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研究生:郭素青
研究生(外文):Su Ching Kuo
論文名稱:腦中風病人主要照顧者之憂鬱及照顧正向感:以Pearlin Model為架構
論文名稱(外文):Depressive symptoms and positive aspects of caregiving among family caregivers of stroke patients: based on the framework of Pearlin Model
指導教授:翁麗雀翁麗雀引用關係
指導教授(外文):L. C. Weng
學位類別:博士
校院名稱:長庚大學
系所名稱:臨床醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2020
畢業學年度:109
語文別:中文
論文頁數:221
中文關鍵詞:腦中風主要照顧者憂鬱照顧正向感內外在資源自我握控信念社會支持
外文關鍵詞:Strokefamily caregiversdepressive symptomspositive aspects of caregivinginternal and external resourcessense of masterysocial support
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腦中風是造成全球人口死亡與失能的主要原因之一,即使病人存活也會遺留下不同程度的神經功能障礙,造成病人與照顧者沈重的負擔。憂鬱為家屬於照顧期間的重要心理反應之一。然而,照顧過程家屬不全然感受負向的照顧經驗,亦有照顧經驗所帶來的正向意義,目前研究間隙為同時探討慢性病人家屬正負向影響的研究仍不足,因此本研究擬以Pearlin 照顧壓力過程模式為架構,探討腦中風病人主要照顧者之照顧正向感及憂鬱調適結果,並探討其影響因素。
本研究為一橫斷相關性研究設計,採方便取樣,以一家長照管理中心及居家護理所符合收案標準照顧者進行收案,以結構性問卷收集資料,訪談人數共165人,以結構方程式模式進行資料分析及研究假設檢定。本研究結果顯示,腦中風病人照顧者符合壓力性照顧負荷佔48.5%,憂鬱程度偏高(平均值:15.00+10.71),且達臨床憂鬱症有40%,然而在照顧正向感呈現中上程度(平均值:33.35+5.19)。本研究假設檢定結果,支持下列四項假設,一、主要照顧者感受照顧負荷增加,對憂鬱程度有正向影響(直接效果,路徑係數:0.47, p<.001;經自我握控信念中介效果,路徑係數:-0.53, -0.32, all p<.001);二、主要照顧者感受較高程度自我握控信念,對憂鬱程度有顯著負向影響(路徑係數:-0.32, p<.001);三、主要照顧者的照顧工作強度增加,對照顧正向感有顯著影響(直接效果,路徑係數:0.12, p=.202;經社會支持中介效果,路徑係數:-0.20, 0.36, all p<.050);四、主要照顧者感受較高程度親人社會支持,對照顧正向感程度有顯著正向影響(路徑係數:0.36, p=.002)。
腦中風病人照顧者承擔壓力性照顧負荷,內外在資源為照顧者憂鬱及照顧正向感的重要影響因素。社會支持可以增加照顧者對自我肯定及重新定義自己的生命意義,臨床醫護人員需持續鼓勵親人給予照顧者實質協助、傾聽、支持、陪伴,讓照顧者具備自信面對照顧的困境,重新找到照顧所賦予生命意義及價值。若照顧者處於憂鬱情緒狀態,加強照顧者的自我握控信念,以協助照顧者心理調適能力,適時的給予輔導或轉介。
Stroke is one of the main causes of death and disability in the global population. Even if the patient survives, stroke will leave different levels of neurological dysfunction, causing a heavy burden on the patient and family caregivers. One of the psychological reactions among the family caregivers is depressive symptoms. However, the family caregivers during the caregiving process do not only experience the negative experience, but also positive aspects of caregiving. The current gap of caregivers related studies is still insufficient to explore the positive and negative adjustment among the family caregivers of chronically ill patients. Therefore, our study use the framework of the stress process model of caregiving to explore the positive aspects of caregiving and depressive symptoms , and to explore their influencing factors among family caregivers of stroke patients.
Our study is a cross study design, using convenient sampling. 165 family caregivers are recruited in a long-term care center and a home care center. Their influencing factors of the depressive symptoms and positive aspects of caregiving are identified by structural equation modeling. The results show that family caregivers of stroke patients accounted for 48.5% of stressful caregiving burden, with a high level of depressive symptoms (mean: 15.00+10.71) and 40% of clinical depression. However, the positive aspects of caregiving is moderately level (mean: 33.35+5.19). Our results support the following research hypothesis: 1. The caregivers experience more caregiving burden, which has a positive association with depressive symptoms (direct effect, path coefficient: 0.47, p<.001; sense of mastery mediating effect, path coefficient: -0.53, -0.32, all p<.001); 2. The caregivers experience a higher sense of mastery, which has a significant negative association on depressive symptoms (path coefficient:-0.32, p<.001); 3. The caregivers experience more objective caregiving loading, which has a association on the positive aspects of caregiving (direct effect, path coefficient: 0.12, p=.202; social support mediating effect, path coefficient:-0.20, 0.36, all p<.050); 4. The caregivers experience a more social support from their relatives, which has a significant positive association positive aspects of caregiving (path coefficient: 0.36, p=.002).
Caregivers take a stressful caregiving burden, only internal and external resources are important factors influencing caregivers’ depressive symptoms and positive aspects of caregiving. Social support can increase caregivers’ self-affirmation and redefine own meaning in their life. Health professionals need persistently encourage family relatives give caregivers to instrumental help, listen, support, and accompany, so that caregivers have the confidence to face the adversity of caregiving, and re-discover the meaning and value of life. If the caregivers have depressive symptoms, provide relevant care to strengthen the caregivers’ sense of mastery to assist the caregiver psychological adjustment, timely counseling or referral.
目錄
指導教授推薦書

論文口試委員審定書

致謝 ................................ iii

摘要 ................................ iv

Abstract ................................ vi

第一章 緒論.......................................... 1
第一節 研究背景.............................. 1
第二節 研究動機及重要性...................... 5
第三節 研究目的.............................. 10
第四節 名詞界定.............................. 11
第二章文獻查證..................................... 14
第一節 腦中風及照顧者的相關概念.............. 14
第二節 Pearlin照顧壓力過程模式............... 21
第三節 慢性疾病病人主要照顧者的壓力.......... 25
第四節 憂鬱之定義及概念…………………………… 32
第五節 影響主要照顧者憂鬱的因素………………… 34
第六節 慢性疾病病人主要照顧者之照顧正向感…… 43
第七節 影響主要照顧者照顧正向感的因素………… 46
第八節 文獻總結……………………………………… 52
第九節 研究概念架構.......................... 54
第十節 研究假設……………………………………… 55
第三章 研究方法..................................... 56
第一節 研究設計……………………………………… 56
第二節 研究對象與取樣方法………………………… 57
第三節 研究變項的操作性測量及研究工具信效度… 58
第四節 資料收集過程………………………………… 78
第五節 資料處理與統計分析………………………… 79
第六節 倫理考量……………………………………… 84
第四章 研究結果..................................... 85
第一節 腦中風病人其主要照顧者背景及情境因素、壓力源及內外在資源之得分………………87
第二節 腦中風病人之主要照顧者憂鬱及正向照顧感得分…………………………………99
第三節 雙變量分析探討影響憂鬱之因素…………… 102
第四節 雙變量分析探討影響照顧正向感之因素…… 108
第五節 結構方程式分析探討影響憂鬱及照顧正向感之因素………………………………114
第五章 討論.......................................... 127
第一節 腦中風病人主要照顧者的憂鬱及照顧正向感 127
第二節 腦中風病人主要照顧者壓力源對憂鬱的影響 130
第三節 腦中風病人主要照顧者的宗教信仰、社會支持及自我握控信念對憂鬱的影響..132
第四節 腦中風病人主要照顧者的壓力源對照顧正向感的影響...........................136
第五節 腦中風病人主要照顧者的宗教信仰、社會支持及自我握控信念對照顧正向感的影響.... 138
第六章 結論與建議................................... 141
第一節 結論.................................. 141
第二節 護理運用……………………………………… 145
第三節 研究限制及建議……………………………… 149
參考文獻............................................. 150
附錄................................................. 179


圖目錄
圖2-1 Pearlin's model for stress process model of caregiving..... 24
圖2-2 Research framework of depressive symptoms and postive aspects of caregiving among family caregivers of stroke patients...........................................54
圖4-1 腦中風病人照顧者影響憂鬱之整體結構模式............ 122
圖4-2 腦中風病人照顧者影響照顧正向感之整體結構模式… 125

表目錄
表3-1 研究變項的操作性測量及研究工具信度……………… 77
表3-2 研究變項的資料統計方法……………………………… 80
表3-3 模式適配指標綜合表…………………………………… 83
表4-1 參與及拒絕腦中風病人照顧者人口學變項之比較…… 86
表4-2 主要照顧者人口學資料………………………………… 89
表4-3 照顧工作強度各題得分狀況…………………………… 93
表4-4 照顧者照顧負荷各題得分狀況………………………… 94
表4-5 照顧者宗教信仰各題得分狀況………………………… 96
表4-6 照顧者自我握控信念各題得分狀況…………………… 96
表4-7 照顧者社會支持各題得分狀況………………………… 97
表4-8 照顧者憂鬱各題得分狀況……………………………… 100
表4-9 照顧者照顧正向感各題得分狀況……………………… 101
表4-10 不同背景情境因素之腦中風病人照顧者憂鬱之差異分析……………………………………………104
表4-11 不同背景及情境因素之腦中風病人照顧者與憂鬱之相關性分析…………………………………………106
表4-12 腦中風病人主要照顧者的壓力源、內外在資源與憂鬱之相關性分析………………………………………107
表4-13 不同背景及情境因素之腦中風病人照顧者照顧正向感之差異情形………………………………110
表4-14 不同背景及情境因素之腦中風病人照顧者的與照顧正向感之相關性分析…………………………………112
表4-15 腦中風病人照顧者的壓力源、內外在資源與照顧正向感之相關性分析…………………………………113
表4-16 腦中風病人照顧者影響憂鬱及照顧正向感變項之共線性檢定………………………………………115
表4-17 各變項測量模式之適配度指標………………………… 119
表4-18 憂鬱及照顧正向感整體結構模式之適配度指標……… 120
表4-19 憂鬱之整體結構模式路徑分析假設…………………… 123
表4-20 照顧正向感整體結構模式路徑分析假設……………… 126
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