臺灣博碩士論文加值系統

本研究目的是深入探討再次懷有重型海洋性貧血胎兒之孕婦從接受產前診斷(絨毛採樣或羊膜穿刺)到確定胎兒異常接受終止妊娠後兩週期間，因為疾病導致的結果而引發孕婦對自我的看法、評價與調適行為。
本研究係採田野研究法，以觀察者即參與者的方式進行研究，而研究對象是以立意取樣決定，共選取五位曾懷有重型海洋性貧血胎兒之孕婦，並於選定研究對象後，研究者以其主護護理師身份於其接受檢查時開始與之接觸，提供其所需要的護理指導與服務﹐期間每週以電話訪談，以瞭解孕婦內在的想法與對自己的看法，在診斷胎兒異常後終止妊娠期間予以陪伴，返家後兩週內繼續電話訪談，以進一步瞭解其感受。
每位研究對象共接觸9-11次，採非結構式的觀察與會談收集資料，每次接觸後均將觀察與會談時孕婦所表達出的語言及非語言的行為寫成敘述體的行為過程記錄，再以內容分析法將語言資料加以整理、分析、歸類。
研究結果發現，海洋性貧血帶因孕婦從懷孕至診斷確定胎兒異常接受終止妊娠後兩週期間，她們對自我的看法為：壹、陷入帶有先天遺傳疾病基因之無奈；貳、看似正常的軀體卻隱藏著危險因子的缺陷；參、咀嚼躲不過命運安排的苦難；肆、處於家族地位時時受到考驗的囹圄。以及調適行為有：壹、努力讓自己暫時跳脫桎梏；貳、在變與不變之間找到平衡；參、維護自我遠離傷害；肆、痛定思痛思從「心」再出發。
經由本研究結果可瞭解再次懷有重型海洋性貧血胎兒之孕婦們的自我看法及所需要的護理照護，可作為產科護理人員之參考。

The purpose of this study is to explore the self-concepts, evaluation and coping mechanisms of pregnant women carrying a Thalassemia fetus for a second time. The study period is from the prenatal diagnosis, which ascertain the fetal abnormality regarding Chorionic Villus Sampling or Amniocentesis, to two weeks after termination.
This qualitative study is done as a clinical field study. With purposive sampling, five pregnant women who one had Thalassemia fetus were enrolled and observer-as-participant approach was employed. After choosing the study subjects, the researcher acted as a primary nurse and contacted the subjects on their medical visits. Through the research period, the researcher provided the subjects with any clinical help they needed and had telephonecally interviews once a week to understand the inner thoughts and self-concepts of those subjects. From the initial prenatal diagnosis to the termination of pregnancy, the researcher accompanied the subjects and interviewed them telephone untill two weeks after termination to know more about their feelings.
Nine to eleven contacts were made for each subject, and the researcher gathered the data by the way of non-structural observations and conversations. The pregnant women's verbal and non-verbal behaviors were documented as narrative process-recordings which were analyzed and categorized with the method of content analysis.
This research shows as follows:
Their self-concepts are: (1)A feeling of powerlessness regarding being a carrier of inheritable disease genes；(2) seeing oneself as a normal figure with a hidden defect；(3)Suffering from her destiny；(4)Worried about one's status in the family clan.
Their coping behaviors are: (1)Making efforts to escape from the imprisoned status for the time being；(2)Trying to keep a balance between change and stability；(3)Protecting oneself from harm；(4)seeing suffering as a growth mechanism.
With this research, we can understand the self-concepts of pregnant women who have a Thalassemia fetus for a second time and provide them with the nursing care they need. This will also provide obstetric nursing with a clinical reference.

致謝…………………………………………………………… I
摘要…………………………………………………………… II
目錄…………………………………………………………… VI
第一章 緒論………………………………………………… 1
第一節 研究動機及重要性………………………… 1
第二節 研究問題的陳述…………………………… 3
第三節 名詞界定……………………………………. 3
第二章 文獻查證……………………………………………. 4
第一節 自我概念…………………………………….. 4
第三節 產前診斷對遺傳疾病帶因者的
重要性……………………………………….. 8
第四節 遺傳疾病對懷孕婦女的意義及對
自我概念的影.………………………………. 10
第四節 研究方法論…………………………………… 12
第三章 研究方法…………………………………………….. 15
第一節 研究設計……………………………………… 15
第二節 研究對象……………………………………… 17
第三節 研究情境……………………………………… 17
第四節 研究工具……………………………………… 18
第五節 資料收集……………………………………… 18
壹、嘗試研究…………………………………….. 18
貳、資料收集過程……………………………….. 20
參、資料的記錄………………………………….. 21
第六節 資料之分析…………………………………. 22
第七節 資料收集與分析的嚴謹度…………………… 23
第四章 資料分析與結果……………………………………... 25
第一節 再次懷有重型海洋性貧血胎兒之
孕婦於懷孕至終止妊娠期間的
自我看法……………………………………… 33
壹、 陷入帶有先天遺傳疾病基因之
無奈………………………………….…….. 33
貳、 看似正常的軀體卻隱藏著危險
因子的缺陷………………………………… 43
參、咀嚼躲不過命運安排的苦難………………. 51
肆、、處於家族地位時時受到考驗的
囹圄…………………………………………. 58
第二節 再次懷有重型海洋性貧血胎兒之
孕婦於懷孕至終止妊娠期間的調
適行為……………………………………… 64
壹、努力讓自己暫時跳脫桎梏………………… 64
貳、 在變與不變之間找到平衡………………… 70
參、 維護自我遠離傷害………………………… 73
肆、 痛定思痛從「心」再出發………………… 79
第五章 討論………………………………………………….. 90
第一節 本研究結果的探討…………………………… 90
第二節 本研究結果與相關研究探討………………… 100
壹、 與國內相關研究比較……………………….. 100
貳、 與國外相關研究比較……………………….. 105
第三節 本研究概念架構之形成與討論……………… 110
第六章 結論與建議………………………………………… 113
第一節 結論…………………………………………… 113
第二節 護理學上的應用……………………………… 114
第三節 研究的限制及對未來研究的建議…………… 119
參考文獻……………………………………………………….. 121
附錄：行為過程記錄與內容分析實例摘要………………… 126
圖表目次
表一 五位研究對象的基本及相關資料…………………….. 27
表二 再次懷有重型海洋性貧血胎兒之孕婦於
懷孕至終止妊娠期間的自我看法之現象
主題與相關內容一欄表……………………………….. 28
表三 再次懷有重型海洋性貧血胎兒之孕婦於
懷孕至終止妊娠期間的調適行為之現
象主題與相關容一欄表……………………………… 31
表四 與國內相關研究比較………………………………….. 102
表五 與國外相關研究比較………………………………….. 106
圖一 研究方法及資料收集過程之流程……………………. 16
圖二 本研究資料收集流程………………………………….. 21
圖三 再次懷有重型海洋性貧血胎兒之孕婦於
懷孕至終止妊娠期間的自我看法與調適
行為之概念架構圖…………………………………… 112

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