臺灣博碩士論文加值系統

本研究採質性研究深入探討六位巴金森氏症(Parkinson＇s Disease，以下簡稱PD)患者之生活適應歷程，其中一位為PD第一階段患者、兩位第二階段患者及三位第三階段患者。研究者透過深入訪談、相關文件分析方式及訪談記錄等工具蒐集資料，據此分析研究參與者在生活適應之危機事件、對該事件之認知處理、調適策略、適應結果以及相關因素與生活適應之關係。 研究結果顯示，研究參與者的生活危機事件主要來自角色改變、未來規劃、人際關係改變、PD疾病本身四方面。家庭或工作角色的改變危機主要來自於研究參與者的能力無法達到角色的要求，而對未來規劃的改變則造成大部分研究參與者感受到角色的責任和壓力，過度依賴醫護人員的治療與關心也使研究參與者承受人際關係改變的危機；此外，來自PD疾病本身的影響與不確定感造成大部份研究參與者之危機來源。 大部分研究參與者對於不同危機事件的負面自動化思考包含了：極端化思考、過度概括化、選擇性斷章取義、擴大與貶低、隨意結論與亂貼標籤，進而作出負向消極的假設，其中的認知基模包括了絕望、放棄、悲觀、自我否定、失望和恐懼。由於無法預測PD的病情發展，大部分的研究參與者對自己的未來、病情、以及人際關係尤其和醫生之間的互動感到憂慮，沒有安全感。另外，PD所帶來的角色改變也讓一部分的研究參與者否定了自我而覺得自己沒有用，並對家人感到歉疚，只求一死百了。然而，其中一位參與者一直堅持一家之主的責任，不逃避疾病，勇敢對危機事件作正向的認知處理面對挑戰。研究參與者對於危機事件負面的認知處理有其相當的一致性，但也有少數持有正向的處理或由初期的負向轉為正向。這顯示研究參與者的認知處理是很複雜的，並不一定僅是單一的處理。 至於研究參與者對危機所採取的調適策略可歸納為：調適工作和因應技巧。調適工作分成處理疼痛和其他症狀、處理醫院環境和特殊治療程序以及培養及維繫與健康照顧人員適當的關係；因應技巧包括著重認知和問題的因應技巧以及情緒的應付。情緒的因應技巧為研究參與者普遍採用的調適策略；在同一危機事件下，研究參與者有時會兼用兩種以上的策略，而通常是兼具認知、問題及情緒應付的策略。 根據研究參與者對於危機事件的適應結果，可以發現即使不同研究參與者使用相同屬性的調適策略，其危機適應結果也會有所不同；當採用的策略造成危機事件的適應結果不佳時，會影響研究參與者的適應；即使有採取調適策略，若是環境因素對其不利時，仍無法解除或減輕研究參與者的危機。 在生活適應的相關因素方面，研究結果顯示，個人因素中，研究參與者有角色責任的自我要求、自己設定的目標或是其他的個人承諾，當無法達成時便會造成危機；若預期自己對事件結果的掌控不佳時，往往會使其採取較為消極的調適策略；當其將事件的原因歸因於PD時，通常會被認知處理為有危機的事件，也會影響部分研究參與者採取的調適策略。此外，研究參與者的PD階段和疾病認知，對其在不同方面的生活適應有密不可分的關係；而社交互動較依賴醫生時，人際關係也常是危機來源。另外，研究參與者的年齡、性別、社經背景及宗教信仰亦影響其適應。在環境因素中，家人的角色期待是一家之主的責任與工作，當研究參與者無法達成這些期待時，便會造成危機；研究中也發現，若是研究參與者有很好的社會支持系統，他們的危機便能得以減輕。 最後本研究依據研究的結果與發現針對PD患者的本身、家人及醫療、社工單位提出相關建議，包括：協助PD患者尋找自我存在與受苦的價值和意義、加強PD患者家人疾病認知和壓力調適的能力以及建立PD患者及其家人的支持系統。此外，也對未來進行PD患者生活適應歷程相關研究提出幾點建議。

The purpose of this research was to explore the life adjustment process of six patients with PD. The participants were three males, among which three were stage 3 of PD, two were stage 2, and one was stage 1. The qualitative research method was employed and the data was gathered by in-depth interviews, personal documents and reflective journals. The results indicated that the main crisis events the participants encountered in their life after getting PD included three changes: role playing, interpersonal relationship, and future plan and the disease itself. Mainly the crisis of role playing derived from the participants’ failure on achieving the responsibility of the roles they played in the family or job. The uncertainty for the future plan was another crisis faced by the participants. In addition, depending too much on doctors’ curing and caring was the crisis event of interpersonal relationship. The influence of the physical and mental from PD itself was also identified. In the cognitive processing of the different crisis events, negative automatic thinking, which the participants explicated, included polarized thinking, overgeneralization, selective abstraction, magnification and minimization, arbitrary inference, and labeling and mislabeling or two or more of the above. And then they made conditional or unconditional hypotheses. All of them arose from core belief which contained fear, desperation, pessimism, disappointment, and denial. Although most of the participants had such the way of negative thinking process, some of them still got positive thinking from the start or turned the negative to the positive. This complexity revealed that the participants might not only adopt single cognitive processing. For instance, some participants were mentally hurt by the impairment resulted from PD. Some might complain about their disability that caused the feeling of hatred, loss, and denial, whereas some took it as a challenge or something common. Conflict between the participants’ expectation and the fact was also appraised as a crisis event. The attributes of the adaptive strategies which the participants adopted include adaptation work and coping skills. Adaptation work was composed of dealing with pain or other symptoms from PD, the special cure, and developing and maintaining the relationship with the health carers. The participants generally adopted one or two of them. And coping skills was divided into three domains: the cognitive, problem-solving, and emotional. In the life adjustment process, the participants sometimes adopted two or more skills, whichincluded problem-focused and emotion-focused skills. The conclusions of the participants’ adjustment outcomes showed that different participants using the same strategy might cause different outcomes. Personal factors were connected with the life adjustment of PD patients. When the participants couldn’t achieve their own commitment or expectations, the crisis events appeared. When the participants predicted that they couldn’t control the outcomes well, they generally adopted passive adaptive strategies. When the participants thought that the event was caused by their disease, they generally considered it a crisis event. Furthermore, Obviously different steps of PD and common knowledge and concept of PD were associated with different aspects of life adjustment. And if the participants depended too much on social interactions with doctors, they usually had the crisis on interpersonal relationship. Besides, their age, sex, social and economic background, and religion also have something to do with the life adjustment. Among environmental factors, if they couldn’t behave the way their roles were requested to be , it would cause crises. Finally, if they had the good social support system, it could reduce their crises. Finally, according to the findings of the research, some suggestions for PD patients, their family, and the associations of the medical and social workers were made below. Patients with PD were encouraged to look for their self-value or the reason why they lived. The family of the PD patients were assisted to learn how to cope with the pressure PD had brought them, and what PD was about. As for the associations of the medical and the social workers, they were required to be in charge of the support system. The suggestions were also made if you would like to make the related research .

謝誌 ……………………………………………………………………… I
摘要 ……………………………………………………………………… II
英文摘要 ……………………………………………………………………… V
總目錄 …………………………………………………………………… VII
表次 ……………………………………………………………………… IX
圖次 ……………………………………………………………………… X
附錄次 ……………………………………………………………………… XI
第一章 緒論
第一節 問題背景與研究動機 …………………………………………………1
第二節 研究目的與待答問題 …………………………………………………6
第三節 名詞釋義 ………………………………………………………………6
第二章 文獻探討
第一節 巴金森氏症患者身心症狀與疾病危機 ……………………………10
第二節 生活適應的概念與指標………………………………………………18
第三節 生活適應歷程…………………………………………………………25
第四節 生活適應歷程之相關因素……………………………………………31
第五節 巴金森氏症患者的調適及其相關因素………………………………36
第三章 研究方法
第一節 研究設計與架構………………………………………………………42
第二節 研究參與者……………………………………………………………46
第三節 研究場所………………………………………………………………54
第四節 研究工具………………………………………………………………55
第五節 研究程序………………………………………………………………64
第六節 資料蒐集………………………………………………………………69
第七節 資料分析………………………………………………………………71
第八節 研究倫理………………………………………………………………76
第四章 結果與討論
第一節 研究參與者之生活危機事件 ………………………………………78
第二節 危機事件之調適歷程 ………………………………………………94
第三節 個人及環境因素與生活適應關係之探討 ………………………130
第四節 綜合討論 ……………………………………………………………150
第五章 結論與建議
第一節 結論 ………………………………………………………………163
第二節 建議 ……………………………………………………………167
第三節 研究限制 …………………………………………………………169
後記 …………………………………………………………………………172
參考文獻 ……………………………………………………………………177

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