臺灣博碩士論文加值系統

本研究是以探討精神分裂症患者自急性期發病到恢復自我照顧功能期間，自我力量激發的經驗過程以及其中的相關影響因素。本研究將以茁根理論質性研究法進行，以立意取樣方式針對台北巿某醫學中心精神科門診之精神分裂症患者為收案對象，並根據自擬之半結構訪談指引與個案進行深入會談來收集資料，經過4個月的收案過程，共收案5 名為實際研究個案，將所得資料依據茁根理論的開放性譯碼、主軸性譯碼及選擇性譯碼等程序進行分析，以瞭解精神分裂症自我力量激發過程中的影響因素，以及該因素影響的方式。
研究結果發現本研究之核心概念為「克服失控感」其內容可分為五大類目，即病程中出現的失控感、啟動自我力量、克服失控感的措施、持續下去的力量以及障礙力量。在病程中出現的失控感其主題包括生活功能上的失控感、自我的失控感、人際關係的失控感、面對疾病處理的失控感、命運的失控感以及未來的失控感。而在啟動自我力量的因素有本性、痛苦、希望、正常化、不足、獨立。克服失控感的措施即針對失控感的各項主題予以整理，即針對生活功能方面、針對自我內在環境、針對人際關係、針對疾病控制、針對感受到命運的無奈、針對未來生活等。持續下去的力量，分別為進步、肯定、自信、支持以及能力等。亦發現在病程中有一些障礙力量可能影響個案適應疾病，包括辛苦、環境影響、情緒障礙、完美主義等。
本研究的架構在於力量的流動。當精神分裂症患者在身體、心理、社會、疾病各方面都陷入了失控的無助感中，需要啟動自我力量讓病患能重新面對自己的疾病，而發展出克服失控感的措施，在過程中有一些可以支持病患持續下去的力量，也有一些也會形成障礙力量，整個疾病適應過程自我力量的激發是起起伏伏的，若在其中可以感到穩定中的平衡，不會一直陷於失控感中，便可算是成功適應疾病，感到對生活、對疾病有充份的控制感，而能繼續朝自己所選擇、所決定的人生目標向前邁進。
此研究希望能提供精神科護理人員對精神分裂症患者病程、及病程中的主觀感受有更深入的瞭解，進一步給予更適切的協助，發揮更完整的護理功能。

This study was an exploration of the self-empowerment process and influencing factors during the schizophrenia patient experiencing the adaptation process. Subjects were selected from the psychiatric clinic department of the National Taiwan University Hospital by purposive sampling in four month. The researcher used the semi-structured interview guide to gather the research data through in-depth interview about 60-90 minutes. Five subjects data was analyzed by open coding, axial coding and selected coding based on the grounded theory.
The core concept of this study was "overcoming the powerless". Five categories of the self-empowerment process of schizophrenia were "powerless when experiencing schizophrenia", "inspiring the self-empowerment", "strategies of overcoming the powerless", "the supportive strength" and "obstruction of the adaptation process". Six themes of powerless when experiencing schizophrenia were about "normal life", "self concept", "interpersonal relationship", "management of illness", "bad fortune" and "future life". The factors of inspiring the self-empowerment included seven themes: "personality", "suffering ", "hope", "normalize", "more expectation of medication", "to be independent" and . The strategies of overcoming powerless were against every powerless when experiencing schizophrenia, so there were also six themes included. And the supportive strength included "illness becoming better", "to get positive commend", "getting confidence", "family and spiritual support " and "capable of managing illness". Finally the themes of the obstruction of the adaptation process were "difficult adaptation process", "environment hard to deal with", "emotional disturbance" and "perfectionism".
We can see the power flow in the adaptation process of schizophrenia. When schizophrenia patient trapped into the powerless feeling, they didn''t have any power to fight their illness. They must inspire their self-empowerment, so they could get the power to develop the strategies of overcoming powerless. Patient still mentioned some kind of power that influenced the adaptation process like the supportive strength and obstructive factors. The supportive strength strengthened the self-empower, but the obstructive factors made patient back to powerless feeling, that they should inspire the self-empowerment again. The whole process went up and down, until they felt powerful, controllable to their illness and life. They became well empowerment.
The contribution of this study could enhance the knowledge about the subject feeling and the self-empowerment process of schizophrenia. The findings could provide the psychiatric nurses giving schizophrenia nursing intervention, especially the community care, and giving the evidence for further study.

第一章 前言 …………………………………………………… 1
第一節 研究動機 …………………………………………… 2
第二節 研究目的 …………………………………………… 4
第三節 研究問題 …………………………………………… 4
第四節 名詞界定 …………………………………………… 5
第二章 文獻查證 ……………………………………………… 6
壹、研究主題相關文獻 ……………………………………….. 6
第一節 精神分裂症及其病程發展 …………………………. 6
第二節 權能激發的定義及概念發展 ………………………. 10
第三節 精神疾病患者的自我力量激發 …………………… 13
貳、研究方法的考量 …………………………………………. 20
第一節 質性研究 ……………………………………………. 20
第二節 茁根理論 ……………………………………………. 22
第三章 研究方法 ……………………………………………… 26
第一節 研究設計 …………………………………………….. 26
第二節 研究對象 …………………………………………….. 26
第三節 研究工具 …………………………………………….. 27
第四節 資料收集過程 ……………………………………….. 28
第五節 資料分析方法 ……………………………………….. 29
第六節 嚴謹度的評鑑 ……………………………………….. 31
第七節 倫理考量 …………………………………………….. 33
第四章 研究結果 ……………………………………………….. 34
第一節 基本資料 …………………………………………….. 34
第二節 精神分裂症患者的失控感………………………….. 36
第三節 精神分裂症患者啟動自我力量的特質…………….. 59
第四節 克服失控感的措施 ….………….………………….. 65
第五節 疾病適應過程中的持續力量及障礙力量 ………… 87
第五章 討論 ……………………………………………….…. 97
第一節 本研究概念架構…………………………………….. 97
第二節 啟動自我力量的因素探討………………………….. 100
第三節 持續力量與障礙力量在疾病適應過程中的關係及重要性 …………………………………………………. 106
第四節 失控感對疾病適應及疾病預後的影響………………. 108
第五節 其他相關研究探討………………………………... 110
第六章 結論 …………………………………………………. 113
第一節 研究發現………………………………….……….. 113
第二節 研究限制………………………………….……….. 114
第三節 研究結果在護理上的應用及建議.………….…….. 116

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