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研究生:林冠群
研究生(外文):Lin, Guan-Chun
論文名稱:台灣東南亞籍早產母親與醫護人員之溝通狀況--以北部地區某醫學中心新生兒科為例
論文名稱(外文):A Study about the Communication between the Southeast Asian Mothers of Preterm Infants in Taiwan and the Health Care Personnel -Case Studies of the Neonatology of a Medical Center in North of Taiwan
指導教授:邱玉蟬邱玉蟬引用關係
指導教授(外文):Chiu, Yu-Chan
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2006
畢業學年度:95
語文別:中文
論文頁數:134
中文關鍵詞:病醫溝通新移民女性早產
外文關鍵詞:Patient-Phusycian CommunicationSoutheastasian Immigrant FemalePremature Delivery
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自1980年代以來,新移民女性及其所產下的「新台灣之子」便已成為我國人口組成相當重要的一份子。在面臨文化差異、環境適應、角色認同、語言隔閡、心理調適或經濟困境等問題之際,這群新移民女性同時必須面對懷孕、生產等重大轉變所造成的巨大壓力;若她們不幸產下早產兒,除了面對上述壓力,更多外在環境與心理挫折勢必成為其嚴苛的挑戰,對於新生兒住院期間病醫雙方溝通也將造成更深遠的影響。即便如此,國內目前針對東南亞籍早產媽媽與醫護人員溝通狀況之研究依然付之闕如,病醫雙方倘面臨溝通問題或溝通障礙,亦難以藉由公正客觀的研究發現作為參考建議,幫助雙方克服溝通障礙。是故,本研究於民國94年7月起至95年5月,分兩階段於北部地區某醫學中心新生兒加護病房,以臨床追蹤觀察及深入訪談等質性研究方法了解東南亞籍早產母親在新生兒住院期間與醫護人員之溝通狀況。
透過第一階段六名個案初步了解狀況以及第二階段六名個案深入分析探討後發現,東南亞籍早產媽媽常因為家人限制出門、給予的支持不足、態度看法、說話語氣、以及對其家庭角色的期待而影響她們到院探視寶寶、與醫護人員建立關係、溝通意願、態度與溝通狀況,進而引發家庭角色、社會角色及情緒等溝通障礙。醫護人員方面,則可能因為病醫雙方語言能力不足、溝通表達用語、溝通方式、說話語氣與態度及溝通對象等而造成社會角色、情緒、語言、理解與醫療專業知識等障礙。綜合各種溝通障礙發現,各影響與被影響因素彼此息息相關、相互影響,因而各種內外在因素時常演變成為病醫溝通過程中的惡性循環,以致於雙方溝通問題更形嚴重。
相較於這些溝通障礙,包括資訊流通、家人與醫護的支持鼓勵、醫療科技發達、健保政策健全和宗教支持等因素,則能某種程度地幫助東南亞籍早產媽媽克服情緒感受與理解困難等問題。
透過本研究也可以了解到,無論是負面影響或正面助益,家人、醫護人員、乃至於社會等外在環境,都是影響東南亞籍媽媽的原由;換言之,東南亞籍媽媽臨床所面臨的溝通問題,不僅不是肇因於她們個人能力或教育程度的不足,相反的,更是社會整體問題所導致的結果。
Since the year 1980, the number of foreign brides from Southeast Asia and their children is keeping on increasing in Taiwan. Besides of the pressures from cultural differences, acclimations, identification of social and familial role, language barrier, psychological and economical problems, the foreign brides also have to adapt themselves to face the stress because of being pregnant and birthing. If they give birth to a premature baby unfortunately, more pressures and frustrations will become their draconian challenges and affect the communication between them and the health care personnel vastly when the newborn baby stays in neonatal intensive care unit.
Even then, there is also too little researches in Taiwan, which focus on the communication between Southeast Asian mothers and the health care personnel, and thus can not help the clinical personnel to improve their communication with foreign patients. Based on this situation, from July 2005 to May 2006 this study investigated the communication situations and problems between the Southeast Asian mothers of premature infants and the health care personnel in a NICU of a Medical Center in North of Taiwan through bedside participant observation and in-depth interviews with semi-structured guidelines.
After the descriptive and interview data were induced and analyzed, this study finds many factors, which limit and affect Southeast Asian mothers visiting babies, cultivating the relationship and their will and attitude to communicate with the clinical personnel. The main findings of this study were listed follows:
1. The most Southeast Asian mothers’ freedom to leave home is abridged by their in-laws families. Thus they have not enough time and chance to visit baby or cultivate the relationship with the clinical personnel. Besides, their in-laws families give them often insufficient support. The attitude, estimation, manner of speaking and expectation of familiar role from their in-laws families also influence their communication with the clinical personnel. Altogether, these all may solicit Southeast Asian mothers’ familial, social and emotional patient-physician communication barriers.
2. The clinical personnel might not fully comprehensive foreign languages and the Southeast Asian mothers of premature infant might speak Chinese not so fluently or understand not so well, this could also affect their communication. Furthermore, clinical personnel’s expression, mode and object communication(for example: communicate with the husband or families of Southeast Asian mothers but not with them), attitude, tone or manner of speaking could also cause Southeast Asian mothers’ social, emotional, linguistic, perceptive and medical professional knowledge communication barriers.
3. After synthesize the above factors we can understand, all factors are closely bound up and interact each other. These external factors and the internal factors of Southeast Asian mothers often evolve into vicious circles of the patient-physician communication. As a result this may also make the problems of communication between Southeast Asian mothers and clinical personnel much more seriously.
4. Except to the factors that induce communication barriers, the information flow, support and encouragement from families and health care personnel, progressive medical science and technology, well health insurance policy and religion believes can more or less help Southeast Asian mothers to overcome their emotional and comprehensive problems when they face and communicate with the clinical personnel.

Through the findings of this research we can understand, no matter negative affections or positive support and assistances, families, health care personnel and even the whole society are all the reasons, which influence the communication between Southeast Asian mothers and health care personnel. In other words, the communication problems, which the Southeast Asian mothers face on bedside, are not because of their insufficient personal ability or deficiency of the education. On the contrary, all these problems are induced from our society and are the result of the whole social structure.
指導教授推薦書 ……………………………………………………………………………i
口試委員會審定書 …………………………………………………………………………ii
國家圖書館授權書 …………………………………………………………………………iii
長庚大學授權書 …………………………………………………………………………… iv
誌謝 ………………………………………………………………………………………… v
中文摘要 …………………………………………………………………………………… vi
英文摘要 …………………………………………………………………………………… vii
目錄 …………………………………………………………………………………………ix
圖表目錄 …………………………………………………………………………………… x

第一章 緒論 …………………………………………………………………………… 1
第一節 研究背景 …………………………………………………………… 1
第二節 研究目的與預期貢獻 ……………………………………………… 3
第二章 文獻探討 ………………………………………………………………………… 6
第一節 早產兒相關現況及其雙親病醫溝通狀況 ………………………… 6
第二節 跨文化互動 ………………………………………………………… 9
第三節 影響移民接受照護及跨文化病醫關係的因素 …………………… 11
第四節 醫護人員對早產兒雙親之影響及關係 …………………………… 14
第五節 文化照護理論 ……………………………………………………… 16
第六節 文獻探討總結 ……………………………………………………… 21
第三章 研究問題與研究設計 …………………………………………………………… 24
第一節 研究問題 …………………………………………………………… 24
第二節 研究方法與設計 …………………………………………………… 24
第三節 研究流程 …………………………………………………………… 28
第四節 收案結果 …………………………………………………………… 29
第四章 收案內容與研究分析 …………………………………………………………… 34
第一節 家人的態度看法影響媽媽與醫護互動心情和態度 ……………… 34
第二節 病醫雙方溝通方式與狀況 ………………………………………… 41
第三節 心情與哲學靈性影響媽媽對醫護的態度與評價 ………………… 61
第四節 我國外籍早產雙親病醫溝通狀況與國外有所差異 ……………… 72
第五節 醫療與資訊發達促進媽媽對醫護信心與溝通能力 ……………… 80
第六節 綜合討論 …………………………………………………………… 89
第五章 研究發現、結論與反思建議 …………………………………………………… 101
第一節 研究發現 …………………………………………………………… 101
第二節 研究結論與建議 …………………………………………………… 107
第三節 研究限制與反思 …………………………………………………… 116
第四節 未來研究方向建議 ………………………………………………… 118
參考文獻 …………………………………………………………………………………… 120
附錄 ………………………………………………………………………………………… 125
1. 東南亞籍媽媽訪談大綱 ………………………………………………… 125
2. 護理人員訪談大綱 ……………………………………………………… 128
3. 臨床觀察到照護習慣與生活習俗的差異 ……………………………… 130
4. 國內東南亞籍早產兒媽媽國籍取得之概況與心得 …………………… 133
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中華民國全國法規資料庫(2006,1月27日)˙中華民國國籍法全文條例˙2006年7月13日取自
http://law.moj.gov.tw/Scripts/NewsDetail.asp?no=1D0030001
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李慧貞、蘇秀娟、許芷音(2004)˙外籍新娘的健康評估—以新店市為例˙護理雜誌,51(4),88-93。
夏曉鵑(2000)˙資本國際化下的國際婚姻—以台灣的「外籍新娘」現象為例˙台灣社會研究季刊,39,45-92。
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鄒國英(2005,4月)˙台灣極低出生體重兒追蹤檢查十年發表—極低出生體重兒罹病及存活率六年之變化˙早產兒基金會主辦,早產兒追蹤檢查十週年成果發表暨記者會˙台北:馬偕紀念醫院。
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