1% 109 79% 5 96 69.6% 3~9761~8060 43.5% 1~192 8~24 8418 50.5 14.041~60 70 50.7% 4~24 17~24 76 55.1% 2483 37 37 8 27.6 83% 81% 67% 8 2 1 100% 99% 96% 93% 24 0.93%93% 92% 92% 91% 91% 91% 99% 96% 93% 92% 92% 91%91% 93% 89%88% 81% 81% 81% 100%24 93% ㈠ 1. t = 3.59, p <.01 F = 6.39, p <.01F = 5.47, p <.01 12.14 > 10.67 12.20 11.80 10.55 10.64 12.1611.94 r = 0.27, p <.01 5 卷 4 期 中華民國 98 年 12 月
307 % 2. F = 8.37, p <.01 t = 9.50, p <.01 F = 95.42, p <.01F = 80.78, p <.01F = 26.35, p <.01 N = 138 83 1 92 4 7 * 96 2 3 * 91 6 10 * 91 6 10 * 92 4 7 * 93 3 4 * 91 8 9 63 12 28 89 9 12 * 52 14 34 * 99 1 2 * 58 13 31 81 10 15 * 72 11 21 81 2 100 1 1 24 93 2 4 67 3 * 81 4 15 88 3 14 70 9 22 67 11 25 66 13 26 28 20 36 * 64 14 27 * 69 10 23 * 78 7 19 49 19 35 58 17 31 20 21 37 81 4 15 * 81 4 15 * 89 2 12 * 77 8 20 * 59 16 30 * 93 1 6 * 57 18 33 63 15 28 67 11 24 * 16.27 > 12.65 16.86 > 9.22 17.05 14.91 7.83 17.84 15.51 8.18 16.21 13.61 8.617.10 r =.69, p <.01 3. F = 3.63, p <.01 r = -.20, p <.05 r =.20, p <.05 ㈡ r =.29, p <.01 r =.16, p <.05 5 卷 4 期 中華民國 98 年 12 月
308 The Care Needs of Caregivers t / F / r - - - - F = 8.37** F = 3.63* t = 3.59** t = 9.50** - - - - F = 6.39** F = 95.42** - F = 5.47** F = 80.78** - - F = 26.35** - - - - - - r = -0.20* r =.27** r =.69** r =.20* - - - - - - - - - - - - - - - - - - - r =.29** r =.16* - - - *p <.05. **p <.01. 60.1% 3~97 8~24 50% 43.5% 63.8% 37.0% 66.7% 2001100 68.8%88% 56.3% 0 75% 68.8% 2003 4 ~96 80.8% 35.5% 56.7%65% 37.7%18~8450.5 ± 14.0 3~248 54.7 ± 47.44~24 17.6 ± 6.9 50.7% 69.6% 83.3% Hung Liu Kuo 2002 2004 Hung 2002 83.3% 115 3~248 2004 5 卷 4 期 中華民國 98 年 12 月
309 2005 Simonds, 2006 24 Hung 2002 2000 2004 2003 2008 4 30 2008 5 18http://www.nhi.gov.tw/webdata/AttachFiles/Attach_8896_1 5 卷 4 期 中華民國 98 年 12 月
310 The Care Needs of Caregivers 2004 29 1 40 47 2005 11 4 215 223 2003 1 1 21 26 2002 6 4 514 522 2004 8 2 236 250 2003 5 1 12 25 2005 9 3 245 262 1999 NHRI-GT-EX89P706C 2004 51 5 53 59 2001 11 2 167 177 2000 2000 2 3 111 115 2001 NSC-90-2314-B-006-118 2000 15 2 77 83 2003 1 3 79 88 2004 23 3 235 248 2000 8 4 410 421 2005 4 1 57 62 Exel, N. J. A., Koopmanschap, M. A., Berg, B., Brouwer, W. B. F., & Bos, G. A. M. (2005). Burden of informal caregiving for stroke patients. Cerebrovascular Diseases, 19(1), 11 17. Farré, R., Giró, E., Casolivé, V., Navajas, D., & Escarrabill, J. (2003). Quality control of mechanical ventilation at the patient s home. Intensive Care Medicine, 29(3), 484 486. Farré, R., Lloyd-Owen, S. J., Ambrosino, N., Donaldson, G., Escarrabill, J., Fauroux, B., et al. (2005). Quality control of equipment in home mechanical ventilation: A European survey. European Respiratory Journal, 26(1), 86 94. Hung, L. C., Lin, C. C., & Kuo, H. W. (2002). Unmet nursing care needs of home-based disabled patient. Journal of Advanced Nursing, 40(1), 96 104. Leff, B., Burton, L., Mader, S., Naughton, B., Burl, J., Clark, R., et al. (2006). Satisfaction with hospital at home care. Journal of the American Geriatrics Society, 54(9), 1355 1363. Morimoto, T., Schreiner, A. S., & Asano, H. (2003). Caregiver burden and health-related quality of life among Japanese stroke caregivers. Age and Ageing, 32(2), 218 223. MacIntyre, N. R., Epstein, S. K., Carson, S., Scheinhorn, D., Christopher, K., & Muldoon, S. (2005). Management of patients requiring prolonged mechanical ventilation. Chest, 12(6), 3937 3955. Simonds, A. K. (2006). Risk management of the home ventilator dependent patient. Thorax, 61(5), 369 371. Warren, M. L., Jarrett, C., Senegal, R., Parker, A., Kraus, J., & Hartgraves, D. (2004). An interdisciplinary approach to transitioning ventilator-dependent patients to home. Journal of Nursing Care Quality, 19(1), 67 73. 5 卷 4 期 中華民國 98 年 12 月
311 The Related Factors and Care Needs of Caregivers Responsible for Home Ventilator-Dependent Patients Wen-Fang Kuo Tzu-Chuan Chien Chen * Abstract Background: The Integrated Nursing Care Plan for Ventilator-Dependent Patients proposed and promoted by the National Health Insurance Bureau mandates home care for most ventilator-dependent patients. Implementation of this policy greatly increases the stress and responsibility of caregivers. This paper discusses key problems faced by caregivers in caring for this group of patients and identifies areas of particular need as a reference for nurses. Objective: This paper explored the needs and related factors of caregivers responsible for the care of home-based ventilator-dependent patients. Method: A cross-sectional correlation design was used to sample caregivers of home ventilator-dependent patients in central Taiwan. A structured questionnaire was used to collect data. A total of 138 valid questionnaires were collected. Results: 1) Relevant caretaking knowledge was the most important needs-related item; 2) A significant correlation was identified between caregiver needs and patient diagnoses and severity of illness; 3) As expected, a significantly positive correlation between caregiver hours of daily service and caretaking-related skill and service needs. Conclusion/Practical Application: The high level of identified need for amongst caregivers for relevant caretaking knowledge suggests a need to establish sound home care guidance that addresses physical assessments, disease monitoring, management, medication, nutrition and rehabilitation in order to reduce stress and injury risks. Key Words: home ventilator-dependent patient, caregiver, care needs. RN, MSN, Respiratory Intensive Care Unit, Department of Nursing, Taichung Veterans General Hospital; *RN, PhD, Assistant Professor, School of Nursing, HungKuang University. Received: June 11, 2009 Revised: September 1, 2009 Accepted: October 13, 2009 Address correspondence to: Tzu-Chuan Chien Chen, No. 34, Chung-Chie Rd., Sha Lu, Taichung 44302, Taiwan, ROC. Tel: +886 (4) 2631-8652 ext. 3074; E-mail: june1678@hotmail.com 5 卷 4 期 中華民國 98 年 12 月