臺灣博碩士論文加值系統

本研究主要目的是探討心臟移植病患術後出院返家後，身心社會調適及社會支持之情形，及其間之相關性。研究對象是採立意取樣，以北部兩家醫學中心之心臟外科門診收案的場所，共收集90位個案。研究方法採結構性問卷進行資料的收集，使用的工具包括生理困擾調適量表、心理社會調適量表及社會支持量表、個人基本屬性及疾病特性資料表共四部份，所得資料以描述性統計、t-test、單因子變異數分析及皮爾遜積差相關等方法進行統計分析，研究結果歸納如下：
一、 心臟移植病患術後，生理困擾調適及心理社會調適均介 於「無障礙」至「輕度障礙」之間。在生理困擾調適方面，調適最差的項目為毛髮增生；在心理社會調適各層面調適中，以心理困擾調適最佳，社會環境調適最差。
二、 心臟移植病患術後之整體社會支持為中下程度，在各層次中以訊息支持獲得最多，實質支持獲得最少。在支持來源中，以家人親友為主要提供者。
三、 心臟移植病患術後之基本屬性中，年齡與健康照顧調適，性別與整體心理社會調適、家庭生活調適及非共居家人調適，婚姻狀況與整體心理社會調適、家庭生活調適及非共居家人調適，工作狀況與工作狀況調適及健康照顧調適，均達顯著差異。在疾病特性中，住院月數與生理困擾調適、健康照顧調適、家庭生活調適及性生活調適均呈顯著差異。
四、 心臟移植病患術後之基本屬性中，性別與整體社會支持、情緒支持、訊息支持及評價支持，均達顯著差異。在疾病特性中，出院月數與整體社會支持、情緒支持及評價支持，均達顯著差異，出院後有無發生排斥或感染再度入院者，與整體社會支持、情緒支持及評價支持均呈顯著差異，出院後有發生排斥者，與訊息支持呈顯著差異。
五、 心臟移植病患術後之社會支持與生理困擾調適無顯著相關。社會支持與整體心理社會調適、家庭生活調適、性生活調適、非共居家人調適及社會環境調適，均呈顯著正相關。
六、 心臟移植病患術後之生理困擾調適與整體心理社會調適、心理困擾調適、工作狀況調適、家庭生活調適及性生活調適，均呈顯著負相關，即生理困擾調適愈佳，則整體心理社會調適、心理困擾調適、工作狀況調適、家庭生活調適及性生活調適愈佳。
本研究結果可以提供臨床對心臟移植病患術後，設計出院衛教計畫之參考，以提供出院返家病患之持續性照護，並針對護理實務、護理行政及護理教育方面提出建議。

The purpose of this descriptive cross-sectional survery study was to examine the bio-psychosocial adjustment and social support in heart transplantation recipients after their discharge from hospital. In this study, 90 patients were selected by purposive sampling from cardiac surgery out-patient department of two medical centers in the northern Taiwan.The instruments which is structured questionnaires used in this study included physical distress adjustment, psychosocial adjustment to illness scale (PAIS), social support scale, demographyic data and characteristic of illness.The data were analyzed by mean, standard deviation, percentage, one-way ANOVA, post Scheff’s examination, Pearson product-moment correlation, and multiple regression. The important results were summarized as follows:
1. The degress of bio-psychosocial adjustment in post-heart transplant recipients was mild disturbance to none.The hirsutism was the most difficult item in physical distress adjustment; The psychological distress adjustment was the best item in psychosocial adjustment aspects, the adjustment to social environment was the worst in psychosocial adjustment aspects.
2. The whole social support in post-heart transplant recipients was at moderate-inferior degree.The informational support was the best, but tangible support was the worst.The family and relatives were the major providers in social network.
3. In demographic data, the relation of patient’s age to health care orientation; sex to whole psychosocial adjustment, domestic environment and extended family; marital atatus to whole psychosocial adjustment, domestic environment and extended family; employment to vocational environment and health care orientation have been significantly different. In characteristics of illness data, length of hospital stay to physical distress adjustment, health care orientation, domestic environment and sexual relations have been significantly different.
4. In demographic data, sex to whole social support, emotional support, informational support and appraisal support have been significantly different. In characteristic of illness data, length of discharge to whole social support, emotional support and appraisal support have been significantly different; the group who re-admitted due to rejection or infection to whole social support, emotional support and appraisal support have been significantly different; the group who re-admitted due to rejection to informational support have been significantly different.
5. The relationship between social support and physical distress adjustment was not statistically significant. Social support and whole psychosocial adjustment,domestic environment, sexual relations, extended family, social environment were positive correlation.
6. Patient’s physical distress adjustment and whole psychosocial adjustment, psychological distress, vocational environment, domestic environment, sexual relaions were negtive correlation.
The results of this study provided the reference to design discharge education plan and continuous nursing intervention in post transplantation recipients after their discharge. Nursing implications for further study are included.

目 錄
第壹章、 緒論……………………………….……………………………..1
第一節、 問題的重要性…………………………………………………….1
第二節、 研究動機…………………………………………..……….……2
第貳章、 文獻查證…………………………………………....………...4
第一節、 心臟移植手術…………………………………………………….4
第二節、 身心社會調適…………………………………………………….6
一、 調適概念…………………………………………………...…………6
二、 心臟移植病患身心社會調適………………………………......….8
（一)生理困擾調適…………………………………………….......……8
（二)心理社會調適……………………………………...........…….10
三、影響身心社會調適之相關因素……………………………………….14
第三節、 社會支持…………………………………………………………18
一、 社會支持種類及功能……………………………………….……….18
二、 影響社會支持之相關因素…………………………………....…..19
第四節、 身心社會調適與社會支持之相關性………….…….........20
第參章、 研究架構、研究目的與名詞界定………………………………23
第一節、 研究架構………………………………………….…….…....23
第二節、 研究目的………………………….…................….…24
第三節、 名詞界定……………………………………...….......……25.
第肆章、 研究方法………………………………………………....……28
第一節、 研究對象與場所………………………….……..…….......28
第二節、 研究工具………………………………………….………...…29
第三節、 資料收集步驟…………………………………….……….....36
第四節、 資料處理及統計分析…………………………….…….....…37
第伍章、 研究結果……………………………….….…...….........43
第一節、 心臟移植病患術後之個人基本屬性及疾病特性………………43
第二節、 心臟移植病患術後之身心社會調適狀況…………………....49
第三節、 心臟移植病患術後之社會支持狀況……………………......60
第四節、 個人基本屬性、疾病特性與身心社會調適之關係…………..63
第五節、 個人基本屬性、疾病特性與社會支持之關係…………………86
第六節、 社會支持與身心社會調適之相關性………………..........99
第七節、 生理困擾調適與心理社會調適之相關性………………..….100
第陸章、 討論…………………………………...………….….…....104
第一節、心臟移植病患術後之身心社會調適狀況…….…………...…104
第二節、心臟移植病患術後之社會支持狀況….……………….......109
第三節、心臟移植病患術後之個人基本屬性、疾病特性與身心社會之關係..........................................................109
第四節、心臟移植病患術後之個人基本屬性、疾病特性與社會支持之關係….….....................................................114
第五節、心臟移植病患術後之社會支持與身心社會調適之相關性……117
第六節、心臟移植病患術後之生理困擾調適與心理社會調適之相關性118
第柒章、結論與建議………………………………….……………...…119
第一節、結論……………………………………………….………,,,119
第二節、建議………………………………………………………..…121
第三節、研究限制及未來研究之建議………………………………..124
參考資料………………………..……...…….……..…………………126
中文部份……………………..…………………….…………...….126
英文部份…………………………………………………...…….….128
附錄
附錄一 研究同意書…..….....……………..…………...……...134
附錄二 個人基本屬性及疾病特性資料表…………....…...…....135
附錄三 生理困擾調適量表……….………………………...……….136
附錄四 心理社會調適量表…...………..……………………………137
附錄五 社會支持量表………..…………………………..………...141
附錄六 心理社會調適量表使用授權同意書……….………….…...142
附錄七 社會支持量表使用授權同意書…………………..….……..143
附錄八 問卷效度測試之專家名單….….………………….……..…144

一、中文部份
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朱日橋‧(1992)‧器官捐贈理念的剖析‧醫院，25(1)，49-52‧
汪素敏‧(1997a)‧心臟移植術後病人症狀困擾﹑社會支持與自我照顧行為相關之探討.國防醫學院護理學研究所碩士論文‧
汪素敏‧(1997b)‧心臟移植及其病患的護理‧護理雜誌，44(3)，85-90‧
李明德‧(1992)‧老年心肌梗塞病患生活調適與相關因素之探討‧國防醫學院護理學研究所碩士論文‧
林錦定‧(1994)‧無喉者生活適應與社會支持之探討.國防醫學院護理學研究所碩士論文‧
沈楚文‧(1988)‧器官移植的心理精神問題‧臨床醫學，21(4)，306-310‧
周銘霆﹑謝碧珠﹑李開敏‧(1994)‧台灣地區心臟移植後病患之心理及社會適應‧中華民國心臟學會雜誌，10(3)，149-154‧
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胡月捐‧(1994)‧慢性病患所承受的衝擊與因應行為‧護理研究，2(2)，140-151‧
張衍﹑朱樹勳.(1987)‧心臟移植(上).當代醫學，14(10)，766-873‧
張衍﹑朱樹勳‧(1987)‧心臟移植(下)‧當代醫學，14(12)，968-974‧
陳綱華‧(1995)‧心臟移植後患者的壓力源﹑因應行為及生活滿意度之關係. 國防醫學院護理學研究所碩士論文‧
梁淑媛‧(1995)‧心臟移植手術後感染合併症之護理‧護理雜誌，42(4)，49-53‧
梁淑媛‧(1998) ‧冠狀動脈繞道手術病患不確定感﹑社會支持與生活適應之探討‧國立陽明大學臨床護理研究所碩士論文‧
黃光琪‧(1996)‧心臟移植後患者生活品質及相關因素之探討‧國防醫學院護理學研究所碩士論文‧
黃嗣棻‧(1991)‧急性心肌梗塞患者出院之心理社會調適及其相關因素之探討‧國立台灣大學醫學院護理學研究所碩士論文‧
彭芳谷‧(1988)‧器官移植之過去﹑現在及未來.臨床醫學，21(4)，303-305‧
鄭國琪‧(1988)‧心臟移植.臨床醫學，21(4)，333-338‧
賴曉亭﹑游堂振﹑翁仁崇﹑黃正雄﹑施俊哲﹑王志軒﹑余榮敏﹑丁志中‧(1987)‧心臟移植以治療末期衰竭心臟病‧臨床醫學， 40(6)，318-325‧
謝碧珠‧(1993)‧台灣地區心臟移植後病患的心理暨社會適應之探討‧私立東吳大學社會工作研究所碩士論文‧
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魏崢﹑張忠毅﹑汪以進﹑童玉龍﹑萬偉明﹑范思善﹑莊義成﹑李芳艷﹑楊茂勳‧(1996)‧心臟移植用於缺氧性心肌症之治療.中華民國心臟協會雜誌，12(1)，1-5‧
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二、英文部份
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