影響小兒開心病患出院準備服務之相關因素探討

A Study of Discharge Planning and Related Factors in Open Heart Pediatric Patients

本研究旨在評估病童健康狀態、出院後居家照護需求，予以出院準備服務計劃之介入性措施，給予病童之主要照護者合適出院護理指導，進而探討影響出院準備服務之相關因素，並預測影響出院服務品質之主要因素。本研究採縱剖式研究設計之追蹤研究，以立意取樣選取93位（41位病童、41位主要照護者、11位護理人員）符合收案條件之個案為對象。結果顯示病童診斷為心室中隔缺損之主要照護者，照護病童知識正確性顯著高於其他組，主要照護者之教育程度為高中以上者，其知識正確性顯著優於高中（含）以下者。給予出院護理指導項目愈多，則照護病童的知識及技術正確性即愈高。經出院準備服務計劃之執行，主要照護者照護病童知識及技術有顯著提升。在影響出院服務品質的因素方面，主要照護者學習需要滿足程度及主要照護者親戚給予支持程度可解釋護理服務滿意度41.07 %之變異量；病童有無接受其他方式醫療可解釋主要照護者照護病童知識正確性11.70%之變異量；出院護理指導項目加總可解釋主要照護者照護病童技術正確性31.32%之變異量。

The purposes of this study were to assess patient's health and home care status, and using discharge planning as intervention to educate care givers in order to fulfill clients' health care needs. Through assessing subjects' related variables, researchers tended to investigate quality of discharge planning, and to predict factors which would influence the quality of discharge planning. The longitudinal follow-up study was used for research design. A total of 93 samples were recruited which included 41 patinets,41 care givers, and 11 primary nurses. Care givers with high school and above educational preparation had significantly higher care knowledge than others. Those with VSD diagnosis had self-care skill score significantly higher than that of other illnesses. Those who received more discharge planning services had higher scores in both self-care knowledge and skills. The implementation of discharge planning significantly improve the care givers' knowledge and skills for caring open heart pediatric patients. In revealing the predicting factors for quality of discharge planning, the fulfillment of learning needs of care givers and their level of social support from relatives could explain 41.07% of variance toward their satisfaction of nursing care. Whether patients received other medical treatment could explain 11.70 % of variance toward care knowledge. The numbers of discharge planning services nurses' implemented could explain 31.32% of variance toward the accuracy of care skills.