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研究生:陳志軒
研究生(外文):Chi-Hsuan Chen
論文名稱:原住民胎兒酒精症候群與胎兒酒精效應的問題---以花蓮縣原住民的社會文化分析為例
論文名稱(外文):Sociocultual Analysis about Problem of Fetal Alcohol Syndrome and Fetal Alcohol Effect:an example of aborigine in Haulien
指導教授:許木柱許木柱引用關係
學位類別:碩士
校院名稱:慈濟大學
系所名稱:原住民健康研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
畢業學年度:89
語文別:中文
論文頁數:102
中文關鍵詞:胎兒酒精症候群飲酒問題原住民婦女懷孕
外文關鍵詞:Fetal alcohol Syndromedrinking problemaboriginepregnancy
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過去對於台灣原住民酒癮的研究結果顯示:(1)臺灣原住民婦女有相對偏高的酒癮盛行率;(2)泰雅、阿美、布農等原住民族群中發現有胎兒酒精症候群(Fetal Alcohol Syndrome,簡稱FAS)以及胎兒酒精效應(Fetal Alcohol Effect,簡稱FAE)的兒童。FAS及FAE孩童的出現,其原因是母親於懷孕時期過度飲酒,因而對發育中的胎兒產生永久的器質性傷害。在此情況下,本研究試圖瞭解生出胎兒酒精症候群及胎兒酒精效應孩童之母親在懷孕時期的醫療照護需求,以及對懷孕飲酒的主觀認知與經驗。此外,本研究也意圖瞭解公衛護士、校護及社工人員對於FAS/FAE的認知及原住民婦女飲酒的看法,並藉以思考醫療照護是否能夠符合母親的需求。本研究對於生出FAS/E孩童的母親運用深度訪談的方法,收集母親的懷孕史以及懷孕過程接受產檢的情形,共訪談12位母親。此外,對當地衛生所公衛護士、校護以及社工人員進行結構性問卷調查,以瞭解他們對於FAS/E的認知及看法。研究結果發現:(1)FAS/E孩童的母親在懷孕時期飲酒的兩個原因分別為:婦女獨自面對懷孕及生產的過程以及在認知上不確定酒精對於胎兒的傷害。婦女獨自面對懷孕及生產的過程主要的原因包括經濟、婚姻、家庭衝突等因素外,阿美族及泰雅族傳統文化中模塑女性獨立面對懷孕及生產過程亦有影響。而母親不確定酒精對於胎兒的傷害其原因則來自婦女自身的經驗與醫學知識的衝突以及對於懷孕與胎兒異常的宿命論。(2)填寫問卷的公衛護士、校護及社工人員共63人,有76.2 %曾經聽過胎兒酒精症候群這個名詞,實際上看過胎兒酒精症候群的小孩佔33.3%,曾經看過懷孕婦女正在飲酒的人佔83.9%,當被問起若在工作時碰到胎兒酒精症候群的小孩時,有高達90.5%的人表示她們會主動去處理他們的問題,處理的方法則以轉介給專業人員為主,而當她們知道某個小孩被醫師診斷為胎兒酒精症候群時,有93.5%的人會告訴母親孩童的診斷。(3)這些人都同意米酒、維士比及保力達等酒精飲料對於胎兒都有害處。此外,傾向同意生出胎兒酒精症候群的孩童是母親的錯以及飲酒問題為個人歸因。結論:有酒精使用問題的母親在懷孕時所面對的問題及需求是多元的,對於她們懷孕時期所介入的服務,不應先對她們做任何的道德及價值觀定,具全面觀的照護模式應被更廣泛的討論與應用。
Background: according to many past studies show that the Taiwan aborigines' have severe drinking problem; there also have high prevalence of alcoholism among female aborigines. As it is, Fetal Alcohol Syndrome(FAS) and Fetal Alcohol effect (FAE) cases are also found among Tayal, Bunun and Amis tribes' children. Causing FAS/FAE are due to the female over-drinking during their pregnant periods, which will cause organic injury to the fetus permanently. Purpose: In order to prevent FAS/E problems, the different opinions and the points of view between the mothers and professionals for the topic will be studied. Method: 12 aboriginal women who gave birth to FAS/E children are studied , and the information about their pregnant experiences and drinking behavior will be collected too. Also, in searching the cognition and knowledge in FAS/E and pregnant mother drinking conditions, the result will be collected from the local health professionals and social workers by the designed structured questionnaire. Result: (1)there are two conditions found in contribution to those women become drinking- abused during they were pregnant: (i)these pregnant mothers were facing their difficulties alone during the pregnancy, and struggling for living without sufficient support system. (ii)in another hand, these mothers were unaware that drinking alcohol can cause problems or damage permanently to the unborn baby during their pregnancy.(2)survey result shows, there are 76.2% of local health professionals and social workers, who ever heard the term of "FAS" ,and 33.3% of these professionals who actually saw the FAS children in their working experiences.(3)furthermore, the local health professionals and social workers also expressed more agree that, the FAS/E situation is the mother' responsibility to the result, and this result have less related factors from the father . Conclusion: In suggest, when local health care professionals and social workers are promoting prevention program for alcohol-abused pregnant female, they should aware of not to jump to the conclusion by moral judgment or making stereotype opinions to the females. Therefore, being culture sensitive and trans-culture practice should be more discussed and applied to the aboriginal people in this issue.
摘要 英文摘要 第一章 緒論-----------------------------------------------------------------------------------1 第二章 文獻回顧-----------------------------------------------------------------------------5 第一節 酒精與胎兒及其相關的影響----------------------------------------------------5 第二節 胎兒酒精症候群母親的特性----------------------------------------------------12 第三節 產前照護阻礙--------------------------------------------------------------------15 第四節 懷孕現象的研究-------------------------------------------------------------------19 第五節 台灣原住民飲酒問題的研究----------------------------------------------------24 第六節 酒癮與文化-------------------------------------------------------------------------28 第七節 醫療人類學的應用----------------------------------------------------------------30 第三章 研究方法-------------------------------------------------------------------------------33 第一節 知識論的基礎-----------------------------------------------------------------------33 第二節 研究問題-----------------------------------------------------------------------------35 第三節 資料收集方式的討論--------------------------------------------------------------35 第四節 研究個案基本資料-----------------------------------------------------------------36 第五節 研究場域的介紹--------------------------------------------------------------------39 第六節 資料分析的方法--------------------------------------------------------------------41 第七節 研究流程-----------------------------------------------------------------------------43 第四章 影響婦女懷孕飲酒與醫療利用的------------------------------------------------ 44 第一節 FAS/E孩童之母親家庭的基本資料 ----------------------------------------- 44 第二節 FAS/E母親懷孕飲酒的原因----------------------------------------------------47 第三節 母親懷孕時期接受產檢的狀況-------------------------------------------------63 第四節 FAS/E母親對於產前檢查的意義詮釋---------------------------------------64 第五章 護理與社工人員對原住民胎兒酒精症候群的認知與態度---------------66 第一節 基本資料 ------------------------------------------------------------------------66 第二節 護理與社工人員對胎兒酒精症候群的歸因--------------------------------70 第六章 討論------------------------------------------------------------------------------------80 第一節 研究結果簡述--------------------------------------------------------------------80 第二節 相關議題之探討-----------------------------------------------------------------81 第三節 對於原住民婦女懷孕飲酒問題的建議--------------------------------------85 第四節 研究限制--------------------------------------------------------------------------87 中文參考資料-----------------------------------------------------------------------------------89 英文參考資料-----------------------------------------------------------------------------------91 附錄 一 研究同意書-----------------------------------------------------------------------97 附錄 二 FAS/E母親訪談大綱-----------------------------------------------------------98 附錄 三 醫護人員及社工人員對於胎兒酒精症候群認知之問卷---------------100
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