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研究生:林錦穗
研究生(外文):Chin-Sui Lin
論文名稱:成人心臟移植病患及主要照顧家屬於術後恢復期中黑暗期的經歷、調適經驗及所需協助之探討
論文名稱(外文):The Dark Experiences, Coping Strategies and Needs of Adult Heart Transplant Recipients and Their Families During Recovery Process
指導教授:施富金施富金引用關係
指導教授(外文):Fu-Jin Shih
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床暨社區護理研究所
學門:醫藥衛生學門
學類:護理學類
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:279
中文關鍵詞:台灣心臟移植成人心臟移植主要照顧者恢復期黑暗期經歷調適策略所需協助
外文關鍵詞:Heart transplantation in TaiwanAdult heart transplantationPrimary family caregiverRecovery stageDark recovery experiencesCoping strategiesNeeded help
相關次數:
  • 被引用被引用:2
  • 點閱點閱:258
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:4
研究背景
心臟衰竭是許多心臟疾病進展到最後的結果,同時是ㄧ種不可逆的失能性疾病,在病程惡化過程中,病患的身體機能會不斷下降。心臟移植可以有效改善心臟衰竭病患的身體狀況,延長生命,及提升病患的生活品質。然而,移植者在接受心臟移植後重生的開始,即面臨急性與亞急性恢復期中嚴苛的身心靈挑戰,亟需受贈者本人及其親友、醫療團隊、社會等支持系統共同合作,其生存與長期之恢復方有可能。其中,主要照顧家屬之協助對移植者的恢復更是關鍵。隨著移植者後續的恢復過程中病程多面向的變化與發展,其主要照顧家屬亦因此承受諸多複雜而長期的高度壓力。移植者及其主要照顧家屬雙方是否有其不易甚或無法忍受之恢復黑暗期存在?經歷為何?其調適經驗及所需協助又為何?至今,仍所知有限。
研究目的
1. 探討成人心臟移植者及其主要照顧家屬與術後恢復有關的黑暗期的經歷。
2. 探討成人病患心臟移植者及其主要照顧家屬於術後恢復黑暗期的調適策略。
3. 探討成人病患接受心臟移植者及其主要照顧家屬於術後恢復黑暗期所需的協助。
4. 探討成人心臟移植者對出院準備計畫的評價。
研究方法
本研究採探索性質性研究法,在台灣最著名之醫學中心之心臟移植門診,針對成人心臟移植者及其主要照顧家屬,有術後恢復黑暗期經驗者,以立意取樣法收案。再以半結構訪談指引,與個案進程面對面深入訪談收集資料,訪談資料以質性內容分析法分析。
研究結果
總共收案33位,含20位成人心臟移植者及13位主要照顧家屬。其中移植者有16位男性;年齡介於32∼70歲(平均46.95歲),大多已婚。術後至收案時間介於3個月∼2年10個月。主要照顧家屬中,11位為夫妻,男女朋友或母子關係各為1位。共有2位男性,11位女性;年齡介於28∼67歲(平均47.53歲); 12位已婚,1位未婚。有2位罹患高血壓,另,罹患十二指腸潰瘍、心臟疾病(心悸)及乳癌(術後)者各1位。
研究發現,移植者的黑暗期經歷為:(1)侵入性檢查帶來的身心不適及病情發生重大變化(n = 8)、(2)對未來的健康狀況產生不確定感(n = 15)、(3)對未來生活產生不確定感(n = 13)、(4)自覺造成家庭成員負擔(n = 2)、與(5)不熟悉的醫療行為及環境(n = 2)。黑暗期的調適策略為:(1)以恢復及維持健康為目標(n = 10)、(2)心靈寄託(n = 10)、(3)順應困境(n = 10)、(4)正向態度(n = 11)、與(5)尋找合適自己的工作(n = 1)。黑暗期所需協助為:(1)醫護團隊協助(n = 10)、(2)心靈支持(n = 11)、(3)病友團體的協助(n = 1)、與(4)社會資源(n = 4)。主要照顧家屬的黑暗期經歷為:(1)因擔心病患病況造成生理狀態改變(n = 1)、(2)病患病況起伏造成心理壓力(n = 6)、(3)擔心病患失去健康(n = 5)、(4)病患術後未立即恢復,造成壓力(n = 2)、(5)擔心無法將病患照顧好(n = 2)、(6)蠟燭兩頭燒,無法兼顧病患和家庭(n = 1)、(7)見病患受苦而不捨(n = 1)、與(8)無法兼差其他的工作造成經濟來源不足(n = 1)。其黑暗期所需協助為:(1)心靈寄託(n = 10)、(2)協助病患維持健康為目標(n = 8)、(3)正向態度面對(n = 7)、(4)順應困境(n = 3)、與(5)相信醫療專業(n = 3)。其所需協助為:(1)醫護團隊協助(n = 8)、(2)心靈支持(n = 7)、(3)病友團體的協助(n = 2)、與(4)社會資源(n = 3)。成人心臟移植者對出院準備計畫的評價中,優點為醫療團隊有計畫的幫助(n = 10)、病友經驗交流(n = 2)、及衛教方式(n = 2)。評價不足之處則為:(1)缺乏完整的衛教手冊(n = 5)、(2)宣導方式宜改進(n = 2)、與(3)照護團隊人力不足,缺個管師(n = 2)。
結論
本研究發現台灣成人心臟移植者及其主要照顧家屬,雙方在術後恢復期,卻曾經歷不易甚或無法忍受之恢復黑暗期。其術後恢復黑暗期相關經驗之內涵、原因、其調適策略及所需協助,亦已初步釐清。心臟及其他器官移植醫療團隊可參考本研究結果,預防並及早發現心臟移植者及其主要照顧家屬在術後恢復期之困境,並進一步規劃相關醫護措施及改善出院規劃內容,以提升心臟移植醫護品質。
Background End-stage-heart-failure is there terminal phase of heart disease with irreversibly multiple dysfunction, and heart transplantation (HT) has been long acknowledged as the only avenue for the patients’ survival and possibility of quality of life. Nevertheless, most of the recipients (HTR) and their care givers, primary family caregivers (PFC) in particular, continued to suffer from numerous discomforts/distress during the recipients’ recovery process of resuming their holistic well-being including physical, psychological, cognitive, social and spiritual optimal functions. Dark recovery stage (DRS) is referred to the post-HT stage when the HRT or their PFC reported having suffered from intolerable recovery experiences. Did the DRS exist in Taiwan’s HTR and their PFC groups? What are the contents and rationales for their DRS experiences? What are their coping strategies and needed help during DRS? All these questions deserve HT health professionals’ investigation.
Aims The aims of this project were to explore:
1. the DRS experiences for Taiwan’s adult HTR and their PFC;
2. the coping strategies employed by Taiwan’s adult HTR and their PFC;
3. Taiwan’s adult HTR’s and their PFC’s needed help from others during DRS; and
4. Twain’s adult HTR’s appraisals for the discharge-planning provided by hospital.
Design & Method An explorative descriptive qualitative design was used. A purposive sample of adult HTR and their PFC with DRS experiences in the most famous HT hospital in Taiwan was obtained. . Face-to-face depth interviews were and conducted with a semi-structured interview guide. Data were analyzed by qualitative content analysis mode.
Results A total of 52 informants including 20 HTR and 13 of their PFC participated in this project. In the HTR group, 16 of them were male aging from 32 to 70 (M = 46.95) years old. Most of them are married. Their post-HT duration ranged from 3 months to 2 years and 10 months. In the PFC group, 11 of them were females aging from 28 to 67 (M = 47.53) years old; 12 were married, and 1 was single. The relationships of the PFC group were reported spousal (n =11), mother/son (n = 1), and boy/girlfriend (n = 1). Five of them reported suffering from various disease including hypertension (n = 2), duodenal ulcer (n = 1), cardiopalmus (n = 1), and breast cancer (post-operation) (n = 1).
The DRS experienced by HTR were: (a) The physical and psychological discomforts caused by intrusive examinations and major changes of the health status(n = 8); (b) the sense of uncertainty with future health condition(n = 15); (c) the sense of uncertainty with future life(n = 13); (d) the sense of becoming a burden for families(n = 2); and (e) the unfamiliar medical treatment and environment(n = 2). Their coping strategies were: (a) setting a goal for recovery and maintaining healthy status(n = 10); (b) searching for spiritual support(n = 10); (c) complying with the difficulties(n = 10); (d) holding positive attitudes(n = 11); and (e) searching for possible job opportunities(n = 1). Their needs help included: (a) help from HT and other health professionals(n = 10); (b) spiritual support(n = 11); (c) assistance from HTR supporting groups(n = 1); and (d) social welfare resources(n = 4).
The DRS experiences for PFC were: (a) worries about HTR’s physical discomforts caused by disease/treatment(n = 1); (b) psychological turmoil caused by HTR’s unstable health condition(n = 6); (c) worries about the loss of HTR’s healthy status(n = 5); (d) psychological stress from HTR’s inadequate physical strength after HT(n = 2); (e) worries about poor quality of care by PFC(n = 2);. (f) being unable to take care of other families and HTR in the same time(n = 1); (g) psychological suffering from the HTR’s suffers(n = 1); and (h) difficulties in having part-time job to meet financial needs(n = 1). The PFC’s needed help were identical to the HTR’s. In terms of HTR’s appraisals for discharge-planning, the benefits were systematical help from health professionals(n = 10), exchanges of recovery tips with other HTR(n = 2), and learning strategies of health information(n = 2). The limitations were lacking of complete health teaching package(n = 5) and advertisement(n = 2), as well as inadequate health care manpower such as case manager(n = 2).
Conclusions This project identified the contents, rationales, coping strategies and needed help of Taiwan’s adult HTR and their PFC during the most difficult recovery time from HT named as DRS. In order to facilitate the adult HTR’s post-HT recovery, their experiences of DRS need to be prevented, early detected and effectively managed.
HT health professionals are encouraged to further develop related caring plans and systematically evaluate the effectiveness of the protocols. The findings of this project can also serve as innovative information for other organ transplant societies.
致 謝 i
中文摘要 iii
英文摘要 .iiii
目錄 xi
圖目錄 xi
圖一 成人心臟移植病患及主要照顧家屬於術後恢復期中黑暗期的經歷、調適經驗及所需協助之研究進行流程 32
圖二 成人心臟移植病患於術後各階段恢復期中黑暗期的經歷之研究架構圖 213
圖三 成人心臟移植病患於術後各階段恢復期中黑暗期的調適經驗之研究架構圖 214
圖四 成人心臟移植病患於術後各階段恢復期中黑暗期的所需協助之研究架構圖 215
圖五 成人心臟移植病患於術後恢復期中黑暗期的經歷、調適經驗及所需協助之探討研究關係圖 219
圖六 成人心臟移植病患主要照顧家屬於術後各階段恢復期中黑暗期的經歷之研究架構圖 226
圖七 成人心臟移植病患主要照顧家屬於術後各階段恢復期中黑暗期的調適經驗之研究架構圖 227
圖八 成人心臟移植病患主要照顧家屬於術後各階段恢復期中黑暗期的所需協助之研究架構圖 228
圖九 成人心臟移植病患主要照顧家屬於術後恢復期中黑暗期的經歷、調適經驗及所需協助之探討研究關係圖 232
圖十 心臟移植病患出院準備計畫未來發展之建議研究架構圖 245

表目錄 xi
表一 病患基本資料一覽表 43
表二 病患基本資料總數表 46
表三 主要照顧家屬基本資料一覽表 52
表四 主要照顧家屬基本資料總數表 53
表五 成人病患接受心臟移植術後恢復相關的黑暗期經歷意義單元一覽表 91
表六 成人病患接受心臟移植術後恢復相關的黑暗期調適經驗意義單元一覽表 113
表七 成人病患接受心臟移植術後恢復相關的黑暗期所需之協助意義單元一覽表 134
表八 心臟移植成人病患主要照顧家屬恢復相關的黑暗期經歷意義單元一覽表 152
表九 心臟移植成人病患主要照顧家屬恢復相關的黑暗期調適經驗意義單元一覽表 171
表十 心臟移植成人病患主要照顧家屬恢復相關的黑暗期所需之協助意義單元一覽表 195
表十一 心臟移植病患對出院準備計畫的評價意義單元一覽表 205
表十二 成人心臟移植病患術後各階段恢復相關的黑暗期經歷、調適經驗及所需的協助一覽表 216
表十三 成人心臟移植病患主要照顧家屬術後各階段恢復相關的黑暗期經歷、調適經驗及所需的協助一覽表 229
第一章 緒論 1
第一節 研究動機與背景 1
第二節 研究問題 4
第三節 研究目的 5
第四節 名詞界定 6
第貳章 文獻查證 7
第一節 心臟衰竭疾病與治療 7
第二節 心臟移植手術 9
第三節 心臟移植病患移植後之生理、心理及社會困擾及調適 13
第四節 主要照顧家屬之衝擊、影響因素及所需協助 17
第五節 出院準備計畫 20
第參章 研究方法 24
第一節 研究設計 24
第二節 研究對象 28
第三節 研究工具 29
第四節 資料的收集 31
第五節 資料的分析方法 33
第六節 研究的嚴謹度 34
第七節 研究的倫理考量 38
第肆章 研究結果 40
第一節 個案人口學基本資料 41
第二節 成人心臟移植病患術後恢復相關的黑暗期經歷 55
第三節 成人心臟移植病患術後恢復相關的黑暗期調適經驗 95
第四節 成人心臟移植病患術後恢復相關的黑暗期所需的協助 116
第五節 成人心臟移植病患主要照顧家屬恢復相關的黑暗期經歷 138
第六節 成人心臟移植病患主要照顧家屬恢復相關的黑暗期調適經驗 155
第七節 成人心臟移植病患主要照顧家屬恢復相關的黑暗期所需之協助 175
第八節 成人心臟移植病患對出院準備計畫的評價 195
第伍章 討論 207
第一節 成人心臟移植病患術後恢復相關的黑暗期經歷、調適經驗及所需的協助之概念架構圖 208
第二節 成人心臟移植病患主要照顧家屬術後恢復相關的黑暗期經歷、調適經驗及所需的協助之概念架構圖 220
第三節 成人心臟移植病患術後恢復相關的生理、心靈及社會方面黑暗期經歷、調適經驗及所需的協助之探討 233
第四節 成人心臟移植病患主要照顧家屬術後各階段恢復相關的生理、心靈及社會方面的黑暗期經歷、調適經驗及所需的協助之探討 239
第五節 心臟移植病患出院準備計畫未來發展之建議 243
第六章 結論與建議 245
第一節 研究結論 245
第二節 研究限制 247
第三節 研究建議 249
參考資料 252
中文部分 252
英文部分 254
研究附錄 265
附錄一 研究同意書 265
附錄二 基本資料〈病患〉 266
附錄三 基本資料〈主要照顧家屬〉 270
附錄四 訪談指引〈病患〉 272
附錄五 訪談指引〈主要照顧家屬〉 273
附錄六 研究進度的甘特圖 274
附錄七 國立台灣大學醫學院附設醫院函 275
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張治瑤(2007).心臟衰竭病患出院準備服務之成本與成效評值.未發表的碩士論文,台北:臺北醫學大學。
雷若莉(2006)•質性研究˙於李選總教閱,護理研究與應用(三版,217-218頁),台北:華杏。
楊克平(2001) •個案管理制度下的倫理考量•護理雜誌,48(3),38-43。
蔡甫昌、林芝宇、張至寧(2008).研究倫理的歷史、原則與準則.台灣醫學,12,107-122。
潘依琳(2002)•出院準備服務的建構與發展-以馬偕醫院為例•護理雜誌,47,76-86。
劉春年、胡月娟、李孟智(1998) •住院中風病患主要照顧家屬負荷及其相關因素之探討•公共衛生,25,196-210。
謝碧珠(1993)•台灣地區心臟移植後病患的心理暨社會適應之探討•私立東吳大學社會工作研究所碩士論文。
戴玉慈、張丹蓉、羅美芳•台灣地區之出院準備服務-試行計畫成果分析•慈濟醫學雜誌,10,61-68。







英文部分
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1. 汪素敏、顧乃平(1998) .出院後心臟移植病患的困擾及其處置.護理雜誌, 45, 85-90。
2. 汪素敏、顧乃平(1998) .出院後心臟移植病患的困擾及其處置.護理雜誌, 45, 85-90。
3. 李麗傳(2001) •應用個案管理提昇出院準備服務•護理雜誌,48,19-24。 
4. 李麗傳(2001) •應用個案管理提昇出院準備服務•護理雜誌,48,19-24。 
5. 杜友蘭(1998).護理的質性與量性研究-哪一類研究比較重要?.護理雜誌,45,75-78。
6. 杜友蘭(1998).護理的質性與量性研究-哪一類研究比較重要?.護理雜誌,45,75-78。
7. 楊克平(2001) •個案管理制度下的倫理考量•護理雜誌,48(3),38-43。
8. 楊克平(2001) •個案管理制度下的倫理考量•護理雜誌,48(3),38-43。
9. 潘依琳(2002)•出院準備服務的建構與發展-以馬偕醫院為例•護理雜誌,47,76-86。
10. 潘依琳(2002)•出院準備服務的建構與發展-以馬偕醫院為例•護理雜誌,47,76-86。
11. 劉春年、胡月娟、李孟智(1998) •住院中風病患主要照顧家屬負荷及其相關因素之探討•公共衛生,25,196-210。
12. 劉春年、胡月娟、李孟智(1998) •住院中風病患主要照顧家屬負荷及其相關因素之探討•公共衛生,25,196-210。
13. 戴玉慈、張丹蓉、羅美芳•台灣地區之出院準備服務-試行計畫成果分析•慈濟醫學雜誌,10,61-68。
14. 戴玉慈、張丹蓉、羅美芳•台灣地區之出院準備服務-試行計畫成果分析•慈濟醫學雜誌,10,61-68。