基于ADL评分的居家脑卒中患者专业化照护需求的工具研制及应用

发布时间：2018-02-08 10:10

本文关键词： 居家脑卒中专业化照护需求评估工具日常生活活动能力　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1.研制并评测《居家脑卒中患者专业化照护需求问卷》;2.了解居家脑卒中患者的专业化照护需求现状及影响因素,并探讨不同ADL的居家脑卒中患者对专业化照护的需求差异。方法研究分为两个部分:第一部分为居家脑卒中患者专业化照护需求问卷的研制及信效度检验:首先是居家脑卒中患者专业化照护需求的质性研究,采用目的抽样法选取居家脑卒中患者11位和/或其照顾者7位,采用半结构访谈及Colaizzi 7步分析法收集和分析资料。之后形成《居家脑卒中患者专业化照护需求问卷》条目池,以马斯洛需要层次理论和奥瑞姆自护理论为指导形成《居家脑卒中患者专业化照护需求问卷》初稿,经Delphi专家函询对问卷初稿进行修改后形成问卷函询稿。预调查后形成问卷施测稿。选取318位居家脑卒中患者及6位专家测评问卷信效度。第二部分为居家脑卒中患者专业化照护需求的量性研究:以《居家脑卒中患者专业化照护需求问卷》和巴氏指数为工具,便利选取428位居家脑卒中患者进行调查。采用IBM SPSS Statistics 21.0软件包进行数据录入与分析,采用描述性统计、单因素分析、逐步多重线性回归的方法分析居家脑卒中患者专业化照护需求现状及影响因素;采用随机区组设计的方差分析和多重比较分析不同日常生活活动能力的居家脑卒中患者群体对各维度专业化照护需求的差异。结果第一部分:针对居家脑卒中患者专业化照护需求得出3个主题,9个亚主题。(1)生理的需要:饮食指导,睡眠指导;(2)安全的需要:疾病知识,康复指导,用药指导,资源信息,指标监测;(3)归属的需求:回归社会,心理援助。形成的《居家脑卒中患者专业化照护需求问卷》,包括指导生活护理(11个条目),专业知识技能(11个条目),后遗症、并发症护理(12个条目),社会支持(10个条目)4个维度。问卷信效度检验时,各条目决断值各条目均t3.00(P≤0.05),条目与总分的相关性为0.672~0.872(P≤0.01);整体水平全体一致性内容效度为0.82,平均内容效度为0.97,各条目水平内容效度为0.83~1.00;探索性因子分析提取4个因子,累计方差贡献率83.894%;总Cronbach'sα系数、Guttman Spilt折半系数、重测信度分别为0.987、0.919、0.988。第二部分:居家脑卒中患者专业化照护需求总分为(126.73±46.58)分,其中,指导生活护理维度(31.37±15.62)分,专业知识技能维度(35.61±11.73)分,后遗症、并发症护理维度(29.30±15.26)分,社会支持维度(30.46±10.54)分。其中,日常生活活动能力、主要照顾者可影响居家脑卒中患者专业化照护需求总分及各维度需求得分。随机区组设计的分析结果显示,指导生活护理是重度依赖的居家脑卒中患者最需要的专业化照护,专业知识技能是中度依赖、轻度依赖和无需依赖的居家脑卒中患者最需要的专业化照护。结论1.《居家脑卒中患者专业化照护需求问卷》信效度良好,可用于居家脑卒中患者专业化照护需求的评估。2.居家脑卒中患者专业化照护需求较高,日常生活活动能力、婚姻状况、脑卒中类型及主要照顾者是其主要影响因素。另外,指导生活护理是重度依赖的居家脑卒中患者最需要的专业化照护,而专业知识技能是中度依赖、轻度依赖、无需依赖的居家脑卒中患者最需要的专业化照护,提示不同日常生活活动能力的脑卒中患者关注点不一样,在满足需求的同时应针对不同日常生活活动能力的患者有不同的侧重,以满足其最需要的照护。
[Abstract]:Objective to develop and evaluate < 1. stroke patients at home professional care needs questionnaire > 2.; understand the home patients with stroke care professional status and demand factors, and to explore the different needs of different ADL of stroke patients at home for professional care. Methods the study was divided into two parts: the first part is the development of reliability and validity test for stroke patients at home professional care needs questionnaire: the first is a qualitative study of stroke patients at home professional care needs, select stroke patients at home to take care of the 11 and / or by purpose sampling method 7, using semi-structured interviews and Colaizzi 7 step method to collect and analyze the data. After the formation of "stroke patients at home professional care needs questionnaire > item pool, with Maslow's hierarchy of needs theory and theory of the formation of" Orem self-care of stroke patients at home professional care needs questionnaire "Draft by Delphi expert consultation on the draft questionnaire was revised form of questionnaire inquiry draft. After the formation of the pre survey questionnaire draft. Selected 318 stroke patients at home and 6 experts evaluating the reliability and validity of the questionnaire. The second part is the amount of stroke patients at home care needs professional research: in" home of brain stroke patients with professional care needs questionnaire > and Barthel index as a tool, a convenient sample of 428 home stroke patients were investigated. The package for data entry and analysis using IBM SPSS Statistics 21 software, using descriptive statistics, single factor analysis, stepwise multiple linear regression analysis of stroke patients at home care professional status and influence of demand the factors of stroke patients at home; the population variance analysis and multiple comparison of randomized block design analysis of different daily activities on each dimension of professional care needs The first part: according to the results. The difference of stroke patients at home professional care needs that 3 themes and 9 sub themes. (1) physiological needs: diet guidance, sleep guidance; (2) security needs: disease knowledge, rehabilitation guidance, medication guide, resource information, monitoring index (3;) belonging needs: return to society, professional psychological assistance. The formation of cerebral apoplexy patients in home care needs questionnaire of < >, including the direction of life care (11 items), professional knowledge and skills (11 items), sequelae, complications (12 items), social support (10 items) 4 dimensions. The reliability and validity of the questionnaire survey, the entry decision value of each entry is t3.00 (P = 0.05), the correlation between item score and total score for 0.672~0.872 (P = 0.01); the overall level of the consistency of content validity was 0.82, the average content validity was 0.97, the entry level of content validity was 0.83~1.00; exploratory factor analysis Take the 4 factors, the cumulative variance contribution rate of 83.894%; the total Cronbach's alpha coefficient, split half coefficient Guttman Spilt, the test-retest reliability was 0.987,0.919,0.988. second parts: professional home care needs of patients with Nao Zuzhong score was (126.73 + 46.58), among them, the guidance of life care dimensions (31.37 + 15.62) points, professional knowledge and skills dimensions (35.61 + 11.73) points, sequelae and complications nursing dimensions (29.30 + 15.26), social support dimensions (30.46 + 10.54). Among them, the activities of daily living, caregivers can affect the professional home care needs of patients with Nao Zuzhong score and each dimension score. Demand analysis results of randomized block design display. The guidance of life nursing professional care on severe stroke patients at home most in need of professional knowledge and skills are moderately dependent, mild dependence and without relying on the stroke patients at home are most in need of professional Conclusion 1.< care of stroke patients at home professional care needs questionnaire > good reliability and validity can be used at home with Nao Zuzhong professional care needs assessment.2. stroke patients at home professional care needs higher, marital status, activities of daily living, stroke types and caregivers are the main influencing factors. In addition, guidance life is a specialized nursing care on severe stroke patients at home need most, and professional knowledge and skills are moderately dependent, mild dependence, without relying on the home of Nao Zuzhong patients most in need of professional care, focus on stroke patients suggested that different activities of daily life are not the same, according to the different activities of daily living the patient has a different focus should be at the same time to meet the demand, to meet the need of care.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.2

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