臺灣博碩士論文加值系統

本研究旨在以自我決定理論為背景，分析探討自我決定、情緒、腎功能、和生活品質之相關因素。研究採橫斷式設計，針對新北市某區域醫院之慢性腎臟病人，以結構式問卷訪談，共有105位慢性腎臟病人參與。研究工具包括基本資料問卷，基本需求滿意問卷、健康照護情境氣氛問卷、尋求治療動機問卷、醫院焦慮與憂鬱量表。資料以SPSS 19.0統計軟體處理。統計方法包括描述性統計(平均值、標準差、百分比)及推論性統計(t-test, one-way ANOVA, correlation, multiple regressions)。
研究結果發現慢性腎臟病人之自主性、勝任感、聯繫感、憂鬱情緒、腎功能指標、和生活品質有顯著的相關性(p < .05)。回歸統計分析結果顯示腎臟功能指標之預測因子為連繫感(45%)、自覺身體健康狀態(9%)、和自主性(3%)，共解釋的變異量56%的變異量( p <.01)。生活品質之生理健康層面之預測因子為勝任感(10%)和自覺疾病嚴重度(4%)的變異量( p <.001)。在心理健康層面之生活品質的預測因子為自覺身體健康狀態(10%)和自覺疾病嚴重度(3%)共解釋14%的變異量( p <.001 )。
本研究結果可作為照護慢性腎臟病人的重要參考，可應用自我決策理論設計護理措施，激發慢性腎臟疾病病人的動機，進而進行自我疾病管理，以減緩慢性腎臟疾病的進展，減輕負向情緒的困擾，進而增進生活品質。

The purpose of this study was to investigate the relationships of self-determination, emotion, kidney function index, and quality of life of chronic kidney disease patients based on the self-determination theory. Participants were 105 chronic kidney patients recruited from a regional hospital in New Taipei City, Taiwan. This study used a cross-sectional study design. Research questionnaires included demographic and disease-related data, Basic Need Satisfaction in General, the Health-Care Climate Questionnaire, the Treatment Motivation Questionnaire, and the Hospital Anxiety and Depression Scale. Statistical analysis included descriptive statistics (mean, SD, %, n) and inferential statistics (t-test, one-way ANOVA, correlation, multiple regressions).
The results demonstrated that there was a significant correlation between the basic psychological attribution of autonomy, perceived competence, relatedness, depression, kidney function index, and the quality of life in patients with chronic kidney diseases. Multiple regression analyses indicated that relatedness, autonomy, and perceived health status were the predictor for renal function index (a total of 54% variance). Additionally, perceived competence and perceived disease severity predicted physical component scores of the quality of life, and explained 14% of the variance. Furthermore, perceived health status and perceived disease severity predicted mental component scores of the quality of life, and explained 13% of the variance (p < .05).
The result of this study provided references for the care of chronic kidney disease patients. Using the self-determinate theory to design nursing interventions in order to facilitate patients’ autonomy, perceived competence, relatedness, and depression, thus the quality of life could be improved.

目　　次

中文摘要 …………………………………………………………………………… i
英文摘要 …………………………………………………………………………… ii
目次 ………………………………………………………………………………… iv
表次 ………………………………………………………………………………… v
圖次 ………………………………………………………………………………… viii
第一章 緒論
第一節 研究背景與動機 ………………………………………………………… 1
第二節 研究目的 ……………………………………………………………… 2
第二章 文獻探討
第一節 慢性腎臟疾病之相關概念……………………………………………… 3
第二節 慢性腎臟疾病病人腎臟功能指標及照護之相關概念………………… 4
第三節 慢性腎臟疾病病人情緒之相關概念…………………………………… 7
第三節 自我決定理論之相關概念……………………………………………… 8
第四節 慢性腎臟疾病病人生活品質之相關概念……………………………… 13
第三章 研究方法
第一節 研究架構………………………………………………………………… 15
第二節 研究假設………………………………………………………………… 15
第三節 研究設計………………………………………………………………… 16
第四節 研究對象、選樣、場所…………………………………………………… 16
第五節 研究工具與變項測量…………………………………………………… 17
第六節 資料收集過程…………………………………………………………… 20
第七節 資料處理分析方法……………………………………………………… 22
第八節 倫理考量研究倫理考量………………………………………………… 22
第四章 研究結果與討論
第一節 慢性腎臟病人口學及疾病特性分析結果……………………………… 23
第二節自我決定理論分析慢性腎臟病基本心理需求及尋求治療動機………… 29
第三節 慢性腎臟病病人之健康照護情境氣氛滿意度分析…………………… 47
第四節 慢性腎臟病人之情緒狀態……………………………………………… 53
第五節 慢性腎臟病人口學之相關性分析結果………………………………… 59
第六節 慢性腎臟病人與生活品質之相關分析………………………………… 63
第七節 探討慢性腎臟病人的腎臟功能指標之預測因子……………………… 70
第八節 探討慢性腎臟病人的生活品質之預測因子…………………………… 71
第五章 結論與建議
第一節 人口學屬性及疾病特性分析…………………………………………… 77
第二節 自我決定理論…………………………………………………………… 78
第三節 情緒……………………………………………………………………… 81
第四節 慢性腎臟病人的腎臟功能指標之預測因子…………………………… 83
第五節 慢性腎臟病人的生活品質之預測因子………………………………… 83
第六章 結論與建議
第一節 結論……………………………………………………………………… 85
第二節 研究限制………………………………………………………………… 87
第三節 研究建議………………………………………………………………… 88
參考文獻
中文部分 ………………………………………………………………………… 89
外文部分 ………………………………………………………………………… 90
附錄
附錄一 問卷 …………………………………………………………………… 97
附錄二　自我決定量表授權書 ………………………………………………… 112
附錄三 身心健康量表授權書 ………………………………………………… 113
附錄四 人體試驗委員會同意臨床試驗證明書………………………………… 114

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