冠狀動脈繞道手術病患出院後自覺的健康問題及護理指導需求

The Perceived Health Problems and Needs for Nursing Instruction in Patients Undergoing Coronary Artery Bypass Grafting Surgery after Discharge

本研究採描述比較研究設計，123位某醫學中心冠狀動脈繞道手術病患接受出院護理指導後，於出院一個月內，研究者以電話依結構式問卷訪談，了解病患出院一週及一個月自覺的健康問題及護理指導需求及影響之相關因素。研究結果發現：(1)病患出院一週自覺的健康問題依序是睡眠障礙、胸骨切開傷口問題、腸胃症狀、心臟血管系統症狀、呼吸系統症狀、腿部取大隱靜脈傷口、活動障礙。追蹤至出院一個月自覺的健康問題總數有顯著減少(p<.001)。(2)出院一週的護理指導需求依序是傷口處理、手術後復原過程、活動、用藥指導、情緒支持、飲食、藥物解釋。出院一個月的護理指導需求總數較出院一週的護理指導需求總數有顯著減少(p<.05)。(3)無主要照顧者之個案在出院一週自覺之健康問題總數較有主要照顧者之個案為多(t=-2.2，p<.05)。研究結果可以提供醫護人員做為持續修正出院護理指導之參考。The purpose of this descriptive comparative study was (1) to understand patients' perceptions of health problems and nursing instruction needs among discharged patients, and (2) to analyze the relative factors of demographic characteristics between patients' perceptions of health problems and nursing instruction needs among discharged patients. The subjects were 123 hopitalization patients who had undergone coronary artery bypass grafting surgery and accepted nursing instructions for discharge from 2 cardiovascular surgery wards in a medical center. All of the subjects were interviewed by the researchers via telephone. They were called in the 1st week and 1st month after discharge. The results included: (1) ranking order of patients' perceptions of health problems in the 1st week after discharge were sleep disturbance,sternalotomy wound, symptoms of gastrointestinal disturbance, symptoms of cardiovascular, system symptoms of respiratory syetem, wound of leg incision, and activity diturbance. These problems were significantly decreased during the first after month discharge (p<.001); (2)following order sof subjects' nursing instruction needs in the 1st week after discharge were wound mangement , postoperative progrsss,instructing about activities, emotional support, diet information, and explaining medication. These nursing instruction needs were significantly decreased at the second calls (p<.05); (3)the number of patients' perceived health problems in the 1st week after discharge without a caregiver exhibited significant increased than those with a caregiver in the 1st week after discharge (t=-2.2, p<.05). Therefore,members of the multidisciplinary health care team should modify nursing instructions before discharge.