探討護理指導方案經由改變不確定感刺激結構對不確定感之成效－－初次罹患突發性聽力喪失病人

Exploring the Effectiveness of a Health Education Program on the Stimuli Frame and on Uncertainty in Patients with Sudden Hearing Loss

背景：不確定感會阻隔訊息接收及自我調適能力，繼而影響預後。突發性聽力喪失病患高度疾病不確定感與疾病瞭解程度不足以及訊息缺乏有關，然而目前尚缺乏明確的護理指導方案。目的：探討「一對一」口頭指導並配合手冊方式，對初次罹患不明原因、突發性聽力喪失病患，經由改變不確定感刺激結構對不確定感的成效。方法：採實驗性設計，將60位病患隨機分配於實驗組28位以及控制組32位。並以問卷方式收集基本資料、不確定感刺激結構及疾病不確定感。全體研究對象於住院時立即給予常規照護，並於24小時內進行前測；之後實驗組立即予一對一護理指導方案介入，三天後全體研究對象接受後測。結果：護理指導介入，可以增加自覺疾病瞭解程度，提升對突發性聽力喪失疾病的自我了解及降低疾病不確定感。疾病不確定感隨著不確定感刺激結構認知程度的增加而下降。經由介入措施增加不確定感刺激結構的認知程度，而間接降低疾病不確定感。結論／實務應用：個別性護理指導配合手冊運用，可提供病患明確的訊息來源，有效增加突發性聽力喪失病患對自我疾病的了解以及降低不確定感，並可提供臨床護理指導之參考。

Background: Uncertainty may limit communication and affect the ability of patients to adapt to their illness. A high level of uncertainty in patients concurrent with sudden hearing loss has been related to poor comprehension of communications and poor illness understanding. Currently, there is no any certain standard information sheet in the clinical setting. Purpose: This study evaluates the effect of a one-to-one oral instruction strategy combined with an information sheet firstly on the stimuli frame and then on uncertainty in patients suffering from idiopathic sudden sensorineural hearing loss. Method: An experimental design was employed and 60 patients were randomly assigned to either the experimental group (n = 28) or the control group (n = 32). A structured questionnaire that included the stimuli frame of uncertainty and the Mishel uncertainty illness scale was used to collect data. All samples received regular care following admission to the hospital and received the pretest within 24 hours after admission. The experimental group received the one-to-one oral instruction strategy combined with an information sheet immediately after the pretest. All participants completed the posttest three days later. Results: The health education program increased perceived understanding of illness in patients with the sudden hearing loss, and reduced their illness uncertainty. Perceived understanding of illness was negatively related to the level of illness uncertainty. The stimuli frame of uncertainty acted as a mediator between the intervention and the uncertainty. The intervention increased the level of cognition of the stimuli frame of uncertainty and then indirectly lowered the uncertainty level. Conclusions / Implications: These findings support the effectiveness of the individual health education strategy with the information sheet in delivering to patients critical information about their condition and treatment. Moreover, this intervention may effectively increase illness cognition and reduce uncertainty in patients with sudden hearing loss. Clinical nurse staffs may use the findings of this study to improve their health education efficacy.