[[alternative]]The Relationships Between Stress Perceptions and Coping Behaviors in Young Stroke Patients

[[abstract]]本研究目的主要是探討年輕型中風患者之壓力感受與因應行為及其相關因素。採橫斷性(cross-sectional)研究設計，以計畫性取樣(purposive sampling)方式於台北某醫學中心之神經內外科、復健科門診及病房等場所，選取符合選樣的年輕型中風患者為研究對象，共收案100名，採自填結構式問卷進行資料收集，研究工具為人口學基本屬性、功能獨立自主量表(Functional Independent Measure ;FIM)、中風患者壓力量表、台灣人憂鬱症量表、中風患者因應行為量表，所得資料以SPSS for Windows12.0套裝統計軟體進行建檔及資料分析，並以百分比、平均值、標準差及t檢定、單因子變異數分析、皮爾森積差相關、複迴歸分析法進行統計分析。 研究結果歸納如下：研究對象平均年齡37.48±6.77歲，其中以41~45歲患者佔多數，日常生活功能獨立自主能力在動作功能以排泄能力（大小便控制）最好，認知功能以溝通能力最佳；對疾病之壓力感受最高為擔心再次中風；憂鬱狀況方面為覺得比以前較沒信心；因應行為方面，最常使用的為專心治病，而情緒導向的因應行為，最常使用的因應行為為責怪自己，最少使用的為否認。 人口學變項方面與因應行為具相關性為經濟來源自給自足者、首次中風者、教育程度在高中職以上以及中風後仍擔任原工作者其因應行為較多。中風前後婚姻(P<.05)及職業(P<.001)變化有顯著差異。而功能獨立自主能力與因應行為呈正相關(γ=.496，p=<.001)，壓力感受與因應行為呈負相關(γ=-.505，p=<.001)，憂鬱狀況與因應行為呈負相關(γ=-.438，p=<.001)；另有部份個案處高壓力及憂鬱與因應行為呈正相關，可能與人格特質以及成年期發展自我的任務特性，促使其面對重大壓力仍能採用較多的因應行為以解決問題有相關。 以逐步複迴歸模式探討影響因應行為之重要預測因子：對整體因應行為最具預測力的變項為中風次數及壓力感受，可解釋所有變異量的29.7%。對問題導向因應行為最具預測力的變項為教育程度、中風後職業及中風次數，可解釋所有變異量的26.3%。對情緒導向因應行為具預測力的變項為功能獨立自主能力及憂鬱，可解釋所有變異量的35.3%。其他包括：年輕型中風患者在生活中最大困擾為肢體活動不便，最想恢復的能力為行動力，在提供支持方面，以家人的日常生活協助及支持程度最高；本研究結果可提供臨床護理實務，作為日後復健醫療團隊提昇照護品質之參考。 關鍵字：年輕型中風、壓力感受、因應行為[[abstract]]The purpose of this study was to understand the relationship between stress perceptions and coping behaviors in young stroke patients. A cross-sectional design and purposive sampling technique were applied; total 100 young stroke patients were collected from neurological ward, OPD and rehabilitation unit of a medical center in Taipei. The research instruments included: A structuralized demographic questionnaire, The Functional Independence Measure (FIM), The Stress Scale of the stroke patient, The Depression Scale of the Taiwanese, and The Coping Behaviors Scale of the stroke patient. The data were analyzed by is the software of SPSS for Windows 12.0, percentage, average, mean, standard deviation was used descript the sample; t-test, one-way ANOVA, Pearson’s correlation, and multiple regression analysis were used to examine the relationships among variables. The results of the study were concluded as following. The mean age of the participants is 37.48 ± 6.77 years old. The majority of the age group lies between 41 to 45 years old. The average best performance in the motor functional independence measure was the sphincter control including bladder and bowel management, and the best performance parameter in the cognitive functional independence measure was the social interaction. The most important stress factor in the stroke patients was worrying about recurrence of stroke. The most common factor in the depression evaluation was not as confident as before. In the aspect of coping behaviors of the stroke patients, the most common behaviors were concentrating himself in the treatment of the morbidity. In the emotion- orientated coping behaviors evaluation, the most common behaviors was blaming on themselves. The least common behaviors are denying. The predictors of more coping behaviors were those who are economically independent, suffered from the first episode of stroke, graduated from senior high school or higher, and keeping the previous position of career. There was a statistically significant difference in the marriage (p<.05) and career status (p<.001) before and after the episode of stroke. Positive correlation was observed between the FIM and the coping behaviors (γ=.496, p<.001), negative correlation was observed between the stress perceptions score and the coping behaviors (γ=-.505, p<.001), and negative correlation was observed between the depression status and the coping behaviors (γ=-.438, p<.001). Positive correlation among the stress perceptions, the depression status, and the coping behaviors was observed in some participants, and it was probably related to the personality characteristics, developmental tasks of the age group. The significant predictors of the coping behaviors were examined by the multiple regression analysis. The most important predictors of the general coping behaviors were the times of the stroke attack and the stress perceptions, which could explain 29.7% of the variation. The most important predictors of the problem-orientated coping behaviors were the education level, the career after stroke attack, and the times of the stroke attack, which could explain 26.3% of the total variation. The most important predictors of the emotion-orientated coping behaviors were the functional independence measure and the depression status, which could explain 35.3% of the variation. Impaired mobility of limbs was the most important trouble the young stroke patients encounter in the activity of daily life, and the function they want most to recover is the mobility. In analyzing the source of providing support, family members constitute the most important part in the assistance of daily life of the stroke patients. The results might provide as a reference for promoting the quality of clinical nursing and rehabilitative care of young stroke patients. Key words: young stroke, stress perceptions, coping behavior