Long-Term Care Services Needs for Spinal-Cord Injury Patients in Taiwan

脊髓損傷患者之長期照護需求

李怡娟(I-Chuan Li)；連倚南( I-Nai Lien)；林月春(Yueh-Chun Lin)

長期照護 ； 脊髓損傷 ； 需求評估 ； long-term care ； spinal cord injury ； needs assessment

The Journal of Nursing Research

9卷4期（2001 / 09 / 01）

127 - 138

英文

根據衛生署的統計報告，意外事故是多年來威脅著國人十大死因的第三位。隨著醫療科技的進展，發生意外存活下來之息者常會伴隨一連串永久損傷的病變及症狀。是故，長期照護服務對脊髓損傷病人而言，即為相當迫切及重要的。然而受到全民健康保險給付照護服務的諸多限制，脊髓損傷患者常被排除於服務範圍之外。本研究之主要目的有二：（1）瞭解脊髓損傷患者之健康狀況及長期照護需求之種類及程度；（2）探討脊髓損傷患者健康狀況及長期照護需求之問的相關性。研究對象為高雄市及屏東縣市共133位個案，其平均年齡為43.15歲，以男性居多（72.9%），生理健康狀況尚可（平均值為2.33)，其中以解尿、性功能、排泄、舒適及活動能力等之平均值皆大於2.5，功能最差。活動能力普通；完全臥床及可藉助輪椅自行外出者各分別佔45.9%及36.8%。心理社會功能較差（平均值2.8)，其中以角色功能（平均值偽2.92)，情緒穩定性（平均值為2.92)，社區資源運用（平均值為2.79）最差。長期照護需求方面，以在宅服務最為迫切（平均值為2.21)，其次為轉介及監測性服務（平均值為2.19）。本研究建議在針對脊髓損傷患者的長期照護服務提供上，應以綜合性服務為主，亦即包括了護理技術性及社會支持性服務，以滿足其真正的需求，同時能根據患者的健康狀況及需求，提供適當的長期照護相關資源。

According to official health statistics, accidents and their adverse effects are the third leading cause of death in Taiwan. More accident victims are surviving thanks to treatment using high medical technology, but this results in many disabled patients with irreversible impairments. The demand for long-term care (LTC) services for spinal cord injury (SCI) patients has thus become a major concern. However, homebound SCI patients may easily face exclusion from LTC services because they are often ineligible for benefits under the regulations of National Health Insurance (NHI). The purposes of this study were: 1. To quantify the LTC needs of SCI patients, and 2. To evaluate the correlation between SCI patient health status and LTC needs. A total of 133 samples were visited from Kaohsiung City and Pingtung County. The results of this study showed that the average age of subjects was 43.15, with 72.9% male. The health status of most of the research subjects was fair (M= 2.33). The test of physiological health status was a 20-item scale with a five-point response format. The worst dysfunctions were urination (M 3.36, SD 1.06), sexual function (M 3.30, SD 0.88), excretion (M= 3.26, SD = 1.06), comfort (M= 3.25, SD = 0.84), and mobility (M= 2.75, SD = 1.1 1). All of the above items showed higher mean scores than average. More than one third of the subjects (36.8%) used wheelchairs, had better mobility and went out often. However, half of subjects were completely bedridden (45.9%). The mean psychosocial health status was poor with a mean score of 2.80 which showed higher mean score than average. The subjects were less satisfied with role function (M = 2.92), emotional stability (M = 2.92), and application for community resources (M = 2.79). The most needed LTC services for SCI patients was home-making services; referral and monitoring services ranked second. Suggestions derived from this study were to coordinate nursing care services with social support services for LTC patients and to allocate LTC resources based on patients’ health status and their need for LTC services.

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