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研究生:羅敏馨
論文名稱:脊髓損傷者及其家庭照顧者之適應模式研究—從雙重ABCX模式分析
論文名稱(外文):The Study of Adaptation Model for Spinal Cord Injuries and Their Family Caregivers : The Double ABCX Model
指導教授:王智弘王智弘引用關係
學位類別:碩士
校院名稱:國立彰化師範大學
系所名稱:復健諮商研究所
學門:社會服務學門
學類:身心障礙服務學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:136
中文關鍵詞:脊髓損傷家庭照顧者壓力因應適應模式
外文關鍵詞:spinal cord injuryfamily caregivercopingadaptation model
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本研究主要目的在探討脊髓損傷者的家庭適應模式,瞭解脊髓損傷者與家庭照顧者在面對生活持續發生的壓力源,過程中所使用的資源與對壓力的因應程度,進而探討家庭整體適應情形,建立脊髓損傷者與家庭照顧者之適應模式。
本研究以各縣市脊髓損傷者協會之脊髓損傷者、家庭照顧者為研究對象,採橫斷式調查法,應用結構式問卷為研究工具,包含生活壓力事件量表、資源量表、壓力因應量表與家庭生活適應量表,進行資料之收集,共得241位脊髓損傷者、194位家庭照顧者的資料。將收集所得資料以SPSS 13.0軟體及結構方程式分析軟體LISREL 8.80為統計資料分析工具,進行信效度分析、描述性統計、t檢定、單因子變異數分析、Pearson積差相關分析、結構方程模式,以分析所收集之資料並驗證本研究假設。研究結果分析如下:
一、 脊髓損傷者性別對家庭生活壓力事件有顯著差異,男性的生理壓力大於女性。
二、 脊髓損傷者年齡、婚姻、學歷、損傷部位在資源使用上有顯著差異,學歷高、年齡低、損傷部位高、未婚之脊髓損傷者使用資源較多。
三、 家庭照顧者大專以上,較高中、高職、國中以下使用較多資源。
四、 脊髓損傷者適應模式中,壓力源與資源呈顯著正相關,壓力源對資源成正向預測,壓力源對生活適應成負向預測。
五、 家庭照顧者適應模式中,家庭照顧者之壓力源對家庭適應成負向預測,以壓力因應為中介後,對家庭適應成正向預測。
六、 整體適應模式,壓力源與資源對壓力因應成正向預測,以壓力因應為完全中介,對家庭適應呈正向預測。
本研究結果可提供脊髓損傷者與家庭照顧者面對自身的壓力與家庭環境的壓力下,使用資源、壓力因應對家庭生活適應的關係,以達良好的整體適應狀態,並作為脊髓損傷者家庭增進其生活適應,及相關機構、政府單位等相關人員日後服務脊髓損傷者與其家庭照顧者之參考依據。
This study assessed the extent to which the double ABCX model of family crisis can accommodate the family functioning after rehabilitation form spinal cord injury. Path analysis supported the proposed model, and showed that family adaptation after a year was the product of family stress, resources, coping.
A total of 241 spinal cord injury individuals and 194 family caregivers were recruited. The statistical methods used to analyze the data were descriptive statistics, t-test, one-way ANOVA, and structural equation models by SPSS and LISREL.
The findings of the study were as follows:
1. Family stressors of men with spinal cord injury were higher than women.
2. More resources would be used if the spinal cord injury with higher education, younger age, higher level injury, or single.
3. The family caregivers with higher education used more resources.
4. The relationship between family stressors and resources was significant in the adaptation model of SCI.
5. Family stressors may predict the adaptation of family caregivers, and coping of stress has certain mediating effect to family adaptation.
6. Coping, was mediating, may predict the adaptation of family adaptation, when family stressors and resources predicted the adaptation of family.
The findings proposed several suggestions for the government and the association, also for the family with spinal cord injury to adapted family stretch.
目 次 II
圖 次 IV
表 次 V
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與待答問題 2
第三節 名詞解釋 3
第二章 文獻探討 5
第一節 脊髓損傷者之壓力與調適因子 5
第二節 家庭照顧者之壓力與調適因子 12
第三節 家庭適應相關理論與模式 16
第四節 雙重ABCX模式及相關研究 19
第三章 研究方法 26
第一節 研究架構與研究假設 26
第二節 研究對象與研究法 27
第三節 研究工具 29
第四節 研究程序與進度 40
第五節 資料處理與統計方法 42
第四章 結果與分析 48
第一節 脊髓損傷者個人背景資料、壓力源、資源、壓力因應及家庭適應之現況調查 49
第二節 家庭照顧者個人背景資料、壓力源、資源、壓力因應及家庭適應之現況調查 57
第三節 脊髓損傷者背景變項在各分量表之差異分析 64
第四節 家庭照顧者背景變項在各分量表之差異分析 79
第五節 脊髓損傷者及家庭照顧者在雙重ABCX模式之關係 94
第五章 結論與建議 105
第一節 結論與討論 105
第二節 建議 110
參考文獻 112

圖 次
圖 2-1 婚姻與家庭環繞理論模式 .............................. 18
圖 2-2 雙重ABCX模式之理論架構圖 ............................ 20
圖 2-3 雙重ABCX模式之變項關係 ............................. 24
圖 3-1 研究架構 .......................................... 27
圖 3-2 研究程序 .......................................... 41
圖4-1 脊髓損傷者ABX因素路徑圖 ............................. 96
圖4-2 脊髓損傷者ACX因素路徑圖 ............................. 96
圖4-3 脊髓損傷者BCX因素路徑圖 ............................. 97
圖4-4 脊髓損傷者ABC因素路徑圖 ............................. 97
圖4-5 脊髓損傷者ABCX因素路徑圖 ............................ 99
圖4-6 家庭照顧者ABX因素路徑圖 ............................. 99
圖4-7 家庭照顧者ACX因素路徑圖 ............................ 100
圖4-8 家庭照顧者BCX因素路徑圖 ............................ 101
圖4-9 家庭照顧者ABC因素路徑圖 ............................ 101
圖4-10 家庭照顧者ABCX因素路徑圖 .......................... 102
圖4-11 雙重ABCX因素路徑圖 ................................ 103

表 次
表2-1 神經受損等級擬定復健後的功能性目標 ..................... 7
表2-2 ABCX模式及雙重ABCX模式之各因素 ........................22
表3-1 問卷回收與發放情形 ...................................28
表3-2 家庭生活壓力量表內部一致性及相關分析摘要表 ..............32
表3-3 家庭生活壓力事件量表預詴之因素分析摘要表 ................34
表3-4 壓力因應量表內部一致性及相關分析摘要表 ..................36
表3-5 壓力因應量表預詴之信度分析摘要表 .......................37
表3-6 家庭適應量表內部一致性及相關分析摘要表 ..................39
表3-7 家庭適應量表預詴之信度分析摘要表 .......................39
表3-8 模型適配度指標 .......................................46
表3-9 研究問題統計方法整理表 ................................47
表4-1 脊髓損傷者個人背景資料表 ..............................50
表4-2 脊髓損傷者生活壓力事件分析摘要表 .......................51
表4-3 脊髓損傷者可利用資源之分析摘要表 .......................53
表4-4 脊髓損傷者壓力因應分析摘要表 ..........................55
表4-5 脊髓損傷者生活適應分析摘要表 ..........................56
表4-6 家庭照顧者基本資料摘要表 ..............................58
表4-7 家庭照顧者生活壓力事件摘要表 ..........................59
表4-8 家庭照顧者可利用資源之分析摘要表 .......................60
表4-9 家庭照顧者壓力因應分析摘要表 ..........................62
表4-10 家庭照顧者生活適應分析摘要表 .........................63
表4-11 脊髓損傷者背景變項與生理壓力之變異數分析 ...............65
表4-12 脊髓損傷者背景變項與心理壓力之變異數分析 ...............66
表4-13 脊髓損傷者背景變項與社會政策壓力之變異數分析 ...........67
表4-14 脊髓損傷者背景變項與環境壓力之變異數分析 ...............68
表4-15 脊髓損傷者背景變項與生活壓力事件之變異數分析 ...........69
表4-16 脊髓損傷者背景變項與宗教資源之變異數分析 ...............71
表4-17 脊髓損傷者背景變項與醫療資源之變異數分析 ...............72
表4-18 脊髓損傷者背景變項與靜態休閒之變異數分析 ...............73
表4-19 脊髓損傷者背景變項與動態活動之變異數分析 ...............74
表4-20 脊髓損傷者背景變項與其他可利用資源之變異數分析 ..........75
表4-21 脊髓損傷者背景變項與資源分量表之變異數分析 .............76
表4-22 脊髓損傷者背景變項與壓力因應之變異數分析 ...............77
表4-23 脊髓損傷者背景變項與生活適應之變異數分析 ...............78
表4-24 家庭照顧者背景變項與個人壓力變異數分析 .................80
表4-25 家庭照顧者背景變項與照顧壓力變異數分析 .................81
表4-26 家庭照顧者背景變項與家庭內部壓力變異數分析 .............82
表4-27 家庭照顧者背景變項與經濟理壓力變異數分析 ...............83
表4-28 家庭照顧者背景變項與生活壓力事件變異數分析 .............84
表4-29 家庭照顧者背景變項與宗教資源變異數分析 .................86
表4-30 家庭照顧者背景變項與醫療資源變異數分析 .................87
表4-31 家庭照顧者背景變項與靜態休閒變異數分析 .................88
表4-32 家庭照顧者背景變項與動態活動源變異數分析 ...............89
表4-33 家庭照顧者背景變項與其他資源變異數分析 .................90
表4-34 家庭照顧者背景變項與資源量表變異數分析 .................91
表4-35 家庭照顧者背景變項與壓力因應量表變異數分析 .............92
表4-36 家庭照顧者背景變項與生活適應變異數分析 .................93
表4-37 脊髓損傷者與家庭照顧者ABCX因素相關分析表 ..............95
表4-38 脊髓損傷者模型適配度分析結果 .........................98
表4-39 家庭照顧者模型適配度分析結果 ........................102
表4-40 家庭照顧者模型適配度分析結果 ........................103
表4-41 模式結果彙整表 ....................................104
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