肝硬化病人疲憊與不確定感之相關性探討

The Relationship Between Fatigue and Uncertainty in Patients With Liver Cirrhosis

背景：肝硬化是慢性、進行性且無法治癒的疾病；病人易因症狀控制不佳、反覆復發而出現不確定感。疲憊是肝硬化病人常見症狀，因臨床上無有效改善疲憊的方法，故常被健康照護專業人員忽略。未適當處理病人的疲憊可能引發更多不確定感受，影響疾病適應。目的：探討肝硬化病人之疲憊、不確定感及其相關因素。方法：採橫斷式、相關性研究設計，以方便取樣方式選取76位住院中之肝硬化病人。使用病人屬性問卷表、台灣版簡明疲憊量表及Mishel疾病不確定感量表收集資料。結果：（1）病人疲憊感受屬中高程度，平均疲憊程度5.39 ± 2.34分（0–10計分），對日常生活功能中之「休閒活動」影響最高；病人疾病嚴重度、白蛋白、總膽紅素、腹水、疲憊干擾日常生活功能程度與疲憊感受有顯著相關。（2）病人整體不確定感屬中高程度，平均71.81 ± 10.67分（ 總分23–115分）；病人之疲憊程度越高、疲憊干擾日常生活功能程度越高、疾病嚴重度越高、白蛋白越低者其整體不確定感越高。結論：實務應用疲憊、不確定感常令肝硬化病人苦惱，評估疲憊、不確定感以提供護理指導，可協助病人調適疾病帶來的負面影響。

Background: Cirrhosis is a chronic, progressive, and currently incurable disease. Cirrhotic patients often experience uncertainty due to poor control of symptoms and disease recurrence. Although fatigue is a common symptom in patients with liver cirrhosis, this symptom is often ignored by healthcare professionals due to the lack of efficacious treatment options. Improper management of fatigue may trigger greater uncertainty and affect adaptation success. Purpose: To explore the relationship between fatigue and uncertainty and the factors that respectively relate to these two concepts in liver cirrhosis patients. Methods: A cross-sectional, correlational design and convenience sampling were used to recruit 76 liver cirrhotic inpatients from one hospital. Three structured questionnaires, including the Personal Demographic Questionnaire, Brief Fatigue Inventory-Taiwan Form, and Mishel’s Uncertainty in Illness Scale, were used for data collection. Results: (1) The participants suffered from fatigue at a moderate or higher level, with an average score of 5.39 ± 2.34, which affected their daily activities and greatly impacted their recreational activities. Factors that were found to be associated with fatigue included disease severity, albumin level, total bilirubin level, ascites, and the degree to which fatigue affected the performance of daily activities. (2) Uncertainty was found to be at a moderate or higher level, with an average score of 71.81 ± 10.67. Level of fatigue, the degree to which fatigue affected the performance of daily activities, disease severity, and albumin level were found to relate significantly to level of uncertainty. Conclusions/Implications for Practice: Fatigue and uncertainty are prevalent and distressing experiences for patients with liver cirrhosis. A comprehensive assessment and broad-based approach to nursing interventions are necessary in order to alleviate fatigue and uncertainty effectively.