老年前列腺增生症患者自我照顾及主观幸福模式的研究
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摘要
目的
(1)大样本调查老年前列腺增生症患者自我照顾(自我护理能力、自我护理行为)、生活质量水平及影响因素。(2)实验性研究设计旨在阐明延续性护理对老年前列腺增生症患者自我护理的影响。(3)根据主观幸福感与自我护理能力、自我护理行为、生活质量的关系,旨在构建老年前列腺增生症患者的主观幸福感模式。
方法
第一章：采用描述性相关设计,采用方便抽样的方法,于2010年1月至2011年2月采用问卷的形式调查我院201例老年前列腺增生症患者的自我护理能力、自我护理行为、生活质量和主观幸福感的情况,用国际前列腺症状评分量表(IPSS)进行疾病症状测评。描述老年前列腺增生症患者自我护理能力的情况；比较老年前列腺增生症患者和正常对照组自我护理能力的差异；对老年前列腺增生症患者的自我护理能力进行单因素和多元线性回归分析。描述老年前列腺增生症患者的自我护理行为的情况。对老年前列腺增生症患者的自我护理行为进行单因素分析和多元线性回归分析；描述老年前列腺增生症患者生活质量的情况；描述老年前列腺增生症患者和正常对照组普适生活质量量表WHOQOL OLD的得分；比较两组人群生活质量的差异；对老年前列腺增生症患者生活质量(BPHQOL量表)进行单因素分析和多元线性回归分析；描述老年前列腺增生症患者主观幸福感的情况；对主观幸福感进行单因素分析和多元线性回归分析；描述自我护理能力和自我护理行为、生活质量、社会支持、主观幸福感之间的关系；描述自我护理行为和生活质量、社会支持、主观幸福感之间的关系；描述生活质量和主观幸福感之间的关系。
第二章：用实验性研究设计,对我院泌尿二个区的住院老年前列腺增生症患者50例作为干预组,采用延续性护理,干预时间为3个月。采用一般社会人口学资料、自我护理能力测定量表、良性前列腺增生症生活质量评定量表、自我护理行为测定量表等问卷进行干预前后的测量。比较干预组在干预前后的自我护理能力、自我护理行为和生活质量得分。
第三章：基于文献检索的基础,本研究使用自我护理能力量表、自我护理行为量表、良性前列腺增生症患者生活质量评定量表、主观幸福感量表对201例老年前列腺增生症患者进行调查。以自我护理能力、自我护理行为和生活质量三者整合主观幸福感的理论模型。模型的整合分为两个过程：探索性分析和验证性分析。探索性分析中,先从自我护理能力、自我护理行为和生活质量三个量表中提取因子,分析各个因子之间的结构关系。验证性分析过程是通过提取的因子来考察结构效度,最终确定模型。
数据分析通过SPSS16.0软件包进行处理及分析。使用的统计学方法包括问卷的信效度检验、频数分布分析、描述性统计分析、Pearson相关分析、两独立样本t检验、配对t检验、方差分析、多元线性回归、χ2检验、秩和检验等。使用Lisrel8.51软件包构建老年前列腺增生症患者主观幸福感的模型。
结果
本研究共发出问卷215份,回收有效问卷201份,有效问卷回收率为96.9%,年龄为73.30±7.22,婚姻状况是已婚174(96.5%),离异1(0.5%),孤寡6(3.0%)；教育水平是小学以下69(34.3%),中学83(41.3%),高中12(6.0%),大专34(18.9%),本科以上3(1.5%)；病程情况是<5年为114(57.0%),5-10年为54(27.0%),>10年为32(16.0%)。
第一章第一节：一般资料的调查结果：老年前列腺增生症患者最喜爱的教育方式为自己返院咨询124(61.7%),电话咨询37(18.4%),医护上门服务36(17.9%)。老年前列腺增生症患者和正常对照组一般资料的比较,结果显示老年前列腺增生症患者的家庭关系要比正常对照组差(P=0.004),老年前列腺增生症患者的居住者资料与正常对照组比较也有统计学差异(P=0.040)。
IPSS症状评分量表内部一致性(Cronbach's alpha为0.891,条目经标化后算得的Cronbach's alpha为0.883)较好。IPSS症状的调查结果显示IPSS条目由大到小排列的顺序为“过去1个月夜间睡觉时起床排尿次数”、“过去1个月排尿不尽感”、“过去1个月排尿后2小时内又要排尿”、“过去1个月排尿感觉尿线变细”、“过去1个月感觉排尿费力”、“过去1个月排尿时断断续续”、“过去1个月排尿不能力等待”,其中“过去一个月排尿后2小时内又要排尿?”选项“几乎总是”的病人最多,人数为60人(29.9%)；“过去一个月排尿不尽感”、“过一个月排尿断断续续?”、“过去一个月感觉尿线变细?”、“过去一个月感觉排尿费力”、“过去一个月夜间睡觉时起床排尿次数?”这些条目中选择“几乎总是”的病人数都多于50人。老年前列腺增生症患者IPSS症状困扰评分(BS)的调查结果显示37.8%的患者在排尿时是多数不满意的,28.9%的患者是满意和不满意各半,14.9%患者是多数满意,9.0%的患者是很痛苦的。
自我护理能力量表的Cronbach's alpha为0.938,条目经标化后算得的Cronbach's alpha为0.939,说明信度较好。老年前列腺增生症患者的自我护理能力总分为108.37±20.74,自我护理能力各维度得分分别为自我护理技能28.03±5.31、自护责任感16.08±3.94、自我概念18.13±4.13和健康知识水平47.85±8.58。老年前列腺增生症患者自我护理能力分级水平结果显示,59.7%的老年前列腺增生症患者的自我护理能力是中等水平,40.3%的患者呈高等水平。老年前列腺增生症患者自我护理能力总分及各维度得分与正常对照组比较,结果显示总分和各维度得分与正常对照组相比均有统计学差异(P<0.001)。老年前列腺增生症患者和正常对照组的自我护理能力总分和各项目得分的分级水平比较也有统计学差异(P<0.001)。一般社会人口学资料对患者自我护理能力的单因素分析结果显示医疗费用支付方式对老年前列腺增生患者的自我护理能力有影响。多元逐步回归分析结果显示抑郁总分(P<0.001)是影响老年前列腺增生症患者自我护理能力的因素。
第二节：自我护理行为量表的内部一致性(Cronbach's alpha为0.945,条目经标化后算得的Cronbach's alpha为0.946,说明该量表信度较好。本研究结果显示老年前列腺增生症患者的自我护理行为的总分为130.06±18.46,自我护理行为各维度得分分别为健康责任感23.28±3.72、躯体活动22.36±3.75、健康营养20.64±4.19、心理健康21.51±3.88、人际关系21.43±4.02、压力调节20.98±3.19。老年前列腺增生症患者自我护理能力分级水平结果显示44.8%的患者表现出较高水平的自我护理行为。一般社会人口学资料对自我护理行为的单因素分析结果显示月收入对患者的自我护理行为有影响(P=0.014)。多元逐步回归分析结果显示社会支持和抑郁总分(P<0.001)对老年前列腺增生症患者的自我护理行为有影响。
第三节：WHOQOL-OLD量表的信度Cronbach's alpha系数为0.879,条目经标化后算得的Cronbach's alpha为0.901,说明此量表信度较好。使用WHOQOL-OLD量表来老年前列腺增生症患者测量生活质量的结果显示：生活质量总分为100.35±13.14,生活质量各维度得分分别为感觉能力领域11.98±2.29、自主领域12.36±2.76、过去、现在和将来行为经历领域20.12±4.02、参与社会活动的机会领域13.23+4.04、死亡观领域22.40±3.43及亲密观领域21.27±3.05。般社会人口学资料对患者生活质量(WHOQOL-OLD)的单因素分析结果显示文化程度(P=0.042)、人均月收入(P=0.039)对患者的生活质量有影响。比较老年前列腺增生症患者和正常对照组的生活质量得分,结果显示除了感觉能力领域、参与社会活动的机会领域没有统计学差异外(P>0.05)、自主领域、过去、现在和将来行为经历领域、死亡领域及亲密关系领域都有统计学差异(P<0.05)。
老年前列腺增生症患者生活质量测评量表(BPHQLS)的内部一致性Cronbach's alpha系数为0.959,条目经标化后算得的Cronbach's alpha系数为0.960,说明此量表有较好的信度。使用BPHQLS量表测量老年前列腺增生症患者的生活质量结果显示：老年前列腺增生症患者生活质量总分为190.54±44.61,生活质量各维度得分分别为疾病维度71.70±17.64、生理维度38.75±12.19、社会维度29.98±10.81、心理维度23.87±6.63及满意度维度20.86±4.96。老年前列腺增生症患者生活质量的分级水平结果显示77.6%的患者是中等水平,15.9%的患者是高等水平。一般社会人口学资料对老年前列腺增生症患者生活质量(BPHQLS量表)的单因素分析结果显示居住情况(P=0.022)、家庭关系(P=0.008)和健康状况(P=0.013)对患者的生活质量有影响。多元逐步回归分析结果显示抑郁、IPSS、自我护理行为、家庭关系、社会支持、主观幸福感(P<0.05)对老年前列腺增生症患者的生活质量有影响。
第四节：纽芬兰纪念大学幸福度量表的内部一致性Cronbach's alpha系数为0.668,条目经标化后算得的Cronbach's alpha系数为0.653,说明此量表有较好的信度。本研究结果显示老年前列腺增生症患者的主观幸福感总分为18.28±5.74,主观幸福感各维度得分分别为正性情感4.41±2.74,负性情感2.37±2.20,正性体验7.10±3.50,负性体验4.37±2.52,正性因子11.52±5.68,负性因子6.75±2.20。多元逐步回归分析结果显示IPSS、疾病知识、自我护理能力(P<0.05)对老年前列腺增生症患者的主观幸福感有影响。
第五节：老年前列腺增生症患者的自我护理能力和自我护理行为呈正相关(r=0.549,P<0.05)。老年前列腺增生症患者的自我护理能力与主观幸福感呈正相关(r=0.298,P<0.01)。老年前列腺增生症患者的社会支持和自我护理能力呈正相关(r=0.374,P<0.05)。老年前列腺增生症患者的自我护理行为和生活质量呈正相关(r=0.422,P<0.01)。老年前列腺增生症患者的自我护理行为和主观幸福感呈正相关(r=0.386,P<0.01)。老年前列腺增生症患者的社会支持与自我护理行为呈正相关(r=0.319,P<0.01)。老年前列腺增生症患者的生活质量和主观幸福感呈正相关(r=0.363,P<0.01)。
第二章：采用实验性研究设计,采用延续性护理,干预后老年前列腺增生症患者的自我护理能力除了自我护理技能外,总分及其他各维度得分都明显高于干预前,前后比较有统计学差异(P<0.05)。干预组生活质量总分和各个维度在干预前后都有统计学差异(p<0.05)。干预组自我护理行为的总分及各个维度除了健康责任感外,其他都有统计学差异。
第三章：老年前列腺增生症患者主观幸福感模型的构建分为探索性因子分析和验证性因子分析两部分。探索性因子分析结果显示本组数据的KMO=0.884, Bartlett's Test of Sphericity的值为2307.63,P<0.001,提示可以采用因子分析。使用主成分分析提取共同因素,再用方差极大法旋转,结果抽取出3个因子,可解释总变异的73.638%。根据自我护理能力量表、自我护理行为量表、良性前列腺增生症患者生活质量量表测试版的因素分析,提取出自我护理技能、自我护理责任感、自我概念、健康感知水平,健康责任感、躯体活动、健康营养、心理健康、人际关系、压力调解、疾病、生理、社会、心理、满意度这15个因子。每个因子的关系存在着统计学意义(P<0.05),提示可以采用因子分析,适合做老年前列腺增生症患者主观幸福感模型的构建。验证性因素分析结果显示拟合指数：(1)绝对拟合指数：P<0.001, X2/df=5.4, CFI=0.812, REMSEA=0.148,(2)相对拟合指数：NFI=0.78, CFI=0.812(3)信息指数：AIC=612.67,综合以上拟合指数提示本组研究数据拟合的模型效果欠佳。
结论
老年前列腺增生症患者的IPSS症状的调查结果显示,IPSS条目由大到小前五位为“过去1个月夜间睡觉时起床排尿次数”、“过去1个月排尿不尽感”、“过去1个月排尿后2小时内又要排尿”、“过去1个月排尿感觉尿线变细”、“过去1个月感觉排尿费力”、“过去1个月排尿时断断续续”、“过去1个月排尿不能力等待”。老年前列腺增生症患者的自我护理能力呈中等以上水平,老年前列腺增生症患者的自我护理能力低于正常对照组。老年前列腺增生症患者的自我护理能力的影响因素是抑郁。提示医护人员应加强对患者的心理护理,多和患者沟通和交流,安慰患者从而减少患者的负面情绪。老年前列腺增生症患者的自我护理行为呈中等以上水平,老年前列腺增生症患者自我护理行为的影响因素是社会支持和抑郁。提示医护加强患者的社会支持系统,鼓励患者及其家属主动参与疾病的护理,减少患者抑郁等负面情绪,从而增强患者自我护理行为。老年前列腺增生症患者生活质量(BPHQLS量表)呈中等水平,影响因素为抑郁、IPSS、家庭关系、自我护理行为、社会支持和主观幸福感,提示医护人员重视患者的心理健康,多于病人沟通交流,排解患者的负性情绪,促使患者产生对抗疾病的信心,主动学习疾病的护理知识,从而提高患者自我护理行为,改善生活质量。老年前列腺增生症患者的自我护理能力与主观幸福感、自我护理行为、社会支持呈正相关。老年前列腺增生症患者的自我护理行为和生活质量、主观幸福感、社会支持呈正相关。老年前列腺增生症患者的生活质量和主观幸福感呈正相关。延续护理可以提高老年前列腺增生症患者的自我护理能力、自我护理行为和生活质量。提示护理人员在临床工作中应该除了加强患者在住院期间护理和教育,还应该重视患者居家疾病护理,为患者制定详细的护理计划,定期回访。主观幸福感模型的构建结果显示,探索性因子分析结果说明各个因子之间既相互独立,又存在内部联系,符合模型的构想,验证性因子分析得到的拟合指数提示模型的拟合效果欠佳。提示我们在以后的研究中应该加大样本量,从而构建更合适的主观幸福感模型。
Objectives
(1)This study is large sample survey about self-care (self-care agency、self-care behavior)、quality of life of elderly patients with benign prostatic hyperplasia. To understand the BPH patients' self-care、quality of life、subjective well-being the three facts'situation、level、influence factors.(2)This study used an experimental design. It is in order to first represent how does extended care affect elderly BPH patients' self-care.(3)According to the relationship between subjective well-being and self-care agency、self-care behavior、quality of life, in order to construct the model elderly BPH patients'subjective well-being
Methods
Chapter 1:This study used descriptation correlation design, using the method of convenience sample drawing, using scales' form, in order to investigate the depressing、social support、self-care agency、self-care behavior、quality of life and subjective well-being of the elderly BPH patients, using IPSS to assessed the BPH symptoms from January 2010 to February 2011. This study describes situation of elderly BPH patients'self-care agency. Compare the discrepancy of self-care agency between elderly BPH patients and normal healthy elderly people. Using one-factor analysis method and multiple stepwise regression analysis the elderly BPH patients' self-care agency.This study describes situation of elderly BPH patients' self-care behavior. Using one-factor analysis method and multiple stepwise regression analysis the elderly BPH patients'self-care behavior. This study describes situation of elderly BPH patients' quality of life. This study describes the score of common quality of life (WHOQOL OLD) between elderly BPH patients and normal people group. Compare the discrepancy of quality of life between two groups. Using one-factor analysis method and multiple stepwise regression analysis the elderly BPH patients'quality of life (BPHQOL).This study describes situation of elderly BPH patients'subjective well-being. Using one-factor analysis method and multiple stepwise regression analysis elderly BPH patients'subjective well-being. Describe the relationship of self-care agency and self-care behavior、quality of life、social support、subjective well-being. Describe the relationship of self-care behavior and quality of life、social support、subjective well-being. Describe the relationship of quality of life and subjective well-being.
Chapter 2:This study is an experimental design. Randomly Choosing the elderly BPH patients 50 cases who came from inpatient of two departments of Urology of hospital. They were allocated to intervetension group. The intervetension group uses extended care program. The intervention time is lasted for 3 months. Using general demographics、self-care agency scale、quality of life for benign prostatic hyperplasia rating scale、self-care behavior scale et al to investigate analysis the elderly BPH patients before and after intervention. Comparison the intervetion group of elderly BPH patients score of self-care agency、score of self-care behavior、score of quality of life before and after intervention.
Chapter 3:Based on literature search, this study using self-care agency scale、quality of life for benign prostatic hyperplasia rating scale、self-care behavior scale、subjective well-being scale to investigate the 201 elderly BPH patients. Using self-care agency, self-care behaviors and quality of life integrate theoretical model of subjective well-being. The Exploratory analysis, start with self-care ability, self-care behaviors and quality of life to extract factors from three scales, analysis the structural relationship between the various factors, Confirmatory factor analysis by extracting the factors to examine construct validity, and ultimately determine the Model.
All the date obtained in the field investigation were statistically analyzed by computer with the software package SPSS 16.0 for Windows. Statistical methods include reliability of homogeneity and construct-related validity analysis, frequencies and descriptive statistics, Pearson correlation analysis、two independent samples T test、analysis of variance、multiple linear regression、X2 test、Pair T test、Rank sum test et al. The construction of the model of subjective well-being use software package Lisrel8.70.
Results
In study group,215 sets of scales were handed out and the valid sets received were 201,with the validity rate being 96.9%, the average age is 73.30±7.22,174(96.5%) patients had married, one (0.5%)patient had divorced, 6(3.0%)patients were isolated. The state of education level was that 69 (34.3%)of patients were graducated form below primary school,83(41.3%) of patients were graducated from middle school,12 of patients were graducated high school,34 of patients were graducated college,3(1.5%) of patients were graducated from university. The state of course of disease was that 114(57.0%) of patients were less than 5 years, 54(27.0%) were between 5 years and 10 years,32(16.0%) of patients were larger than 10 years.
Chapter 1 section 1:Survey result of general information:the education way of elderly BPH patients like most is consulting back to hospital by themselves 124 (61.7 %),consulting by telephone 37 (18.4%),home health care services 36 (17.9%)。Comparison of general information of elderly BPH patients group and normal control group, the result is study group having poorer family relationship than control group(P<0.001). Comparison of habitant date between elderly PBH patients and normal control group also has significant difference (P=0.014)
The reliability of homogeneity (Cronbach's alpha is 0.891, Cronbach's alpha based on standardized items is 0.883) is very good. The survey result of IPSS symptom displays that According to the score of the items of IPSS from high to low,the sequence is "Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?"、"Over the past month, how often have you had to push or strain to begin urination?"、"Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?"、"Over the past month, how often have you had to urinate again less than two hours after you finished urinating?"、"Over the past month, how often have you had a weak urinary stream?"、"Over the past month, how often have you found you stopped and started again several times when you urinated?"、"Over the last month, how difficult have you found it to postpone urination?", and the item of "Over the past month, how often have you had to urinate again less than two hours after you finished urinating?" that the elderly BPH patients choose "almost always" is most, the total of the number is 60(29.9%); these items of "Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?"、"Over the past month, how often have you found you stopped and started again several times when you urinated?"、"Over the past month, how often have you had a weak urinary stream?"、"Over the past month, how often have you had to push or strain to begin urination?"、"Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?" that the number of elderly BPH patients choosing "almost always" is more than 50.The survey result of IPSS symptom bother score display that 37.8% of patients are feeling most dissatisfied with urination,28.9% of patients are feeling mixed-about equally satisfied and dissatisfied with urination,14.9% of patients are feeling mostly satisfied with urination,9.0%of patients are feeling terrible with urination.
The reliability of homogeneity Cronbach's alpha is 0.938, Cronbach's alpha based on standardized items is 0.917. The reliability of homogeneity of this scale is very good. The mean score of self-care agency of elderly BPH patients is 108.37±20.74, the mean score of the dimensions of self-care agency is as following self-care ability is 28.03±5.31, self-care responsibility is 16.08±3.94, self-concept is 18.13±4.13, healthy knowledge is 47.85±8.58.59.7% of the elderly BPH patients perceived a moderate level of self-care agency,40.3% patients perceived high level of self-care agency. Comparison of the sum score of self-care agency and the score of every dimension between elderly BPH patients and normal control group, the result is the sum score and the score of the dimensions compare to the normal control group has statistically significant (P<0.001). Comparison of the grade level of self-care agency and every dimension between elderly BPH patients and normal control group, the result is the grade level of self-care agency and every dimension compare to the normal control group also has statistically significant (P<0.001). General social data influence patients self-care behavior, using one factor analysis, the result is medical care costs influence patients'self-care agency. Factors that can influence significantly self-care agency, used linear regression, were depression.
The reliability of homogeneity Cronbach's alpha is 0.945, Cronbach's alpha based on standardized items is 0.946, The reliability of homogeneity of self-care behavior is very good. This result of this study shows that the mean score of self-care behavior of elderly BPH patients is 130.06±18.46, the mean score of the dimensions of self-care behavior is as following the healthy responsibility is 23.28±3.72, physical activity is 22.36±3.75, healthy nutrition is 20.64±4.19, psychology health is 21.51±3.88, interpersonal relationship is 21.43±4.02, stress mediation is 20.98±3.19. The result of the grade level of self-care behavior of elderly BPH patients is that 44.8% of patients perceived high level of self-care behavior. General social data influence patients self-care behavior, using one factor analysis, the result is monthly income influence patients' self-care behavior(P=0.014). Factors that can influence significantly self-care behavior, used linear regression, were social support and depression.
Section 3:The reliability of homogeneity Cronbach's alpha is 0.879, Cronbach's alpha based on standardized items is 0.926, The reliability of homogeneity of WHOQOL-OLD scale is very good. Using WHOQOL-OLD scale to measure the patients' quality of life, the result is the total score of the scale is 100.35±13.14, the score of the sensory abilities field is 11.98±2.29,the score of the autonomy field is 12. 36±2.76,the score of past、present and future field is 20.12±4.02,the score of social participant field is 13.23±4.04,the score of death field is 22.40±3.43, the score of intimacy field is 21.27±3.05. General social data influence patients quality of life, using one factor analysis, the result is monthly income(P=0.039) and education(P=0.042) influence patients' self-care behavior.Comparison of the score of quality of life between elderly BPH patients and normal control group, the sensory abilities field and the score of social participant field has no significant difference (P>0.05),others has significant difference。(P<0.05)
The reliability of homogeneity Cronbach's alpha is 0.959, Cronbach's alpha based on standatdized items is 0.926, The reliability of homogeneity BPHQLS is very good. Using BPHQLS to measure elderly BPH patients'quality of life, the result is the total score of quality of life of elderly BPH patient is 190.54±44.61, the mean score of the dimensions of quality of life is as following disease dimension is 71.70±17.64,physiology dimension is 38.75±12.19, social dimension is 28.98±10.81, psychology dimension is 23.87±6.63, satisfaction dimension is 20.86±4.96.The result of grade level of quality of life of elderly BPH patients is 77.6% of patients'quality of life perceived a moderate level,15.9% of patients perceived a high level of quality of life. General social data influence patients quality of life(BPHQLS), using one factor analysis, the result is habitation situation (P=0.022)、family relationship (P=0.008) and healthy condition (P=0.013) influence patients' quality of life. Factors that can influence significantly patients'quality of life, used linear regression, were depression、IPSS、family relationship、self-care behavior、social support and subjective well-being. (P<0.05)
Section 4:The reliability of homogeneity Cronbach's alpha is 0.668,adjustive Cronbach's alpha is 0.668, The reliability of homogeneity Memorial university of Newfoundland scale of happiness is very good. This study shows that the mean score of subjective well-being of elderly BPH patients isl8.28±5.74, the mean score of the dimensions of subjective well-being is as following positive feeling is 4.41±2.74, negative feeling is 2.37±2.20, positive experience is 7.10±3.50, negative experience is 4.37±2.52, positive factor is 11.52±5.68,negative factor is 6.75±2.20. Factors that can influence significantly patients'subjective well-being, used linear regression, were IPSS、disease knowledge、self-care agency (P<0.05)
Section 5:Finding from the present study reveal that There're a significant positive relationship between self-care agency and self-care behavior on olderly BPH patients (r=0.549,P<0.05). There're a significant positive relationship between self-care agency and subjective well-being on olderly BPH patients(r=0.298, P<0.01). There're a significant positive relationship between self-care agency and social support on olderly BPH patients (r=0.374,P<0.05). There're a significant positive relationship between self-care behavior and quality of life on olderly BPH patients (r=0.422,P<0.01). There're a significant positive relationship between self-care behavior and subjective well-being on olderly BPH patients (r=0.386,P<0.01). There are a significant positive relationship between self-care behavior and social support in olderly BPH patients (r=0.319,P<0.01). There're a significant positive relationship between quality of life and subjective well-being in olderly BPH patients (r=0.363,P<0.01)
Chapter 2:Using an experimental design,Comparison the self-care agency's total score and every item's score of extended care group of olderly BPH patients' self-care agency before and after intervention, except self-care responsibility, others all have a significant difference (P<0.05).The total score and every item's score of quality of life of extended care group after intervention are higher than before intervention, There are a significant difference (P<0.05). Comparison the total score and every item's score of control group of olderly BPH patients'self-care agency in the two times, only self-care responsibility has significant difference (P<0.05), other items have no significant difference (P>0.05)
Chapter 3:The construction of patients' subjective well-being had two steps:exporatory factor analysis and confirmatory factor analysis. The result of exporatory factor analysis is this study data's KMO=0.884, Bartlett's Test of Sphericity is 2307.63, P<0.001.Using component analysis extracted common factors,then use maximum rotation method variance,finally,extracted three factors.They can explain 73.638%of the total variance. According to factor analysis of self-care agency scale、self-care behavior scale、quality of life scale for benign prostatic hyperplasia patient-prior test version, then extracted fifteen factors, They are self-care ability、self-care responsibility、self-conception、healthy perceive level、healthy responsibility、psychology actity、healthy nutrition、psychology health、interpersonal relationship、stress mediation、disease、physiology、social、psychology、satisfaction. The relationship between every factor has significant difference (P<0.05). The results of exploratory factor analysis can show that these factors were suitable for factor analysis,were suitable for construction model of patients subjective well-being. The result of confirmatory factor analysis shows following fit index:(1) Absolutely fit index:P<0.001, X2/df=5.4,REMSEA=0.148,GFI=0.812. (2)Relative fit index: NFI=0.78,CFI=0.812. (3)Information fit index AIC=612.67.All of these indexes suggest data of this study dose not fit to construct model.
Conclusion
The survey result of IPSS symptom displays that According to the score of the items of IPSS from high to low,the sequence is "Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?"、"Over the past month, how often have you had to push or strain to begin urination?"、"Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?"、"Over the past month, how often have you had to urinate again less than two hours after you finished urinating?".Elderly patients perceived a moderate level of self-care agency. Factors that can influence self-care agency was depression.We should take more care of the phychology of patients, take more communication with the patients, make the patients feel more comfortable, then reduce the negative emotion of patients. Elderly patients perceived a moderate level of self-care behavior.Factors that can influence self-care behavior were social support and depression.We should encourge patients to use social support, encourge patients and their families involved in caring the disease, reduce the negative emotion of patients,finally improve the self-care behavior of patients. Elderly patients perceived a moderate level of quality of life. Factors that can influence significantly patients'quality of life,were depression、subjective well being、IPSS、family relationship、self-care behavior、social support and subjective well-being.Suggest we should pay attention to mental health patients,communicate with them,reslove the negative emotion, then patients will learn the knowledge of disease, improve the self-care behavior,finally increase quality of life.There're a significant positive relationship between self-care agency and self-care behavior、subjective well-being、social support. There're a significant positive relationship between self-care behavior and subjective well-being、social support、quality of life. There're a significant positive relationship between quality of life and subjective of well-being. Extended care can improve patients'self-care agency、self-care behavior and quality of life. Nurses should not only make education for patients at hospital,but also focus on home care,develop detailed plan for patients and regular visit patients. The subjective well-being model of patients' contain two parts,The results of exploratory factor analysis show that these factors were not only independent,but also had internal links. So the result was consistent with the idea of model. The fit index of confirmatory factors analysis suggest that model fitting was poor.It suggest us that should increase samples,and then to construct the better subjective well-being model.
(1)大样本调查老年前列腺增生症患者自我照顾(自我护理能力、自我护理行为)、生活质量水平及影响因素。(2)实验性研究设计旨在阐明延续性护理对老年前列腺增生症患者自我护理的影响。(3)根据主观幸福感与自我护理能力、自我护理行为、生活质量的关系,旨在构建老年前列腺增生症患者的主观幸福感模式。
方法
第一章：采用描述性相关设计,采用方便抽样的方法,于2010年1月至2011年2月采用问卷的形式调查我院201例老年前列腺增生症患者的自我护理能力、自我护理行为、生活质量和主观幸福感的情况,用国际前列腺症状评分量表(IPSS)进行疾病症状测评。描述老年前列腺增生症患者自我护理能力的情况；比较老年前列腺增生症患者和正常对照组自我护理能力的差异；对老年前列腺增生症患者的自我护理能力进行单因素和多元线性回归分析。描述老年前列腺增生症患者的自我护理行为的情况。对老年前列腺增生症患者的自我护理行为进行单因素分析和多元线性回归分析；描述老年前列腺增生症患者生活质量的情况；描述老年前列腺增生症患者和正常对照组普适生活质量量表WHOQOL OLD的得分；比较两组人群生活质量的差异；对老年前列腺增生症患者生活质量(BPHQOL量表)进行单因素分析和多元线性回归分析；描述老年前列腺增生症患者主观幸福感的情况；对主观幸福感进行单因素分析和多元线性回归分析；描述自我护理能力和自我护理行为、生活质量、社会支持、主观幸福感之间的关系；描述自我护理行为和生活质量、社会支持、主观幸福感之间的关系；描述生活质量和主观幸福感之间的关系。
第二章：用实验性研究设计,对我院泌尿二个区的住院老年前列腺增生症患者50例作为干预组,采用延续性护理,干预时间为3个月。采用一般社会人口学资料、自我护理能力测定量表、良性前列腺增生症生活质量评定量表、自我护理行为测定量表等问卷进行干预前后的测量。比较干预组在干预前后的自我护理能力、自我护理行为和生活质量得分。
第三章：基于文献检索的基础,本研究使用自我护理能力量表、自我护理行为量表、良性前列腺增生症患者生活质量评定量表、主观幸福感量表对201例老年前列腺增生症患者进行调查。以自我护理能力、自我护理行为和生活质量三者整合主观幸福感的理论模型。模型的整合分为两个过程：探索性分析和验证性分析。探索性分析中,先从自我护理能力、自我护理行为和生活质量三个量表中提取因子,分析各个因子之间的结构关系。验证性分析过程是通过提取的因子来考察结构效度,最终确定模型。
数据分析通过SPSS16.0软件包进行处理及分析。使用的统计学方法包括问卷的信效度检验、频数分布分析、描述性统计分析、Pearson相关分析、两独立样本t检验、配对t检验、方差分析、多元线性回归、χ2检验、秩和检验等。使用Lisrel8.51软件包构建老年前列腺增生症患者主观幸福感的模型。
结果
本研究共发出问卷215份,回收有效问卷201份,有效问卷回收率为96.9%,年龄为73.30±7.22,婚姻状况是已婚174(96.5%),离异1(0.5%),孤寡6(3.0%)；教育水平是小学以下69(34.3%),中学83(41.3%),高中12(6.0%),大专34(18.9%),本科以上3(1.5%)；病程情况是<5年为114(57.0%),5-10年为54(27.0%),>10年为32(16.0%)。
第一章第一节：一般资料的调查结果：老年前列腺增生症患者最喜爱的教育方式为自己返院咨询124(61.7%),电话咨询37(18.4%),医护上门服务36(17.9%)。老年前列腺增生症患者和正常对照组一般资料的比较,结果显示老年前列腺增生症患者的家庭关系要比正常对照组差(P=0.004),老年前列腺增生症患者的居住者资料与正常对照组比较也有统计学差异(P=0.040)。
IPSS症状评分量表内部一致性(Cronbach's alpha为0.891,条目经标化后算得的Cronbach's alpha为0.883)较好。IPSS症状的调查结果显示IPSS条目由大到小排列的顺序为“过去1个月夜间睡觉时起床排尿次数”、“过去1个月排尿不尽感”、“过去1个月排尿后2小时内又要排尿”、“过去1个月排尿感觉尿线变细”、“过去1个月感觉排尿费力”、“过去1个月排尿时断断续续”、“过去1个月排尿不能力等待”,其中“过去一个月排尿后2小时内又要排尿?”选项“几乎总是”的病人最多,人数为60人(29.9%)；“过去一个月排尿不尽感”、“过一个月排尿断断续续?”、“过去一个月感觉尿线变细?”、“过去一个月感觉排尿费力”、“过去一个月夜间睡觉时起床排尿次数?”这些条目中选择“几乎总是”的病人数都多于50人。老年前列腺增生症患者IPSS症状困扰评分(BS)的调查结果显示37.8%的患者在排尿时是多数不满意的,28.9%的患者是满意和不满意各半,14.9%患者是多数满意,9.0%的患者是很痛苦的。
自我护理能力量表的Cronbach's alpha为0.938,条目经标化后算得的Cronbach's alpha为0.939,说明信度较好。老年前列腺增生症患者的自我护理能力总分为108.37±20.74,自我护理能力各维度得分分别为自我护理技能28.03±5.31、自护责任感16.08±3.94、自我概念18.13±4.13和健康知识水平47.85±8.58。老年前列腺增生症患者自我护理能力分级水平结果显示,59.7%的老年前列腺增生症患者的自我护理能力是中等水平,40.3%的患者呈高等水平。老年前列腺增生症患者自我护理能力总分及各维度得分与正常对照组比较,结果显示总分和各维度得分与正常对照组相比均有统计学差异(P<0.001)。老年前列腺增生症患者和正常对照组的自我护理能力总分和各项目得分的分级水平比较也有统计学差异(P<0.001)。一般社会人口学资料对患者自我护理能力的单因素分析结果显示医疗费用支付方式对老年前列腺增生患者的自我护理能力有影响。多元逐步回归分析结果显示抑郁总分(P<0.001)是影响老年前列腺增生症患者自我护理能力的因素。
第二节：自我护理行为量表的内部一致性(Cronbach's alpha为0.945,条目经标化后算得的Cronbach's alpha为0.946,说明该量表信度较好。本研究结果显示老年前列腺增生症患者的自我护理行为的总分为130.06±18.46,自我护理行为各维度得分分别为健康责任感23.28±3.72、躯体活动22.36±3.75、健康营养20.64±4.19、心理健康21.51±3.88、人际关系21.43±4.02、压力调节20.98±3.19。老年前列腺增生症患者自我护理能力分级水平结果显示44.8%的患者表现出较高水平的自我护理行为。一般社会人口学资料对自我护理行为的单因素分析结果显示月收入对患者的自我护理行为有影响(P=0.014)。多元逐步回归分析结果显示社会支持和抑郁总分(P<0.001)对老年前列腺增生症患者的自我护理行为有影响。
第三节：WHOQOL-OLD量表的信度Cronbach's alpha系数为0.879,条目经标化后算得的Cronbach's alpha为0.901,说明此量表信度较好。使用WHOQOL-OLD量表来老年前列腺增生症患者测量生活质量的结果显示：生活质量总分为100.35±13.14,生活质量各维度得分分别为感觉能力领域11.98±2.29、自主领域12.36±2.76、过去、现在和将来行为经历领域20.12±4.02、参与社会活动的机会领域13.23+4.04、死亡观领域22.40±3.43及亲密观领域21.27±3.05。般社会人口学资料对患者生活质量(WHOQOL-OLD)的单因素分析结果显示文化程度(P=0.042)、人均月收入(P=0.039)对患者的生活质量有影响。比较老年前列腺增生症患者和正常对照组的生活质量得分,结果显示除了感觉能力领域、参与社会活动的机会领域没有统计学差异外(P>0.05)、自主领域、过去、现在和将来行为经历领域、死亡领域及亲密关系领域都有统计学差异(P<0.05)。
老年前列腺增生症患者生活质量测评量表(BPHQLS)的内部一致性Cronbach's alpha系数为0.959,条目经标化后算得的Cronbach's alpha系数为0.960,说明此量表有较好的信度。使用BPHQLS量表测量老年前列腺增生症患者的生活质量结果显示：老年前列腺增生症患者生活质量总分为190.54±44.61,生活质量各维度得分分别为疾病维度71.70±17.64、生理维度38.75±12.19、社会维度29.98±10.81、心理维度23.87±6.63及满意度维度20.86±4.96。老年前列腺增生症患者生活质量的分级水平结果显示77.6%的患者是中等水平,15.9%的患者是高等水平。一般社会人口学资料对老年前列腺增生症患者生活质量(BPHQLS量表)的单因素分析结果显示居住情况(P=0.022)、家庭关系(P=0.008)和健康状况(P=0.013)对患者的生活质量有影响。多元逐步回归分析结果显示抑郁、IPSS、自我护理行为、家庭关系、社会支持、主观幸福感(P<0.05)对老年前列腺增生症患者的生活质量有影响。
第四节：纽芬兰纪念大学幸福度量表的内部一致性Cronbach's alpha系数为0.668,条目经标化后算得的Cronbach's alpha系数为0.653,说明此量表有较好的信度。本研究结果显示老年前列腺增生症患者的主观幸福感总分为18.28±5.74,主观幸福感各维度得分分别为正性情感4.41±2.74,负性情感2.37±2.20,正性体验7.10±3.50,负性体验4.37±2.52,正性因子11.52±5.68,负性因子6.75±2.20。多元逐步回归分析结果显示IPSS、疾病知识、自我护理能力(P<0.05)对老年前列腺增生症患者的主观幸福感有影响。
第五节：老年前列腺增生症患者的自我护理能力和自我护理行为呈正相关(r=0.549,P<0.05)。老年前列腺增生症患者的自我护理能力与主观幸福感呈正相关(r=0.298,P<0.01)。老年前列腺增生症患者的社会支持和自我护理能力呈正相关(r=0.374,P<0.05)。老年前列腺增生症患者的自我护理行为和生活质量呈正相关(r=0.422,P<0.01)。老年前列腺增生症患者的自我护理行为和主观幸福感呈正相关(r=0.386,P<0.01)。老年前列腺增生症患者的社会支持与自我护理行为呈正相关(r=0.319,P<0.01)。老年前列腺增生症患者的生活质量和主观幸福感呈正相关(r=0.363,P<0.01)。
第二章：采用实验性研究设计,采用延续性护理,干预后老年前列腺增生症患者的自我护理能力除了自我护理技能外,总分及其他各维度得分都明显高于干预前,前后比较有统计学差异(P<0.05)。干预组生活质量总分和各个维度在干预前后都有统计学差异(p<0.05)。干预组自我护理行为的总分及各个维度除了健康责任感外,其他都有统计学差异。
第三章：老年前列腺增生症患者主观幸福感模型的构建分为探索性因子分析和验证性因子分析两部分。探索性因子分析结果显示本组数据的KMO=0.884, Bartlett's Test of Sphericity的值为2307.63,P<0.001,提示可以采用因子分析。使用主成分分析提取共同因素,再用方差极大法旋转,结果抽取出3个因子,可解释总变异的73.638%。根据自我护理能力量表、自我护理行为量表、良性前列腺增生症患者生活质量量表测试版的因素分析,提取出自我护理技能、自我护理责任感、自我概念、健康感知水平,健康责任感、躯体活动、健康营养、心理健康、人际关系、压力调解、疾病、生理、社会、心理、满意度这15个因子。每个因子的关系存在着统计学意义(P<0.05),提示可以采用因子分析,适合做老年前列腺增生症患者主观幸福感模型的构建。验证性因素分析结果显示拟合指数：(1)绝对拟合指数：P<0.001, X2/df=5.4, CFI=0.812, REMSEA=0.148,(2)相对拟合指数：NFI=0.78, CFI=0.812(3)信息指数：AIC=612.67,综合以上拟合指数提示本组研究数据拟合的模型效果欠佳。
结论
老年前列腺增生症患者的IPSS症状的调查结果显示,IPSS条目由大到小前五位为“过去1个月夜间睡觉时起床排尿次数”、“过去1个月排尿不尽感”、“过去1个月排尿后2小时内又要排尿”、“过去1个月排尿感觉尿线变细”、“过去1个月感觉排尿费力”、“过去1个月排尿时断断续续”、“过去1个月排尿不能力等待”。老年前列腺增生症患者的自我护理能力呈中等以上水平,老年前列腺增生症患者的自我护理能力低于正常对照组。老年前列腺增生症患者的自我护理能力的影响因素是抑郁。提示医护人员应加强对患者的心理护理,多和患者沟通和交流,安慰患者从而减少患者的负面情绪。老年前列腺增生症患者的自我护理行为呈中等以上水平,老年前列腺增生症患者自我护理行为的影响因素是社会支持和抑郁。提示医护加强患者的社会支持系统,鼓励患者及其家属主动参与疾病的护理,减少患者抑郁等负面情绪,从而增强患者自我护理行为。老年前列腺增生症患者生活质量(BPHQLS量表)呈中等水平,影响因素为抑郁、IPSS、家庭关系、自我护理行为、社会支持和主观幸福感,提示医护人员重视患者的心理健康,多于病人沟通交流,排解患者的负性情绪,促使患者产生对抗疾病的信心,主动学习疾病的护理知识,从而提高患者自我护理行为,改善生活质量。老年前列腺增生症患者的自我护理能力与主观幸福感、自我护理行为、社会支持呈正相关。老年前列腺增生症患者的自我护理行为和生活质量、主观幸福感、社会支持呈正相关。老年前列腺增生症患者的生活质量和主观幸福感呈正相关。延续护理可以提高老年前列腺增生症患者的自我护理能力、自我护理行为和生活质量。提示护理人员在临床工作中应该除了加强患者在住院期间护理和教育,还应该重视患者居家疾病护理,为患者制定详细的护理计划,定期回访。主观幸福感模型的构建结果显示,探索性因子分析结果说明各个因子之间既相互独立,又存在内部联系,符合模型的构想,验证性因子分析得到的拟合指数提示模型的拟合效果欠佳。提示我们在以后的研究中应该加大样本量,从而构建更合适的主观幸福感模型。
Objectives
(1)This study is large sample survey about self-care (self-care agency、self-care behavior)、quality of life of elderly patients with benign prostatic hyperplasia. To understand the BPH patients' self-care、quality of life、subjective well-being the three facts'situation、level、influence factors.(2)This study used an experimental design. It is in order to first represent how does extended care affect elderly BPH patients' self-care.(3)According to the relationship between subjective well-being and self-care agency、self-care behavior、quality of life, in order to construct the model elderly BPH patients'subjective well-being
Methods
Chapter 1:This study used descriptation correlation design, using the method of convenience sample drawing, using scales' form, in order to investigate the depressing、social support、self-care agency、self-care behavior、quality of life and subjective well-being of the elderly BPH patients, using IPSS to assessed the BPH symptoms from January 2010 to February 2011. This study describes situation of elderly BPH patients'self-care agency. Compare the discrepancy of self-care agency between elderly BPH patients and normal healthy elderly people. Using one-factor analysis method and multiple stepwise regression analysis the elderly BPH patients' self-care agency.This study describes situation of elderly BPH patients' self-care behavior. Using one-factor analysis method and multiple stepwise regression analysis the elderly BPH patients'self-care behavior. This study describes situation of elderly BPH patients' quality of life. This study describes the score of common quality of life (WHOQOL OLD) between elderly BPH patients and normal people group. Compare the discrepancy of quality of life between two groups. Using one-factor analysis method and multiple stepwise regression analysis the elderly BPH patients'quality of life (BPHQOL).This study describes situation of elderly BPH patients'subjective well-being. Using one-factor analysis method and multiple stepwise regression analysis elderly BPH patients'subjective well-being. Describe the relationship of self-care agency and self-care behavior、quality of life、social support、subjective well-being. Describe the relationship of self-care behavior and quality of life、social support、subjective well-being. Describe the relationship of quality of life and subjective well-being.
Chapter 2:This study is an experimental design. Randomly Choosing the elderly BPH patients 50 cases who came from inpatient of two departments of Urology of hospital. They were allocated to intervetension group. The intervetension group uses extended care program. The intervention time is lasted for 3 months. Using general demographics、self-care agency scale、quality of life for benign prostatic hyperplasia rating scale、self-care behavior scale et al to investigate analysis the elderly BPH patients before and after intervention. Comparison the intervetion group of elderly BPH patients score of self-care agency、score of self-care behavior、score of quality of life before and after intervention.
Chapter 3:Based on literature search, this study using self-care agency scale、quality of life for benign prostatic hyperplasia rating scale、self-care behavior scale、subjective well-being scale to investigate the 201 elderly BPH patients. Using self-care agency, self-care behaviors and quality of life integrate theoretical model of subjective well-being. The Exploratory analysis, start with self-care ability, self-care behaviors and quality of life to extract factors from three scales, analysis the structural relationship between the various factors, Confirmatory factor analysis by extracting the factors to examine construct validity, and ultimately determine the Model.
All the date obtained in the field investigation were statistically analyzed by computer with the software package SPSS 16.0 for Windows. Statistical methods include reliability of homogeneity and construct-related validity analysis, frequencies and descriptive statistics, Pearson correlation analysis、two independent samples T test、analysis of variance、multiple linear regression、X2 test、Pair T test、Rank sum test et al. The construction of the model of subjective well-being use software package Lisrel8.70.
Results
In study group,215 sets of scales were handed out and the valid sets received were 201,with the validity rate being 96.9%, the average age is 73.30±7.22,174(96.5%) patients had married, one (0.5%)patient had divorced, 6(3.0%)patients were isolated. The state of education level was that 69 (34.3%)of patients were graducated form below primary school,83(41.3%) of patients were graducated from middle school,12 of patients were graducated high school,34 of patients were graducated college,3(1.5%) of patients were graducated from university. The state of course of disease was that 114(57.0%) of patients were less than 5 years, 54(27.0%) were between 5 years and 10 years,32(16.0%) of patients were larger than 10 years.
Chapter 1 section 1:Survey result of general information:the education way of elderly BPH patients like most is consulting back to hospital by themselves 124 (61.7 %),consulting by telephone 37 (18.4%),home health care services 36 (17.9%)。Comparison of general information of elderly BPH patients group and normal control group, the result is study group having poorer family relationship than control group(P<0.001). Comparison of habitant date between elderly PBH patients and normal control group also has significant difference (P=0.014)
The reliability of homogeneity (Cronbach's alpha is 0.891, Cronbach's alpha based on standardized items is 0.883) is very good. The survey result of IPSS symptom displays that According to the score of the items of IPSS from high to low,the sequence is "Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?"、"Over the past month, how often have you had to push or strain to begin urination?"、"Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?"、"Over the past month, how often have you had to urinate again less than two hours after you finished urinating?"、"Over the past month, how often have you had a weak urinary stream?"、"Over the past month, how often have you found you stopped and started again several times when you urinated?"、"Over the last month, how difficult have you found it to postpone urination?", and the item of "Over the past month, how often have you had to urinate again less than two hours after you finished urinating?" that the elderly BPH patients choose "almost always" is most, the total of the number is 60(29.9%); these items of "Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?"、"Over the past month, how often have you found you stopped and started again several times when you urinated?"、"Over the past month, how often have you had a weak urinary stream?"、"Over the past month, how often have you had to push or strain to begin urination?"、"Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?" that the number of elderly BPH patients choosing "almost always" is more than 50.The survey result of IPSS symptom bother score display that 37.8% of patients are feeling most dissatisfied with urination,28.9% of patients are feeling mixed-about equally satisfied and dissatisfied with urination,14.9% of patients are feeling mostly satisfied with urination,9.0%of patients are feeling terrible with urination.
The reliability of homogeneity Cronbach's alpha is 0.938, Cronbach's alpha based on standardized items is 0.917. The reliability of homogeneity of this scale is very good. The mean score of self-care agency of elderly BPH patients is 108.37±20.74, the mean score of the dimensions of self-care agency is as following self-care ability is 28.03±5.31, self-care responsibility is 16.08±3.94, self-concept is 18.13±4.13, healthy knowledge is 47.85±8.58.59.7% of the elderly BPH patients perceived a moderate level of self-care agency,40.3% patients perceived high level of self-care agency. Comparison of the sum score of self-care agency and the score of every dimension between elderly BPH patients and normal control group, the result is the sum score and the score of the dimensions compare to the normal control group has statistically significant (P<0.001). Comparison of the grade level of self-care agency and every dimension between elderly BPH patients and normal control group, the result is the grade level of self-care agency and every dimension compare to the normal control group also has statistically significant (P<0.001). General social data influence patients self-care behavior, using one factor analysis, the result is medical care costs influence patients'self-care agency. Factors that can influence significantly self-care agency, used linear regression, were depression.
The reliability of homogeneity Cronbach's alpha is 0.945, Cronbach's alpha based on standardized items is 0.946, The reliability of homogeneity of self-care behavior is very good. This result of this study shows that the mean score of self-care behavior of elderly BPH patients is 130.06±18.46, the mean score of the dimensions of self-care behavior is as following the healthy responsibility is 23.28±3.72, physical activity is 22.36±3.75, healthy nutrition is 20.64±4.19, psychology health is 21.51±3.88, interpersonal relationship is 21.43±4.02, stress mediation is 20.98±3.19. The result of the grade level of self-care behavior of elderly BPH patients is that 44.8% of patients perceived high level of self-care behavior. General social data influence patients self-care behavior, using one factor analysis, the result is monthly income influence patients' self-care behavior(P=0.014). Factors that can influence significantly self-care behavior, used linear regression, were social support and depression.
Section 3:The reliability of homogeneity Cronbach's alpha is 0.879, Cronbach's alpha based on standardized items is 0.926, The reliability of homogeneity of WHOQOL-OLD scale is very good. Using WHOQOL-OLD scale to measure the patients' quality of life, the result is the total score of the scale is 100.35±13.14, the score of the sensory abilities field is 11.98±2.29,the score of the autonomy field is 12. 36±2.76,the score of past、present and future field is 20.12±4.02,the score of social participant field is 13.23±4.04,the score of death field is 22.40±3.43, the score of intimacy field is 21.27±3.05. General social data influence patients quality of life, using one factor analysis, the result is monthly income(P=0.039) and education(P=0.042) influence patients' self-care behavior.Comparison of the score of quality of life between elderly BPH patients and normal control group, the sensory abilities field and the score of social participant field has no significant difference (P>0.05),others has significant difference。(P<0.05)
The reliability of homogeneity Cronbach's alpha is 0.959, Cronbach's alpha based on standatdized items is 0.926, The reliability of homogeneity BPHQLS is very good. Using BPHQLS to measure elderly BPH patients'quality of life, the result is the total score of quality of life of elderly BPH patient is 190.54±44.61, the mean score of the dimensions of quality of life is as following disease dimension is 71.70±17.64,physiology dimension is 38.75±12.19, social dimension is 28.98±10.81, psychology dimension is 23.87±6.63, satisfaction dimension is 20.86±4.96.The result of grade level of quality of life of elderly BPH patients is 77.6% of patients'quality of life perceived a moderate level,15.9% of patients perceived a high level of quality of life. General social data influence patients quality of life(BPHQLS), using one factor analysis, the result is habitation situation (P=0.022)、family relationship (P=0.008) and healthy condition (P=0.013) influence patients' quality of life. Factors that can influence significantly patients'quality of life, used linear regression, were depression、IPSS、family relationship、self-care behavior、social support and subjective well-being. (P<0.05)
Section 4:The reliability of homogeneity Cronbach's alpha is 0.668,adjustive Cronbach's alpha is 0.668, The reliability of homogeneity Memorial university of Newfoundland scale of happiness is very good. This study shows that the mean score of subjective well-being of elderly BPH patients isl8.28±5.74, the mean score of the dimensions of subjective well-being is as following positive feeling is 4.41±2.74, negative feeling is 2.37±2.20, positive experience is 7.10±3.50, negative experience is 4.37±2.52, positive factor is 11.52±5.68,negative factor is 6.75±2.20. Factors that can influence significantly patients'subjective well-being, used linear regression, were IPSS、disease knowledge、self-care agency (P<0.05)
Section 5:Finding from the present study reveal that There're a significant positive relationship between self-care agency and self-care behavior on olderly BPH patients (r=0.549,P<0.05). There're a significant positive relationship between self-care agency and subjective well-being on olderly BPH patients(r=0.298, P<0.01). There're a significant positive relationship between self-care agency and social support on olderly BPH patients (r=0.374,P<0.05). There're a significant positive relationship between self-care behavior and quality of life on olderly BPH patients (r=0.422,P<0.01). There're a significant positive relationship between self-care behavior and subjective well-being on olderly BPH patients (r=0.386,P<0.01). There are a significant positive relationship between self-care behavior and social support in olderly BPH patients (r=0.319,P<0.01). There're a significant positive relationship between quality of life and subjective well-being in olderly BPH patients (r=0.363,P<0.01)
Chapter 2:Using an experimental design,Comparison the self-care agency's total score and every item's score of extended care group of olderly BPH patients' self-care agency before and after intervention, except self-care responsibility, others all have a significant difference (P<0.05).The total score and every item's score of quality of life of extended care group after intervention are higher than before intervention, There are a significant difference (P<0.05). Comparison the total score and every item's score of control group of olderly BPH patients'self-care agency in the two times, only self-care responsibility has significant difference (P<0.05), other items have no significant difference (P>0.05)
Chapter 3:The construction of patients' subjective well-being had two steps:exporatory factor analysis and confirmatory factor analysis. The result of exporatory factor analysis is this study data's KMO=0.884, Bartlett's Test of Sphericity is 2307.63, P<0.001.Using component analysis extracted common factors,then use maximum rotation method variance,finally,extracted three factors.They can explain 73.638%of the total variance. According to factor analysis of self-care agency scale、self-care behavior scale、quality of life scale for benign prostatic hyperplasia patient-prior test version, then extracted fifteen factors, They are self-care ability、self-care responsibility、self-conception、healthy perceive level、healthy responsibility、psychology actity、healthy nutrition、psychology health、interpersonal relationship、stress mediation、disease、physiology、social、psychology、satisfaction. The relationship between every factor has significant difference (P<0.05). The results of exploratory factor analysis can show that these factors were suitable for factor analysis,were suitable for construction model of patients subjective well-being. The result of confirmatory factor analysis shows following fit index:(1) Absolutely fit index:P<0.001, X2/df=5.4,REMSEA=0.148,GFI=0.812. (2)Relative fit index: NFI=0.78,CFI=0.812. (3)Information fit index AIC=612.67.All of these indexes suggest data of this study dose not fit to construct model.
Conclusion
The survey result of IPSS symptom displays that According to the score of the items of IPSS from high to low,the sequence is "Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?"、"Over the past month, how often have you had to push or strain to begin urination?"、"Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?"、"Over the past month, how often have you had to urinate again less than two hours after you finished urinating?".Elderly patients perceived a moderate level of self-care agency. Factors that can influence self-care agency was depression.We should take more care of the phychology of patients, take more communication with the patients, make the patients feel more comfortable, then reduce the negative emotion of patients. Elderly patients perceived a moderate level of self-care behavior.Factors that can influence self-care behavior were social support and depression.We should encourge patients to use social support, encourge patients and their families involved in caring the disease, reduce the negative emotion of patients,finally improve the self-care behavior of patients. Elderly patients perceived a moderate level of quality of life. Factors that can influence significantly patients'quality of life,were depression、subjective well being、IPSS、family relationship、self-care behavior、social support and subjective well-being.Suggest we should pay attention to mental health patients,communicate with them,reslove the negative emotion, then patients will learn the knowledge of disease, improve the self-care behavior,finally increase quality of life.There're a significant positive relationship between self-care agency and self-care behavior、subjective well-being、social support. There're a significant positive relationship between self-care behavior and subjective well-being、social support、quality of life. There're a significant positive relationship between quality of life and subjective of well-being. Extended care can improve patients'self-care agency、self-care behavior and quality of life. Nurses should not only make education for patients at hospital,but also focus on home care,develop detailed plan for patients and regular visit patients. The subjective well-being model of patients' contain two parts,The results of exploratory factor analysis show that these factors were not only independent,but also had internal links. So the result was consistent with the idea of model. The fit index of confirmatory factors analysis suggest that model fitting was poor.It suggest us that should increase samples,and then to construct the better subjective well-being model.
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