中文摘要
健康是護理之家老人調適經驗中其最關注的議題，發展同時考量個人及環境因素的介入性方案來提升其適應以促進健康有其必要。本研究目的旨在探討整合性介入性方案對提昇護理之家住民調適經驗(健康)之成效。研究設計採類實驗法，以立意取樣共選取16家護理之家105位符合收案條件之個案進入各組：對照組(50位)、視訊組(24位)、尊嚴組(21位)及整合組(尊嚴及視訊組)(10位)。尊嚴組個案接受連續四天一對一的尊嚴療法，每次會談時間20分鐘；視訊組個案接受每週一次，每次至少5分鐘的視訊會議，共三個月；整合組個案先接受連續四天尊嚴療法，每次會談時間20分鐘，再接受每週一次，每次至少5分鐘的視訊會議方案，為期共三個月；對照組的個案則維持護理之家的常規照護，包含一般生活照護及專業護理及醫療照護，並無任何介入性措施。每組都有三次測量：前測、前測後一星期及三個月，評估量表包括Rosenberg自尊量表、社會支持行為量表、歐盟生活品質量表、身體活動功能量表、老人憂鬱量表及UCLA孤寂量表。以廣義估計方程式(Generalized Estimating Equation)來比較四組(對照組、視訊組、尊嚴組、整合組)在三個施測點之差異。結果發現：尊嚴療法可以提升住民一星期及三個月的自尊和改善一星期及三個月的孤寂；而雖可改善一星期的憂鬱，但在第三個月的憂鬱改善未達統計顯著意義。視訊會議可提升住民在情感性及贊同性社會支持，且達統計上的顯著意義，並能提升一星期及三個月的自尊及改善孤寂和三個月的憂鬱。整合性介入方案可以改善一星期及三個月的自尊，且較單獨實施尊嚴療法對自尊提升成效較佳；並能改善一星期及三個月的憂鬱，且較單獨實施尊嚴療法對憂鬱改善成效為佳；此方案亦可提升住民情感性及贊同性社會支持，且較單獨實施視訊方案效果為佳。雖各組對孤寂較對照組改變量皆達統計上顯著差異，但以整合組改善最多。由此結果建議可推廣整合性方案於護理之家住民以有效改善孤寂和憂鬱及提升自尊；此外，可單獨推行尊嚴療法或視訊以提升住民自尊和改善孤寂。最後，建議可進一步推廣視訊方案於活動功能較好的長期照護機構住民，以提升機構住民的健康。
關鍵字: 整合性介入性方案、視訊會議、尊嚴療法、護理之家、老人

ABSTRACT
Nurture health is the major theme among the nursing home elderly residents’ adjustment experience. It is a need to develop an integrated program that included individual and environment part to enhance their health. The purpose of this study was to conduct a quasi-experiment design to evaluate the effectiveness of an integrated intervention program in improving nursing home residents’ adaptation outcomes (health). A total of 105 elderly residents were recruited from 16 nursing homes and divided into four groups: dignity therapy group (n=21), videoconference group (n=24), integrated group (dignity therapy plus videoconference) (n=10), and control group (n=10). The dignity therapy group received a 20 minutes dignity therapy per day last for 4 days. The videoconference group received 5 minutes videoconference per week for 3 months. The integrated group received both dignity therapy and videoconference; while the control group didn’t receive any treatment. During face-to face interviews, Rosenberg Self-Esteem Scale, Social Supportive Behavior Scale, The European Quality of Life Scale (EQ-5D), Activity of Daily Living Scale, Geriatric Depression Scale, and University of California Los Angeles Loneliness Scale were used for data collection at three points (baseline, 1 week, and 3 months after the baseline). Generalized Estimating Equation was used to analyze the data. The results revealed that dignity therapy significantly reduced subjects’ loneliness at 1 week and 3 months after the baseline, and increased their self-esteem both at 1 week and 3 months after the baseline, but only reduced their depression at 1 week after the baseline. Videoconference significant increased subjects’ emotional and appraisal social support. It also increased subjects’ self-esteem and reduced loneliness at 1 week and 3 months after the baseline, and reduced their depression at 3 months after the baseline. The integrated group program significant reduced subjects’ loneliness and depression, and increased their self-esteem both at 1 week and 3 months after the baseline, and had better effect than either dignity therapy or videoconference group alone. Based on the results, the author suggests applying the integrated group to improve nursing home residents’ self-esteem and depression, and reduced their loneliness. It is also suggested to apply either the dignity therapy or videoconference to enhance these residents’ self-esteem and improve their loneliness. Finally, it may be useful to provide the videoconference program to those residents living in long-term care institutes who have better function in activities to promote their health.

Key words: Integrated program, nursing home, videoconference, dignity therapy, elderly

目 錄
指導教授推薦書………………………………………………………
口試委員會審定書……………………………………………………
長庚大學博碩士論文著作授權書……………………………………...iii
致謝……………………………………………………………………...iv
中文摘要………………………………………………………………...v
英文摘要……………………………………………………………......vii
目錄……………………………………………………………………...ix
表目錄………………………………………………………………….xiii
圖目錄……………………………………………...…………………...xv
第一章 緒論……………………………………………………………1
　 第一節 研究動機及重要性…………………………………..1
　 第二節 研究目的……………………………………………..5
第三節 名詞解釋……………………………………………..5
第二章 文獻查證………………………………………………………7
　 第一節 護理之家之生活狀況………………………………..7
一、老年人的生活文化……………………………..7
二、護理之家的適應………………………………..8
第二節 護理之家住民之健康狀況及影響因素…………......9
一、身體健康……………………………………....10
二、心理社會健康…….………………………...…10
第三節 護理之家之介入措施……………………………....11
ㄧ、個人能力……………………………………....12
(一)尊嚴療法…………………………………...13
二、社會支持…………………… …………….......17
(一)社會支持………………………………….17
(二)社會支持之介入性措施………………….17
第四節 文獻總結……………………………………………19
第五節 研究架構……………………………………………20
第六節 研究假設……………………………………………21
第三章 研究方法……………………………………………………..23
　 第一節 研究設計……………………………………………23.
第二節 介入性方案介紹……………………………………23
一、尊嚴療法方案…………………………………24
二、視訊會議方案…………………………………24
三、整合組方案……………………………………26
四、對照組方案……………………………………26
第三節 樣本及樣本數………………………………………26
一、研究對象與收案場所…………………………26
二、收案條件………………………………………27
第四節 研究工具……………………………………………29
一、基本資料……………………………………...29
二、自尊及社會支持……………………………...29
三、健康測量……………………………………...31
第五節 研究步驟……………………………………………33
第六節 資料分析……………………………………………33
第七節 研究倫理……………………………………………34
ㄧ、研究同意書……………………………………34
二、利益原則………………………………………34
三、隱私權…………………………………………35
第四章 結果…………………………………………………………..36
第一節 研究對象基本屬性…………………………………37
一、研究對象社會人口學特性……………………37
二、研究對象自尊及社會支持狀況.. …………….38
三、研究對象健康狀況...………………………….40
第二節 介入性措施對自尊及社會支持之影響……………40
一、介入措施對自尊之影響………………………40
二、介入措施對社會支持之影響…………………41
第三節 介入性措施對健康之影響…………...…………….42
一、介入性措施對整體健康之影響………………42
二、介入性措施對身體活動功能之影響…………43
三、介入性措施對心理社會健康之影響…………44
第四節 質性資料結果………………………………………45
第五章 討論…………………………………………………………..47
第一節 研究參與率…………………………………………47
第二節 研究對象基本屬性…………………………………48
第三節 介入性措施對自尊及社會支持影響之探討………50
第四節 介入措施對健康影響之探討………………………52
第五節 質性研究結果………………………………………54
第六章 結論與建議…………………………………………………..56
第一節 結論…………………………………………………56
第二節 研究結果在護理上的應用…………………………56
第三節 研究限制與未來研究方向之建議…………………57
一、研究對象………………………………………57
二、研究方法………………………………………57
參考文獻………………………………………………………………..59
附件一 尊嚴療法訪談大綱………………………………………..111
附件二 視訊使用手冊……………………………………………..113
附件三 研究問卷…………………………………………………..140
附件四 EQ-5D同意書…………………………………………….. 149
附件五 受試者同意書 …………………………………………..150

表目錄
表3-1 研究設計…………………………………………………...23
表3-2 社會支持量表之信度分析………………………………...74
表4-1 護理之家總收案一覽表…………………………………...75
表4-2 拒絕參與研究之護理之家所在縣市及理由……………...76
表4-3 研究對象社會人口特性…………………………………...77
表4-4 研究對象社交互動………………………………………...82
表4-5 研究對象社會支持行為及支持來源……………………...84
表4-6 研究對象前測整體、身體及心理社會健康狀況………….85
表4-7 自尊在前測、一星期、三個月之數據……………………86
表4-8 介入措施對自尊在一星期、三個月之成效………………87
表4-9 調整組別及時間效應對自尊結果………………………...88
表4-10 社會支持在前測、一星期、三個月之數據………………89
表4-11 介入措施對社會支持參數在一星期、三個月之成效……94
表4-12 調整組別及時間效應對社會支持各參數結果…………...98
表4-13 整體健康(EQ-5D)在前測、一星期、三個月之數據….....99
表4-14 介入措施對整體健康在一星期、三個月之成效....……..100
表4-15 調整組別及時間效應對整體健康結果…..……………...101
表4-16 身體活動功能(ADL) 在前測、一星期、三個月之數據…102
表4-17 介入措施對身體活動功能在一星期、三個月之成效….103
表4-18 調整組別及時間效應對身體活動功能結果…………….104
表4-19 憂鬱(GDS) 在前測、一星期、三個月之數據………….105
表4-20 介入措施對憂鬱在一星期、三個月之成效…………….106
表4-21 調整組別及時間效應對憂鬱結果……………………….107
表4-22 孤寂(UCLA) 在前測、一星期、三個月之數據………..108
表4-23 介入措施對孤寂在一星期、三個月之成效…………….109
表4-24 調整組別及時間效應對孤寂結果…...…………………..110

圖目錄
圖2-1 研究架構………………………………………………...…21
圖3-1 研究流程圖………………………………………………...28
圖4-1 自尊在前測、一星期、三個月之數據…………………….86
圖4-2 社會支持總量在前測、一星期、三個月之數據. …….......91
圖4-3 社會支持之訊息性在前測、一星期、三個月之數據……..91
圖4-4 社會支持之贊同性在前測、一星期、三個月之數據……..92
圖4-5 社會支持之情緒性在前測、一星期、三個月之數據….….92
圖4-6 社會支持之工具性在前測、一星期、三個月之數據….….93
圖4-7 整體健康(EQ-5D)在前測、一星期、三個月之數據…...….99
圖4-8 身體活動功能(ADL) 在前測、一星期、三個月之數據…102
圖4-9 憂鬱(GDS) 在前測、一星期、三個月之數據………….105
圖4-10 孤寂(UCLA) 在前測、一星期、三個月之數據……….108

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