個案管理模式對心臟衰竭病人自我照顧行為之成效探討

Effects of Case Management on Self-Care in Patients with Heart Failure

10.6142/VGHN.201909_36(3).0010

黃麗月(Li-Yueh Huang)；吳巧雯(Chiao-Wen Wu)；黃翠媛(Tsuey-Yuan Huang)

個案管理模式 ； 心臟衰竭 ； 自我照顧 ； case management model ； heart failure ； self-care

榮總護理

36卷3期（2019 / 09 / 01）

309 - 318

繁體中文

心臟衰竭具高盛行率、高死亡率及高復發率之特性，建立連續且完整的照護模式，促進病人自我照顧行為，有助於心臟衰竭照護品質。本研究目的為探討個案管理模式對心臟衰竭病人自我照顧行為的效果，採實驗設計法，招募北部某醫學中心63位心臟衰竭病人，對照組33位及介入組30位。兩組均接受常規照護，介入組以個案管理模式，提供全面性評估、個別性衛教指導、出院後電話與返院追蹤及諮詢，以因應其個別化需求予以協助。測量時間在兩組病人於住院後2天及出院後3個月，自我照顧行為問卷包括維持、管理、自信程度三個面向。結果顯示介入組心臟衰竭病人的自我照顧行為自信程度呈現顯著差異（F = 6.84, p ＜ .05），而自信程度越高，自我照顧行為越好。未來可將個案管理模式提供臨床照護人員與相關研究參考使用，精進心臟衰竭照護品質。

Heart failure is a major health problem with high prevalence, mortality, and recurrence rates. Improved patient self-care behaviors and a continuous care model to provide an effective strategy to promote patient self-care have contributed toward improving the quality of patient care. The purpose of this study was to examine the effectiveness of a case management model on self-care in patients with heart failure. The research method involved a randomly assigned experimental class design. A total of 63 patients with heart failure from a medical center were categorized into two groups; a control group (33 patients) and an experimental group (30 patients). At baseline, demographic data and self-care behavior (maintenance, management, and confidence) were collected on the first or second day after admission. The control group was provided conventional hospital care, whereas the experimental group received the case management model care, including individualized health education. Telephone follow-ups were scheduled for the first, fourth, and eighth week after discharge. An outpatient consultation was also scheduled for the patients' visit. All outcome assessment data were collected during the third month after discharge. Results showed that the case management model increases the confidence level of self-care (F = 6.84, p ＜ .05). This study demonstrates that a case management model can provide continuous quality improvement and high-quality care to heart failure patients.

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