血液透析患者主要照顧者的負荷、需求及相關因素之探討

An Exploratory Study of Primary Caregivers' Burdens, Needs, and Related Factors in Hemodialysis Patients

本研究目的在了解血液透析患者之主要照顧者負荷、需求及其相關因素。針對北區某 區域教學醫院洗腎室透析患者之主要照顧者共101 位，採結構式問卷收集資料。結果顯示 ：(1)照顧者負荷平均得分為1.77 分偏中度負荷，其中以“擔心患者病情變化＂為最重的 負荷。照顧者負荷與慢性病、更換職業、外傭之有無、目前健康狀況及照顧前後之健康狀 況、家人互動、親友互動、經濟狀況的改變達統計上顯著差異。目前健康狀況、照顧前後 之家人互動情形、日常生活活動功能、外傭之有無、照顧前後之經濟狀況等為照顧者負荷 的顯著預測因子，解釋變異量為48.8%。（2）照顧者需求平均得分為1.87 分屬中度需求 ，其中以“醫護人員能盡全力照顧患者＂為最大需求。照顧需求與照顧前後的健康狀況、 家人互動、經濟狀況的改變等達統計上顯著差異。目前健康狀況、照顧前後的家人互動情 形為照顧者需求的顯著預測因子，解釋變異量為11.4%。(3)患者的日常生活活動功能愈 差，主要照顧者負荷愈高（r= -0.279，p< 0.001）；主要照顧者負荷愈高，則主要照顧者 需求則愈高（r= 0.559，p< 0.001）。依本研究結果將有助於瞭解北台灣血液透析者之主 要照顧者需求，並作為日後發展血液透析患者整體照護之參考。

The purpose of this study was to explore the burdens, needs, and related factors among primary caregivers while they were taking care of their hemodialysis patients. There were 101 questionnaires collected from those patients' primary caregivers in one hospital located in Northern Taiwan. The results of this study were as follows: Firstly, the mean for primary caregivers' burdens was 1.77, a medium burden level, and ”worrying about the patient's disease progression” was the major identified burden. In addition, the caregivers' burden showed significant differences according to whether they have chronic diseases, job changes for patient care, and foreign helpers or not. Also, the changes of health status, family relationship, kin interaction, and economics, among primary caregivers, before and during care of patients, yield significant differences in burden. Using a multiple stepwise regression analysis, health status, family relationship, Barthel's score revealed that, foreign helpers or not, and economic change were found to explain 48.8% of the variance of primary caregivers' burdens. Secondly, the mean for primary caregivers' needs was 1.87, a medium level of needs, and the best care from medical staffs was the most important need. Factors associated with caregivers' needs include the changes of health status and family relationship for primary caregivers before and during care of patients. Both health status and family relationship were found to explain 11.4% variance of primary caregivers' needs. Thirdly, the lower the Barthel's score, the higher the caregivers' burden. Also, there was a positive relationship between the caregivers' burdens and needs. Results of the study will be of assistance to health professionals in understanding the needs of caregivers who care for hemodialysis patients in Northern Taiwan, and will act as a reference for the future development of action plans and techniques for the holistic care of hemodialysis patients.