以賦權式術前衛教提昇膝關節置換術病人之自我照顧效能

Enhancing the Self-Care Efficacy of Patients Undergoing Knee Replacement Through Empowerment Preoperative Education

10.6142/VGHN.202003_37(1).0002

蔡玉梅(Yu-Mei Tsai)；莊峰玲(Feng-Ling Chuang)；陳冠蓁(Guan-Jhen Chen)；陳寶珍(Bao-Chen Chen)

膝關節置換術 ； 焦慮 ； 自我照顧效能 ； knee replacement ； anxiety ； self-care efficacy

榮總護理

37卷1期（2020 / 03 / 01）

14 - 24

繁體中文

本研究目的為探討介入賦權式術前衛教於膝關節置換術病人是否能提升其自我照顧效能。本研究為類實驗性研究，對象來源為南部某區域教學醫院準備接受人工膝關節置換術之手術前病人共收案41位（控制組21位，實驗組20位），為避免控制組與實驗組互相干擾，因此先收集控制組，再收集實驗組。實驗組衛教時機為入院後至手術前，研究工具為state-STAI問卷共20題，及手術自我照顧效能量表共21題，各在手術前、出院前及出院一週後進行問卷填寫。將控制組與實驗組進行重複測量變異數比較及獨立t檢定，結果顯示自我照顧效能的自信程度在出院前及出院一週二組間呈現顯著差異；另發現賦權式衛教較傳統式衛教能改善手術前的焦慮平均分數，雖焦慮嚴重程度無法明顯減輕，最終仍能提昇自我照顧效能。建議在住院中有計畫性的安排衛教及學習自我照顧技巧，並能推廣使用賦權式衛教進而促進術後自我照顧能力。

The purpose of this study was to investigate whether interventional empowerment in the field of knee replacement surgery can improve the self-care efficacy of patients. This is a quasi-experimental study. A total of 41 patients who were prepared to undergo artificial knee replacement in a teaching hospital in a southern region were evaluated in the study (21 in the control group and 20 in the experimental group). To avoid the groups from interfering with each other, the control group was collected first and then the experimental group was collected. For the experimental group, the time for teaching was from the time of admission to the preoperative period. State-STAI 20 questionnaire and the surgical self-care efficacy table totaling 21 questions were used in the study. Patients were provided the questionnaire before surgery, before discharge, and 1 week after discharge. Results of the control group and the experimental group were compared using repeated measurement variation and an independent t test. Significant differences in self-care efficacy were observed between pre-discharge and discharge. The results of this study proved that the empowerment preoperative education reduced the average anxiety before surgery compared with the traditional preoperative education. Although the severity of anxiety cannot be significantly reduced, self-care efficacy can be improved. A systematic program is recommended for teaching self-care skills during hospitalization and promoting the use of empowered education to improve postoperative self-care.

1. 王國川,鍾鳳嬌(2016)。中文版「情境─特質焦慮量表」之多元因素效度探討。測驗學刊，63(4)，287-313。
   連結：
2. 洪曉佩,曾麗華,雍允雯,林素萍,黃瓊慧,明金蓮(2019)。術前焦慮概念分析。榮總護理，36(2)，212-219。
   連結：
3. 陳美菊,龔秀華,湯玉珊,簡麗瑜(2016)。改善骨科手術前病人焦慮程度之專案。長庚護理，27(2)，197-208。
   連結：
4. 黃韻伊,張櫻霖(2016)。術前衛教對人工全膝關節置換術患者的活動功能及生活品質之探討。彰化護理，23(3)，11-23。
   連結：
5. Bandura, A.(1997).Self-efficacy: The exercise of control.New York:Freeman.
6. Duivenvoorden, T.,Vissers, M. M.,Verhaar, J. A. N.,Busschbach, J. J. V.,Gosens, T.,Bloem, R. M.,Reijman, M.(2013).Anxiety and depressive symptoms before and after total hip and knee arthroplasty: A prospective multicentre study.Osteoarthritis and Cartilage,21(12),1834-1840.
7. Johansson, K.,Nuutila, L.,Vi rtanen, H.,Katajisto, J.,Salantera, S.(2005).Preoperative education for orthopaedic patients: Systematic review.Journal of Advanse Nursing,50(2),212-223.
8. McDonald, S.,Page, M. J.,Beringer, K.,Wasiak, J.,Sprowson, A.(2014).Preoperative education for hip or knee replacement.Cochrane Database of Systematic Reviews,5,1-85.
9. Mitchell, M.(2000).Nursing intervention for Pre-operative anxiety.Nursing Standard,14(37),40-43.
10. Oetke r-Black, S. L.,Jones, S.,Estok, P.,Ryan, M.,Gale, N.,Parker, C.(2003).Preoperative teaching and Hysterectomy outcomes.Association of Operating Room Nurses Journal,77(6),1215-1231.
11. Ouyang, C. M.,Dwyer, J. T.,Jacques, P. F.,Chuang, L. M.,Haas, C. F.,Weinger, K.(2015).Determinants of dietary self-care behaviours among taiwanese patients with type 2 diabetes.Asia Pacific Journal of Clinical Nutrition,24(3),430-437.
12. Pellino, T.,Tluczek, A.,Collins, M.,Trimborn, S.,Norwick, H.,Engelke, Z. K.,Broad, J.(1998).Increasing self-efficacy through empowerment: Preoperative education for orthopaedic patients.Orthoppaedic Nursing,17(4),48-59.
13. Pritchard, M. J.(2009).Managing anxiety in the elective surgical patient.British Journal of Nursing,18(7),416-419.
14. Salmon, P.,Hall, G. M.(2004).Patient empowerment or the emperor's new clothes.Journal of The Royal Society of Medicine,97(2),53-56.
15. Walker, J. A.(2002).Emotional and psychological preoperative preparation in adults.British Journal of Nursing,11(8),567-575.
16. 史麗珠(2014).生物統計學.台北市:華杏.
17. 林莉萱(2003)。臺北醫學大學醫學研究所。
18. 陳美芳,王瑞霞(2012)。賦權於糖尿病個案自我照顧行為的應用 - 魔力策略。護理雜誌，59(5)，68-73。
19. 陳淑華,喬萍,黃瑞珍,王美文,簡麗瑜(2014)。比較不同術前衛教對初次全膝關節置換術病人焦慮及生理指標之成效。護理暨健康照護研究，10(1)，42-50。
20. 維基百科 ( 無日期 )．自我效能．取自 https://zh.wikipedia.org/wiki/%E8%87%AA%E6%88%91%E6%95%88%E8%83%BD
21. 衛生福利部 (2017，5 月 11 日 )．保署與醫界合作推動「人工關節登錄制度」，共同守護民眾就醫安全． 取自 https://www.mohw.gov.tw/cp-207-14659-1.html
22. 謝瑞玲,李佩娟,黃素錦,劉秀嬌(2015)。退化性關節炎患者使用玻尿酸注射治療是否可以減緩關節疼痛症狀。2015健康與管理學術研討會，新竹市:

1. 曾語柔,曾怡菱(2023)。照護一位退化性關節炎行全膝關節置換術病人之護理經驗。彰化護理，30(3)，131-143。
2. 蕭詠勳,林思親,李柏勳(2023)。運用自我效能理論護理一位全膝關節置換術後病人之經驗。榮總護理，40(1)，66-73。