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研究生:范秀麗
研究生(外文):HSIU-LI FAN
論文名稱:學前腦性麻痺兒家庭壓力及其相關因素研究
論文名稱(外文):AN exploration of Family Stress and Related Factors in Pre-school Children with Cerebral Palsy
指導教授:章美英章美英引用關係
指導教授(外文):Meiying Chang,RN,Ph.D.
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:長期照護研究所
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:2006
畢業學年度:94
語文別:中文
論文頁數:182
中文關鍵詞:學前腦性麻痺兒家庭功能社會支持因應方式健康狀況家庭壓力
外文關鍵詞:Pre-school children with cerebral palsyfamily functionsocial supportcoping methodshealth statusfamily stress
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本研究之目的在瞭解腦性麻痺兒童及家庭的背景資料與家庭功能、社會支持、因應方式、照顧者健康狀況與家庭壓力之關係,進而探討這些因素與家庭壓力之相關性。以立意取樣方式,選取北部某醫學中心6歲以下腦性麻痺兒童的主要照顧者為抽樣對象。共計有102名母親參與,採結構式問卷,內容包括;病童之個人/家庭基本資料、家庭功能量表、社會支持量表、家庭因應方式量表、中國人健康狀況量表、與家庭壓力與資源量表等6項。所取得資料採SPSS/PC 13.0軟體進行百分比、次數分配、平均值、標準差、變異數分析、皮爾森積差相關、及逐步複迴歸等項統計分析。

研究結論可綜合如下:
一、家庭壓力以源自「父母及家庭問題」與「孩子未來獨立生活感到悲觀」為主。母親年屆35~39較30~34、或病童殘障嚴重度較高者感受家庭壓力愈大。
二、父/母親具較高教育程度、本國籍母親、家庭子女數2位較1位或家庭收入較高者其家庭功能較佳。
三、社會支持包括「專業人員服務」、「社區支持性服務」、「社會福利」與「非正式支持系統」等四類。小家庭、病童1年內有住院、母親年齡≧40歲者較<30歲者、非獨生子女或病童未上學,其家庭對社會支持滿意度較高。
四、因應方式以「問題取向」與「情緒取向」為主。父/母親教育程度高、本國籍母親,其家庭較常使用「問題取向」之方式。
五、母親健康狀況可區分「心理/社會健康」與「生理健康」。母親年齡<30較≧40歲、父親教育程度低或大家庭,母親之「心理/社會健康」狀況較差。
六、家庭功能、社會支持、母親健康狀況與家庭壓力之間呈負相關。即上述3項因素狀況越差或滿意度越低者其家庭整體壓力越大。
七、母親年齡越大、心理社會健康越差或家庭獲得社會支持滿意度越低者,其家庭壓力愈大。此因素可解釋家庭壓力變異量的43.1%。

本研究結果可供護理專業人員於研究、教學與服務參考,也可提供政府在推動、規劃或制訂身心障礙兒童相關福利、教育、衛生政策時之參考。

關鍵詞: 學前腦性麻痺兒 家庭功能 社會支持 因應方式 健康狀況
家庭壓力
The purpose of this study were to explore various factors, found related to the children with cerebral palsy, these including family function, coping methods, social support, family stress and others. To correlate the relationship between those factors and family stress, a purposive sampling taken from the pediatric ward and rehabilitation of outpatient from a medical center located in Taipei area was studied. A total number of 102 patients’ mothers having children with CP aged less than 6 years were involved. The questionnaire requested contained six parts; demographic data, Family Assessment Devices, Way of Coping Questionnaire, Chinese Health Questionnaire, and Questionnaire on Resources and Stress-Short Form. All obtained data were analyzed by a software SPSS/PC 13.0, and the results was also compared further by descriptive analysis on percentage, frequency and inferential analysis on t-test, One-Way ANOVA, Person’s product-moment correlation and stepwise multiple regressions.
A few major findings were summarized as follows:
1. Family stress originated in general from parents and family problems and feeling the pessimism of children’ future independence. Mothers aged at 35~39 agonized the stress more than those aged at 30~34. Also, the higher the severity of the disease, the higher stress of the family stress will be.
2. Parents with higher education, native mothers, family with two children over one, have better family function.
3.Social support comprised professional service, community supporting service, social welfare and informal support. Those family grouped as smaller family, mothers’ age ≧40 over<30 , not singleton were often more satisfied for the social support.
4. Coping methods were often oriented by problems and emotion. Parents with higher education, native mothers or family with higher income often cope with problem oriented.
5. Mother’s health status was either psychological/social or somatic health . Mothers’ aged <30 than ≧40, fathers with lower education, or larger family revealed worse condition in psychological/social health.
6. Family function, social support and mother’s health status showed negative correlation with family stress. The worse in above three categories, the higher the overall family stress will feel.
7. The older the mothers, the lower support in psychological/social health or the less social support received, and the higher the family stress will be. These results explained a portion of 43.1% of the variance in family stress.
In conclusion, the results provided valuable information to professional medical worker on research, teaching and services. The result can also referred to the government while promoting the legislation of welfare, education and health policy for children with physical and psychological disabilities.

Keywords: Pre-school children with cerebral palsy, family function, social support, coping methods, health status, family stress.
第一章 緒論
第一節 研究動機...........................................................................1
第二節 研究目的...........................................................................4
第三節 研究假設.………………………………………………..4
第四節 名詞界定...........................................................................5
第二章文獻探討
第一節 腦性麻痺............................................................................7
第二節 腦性麻痺兒童的家庭壓力...............................................10
第三節 腦性麻痺兒童的家庭功能...............................................22
第四節 社會支持對家庭壓力的緩衝效果....................................28
第五節 腦性麻痺兒童家庭因應方式............................................36
第六節 照顧者的健康....................................................................42
第三章 研究方法
第一節 研究架構...........................................................................54
第二節 研究假設...........................................................................55
第三節 研究設計............................................................................56
第四節 研究對象與場所………………………………………....57
第五節 研究工具............................................................................59
第六節 研究實施步驟....................................................................69
第七節 倫理考量.............................................................................72
第八節 資料統計與分析.................................................................73
第四章 研究結果
第一節 腦性麻痺兒童及家庭基本資料……………………........74
第二節 腦性麻痺兒童、家庭基本屬性與家庭壓力的相關性....80
第三節 腦性麻痺兒童、家庭基本屬性與家庭功能相關性.........83
第四節 腦性麻痺兒童、家庭基本屬性與社會支持相關性….....86
第五節 腦性麻痺兒童、家庭基本屬性與因應方式相關性.........90
第六節 腦性麻痺兒童、家庭基本屬性與照顧者健康狀況相關
性...........................................................................93
第七節 腦性麻痺兒童家庭功能、社會支持、因應方式、照顧者
健康狀況與家庭壓力的相關性…………………………96
第八節 腦性麻痺家庭壓力的預測變項…………………………99
第五章 討論
第一節 研究對象基本屬性不同與家庭功能、社會支持、因應方
式、照顧者健康狀況、家庭壓力之差異.......................101
第二節 家庭功能、社會支持、因應方式、照顧者健康狀況
與家庭壓力的關係...........................................................122
第三節 研究對象家庭壓力之預測因子......................................130
第六章 結論與建議
第一節 結論..................................................................................134
第二節 護理上的應用..................................................................142
第三節 對醫療政策的建議..........................................................145
第四節 研究限制..........................................................................149
參考資料
一、中文部份................................................................................152
二、英文部份................................................................................159
圖表目次
圖2-1家庭壓力理論模式..............................................................15
圖3-1研究概念架構......................................................................53
圖3-2資料收集步驟流程圖……… …………………….............71
圖6-1修訂後研究架構................................................................141
表2-1腦性麻痺成因.………………………………………..…….8
表2-1腦性麻痺國內外護理及福利相關研究.……………….…51
表3-1 各量表Cronbach's Alpha …………………………...........68
表3-2 資料分析步驟..………………………………………........73
表4-1 家庭基本資料..………………………………………........75
表4-2 病童基本資料…………………..………………………....77
表4-3 家庭基本屬性與家庭壓力與資源量表之單因子變異數分
析及t檢定…….………………………………………..…81
表4-4 病童基本屬性與家庭壓力之相關性…..…………………82
表4-5家庭屬性與家庭功能之單因子變異數分析及t檢定……84
表4-6 病童屬性與家庭功能之單因子變異數分析及t檢定...... 85
表4-7家庭基本屬性與社會支持的相關性單因子變異數分析t
及檢定...................................................................................88
表4-8病童基本屬性與社會支持的相關性單因子變異數分析及t
檢定........................................................................................89
表4-9家庭基本屬性與因應方式之單因子變異數分析及t檢定91
表4-10 病童基本屬性與因應方式之相關性.................................92
表4-11家庭屬性與照顧者健康狀況之單因子變異數分
析及t檢定定…………………..………………………...94
表4-12 病童基本屬性與照顧者健康狀況之單因子變異數分析及
t檢定…………………………………………………….95
表4-13 家庭功能與家庭壓力之相關分析.....................................97
表4-14 社會支持與家庭壓力與資源之相關分析.........................97
表4-15 因應方式與家庭壓力與資源之相關分析.........................98
表4-16 照顧者健康狀況與家庭壓力之相關分析…......................98
表4-17 家庭壓力預測 stepwise best model..................................100
表5-1 照顧者曾經出現的身心症狀............................................ 121
表6- 1 台北市身心障礙補助表......................................................147
表6- 2 台北縣低收入戶身心障礙補助..........................................147
附錄
附錄一: 專家效度名單.................................................................. 169
附錄二: IRB通過公文..................................................................170
附錄三: 參加研究同意書................................................................171
附錄四: 病童及家庭基本資料....…………………………………173
附錄四: 家庭壓力與資源量表........................................................175
附錄五: 家庭功能量表....................................................................177
附錄六: 社會支持量表....................................................................178
附錄七: 因應行為量表....................................................................180
附錄八: 中國人健康狀況量表........................................................182
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