冠狀動脈脈擴張術病患治療後最初三個月的社會支持、不確定感與心理健康追蹤

Social Support, Uncertainty and Psychological Well-being of Patients During the First Three Months After Percutaneous Transiuminal Coronary Angioplasty

10.7081/NR.200010.0529

林素玉(Su-Yu Lin)；顧乃平(Nai-Ping Ku)；楊世平(Shih-Ping Yang)；伍志祥(Jyh-Shang Wu)

冠狀動脈氣球擴張術 ； 社會支持 ； 不確定感 ； 心理健康 ； (percutaneous transluminal coronary angioplasty) PTCA ； social support ； uncertainty ； psychological well-being

護理研究

8卷5期（2000 / 10 / 01）

529 - 541

繁體中文

本研究旨在追蹤冠狀動脈氣球擴張術病患治療後最初三個月的社會支持、不確定感與心理健康。採縱貫式研究，樣本來自台北市四所醫院，1、2、3個月的樣本數爲35、34、30人，樣本之基本特性經卡方檢定無顯著差異。結果顯示：(1)第2、3月較第1個月，社會支持流失多，心理健康差，2、3月間則無顯著變化。(2)第1個月的社會支持綱、社會支持功能與心理健康有顯著正相關。(3)不確定感與心理健康呈顯著負相關。(4)身體活動受限者較不受限者，不確定感高，心理健康差。(5)第2個月，與家人同住者及冠狀動脈血管阻塞2或3條者較阻塞1條者，社會支持流失較多。(6)第3個月，冠狀動脈血管阻塞2或3條者，不確定感較高；自覺疾病嚴重度爲中度或重度者，心理健康較差。依研究結果，「主訴活動受限、自覺疾病中度或重度嚴重及阻塞多條冠狀動脈血管」之病患，應優先以本文所採用之「不確定感量表」及「中國人問卷」評估其不確定感及心理健康。

The purpose of this research was to study the aspects of social support, uncertainty and psychological well-being patients who received PTCA during the first three months following the procedure. A longitudinal exploratory design was used. The study sample was recruited from four hospitals in Taipei. The sample sizes for the three months were 35, 34 and 30. The sample’s demographic data showed no significant different among the three months by x2 test. The findings showed: (1) Patients who lost more network, psychological wellbeing in the second and third months were worse than those in the first month, but there was no significant difference between the second and the third months. (2) Social support network and social support function in the first month showed a significant positive relation with psychological well-being. (3) There was a significantly negative relation between uncertainty and psychological well-being. (4) Patients with limited physical activity had higher uncertainty and worse psychological well-being than those with no such limitation. (5) In the second month, patients living with families lost more social support; patients with two or three coronary artery occlusions lost more social support. (6)In the third month, patients with two or three coronary artery occlusions had higher uncertainty; patients who perceived themselves as having moderate or severe illness had worse psychological well-being. According to the results, we suggest that patients should be assessed first as to their uncertainty and psychological well-being, limited physical activity, self-perception of moderate or severe illness, and number of coronary artery occlusions.

1. Bliley, A. V.,Ferrans, C. E.(1993).Psychologic aspects of cardiovascular care: Quality of life after coronary angioplasty.Heart & Lung,22(3),193-199.
2. Brodie, B. R.,Stuckey, T. D.,Hansen, C.,Muncy, D.(2000).Benefit of coronary reperfusion before intervention on outcomes after primary angioplasty for acute myocardial infarction.The American Journal of Cardiology,85(1),13-18.
3. Buselli, E. F.,Stuart, E. M.(1999).Influence of Psychosocial factors and biopsychosocial interventions on outcomes after myocardial infarction.Journal of Cardiovascular Nursing,13(3),60-72.
4. Cheng, T. A.,Williams, P.(1986).The design and development of a screening questionnaire (CHQ) for use in community studies of mental disorders in Taiwan.Psychological Medicine,16(2),415-422.
5. Cheng, T. A.,Wu, J. T.,Chong, M. Y.,Williams, P.(1990).Internal consistency and factor structure of the Chinese Health Questionnaire.Acta Psychiatrica Scandinavica.
6. Chong, M.Y.,Wilkinson, G.(1989).Validation of 30-and 12-items versions of the Chinese Health Questionnaire (CHQ) in patients admitted for general health screening.Psychological Medicine,19(2),495-505.
7. Clark, D. A.(1991).Coronary angioplasty.
8. Cohen, S.,Wills, T. A.(1985).Stress, social support, and the buffering hypothesis (review).Psychological Bulletin.https://doi.org/10.1037/0033-2909.98.2.310
9. Conn, V.,Taylor, S.,Abele, P.(1991).Myocardial infarction survivors: Age and gender differences in physical health, psychosocial state and regimen adherence.Journal of Advanced Nursing,16(9),1026-1034.
10. Coyne, J.,Smith, D.(1991).Couples coping with a myocardial infarction: A contextual perspective on wives distress.Journal of Personality and Social Psychology,61(3),404-412.
11. Cronin, S. N.,Freeman, L. H.,Ryan, G.,Drake, D. M.(2000).Recovery after percutaneous transluminal coronary angioplasty: Assessment after discharge.Critical Care Nurse.
12. Davis, L. L.(1990).Illness uncertainty, social support, and stress in recovering individuals and family care givers.Applied Nursing Research,3(2),69-71.
13. Feather, B. L.,Wainstock, J. M.(1989).Perceptions of post mastectomy patients. Part Ⅰ: The relationships between social support network providers.Cancer Nursing,10(5),293-300.
14. Guiteras-Val, P.,Varas-Lorenzo, C.,Garcia-Picart, J.,Marti-Claramunt, V.,Auge-Sanpera, J. M.(1999).Clinical and sequential angiographic follow-up six months and 10 years after successful percutaneous transluminal coronary angioplasty.The American Journal of Cardiology,83(6),868-874.
15. Hannan, E. L.,Racz, M. J.,McCallister, B. D.,Ryan, T. J.,Arani, D. T.,Isom, O. W.,Jones, R. H.(1999).A comparison of three-year survival after coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty.Journal of the American College of Cardiology,33(1),63-72.
16. Hilton, B. A.(1992).Perceptions of uncertainty: Its relevance to life-threatening and chronic illness.Critical Care Nurse,12(2),70-73.
17. Hilton, B. A.(1988).The phenomenon of uncertainty in women with breast cancer.Issues in Mental Health Nursing,9(3),217-238.
18. Lindsey, A. M.,Ahmed, N.,Dodd, M. J.(1985).Social Support: Network and quality as perceived by egyptian cancer patients.Cancer Nursing,8(2),37-42.
19. McDowell, I.,Newell, C.(1987).Measuring health: A guide to rating scales and questionnaires.
20. McKenna, K. T.,McEniery, P. T.,Maas, F.,Aroney, C. N.,Bett, J. HN.,Cameron, J.,Garrahy, P.,Holt, G.,Hossack, K. F.,Murphy, A. L.(1992).Clinical results and quality of life after percutaneous transluminal coronary angioplasty: A preliminary report.Catheterization and Cardiovascular Diagnosis,27(2),89-94.
21. Mishel, M. H.,Braden, C. J.(1988).Finding meaning: Antecedents of uncertainty.Nursing Research,37(2),98-103.
22. Mishel, M. H.,Epstein, D.(1990).Uncertainty in illness scales manual.
23. Murray, R. B.,Huelskoetter, M. M. W.(1991).Psychiatric/Mental health nursing: Giving emotional care.
24. Norbeck, J. S.,Lindsey, A. M.,Carrieri, V. L.(1981).The development of an instrument to measure social support.Nursing Research,30(5),264-269.
25. Nunn, C. M.,O`Neill, W. W.,Rothbaum, D.,Stone, G. W.,O`Keefe, J.,Overlie, P.,Donohue, B.,Grines, L.,Browne, K. F.,Vlietstra, R. E.,Catlin, T.,Grines, C. L(1999).Long-term outcome after primary angioplasty: Report from the primary angioplasty in myocardial infarction (PAMI-I) trial.Journal of the American College of Cardiology,33(3),640-646.
26. Scheidt, S.(1987).Ischemic heart disease: A patient-specific therapeutic approach with emphasis on quality of life considerations.American Heart Journal,114(1),251-257.
27. Silverstein, M.,Bengtson, V.(1994).Does intergenerational social support influence the psychological well-being of older parters? The contingencies declining health and widowhood.Social Science & Medicine,38(7),943-967.
28. Sipperly, M. E.(1989).Expanding role of coronary angioplasty: Current implications, limitations, and nursing considerations.Heart & Lung,18(5),507-513.
29. Stewart, M. J.,Hirth, A. M.,Klassen, G.,Makrides, L.,Wolf, H.(1997).Stress, coping, and social support as psychosocial factors in readmissions for ischaemic heart disease.International Journal of Nursing Studies,34(2),151-163.
30. Uncertainty, coping, and distress following myocardial infarction: Transition from hospital to home(1988).Research in Nursing and Health,11(2),71-82.
31. Webster, K. K.,Christman, N.J.(1988).Perceived uncertainty and coping post myocardial infarction.Western Journal of Nursing Research,10(4),396-398.
32. White, R. E.,Frasure-Smith, N.(1995).Uncertainty and psychologic stress after coronary angioplasty and coronary bypass surgery.Heart & Lung,24(1),19-27.
33. Wineman, N. M.,Schwetz, K. M.,Goodkin, D. E.,Rudick, R. A.(1996).Relationships among illness uncertainty, stress, coping, and emotional well-being at entry into a clinical drug trial.Applied Nursing Research,9(2),53-60.
34. Yates, B. C.(1995).The relationships among social support and short-and long-term recovery outcomes in men with coronary heart disease.Research in Nursing and Health,18(3),193-203.
35. 李卓倫(1985).健康的定義與假說.公共衛生,12(2),146-159.
36. 林明珍,顧乃平(1993).團體衛教對改善心肌梗塞病人認知與壓力之成效探討.護理研究,1(4),341-349.
37. 許淑蓮,黃秀梨(1996).Mishel疾病不確定感量表之中文版測試.護理研究,4(1),59-68.
38. 劉淑娟(1986).台北,國防醫學院護理研究所.
39. 鄭琳(1994).心理衛生緒論.心理學與心理衛生,2
40. 鍾玉珠(1995).台北,國防醫學院護理研究所.