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研究生:謝佳吟
研究生(外文):Chia-Yin Hsieh
論文名稱:男性愛滋病毒感染者入住中途之家前後的決策過程與調適
論文名稱(外文):Male HIV-Positive Patient’s Decision-Making Process and Adaptation of Living in Mid-Way Shelter
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:257
中文關鍵詞:愛滋病/愛滋病毒陽性台灣男性感染者途之家/無家可歸決策過程調適困境所需協助探索性質性研究
外文關鍵詞:AIDS/HIVTaiwan’s male patientsmid-way shelter/ homelessdecision-makingadjustmentsocial adaptationneeded helpxplorative qualitative research
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中文摘要
研究背景
UNAIDS (2008)的流行病學報告,全球感染愛滋病毒的年齡層有不斷下降的趨勢,青壯年已為感染愛滋的最大族群。感染者常因社會文化的負面標籤烙印、親友們對他們排斥或放棄,而有社交隔離等負面情緒。許多感染者因而認為,自己無法回到主流社會生活或工作,自行決定或被迫離開原來的人際與角色依存關係網絡,進而成為遊民、或入住中途之家。有關台灣男性愛滋病毒陽性感染者決定入住中途之家的決策過程、所遭遇的困難及需求、回歸社會的調適困境、及面對決策與調適困境時所需之協助,至今仍所知有限。

研究目的
本研究之目的為:(1) 探討入住中途之家的愛滋病毒陽性感染者
之人口學特色;(2) 探討愛滋病毒陽性感染者決定入住中途之家的決策過程;(3) 探討愛滋病毒陽性感染者入住中途之家時期,所遭遇的困難及需求;(4) 探討入住中途之家愛滋病毒陽性感染者回歸社會的調適困境;及(5) 探討入住中途之家愛滋病毒陽性感染者面對決策與調適困境時所需之協助。

研究方法
本研究採探索性質性研究設計,以立意取樣法,邀請目前入住於台灣北部某中途之家的愛滋病毒陽性感染者參與本研究。以半結構訪談指引進行面對面深入訪談,訪談內容以質性內容分析法整理。

研究結果
參與本研究個案共14,皆為男性,年齡介於30至62歲(平均44.6 ± 7.0)歲。本研究發現愛滋病毒陽性感染者決定入住中途之家的決策過程分為四個階段:被評估階段、資訊來源階段與中途之家介入評估階段、入住與相關照護接受階段、入住期滿再轉介階段等四階段。在被評估階段的考慮內涵為:確認有居住需求與確認有醫療照護需求。此期所遭遇的困難為沒有受尊重的感覺與擔心無人照顧的窘境,所對應的是希望獲得平等對待的需求。
在資訊來源階段與中途之家介入評估階段考慮內涵為:醫療轉介、感染者主動搜尋、家人的決定、與中途之家工作人員評估感染者。此期面臨不得其門而入的困難;希望中途之家能主動協助入住、並協助處理當時的需求。
在入住與相關照護接受階段考慮內涵為:被認同與活得自在的需求、符合自我需求的環境。困難為:未符合期待的居住需求、與缺乏支持性的關係。因而有獲得支持性關係、獲得醫療照護、與符合居住環境等需求。
在入住期滿再轉介階段考慮內涵為:入住時間未到期即離開、在預定時間內離開的準備情形、與入住時間到期尚未離開等。此期面臨還沒有準備好被轉介、不知下一步在何方的困難。希望面對下一步時,有充足的時間調適的需求。
個案表示在重新進入社會時,面臨無法解決的困難,包括疾病帶來的身心靈傷害、擔心無法適應社會期望、及萬事起頭難的壓力感。在準備回歸社會時,他們會檢視自己的困境,所需協助為提供所需資訊、與靈性關懷。

結論
入住中途之家的決策過程包含四個階段,一半的感染者表示被動接受相關訊息、但主動參予入住決策;其中醫療人員為主要資訊提供者。入住中途之家後,其服藥順從性增加,CD4與病毒量的疾病控制亦較佳。回歸社會所面臨的困境中,多數個案表示擔心工作能力不足。自入住中途之家前至回歸社會的過程中,社會烙印與自我烙印的影響仍然存在。因此,建議除了提供各種資訊來協助愛滋病毒感染者盡速回歸社會外,仍需考慮強化感染者本身的信心、與來自家人、醫療工作團隊、社會的共同支持,方能逐步改善疾病標籤化對個案的負面影響,進而協助其回歸社會的努力。
ABSTRACT
Background
In an epidemiological reportof UNAIDS (The Joint United Nations Programme on HIV/AIDS; UNAIDS) (2008), the age trend of HIV (Human Immunodeficiency Virus; HIV) infected patients (HIVIP) continued to decline. Young adults now have become the largest HIVIP. Many of them have senses of low self-esteem and neagative appraisals due to negative social stigma and lack of significant other’s (SO) support. Some of them, then, decide to stay away from their normal social interdepende network, and become howsless people or move to a mid-way shelter (MWS). Until now, little information is available about Taiwan’s male HIVIP’s (TMHIVIP) decision-making process of moving to a MWS, the related difficulties and adaptation dilemmas, as well as needed help.

Method
An explored qualitative research method was used in this study. A purposive sample was obtained from TMHIVIP living in a MWS in northern Taiwan. Data were collected through semi-structured face-to-face in-depth interviews, and then analyzed by qualitative content analysis.

Aims
This project attempted to explore: (a) the demographic characteristics of TMHIVIP living in a MWS; (b) TMHIVIP’s decision-making process of moving to a MWS; (c) the difficulties and needs involves in TMHIVIP’s decision-making process of moving to a MWS; (d) the adaptation dilemma for TMHIVIP’s preparation for re-enter to society; and (d) the needed help of TMHIVIP during decision-making process of moving to a MWS and re-ter to society.

Results
A total of 14 TMHIVIP participated in this study. They aged from 30 to 62 years old (mean ± SD = 44.6 ± 7). Their decision-making process of moving to a MWS involved four transitions: (a) under being assessed transition; (b) information gathering and MWS’ involvement in assessment transition; (c) admission and under caring transition; and (d) being referred to another health institute transition.
During under being assessed transition, the factors contributing to decision-making were making sure the needs of living and health care. The related difficulties were lack of senses of respect and being cared; the related needs were being treaed fare as a human being.
During information gathering and MWS’ involvement in assessment transition, the factors contributing to decision-making were medical refer system, informants’ taking initiative in searching for information, families’ decision-making, and MWS’s staff’s assessment report. The related difficulties were the opportunities of getting into a MWS. They reported needs of the MWS’ taking initiative in helping their admission, and managing their needs based on their individual conditions.
During admission and under caring transition, the factors contributing to decision-making were supportive relationships appraisals of senses of belonging and free living style, as well as meeting self-expectations for living environment. The related difficulties were under-expected living environment, and lack of supportive relationships. Their needs were having supportive relationships, medical care, and a better living environment.
Finally, during the being referred to another health institute transition, the factors contributing to decision-making were leaving MWS before due days, readiness of leaving MWS, and period of postpone leaving from MWS. The related difficulties were sense of uneasiness of leaving from MWS, and uncertainty about the next step. They called for need of more time for preparation.
Most informants were afraid of the following difficulties after re-entry the society: (a) the physical and psychological trauma caused to disease; (b) being unable to meet social expectations; and (c) the stress of managing challenges in the beginning stage.
Conclusions
Four transitions wren found involved with TMHIVIP’s decision-making process of moving to a MWS and re-entry to society. About half of the informants reported having received related information in a passive way, and then taking an initiative in decision-making later. The major information providers were cited as health professionals. They reported better compliant to medication, better outcome of CD4 and disease control. Most of them were afraid of lacking competence required after re-try to society, and the negative impacts of social sigma of disease.
Health professionals are suggested to continue to provide adequate and reliable information for them and their SO. Additionally, TMHIVIP’s confidence in re-try to society requires their self-empowerment, and the reliable social support from TMHIVIP’s SO, medical team, as well as public. With these help, the negative impacts of social stigma of disease will be gradually decreased and TMHIVIP’s positive participation in society will be more possibly ensured.
男性愛滋病毒感染者入住中途之家前後的決策過程與調適
目 錄
論文電子檔著作權授權書………………………………………………..
論文審定同意書…………………………………………………….…….
誌謝…………………………………………………………..……….…...i
中文摘要…………………………………………………………...……. iii
英文摘要…………………………………………………………….…..vii
目錄…………………………………………………………………..…..xii
圖目錄…………………………………………………………….….….xvi
圖一 研究過程進行流程圖……………………………….…..…..44
圖二 愛滋病毒陽性感染者入住中途之家之決策過程……………
回歸社會調適及所需協助之概念架構圖.............…...…….171
圖三 入住中途之家所遭遇的困難與需求……………..…..……172
表目錄……………………………………………………………..……xvii
表一 受訪者基本資料一覽表…………………………..…………55
表二 受訪者基本資料總數表………………………………..……58
表三 入住中途之家的決策過程…………………...……..….……96
表四 入住中途之家中過程所遭遇的困難及需求…………..…..134
表五 愛滋病毒陽性感染者回歸社會的調適…………….......…...157
第壹章 緒論 1
第一節 研究動機與重要性 1
第二節 名詞解釋 5
第三節 研究問題 6
第四節 研究目的 7
第貳章 文獻查證 8
第一節 全球與台灣愛滋病流行病學 8
第二節 愛滋病疾病生理病理機轉與治療 13
第三節 入住中途之家愛滋病毒陽性感染者的背景與現況 18
第四節 愛滋病毒陽性感染者的決策理論 24
第五節 愛滋病毒陽性感染者之適應理論與調適 32
第叁章 研究方法 38
第一節 研究設計 38
第二節 研究對象 41
第三節 研究工具 42
第四節 資料收集過程 43
第五節 資料分析方法 45
第六節 研究嚴謹度 47
第七節 研究倫理考量 48
第肆章 分析與結果 50
第一節 入住中途之家的愛滋病陽性感染者之人口學特色 51
第二節 愛滋病毒陽性感染者決定入住中途之家的決策……….…….
過程…………………………………………………..….......68
第三節 探討愛滋病毒陽性感染者在入住中途之家時期……...……..
所遭遇的困難及需求………………………………………99
第四節 探討入住中途之家之愛滋病毒陽性感染回歸社會
的調適……………………………………………….……...138
第五節 探討入住中途之家之愛滋病毒陽性感染者面對...………...…
回歸社會的調適時之所需協助……………………………159
第伍章 討論 ….169
第一節 決策過程與調適過程的概念架構 169
第二節 探討入住中途之家的愛滋病毒陽性感染者………………….
之人口學特色………………………………………….….173
第三節 探討愛滋病毒陽性感染者決定入住中途之家………………..
的決策過程………………………………………………....177


第四節 探討愛滋病毒陽性感染者入住中途之家…………………..
的困難與需求 185
第五節 探討入住中途之家之愛滋病毒陽性……………………...…
感染者回歸社會的調適……………………………...……190
第六節 探討入住中途之家之愛滋病毒陽性感染者………………….
面對回歸社會的調適時之所需協助…………………..…200
第陸章 結論與建議 …204
第一節研究結論 204
第二節研究限制 208
第三節研究建議 209
參考文獻
中文部分 213
英文部分 215
附錄 233
(附錄一)同意書…..………………………………………..…..…..233
(附錄二)訪談基本資料 ...234
(附錄三)訪談指引 …………………………………………………236



圖目錄…………………………………………………………….….….xvi
圖一 研究過程進行流程圖……………………………….…..…...44
圖二 愛滋病毒陽性感染者入住中途之家之決策過程……………
回歸社會調適及所需協助之概念架構圖.............…...…….171
圖三 入住中途之家所遭遇的困難與需求……………..…..……172


表目錄……………………………………………………………..……xvii
表一 受訪者基本資料一覽表……………………….…………..…55
表二 受訪者基本資料總數表……………………………….….…58
表三 入住中途之家的決策過程…………………...………..….…96
表四 入住中途之家中過程所遭遇的困難及需求……….….…..134
表五 愛滋病毒陽性感染者回歸社會的調適…………….......…...157
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