【作者】 姚祚星；

【导师】 陈锦秀；

【作者基本信息】 福建中医学院 ， 中西医结合临床， 2009， 硕士

【摘要】 目的:(1)对英文原版患者学习需求量表(Patients Learning Needs Scale,PLNS)进行中文版的开发研制,评价其信效度,为我国出院患者健康教育需求评估提供测量工具。(2)将中文PLNS量表进行临床应用,测量冠心病患者出院健康教育学习需求及影响因素,为冠心病患者出院健康教育提供指导,提高患者康复护理质量。方法:(1)中文版患者学习需求量表(PLNS)的研制:由量表原作者Galloway于2007年12月授权提供源量表,遵循目前国际通行的“翻译-逆向翻译-文化调适-预试验”国外量表引进程序,译制并修订PLNS。通过运用中文版PLNS调查385例临床样本,对其临床可行性、内部一致性、分半信度和结构效度进行评定。(2)中文版PLNS在冠心病患者中的临床初步应用:采用本研究研制的中文版PLNS及自行设计的冠心病患者资料调查表,调查3所医院146例冠心病出院患者的健康教育需求状况,对冠心病出院患者学习需求的影响因素做探索性分析。结果:(1)对原版PLNS进行译制及修订,形成中文版患者学习需求量表。经临床考核,中文版PLNS有良好的科学性。问卷有效回收率为96.25%,,完成问卷时间为13.75±4.36min;总量表克朗巴赫系数(Cronbach’αCoefficient)为0.95,5个领域的Cronbach’α系数分别为:社区支持与照顾0.858,用药0.841,日常治疗与活动0.853,症状0.841,其他疾病相关0.753。总量表分半信度为0.935,5个领域的分半信度在分别为:社区支持与照顾0.877,用药0.856,日常治疗与活动0.867,症状0.845,其他疾病相关0.803。八名专家对量表内容效度评价的CVI值为0.78～0.99,全部条目的平均CVI为0.86。经主成分及因子分析,抽取特征值＞1的9个主成分,累计贡献率达64.553%,基本涵盖了社区支持与照顾、用药、症状、日常治疗与活动、其他疾病相关6个领域,证实该量表有较好的结构效度。(2)冠心病患者学习需求状况:中文版PLNS显示了良好的内部一致性和稳定性(总量表Cronbach’α系数0.94,分半信度0.954:5个领域Cronbach’α介于0.734～0.949,分半信度0.757～0.856)。调查表明冠心病患者存在不同程度的学习需求感受。调查表中得分前5位的条目全部属于症状和用药方面。量表各领域得分从高到低依次为:症状、用药、日常治疗与活动、其他疾病相关、社区支持与照顾,且差别有统计学意义(P＜0.01)。(3)冠心病患者学习需求影响因素:单因素分析结果显示与患者学习需求有关的因素包括:患者年龄、婚姻状况、文化程度、医疗费用支付形式、冠心病住院次数、用药情况、是否介入治疗/检查、临床类型。多因素分析结果显示,患者总学习需求的主要影响因素由大到小排列为:冠心病自捍问⒘俅怖嘈汀⒁搅品延弥Ц缎问健！吧缜С钟胝展恕狈矫嫜靶枨蟮闹饕跋煲蛩匚幕潭取！坝靡狈矫嫜靶枨蟮闹饕跋煲蛩赜纱蟮叫∨帕形?医疗费用支付形式、用药情况、冠心病住院次数。“日常治疗与活动”方面学习需求的主要影响因素由大到小排列为:冠心病住院次数、治疗方式。“并发症与症状”方面学习需求的主要影响因素由大到小排列为:医疗费用支付形式、治疗方式。“其他疾病相关”方面学习需求的主要影响因素是临床类型。结论:(1)研究结果显示中文版PLNS有良好的可行性及信度效度,可望为出院患者健康教育学习需求的评价及科研工作提供一个科学的评估工具。(2)冠心病患者普遍存在较高程度的学习需求,且具有多维性。影响冠心病患者学习需求的人口统计学主要因素是:年龄、婚姻状况、文化程度、医疗费用支付形式。影响冠心病患者学习需求的疾病相关特征主要因素是:冠心病住院次数、临床类型、用药情况、治疗方式。更多还原

【Abstract】 Objective: To develop the Chinese version of Patient Learning Needs Scale(PLNS), and evaluate feasibility, validity and reliability of the developed scale. Supply an instrument to measure patients’ perception of learning needs at time of discharge for clinical nurses. To explore the learning needs of patients who have received treatment for Coronary Heart Disease (CHD) before their discharge home from hospital.Methods: (1) Development Chinese version of PLNS: The standard procedure of cross-culture adaptation was used to develop the Chinese version PLNS. A total of 385 adults hospitalized with a medical or surgical illness completed the Chinese version PLNS. The feasibility and psychometric properties of the scale such as internal consistency, split-half reliability, content validity and construct validity were evaluated.(2) Preliminary Application in Patient with Coronary Heart Disease: The Chinese Version of Patient Learning Needs Scale was completed by 135 CHD patients within 72 hours of their intended discharge. Quantitative descriptive and inferential analysis was conducted using Statistical Package for Social Sciences.Result: (1) The Chinese version of PLNS was developed which consist of 40items and 5 subscales:①Support and Care in the Community (10 items);②Medications (8 items);③Treatment and Activities of Living (8 items);④Complications and symptoms (8 items);⑤Illness-Related Concerns (6 items).These are evaluated using a five-point likert scale, responses ranging from 1 (not at all important) to 5 (extremely important).(2) The Chinese version of PLNS has satisfactory feasibility, validity and reliability. Questionnaire recovery rate of the investigation was 98.5%, the completion rate was 97.7%. Average time of completing was 13.75±4.36min. The overall Cronbach’sαcoefficient was 0.95 and the value ofαin 5 subscales of PLNS ranged from 0.75 to 0.86. The overall split-half reliability coefficient was 0.95 and the value of split-half in 5 subscales of PLNS ranged from 0.802 to 0.876. the CVI for content validity was 0.86. The construct validity was confirmed by factor analysis with 55, 08 % variance was explained by 9 factors.(3) CHD patients indicated how important it was to know about each of 40 information items before discharge from hospital. The 5 item which scores are all higher than the others are all belong to the dimensions of symptom and medication. Subscales relating to medications, complications and symptoms, treatment and activities of living were rated highly.Univariate analysis revealed a significant association between patients’ leaning needs and patients’ age, education level, marriage status, ways of payment, times of hospitalization, ways of treatment, clinical type of CHD and medication.Stepwise canonical discriminant analysis found that three factors, times of hospitalization, clinical type, ways of payment, were the important influencing factors of total score. The important influencing factor of Support and Care in the Community is patients’ education level. The important influencing factors of Medications are ways of payment, types of medication, marriage status and times of hospitalization. The important influencing factor of Treatment and Activities of Living are times of hospitalization and ways of treatment. The important influencing factors of Complications and Symptoms are ways of payment and ways of treatment and. The important influencing factor of Illness-Related Concerns is clinical type.Conclusion: (1) An acceptable psychometric property of the Chinese version of PLNS was indicated. PLNS could be used as positive aspects measurement of general patients’ perceptions of learning needs to manage their care at home at time of discharge from hospital to home for further clinical study and nursing care.(2) The perception of learning needs of CHD patient is existed in every dimensions. The main influencing factors of patients’ learning needs are the following such as patients’ education level, ways of payment, types of medication, marriage status, times of hospitalization, hospitalization days, clinical type of CHD and ways of treatment. Further should be taken to meet patients’ needs for information and continuing support. Comprehensive and scientific health education based on individual differences in patients with CHD should be carried out to meet the needs of patients in support of health information.更多还原