A Caring Experience for a Patient Suffering from Acute Pancreatitis with Pleural Effusion

[[abstract]]本文在探討一位急性胰臟炎併發肋膜積水的個案，鈴住院期間的疾病經驗。護理期間自民國2008年12月14日至12月28日爲止。照顧個案期間，依Gordon十一項功能性健康型態評估爲依據，藉由觀察、會談以及身體評估箏方式收集資料，發現個案住院期間的主要護理問題有：一、低效型呼吸型態／右側肋膜積水有關；二、疼痛／疾病導致腹痛、嘔吐；三、高危險性感染／侵入性導管留置；四、營養少於身體所需／疾病導致禁食；五、健康維護能力改變／缺乏維護健康的基本知識。筆者於護理期間以真誠和同理心的態度與個案及其家屬建立良好的治療性人際關係，並針對個案的獨特性與個別性，適時的緩解身體的不適感、提供相關資訊並給予心理支持，以協助個案日後建立健康的生活型態。 This case report described the caring experience of a patient who suffered from acute pancreatitis with pleural effusion. The author took care of the patient from the 14th to the 28th of December 2008. Based on the Gordon's Model, the data were collected by means of observation, interview, and physical assessment during the nursing process. The patient's health problems were identified as ineffective breathing related to pleural effusion on the right side, pain related to disease and vomiting, high risk of infection related to invasion of tubes, nutrition altered: less than body requirements, and altered health maintenance: lacking of the essential knowledge in health maintenance. The author specially designed a set of programs to alleviate patient's discomfort according to his physical and medical conditions. During the nursing process, the author showed attentiveness towards patient and his family and established a good nurse-patient relationship and provided individualized nursing care to facilitate the patient creating a healthy living style

[[alternative]]Resilience and Leisure Activity in Sarcopenia Geriatric Population With Heart Disease-A Trajectory Research

[[abstract]]背景：肌少症是目前影響高齡者健康的重要因素，且高齡者罹患慢性疾病之比例較高，高齡肌少症合併心臟病者之心理狀態與休閒活動方面之研究仍付之如闕，且其長期心理狀態與休閒活動之變化的研究結果證據尚且不足。因此探討此族群之心理韌性與休閒活動之關係以及長期軌跡變化趨勢。目的：檢視心理韌性及休閒活動於高齡肌少症合併心臟病之患者的相關性及其長期之軌跡變化。第一階段研究計畫(文獻評析期)：評析心理韌性與休閒活動之文獻評析結果，第二階段研究計畫(縱貫追蹤期)：以軌跡之縱貫追蹤研究，檢測縱貫資料追蹤不同時間點對高齡肌少症合併心臟病人之心理韌性與休閒活動之變化探討。方法：本研究為二階段研究計畫，第一階段為系統性文獻回顧與評析，分析資料庫中高齡者休閒活動以及心理韌性的相關變項；第二階段研究階段為縱貫追蹤期，本研究共收96位樣本數，於第一次門診(基礎點)收案後，進行資料收集包含基本資料、心理韌性與休閒活動等變項之分析，並檢測縱貫資料追蹤不同時間點(三個月、六個月後)對高齡肌少症合併心臟血管疾病人者之心理指標(心理韌性)與休閒活動(休閒活動)等變項變化之探討。結果：第一階段研究：文獻回顧評析結果發現，休閒活動介入對於高齡者之肌肉質量、步行速度或是握力具有顯著改善成效，且介入措施至少有兩種以上之運動，但運動類型、強度與持續時間皆無一致，且介入措施後檢視成效之工具尚缺乏一致性與標準性。第二階段研究：本研究之研究對象中為大於65歲以上之高齡者、男性多於女性、已婚、與家人同住，教育程度以國中居多、信仰佛教、運動時間每次小於30分鐘、慢性病以心臟血管疾病以及高血壓為主。心理韌性之狀態與性別有顯著差異(p=.02)、與年齡有顯著差異(p =.03)、與自我照顧有顯著差異(p <.01)。休閒活動與年齡有顯著差異(p =.01)、與教育程度有顯著差異(p =.02)、與家庭收入以及運動時間有顯著差異(p =.01, p<.01)。心理韌性與休閒活動兩者呈現正相關(r=.42, p<.01)，且心理韌性的程度可以預測休閒活動的參與率，且具有顯著意義(p=0.00)，整個模式可以解釋整體休閒活動之總變異量達17.3%。於縱貫資料追蹤不同的時間點(基礎點、3個月與6個月)其心理韌性與休閒活動之頻率逐漸上升。以Group-Based trajectory 分析，分群四組後第二組的個案在控制變項為年齡、性別與自我照顧下，顯示心理韌性在第二組的研究對象中呈現顯著差異(Β=4.2, SE=1.46, p<0.00)，顯示心理韌性有顯著上升；休閒活動第一組個案隨著時間變化，其參與休閒活動的頻率顯著上升；而休閒活動在第一組的研究對象中呈現顯著差異(Β=2.7, SE=1.24, p=0.03)，顯示休閒活動有顯著上升。結論：本研究結果證實，心理韌性與休閒活動在高齡肌少症合併心臟疾病者中扮演很重要的因素，而高齡者的心理狀態會影響其休閒活動的參與頻率，對肌少症的患者來說，休閒活動頻率增加則可以避免肌少症所帶來的失能、跌倒或是自我照顧能力喪失。在邁入高齡社會的台灣，長者的心理狀態與對疾病適應調整的能力都需要醫療相關人員共同關心與評估，且鼓勵老年人參與合適之休閒活動，除了增加休閒活動外也能促進心理健康。臨床應用與實務：此研究結果將可幫助相關臨床照護人員提高對肌少症合併心臟疾病人者的重視，同時也了解單獨個案長期的心理韌性狀態與休閒活動的變化。再者，此研究結果將可作為設計發展提升照護結果與品質的有效性介入措施進而可能降低醫療成本以及肌少症的發生，進而提升高齡者之生活品質以及促進成功老化。[[abstract]]AbstractBackground: Sarcopenia is an important factor affecting the health status for the geriatric population, and the proportion of elderly people suffering from chronic diseases is relatively high. The study of the psychology and leisure activity of elderly patients with sarcopenia combined with heart disease is insufficient. There is insufficient evidence for the findings of changes in mental state and leisure activity. Therefore, the relationship between resilience and leisure activity of this ethnic group and long-term trajectory trends are explored. Purpose: To examine the relationship between resilience and leisure activity in elderly people with sarcopenia combined with heart disease and change long-term trajectory. The first stage of the research project (systematic literature review phrase):review of resilience and leisure activity literature reviewing results, the second stage of the research project (long-term trajectory): tracking longitudinal tracking studies, detection of longitudinal data tracking for resilience and leisure activity in different time points. Method: This study is a two-stage research project. The first stage is the review and analysis of systematic literature, and analyzes the related variables of physical activity and resilience of elderly people in the databases. The second stage of research is the long-term trajectory study. The number of 96 samples was collected at the first outpatient (baseline) after the case was collected. Data collection included analysis of demographics data, resilience, leisure activity, and other variables, and the detection of longitudinal data at different time points (three and six months). Six months later, we discussed the changes of psychological indicators (psychological resilience) and physical activities (leisure activities) in elderly patients with sarcopenia combined with heart disease.Results: The first stage of the study: the review of literature found that physical activity intervention has significant improvement in muscle mass, walking speed, or grip strength for elderly people, and intervention plan include at least two types of exercises, however, the type of exercise, intensity, and duration were no consistency in each research. Besides, the tools for examining the effectiveness after interventions lack of consistency and standardization. The second stage of the study: The subjects of this study were older than 65 years old, more males than females, married, living with family members, education in senior high school, belief in Buddhism, exercise time less than 30 minutes per each time. Chronic diseases are mainly heart diseases and hypertension. The state of resilience was significantly different from gender (p=.02), age (p=.03), and self-care (p<.01). There were significant differences between leisure activity and age (p = .01), significant differences with education (p = .02), and family income and exercise time (p = .01, p < .01). There was a positive correlation between resilience and leisure activity (r=.42, p<.01), and the level of resilience was predictive of the participation rate of leisure activities, with significant significance (p=0.00). The model could explain the overall situation. The total variation of leisure activities reached 17.3%. The resilience and leisure activity gradually increased at different time points (baseline, 3 months, and 6 months) across the long-term trajectory. In the Group-Based trajectory analysis, the second group of patients after clustering four groups showed significant differences in the resilience of the second group of subjects under control variables of age, gender, and self-care (Β = 4.2, SE = 1.46, p<0.00), showing that there is a significant increase in resilience; the first group of leisure activities changes with time, their frequency of participation in leisure activities increased significantly; and leisure activities in the first group of research objects show significant differences (Β =2.7, SE = 1.24, p = 0.03), indicating a significant increase in leisure activitiesConclusion: The results of the study confirm that resilience and leisure activities play an important role in the elderly patients with sarcopenia combined with heart disease. The psychological state of the elderly will affect the frequency of their participation in physical (leisure) activities, and for patients with sarcopenia. It is benefit for elder people to prevent disability, falls, or loss of self-care ability due to sarcopenia. In the ageing society in Taiwan, the psychological statues and the ability to adjust chronic are important factors for older people. We can encourage them to take part in appropriate leisure activities in order to increase physical activity and promote mental health.Clinical and Practical Applications: The results of this study focus on patients with sarcopenia combined with heart disease, as well as to explore the long-term changes in resilience and physical activity in individual. It is help for clinical staff to design intervention to improve the nursing care quality, which in advance to lower medical costs and the occurrence of sarcopenia, thereby improving the quality of life for elderly people and promoting successful aging. Key words: Resilience, Physical activity, Leisure activity, Sarcopenia, geriatric population, heart diseas

三明治教學校外實習專題實習公司： 安心食品股份有限公司

[[abstract]]摩斯漢堡為台灣第一家創造「米漢堡」的速食連鎖店。摩斯漢堡始終堅持餐點現點現做，以及送餐到位的服務，避免顧客花費時間在等待餐點上，餐點製作完成後立刻送到顧客的位置上。 在摩斯漢堡的實習過程中，一開始從什麼都不會的新人，一直學習到現在十大工作站都非常熟悉的狀態，也了解到店鋪內部的營運方向。學習與同事之間的想處與該如何確實去執行店長所交代的事物，實係至今已有九個月了，覺得摩斯漢堡是一家非常有制度規劃的公司，摩斯漢堡的教育訓練是非常扎實的，夥伴們之間都非常親切、熱心助人，在實習過程中曾經因為工作時不小心燙傷了，店鋪的夥伴們都很關心，區經理也多次來訪店鋪關心傷勢以及詢問恢復狀況，讓我倍感窩心。 在升遷方面，店長會依個人能力去輔導考「職等考試」。在這個完整的教育訓練與升遷制度以及充滿人情味的公司，讓我畢業後會想繼續留任這家公司，也非常歡迎學弟妹加入摩斯這個大家庭

Exploration of Health-Promoting Lifestyle and Related Factors Among Bladder Cancer Survivors

[[abstract]]背景：膀胱癌為男性泌尿道常見的惡性腫瘤，而罹癌後健康促進生活型態有助於存活期間展開正向之生活方式，可提升心理與生理之健康狀態，然而目前對於膀胱癌族群之健康促進生活型態之研究證據仍然有限。目的：本研究目的為探討台灣膀胱癌病人於存活期之健康促進生活型態變化及重要之預測因子。方法：前瞻縱貫性研究設計，方便取樣，共收案台灣某地區醫院81位存活期膀胱癌病患，以三個時間點進行資料收集，研究工具包含人口學基本資料及健康促進生活型態量表，以描述性統計、皮爾森相關係數、廣義估計方程式進行資料分析。結果：膀胱癌病患於存活期之健康促進生活型態，營養及心理安適暨健康責任面向，隨時間呈現越來越好的趨勢。身體活動為膀胱癌存活者最差之健康促進生活型態次面向。放射線治療、頻尿為其重要預測因子。結論／實務應用：研究結果顯示腫瘤照護人員應於膀胱癌病患接受治療前、治療後並且續追蹤三個月，以監測其健康促進生活型態，並進一步發展以病患為中心的護理介入措施，以提高膀胱癌病人更佳之存活期健康成效。 Background: Bladder cancer is a common urinary tract cancer in men. A health-promoting lifestyle helps patients develop a positive lifestyle during survival and can improve mental and physical health. However, the evidence of health-promoting lifestyle is insufficient in bladder cancer populations. Purpose: The purposes of this study were to examine the trend and factors associated with health-promoting lifestyle in Taiwanese bladder cancer survivors and to identify the predictors of a health-promoting lifestyle. Methods: A prospective longitudinal design with convenient sampling was used. A total of 81 participants were sampled. Data were collected at three points in time using a demographic questionnaire and the Health-Promoting Lifestyle Profile questionnaire. Data were analyzed by descriptive statistics, Pearson's correlation, and Generalized Estimating Equations. Results: Survivors were concerned about nutrition, psychological wellbeing, and personal responsibility of health-promoting lifestyle over time. Physical activity presented the poorest results in health-promoting lifestyle. Radiotherapy and frequent urination were predictors of health-promoting lifestyle. Conclusion: The results imply that oncology nurses should keep track of the health-promoting lifestyles among bladder cancer survivors. After that, further development of patient-center care interventions and enhancing better health outcomes of bladder the patients in survival periods is advised