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研究生:梁哲源
研究生(外文):Zhe-yuan Liang
論文名稱:醫生言談類別分類及其在醫病溝通之應用─以兒童臨床牙科治療為例
論文名稱(外文):Classification of Dentists' Types of Talk and Their Application in Doctor-patient Conversation—In the Case of Pediatric Dental Treatment
指導教授:高實玫高實玫引用關係
指導教授(外文):Shin-Mei Kao
學位類別:碩士
校院名稱:國立成功大學
系所名稱:外國語文學系碩博士班
學門:人文學門
學類:外國語文學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:英文
論文頁數:126
中文關鍵詞:醫療重心語醫療相關語關係語訊息蘊含度情感度臨床言談寒暄語機構言談多功能分法連續線關聯度
外文關鍵詞:continuumphaticityrelevancephatic communionmedicine-related talkinformativityrelational talkmedicine-focused talkinstitutional discourseclinical discoursemultifunctionality
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在牙科診治過程中,高度牙科畏懼的兒童患者時常表現出不合作的行為,然而文獻指出牙醫師的話語內容對兒童患者的行為,尤其對看牙科很恐懼的兒童,有很大的影響 (Nash, 2006)。不過至今鮮少文獻研究兒童患者的畏懼程度、年齡和性別對醫師的言談類別比例的影響。此外,過去文獻對言談類別分類的定義不ㄧ。過去文獻對言談類別分類持兩種不同意見:二分法與多功能分法。支持多功能分法的學者認為二分法過於簡化機構言談的複雜性。支持多功能派,Holmes (2000) 針對工作場合言談提出一種以連續線概念的言談類別分類法,在這連續線上的兩端為「以公事為主語」及「寒暄語」這兩種言談類別。以Holmes (2000)所提的連續線概念架構為基礎,本研究旨在針對臨床言談提出適合的言談類別分類架構,進而研究三組變項關係:兒童牙醫師的言談類別與兒童患者畏懼與不合作程度的關係、兒童牙醫師的言談類別與兒童患者年齡的關係及兒童牙醫師的言談類別與兒童患者性別的關係。研究對象為2名兒童牙科醫師(ㄧ男,一女)及13名兒童牙科患者(七男孩,六女孩);語料收集地點為高雄某ㄧ私人牙科診所。根據在小兒牙科收集的語料,本研究提出ㄧ個矩陣架構。此矩陣架構為三個言談分類標準及四個言談類別組成。這三個言談分類標準分別為「關聯度」、「情感度」及「訊息蘊含度」;此四個言談類別分別為「醫療重心語」、「醫療相關語」、「關係語」及「寒暄語」;這三個分類標準分類出這四個在連續線上的言談類別。以這些言談類別為主,本研究量性分析用Spearman相關分析以求得上述三組變項間的關係。研究結果發現以下四點顯著關係:
1. 兒童牙醫師的關係語和兒童患者的畏懼與不合作程度呈現顯著負相關。
2. 兒童牙醫師的醫療相關語和兒童患者的畏懼與不合作程度呈現顯著正相關。
3. 兒童牙醫師的醫療相關語和兒童患者的年齡呈現顯著負相關。
4. 兒童牙醫師的關係語和男兒童患者的畏懼與不合作程度呈現顯著負相關;兒童牙醫師的醫療相關語和女兒童患者的畏懼與不合作程度呈現顯著正相關。
由此可見,兒童牙醫師的言談類別對兒童患者在診治過程中的表現有很大的影響。這些結果可藉由考慮兒童的發育變化及兒童社會化過程所造成的性別差異來解釋。本研究針對醫療環境下的語言使用提出了一個較明確且可量化的分析架構,並透過量化分析來解釋兒童牙醫師的言談類別與兒童患者畏懼與不合作程度、年齡和性別之動態關係。
Previous literature points out that the content of dentists' talk influences the behavior of the child patients, especially that of the anxious ones (Nash, 2006). However, few studies have been conducted to examine the effects of anxiety, age, and gender of child patients on the talk types of dentists. Two distinct views concerning the talk types have been proposed: dichotomy and multifunctionality. In favor of multifunctionality, Holmes (2000) proposes a continuum with the “core business talk” and “phatic communion” at the two ends based on workplace discourse. By modifying the continuum framework proposed by Holmes (2000), the present study aims to create a suitable framework of talk types in clinical discourse, and to investigate the relationships of three sets of variables: the correlation of the talk types of the pediatric dentists with (1) the anxiety and non-cooperativity levels, (2) age, and (3) gender of their child patients. The data were obtained from 13 treatment sessions conducted by two pediatric dentists (one male and one female) with their child patients (7 boys and 6 girls) at a private dental clinic in Kaohsiung City, Taiwan. Based on the collected data, a matrix system was developed. This matrix is composed of three criteria, relevance, phaticity, and informativity, for locating four talk types of the pediatric dentists on a continuum from medicine-focused talk, medicine-related talk, relational talk to phatic communion. Based on the talk types, the quantitative analysis was conducted through Spearman correlation to find the relationships between the three sets of variables aforementioned. The major findings are as follows.
1. A significant and negative correlation was found between relational talk of the pediatric dentists and the anxiety and non-cooperativity levels of their child patients.
2. A significant and positive correlation was obtained between medicine-related talk of the pediatric dentists and the anxiety and non-cooperativity levels of their child patients.
3. A significant and negative correlation was found between medicine-related talk of the pediatric dentists and the age of their child patients.
4. A significant and negative correlation was found between relational talk of the pediatric dentists and the anxiety and non-cooperativity levels of the boys, while a significant and positive correlation was obtained between medicine-related talk of the pediatric dentists and the anxiety and non-cooperativity levels of the girls.
These findings demonstrate that the talk types of the pediatric dentists have a great effect on the performance of the child patients. These results may be explained by considering developmental changes in children and the gender difference in their socialization processes. In conclusion, this study may be of importance in providing a more specific and quantifiable coding system, as well as explaining the dynamic relationships of the talk types of the pediatric dentists with the anxiety and non-cooperativity levels, age, and gender of their child patients through quantitative analysis of the coding system.
TABLE OF CONTENTS
ABSTRACT (Chinese) i
ABSTRACT (English) iii
ACKNOWLEDGEMENTS v
TABLE OF CONTENTS vi
LIST OF TABLES ix
LIST OF FIGURES x


CHAPTER ONE INTRODUCTION 1
Motivation and Background 1
Purposes of the Study 6
Research Questions 8
Significance of the Study 8
Limitations of the Study 9
Definition of Terms 10

CHAPTER TWO LITERATURE REVIEW 13
Background of Doctor-child Conversation 13
The Current Debate on Structure Analysis of Talk: Dichotomy and Multifunctionality 15
Dichotomy between Phatic Talk and Non-phatic Talk 16
Multifunctionality: Degrees of Focus on Task and Phaticity 18
Anxiety in Child Dental Settings 25

CHAPTER THREE METHODOLOGY 29
Participants 29
Data Collection 30
The Methodological Approach 30
Procedures 31
Pilot Study 33
Measuring Unit and Data Coding 33
Measurement Unit of Talk Types 34
Coding Procedures of Talk Types 36
Clinical Anxiety Scale and Cooperative Behavioral Scale 38
Data Analysis 39
Criteria for the Identification of Talk Types on a Continuum 40
Principles of Determining the Degrees of the Three Criteria 41
Interactional Sociolinguistics and the degrees of relevance. 41
Politeness principle and the degrees of phaticity. 45
Discourse analysis framework and the degrees of informativity 49
Summary of the degrees of relevance, phaticity, and informativity. 52
A Continuum of Talk Types 54
Coding Matrix System 55
Statistical Analysis 57
Summary of the Study Procedures 59

CHAPTER FOUR RESULTS AND DISCUSSION 60
Demonstration of Talk Types on the Continuum 61
Medicine-focused Talk 61
Medicine-related Talk 64
Relational Talk 70
Phatic Communion 76
Percentage of the Talk Types in Dentist-child Conversation 81
Correlation between the Talk Types and the Levels of Anxiety and Non-cooperativity 84
Correlation between the Talk Types and the Age 86
Correlation between the Talk Types and the Gender 88
Summary and Discussion 91
Discussion on the Matrix System 92
Discussion on the Proportion of the Talk Types in Dentist-child Conversation 95
Discussion on the Correlation between the Talk Types and the Levels of Anxiety and Non-cooperativity 97
Discussion on the Correlation between the Talk Types and the Age of the Child patients 99
Discussion on the Correlation between the Talk Types and the Gender of the Child patients 101

CHAPTER FIVE CONCLUSIONS AND IMPLICATIONS 104
Summary of the Talk Types of the Pediatric Dentists and the Anxiety and Non-cooperativity Levels, Age, Gender of the Child Patients 104
Implications of the Study 107
Suggestions for Future Research 108

REFERENCES 111


APPEDICES
Appendix A 122
Appendix B 123
Appendix C 124
Appendix D 125
Appendix E 126
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