探討腸造口病人家庭照顧者之照顧者負荷及其相關性探討

Burden in family caregivers of patient with ostomy and Its Correlation

康雯茹

腸造口 ； 家庭照顧者 ； 照顧者負荷 ； ostomy ； family caregiver ； caregiver burden

中山醫學大學護理學系學位論文

2017年

碩士

黃正宜

繁體中文

腸造口建置在病人生理功能方面，失去可自己意志控制的肛門括約肌的解便能力，並且需學習傷口清潔照護與生活模式的調整改變等照護負擔。病人面對疾病過程的壓力事件，家人是其身心社會支持的主要來源，對於病人預後復健有潛在的影響。 本研究採橫斷式相關性研究設計，以方便取樣於中部某醫學中心進行收案，共收案 96位造口病人及其家庭照顧者。採結構式問卷收取資料，包括：病人人口學特性與疾病特質、家庭照顧者之人口學特性與照顧特質，照顧者反應量表（CRA）評估工具。研究資料以SPSS Windows20.0軟體進行描述性及推論性統計分析。 病人之人口學特性、疾病特質與家庭照顧者負荷之關係，研究結果顯示：（1）照顧對象有配偶者、暫時性造口其家庭照顧者之自尊感受較高；（2）照顧對象為男性、尚有配偶者，家庭照顧者之時間安排負荷較重；（3）時間安排負荷與病人年齡呈正相關；（4）照顧對象為男性者，家庭照顧者之健康負荷較高。 家庭照顧者之人口學特性、照顧特質與家庭照顧者負荷之關係，研究結果顯示：（1）自尊感受與每週照顧天數呈正相關；（2）家人支持負荷會因家庭經濟狀況不同而呈顯著差異；（3）獨立照顧之家庭照顧者家人支持負荷與時間負荷程度較高；（4）總照顧週數越長，家人支持負荷越重；（5）女性家庭照顧者之時間安排負荷較男性高；（6）辭去工作之家庭照顧者的時間安排負荷較高；（7）照顧時間越長，時間安排負荷越重。 家庭照顧者負荷的預測因素，研究結果顯示：（1）自尊感受的重要因子為病人婚姻狀況及造口留置時間，可解釋自尊感受之變異量為10.7%（p=.005）；（2）家人支持負荷的重要因子為照顧型態，可解釋家人支持負荷之變異量為16.3%（p=.004）；（3）時間安排負荷的重要因子，為每天照顧時數、家庭照顧者職業狀況及照顧型態，可解釋時間安排負荷之變異量為34.7%（p=.000）；（4）健康負荷的重要因子為病人性別，可解釋健康負荷之變異量為9.5.%（p=.002）。 本研究結果建立台灣本土化腸造口病人之家庭照顧者於術後的照顧者負荷資料，建議未來照護過程提供喘息時間安排，讓照顧者擁有自我的角色，減輕照顧負荷，於未來研究採縱貫式研究方法，從病人入院時開始收案，定期追蹤，了解在病人不同時期與家庭照顧者負荷的變化。

Individuals living with an ostomy may suffer from a variety of stressor related to lose of control of anal sphincter, increased burden on learning wound care and change of lifestyle. Family caregivers are the main source of support for patients while facing the stress during disease process. The study adopted a cross-sectional study design with purpose sampling from on medical center in central Taiwan. Ninety-six pairs of eligible patients and their primary family caregiver were recruited. Data collection included patient and caregiver’s demographics, disease-related information, care pattern, and the caregiver’s burden (measured with the Caregiver Reaction Assessment, CRA). Data were analyzed using SPSS Windows 20.0 software. In terms of correlation among patient demographics, disease-related, and family caregiver’s burden, the study showed the following results: (1) The type of ostomy and patient’s marital status are the factors to family caregivers’ self-esteem. (2) Patient’s gender and marital status were related with family caregiver’s disrupted schedule. (3) Patient’s age was positively associated with disrupted schedule (4) Patient’s gender was related with family caregiver’s loss of physical strength. According to the correlation among family caregiver demographic, care pattern and family caregiver burden, the results of the study showed that: (1) The days of caregiving per week was positively correlated with caregiver’s self-esteem. (2) Family income status was related with family caregiver’s lack of family support. (3) Care pattern was related with caregiver’s lack of family support and disrupted schedule. (4) The days of caregiving was positively correlated with caregiver’s lack of family support the burden of the family. (5) Female caregivers would suffer from higher level of disrupted schedule then male. (6) Caregiver’s occupation status was related with family caregiver’s disrupted schedule; (7) the hours of caregiving per day was positively correlated with caregiver’s disrupted schedule. As for the predictors to a family caregiver burden, the result of the study showed that: (1) The main predictors of self-esteem were the patient’s marital status and the type of ostomy, 10.7%(p= .005) of variances could be explained; (2)The main predictors of lack of family support was care pattern, 16.3% (p= .004) of variances could be explained; (3) The main predictors of disrupted schedule were the number of hours of caregiving per day, caregiver’s occupation status, and the care pattern, up to 34.7% (p=.000) of variances could be explained; (4) The main predictors of caregivers’ physical health status was the patient’s gender, 9.5.% (p=.002) of variances could be explained. The result of the present study can provide information which based on caregiver burden of Taiwan ostomy patient in postoperative care. It is suggested that we should provide a respite schedule to let the caregiver have a self-role and reduce burden during future care process. In the future, it is recommended to adopt longitudinal research methods which following up the patient from hospitalizing in the beginning to understand family caregiver’s burden in different stages of the case.

1. 王秀紅 (1994)•照顧者角色對婦女衝擊：護理的涵義•護理雜誌，41(3)，18-23。
   連結：
2. 王春葉、林佑樺、李憶農、陳靖博、林耀信(2002)•血液透析病患主要照顧者的負荷
   連結：
3. 主要照顧者之照顧負荷與其相關性因素探討•護理雜誌，58(6)，54-64。
   連結：
4. 王增勇（2011）•家庭照顧者做為一種改革長期照顧的社會運動•臺灣社會研究季刊，85，
   連結：
5. 江支銘（2008）•直腸癌手術治療之現況•中華癌醫會誌，24（3），167-171。
   連結：
6. 李英芬(2006) •住院腸胃道癌症病人主要照顧者的負荷及相關因素•臺北：臺北醫學
   連結：
7. 李佳苓、劉立凡、陳淑馨、林綉君(2014)•探討照顧管理服務成效與主要照顧者照顧荷
   連結：
8. 之相關性研究•[Relationship of the Effectiveness of Care Management Services and
   連結：
9. 李英芬、蔡麗雲、張澤芸(2008)•末期癌症病人之主要照顧者的負荷相關因素探討•安
   連結：
10. 屈蓮、白璐、鄧光銳、王修平(1996)•大台北地區主要照顧者之工作負荷量及對居家照
    連結：
11. 林玲華、林佳蓉、陳美伶(2004)•癌症與非癌症手術後住院病患照顧者的負荷及其相關
    連結：
12. Coping Behaviors, Health Status and Related Aspects in Family Caregivers of
    連結：
13. 林麗英、許凰珠 (2005)•護理人員的造口護理知識與態度之調查研究•榮總護理， 22(2)
    連結：
14. 邱啟潤、許淑敏、吳瓊滿(2002)•主要照顧者負荷、壓力與因應之國內研究文獻回顧•
    連結：
15. [Literature Review of Primary Caregivers' Burden, Stress and Coping in Taiwan
    連結：
16. 洪淑惠、林淑媛(2010)•癌末病患家屬照顧者照顧負荷量表之發展：前驅研究•志為護
    連結：
17. 理-慈濟護理雜誌，9(6)，66-77。
    連結：
18. 洪淑惠、張肇松、林淑媛、謝秀芳•(2009)•癌末病患主要家屬照顧者照顧負荷
    連結：
19. 及其影響因素之探討•[Factors Associated with Caregiver Burden in Families
    連結：
20. 高啟雯、顧乃平（1997）•結腸造口病人出院前自我照顧能力及相關因素之探討•護理
    連結：
21. 高淑芳、盧孳豔、葉淑惠、劉雪娥(1999)•探討家庭功能、社會支持與社區殘病老人照
    連結：
22. 馬先芝(2003)•照顧者負荷之概念分析•護理雜誌，50(2)，82-86。
    連結：
23. 馬吉男(2001)•居家脊髓損傷病患家庭照顧者負荷及需求之探討•台北醫學院醫學研究
    連結：
24. 曾惠珍、王秀紅、金繼春、陳麗糸、簡淑媛(2000)•出院永久性結腸造口患者之壓力•
    連結：
25. 張世昌、施耀明、徐淑芳、蔡鳳嬌、李興中(2005)•Stoma-site Skin Complications and Body
    連結：
26. 黃寶珠(2007)•腸胃道癌症手術病人主要照顧者的負荷及相關因素•臺北：臺北醫學大
    連結：
27. 黃卓禕、李世代、張宏哲、江玲玲、李俊年(2008)•居家呼吸器依賴病患與主要照顧者
    連結：
28. 負荷之初探•[A Descriptive Study on Primary Caregiver Burden for Home
    連結：
29. 劉永芳(2003)•迴腸造口病患自我照顧指導•[Self-Care Instructions for Patients with
    連結：
30. 劉清香、陳清惠(2007)•低位直腸癌行肛門括約肌保留手術病患之護理•[Nursing Care for
    連結：
31. Lower Rectal Cancer Patients Undergoing Anal Sphincter-Saving Operation]•護理雜
    連結：
32. 陳玉葉、陳桂敏(2007)•癌末病患居家照顧工作量及困難度與照顧壓力負荷之相關性探
    連結：
33. 討•[Caregiving Tasks, Difficulties and Stress for Home Care of Terminal Cancer
    連結：
34. 陳芬婷、邱啟潤(2015)•喘息服務方案對家庭照顧者之效益•[The Benefits of Respite Care
    連結：
35. 陳秀娟、陳美伶(2004)•癌症病患家屬照顧者照顧工作之探討•[The Caring Tasks for
    連結：
36. 蕭佳莉、邱啟潤(2011)•居家照護病患之主要照顧者正負向照顧經驗及其相關因素之
    連結：
37. 探討•[Primary Caregivers of Home Nursing Care Recipients: Their Caregiving
    連結：
38. 鍾玉珠、呂秋華(2007) •血液透析患者主要照顧者的負荷、需求及相關因素•臺灣腎
    連結：
39. 謝秀祝•結直腸癌術後病人主要照顧者之負荷及相關因素之探討•國立台北護理學院護
    連結：
40. Ang, S. G., Chen, H. C., Siah, R. J., He, H. G., & Klainin-Yobas, P. (2013). Stressors relating
    連結：
41. to patient psychological health following stoma surgery: an integrated literature review.
    連結：
42. Oncology Nursing Forum, 40(6), 587-594. doi: 10.1188/13.onf.587-594
    連結：
43. adjustment: a comparison of husband and daughter caregivers of breast cancer
    連結：
44. hospice patients. Gerontologist, 43(6), 808-816.
    連結：
45. Black, P. K. (2004). Psychological, sexual and cultural issues for patients with a stoma.
    連結：
46. British Journal of Nursing, 13(12), 692-697. doi: 10.12968/bjon.2004.13.12.13254
    連結：
47. Brown, H., & Randle, J. (2005). Living with a stoma: a review of the literature. Journal of
    連結：
48. Clinical Nursing,14(1), 74-81. doi: 10.1111/j.1365-2702.2004.00945.x
    連結：
49. Burch, J. (2011). Essential care for patients with stomas. Nursing Times, 107(45), 12-14.
    連結：
50. Burch, J. (2013). Care of patients with a stoma. Nursing Standard, 27(32), 49-56; quiz 58.
    連結：
51. for understanding Mexican American cancer caregiving. Hispanic Health Care
    連結：
52. Carter, P. A., & Chang, B. L. (2000). Sleep and depression in cancer caregivers. Cancer
    連結：
53. Chen, Y. C. (2001). Chinese values, health and nursing. Journal of Advanced Nursing, 36(2),
    連結：
54. Cotrim, H., & Pereira, G. (2008). Impact of colorectal cancer on patient and family:
    連結：
55. implications for care. European Journal of Oncology Nursing, 12(3), 217-226.
    連結：
56. the caregivers: a review of self-report instruments developed to measure the burden,
    連結：
57. needs, and quality of life of informal caregivers. Journal of Pain Symptom Management,
    連結：
58. caregivers of patients with intracranial tumors. Surgical Neurology International, 6, 160.
    連結：
59. doi:10.4103/2152-7806.167084
    連結：
60. Caring for a loved one with advanced cancer: determinants of psychological distress in
    連結：
61. Cronin, E. (2012). Dietary advice for patients with a stoma. British Journal of Nursing,
    連結：
62. 21(16), S32-34, s36-38, s40. doi: 10.12968/bjon.2012.21.Sup16.S32
    連結：
63. 2315-2322. doi: 10.1111/j.1532-5415.2010.03177.x
    連結：
64. caregiver reaction assessment (CRA) for caregivers to persons with chronic physical
    連結：
65. and mental impairments. Research Nursing Health, 15(4), 271-283.
    連結：
66. Burden and depression among caregivers of patients with cancer at the end of life.
    連結：
67. Oncology Nursing Forum, 31(6), 1105-1117. doi: 10.1188/04.onf.1105-1117
    連結：
68. Given, B. A., Given, C. W., & Kozachik, S. (2001). Family support in advanced cancer.
    連結：
69. Grad, J., & Sainsbury, P. (1963). Mental illness and the family. Lancet, 1(7280), 544-547.
    連結：
70. (2004). Family caregiver burden: results of a longitudinal study of breast cancer patients
    連結：
71. and their principal caregivers. Canadian Medical Association Journal, 170(12), 1795-
    連結：
72. Hartnett, J., Thom, B., & Kline, N. (2016). Caregiver Burden in End-Stage Ovarian Cancer.
    連結：
73. cultural perspective of nursing care behaviours in an acute setting. Journal of Advanced
    連結：
74. Hsiao, P. C., Chu, C. M., Sung, P. Y., Perng, W. C., & Wang, K. Y. (2014). Differences in
    連結：
75. COPD patient care by primary family caregivers: an age-based study. Public Library of
    連結：
76. Science One, 9(9), e107870. doi:10.1371/journal.pone.0107870
    連結：
77. family caregivers of palliative care patients: psychometric properties of nine self-report
    連結：
78. instruments. Journal of Pain and Symptom Management, 31(3), 215-228. doi:
    連結：
79. Klopp, A. L. (1990). Body image and self-concept among individuals with stomas. Journal
    連結：
80. Enterostomal Therapy,17(3), 98-105.
    連結：
81. health among family caregivers of geriatric patients with cancer--a longitudinal view.
    連結：
82. the new Structural-Functional Social Support Scale (SFSS) measurement tool.
    連結：
83. Support Care Cancer, 12(5), 326-337. doi: 10.1007/s00520-004-0620-7
    連結：
84. Li, L., & Moore, D. (1998). Acceptance of disability and its correlates. The Journal Social
    連結：
85. Psychology, 138(1), 13-25. doi: 10.1080/00224549809600349
    連結：
86. Lim, S. H., Chan, S. W., Lai, J. H., & He, H. G. (2014). A randomized controlled trial
    連結：
87. examining the effectiveness of a STOMA psychosocial intervention programme on the
    連結：
88. Nursing. doi: 10.1111/jan.12595
    連結：
89. Loke, A. Y., Liu, C. F., & Szeto, Y. (2003). The difficulties faced by informal caregivers of
    連結：
90. Lowdermilk, D., & Germino, B. B. (2000). Helping women and their families cope with the
    連結：
91. impact of gynecologic cancer. Journal of Obstetric Gynecologic,and Neonatal
    連結：
92. Nurssing, 29(6), 653-660.
    連結：
93. Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research,
    連結：
94. Scandinazian Journal of Public Health, 29(2), 113-121.
    連結：
95. quality of life of cancer survivors and their family caregivers. Cancer Nursing, 29(2),
    連結：
96. 120-131; quiz 132-123.
    連結：
97. associations between caregiver burden and patient and spouse distress in couples coping
    連結：
98. doi:10.1007/s00520-013-1795-6
    連結：
99. Montgomery, R. V., Stull, D. E., & Borgatta, E. F. (1985). Measurement and the analysis of
    連結：
100. (1998). Cancer and caregiving: the impact on the caregiver's health. Psychooncology(7),
     連結：
101. (2000). Patterns of caregiver experiences among partners of cancer patients
     連結：
102. Gerontologist, 40(6), 738-746.
     連結：
103. Determinants of caregiving experiences and mental health of partners of cancer patients.
     連結：
104. Novak, M., & Guest, C. (1989). Application of a multidimensional caregiver burden
     連結：
105. inventory. Gerontologist, 29(6), 798-803.
     連結：
106. study of family caregivers' quality of life caring for patients with a stoma.
     連結：
107. Gastroenterology Nursing, 35(2), 99-104.
     連結：
108. Payne, S., Smith, P., & Dean, S. (1999). Identifying the concerns of informal carers in
     連結：
109. palliative care. Palliative Medicine, 13(1), 37-44.
     連結：
110. influencing the adjustment to a colostomy. Journal of Wound Ostomy and Continence
     連結：
111. Printz-Feddersen, V. (1990). Group process effect on caregiver burden. Journal of
     連結：
112. Neuroscience Nursing, 22(3), 164-168.
     連結：
113. Discharge planning for a patient with a new ostomy: best practice for clinicians. Journal
     連結：
114. of Wound Ostomy and Continence Nursing, 42(1), 79-82. doi: 10.1097/won.
     連結：
115. cancer at home: caregiving and bereavement. Palliative Medicine, 18(2), 129-136.
     連結：
116. Perceived health, caregiver burden, and quality of life in women partners providing care
     連結：
117. Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: the Caregiver
     連結：
118. Health Effects Study. Journal of the American Medical Association, 282(23),2215-2219.
     連結：
119. between available support, unmet needs and caregiver burden in patients with advanced
     連結：
120. cancer and their carers. Psychooncology, 14(2), 102-114. doi: 10.1002/pon.825
     連結：
121. Nursing Scholarsh, 44(3), 223-231. doi: 10.1111/j.1547-5069.2012.01453.x
     連結：
122. Shih, F. J. (1996). Concepts related to Chinese patients' perceptions of health, illness and
     連結：
123. person: issues of conceptual clarity. Accident and Emergency Nursing, 4(4), 208-215.
     連結：
124. stoma acceptance, stoma care self-efficacy and interpersonal relationships. Journal of
     連結：
125. Advanced Nursing, 60(6), 627-635. doi: 10.1111/j.1365-2648.2007.04446.x
     連結：
126. of caring for a patient with cancer. Psychooncology, 19(10), 1013-1025. doi: 10.1002/
     連結：
127. Krouse, R. S. (2012). Surviving colorectal cancer: long-term, persistent ostomy-
     連結：
128. specific concerns and adaptations. Journal of wound, ostomy, and continence nursing:
     連結：
129. official publication of The Wound, Ostomy and Continence Nurses Society/WOCN,40(1),
     連結：
130. and burden reported by family caregivers of patients with advanced cancer. Support
     連結：
131. Care Cancer, 21(9), 2527-2535. doi:10.1007/s00520-013-1824-5
     連結：
132. life in the early follow-up of colon and rectal cancer. Disease of the Colon and Rectum,
     連結：
133. 49(11), 1692-1702. doi: 10.1007/s10350-006-0709-9
     連結：
134. Evaluation of the Ostomy Adjustment Scale in Chinese Cancer Patients With
     連結：
135. 中文部分：
136. 于博芮（1996）•造口護理的基本概念•護理新象，6(4)，457-465。
137. 及其相關因素之探討• [Caregivers' Burden in Hemodialysis Patients and Related
138. Factors-An Exploratory Study] •臺灣腎臟護理學會雜誌，1(1)，31-46。
139. 王俐絜、陳威宇、張書展、黃安年、洪榮駿、王瑞霞(2011)•消化道末期癌症病患居家
140. 397-414。
141. 中華民國家庭照顧者關懷總會（2007年）•2007家庭照顧者現況調查•取自
142. http://www.familycare.org.tw/index.php/blog/395-2012-08-10-06-00-24
143. 朱瑞玲、章英華（2001）•華人社會的家庭倫理與家人互動：文化及社會的變遷效果•
144. 載於中央研究院經濟研究所【華人家庭動態資料庫】學術研討會。
145. 大學護理學系碩士暨碩士在職專班學位論文，1-118。
146. 李和惠、林麗秋、黃玉琪、吳碧雲、林貴滿、林靜琪等（2005）•內外科護理學（上冊）•
147. 台北：華杏。
148. Burdens of Primary Family Caregivers]•護理雜誌，61(1)，64-73. doi:10.6224/jn.61.1.64
149. 寧療護雜誌，13(4)，394-410。
150. 沈莉真（1998）•癌末病患家屬接受安寧療護服務之分析─以佛教慈濟綜合醫院為例•
151. 國立陽明大學衛生福利研究所碩士論文•87•1-170。
152. 顧服務之需求程度的調查•中華公共衛生雜誌，15(4)，289-302。
153. 因素之初探•[Caregiver Burden and Related Factors between Caregivers of
154. Post-surgical Hospitalized Cancer and Non-Cancer Patients: A Pilot Study]•長庚護
155. 理，15(2)，141-155。
156. 林梅香、顧乃平、劉仲冬、陳政友、林麗嬋(1996)•肝癌患者家屬主要照顧者的壓力、
157. 因應行為、健康狀況及其相關因素之探討•[An Exploration of the Stress Aspects,
158. Hepatoma Patients]•護理研究，4(2)，171-185。
159. 191-203。
160. Research]•醫護科技學刊，4(4)，273-290。
161. of Terminal Cancer Patients]•護理暨健康照護研究，5(3)，163-172。doi:10.
162. 6225/jnhr.5.3.163
163. 胡綾眞、陳美伶、陳明岐、林佳靜、林玲華（2001）•轉移性癌症病患之居家主要照顧
164. 者的照顧負荷及其相關影響因素•[The Caregiving Burden and Related Factors of
165. Primary Caregivers of Metastatic Cancer Patients at Home]•長庚護理，12（4），
166. 282-293。
167. 研究，5(5)，413-424。
168. 顧者負荷之關係•護理研究，7(2)，172-182。
169. 所碩士論文，1-116。
170. 國語日報出版中心主編(1997)•新編國語日報辭典（第一版）•台北：國語日報社。
171. 護理研究，8(6)，685-695。
172. Mass Index•中華民國大腸直腸外科醫學會雜誌，16(2)，33-38。
173. 學護理學研究所碩士論文，1-137。
174. Ventilator-Dependent Care]•呼吸治療, 7(1), 1-14. doi: 10.6269/jrt.2008.7.1.01
175. Ileostomy]•長庚護理，14(2)，142-150。
176. 劉淑娟(2006)•談女性與家庭照護•家庭教育雙月刊，（1），78-84。
177. 誌，54(4)，78-82。doi: 10.6224/jn.54.4.78
178. 衛生福利部(2013，6月)•101年死因統計結果分析•取自 http://www.doh.gov.tw/
179. CHT2006/DM/DM2_2.aspx?now_fod_list_no=12939&class_no=440&level_no=4
180. Patients]•安寧療護雜誌，12(2)，143-155。doi:10.6537/tjhpc.2007.12(2).2
181. Programs for Family Caregivers]•護理暨健康照護研究，11(1)，53-63。
182. doi:10.6225/jnhr.11.1.53
183. Family Caregivers of Cancer Patients]•長庚護理，15(3)，258-270。
184. 陳惠津（1996）•居家癌病家屬照顧者之需要狀況及其相關因素之探討•國立陽明大學
185. 社區護理研究所碩士論文，1-165。
186. Experiences and Related Factors] •護理暨健康照護研究，7(2)，127-139。doi:
187. 10.6225/jnhr.7.2.127
188. 賴鵬聖•家庭照顧者就業狀況與其照顧負荷之關係•國立台灣大學衛生政策與管理研究
189. 所碩士論文，1-153。
190. 臟護理學會雜誌，6(1)，23-36。
191. 理研究所論文，1-84。
192. 英文部分：
193. Alterescu, K. B. (1987). Colostomy. Nursing Clinics North America, 22(2), 281-289.
194. Andrews, S. C. (2001). Caregiver burden and symptom distress in people with cancer
195. receiving hospice care. Oncology Nursing Forum, 28(9), 1469-1474.
196. Aranda, S. K., & Hayman-White, K. (2001). Home caregivers of the person with advanced
197. cancer: an Australian perspective. Cancer Nursing, 24(4), 300-307.
198. Bernard, L. L., & Guarnaccia, C. A. (2003). Two models of caregiver strain and bereavement
199. Cagle, C. S., Wells, J. N., Hollen, M. L., & Bradley, P. (2007). Weaving theory and literature
200. International, 5(4), 149-161.
201. Calpista, A, Lai, S, Agostini, A, Mancini, M, & Artibani, W. (2007). Functional urological
202. complications after colo-rectal cancer surgery. Pelviperineology, 26, 38-401.
203. Cakmak, A., Aylaz, G., & Kuzu, M. A. (2010). Permanent stoma not only affects patients'
204. quality of life but also that of their spouses. World Journal of Surgery, 34(12),
205. 2872-2876.
206. Nursing, 23(6), 410-415.
207. 270-273.
208. Deeken, J. F., Taylor, K. L., Mangan, P., Yabroff, K. R., & Ingham, J. M. (2003). Care for
209. 26(4), 922-953.
210. Dhandapani, M., Gupta, S., Dhandapani, S., Kaur, P., Samra, K., Sharma, K., . . .
211. Gupta, S. K. (2015). Study of factors determining caregiver burden among primary
212. Dumont, S., Turgeon, J., Allard, P., Gagnon, P., Charbonneau, C., & Vezina, L. (2006).
213. family caregivers. Journal of Palliative Medicine, 9(4), 912-921. doi: 10.1089/jpm.
214. Garlo, K., O'Leary, J. R., Van Ness, P. H., & Fried, T. R. (2010). Burden in caregivers of
215. older adults with advanced illness. Journal of American Geriatrics Society, 58(12),
216. George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: a multidimensional
217. examination of family caregivers of demented adults. Gerontologist, 26(3), 253-259.
218. 10.1089/jpm.2006.9.912
219. Given, C. W., Given, B., Stommel, M., Collins, C., King, S., & Franklin, S. (1992). The
220. Given, B., Wyatt, G., Given, C., Sherwood, P., Gift, A., DeVoss, D., & Rahbar, M. (2004).
221. CA:A Cancer Journal for Clincians, 51(4), 213-231.
222. Grunfeld, E., Coyle, D., Whelan, T., Clinch, J., Reyno, L., Earle, C. C., . . . Glossop, R.
223. 1801.
224. Haley, W. E. (2003). Family caregivers of elderly patients with cancer: understanding and
225. minimizing the burden of care. The Journal of Support Oncology, 1(4 Suppl 2), 25-29.
226. Clinical Journal of Oncology Nursing, 20(2), 169-173. doi:10.1188/16.cjon.169-173
227. Holroyd, E., Cheung, Y. K., Cheung, S. W., Luk, F. S., & Wong, W. W. (1998). A Chinese
228. Nursing, 28(6), 1289-1294.
229. Hudson, P. L., & Hayman-White, K. (2006). Measuring the psychosocial characteristics of
230. 10.1016/j.jpainsymman. 2005.07.010
231. Kurtz, M. E., Kurtz, J. C., Given, C. W., & Given, B. A. (2004). Depression and physical
232. Medical Science Monitor, 10(8), CR447-456.
233. Lehto-Jarnstedt, U. S., Ojanen, M., & Kellokumpu-Lehtinen, P. (2004). Cancer-
234. specific social support received by newly diagnosed cancer patients: validating
235. outcomes of colorectal patients with a stoma: study protocol. Journal of Advanced
236. patients with terminal cancer in Hong Kong and the available social support. Cancer
237. Nursing, 26(4), 276-283.
238. 35(6), 382-385.
239. Marvardi, M., Mattioli, P., Spazzafumo, L., Mastriforti, R., Rinaldi, P., Polidori, M. C., . . .
240. Mecocci, P. (2005). The Caregiver Burden Inventory in evaluating the burden of
241. caregivers of elderly demented patients: results from a multicenter study. Aging Clinical
242. and Experimental Research, 17(1), 46-53.
243. Meiland, F. J., Danse, J. A., Wendte, J. F., Klazinga, N. S., & Gunning-Schepers, L. J. (2001).
244. Caring for relatives with dementia--caregiver experiences of relatives of patients on the
245. waiting list for admission to a psychogeriatric nursing home in The Netherlands.
246. Mellon, S., Northouse, L. L., & Weiss, L. K. (2006). A population-based study of the
247. Milbury, K., Badr, H., Fossella, F., Pisters, K. M., & Carmack, C. L. (2013). Longitudinal
248. with lung cancer. Support Care Cancer, 21(9), 2371-2379.
249. burden. Research on Aging, 7(1), 137-152.
250. Nijboer, C., Tempelaar, R., Sanderman, R., Triemstra, M., Spruijt, R. J., & Van den Bos, G.
251. 3-13.
252. Nijboer, C., Triemstra, M., Tempelaar, R., Mulder, M., Sanderman, R., & van den Bos, G. A.
253. Nijboer, C., Triemstra, M., Tempelaar, R., Sanderman, R., & van den Bos, G. A. (1999a).
254. Cancer, 86(4), 577-588.
255. Nijboer, C., Triemstra, M., Tempelaar, R., Sanderman, R., & van den Bos, G. A. (1999b).
256. Measuring both negative and positive reactions to giving care to cancer patients:
257. psychometric qualities of the Caregiver Reaction Assessment (CRA). Social Science and
258. Medicine, 48(9), 1259-1269
259. Palma, E., Simonetti, V., Franchelli, P., Pavone, D., & Cicolini, G. (2012). An observational
260. Piwonka, M. A., & Merino, J. M. (1999). A multidimensional modeling of predictors
261. Nursing, 26(6), 298-305.
262. Pontieri-Lewis, V. (2006). Basics of ostomy care. Medsurg Nursing, 15(4), 199-202.
263. Prinz, A., Colwell, J. C., Cross, H. H., Mantel, J., Perkins, J., & Walker, C. A. (2015).
264. 0000000000000094
265. Rossi Ferrario, S., Cardillo, V., Vicario, F., Balzarini, E., & Zotti, A. M. (2004). Advanced
266. Saban, K. L., Griffin, J. M., Urban, A., Janusek, M. A., Pape, T. L., & Collins, E. (2016).
267. to Veterans with traumatic brain injury. Journal of Rehabilitation Research and
268. Development, 53(6),681-692.doi:10.1682/jrrd.2015.07.0143
269. Sharpe, L., Butow, P., Smith, C., McConnell, D., & Clarke, S. (2005). The relationship
270. Shieh, S. C., Tung, H. S., & Liang, S. Y. (2012). Social support as influencing primary
271. family caregiver burden in Taiwanese patients with colorectal cancer. Journal of
272. Simmons, K. L., Smith, J. A., Bobb, K. A., & Liles, L. L. (2007). Adjustment to colostomy:
273. Stenberg, U., Ruland, C. M., & Miaskowski, C. (2010). Review of the literature on the effects
274. pon.1670
275. Sun, V., Grant, M., McMullen, C. K., Altschuler, A., Mohler, M. J., Hornbrook, M. C., .
276. 61-72.
277. Utne, I., Miaskowski, C., Paul, S. M., & Rustoen, T. (2013). Association between hope
278. Wilson, D. (1981). Colostomy: changing the body's image. Nursing Mirror, 152(14), 38-40.
279. Wilson, T. R., Alexander, D. J., & Kind, P. (2006). Measurement of health-related quality of
280. Yusuf, A. J., Adamu, A., & Nuhu, F. T. (2011). Caregiver burden among poor caregivers of
281. patients with cancer in an urban African setting. Psychooncology, 20(8), 902-905.
282. Zhang, J. E., Wong, F. K., Zheng, M. C., Hu, A. L., & Zhang, H. Q. (2015). Psychometric
283. Colostomies. Cancer Nursing. doi: 10.1097/ncc.0000000000000213