臺灣博碩士論文加值系統

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

參考文獻
中文部份
王月伶( 2005)．健康概念分析．護理雜誌，52(1)，40-43。
王秀紅、王瑞霞、邱啟潤、李建廷(1992) ‧婦女健康促進行為及其相
關因素的探討‧公共衛生，9(3)，251-266。
行政院衛生署(2008) ‧94年醫療機構及其他醫事機構概況‧
2009/07/13取自
http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_li
st_no=10306&class_no=440&level_no=4
內政部(2006) ‧97年台灣老人狀況調查報告‧2009/07/31取自
http://sowf.moi.gov.tw/stat/indices/list.xls
周月清、王增勇、林麗嬋 (2007) ‧老年婦女照顧負擔與社會支持之
研究─以智障者和精神障礙者老年女性照顧者為例‧內政部委託
研究報告。
劉景寬、戴志達、林瑞泰、賴秋蓮(2000) ‧臺灣失智症的流行病
學‧應用心理研究， 7，157-169。
呂寶靜(2000) ‧人朋友網絡支持功能之初探‧社會政策與社會工作學
刊，4(2)，43-90。
吳惠鈴(2008) ‧尊嚴療法對護理之家老年住民自尊、憂鬱、靈性安適
與自覺健康狀況之成效‧未發表之碩士論文，桃園：長庚大學護
理研究所。
黃文玲(2004) ‧公費安療養機構老人憂鬱與睡眠品質之探討‧未發表
之碩士論文，桃園：長庚大學護理研究所。
許毅貞(1993)‧鹿港地區65-74歲社區老人態度、社會支持、健康
狀態與憂鬱程度之相關研究‧未發表之碩士論文‧台北：台灣師
範大學衛生教育研究所，。
張惠蓉、何玫樺、黃倩茹(2008) ‧線上社會支持類型探討：
神疾病版及整型美容版為例‧新聞學研究，94，61-105。
經濟部工業局 (2008) ‧台灣家戶網路應用調查‧台北:經濟部。
顧艷秋、劉文健(2005)‧安養機構老人生活品質及其影響因素‧榮
總護理，22(4)，389-397。
蔡秀欣、陳美戎、蔡芸芳(2001)•九二一地震災區某鄉村獨居老人
憂鬱症狀及其相關因素之探討•慈濟醫學，13(3)，169-175。
蔡青青、劉雪娥(1996) ‧自尊的概念‧護理雜誌，43(1)，90-94。
熊曉芳(1999) ‧社區獨居老人健康狀況社會支持及相關因素探討‧
未發表之碩士論文，台北：台灣大學護理研究所碩士論文。。
戴玉慈、羅美芳（1996）‧身體功能評估的概念及量表‧護理雜誌，
43(2)，63-68。

英文部分
Adachi, T., & Miyasaka, K. A. (1996). A case study of
interactive communication by videophone between parents
with handicapped children. Tohoku psychcological Folia,
55, 34-38.
Barrera, M. Jr. (1981). Social support in the adjustment of
pregnant adolescents: Assessment issue. In B. H.
Gottlieb (Ed.),Social network and social support (p.69-
96). London: Sage.
Barron, C. R., Foxall, M. J., Dollen, K. V., Jones, P. A.,
& Shull, K. A. (1994). Marital status, social support,
and loneliness in visually impaired elderly people.
Journal of Advanced Nursing, 19(2), 272-280.
Barry, J. T., & Miller, D. B. (1980). The nursing home
visitor: who, when, where and for how long? Long-Term
Care and Health Services Administration, 4(4), 261-274.
Bass, D. M., McClendon, M. J., Brennan, P. F., & McCarthy,
C. (1998). The buffering effect of a computer support
network on caregiver strain. Journal of Aging Health, 10
(1), 20-43.
Bitzan, J. E., & Kruzich, J. M. (1990). Interpersonal
relationships of nursing home residents. Gerontologist,
30(3), 385-390.
Bondevik, M., & Skogstad, A. (1996). Loneliness among the
oldest old, a comparison between residents living in
nursing homes and residents living in the community.
International Journal of Aging & Human Development, 43
(3), 181-97.
Brodaty, H., Draper, B., Saab, D., Low, L. F., Richards,
V., Paton, H.,et al. (2001). Psychosis, depression and
behavioural disturbances in Sydney nursing home
residents: Prevalence and predictors. International
Journal of Geriatric Psychiatry, 16(5), 504-12.
Brooke, V. (1987). Adjust to living in a nursing home:
toward a nursing intervention. Unpublished doctoral
dissertation, University of Utah, Salt Lake City.
Brown, V. M., Allen, A. C., Dwozan, M., Mercer, I., &
Warren, K. (2004). Indoor gardening older adults:
Effects on socialization, activities of daily living,
and loneliness. Journal of Gerontolgy Nursing, 30(10),
34-42.
Chang, T. J., Tarn, Y. H., Hsieh, C. L., Liou, W. S., Shaw,
J. W., & Chiou, X. G. (2007). Taiwanese Version of the
EQ-5D: Validation in a representative sample of the
Taiwanese population. Journal of Formosa Medical
Association, 106(12), 1023-1031.
Carstensen, L. L., & Erickson, R. J. (1986). Enhancing the
social environments of elderly nursing home residents:
Are high rates of interaction enough? Journal of
Applied Behavior Analysis, 4(19), 349-355.
Chochinov, H. M. (2006). A two day workshop on supporting
patients nearing death handbook. The Hong Kong
Polytechnic University.
Chochinov, H. M. (2002). Dignity-conserving care-A new
model for palliative care. American Medical
Association, 287(17), 2253-2260.
Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L.
J., McClement, S., & Harlos, M. (2005). Dignity
therapy: A novel psychotherapeutic intervention for
patients near the end of life. Journal of Clinical
Oncology, 23(24), 5520-5525.
Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L.
J., McClement, S., & Harlos, M. (2002). Dignity in the
terminally ill: A cross-sectional, cohort study. The
Lancet, 360, 2026-2030.
Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L.
J., McClement, S., & Harlos, M. (2005). Understanding
the will to live in patients nearing death.
Psychosomatics, 46(1), 7-10.
Cody, M., Beck, C., & Svarstad, B. L. (2002). Challenges to
the use of nonpharmacologic interventions in nursing
homes. Psychiatric Services, 53(11), 1402-6.
Cohen, J. (1992). A power primer. Psychological Bulletin,
112, 155–159.
Commerford, M. C., &Reznikoff, M. (1996). Relationship of
religion and perceived social support to self-esteem
and depression in nursing home residents. Journal of
Psychology, 130(1), 35-50.
Cukor, P., Baer, L., Willis, B. S., Leahy, L., O'Laughlen,
J., Murphy, M.,et al. (1998). Use of videophones and
low-cost standard telephone lines to provide a social
presence in telepsychiatry. Telemedicine Journal, 4(4),
313-321.
Dai, Y. T., & Dimond, M. F. (1998). Filial piety. A cross-
cultural comparison and its implications for the well-
being of older parents. Journal of Gerontology Nursing,
24(3), 13-18.
Dauz, E., Moore, J., Smith, C. E., Puno, F., & Schaag, H.
(2004). Installing computers in older adults' homes and
teaching them to access a patient education Web site: A
systematic approach. Computers, Informatics, Nursing,
22, 266-272.
Davis, L. L., & Burgio, L. D. (1999). Planning cognitive-
behavioral management programs for long-term care.
Issues Mental Health Nursing, 20(6), 587-601.
Demiris, G., Oliver, D. R., Hensel, B., Dickey, G., Rantz,
M., & Skubic, M. (2008). Use of videophones for distant
caregiving: An enriching experience for families and
residents in long-term care. Journal of Gerontological
Nursing, 34(7), 50-55.
Drageset, J. (1995). The importance of activities of daily
living and social contact for loneliness: A survey
among residents in nursing homes. Scandinavian Journal
of Caring Sciences, 18(1), 65-71.
Engle, V. F. (1985). Mental status and functional health 4
days following relocation to a nursing home. Research
in Nursing & Health, 8(4), 355-61.
Evans, B. C., & Crogan, N. L. (2001). Quality improvement
practices: Enhancing quality of life during mealtime.
Journal of Nurses Staff Development, 17(3), 131-6.
Ferrell, B. (2005). Dignity therapy: Advancing the science
of spiritual care in terminal illness. Journal of
Clinical Oncology, 23(24), 5427-5428.
Finn, K. E., Sellen, A. J., & Wibur, S. B. (1997). Video-
medicated communication. New Jersey:Lawrence Erlbaum.
Gaugler, J. E., Zarit, S. H., & Pearlin, L. I. (2003).
Family involvement following institutionalization:
Model nursing home visits over time. International
Journal of Aging & Human Development, 57(2), 91-117.
Gerety, M. B., Williams, J. W., Mulrow, C. D., Cornell, J.
E., Kadri, A. A., Rosenberg, J., et al. (1994).
Performance of case-finding tools for depression in the
nursing home: Influence of clinical and functional
characteristics and selection of optimal threshold
scores. Journal of the American Geriatrics Society, 42
(10), 1103-9.
Gietzelt, D. (2001). Computer and internet use among a
group of Sydney seniors: A pilot study. Australian
Academic ＆ Research Libraries, 32(2), 137-152.
Gilberts, R. (1983). The evaluation of self-esteem. Family
& Community Health, 6(2), 29-49.
Gueldner, S. H., Loeb, S., Morris, D., Penrod, J.,
Bramlett, M., Johnston, L., & Schlotzhauer, P. (2001).
A comparison of life satisfaction and mood in nursing
home residents and community-dwelling elders. Archives
of Psychiatric Nursing, 15(5), 232-40.
Gueldner, S. H., Clayton, G. M., Schroeder, M. A., Butler,
S., & Ray, J. (1992). Environment interaction patterns
among institutionalized and non-institutionalized older
adults. Physical and Occupational of Therapy in
Geriatrics, 11(1), 37-53.
Haight, B. K., Michel, Y., & Hendrix, S. (1998). Life
review: Preventing despair in newly relocated nursing
home residents short- and long-term effects.
International Journal of Aging & Human Development, 47
(2), 119-142.
Hanson, E. J., Tetley, J., & Shewan, J. (2000). Supporting
family carers using interative multimedia. British
Journal of Nursing, 9(11), 713-719.
Hensel, B.K., Parker Oliver, D., & Demiris, G. (2007).
Videophone communication between residents and family:
A case study.Journal of the American Medical Directors
Association, 8(2), 123-127.
Hicks, T. J. J. (2000). What is your life like now?
Loneliness and elderly individuals residing in nursing
homes. Journal of Gerontological Nursing, 26(8), 15-19.
Hilliard, R. E. (2004). A post-hoc analysis of music
therapy services for residents in nursing homes
receiving hospice care. Journal of Music Therapy, 41
(4), 266-81.
Hine, N., & Arnott, J. L. (2002). A multimedia social
interaction service for inclusive community living:
Initial user trials. University Access Information
Society, 2, 8-17.
Holroyd, E. (2001). Hong Kong Chinese daughters’
intergenerational caregiving obligations: A cultural
model approach. Social Science & Medicine, 53, 1125–
1134.
Huang, C. H. (1982). Studies in Chinese personality: A
critical review. Bulletin of Educational Psychology,
15, 227-242.
Hui, E., Woo, J., Hjelm, M., Zhang, Y. T., & Tsui, H. T.
(2001). Telemedicine: A pilot study in nursing home
residents. Gerontology, 47(2), 82-87.
Hwu, Y. J., Coates, V. E., & Boore, J. R. P. (2001). The
evolution of health concept in nursing research: 1988-
1999. Patient Education and Counseling, 42, 105-114.
Jadack, R. L., Hyde, M. G., & Keller, S. R. (1995). Self-
esteem: Paradoxes and innovation in clinical therapy
and practice. Washington D. C. American Psychological
Association.
Kellett, U.M. (1998). Meaning-making for family carers in
nursing homes. International Journal of Nursing
Practice, 4(2), 113-9.
King, I. M. (1990). Health as the goal for nursing. Nursing
Science Quarterly, 3(3), 123-128.
King, K. S., Dimond, M., & McCane, K. L. (1987). Coping
with relocation. Geriatric Nursing, 8(5), 258-261.
Koenig, H. G., Weiner, D. K., Peterson, B. L., Meador, K.
G., & Keefe, F. J. (1997). Religious coping in the
nursing home: a biopsychosocial model. International
Journal of Psychiatry Medicine, 27(4), 365-76
Krause, N., & Borawski-Clark, E. (1994). Clarifying the
functions of social support in later life. Research on
Aging, 16, 251-279.
Lai, K. L., Tzeng, R. J., Wang, B. L., Lee, H. S., Amidon,
R. L., & Kao S. (2005). Health-related quality of life
and health utility for the institutional elderly in
Taiwan. Quality of Life Research, 14(4), 1169-80.
Langford, C. P. H., Bowsher, J., Maloney, J. P., & Lillis,
P. P. (1997).Social support: A conceptual analysis.
Journal of Advanced Nursing, 25(1), 95-100.
Lau, D.C.(1992). Confucius: The analects. Hong Kong：The
chinese university press.
Laughlin, A., Parsons, M., Kosloski, K. D., & Bergman-
Evans, B. (2007).Predictors of Mortality Following
Involuntary Interinstitutional Relocation. Journal of
Gerontological Nursing, 33(9), 20-26.
Lee, D. T., Woo, J., & Mackenzie, A. E. (2002). The
cultural context of adjusting to nursing home life:
Chinese elders’ perspectives. Gerontologist, 42(5),
667-675.
Lee, M., Crittenden, K., & Yu, E. (1996). Social support
and depression among elderly Korea immigrants in the
United States. International Journal of Geriatric
Psychiatry, 8(3), 231-237.
Li, I. C., & Yin, J. C. (2005). Care needs of residents in
community-based long-term care facilities in Taiwan.
Journal of Clinical Nursing, 14(6), 711-718.
Liang, K. Y., & Zeger S. L. (1986). Longitudinal data
analysis using generalized linear models. Biometrika, 73
(1), 13-22.
Lin, L. C., Wang, T. G., Chen, M. Y., Wu, S. C., &
Portwood, M. J. (2005). Depressive symptoms in long-
term care residents in Taiwan. Journal of Advanced
Nursing, 51(1), 30-37.
Lin, P. C., Wang, H. H., & Huang, H.T. (2007). Depressive
symptoms among older residents at nursing homes in
Taiwan. Journal of Clinical Nursing, 16(9), 1719-25.
Maas, M., Buckwalter, K., Swanson, E., Sprecht, J., Tripp-
Reimer, T., & Hardy, M. (1994). The caring partnership:
Staff and families of person institutionalized with
Alzheimer’s disease. American Journal of Alzheimer’s
Care and Related Disorders and Research, 22, 21-30.
Mahoney, F. I ., & Barthel, D. W. (1965). Functional
evaluation: The Barthel Index. Maryland State Medical
Journal, 14, 61-65.
Malcolm, M., Mann, W. C., Tomita, M. R. Fraas, L. F.,
Stanton, K. M., & Gitlin, L. (2001).Computer and
internet use in physically frail elders. Physical &
Occupational Therapy in Geriatrics, 19(3), 15-32.
Maslow, A. H. (1970). Motivation and Personality (2nd ed).
New York: Harper & Row.
Marquis, R., Freegard, H., & Hoogland, L. (2004).
Influences on positive family involvement in aged care:
An ethnographic view. Contemporary Nurse, 16(3), 178-186
Martin, J. C., Engle, V. F., & Graney, M. J. (1997). Health
status gender differences of newly admitted black
nursing home residents. Journal of the American
Geriatrics Society, 45(2), 166-173.
McCurren, C., Dowe, D., Rattle, D., & Looney, S. (1999).
Depression among nursing home elders: Testing an
intervention strategy. Applied Nursing Research, 12(4),
185-195.
Meleis, A. I. (1990). Being and becoming health: The core
of nursing knowledge. Nursing Science Quarterly, 3(3),
107-114.
Mikhail, M. L. (1992). Psychological responses to
relocation to a nursing home. Journal of Gerontological
Nursing, 18(3), 35-39.
Mynatt, E.D., Rowan, J., Craighill, S., & Jacobs, A.
(2001). Digital family portraits: Providing peace of
mind for extended family members. In proceedings of the
ACM Conference on human factors in computing systems
(CHI 2001). Seattle, Washington: ACM press.
Nakamura, K., Takano, T., & Akao, C. (1999). The
effectiveness of videophones in home healthcare for the
elderly. Medical Care, 37, 117-125.
Naleppa, M. J. (1996). Families and the institutionalized
elderly: A review. Journal of Gerontology Social Work,
27, 73-86.
Nay, R. (1995) Nursing home residents' perceptions of
relocation. Journal of Clinical Nursing, 4(5), 319-25.
Nelson, P. B. (1989). Ethnic di€erences in
intrinsic/extrinsic religious orientation and
depression in the elderly.Archives of Psychiatric
Nursing, 3, 199-204.
O’Connor, B. P., & Vallerand, R. J. (1994). Motivation,
self-dermination, and person-environment fit as
predictors of psychological adjustment among nursing
home residents. Psychology & Aging, 9(2), 189-194.
Pahkala, K., Kesti, E., Kongas-Saviaro, P., Laippala, P., &
Kivela, S. L. (1995). Prevalence of depression in an
aged population in Finland. Social Psychiatry &
Psychiatric Epidemiology, 30(3), 99-106.
Parmelee, P. A., Katz, I. R., & Lawton, M. P. (1992).
Incidence of depression in long-term care settings.
Journal of Gerontology, 47(6), 189-196.
Patterson, B. J. (1995). The process of social support:
Adjusting to life in a nursing home. Journal of
Advanced Nursing, 21(4), 682-689.
Phillips, C. J., & Henderson, A. S. (1991). The prevalence
of depression among Australian nursing home residents:
Results using draft ICD-10 and DSM-III- R criteria.
Psychological Medicine, 21(3), 739-748.
Polit, D. F., & Hungler, B. P. (1995).Nursing
Resaerch:Principle and method. Philadelphia: J. B.
Lippincott.
Port, C. L., Gruber-Baldini, A. L., Burton, L., Baumgarten,
M., Hebel, J. R., & Zimmerman, S. I., et al. (2001).
Resident contact with family and friends following
nursing home admission. Gerontologist, 41(5), 589-596.
Potts, M. K. (1997). Social support and depression among
older adults living alone: The importance of friends
within and outside of a retirement community. Social
Work, 42(4), 348-362.
Quattrochi-Tubin., & Jason, L. A. (1980). Enhancing social
interactions and activity among the elderly through
stimulus control. Journal of Applies Behavior Analysis,
13(1), 159-163.
Reynold, C. L. (1988). The measurement of health in nursing
research. Advanced in Nursing Science, 10(4), 23-31.
Rosenberg, M. (1965). Society and the adolescent self-
image. Princeton: Princeton University Press.
Ruigrok, J., & Sheridan, L. (2006). Life enrichment
programme; Enhanced dining experience, a pilot project.
International Journal of Health Care Qualility
Assurance Inc Leadersh Health Servey, 19(4-5), 420-9.
Russell, D. (1996). The UCLA Loneliness Scale (Version 3):
Reliability,validity, and factor structure. Journal of
Personality Assessment, 66(1), 20-40.
Scocco, P., Rapattoni, M., & Fantoni, G. (2006). Nursing
home institutionalization of eustress or distress for
the elderly? International Journal of Geriatric
Psychiatry, 21(3), 281-287.
Scharer, K., Colon, E., Moneyham, L., Hussey, J., Tavakoli,
A. & Shugart, M. (2009). A comparison of two types of
social support for mothers of mentally ill children.
Journal of child and adolescent psychiatric nursing, 22
(2), 86-98.
Segal, D. L. (2005) Relationships of assertiveness,
depression, and social support among older nursing home
residents. Behavior Modification, 29(4), 689-95.
Shanas, E. (1980). The health of elderly people: A social
survey NY: Arno Press.
Shapira, N., Barak, A., & Gal, I. (2007). Promoting older
adults' well-being through Internet training and use.
Aging and Mental Health, 11(5), 477-84.
Short, J., Williams, E., & Christie, B. (1976). The Social
Psychology of Telecommunications. London : John Wiley.
Smith, J. A. (1981). The idea of health: A philosophic
inquiry. Advanced in Nursing Science, 12, 93-100.
Spybrook, J., Raudenbush, S., Liu, X., Congdon, R., &
Martinez, A. (2008). Optimal Design for Longitudinal
and Multilevel Research: Documentation for
the “Optimal Design” Software. New York: William T.
Grant Foundation.Retrieved January 14, 2009, from
http://sitemaker.umich.edu/group-based/files/od-manual-
20080312-v176.pdf.
Stafford, C. (1995). The Roads of Chinese Childhood:
learning and identification in Angan.
Cambridge:Cambridge University Press.
Taiwan Association of Long-Term Care Professionals (2007).
The institution of long-term care in Taiwan. Available
at: http://www.ltcpa.org.tw/org/org.php (Accessed 18
June 2007).
Tilden, V. P., & Weinert, C. (1987). Social support and
chronically ill individual. Nursing Clinics of North
America, 22(3), 613-620.
Tripp-Reimer, T. (1984). Reconceptualizing the construct of
health: Integrating emic and etic perspectives.
Research in Nursing and Health, 7(2), 101-109.
Tsai, H. H., & Tsai, Y. F. (2008). A temporary home to
nurture health: Lived experiences of older nursing home
residents in Taiwan.Journal of Clinical Nursing, 17
(14), 1915-1922.
Tsai, H. H., Chen M. H., & Tsai, Y. F. (2008). Perception
of filial piety among Taiwanese University Students.
Journal of Advanced Nursing, 63(3), 284-290.
Tsai, Y. F., Chung, J. W. Y., Wong, T. K. S., & Huang, C.
M. (2005). Comparison of the prevalence and risk
factors for depressive symptoms among elderly nursing
home residents in Taiwan and Hong Kong. International
Journal of Geriatric Psychiatry, 20(4), 315-321.
Tsai, Y. F., Tsai, H. H., Lai, Y. H., & Chu, T. L. (2004).
Pain prevalence,experiences and management strategies
among the elderly in Taiwanese nursing homes. Journal
of Pain and Symptom Management, 28(6), 579-584.
Tsai, Y. F., Wong, T. K. S., Tsai, H. H., & Ku, Y. C.
(2008). Self-worth therapy for depressive symptoms in
older nursing home residents. Journal of Advanced
Nursing, 74(5), 488-494.
Tsai, Y.F., Wong, K. S., Juang, Y. Y., & Tsai, H. H.
(2004). The effects of light therapy on depressed
elders. International Journal of Geriatric Psychiatry,
19(6), 545-548.
Tseng, S. Z., & Wang, R. H. (2001). Quality of life and
related factors among elderly nursing home residents in
Southern Taiwan. Public Health Nursing, 18(5), 304-11.
Tu, Y. C., Wang, R. H., & Yeh, S. H. (2006). Relationship
between perceived empowerment care and quality of life
among elderly residents within nursing homes in Taiwan:
a questionnaire survey. International Journal of
Nursing Studies, 43(6), 673-80.
Wang, J. J. (2004). The comparative effectiveness among
institutionalized and non-institutionalized elderly
people in Taiwan of reminiscence therapy as a
psychological measure. Journal of Nursing Research, 12
(3), 237-45.
Walther, J. B., & Park, M. R. (2002). Cues filtered out,
cues filtered in: Computer-mediated communication and
relationships. In M. L. Knapp & G.. R. Miller (Eds.),
Handbook of interpersonal communication (2nd ed., 529-
563). Thousand Oaks, CA: Sage.
Ware, J. E. (2001). The SF-36® Health Survey; Scaling
assumptions and scoring.
http://www.sf36.com/tools/sf36.shtml#scaling.
White, H., McConnell, E., Clipp, E., Branch, L.G., Sloane,
R., Pieper, C., et al. (2002). A randomized controlled
trial of the psychosocial impact of providing internet
training and access to older adults. Aging Ment Health,
6(3), 213-21
Wickus, M., & Luz, C. (2002). Televisits: sustaining long
distance family relationships among institutional
elders through technology. Aging Mental Health, 6(4),
387-396.
William, K., Kemper, S., & Lee, M. H. (2003). Improving
nursing home communication: An intervention to reduce
elderspeak. The Gerontologist, 43(2), 242-247.
Wilson, K. G., Graham, I. D., Viola, R. A., Chater, S., de
Faye, B. J., Weaver, L. A., & Lachance, J. A. (2004).
Structured interview assessment of symptoms and
concerns in palliative care. Canadian Journal of
Psychiatry, 49(6), 350-8.
Wilson, S. A. (1997). The transition to nursing home life:
A comparison of planned and unplanned admissions.
Journal of Advanced Nursing, 26(5), 864–71.
Windriver, W. (1993) Social isolation: unit-based
activities for impaired elders. Journal of Gerontology
Nursing, 19(3), 15-21.
Yeh, T. L., Liao, I. C., Yang, Y. K., Ko, H. C., Chang, C.
J., & Lu, F. H. (1995). Geriatric depression scale
(Taiwanese and Mandarin Translations). Clinical
Gerontologist, 15(3), 58-60.
Yeh, S. H., Lin, L. W., & Lo, S. K. (2003) A longitudinal
evaluation of nursing home care quality in Taiwan.
Journal of Nursing Care Quality, 18(3), 209-16.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang,
V., Adey, M., et al. (1983). Development and validation
of a geriatric depression screening scale: A
preliminary report. Journal of Psychiatric Research, 17
(1), 37-49.