A Nursing Experience for a Patient with Cerebral Vascular Accident in Emergency Department

[[abstract]]本文敘述一位79歲男性腦中風病患於急診室求診之護理經驗，筆者以羅氏適應模式爲評估工具，透過觀察、身體評估及電訪等收集資料，確立個案有呼吸道清除功能失效、潛在危險性皮膚完整性受損及身體活動功能障礙等健康問題。筆者配合醫療措施執行護理協同性功能外，運用個案在急診有限的護理期間發揮良好治療性溝通，衛教主要照顧者與個案有關之照護技能，配合討論及回覆示教等方式，提供主要照顧者與個案疾病相關居家照護資訊。筆者將此個案護理經驗提出分享，盼能做爲日後照護類似個案參考。 This article describes a nursing experience for a 79-year-old patient with cerebral vascular accident in the emergency department. The author applied Roy's Adaptation Model for patient assessment. Data were collected through patient observation, physical examination, and patient interview via phone. The three identified major health problems were ineffective airway clearance, potential risk for impaired skin integrity, and impaired mobility. Besides working with other disciplines for the patient's medical problems, the author established a therapeutic relationship with the patient and family members. This facilitated patient education on the subject of home care. Discussion and a demonstration of skills were included during the teaching. This article can be used as a reference for nurses who care for stroke patients in the emergency setting

[[alternative]]An Exploration of Dietary behaviors , Physical Activities and Perimenopausal Disturbances among middle - aged Women with Metabolic Syndrome risk factors

[[abstract]]中年婦女的代謝症候群之預防或修正，對於將來臨之健康老年生活有極大的幫助。本研究目的探討中年婦女之代謝症候群危險因子分佈情形及其與基本屬性、飲食行為、身體活動量、更年期症狀困擾的相關性及其預測因子。採橫斷式調查性研究，研究期間為100年01月至100年04月，以立意取樣方式於北部某區域教學醫院門診40-60歲之代謝症候群危險因子中年婦女為研究對象，採結構式問卷調查的方式收集資料，共有101位婦女參與研究調查，研究工具包括：代謝症候群危險因子、飲食頻率問卷、國際身體活動量表自填短版－台灣中文版及更年期症狀困擾問卷。本研究結果發現：一、研究對象平均年齡為52.3±6.2歲，BMI平均為25.9±3.9 kg/㎡，代謝症候群危險因子則以腰圍肥胖居多(80.2％)，其次依序為高血糖(74.3％)、高收縮血壓(55.4％)、高密度脂蛋白膽固醇50mg/dl者之高脂食物攝取頻率較多；（四）三酸甘油酯：烹調油使用頻率(p<.05)，其中以三酸甘油酯≧150mg/dl者比三酸甘油酯<150mg/dl者烹調油使用頻率較多；（五） 舒張血壓：年齡、BMI、停經階段、燕麥及心理精神症狀困擾(p<.05)，其中舒張血壓≧85mmHg者以肥胖居多；（六）收縮血壓：整體更年期症狀困擾及骨關節症狀困擾(p<.05)，其中以收縮血壓≧130mmHg者比收縮血壓<130mmHg者之整體更年期症狀困擾、骨關節症狀困擾較為嚴重；（七）代謝症候群：年齡、BMI、停經階段、油炸食物攝取頻率及身體活動量總METs (p<.05)，其中有代謝症候群者以56-60歲、肥胖及停經後期居多，以無代謝症候群者比有代謝症候群者之身體活動量總METs較多。三、代謝症候群危險因子及代謝症候群之預測因子，經邏輯斯迴歸統計顯示：代謝症候群之預測因子為BMI(OR=1.68; 95％CI=1.33, 2.08)、更年期(OR=12.3; 95％CI=1.25, 120.68)及停經後期(OR=42.97; 95％CI=2.22, 831.41)；此外，腰圍≧80cm之預測因子為BMI(OR=3.46; 95％CI=1.61, 7.46)、三酸甘油酯≧150mg/dl之預測因子為烹調油使用頻率(OR=1.03; 95％CI=1.00, 1.07)、空腹血糖值≧100mg/dl之預測因子為身體活動量不足(OR=11.29; 95％CI=1.72, 73.82)以及舒張血壓≧85mmHg之預測因子為心理精神症狀困擾(OR＝5.08; 95％CI=1.44, 17.86)。綜合以上研究結果，建議中年婦女在其歷經更年期及停經後期時應積極改善生活型態，積極控制體重，飲食應採取低脂肪、低糖及高纖維質等原則，減少汽水、可樂、沙士、運動飲料、油炸食物攝取，增加糙米飯攝取，每週至少累積150分鐘的中度身體活動或75分鐘的費力身體活動，以防治代謝症候群。期望此研究結果可提供醫護人員臨床照護之參考。關鍵詞：代謝症候群、飲食行為、身體活動量、更年期症狀困擾、中年婦女[[abstract]]The prevention or modification of the occurrence of metabolic syndrome in middle-aged women is helpful for having a healthy life in their old age. This study aimed to explore ：（1）the distribution of risk factors for metabolic syndrome （2） the relationships of these risk factors with demographics, dietary behaviors, physical activity, and perimenopausal disturbances.（3）The predicting factors of metabolic syndrome among middle-aged women. The cross-sectional correlated survey using purposive sampling was applied. Data collection was conducted from January 2011 to April 2011. One hundred and one women with metabolic syndrome risk factors aged between 40 and 60 years were recruited from a regional teaching hospital in North Taiwan. Structured questionnaires including risk factors for metabolic syndrome, the food frequency questionnaire, Physical Activity Questionnaire, Short Form (IPAQ-SF), and perimenopausal disturbances were used for data collection. The results showed the following:1.The mean age of the study participants was 52.3 ± 6.2 years, and their mean BMI value was 25.9 ± 3.9 kg/m2. Among these women, the ranking of the most common risk factor for metabolic syndrome was：abdominal obesity (80.2 %), hyperglycemia (74.3 %), high systolic blood pressure (55.4 %), high density lipoprotein cholesterol (HDL-C) < 50 mg/dl (38.6 %), high triglycerides (31.7 %), and high diastolic blood pressure (23.8 %). 55.4 % of the study participants met the criteria of metabolic syndrome.2.Analysis of variance of risk factors for metabolic syndrome: (1) Waist circumference: age, BMI, stage of menopause, frequency of consumption of soft drinks, sports drinks, rice, coarse rice, fried foods, and intake of vitamins, minerals, and other supplements (p < .05). Women with a waist circumference of 80 cm or above were mostly between 56 and 60 years of age, obese, and at the postmenopausal stage. Compared to women whose waist circumference was less than 80 cm, those with a waist circumference of 80 cm or greater had greater frequency of consumption of soft drinks, sports drinks, rice, and fried foods. (2) Fasting blood glucose: age, stage of menopause, frequency of consumption of soft drinks, sports drinks, fried foods, intake of vitamins, minerals, and other supplements, physical activity, and psychiatric perimenopausal disturbance (p < .05). Women with fasting blood glucose levels of 100 mg/dl or above were mostly between 56 and 60 years of age and were at the postmenopausal stage, and they generally had insufficient levels of physical activity. (3) High density lipoprotein cholesterol (HDL-C): frequency of consumption of foods high in fat and coarse rice (p < .05). Women whose HDL-C was less than 50 mg/dl had higher frequency of consumption of high fat foods than those whose HDL-C was greater than 50 mg/dl. (4) Triglycerides: frequency of use of cooking oil (p < .05). Women whose triglyceride levels were 150 mg/dl or higher used cooking oil more frequently than those whose triglyceride levels were lower than 150 mg/dl. (5) Diastolic blood pressure: age, BMI, stage of menopause, consumption of oatmeal, and psychiatric disorders (p < .05). Most women whose diastolic blood pressure was 85 mmHg or higher were obese. (6) Systolic blood pressure: overall disturbance of menopausal and osteoarthritis symptoms (p < .05). Compared to women whose systolic blood pressure was lower than 130 mmHg, women with a systolic blood pressure of 130 mmHg or higher experienced more severe symptoms of menopause and osteoarthritis. (7) Metabolic syndrome: age, BMI, stage of menopause, frequency of consumption of fried foods, and volume of physical activity (METs) (p < .05). Women with metabolic syndrome were mostly between 56 and 60 years of age, obese, and were at the postmenopausal stage. Compared to those with metabolic syndrome, women without metabolic syndrome performed more physical activities (METs).3.Risk factors and predicting factors of metabolic syndrome: according to the results of the logistic regression analyses, BMI (OR=1.68; 95％CI=1.33, 2.08) menopause (OR=12.3; 95％CI=1.25, 120.68) and postmenopausal stage (OR=42.97; 95％CI=2.22, 831.41) were identified as the predicting factors of metabolic syndrome. BMI (OR=3.46; 95％CI=1.61, 7.46) was also the predicting factor for a waist circumference of 80 cm or above. The predicting factor of serum triglyceride levels of greater or equal to 150 mg/dl was the frequency of use of cooking oil (OR=1.03; 95％CI=1.00, 1.07). Insufficient physical activity (OR=11.29; 95％CI=1.72, 73.82) was the predicting factor for fasting blood glucose levels greater or equal to 100 mg/dl, and the predicting factor for a diastolic blood pressure of greater or equal to 85 mmHg was the existence of psychiatric disorders (OR＝5.08; 95％CI=1.44, 17.86).Based on the study results described above, it is recommended that middle-aged women at the stages of menopause or post-menopause actively improve their life style and control their body weight. In addition, middle-aged women should follow the principle of selecting foods that are low in fat and sugar, and high in fiber. Consumption of soft drinks, sports drinks, and fried foods should be decreased, while the intake of brown rice should be increased Women should perform moderate physical activities for 150 minutes, or conduct vigorous physical activities for 75 minutes per week to prevent metabolic syndrome, hopefully, these study results will serve as a reference for metabolic syndrome care.Keywords: Metabolic Syndrome, Dietary behaviors, Physical Activities, Perimenopausal Disturbances, middle-aged wome

[[alternative]]The Medical Seeking Experiences of Delaying Prehospital among the First Time Stroke Patients and The Construction of knowledge scale for Preventing Stroke Prehospital Delay

[[abstract]]背景：FAST(Face-Arms-Speech-Time)中風口訣是普遍宣傳中風病人提早就醫重要關鍵指標，但到院前延誤仍是目前造成腦中風病人無法於黃金治療時間3小時至4.5小時之內抵達醫院主要原因。有一半的腦中風病人都有高血壓病史，若能掌握高血壓病人預防腦中風到院前延誤就醫知識之評估，並針對高血壓患者作為衛教依據，更能落實FAST(Face-Arms-Speech-Time)教導之成效。目的/方法:本研究採序列性三角交叉研究設計，在量表之建構則以高血壓門診病人為主要研究對象，共分三階段：第一階段採質性研究紮根理論研究法，建立初次腦中風患者到院前延遲就醫經驗的描述性理論；第二階段依第一階段質性研究的結果，發展「預防中風到院前延遲就醫知識量表」 （Prevention Knowledge Scale for Stroke Prehospital Delay以下簡稱, PKSPD），並以Dr. Sullivan發展之「中風知識量表」翻譯成中文量表作為收斂效度之檢測工具；第三階段採橫斷性調查的研究設計，探討高血壓患者的基本屬性與PKSPD之關係及PKSPD之預測因子。結果:第一階段深入訪談 24位到院前延誤初次急性中風患者，平均年齡為60.8歲。「猶豫和困惑」為初次腦中風患者到院前延遲就醫經驗過程的核心類屬。「無預警感覺身體功能失調」為先驅類屬，引發初次腦中風患者「猶豫和困惑」的就醫過程經驗。此過程中，五個互動行為類屬如下: 「自我判斷和自我合理化」、「或許只是個小問題」、「自我治療及就近求醫」、「察覺症狀更嚴重」、「奔赴附近急診室-自覺嚴重疾病即將來臨」，最後自己察覺到身體已殘疾而感到悲傷、難過、憂鬱以及懊悔延遲就醫而「成為一個殘疾之人」。 第二階段PKSPD建構依質性研究類屬，發展五個構面共14題：「中風的徵兆」、「身體微恙不會造成中風」、「我是不易得到中風」、「當下即刻的行動」、「到急診的方式」；專家內容效度為0.85、困難指數介於0.2-0.8，鑑別度指數介於0.32-0.72(p < .05)、KR-20為0.714，表示具有良好信效度、PKSPD與中風知識量表-中文版之收斂效度.31(p <0.001)，表示具有建構效度。 第三階段共收集310位高血壓患者為研究對象，平均年齡56.4±9.1歲；高血壓患者對PKSPD普遍存有正確的信念題項答對率前二順位為：「突然一邊手麻或者一邊手腳麻、沒有力」、「走路時單側腳沒有力氣」；答錯率前二順位為「與下列症狀、疾病有關，例如：頭暈、頭痛、感冒、內耳失調、筋膜炎、神經壓迫、手抽筋或被蜜蜂叮有關」、「自行到急診由自己騎車或家人開車或叫計程車」；高血壓患者「教育程度」與PKSPD有顯著差異(t = 6.45, p <0.001)；教育程度大學(專)/研究所以上是PKSPD的預測因子(R2= .031, p < .001)，顯示對於PKSPD，可被教育程度大學(專)/研究所以上解釋總變異量3.1%。 結論與建議:高血壓患者對於預防中風到院前延遲就醫之知識仍不普及，本研究建議宜加強宣導中風的主觀症狀及使用緊急救護系統的必要性，以達安全即刻就醫之零距離的行動性。此外，可以增設中風重點醫院24小時語音諮詢，協助病人及時判斷中風之徵兆。[[abstract]]Background: FAST (Face-Arms-Speech-Time) stroke tips is an important key indicator for generally promoting early medical treatment for patients with stroke. But the prehospital delay is still the main reason why patients with stroke cannot reach the hospital within 3 hours to 4.5 hours of gold treatment time. 50% of patients with stroke have a history of hypertension. If the assessment of knowledge about prevention of stroke prehospital delay following patients with hypertension can be mastered and health education can be implemented for patients with hypertension, it is more likely to achieve the effectiveness of FAST (Face-Arms- Speech-Time) instruction.Aims & Methods: This study adopted the sequential triangulation study design. For the scale development, this study enrolled outpatients with hypertension as the main study subjects. This study included a total of 3 stages, and the purposes are as follows:Stage 1 used qualitative grounded theory research method to stablish the descriptive theory of the medical seeking experience among the first ischemic stroke patients with prehospital delay. Based on the results of the stage 1 qualitative research, stage 2 developed the &quot;Prevention Knowledge Scale for Stroke Prehospital Delay, PKSPD&quot; and translated the &quot;Stroke Knowledge test&quot; developed by Dr. Sullivan into a Chinese scale as tool for testing convergent validity. Stage 3 used cross-sectional correlational research design to explore the correlation between PKSPD of patients with hypertension and basic attributes and their predictors.Results: In the first stage, In-depth interviews were conducted with Twenty-four first-time ischaemic stroke patients with prehospital delay. The average age was 60.8 years. “Hesitating and puzzling” was the core category to describe and guide the process of acute ischaemic stroke patients with prehospital delay. “Sudden loss of physical limbs sensation and dysfunction” was the antecedent category to trigger the experience in the selection of treatment for the symptoms of patients with acute stroke. These patients felt the “sudden loss of physical limbs sensation and dysfunction” and expressed the “Hesitating and puzzling” medical treatment process situation. There were five interactive categories: “Self-judgement and self-rationalization”, “self-treatment and seeking medical attention nearby”, “puzzling and doubting—it may only be a minor problem”, “Worse symptoms” needing immediate advanced medical help, and “Rush to nearby ER—self-alerting that serious disease is coming”. Eventually, they arrive at the ER too late to receive rt-PA. In addition to being deeply regretful, they are sad and depressed when they “become a person with disabilities”. The second stage of PKSPD developed 5 dimensions, with a total of 14 items, according to the qualitative research categories: &quot;Signs of stroke&quot;, &quot;Slight physical discomfort will not cause stroke&quot;, &quot;I am not easy to get stroke&quot;, &quot;Immediate Action ”, and “The way to be admitted to the emergency department”. The expert content validity was 0.85, the difficulty index was between 0.2-0.8, the discrimination index was between 0.32-0.72 (p <.05), and the KR20 was 0.714, indicating that the reliability and validity were good. The convergent validity of the PKSPD and Stroke Knowledge Scale-Chinese version was 0.31 (P <0.001), indicating that the construct validity was good. The third stage enrolled a total of 310 patients with hypertension as the study subjects. The mean age of the subjects was 56.4±9.1 years old. The 2 items with the highest correct answer rate (i.e. patients with hypertension generally possessing accurate knowledge of PKSPD) were: “Sudden numbness in one hand, or both hands and feet, without strength” and “Lack of strength in one foot when walking”. The 2 items with the highest wrong answer rate were “Related to the following symptoms or diseases, such as: dizziness, headache, cold, inner ear disorders, fasciitis, nerve compression, hand cramps or bee stings” and “Go to the emergency department by yourself or by car driven by family or taxi”. The “educational level” of patients with hypertension and the PKSPD showed significantly differences (t = 6.45, p <0.001) . The educational level of university (college)/graduate institute and above was the predictor for PKSPD (R2=.031, p <.001), suggesting that the total variance of PKSPD explained by educational level of university (college)/graduate institute was 3.1%.Conclusions & Recommendation: The knowledge about prevention of delay in admission to hospital following stroke of patients with hypertension is still insufficient. This study suggested that the promotion of subjective symptoms of stroke and the necessity of using an emergency rescue system should be strengthened to achieve zero-distance mobility for safe and immediate medical treatment. In addition, 24-hour voice consultation can be added to stroke hospitals to help patients judge the signs of stroke in a timely manner

高血壓患者中風知識及其相關影響因素之探討

[[abstract]]背景與目的：高血壓患者認識及瞭解中風相關知識有助於降低中風的發生和確保中風發作時的即時反應。儘管高血壓患者是中風的高危險群，但有關於高血壓患者中風知識的數據資料仍缺乏。本研究目的在探討高血壓患者的中風知識及其相關影響因素。方法：採橫斷式調查性研究，於南桃園某區域醫院心臟內科門診收案，共有310位之高血壓患者進行調查。研究工具包括基本資料問卷、中風知識量表-中文版，以SPSS 17.0版進行建檔與統計分析。結果：本研究中75.5%的高血壓患者的中風知識低於平均水準，中風知識答錯率題項前二名為「哪個年齡層最容易中風」、「如果有疑似中風的症狀，應該什麼時候打電話叫救護車？」；中風知識自我認同知識缺口題項前二名為「台灣成年人中風發生率，每千人約有多少人？」、「短暫性腦缺血發作的警訊徵象大多於多久內消失？」。高血壓患者「年齡」與中風知識呈弱的負相關（r= -0.268，p ＜ 0.001），而「教育程度」（F = 51.04，p ＜ 0.001）、「家人是否罹患中風」（t = 2.65，p ＜0.001）、「是否接受中風相關衛教」（t = 2.74，p ＜ 0.001）與中風知識有顯著差異。結論：由本研究結果顯示高血壓患者尚缺乏足夠中風知識，建議可透過公共或社會媒體幫助高血壓患者認識中風知識、安排患者於門診候診時給予衛教並透過提供教育光碟和相關知識之衛教單張提升患者的中風知識