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| 題名: | 支持性心理治療對罹癌父母其子女成效探討 |
| 作者: | 黃詩婷 |
| 貢獻者: | 護理學研究所 |
| 關鍵詞: | 罹癌父(母) 罹癌父(母)之子女 支持性心理治療 支持性團體 |
| 日期: | 2010 |
| 上傳時間: | 2010-10-21 09:37:01 (UTC+8) |
| 摘要: | 本研究目的為探討癌症病患其子女支持性心理治療之實施成效，研究設計採實驗性研究設計，隨機控制試驗法(randomized controlled trial)。研究對象為癌症病患其子女(10~24歲)，於台北市某區域教學醫院腫瘤科收案， 以隨機方式將研究對象分為實驗組(A組)及控制組(B組)，控制組僅接受一般性醫療照護，實驗組除了接受一般性醫療照護外，並加上支持性心理治療，內容包含支持性團體及護理衛教諮詢二部分，支持性團體共進行六週，每週一次，每次約90分鐘，團體皆由資深精神衛生護理師及心理諮詢師擔任團體治療者及協同治療者。護理衛教諮詢採用電話訪談及書面衛教單張指導，來關懷實驗組個案在父母罹病過程、情緒困擾、親子關係等方面之適應。支持性心理治療成效的測量包括兒童憂鬱量表(Children’s Depression Inventory, CDI)、貝克焦慮量表(Beck Anxiety Inventory, BAI)、中文版正向及負向自殺意念量表(Chinese version of the Positive and Negative Suicidal Ideation, PANSI-C)、親子關係量表(Parents and Children Relationship Scale, PCRS) 、及靈性評估量表(Spirituality Assessment Scale, SAS)，於支持性心理治療之前後施行測量。統計分析採用描述性及推論性統計，以重複測量共變數分析(Repeated Measures ANCOVA)進行成效分析；另針對團體中出現的議題作質性分析探討。統計結果發現實驗組較控制組在憂鬱症狀、負向自殺意念、親子關係、靈性健康方面有明顯改善；團體議題分析的範疇包含：模糊不清的癌症、變調的成長、尋求支持力量、寄託未來。研究結果顯示支持性心理治療能有效改善罹癌患者其子女的情緒困擾，增強親子關係知覺及提升正向支持力量。本研究結果有助於臨床護理人員運用支持性心理治療來改善罹癌父母其子女的心理調適。
The major purpose of this study was explored the effectiveness of supportive psychotherapy for children of parents with cancer. The research design was to adopt experimental method and randomized controlled trial. The subjects were children of parents with cancer (aged 10~24) recruited from a local teaching hospital Oncology department in Taipei City. The subjects separated for experimental group (group A) and control group (group B) randomly. Control group only received general medical care. Experimental group not only received general medical care but also supportive psychotherapy which included supportive group and nursing health consultation two parts. The supportive group was leading by psychiatric registered professional nurse and counseling psychologist as group therapist and collaborative therapist in around 90 minutes each week for six weeks. Nursing health consultation group used telephone interviews and guided by health education sheet to concern the experimental group adapted to parent diseased process, emotional distress, parent-children relationship… etc.
The research instruments used included the Children’s Depression Inventory, Beck Anxiety Inventory, Chinese version of the Positive and Negative Suicidal Ideation, Parents and Children Relationship Scale and Spirituality Assessment Scale. Statistical analysis used descriptive and inferential statistics and effectiveness analysis used Repeated Measures ANCOVA. Other group issues were discussed by qualitative analysis.
Statistical results found experimental group improved obviously in depressive symptoms, negative suicidal ideation, parents-children relationship and spirituality health than in control group. Supportive group issues analysis categories were ambiguous cancer, transform of growth, seeking support strength and hope for future. The results showed supportive psychotherapy could ameliorate children of parents with cancer’s emotional distress effectively, reinforce perception of parents-children relationship and advance the power of inside support. These results will help clinical nurses use supportive psychotherapy to improve children of parents with cancer’s psychological adaption. |
| 關聯: | 115頁 |
| 描述: | (一)論文目次
目錄
致謝…………………………………………………………………………...2
中文摘要……………………………………………………………………..3
英文摘要……………………………………………………………………...5
目錄…………………………………………………………………………...7
圖表目次……………………………………………………………………10
第一章 緒論
第一節 研究背景與研究動機…………………………………………..12
第二節 研究目的………………………………………………………..14
第三節 主要研究問題…………………………………………………..14
第四節 名詞解釋………………………………………………………..15
第二章 文獻查證
第一節 父（母）罹癌對兒童、青少年子女之衝擊與影響…………….18
第二節 癌症家庭中的親子關係………………………………………..21
第三節 兒童、青少年的靈性健康………………………………………23
第四節 支持性團體治療………………………………………………..26
第五節 罹癌父（母）之子女支持性團體的相關研究…………………30
第三章 研究方法
第一節 研究架構………………………………………………………..35
第二節 研究設計………………………………………………………..37
第三節 研究對象………………………………………………………..39
第四節 研究工具………………………………………………………..39
第五節 進行步驟………………………………………………………..44
第六節 資料處理………………………………………………………..48
第七節 團體方案………………………………………………………..50
第八節 倫理考量………………………………………………………..54
第四章 分析與結果
第一節 研究對象………………………………………………………..56
第二節 前測量表………………………………………………………..67
第三節 團體介入措施成效……………………………………………..73
第四節 實驗組團體成員之質性描述…………………………………..84
第五章 討論
第一節 研究對象之基本屬性…………………………………………..92
第二節 罹癌父母之子女情緒困擾分析………………………………..92
第三節 支持性心理治療之療效討論…………………………………..93
第四節 支持性團體之議題探討………………………………………..95
第六章 結論與建議
第一節 結論……………………………………………………………..97
第二節 研究限制………………………………………………………..97
第三節 建議……………………………………………………………..98
參考資料
一、中文部分……………………………………………………………100
二、英文部分……………………………………………………………104
附錄
附錄一 臺北醫學大學人體試驗證明書
圖表目次
圖一 支持性團體輔以護理衛教諮詢介入的概念架構.............................36
圖二 研究流程圖 …………………………………………………….......47
圖三 C3個案畫的癌症……………………………………………………85
圖四 C7個案畫的癌症……………………………………………………85
圖五 C5個案送給媽媽長頭髮……………………………………………89
圖六 C2個案送給媽媽開心的微笑………………………………………89
表一 罹癌父母之子女支持團體之相關研究…………………………….32
表二 研究設計之架構…………………………………………………….38
表三 研究工具量表……………………………………………………….40
表四 罹癌父(母)之子女組支持性團體方案內容………………………..52
表五 實驗組參與團體日期……………………………………………….57
表六 實驗組A成員於團體的出席情形…………………………………59
表七 實驗組護理衛教單張主題……………………………………….....61
表八 實驗組與控制組之基本人口學變項資料分析（連續變項）……….65
表九 實驗組與控制組之基本人口學變項資料分析（類別變項）……….66
表十 實驗組與控制組各研究變項前測量表之類別性資料分析…….....70
表十一 實驗組與控制組各研究變項前測量表之連續性資料分析……...71
表十二 憂鬱症狀之共變數分析摘要一覽表……………………………...76
表十三 焦慮症狀之共變數分析摘要一覽表……………………………...77
表十四 正負向自殺意念總分之共變數分析摘要一覽表………………...78
表十五 正向自殺意念之共變數分析摘要一覽表………………………...79
表十六 負向自殺意念之共變數分析摘要一覽表………………………...80
表十七 親子關係知覺之共變數分析摘要一覽表………………………...81
表十八 靈性健康之共變數分析摘要一覽表……………………………...82
表十九 實驗組與控制組之團體成效分析………………………………...83
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