研究目的：探討運用常識模式為基礎的衛教介入對提升住院心臟衰竭病人出院後三個月之患病表徵與自我照顧行為的成效。
研究方法：採實驗性設計、方便性取樣於南部某教學醫院的心臟科病房。採隨機分配為兩組，每位個案完成三次問卷追蹤，時間點為前測、出院後1個月及3個月。納入條件：被醫師診斷心臟衰竭（NYHA II-III）、20歲以上、可國台語溝通、無生活自理能力缺失者，共收案107位，其中介入組58位、對照組49位，完成出院後三個月追蹤者各為30及32位。二組除住院常規衛教外，給予衛教本。介入組於前測後，分析其患病表徵得分狀況，以心臟衰竭自我照顧衛教手冊進行個別性衛教約20-60分鐘，於出院後二周及第2個月電話追蹤。研究工具含心臟衰竭患病信念量表、心臟衰竭自我照顧指標。統計分析包含獨立t檢定及線性混合模式，其中遺漏資料採直接最大可能性估計處理。
研究結果：個案平均年齡為62歲，介入組64歲、控制組60歲，兩組間的人口學特性均無統計上的顯著差異。患病表徵方面，78.5%病人對心衰竭病因有錯誤認知，但多數患病表徵單題得分偏向與醫護人員一致。在二組比較方面，患病表徵總分、辨認、時間軸、控制及後果於時間、組別及時間和組別的交互作用均未達顯著差異。自我照顧方面，兩組於前測之自我照顧信心前測得分為介入組59分、對照組53分，線性混合模式分析顯示組別（p < .001）及時間和組別（p < .05）的交互作用中呈顯著差異，事後比較兩組於出院後第一個月（p < .05）、第三個月（p < .001）以及出院後三個月和前測的變化趨勢（p < .01）呈顯著差異。自我照顧維持前測得分在介入組54分、對照組56分。自我照顧維持於時間（p < .001）達顯著差異，但於組別及組別和時間的交互作用未達顯著差異。
研究結論：整體上，二組個案之患病表徵偏向與醫療人員一致但自我照顧不佳，透過以常識模式為基礎所提供的患病表徵衛教以及三個月的電話追蹤，介入組的自我照顧維持行為並未有顯著的改善，雖然病人的自我照顧信心不足，但衛教能維持病人的信心。

Purpose: The purpose of this study was to examine the effect of a nursing led patient education based on commonsense model on self-care behaviors in patients with heart failure three months after discharge.
Method: This was an experimental design and a convenience sampling study. The study recruited participants at a cardiology ward of a medical center in southern Taiwan. The participants were randomly assigned to 2 groups, and completed questionnaires at baseline, 1 month, and 3 months after discharge. The inclusion criteria: heart failure diagnosed (NYHA class II to III) by physicians, aged above 20 years, able to communicate with Mandarin or Taiwanese, performing activities of daily living independently. There were 107 participants (n=58 in intervention group vs. n=49 in usual care group), and there were 62 participaents finished 3-month follow-up (n=30 vs. n=32). Both groups received usual care and heart failure brochure. The researcher provided a 20-60 minutes of patient education to the participants in the intervention group based on their baseline illness representation score. Two groups completed the Survey of Illness Beliefs in Heart Failure and the Self-care of Heart Failure Index with telephone follow-ups between the data collection time periods. Data were analyzed using independent t-tests and liner mixed effect model, and the missing data were performed by using direct maximum likelihood estimation.
Results: Results showed that the mean age for the total participants was 62 yeas old (64 years old of the intervention group vs. 60 years old of the usual care group). There were no statistically significant differences in demographic data between the 2 groups. There were 78.5% of patients held misperceptions of the cause of heart failure, but the majority of illness representation single-item scores tended to be consistent with the healthcare providers. There were no sidnificant differences between 2 groups in the illness representation total score, identity, timeline, control and consequences on effect of time, group and the interaction between time and group. The self-care confidence mean scores were 59 in the intervention group and 53 in the usual care group at baseline. There were significant differences on the effect of groups (p<.001) and the interaction between time and groups (p<.05) in self-care confidence in the liner mixed effect model. The post hoc tests showed that there were significant differences between 2 groups at the 1st month (p<.05), 3rd month (p<.001) and the gain between 3rd month and baseline (p<.01). The self-care maintenance mean scores were 54 in the intervention group and 56 in the usual care group at baseline. There was a significant difference between 2 groups in self-care maintenance on the effect of time (p<.001), but no significant differences on the effect of groups and interaction between time and groups.
Conclusion: The study showed that the two groups had consistent illness representation with the healthcare providers but poor self-care behaviors. There were no significant improvements of self-care in the intervention group after receiving the illness representation education based on commonsense model and 3-month telephone follow-up. Despite the poor self-care confidence, the education could maintain the patients’ confidence.

吳曉雲、邱艷芬（2011）‧心臟衰竭患者的疾病知識與自我照顧行為‧護理暨健康照護研究，7（4），329-338。doi: 10.6225/JNHR.7.4.78
劉慧玲、李淑琴、許淑娟（2010）‧心衰竭病人自我照顧的影響因素‧護理雜誌，57（2），99-104。doi: 10.6224/JN.57.2.99
衛生福利部（2018）‧106年度死因統計‧取自https://www.mohw.gov.tw/cp-3795-41794-1.html
謝雲涵（2016）‧心臟衰竭病人患病表徵與自我照顧行為之相關性研究‧成功大學護理學系學位論文，1-137。
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