臺灣博碩士論文加值系統

摘 要
希望是生命的能源，帶給人生活具有意義、成就感與快樂。希望是由信心所產生，使人產生活力。激勵希望，促使一個人產生計畫與行動。然而，希望與失望是極密切交織在一起的，也是不確定的。希望的轉換可鼓舞生命的活力，是恢復健康的過程。體外受精治療的婦女，以達成懷孕的希望為其生活的目標，但僅有部分的婦女有實現的機會。本研究目的為整體性探討不孕婦女，從初次體外受精治療到希望的實現或破滅，其追尋懷孕希望的歷程所經歷之希望的階段、生活經驗、情境脈絡及其生活具有意義與焦慮的程度，並探討其相關因素。
研究設計採質性與量性研究之結合，包括田野研究法及調查法，以橫斷式研究；對二個不同治療階段的婦女：體外受精治療中(69人)及曾治療失敗後一至二年內(80人)之婦女，經其同意後，列為本研究對象，共收集149人。研究情境於一所醫學中心，其每年約有400人次之體外受精治療，而本研究獲得該醫學中心之研究倫理委員會審查同意。研究工具為：(1)研究者本身；以參與性的觀察之角色，進行會談，收集質性資料。(2)結構式問卷；生活目的量表及情境-特質焦慮量表等自填問卷，以調查法收集。質性資料以現象學的解釋性分析，量性資料以SPSS 8.0 視窗軟體分析，包括百分比、標準化殘差、平均值、t檢定、卡方檢定、Fisher Exact test、變異數分析、因素分析、線性迴歸分析、共變數分析及區別分析。
研究結果：本研究歸類出追尋懷孕希望的歷程之四個階段：萌生、實現、再接再厲與放棄等階段。四個階段之個案的生活經驗分別為寄託科技但又無法確定、脫離過去並擔負為人母的任務、緊繫希望但又感到徬徨及擺脫無奈並重新尋求自己的生活。其所處的情境脈絡包括：個人、家庭與環境因素，而各具有其獨特性。四階段個案之情境焦慮：萌生階段組與再接再厲階段組在生活處境之焦慮程度較高，且再接再厲階段組在壓力感受的焦慮程度亦較高。特質焦慮程度，以萌生階段組與再接再厲階段組在生活處境的焦慮程度均較高。生活具有意義的程度：再接再厲階段組對生命的面對較消極，放棄階段組對生活的操控與準備程度較高。年齡、體外受精治療次數、接受治療時間的長短、教育程度等變項為相關影響因素。年齡與情境焦慮程度，可用以區別婦女歷經治療失敗後，選擇再接再厲或放棄治療的預測因子，有76.1%的正確預測率。此可由婦女所處之情境脈絡與生活經驗加以詮釋。
結論：體外受精治療婦女追尋懷孕希望的歷程，因為個人、家庭與環境的情境因素隨著治療的歷程，個人主觀感受有所不同，建構不同希望階段的生活經驗，所感受的生活意義與焦慮程度也有差異。建議對處於不同希望階段的婦女，依據其情境脈絡、年齡、體外受精次數、接受治療時間的長短、教育程度及焦慮程度，給予個別之整體性與長期性的醫療照護，協助其希望的激勵或轉換。

Abstract
Hope is a vital life force in human; it is fragile, robust and dynamic. The focus of hope may change throughout the lifespan development or the course of an illness. Infertile women live a life of hope-despair circulation. Their hope changes overtime.
When they received the first treatment of in vitro fertilization (IVF), it may inspire their hope again. They made their effort to search for the hope. But, if the IVF treatment fails, the hope would be destroyed. They must reconstruct their hope. The purpose of this study was to explore the lived experience and situational context during the process of searching for pregnant hope and its influence on the meaning of life and the anxiety status of the women who receive IVF treatment.
The setting was in one of the medical centers in Northern Taiwan that performs 400 cases of IVF annually. The study was under integration of qualitative and quantitative research. Using cross-sectional design, the subjects consisted of 69 women receiving IVF treatment, and 80 women suffering from the failure of IVF treatment one year later. Data were collected by using interview and questionnaire. As a nurse consultant of the IVF women, the researcher took care of the patient, and collected the interview data. The Purpose in Life Test (Crumbaugh & Maholick, 1969) was used to measure the meaning of life, and the State-Trait Anxiety Inventory (Spielberg et al., 1970) was used to measure the level of anxiety. The qualitative data were analyzed based on the interpretive research strategies of phenomenology. Analysis of the quantitative data involving percentage, means, t-test, Chi-Square test, Fisher Exact test, ANOVA, Factor Analysis, Linear regression, ANCOVA, and Discriminate analysis were performed by using SPSS version 8.0 for Windows (SPSS Inc, Chicago, IL, USA).
The results indicated that the process of searching for pregnant hope was divided into 4 stages: creating hope, fulfilling hope, reconstructing hope and giving up hope. (1) The theme of lived experience in the four stages was bracing for high technology but uncertainty in the stage of creating hope, getting rid of pass and enacting maternal role in the stage of actualizing hope, holding on the chance but doubting in the stage of reconstructing hope, and transforming hopeless into other hopes and searching for one’s own living in the stage of giving up hope. The situational context consisted of the specific factors of individual, family and environment in each stage. There was high level of anxiety in both stages of creating hope and reconstructing hope. (2) There was higher level of state-anxiety in the stages of creating and reconstructing hope. Even, there was higher level of trait-anxiety in the stage of reconstructing hope. However, there was lower level confronting of life in the stage of reconstructing hope, higher level self controlling and preparing of the lived in the stage of giving up hope. (3) Age, times of IVF treatment, duration of IVF treatment and education were the influence factors. Age and state-anxiety were the two predictors about the IVF failure women who decided to whether terminate the infertile treatment or not.
According to the result, we suggest proving holistic and long term medical care for the IVF women based on different stage of hope, situational context, age, time of IVF treatment, duration of IVF treatment, education, and anxiety.

目 錄
誌謝-------------------------------------------------------Ⅰ
中文摘要---------------------------------------------------Ⅲ
英文摘要---------------------------------------------------Ⅴ
第一章 緒論------------------------------------------------1
第一節 研究動機-------------------------------------------3
第二節 研究目的-------------------------------------------6
第三節 研究的重要性---------------------------------------7
第二章 理論架構--------------------------------------------8
第一節 研究假說--------------------------------------- 8
第二節 研究假設--------------------------------------- 9
第三節 研究問題-------------------------------------- 10
第四節 名詞界定---------------------------------------11
第五節 研究概念架構---------------------------------- 13
第三章 文獻查證----------------------------------------- 15
第一節 臨床護理理論---------------------------------- 15
第二節 生活經驗-------------------------------------- 17
第三節 生活的意義------------------------------------ 19
第四節 希望的概念------------------------------------ 22
第五節 焦慮理論-------------------------------------- 26
第六節 人性化的關懷照護------------------------------ 30
第七節 相關研究-------------------------------------- 33
第四章 研究方法------------------------------------------ 36
第一節 研究設計-------------------------------------- 36
第二節 本研究進行之步驟-------------------------------39
第五章 第一部份：質性研究
體外受精治療婦女追尋懷孕希望之歷程及生活經驗與情境脈絡-----41
第一節 前言（第一部份）------------------------------ 42
第二節 研究目的（第一部份）-------------------------- 44
第三節 研究方法（第一部份）-------------------------- 45
一、 研究設計----------------------------------------- 45
二、 研究情境----------------------------------------- 48
三、 研究對象----------------------------------------- 49
（一）研究對象一：體外受精治療中的婦女----------------- 49
（二）研究對象二：曾接受體外受精治療失敗後一至二年內的婦女-50
四、 研究工具----------------------------------------- 52
（一）研究者本身的研究工具----------------------------- 52
（二）會談指引----------------------------------------- 53
五、 資料收集的過程----------------------------------- 55
（一）對『體外受精治療中的婦女』為研究對象------------- 55
（二）對『曾接受體外受精治療失敗後一至二年內之婦女』為研究對
象----------------------------------------------- 56
六、 資料分析的方法----------------------------------- 57
七、 研究之信度與效度--------------------------------- 58
八、 研究對象的人權考量------------------------------- 60
第四節 研究結果（第一部份）-------------------------- 61
一、 追尋懷孕希望的歷程─四個希望階段----------------- 63
（一） 萌生階段----------------------------------------- 66
（二） 實現階段----------------------------------------- 66
（三） 再接再厲階段------------------------------------- 67
（四） 放棄階段----------------------------------------- 67
二、追尋懷孕希望歷程之生活經驗與情境脈絡-------------- 69
（一）萌生階段之生活經驗：寄託科技卻又無法確定--------- 71
（二）實現階段之生活經驗：脫離過去並擔負為人母的任務--- 80
（三）再接再厲階段之生活經驗：緊繫希望但又感到徬徨----- 85
（四）放棄階段之生活經驗：擺脫無奈並重新尋求自己的生活- 93
第五節 討論（第一部份）------------------------------100
一、生活經驗與情境脈絡是具獨特性的------------------- 100
二、希望歷程是動態性的，受到情境因素的影響而改變----- 103
三、希望是可激勵與轉換的，但需要支持與鼓勵----------- 105
四、追尋懷孕希望的歷程是為人母角色的嚮往與失落的過程- 107
五、母性任務的執行於希望的實現階段即刻進行----------- 110
第六節 總結（第一部份）----------------------------- 113
第六章 第二部分：量性研究
體外受精治療婦女追尋懷孕希望歷程之生活意義與焦慮程度及相關因素
----------------------------------------------------------114
第一節 前言（第二部分）----------------------------- 115
第二節 研究目的（第二部分）------------------------- 116
第三節 理論架構（第二部分）------------------------- 117
一、研究假說----------------------------------------- 117
二、研究假設----------------------------------------- 118
三、研究問題----------------------------------------- 119
四、研究概念架構------------------------------------- 120
第四節 研究方法（第二部分）------------------------- 122
一、研究設計----------------------------------------- 122
二、研究情境----------------------------------------- 124
三、研究對象----------------------------------------- 125
（一）研究對象一：體外受精治療中的婦女-----------------125
（二）研究對象二：曾接受體外受精治療失敗後一至二年內的婦女126
四、研究工具------------------------------------------128
（一）基本資料表---------------------------------------128
（二）生活的目的量表Purpose in Life Test (PIL) --------128
（三情境-特質焦慮量表State-Trait Anxiety Inventory (STAI)130
五、資料收集的過程------------------------------------134
（一）對『體外受精治療中的婦女』為母群體的研究對象收集資料之
過程--------------------------------------------------134
（二）對『曾接受體外受精治療失敗後一至二年內之婦女』為母群體
的研究對象收集資料之過程------------------------------134
六、資料分析的方法------------------------------------136
七、工具之信度與效度----------------------------------137
八、研究對象的人權考量--------------------------------139
第五節 研究結果（第二部分）--------------------------140
一、研究對象的基本資料--------------------------------140
（一）人口學資料---------------------------------------140
（二）不孕治療史資料---------------------------------- 142
二、生活意義的程度----------------------------------- 148
（一）描述性資料-------------------------------------- 148
（二）生活意義的程度之因素萃取與命名------------------ 155
（三）不同希望階段之生活意義的程度之萃取因素的比較---- 159
三、情境焦慮----------------------------------------- 162
（一）描述性資料-------------------------------------- 162
（二）情境焦慮之因素萃取與命名------------------------ 167
(三）不同希望階段之情境焦慮萃取因素的比較------------ 171
四、特質焦慮----------------------------------------- 174
（一）描述性資料-------------------------------------- 174
（二）特質焦慮之因素萃取與命名------------------------ 179
（三）不同希望階段之特質焦慮萃取因素之比較------------ 182
五、情境焦慮、特質焦慮與生活意義之相關因素----------- 185
（一）年齡-------------------------------------------- 185
（二）教育程度---------------------------------------- 186
（三）工作-------------------------------------------- 187
（四）信仰-------------------------------------------- 187
（五）體外受精治療次數-------------------------------- 187
六、情境焦慮、特質焦慮與生活意義之相關性--------------209
（一）情境焦慮、特質焦慮與生活意義的程度之相關性-------209
（二）情境焦慮萃取因素、特質焦慮萃取因素、生活意義的程度萃取
因素之相關性----------------------------------------- 212
七、不同希望階段之生活意義的程度、情境焦慮與特質焦慮的差異
性--------------------------------------------------- 215
八、再接再厲接受治療或放棄治療的預測因子-------------- 220
第六節 討論（第二部分）------------------------------- 224
一、不同希望階段的相關因素---------------------------- 224
二、不同希望階段對生命意義的影響---------------------- 227
三、不同希望階段對焦慮程度的影響---------------------- 228
第七節 總結（第二部分）------------------------------- 231
第七章 討論--第三部份：質性與量性研究的結合詮釋
體外受精治療婦女追尋懷孕希望歷程之生活經驗與情境脈絡及其與生活意義及焦慮程度的相關性-------------------------------------- 234
第一節 婦女接受體外受精治療之研究在方法學的考量--------- 236
一、 本研究之方法學的依據----------------------------- 236
二、 本研究在質性研究與量性研究結果上的差異----------- 237
三、 本研究與相關研究的比較--------------------------- 238
第二節 透過質性與量性研究結合，較能清楚地詮釋不孕婦女追尋懷
孕希望之整體現象----------------------------------------240
一、 追尋懷孕希望的歷程是動態性的----------------------241
二、 每一個希望階段的婦女均有其獨特性------------------242
三、 希望的激勵與轉換需要專業護理人員的協助------------244
四、 希望的激勵與轉換歷程是婦女對生命意義的反思--------245
(一）希望的激勵及轉換與生命的意義之關係-----------------245
（二）生命的極限意義(Ultimate meaning of life)---------- 247
五、年齡對體外受精治療婦女追尋懷孕希望具關鍵性的涵義----248
（一）年齡與體外受精治療成效的關係-----------------------248
（二）年齡的增長與個人所擁有之生育時間的關係-------------250
第三節 本研究結果的總結--------------------------------251
一、 希望的激勵與轉換歷程------------------------------251
二、 不同希望階段之生活經驗與情境脈絡及對生活意義的焦慮程度
的影響--------------------------------------------------252
(一）萌生階段組-----------------------------------------252
（二）實現階段組-----------------------------------------253
（三）再接再厲階段組-------------------------------------254
（四） 放棄階段組----------------------------------------255
三、 希望的歷程、生活意義與焦慮程度的相關影響因素----- 256
四、 護理措施----------------------------------------- 257
第四節 本研究結果對研究者未來提供醫療照護的省思------- 259
第八章 結論---------------------------------------------- 261
第九章 建議與限制---------------------------------------- 263
第一節 本研究的建議----------------------------------- 263
一、臨床上的建議--------------------------------------- 263
二、研究上的建議--------------------------------------- 265
三、教育上的建議--------------------------------------- 265
第二節 本研究的限制----------------------------------- 267
參考資料-------------------------------------------------- 268
附件------------------------------------------------------ 288
圖 目 錄
圖一：本研究概念架構-------------------------------------- 14
圖二：本論文分三部份進行---------------------------------- 40
圖三：會談指引-------------------------------------------- 54
圖四：追尋懷孕希望的歷程─四個希望的階段------------------ 65
圖五：質性研究概念架構----------------------------------- 112
圖六：量性研究概念架構----------------------------------- 121
圖七：生活意義的程度之因素分析特徵值陡坡圖--------------- 155
圖八：不同希望階段之生活意義的程度萃取因素之因素得點的分布161
圖九：情境焦慮因素分析特徵值陡坡圖------------------------169
圖十：不同希望階段之情境焦慮萃取因素之因素得點的分布------172
圖十一：特質焦慮因素分析特徵值陡坡圖----------------------180
圖十二：不同希望階段之特質焦慮萃取因素之因素得點的分布----184
圖十三：不同年齡層者之情境焦慮與特質焦慮程度的分布--------190
圖十四：不同年齡層者之情境焦慮萃取因素的分布--------------191
圖十五：不同年齡層者之特質焦慮萃取因素的分布--------------192
圖十六：不同年齡層者之生活意義的程度萃取因素的分布--------193
圖十七：不同教育程度者之情境焦慮、特質焦慮與生活意義的程度分布193
圖十八：不同教育程度者之情境焦慮萃取因素分布--------------194
圖十九：不同教育程度者之特質焦慮萃取因素分布--------------194
圖二十：不同教育程度者之生活意義的程度因素萃取分布圖------195
圖二十一：有無工作者之情境焦慮、特質焦慮與生活意義的程度分布195
圖二十二：有無工作者之情境焦慮萃取因素的分布--------------196
圖二十三：有無工作者之特質焦慮萃取因素的分布--------------196
圖二十四：有無工作者之生活意義的程度萃取因素分布----------197
圖二十五：有無信仰者之情境焦慮因素萃取分布----------------197
圖二十六：有無信仰者之特質焦慮萃取因素分布----------------198
圖二十七：有無信仰者之生活意義的程度萃取因素分布----------198
圖二十八：不同體外受精治療次數者之情境焦慮、特質焦慮與生活意義的程度分布--------------------------------------------------199
圖二十九：不同體外受精治療次數者之情境焦慮萃取因素分布----200
圖三十：不同體外受精治療次數者之特質焦慮萃取因素分布------201
圖三十一：不同體外受精治療次數者之生活意義的程度萃取因素分布-202
圖三十二：情境焦慮對特質焦慮之預估迴歸曲線圖--------------210
圖三十三：情境焦慮之「生活處境」因素對特質焦慮之「生活處境」因素的預估迴歸曲線--------------------------------------------214
圖三十四：體外受精治療婦女追尋懷孕希望的激勵與轉換歷程之照護模式--------------------------------------------------------258
表 目 錄
表一：研究對象基本資料------------------------------------ 62
表二：體外受精治療婦女追尋懷孕希望之歷程的生活經驗與情境脈絡69
表三：量性研究基本資料----------------------------------- 146
表四：生活意義的程度得分--------------------------------- 150
表五：不同希望階段之生活意義的程度之得分----------------- 154
表六：生活意義的程度之因素分析萃取之因素----------------- 156
表七：不同希望階段之生活意義的程度萃取因素之因素得點的比較161
表八：情境焦慮得分--------------------------------------- 163
表九：不同希望階段之情境焦慮得分------------------------- 166
表十：情境焦慮因素分析萃取之因素------------------------- 169
表十一：不同希望階段之情境焦慮萃取因素之因素得點比較----- 172
表十二：特質焦慮得分--------------------------------------175
表十三：不同希望階段之特質焦慮得分----------------------- 178
表十四：特質焦慮因素分析萃取之--------------------------- 181
表十五：不同希望階段之特質焦慮萃取因素之因素得點的比較--- 183
表十六：情境焦慮、特質焦慮與生活意義的程度之相關影響因素- 203
表十七：不同年齡層的焦慮程度與生活意義的程度之比較------- 204
表十八：不同教育程度的焦慮與生活意義的程度之比較--------- 205
表十九：工作因素的焦慮與生活意義的程度之比較------------- 206
表二十：有無信仰的焦慮與生活意義的程度之比較------------- 207
表二十一：不同體外受精次數的焦慮與生活意義的程度之比較--- 208
表二十二：情境焦慮、特質焦慮與生活意義的程度之相關矩陣--- 211
表二十三：情境焦慮與生活意義的程度對特質焦慮之簡單直線迴歸分析------------------------------------------------------------211
表二十四：情境焦慮萃取因素、特質焦慮萃取因素、生活意義的程度萃取因素之相關矩陣------------------------------------------- 213
表二十五：不同希望階段之生活意義的程度之共變數分析------- 216
表二十六：不同希望階段之情境焦慮程度之共變數分析--------- 217
表二十七：不同希望階段之特質焦慮程度之共變數分析--------- 218
表二十八：年齡、情境焦慮、特質焦慮與生活意義的程度對再接再厲或放棄階段之區別力------------------------------------------- 222
表二十九：年齡及情境焦慮程度對再接再厲或放棄階段之區別力- 222
表三十：情境焦慮與特質焦慮之萃取因素對再接再厲或放棄階段之區別力------------------------------------------------------- 223
附 件
附件一　參與研究同意書----------------------------------- 288
附件二 基本資料表--------------------------------------- 289
附件三 情境焦慮量表------------------------------------- 291
附件四 特質焦慮量表------------------------------------- 292
附件五 生活的目的量表----------------------------------- 293
附件六 生活的目的量表授權使用同意書--------------------- 296
附件七 情境特質焦慮量表授權使用同意書------------------- 297
附件八 國立台灣大學醫學院附設醫院研究倫理委員會臨床試驗同意書----------------------------------------------------------- 298

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