臺灣博碩士論文加值系統

本研究目的是對失智症患者接受日間照護服務進行評價，評價內容主要是針對失智症患者及家庭照顧者照護需求滿足情形進行探討。本研究是於臺灣北部及中部各一所日間照護機構中進行，方法是採用質性研究法，除面對面訪談9位失智症患者與家庭照顧者，以及6位護理工作人員之外，並包含參與式的觀察以及文件記錄資料的收集，資料分析是依據Miles & Huberman(1994)對質性資料的分析方法進行原始資料的歸納與分析。研究結果發現，日間照護對失智症患者與家庭照顧者主要提供之照護內容有醫療照護服務、日常生活照顧、社會工作服務，以及失智症症狀相關問題處理等四大類。此外，日間照護可以滿足失智症患者有關醫療照護、日常生活照顧以及情感與情緒層面的需求，而有關失智症症狀改善層面則無法證實；對家庭照顧者來說日間照護則可以滿足其有關醫療照護、心理社會負荷以及情感與情緒層面的需求，其中日間照護中心可以滿足失智症患者與家庭照顧者其情感與情緒層面的需求是本研究重要的發現。對失智症患者來說，接受日間照護之後仍可以持續享受家庭的親情，因此日間照護可以滿足老人獲得家庭關係支持的需要；而對家庭照顧者來說仍可以將家庭的愛與關懷呈現出來，滿足實踐傳統孝道的需求，並能維持家庭的完整性。經由本研究結果的發現能深入地瞭解到失智症患者與家庭照顧者接受日間照護服務過程的實際需要，因此可作為未來照護品質指標發展之指引，並有助於提昇日間照護對失智症患者的照護服務品質與功能。

The purpose of this study was to evaluate the adult day care for patients with dementia. The contents of the evaluation focused on exploring the needs satisfaction of patients with dementia and their caregivers. This study was carried out in two adult day care centers located in the northern and central parts of Taiwan. Qualitative study design was used in this study. In addition to face-to-face interviews with nine patients with dementia, their caregivers, and six nurses, participant observation and document were used to collect the data. The analytical method described by Miles & Huberman (1994) was used to analyze the data. The results of the study found that adult day care for patients with dementia and their caregivers provided: medical care, daily living care, social work, management of symptoms and related problems of the dementia. Additionally, findings suggest that adult day care can benefit the patients with dementia by providing the medical care and daily living care services, and support for emotional needs. While it can not be confirmed that the symptom of the dementia was improved. Findings also revealed that adult day care satisfied the medical care needs of the caregivers, decreased the caregivers’ psycho-social burden, and provided supports for feeling and emotional needs. It is the important finding of the study that adult day care can satisfy the feeling and emotional needs of the patients with dementia and their caregivers. For patients with dementia, they can still enjoy the closeness with family while accept adult day care services. On the other hand, for the family caregivers, they can still present their love and care, and fulfill the traditional filial duty of retaining the family''s integrity. Based on the results of the study, the needs of the patients with dementia and their caregivers receiving adult day care can be recognized. These findings can serve as a base for further improvement of the service quality of the adult day care services for patients with dementia. Indicators for quality of care can be developed.

目 錄
頁數
指導教授推薦書----------------------------------------------------------------
口試委員會審定書-------------------------------------------------------------
授權書----------------------------------------------------------------------------Ⅲ
誌謝-------------------------------------------------------------------------------Ⅳ
中文摘要-------------------------------------------------------------------------Ⅴ
英文摘要-------------------------------------------------------------------------Ⅵ
目錄-------------------------------------------------------------------------------Ⅷ
圖表目錄-------------------------------------------------------------------------ⅩⅠ
第一章 緒論 ----------------------------------------------------------------1
第一節 研究的重要性 --------------------------------------------1
第二節 研究動機----------------------------------------------------3
第三節 研究目的----------------------------------------------------5
第四節 解釋名詞----------------------------------------------------5
第二章 文獻查證 ----------------------------------------------------------7
第一節 日間照護之發展與功能----------------------------------7
第二節 日間照護服務之成效------------------------------------11
第三節 失智症與日間照護服務---------------------------------15
第四節 質性評價與研究法之基本概念------------------------21
第三章 研究方法及進行步驟--------------------------------------------25
第一節 研究設計----------------------------------------------------25
第二節 研究場所----------------------------------------------------26
第三節 研究對象----------------------------------------------------28
第四節 研究工具----------------------------------------------------35
第五節 資料收集----------------------------------------------------39
第六節 資料分析----------------------------------------------------42
第七節 資料分析之可信度----------------------------------------47
第八節 研究對象之權利保護-------------------------------------49
第九節 前驅研究結果----------------------------------------------51
第四章 研究結果-----------------------------------------------------------57
第一節 日間照護提供之照護服務內容-------------------------57
第二節 日間照護對失智症患者之影響-------------------------74
第三節 日間照護對家庭照顧者之影響-------------------------86
第四節 日間照護對失智症患者與家庭照顧者的影響之
比較--------------------------------------------------------- 95
第五節 護理工作人員與家庭照顧者對混合型日間照護
中心之看法-------------------------------------------------96
第六節 日間照護服務需再改進之處 -------------------------100
第七節 失智症患者與家庭照顧者照護需求滿足之初步
概念架構 -------------------------------------------------105
第五章 討論 --------------------------------------------------------------109
第一節 日間照護對失智症患者的照護服務內容-----------110
第二節 失智症患者接受日間照護服務之需求滿足情形
----------------------------------------------------------------112
第三節 家庭照顧者接受日間照護服務之需求滿足情形
----------------------------------------------------------------114
第四節 日間照護在中國文化與家庭結構變遷下的時代
意義--------------------------------------------------------116
第五節 日間照護在失智老人長期照護上未來的
發展方向------------------------------------------------- 118
第六節 日間照護中心照護品質指標之建構-----------------119
第七節 資料收集法─三角測定法之運用--------------------121
第六章 結論與建議------------------------------------------------------124
第一節 結論--------------------------------------------------------122
第二節 護理上的應用--------------------------------------------126
第三節 其他非醫療型日間照護之應用-----------------------128
第四節 研究限制--------------------------------------------------128
參考資料------------------------------------------------------------------------130
中文部份-------------------------------------------------------------------130
英文部份-------------------------------------------------------------------132
附錄------------------------------------------------------------------------------136
附錄一：失智症患者訪談指引大綱----------------------------------136
附錄二：失智症家庭照顧者訪談指引大綱-------------------------137
附錄三：護理人員暨助理員訪談指引大綱-------------------------139
附錄四：參與式觀察指引----------------------------------------------141
附錄五：失智症患者暨家庭照顧者參與研究同意書-------------142
附錄六：護理人員暨助理員參與研究同意書----------------------144
附錄七：資料分析各代碼之意義-------------------------------------146

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