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研究生:劉慧芬
研究生(外文):Huei-Fen Liu
論文名稱:乳癌婦女接受乳房全切除手術前後身體心像的變化及因應行為
論文名稱(外文):Body Image Change and Coping Behavior of the Breast Cancer Women Before and Early After Receiving Mastectomy
指導教授:余玉眉余玉眉引用關係
指導教授(外文):Yu-Mei Yu Chao
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:140
中文關鍵詞:乳癌乳房手術身體心像因應行為臨床田野研究法
外文關鍵詞:breast cancermastectomybody imagecoping behaviorclinical field study
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本研究的目的是希望站在乳癌婦女的角度,深入了解她們在確立診斷手術前、及接受乳房切除手術後初期對其身體心像變化的主觀感受及面對此身體心像變化時引發出來的因應行為。
本研究主要採臨床田野研究法,輔以低結構的訪談,研究者以觀察者即參與者的方式,進入個案的真實情境中進行資料收集。於民國90年12月至91年10月,在北市某醫學中心收案,直至資料飽和為止。共收集五位接受改良式乳房根除手術的乳癌婦女,於高度懷疑為乳癌診斷時開始,至手術後三至四週接受其他輔助治療前為止進行資料的收集,將研究對象所表達出來的語言及非語言行為寫成行為過程實錄,並以內容分析法將語言表達的內容配合表情、動作加以有系統的分析、歸類。
本研究發現乳癌婦女在接受乳房手術期間,她們所感受到的身體心像變化,可分為兩個時期加以探討:壹、手術前身體心像威脅的經驗與想像:乳癌診斷引起對身體的重新注意、感受即將失去身體部位的威脅;貳、手術後初期實際感受身體心像的動搖與崩解:乳房手術造成身體完整性的破壞、身體與乳癌間矛盾的趨避情結、接收身體變化後的社會負向訊息。
婦女在面對上述所感受到的身體心像變化時,發展出的因應行為亦可分為兩個時期加以探討:壹、手術前面對身體心像威脅的因應行為:採取認知的迴避,阻斷自己與所面臨身體威脅的溝通管道、確認自身狀況、尋求『安身立命』的途徑、裝備自己,試圖以足夠的準備迎接即將到來的身體變化;貳、手術後初期面對身體心像崩解之因應行為:暫以退化的行為來『面對』身體的改變、努力建構手術後的身體心像、重新拾回身體的主控權及確立身體的定位點。
研究結果呈現在文化脈絡中乳癌婦女所感受到的身體心像變化及面對身體心像變化所發展出的因應行為。此結果將有助於護理人員更深層的了解婦女、身體、照顧角色與文化之間的關係,真正融入婦女的經驗當中,以提供「全人」及「本土化」的護理照顧。
The purpose of this study was to explore, from the viewpoints of the women with breast cancer, how they perceived their body image change and how they coped such change before and early after receiving mastectomy.
Clinical field study, combined with low-structured interview was adopted in this research. The researcher played the role of observer-as-participant while actively interacted with the subjects. The data were collected between December 2001 and October 2002 at a medical center in Taipei, until the data became saturated. A total of 5 women with breast cancer were the subjects in this study. Data were collected from the time when the diagnosis of breast cancer was made and continued to 3-4 weeks after they received mastectomy before these women began complementary treatments. The verbal and nonverbal languages and behaviors expressed by the subjects were written in form of process recordings, and the verbal contents of recordings, combined with expressions, actions were systematically categorized and analyzed by Content Analysis.
The study found that the body image change perceived by the women with breast cancer could be divided into two main stages: 1. Before receiving mastectomy, the experience and fantasy of the threatening body image: the diagnosis of breast cancer induced women to take notice of their body; perceived the threats to loss of body part. 2. Early after receiving mastectomy, actually perceived the integrity of the body was fluctuated and broken down:mastectomy destroyed the body integrity; a complex of “tendence” and “avoidance” between body and breast cancer; receive negative social information after body changed.
The coping behavior adopted by these women as soon as they encountered their body image change could also be divided into two stages: 1. Before receiving mastectomy, the coping behavior of the threatening body image: adopt cognitive avoidance, and kept self away from the communication with the body threats; confirmed body condition; looked for a way to secure and survive; equipped self, and tried to take over the coming body change with enough preparation. 2. Early after receiving mastectomy, the coping behavior of the broken body image: take regression behavior temporarily to “face” their changed body; strive to construct their body image; retrieve the control of self body, and re-establish body orientation firmly.
The result of this study provides a basis to understand the perspectives about body changes and their coping behaviors in cultural context of women who were diagnosed and received surgery with breast cancer. It helps health care professionals to provide holistic and cultural sensitive care, which often ignored by contemporary medicine.
第一章 緒論 --------------------------------------------- 1
第一節 研究動機與重要性 ------------------------------------ 1
第二節 研究問題陳述 ---------------------------------------- 5
第三節 名詞界定 -------------------------------------------- 6
第二章 文獻查證 ----------------------------------------- 8
第一節 身體心像 ------------------------------------------ 8
第二節 乳房對女性的意義----------------------------------- 10
第三節 乳癌的診斷與乳房常見手術--------------------------- 12
第四節 因應行為 ------------------------------------------ 17
第五節 相關研究 ------------------------------------------ 20
第三章 研究設計 ----------------------------------------- 25
第一節 研究對象 ------------------------------------------ 26
第二節 研究情境 ------------------------------------------ 27
第三節 嘗試性研究及研究設計演進--------------------------- 27
第四節 資料收集 ------------------------------------------ 32
第五節 資料分析 ------------------------------------------ 37
第六節 資料收集與分析的嚴謹度 ---------------------------- 38
第四章 研究結果 ---------------------------------------- 42
第一節 研究對象背景描述----------------------------------- 42
第二節 研究結果綱要--------------------------------------- 44
第三節 乳房手術前後婦女感受的身體心像變化----------------- 48
第四節 乳癌婦女對其身體心像變化的因應行為----------------- 66
第五章 討論 ---------------------------------------------102
第一節 本研究結果之討論 ----------------------------------102
第二節 與相關研究比較 ------------------------------------111
第六章 結論與建議 ---------------------------------------119
第一節 結論 ----------------------------------------------119
第二節 護理學上的運用與建議-------------------------------120
第三節 研究限制及對未來研究建議 ----------------------------124
參考文獻 ---------------------------------------------------127
中文部分----------------------------------------------------127
英文部分----------------------------------------------------128
附件--------------------------------------------------------131
附件一 同意臨床試驗證明書-----------------------------------131
附件二 參予研究者同意書-------------------------------------132
附件三 訪談指引---------------------------------------------133
附件四 正式資料收集流程表-----------------------------------135
附件五 個案基本資料表---------------------------------------137
附件六 行為過程實錄及內容分析(實例摘要)-------------------138
一、中文部分:
王德錦(1991)˙乳癌之外科治療˙北市醫誌,35(9),29-33。
行政院衛生署(2002)˙資訊走廊─衛生統計資料(線上查詢)˙摘自http://www.doh.gov.tw/lane。
余玉眉、田聖芳 、 蔣欣欣(1991)˙質性研究─田野研究法於護理學之應用˙台北:巨流。
余玉眉、陳月枝、劉碧玉、周治蕙、金繼春(1975)˙身體心像˙護理雜誌,22(4),39-46。
余玉眉、蔣欣欣、陳月枝、蘇燦煮、劉玉秀(1999a)˙質性研究資料的量化及詮釋─從研究例證探討臨床護理研究方法與認識學 第一部分:質性臨床護理研究之方法學及認識學的探討˙護理研究,7(3),277-287。
余玉眉、蔣欣欣、陳月枝、蘇燦煮、劉玉秀(1999a)˙質性研究資料的量化及詮釋─從研究例證探討臨床護理研究方法與認識學 第二部分:研究例證之分析與詮釋˙護理研究,7(4),376-391。
沈志陽(2000)˙台灣乳癌的研究˙科學發展月刊,28(9),675-678。
呂桂雲、金繼春、黃惠萍(1993)˙乳癌婦女的因應行為˙護理研究1(3),247-256。
林幸道、黃宗人 、 侯明峰(1993)˙乳房的重建整形手術˙醫學繼續教育,3(5),656-658。
季瑋珠、黃俊升、張金堅(1997)˙台灣的乳癌˙中華衛誌,16(1),62-75。
范丹伯(2001)˙於石世明譯,病床邊的溫柔˙台北:心靈工坊。
紀文鳳(1987)˙女人今時今日---今日女性與廣告的種種關係˙台北:遠流。
栗山茂久(2001)˙於陳信宏譯,身體的語言-從中西文化看身體之謎˙台北:究竟。
翁毓秀(1996)‧完形理論的自覺與接觸‧諮商與輔導,127,10-17。
麥克菲(1996)˙於常立譯˙畢卡索的女人-一個乳癌患者的故事˙台北:業強。
郭文宏、張金堅(1999)˙乳癌治療的新趨勢˙當代醫學,26(12),970-973。
張金堅(1991)˙魅力與危機─乳房及乳房常見疾病˙台北:幼獅。
張金堅(1992)˙乳癌之診斷與外科治療˙醫學繼續教育,2(1),2-8。
張鈺佩(1999)˙漢代女教典籍中女性的家庭角色與地位˙教育研究(高師) 7,169-179。
黃俊升(1995)˙乳癌˙醫學繼續教育,5(2),152-156。
陳訓徹(2000)˙乳癌的治療與方向˙台北市醫師公會會刊,44(9),46-51。
陳海焦(1996)˙乳癌婦女接受乳房切除手術後身體改變的經驗˙國防醫學院護理研究所碩士論文。
陳啟明(1993)˙早期乳癌病人之乳房保留手術˙醫學繼續教育,3(4),512-516。
陳惠美(1997)˙乳癌術後婦女身心社會調適之探討─以羅氏適應模式為基礎˙國立陽明大學臨床護理研究所碩士論文。
曾光毅、李福春(2000)˙現階段的乳癌預防與治療˙基層醫學,15(6),115-119。
蔣欣欣、余玉眉(2001)˙護病間的護為主體性˙國立政治大學哲學學報,7,307-322。
賴鈺玫、陳月枝、毛新春、侯勝茂(1992)—骨癌病童接受截肢手術前後面對身體心像改變之適應過程及行為反應—中華癌醫會誌,8(1),1-10。
劉向援(1986)˙接受乳房根除手術之乳癌婦女,於住院期間有關「身體心像改變」與「調適行為」之探討˙國防醫學院護理研究所碩士論文。
劉思源、沈國樑(1990)˙乳癌的偵查與診斷˙國防醫學,10(5),86-89。
謝秀芬(1998)˙台灣女性的家庭角色觀與工作觀研究˙東吳社會工作學報,4,1-34。
羅特(1996)˙於危芷芬、陳瑞雲編譯,女性心理學(pp505-579)˙台北:五南。
二、英文部分:
Ali, N. S. & Khalil, H. Z.(1991). Identification of stressors, level of stress, coping strategies, and coping effectiveness among Egyptian mastectomy patients. Cancer Nursing, 14(5), 232-239.
Bernadine, C. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22(3), 185-194.
Bredin, M.(1999). Mastectomy, body image and therapeutic massage: a qualitative study of women’s experience. Journal of Advanced Nursing, 29(5), 1113-1120.
Burnard, P. (1991). Coping with stress in the professions: a practical guide. London: Chapman & Hall.
Carver, C. S., Pozo, C. Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat, F. L., & Clark, K. C. (1993). How coping mediates the effect of optimism on distress: a study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65(2), 375-390.
Cohen, M. Z., Kahn, D. L. & Steeves, R. H. (1998). Beyond body image: the experience of breast cancer. Oncology Nursing Forum, 25(5), 835-841.
Degner L.F., Kristjanson L.J., Bowman D., Sloan J.A., Carriere K.C., O''Neil J., Bilodeau B., Watson P. & Mueller B. (1997) Information needs and decisional preferences in women with breast cancer. Journal of American Medical Association, 277, 1485-1492.
Denzin, N. K.(1989).The research act: a theoretical introduction to sociological methods.(3ed). New Jersey: Prentice-Hall.
Deutsch, H(1942). Some psychoanalytic observations in surgery. Psychosomatic Medicine, 4, 105-115.
Donegan, W. L. & Spratt, J. S. (1988). surgical management. In W. L. Donegan & J. S. Spratt, Cancer of the Breast. (pp403-461). PA: W. B. Saunders.
Duvall, E. M.(1977). Marriage and family development. Philadelphia:Linppincott.
Ferrell, B. R., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1997). Quality of life in breast cancer: part 1: physical and social well-being. Cancer Nursing, 20(6), 398-408.
Fredette, S. L. (1995). Breast cancer survivors: concern and coping. Cancer Nursing, 18(1), 35-46.
Holahan, C. J., Moos, R. H., & Schaeffer, J. A.(1996). Coping, Stress Resistance, and Growth: Conceptualizing Adaptive Functioning(p24-43). In M. Zeidner, & N. S. Endler. Handbook of coping: theory, research, application. New York: John Wiley & Son.
Holmberg, S. K., Scott, L. L., Alexy, W., & Fife, B. L. (2001). Relationship issues of women with breast cancer. Cancer Nursing, 24(1), 53-60.
Hoskins, C. N. & Haber, J. (2000). Adjusting to Breast Cancer. American Journal of Nursing, 100(4), 26-33
Johnson, R. J.(1994). Caring for the woman who’s had a mastectomy. American Journal of Nursing, 94(5), 25-31.
Kraus, P. L. (1999). Body image, decision making, and breast cancer treatment. Cancer Nursing, 22(6), 421-7.
Lasery, J. M., Marolese, R. G., Poisson, R., Shibata, H., Fleischer, D., Lafleur, D., Legault, S. & Taillefer, S. (1987). Depression and body image following mastectomy and lumpectomy. Journal of Chronic Disease. 40(6), 529-534.
Laster, J. & Fulton, J. S. (1998). Breast cancer: advances in diagnosis and surgical treatment. American Journal of Nursing, suppl., 8-11.
Lavery, J. F. & Clarke, V. A. (1996). Causal attributions, coping strategies, and adjustment to breast cancer. Cancer Nursing, 19(1), 20-28.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Levine, E. M. (1969). The pursuit of wholeness. American Journal of Nursing, 69(1), 93-98.
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McCaul,K. D., Sandgren, A. K., O’Donnell, S., Branstetter, A., & Foreman, G. (1999). Coping and adjustment to breast cancer. Psycho-Oncology, 8, 230-236.
Miller, J. F. (1983). Coping with Chronic Illness: Overcoming Powerlessness. Philadelphia: F. A. Davis company.
Mock, V. (1993). Body image in women treated for breast cancer. Nursing Research, 42, 153-157.
Northouse, L. L. (1989). The impact of breast cancer on patients and husbands. Cancer Nursing, 12(5), 276-84.
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Rubin, R. (1984). The self and the body image. In Maternal Identity & the Maternal Experience. (pp12-24) N.Y.:Springer.
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1. 呂桂雲、金繼春、黃惠萍(1993)˙乳癌婦女的因應行為˙護理研究1(3),247-256。
2. 余玉眉、蔣欣欣、陳月枝、蘇燦煮、劉玉秀(1999a)˙質性研究資料的量化及詮釋─從研究例證探討臨床護理研究方法與認識學 第二部分:研究例證之分析與詮釋˙護理研究,7(4),376-391。
3. 余玉眉、蔣欣欣、陳月枝、蘇燦煮、劉玉秀(1999a)˙質性研究資料的量化及詮釋─從研究例證探討臨床護理研究方法與認識學 第一部分:質性臨床護理研究之方法學及認識學的探討˙護理研究,7(3),277-287。
4. 余玉眉、陳月枝、劉碧玉、周治蕙、金繼春(1975)˙身體心像˙護理雜誌,22(4),39-46。
5. 王德錦(1991)˙乳癌之外科治療˙北市醫誌,35(9),29-33。
6. 沈志陽(2000)˙台灣乳癌的研究˙科學發展月刊,28(9),675-678。
7. 翁毓秀(1996)‧完形理論的自覺與接觸‧諮商與輔導,127,10-17。
8. 郭文宏、張金堅(1999)˙乳癌治療的新趨勢˙當代醫學,26(12),970-973。
9. 張金堅(1992)˙乳癌之診斷與外科治療˙醫學繼續教育,2(1),2-8。
10. 黃俊升(1995)˙乳癌˙醫學繼續教育,5(2),152-156。
11. 陳啟明(1993)˙早期乳癌病人之乳房保留手術˙醫學繼續教育,3(4),512-516。
12. 曾光毅、李福春(2000)˙現階段的乳癌預防與治療˙基層醫學,15(6),115-119。
13. 蔣欣欣、余玉眉(2001)˙護病間的護為主體性˙國立政治大學哲學學報,7,307-322。
14. 劉思源、沈國樑(1990)˙乳癌的偵查與診斷˙國防醫學,10(5),86-89。
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