執行護理指導措施對個案血脂控制之成效研究

The Effects of Nurse-Directed Intervention for Patients with Hyperlipidemia

本研究目的為探討高脂血個案以護理指導措施，改善控制高脂血飲食行為，並間接降低血脂之成效；採類實驗研究法，以立意取樣選取164位高脂血個案，其中實驗組81位，控制組83位。前測後，提供兩組個案「高脂血症之飲食治療」衛教手冊，供其自行參讀，實驗組則在其後的四週中，由研究者教導並協助其提昇控制飲食行為之自我效能。前測之後12週施行後測，前後測除以生化檢驗血脂值外，並以問卷評量控制高脂血的認知、自我效能，及飲食行為等變項。前測時發現兩組個案多數已具備相當程度的控制高脂血認知，但個案間於執行各項飲食行為的自我效能差別甚大，且個案的飲食行為普遍不理想。血脂的分佈有偏高情形，各血脂值的平均值分別為，T-C：242.5 mg/dl，HDL-C：52.3 mg/dl，LDL-C：155.3 mg/dl，TG：172.8 mg/dl。研究結果發現，接受研究者指導的實驗組，其控制高脂血的認知、自我效能、飲食行為，及血脂值的改進幅度顯著大於控制組；實驗組後測時各血脂值下降幅度為，T-C：39.6 mg/dl，LDL-C：32.4 mg/dl，TG：54 mg/dl；HDL-C則平均增加2.4 mg/dl。以上實驗組血脂值前後測以配對t檢定呈顯著差異。綜合以上，於職場中以護理指導方法提供高脂血個案認知及自我效能之提昇，對於飲食行為的改善有相當顯著之成效，而透過控制高脂血的飲食行為，可間接改善個案的血脂值。

The purpose of this study was to understand the effects of nurse-directed intervention on improving behaviors of diet control and decreasing blood lipids in hyperlipidemia patients. The design was quasi-experimental and used purposive sampling to collect data from 164 subjects who had hyperlipidemia. Eighty-one (81) subjects were in the experimental group and 83 were in the control group. After pretesting, both groups of subjects received pamphlets to read. However, only the subjects in the experimental group received nurse-directed interventions to improve their behaviors on diet control; such interventions included health education on blood lipids, recording daily diet intake, and telephone follow-ups during the four week intervention period. After 12 weeks, post-testing was done to evaluate the knowledge of hyperlipidemia, self-efficacy, and diet control behaviors. At pre-testing, both groups of subjects had scores on knowledge related to hyperlipid control that were moderately high, but scores on self-efficacy and diet control behaviors were varied and low. The overall mean blood lipid values (T-C = 242.5 mg/dl, HDL-C = 52.3 mg/dl, LDL-C = 155.3 mg/dl, and TG =172.8 mg/dl) were higher than normal. The results indicate that subjects in the experimental group showed significant improvement on knowledge of controlling high lipids, on self-efficacy, and on diet-control behaviors than did subjects in the control groups. In conclusion, nurse-directed clinical interventions aimed at improving patients' hyperlipidemia resulted in positive patient outcomes.