【作者】 张冰；

【导师】 王克芳；

【作者基本信息】 山东大学 ， 护理学， 2009， 硕士

【摘要】 目的探索脑卒中患者社区康复需要的各个方面,制定一份能够全面和深入地反映脑卒中患者社区康复期需要的调查表;通过对患者的需要进行研究并分析影响康复需要的因素;从护理的角度为患者提供相应的专业帮助,从而促进患者的康复并提高其生活质量,为发展社区康复策略提供依据。方法1研究对象2008年4月至2008年11月选取山东省济南市铁路医院小区,标山小区,趵突泉小区,西苑小区,天福苑小区的社区脑卒中患者共226名作为研究对象。要求入选的患者符合1995年全国第四次脑血管病学术会议制定的脑卒中诊断标准,有CT和MRI的影像学诊断依据并且愿意接受调查和评估。2研究方法包括质性研究和量性研究。(1)通过文献查阅,结合对11名社区脑卒中患者及其主要照顾者访谈的结果,初步制定脑卒中患者社区康复期需要调查表。(2)通过在社区卫生服务中心进行康复知识宣传,选取同意接受调查的符合入选标准者,现场请患者自行填写问卷或到其家中进行入户调查。回答完毕后当场检查资料的完整性及真实性,对于各种原因无法自行填写者,由其主要照顾者或研究者向其阅读问卷,据其意愿代为填写。3数据分析全部数据采用SPSS11.5软件进行处理,采用频数、百分比或(?)±s来描述一般资料;分别采用Spearman相关分析、信度检验和因子分析的方法对调查表进行信度、结构效度检验;采用单因素方差分析、独立样本t检验分析一般资料对社区康复需要的影响;采用多元逐步回归分析社区康复需要对ADL、一般自我效能感和抑郁的影响。结果1社区脑卒中患者康复期需要的质性研究对11例社区脑卒中患者及其主要照顾者深入访谈的结果表明,患者在康复过程中存在①日常生活活动②情感—心理③社会家庭关系④专业指导4个方面的需要。2社区脑卒中患者康复期需要调查表的信效度通过专家评价,条目筛选及因子分析等方等制定出含8个因子,56个条目的患者康复期需要调查表。信度资料收集完毕对全部数据进行信度检验,Q量表(存在问题量表)56个条目总Cronbach’sα系数为0.9040;N量表(需要量表)总的Cronbach’sα系数为0.9692,表明量表有很高的内部一致性。各因素Cronbach’sα系数均大于0.8。通过因子分析共提取8个因子,分别对各因子所含条目与该因子总分和N量表总分进行Spearman相关分析,结果显示各因子与N量表及所含条目间均呈显著正相关(P＜0.01)。说明各因子间和各条目间具有很高的内部一致性。效度采用主轴因子提取法按特征值＞1提取因子,共提取9个因子。迭代8次其累积方差贡献率达到了60.334%。使用方差最大旋转法后,有8个公因子在其相应的项目上有较强的因子载荷。根据原变量所对应的最大因子负荷将原变量分为8类,与量表设计的9个维度基本符合,说明该调查表的区分效度较高。3脑卒中患者社区康复需要的研究通过对调查表进行因子分析的结果共提取8个因子,即社区脑卒中患者在康复期存在8个方面的需要。分别为心理支持需要;信息支持需要;日常活动支持需要;社会适应支持需要;专业支持需要;后遗症应对支持需要;社会支持需要和并发症支持需要。是否有医疗保险对心理支持需要有显著统计学意义(＜0.01);对社会适应支持(P＜0.05),专业支持需要(P＜0.05)和社会支持需要(＜0.05)有统计学意义。是否接受过专业人员的康复指导对专业支持需要(＜0.05)有统计学意义。不同职业对社会适应支持需要有显著统计学意义(＜0.01),对后遗症应对支持需要有统计学意义(＜0.05);不同文化程度对信息及专业支持需要有显著统计学意义(＜0.01),对心理支持,社会适应支持和社会支持3个方面的需要有统计学意义(＜0.05);不同经济收入对社会适应支持需要有显著统计学意义(＜0.01)。其余一般资料对患者社区康复需要的影响无统计学意义(P＞0.05)。患者的ADL与日常活动支持需要和后遗症应对支持需要相关(R~2=0.314,校正R~2=0.308,F=51.015,P=0.000);一般自我效能感与日常活动支持需要有关(R~2=0.046,校正R~2=0.041,F=10.597,P=0.001),但意义不大,提示有更重要的因变量影响因素有待于进一步研究;抑郁与心理支持需要和后遗症应对支持需要相关(R~2=0.212,校正R~2=0.205,F=29.276,P=0.000)。其它康复需要对患者的ADL,一般自我效能感和抑郁均无影响。结论1社区脑卒中患者康复期需要调查表具有良好的信度和效度。2社区脑卒中患者康复期需要调查表共56个条目,包含8个因子。包括患者康复期需要的以下内容:心理支持需要;信息支持需要;日常活动支持需要;社会适应支持需要;专业支持需要;后遗症应对支持需要;社会支持需要以及并发症支持需要。3患者是否有医疗保险,是否接受过专业指导,文化程度与经济收入对社区脑卒中患者康复期需要有影响。其中是否有医疗保险和文化程度对康复需要的影响较为显著。4患者日常活动支持需要和后遗症应对支持需要对患者的ADL有影响;日常活动支持需要对患者的一般自我效能感有影响;心理支持需要和后遗症应对支持需要对患者的抑郁状况有影响。更多还原

【Abstract】 ObjectiveTo explore stroke patients’ need in various aspects during community rehabilitation period,develop a scale(The Scale of Stroke Patient’s Need During Community Rehabilitation Period),which can reflect patients’ need extensively and extensively.To research and analysis the factors which affect the patients’ rehabilitation need;provide the professional assistance from the perspective of care for patients so as to promote the rehabilitation of patients and improve their quality of life.To provide the strategy for development of community based rehabilitation.Methods1.Sample of 226 stroke patients in communities of Jinan city including community of Railway Hospital,Biaoshan,Baotuquan,Xiyuan and Tianfuyuan were studied.Data collection was conducted from Apr.2008 to Nov.2008.Patients selected in line with the requirements of the stroke diagnostic criteria which formulated on the Fourth National Cerebrovascular Disease Symposium in 1995;Based on imaging diagnosis of CT and MRI;Willing to accept the investigation and assessment.2.Methods including quantitative and qualitative research.(1) According to the results of literature review,combined with the results of in-depth interview of 11 community stroke patients and their primary caregivers to develop the scale.(2) By disseminating brochures of rehabilitation knowledge in community health center,investigator selected patients who fulfilled the criteria and agreed to accept investigation to completed the scale on the spot or at home. Completed scale was checked for integrity and authenticity.To the patient who was unable to complete independently,the primary caregiver or researcher would read the scale and filled out on patients’ behalf.3.Data analysisData was processed by SPSS11.5 software.Frequency,percentage or(?)±s were used to describe the general information;Spearman correlation analysis,reliability test and factor analysis were adopted for scale’s reliability and structure validity tests; One-way ANOVA and t-test were introduced to analysis the impact of general information on community rehabilitation need;Multiple stepwise regression was used to analysis the affects of need to ADL,general self-efficacy and depression respectively.Results1.Qualitative research on the need of stroke patients during community rehabilitation periodBy the in-depth interviewing of 11 cases of stroke patients and their primary caregivers,the results of qualitative research showed that:During the rehabilitation process,patients had 4 aspects of need including daily living activities;emotional and psychological;social and family relations,as well as professional guidance.2.Reliability and validity of the scaleAfter evaluating by experts,items filtration and factor analysis,the scale was developed with eight factors and 60 entries.Reliability test was used to analysis all collected data.The total Cronbach’s a coefficient of Q Scale(Question scale) was 0.9040;the overall Cronbach’sαcoefficient of N Scale(Need scale) was 0.9692,those results showed that the scale had high internal consistency.Cronbach’sαcoefficient of each factor was greater than 0.8.At last,eight factors were extracted by the factor analysis.The results of Spearman correlation analysis showed that each factor was significant positive correlation(P＜0.01) with the N scale and inter-entries.It illustrated that high internal consistency existed in the inter-factors as well as inter-entries.According to eigenvalue＞1 factor extraction,9 factors were extracted by using the method of main axis factor extraction.The cumulative variance contribution rate was 60.334%after 8 times of iteration.Using the method of varimax rotation,8 common factors had stronger factor loading on the corresponding items.According to original variable corresponding to the maximum factor loading,the original variable was grouped into 8 categories.That was in line with the designed scale,which had 9 dimensions.It showed that the scale had higher discriminant validity.3.Study of stroke patients’ need during the period of community rehabilitationAccording to results of factor analysis,8 factors were extracted,namely,stroke patients existence eight aspects of need during the community rehabilitation period as followed:psychological support need;information support need;daily activity support need;social-adapting support need;professional support need; sequelae-coping support need;social support need and complication-supporting need. Whether having medical insurance had significant different in psychological support need(＜0.01);and had different in social-adapting support need(P＜0.05), professional support need(P＜0.05) and social support need(＜0.05) respectively. Whether having received rehabilitation guidance was different in professional support need(＜0.05).Patients with different occupation had significant difference in social-adapting support need(＜0.01),and had different in sequelae-coping support need(＜0.05);patients with different levels of education had significant difference in information support need and information support need(＜0.01),as well as had difference in psychological support need,social-adapting support need and social support need(＜0.05);patients with different economic levels had significant difference in social-adapting support need(＜0.01).The rest general information has no impact on patients’ need during the period of community rehabilitation(P＞0.05).Patients’ ADL was related to daily activity support need and sequelae-coping support need(R~2=0.314,Adjusted R~2=0.308,F=51.015,P=0.000);General self-efficacy was related to daily activity support need(R~2=0.046,Adjusted R~2= 0.041,F=10.597,P=0.001),but the correlation had little significance which suggesting that there was more important factors to be further studied;Depression was related to psychological support need and sequelae-coping support need (R~2=0.212,Adjusted R~2=0.205,F=29.276,P=0.000).The rest rehabilitation need had no effect on patients’ ADL,general self-efficacy and depression.Conclusions1.The Scale of Stroke Patient’s Need During Community Rehabilitation Period has good reliability and validity.2.The Scale contains 56 entries and eight factors which reflect the content of patients’ rehabilitation need,including psychological support need,information support need, daily activity support need,social-adapting support need,professional support need, sequelae-coping support need,social support need and complication-supporting need.3.Whether having medical insurance,having received professional guidance,levels of education and economic effect patients’ community rehabilitation need,whereas the impact of medical insurance and education was more remarkable.4.Patients’ ADL was effected by daily activity support need and sequelae-coping support need;general self-efficacy was little influenced by daily activity support need; depression was impacted by psychological support need and sequelae-coping support need.更多还原