本文選題：慢性心力衰竭 + 患者積極度　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:修訂源自臺(tái)灣的中文版患者積極度量表(Patient Activation Measure 13,PAM13),將其應(yīng)用于當(dāng)?shù)芈孕牧λソ呋颊咧胁z驗(yàn)其信度和效度,以制訂適合中國大陸人群的簡(jiǎn)體中文版患者積極度量表,同時(shí)研究慢性心力衰竭患者的積極度水平及其影響因素,以制定提高患者積極度水平的策略。方法:采用方便抽樣的方法,選擇2016年9月至2017年1月于山東省濟(jì)南市兩家三級(jí)甲等醫(yī)院住院治療的200例慢性心力衰竭患者作為研究對(duì)象,采用修訂簡(jiǎn)體中文版患者積極度量表和自編患者基本信息問卷獲得數(shù)據(jù),進(jìn)行中文版患者積極度量表的信度、效度檢驗(yàn),評(píng)價(jià)慢性心力衰竭患者積極度水平,并分析影響患者積極度水平的因素。將調(diào)查數(shù)據(jù)整理后輸入SPSS 17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,采用Cronbach's α系數(shù)、重測(cè)信度評(píng)價(jià)問卷的信度;采用內(nèi)容效度指數(shù)(CVI)、驗(yàn)證性因素分析和探索性因子分析法評(píng)價(jià)量表的效度;慢性心力衰竭患者積極度水平現(xiàn)狀采用描述性統(tǒng)計(jì);慢性心力衰竭患者積極度水平的影響因素采用有序多分類的logistic回歸方法對(duì)進(jìn)行分析。結(jié)果:1.相關(guān)分析法和決斷值法對(duì)問卷進(jìn)行項(xiàng)目分析的結(jié)果顯示,條目與所屬模塊的相關(guān)均達(dá)到顯著性水平(P0.01),其中除條目2與所屬分量表的相關(guān)系數(shù)為0.25,其余條目相關(guān)系數(shù)均在0.4以上,13個(gè)條目的決斷值(CR值)均大于3.0(P0.01);簡(jiǎn)體中文版PAM13總量表的Cronbach's α系數(shù)為0.82,重測(cè)信度0.70,顯示量表具有良好的信度;效度檢驗(yàn)總體CVI是0.87,結(jié)構(gòu)效度探索性因子分析提取出4個(gè)特征根值大于1的因子,解釋變量總變異的58.20%,共提取4個(gè)因子,與原問卷模型基本吻合,驗(yàn)證性因子分析顯示各項(xiàng)擬合優(yōu)度指數(shù)均較理想,表明中文版PAM13具有較好的結(jié)構(gòu)效度。2.200例慢性心力衰竭患者積極度得分最小值36.76分,最大值100分,說明在慢性心力衰竭患者中患者積極度水平有很大的個(gè)體差異;平均56.58分,患者積極度位于第3水平。3.采用方差分析比較慢性心力衰竭患者積極度水平在一般資料上的差異,結(jié)果顯示慢性心力衰竭患者積極度水平在受教育程度、生活主要照顧者、心功能分級(jí)(NYHA)、是否接受過健康教育、是否主動(dòng)獲取自我管理相關(guān)知識(shí)方面方面存在差異(均 P0.05)。4.有序多分類logistic回歸分析結(jié)果顯示慢性心力衰竭患者接受教育水平、家庭經(jīng)濟(jì)狀況、疾病嚴(yán)重程度、家庭照顧支持和是否接受過健康教育是影響患者積極度的主要因素。結(jié)論:1.本研究表明修訂的簡(jiǎn)體中文版患者積極度量表具有較好的信度和效度,可以為慢性心力衰竭患者積極度評(píng)價(jià)提供一個(gè)有用的工具。2.慢性心力衰竭患者的積極度水平總體位于第3水平,積極度水平個(gè)體差異較大。積極度水平在不同接受教育水平、生活主要照顧者、心功能分級(jí)(NYHA)、是否接受過健康教育、是否主動(dòng)獲取自我管理相關(guān)知識(shí)方面存在差異。3.慢性心力衰竭患者的積極度水平與患者接受教育水平、家庭經(jīng)濟(jì)狀況、家庭照顧支持、疾病嚴(yán)重程度、是否接受過健康教育等影響因素有關(guān)。應(yīng)根據(jù)患者積極度水平制定與患者需求匹配的個(gè)性化的支持策略,包括制定與患者積極度水平相匹配的管理目標(biāo)、干預(yù)措施,開展多學(xué)科合作的延伸護(hù)理體系。
[Abstract]:Objective: to amend the Patient Activation Measure 13 (PAM13) from the Chinese version of the Chinese version of Taiwan, to apply it to the patients with chronic heart failure and to test its reliability and validity in order to formulate a simplified Chinese version of the Chinese version of a Chinese version of the Chinese mainland population, and to study the positive level of the patients with chronic heart failure. And the influencing factors, in order to formulate strategies to improve the level of patients' enthusiasm. Methods: using a convenient sampling method, 200 patients with chronic heart failure hospitalized in three grade A hospitals in Ji'nan, Shandong province from September 2016 to January 2017 were selected as the research object, and the revised simplified Chinese version of the positive measurement table and self compilation were adopted. The patient's basic information questionnaire obtained the data, carried out the reliability of the Chinese version of the positive measurement table, tested the validity of the patients with chronic heart failure, and analyzed the factors affecting the level of the patient's enthusiasm. After the survey data were arranged, the statistical analysis was carried out by the SPSS 17 statistical software, and the Cronbach's alpha coefficient and retest reliability evaluation were used. The reliability of the price questionnaire; the validity of the content validity index (CVI), the confirmatory factor analysis and the exploratory factor analysis; the status of the patients with chronic heart failure was described by descriptive statistics; the influence factors of the positive level of chronic heart failure patients were analyzed by the sequential and multi classification of the logistic regression method. Results: results: the results of 1. correlation analysis and decision analysis showed that the correlation between items and their modules reached significant level (P0.01), in which the correlation coefficient of item 2 and subscale was 0.25, the correlation coefficient of the other items were above 0.4, and the 13 CR values were more than 3 (P0.01); The Cronbach's alpha coefficient of the Chinese version PAM13 is 0.82, the retest reliability is 0.70, the display scale has good reliability; the overall CVI of the validity test is 0.87. The exploratory factor analysis of the structural validity extracts 4 factors which are more than 1 of the root values, and the total variation of the variables is 58.20%, and 4 factors are extracted, which are basically consistent with the original questionnaire model and verifying. The factor analysis showed that all the goodness of fit indices were ideal, indicating that the Chinese version of PAM13 had better structural validity in.2.200 patients with chronic heart failure, the minimum of 36.76 scores and the maximum value of 100 points, indicating that there was a large individual difference in the level of the patient's enthusiasm in the patients with chronic heart failure, with an average of 56.58 points and the patient's positive level. The difference in the general data of chronic heart failure patients was compared by variance analysis at third level by variance analysis. The results showed that the level of enthusiasm in the patients with chronic heart failure was educated, the main caregivers of life, the classification of heart function (NYHA), whether they had received health education, and whether they actively acquired knowledge about self management. The difference (all P0.05).4. ordered multi classification logistic regression analysis showed that the education level of patients with chronic heart failure, family economic status, disease severity, family care support and health education were the main factors affecting the patient's enthusiasm. Conclusion: the 1. study showed the revised simplified Chinese version. The positive measurement table has good reliability and validity, it can provide a useful tool for the evaluation of chronic heart failure patients' enthusiasm. The level of.2. chronic heart failure is generally located at the third level, and the individual differences are large in the level of enthusiasm. The level of enthusiasm is at different level of Education, the main caregivers of life and heart work NYHA, whether to receive health education, or not to take the initiative to acquire self-management knowledge, there are differences in the level of.3. chronic heart failure in patients with chronic heart failure, the level of education, family economic status, family care support, the severity of the disease, the health education and other factors, and should be based on patients. The level of initiative is designed to develop a personalized support strategy that matches the needs of the patient, including the management goals that match the patient's initiative level, the intervention measures, and the extended nursing system of multidisciplinary cooperation.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.54

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