臺灣博碩士論文加值系統

研究背景：溝通是人與人訊息交流重要的途徑之一。隨著老年人口數的成長，老化伴隨身體功能衰退，照護需求也跟著改變。了解與老年長者溝通的特徵及型態，可以促進有效的溝通，提供適當的照護，提升老年長者的生活品質，並維持老年長者的尊嚴。
研究目的：本研究旨在運用羅特氏互動式分析法，了解健康照護人員與長庚養生文化村老年長者溝通過程中，其特徵和型態，並比較不同健康照護人員之間的差異。
研究方法：本研究採橫斷式研究設計，以滾雪球法取樣。研究對象為長庚養生文化村21位臨床健康照護人員及46位長庚養生文化村老年長者。同意參加本研究的健康照護人員以配對方式，每位健康照護人員分別與2-3位入住長庚養生文化村的老年長者，以生活方式為訪談主題，進行約30-40分鐘的訪談，以錄音方式將溝通過程記錄下來。之後，再填寫受試者的基本資料問卷。完成後，運用羅特氏互動式分析法，將錄音檔加以編碼，歸類入41編碼，分別歸類為社會情感交流類別和任務焦點交流類別，進而分析溝通資料，並利用描述性統計及推論性統計，了解研究變項，以百分比、平均數、標準差，了解長庚養生文化村不同健康照護人員與老年長者溝通的特徵和型態，並比較不同健康照護人員間的差異。
研究結果：本研究針對13位護理人員與8位非護理人員之健康照護人員進行分析，兩組人員於人口特性上皆無統計學上的顯著差異。護理人員平均工作年資為16.42±12.17年，老年長者平均年齡為78.43±8.21歲，平均溝通時間：33'55 '' (±18'34 '')，最短時間7'18 ''，最長時間為86'00 ''。羅特氏互動式分析法分析顯示，共43970個話語，非護理人員之健康照護人員平均工作年資為8.67±5.5年，老年長者的平均年齡為77.09±9.21歲，平均溝通時間：36'48 '' (±16'20 '')，最短時間為3'00''，最長時間為61'17 ''，共61588個話語。其中社會情感交流類別，護理人員佔58%，非護理人員之健康照護人員佔57%；任務焦點交流類別，護理人員佔42%，非護理人員之健康照護人員佔43%。經羅特氏互動式分析法分析顯示護理人員給予較多關於醫療健康相關的訊息，訪談中較嚴謹，使用較多覆述與澄清的問句(佔社會情感交流類別5.37%)。而非護理人員之健康照護人員給予較多與生活型態相關的訊息，也給予較多的開放性問句(佔任務焦點交流類別11.42%)，使老年長者更可以盡情的表達內在的想法。
結論/實務應用：長庚養生文化村健康照護人員訪談的時間較長，經羅特氏互動式分析法分析顯示。兩組健康照護人員在訪談過程較重視社會情感交流類別的話語，於同理心的話語較少，但同理老年長者的感受以老年長者為中心是不可或缺的技能。於任務焦點交流類別中，兩組健康照護人員較常使用封閉式問句。開放式問句的問答技巧將可以使健康照護人員了解更多資訊，進而提升健康照護人員與老年長者的溝通品質。

Background：Communication is one of the important channels for information exchange between persons. As elderly population grows, aging brings physical function decline, and changes needs for care. Understanding of the characteristics and style of communication with the seniors can promote effective communication and provide proper care. As a result, it may be the opportunity to improve the quality of life and maintain the honor of the seniors.
Purpose：This study aims to use the Roter’s interaction analysis system, to understand the health care staffs to communicate with the Chang Gung Health and Culture Village seniors, their characteristics and style, and to compare the different commutation style between health care staffs.
Methods：In this study, a cross - sectional study design with the snowball sampling method will be conducted. Chang Gung Health and Culture Village 21 health care staffs and 46 Chang Gung Health and Culture Village seniors were involved. As the written consents are attained, each health staff will communicate with two or three seniors individually. The topic is related to seniors lifestyle, and the length of communication is about 30-40 minutes. The whole communication process will be taped with two digital recorders. As the record is done, the subjects will be asked to fill out a questionnaire on their characteristics. The Roter’s interaction analysis system is categorized into 41 coding, which are classified as Socio-Emotional Exchange and Task-Focused Exchange. Using the descriptive statistics and the inferential statistics, To Learn study variables, percentage, mean, standard deviation will better understand the characteristics and styles of communication between health care staffs and seniors. The differences between health care staffs will be compared.
Results : For this study, 13 nurses and 8 non-nursing health care staffs were involved. They are no statistically significant differences in the demographic characteristics. The average working experience of nurses are16.42± 12.17 years, the mean age of seniors are 78.43±8.21 years old. The mean of communication time is 33'55 '' (±18'34 ''), minimum is 7'18 ''', vs. maximum is 86'00 ''. A total of 43970 utterances were identified. The average working experience of non- nurses health care staffs is 8.67 ± 5.5 years, The mean age of seniors is 77.09±9.21 years old.The mean of communication time is 36'48 '' (±16'20 ''), minimum is 3'00 '', vs. maximum is 61'17''. A total of 61588 utterances were identified. The Socio-Emotional Exchange for nurses accounted for 58%, but for the non-nursing health care staffs accounted for 57%. The Task-Focused Exchange nurses accounted for 42%, but for the non-nursing health care staffs accounted for 43%. RIAS shows nurses focus on medical and health-related information, and more rigorous between communication, using more Paraphrase/Checks for understanding (Social- Emotional Exchange 5.37%). Non-nursing health care staffs give more lifestyle-related information. and also given more open questions(Task-Focused Exchange 11.42%), so the seniors can enjoy express seniors inner thoughts.
Applications：In Chang Gung Health and Culture Village health care staffs spend more time on communications with seniors. RIAS analysis shows, although health care staffs in the communication process show more emphasis on Social- Emotional Exchange, they score lower in categories in empathy, Empathy with seniors as the patient center is indispensable skills. Task-Focused Exchange, health care staffs usually employed closed-questions. However, open-questions skills are better at providing information to health care staff, enhancing the quality of health care staff when communicating with seniors.

中文摘要---------------------------------------------------------------------------------- I
Abstract----------------------------------------------------------------------------------- III
論文目錄--------------------------------------------------------------------------------- V
表目錄-------------------------------------------------------------------------------------Ⅷ
圖目錄-------------------------------------------------------------------------------------Ⅸ
第一章 緒論-------------------------------------------------------------------------------1
第一節 研究背景與重要性-------------------------------------------------------1
第二節 名詞界定-------------------------------------------------------------------3
第三節 研究目的-------------------------------------------------------------------4
第二章 文獻查證-------------------------------------------------------------------------5
第一節 何謂溝通-------------------------------------------------------------------5
第二節 老化對溝通的影響之綜論----------------------------------------------6
第三節 健康照護人員與老年長者溝通的重要性----------------------------9
第四節 生活型態對老年長者的關聯性--------------------------------------12
第五節 羅特氏互動式分析法--------------------------------------------------14
第六節 社會交換理論-----------------------------------------------------------19
第三章 研究方法-----------------------------------------------------------------------23
第一節 研究設計-----------------------------------------------------------------23
第二節 研究架構-----------------------------------------------------------------24
第三節 研究場域-----------------------------------------------------------------26
第四節 研究對象及研究倫理--------------------------------------------------27
第五節 研究步驟-----------------------------------------------------------------28
第六節 研究工具-----------------------------------------------------------------30
第七節 研究資料處理及分析--------------------------------------------------32
第四章 研究結果-----------------------------------------------------------------------35
第一節 健康照護人員的基本屬性--------------------------------------------36
第二節 與不同健康照護人員訪談之老年長者的基本屬性-------------40
第三節 兩組健康照護人員與老年長者訪談的溝通類別、話語數及時間差異----------------------44
第四節 護理人員與非護理人員之健康照護人員與老年長者的溝通的特徵與型態及差異分析--------------51
第五節 與健康照護人員訪談之老年長者的溝通的特徵與型態及差異分析----------------------------58
第六節 護理人員與老年長者溝通特徵與型態相關性--------------------65
第七節 非護理人員之健康照護人員與老年長者溝通特徵與型態相關性---------------------69
第八節 健康照護人員與老年長者訪談過程整體情緒評分-------------73
第五章 研究討論-----------------------------------------------------------------------75
第一節 健康照護人員與老年長者的基本屬性-----------------------------76
第二節 兩組健康照護人員與老年長者訪談的時間、溝通話語數及類別的差異-------------------78
第三節 健康照護人員溝通的特徵與型態及差異--------------------------82
第四節 老年長者溝通的特徵與型態及差異--------------------------------87
第五節 健康照護人員與老年長者溝通特徵與型態之相關--------------89
第六節 健康照護人員與老年長者溝通整體情緒評分--------------------93
第六章 研究限制與建議--------------------------------------------------------------95
第一節 研究限制-----------------------------------------------------------------95
第二節 研究建議-----------------------------------------------------------------96
第七章 結論-----------------------------------------------------------------------------97
參考文獻---------------------------------------------------------------------------------99
中文文獻---------------------------------------------------------------------------99
西文文獻--------------------------------------------------------------------------103
附錄一 羅特氏互動式分析法41編碼表-------------------------------------------117
附錄二 整體情緒評分----------------------------------------------------------------119
附錄三 運用羅特氏互動式分析法於健康照護人員與老年長者溝通特徵與型態基本資料調查(老年長者版) ------120
附錄四 運用羅特氏互動式分析法於健康照護人員與老年長者溝通特徵與型態基本資料調查(護理人員版) -----------121
附錄五 運用羅特氏互動式分析法於健康照護人員與老年長者溝通特徵與型態基本資料調查(非護理人員之健康照護人員版)-------------122
附錄六 研究人員與羅特氏互動式分析法受過訓練並領有證書者接受16小時的訓練施測者間羅特氏互動分析41類別項目相關性-----------123
附錄七 研究人員與羅特氏互動式分析法受過訓練並領有證書者測試者一致性--------------125
附錄八 羅特氏互動式分析法工具授權同意書----------------------------------126
附錄九 人體試驗與受試者保護倫理研習會受訓證明-------------------------127
附錄十 臨床試驗同意證明書-------------------------------------------------------128

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