| 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-beingMethodsChapter 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.ResultsIn 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.ConclusionThe 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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