熊秉荃臺灣大學:護理學研究所蘇美雅Su, Mei-YaMei-YaSu2010-05-052018-07-072010-05-052018-07-072008U0001-2907200812245500http://ntur.lib.ntu.edu.tw//handle/246246/180386目的：本研究目的(1)了解身心靈賦能暨衛教團體對於降低乳癌婦女焦慮和身心靈鬱結狀態之效果，以及(2)乳癌婦女對於團體治療如何產生療效之主觀看法。法：本研究採隨機控制試驗(randomized controlled trial)設計。於2007年10月至2008年4月於台北市某醫學中心乳癌外科門診和乳癌基金會收案，以單純隨機方式將研究對象分成實驗組和控制組，最後完成研究的人數實驗組為11人，控制組為10人。實驗組除了接受醫院例行性門診照護外，另有8週精神科護理人員和腫瘤科護理人員共同帶領的身心靈賦能暨衛教團體，每週一次，一次團體120分鐘。對照組僅接受醫院門診的例行性照護。成效測量以結構式自填量表，於實驗前後測量，測量量表為「焦慮狀態量表」、「鬱結量表」。實驗組個案於最後一次團體時，以半結構式訪談團體成員，所獲得的質性資料來了解產生療效的過程。果：經研究結果所收集資料顯示，實驗組和控制組之鬱結和焦慮狀態量表分數於八週實驗後皆有下降情形。經Mann-Whitney U test 檢定兩組前後進步值，發現兩組於鬱結量表(Z = -.353，p=.756)，焦慮狀態量表(Z= -.388，p= .705)，並無顯著差異。質性結果發現，乳癌患者身體困擾包括疲倦、失眠、疼痛、和手活動受限。心理困擾有焦慮、情緒低落、無望感。靈性困擾包含自責、質疑生命存在的意義、覺得自己是孤獨的。分析乳癌患者對於身心靈賦能暨衛教團體療效機轉的看法共產生7個療效層面：傳達資訊、灌輸希望、普同感、情緒宣洩、社交技巧發展、存在因素和自我了解。結果說明藉由團體療效機轉的產生，降低乳癌患者焦慮、改善情緒低落和對於疾病的不確定感、增加對疾病復原信心、知覺生命是有希望的、重建社交網絡和重新面對自己找回生命意義和目標。論：精神科和腫瘤科護理人員合作之身心靈賦能暨衛教團體，可藉由精神科護理人員運用其團體治療的知識及身心靈賦能的技能，使乳癌婦女感受團體成員支持力量，並提升自我內在正向的力量。腫瘤科護理人員運用其腫瘤專業領域，提供關於疾病之相關衛教知識，以改善乳癌婦女身心靈的困擾。未來研究可根據此模式加以擴大研究樣本以檢驗其效果。Aims：The aims of this study were to understand (1) the effects of body-mind-spirit empowerment and education group on reducing the sense of anxiety and status of stagnation for women with breast cancer, and to examine (2) what aspects of group therapy worked to contribute to the therapeutic effects in the views of women with breast cancer. ethods：This study was a randomized controlled trail design. The subjects were recruited from outpatient department of breast cancer surgery of medical centre in Taipei and Foundation of Breast Cancer Prevention and Treatment from October 2007 to April 2008. The subjects were randomly assigned to the experimental or the control group by using simple random method. The eleven subjects in the experimental group and the ten subjects in the control group completed this study. The subjects in the experimental group received both the physician’s usual care of the outpatient department and the eight-session group therapy, with each session lasting for 120 minutes weekly. The group therapy was provided by one psychiatric nurse and one oncology nurse. The subjects in the control group received physician’s usual care of the outpatient department only. The outcome measures included State Anxiety Inventory and Stagnation Scale and they were assessed at pre and post treatments. In the last session of group therapy, the subjects in the experimental group were invited to participate in a semi-structured interview regarding their views on the therapeutic mechanisms of group therapy.esults：The scores of the scale of State Anxiety Inventory and Stagnation Scale after 8-week trial were reduced in the both the experimental and control groups. According to Mann-Whitney U test, the results indicated that there were no significant differences in changing the scores of Stagnation Scale (Z = -.353, p=.756) and State Anxiety Inventory (Z= -.388, p= .705) after treatment between the experimental group and the control group. In the views of women with breast cancer, their physical distress included fatigue, insomnia, pain and decreased activity function of hands. The psychological distress included the senses of anxiety, depression, and hopelessness. The spirits distress included self-blame, doubt about the meanings of life, and sense of being alone. There were seven domains of the therapeutic factors of the body-mind-spirit empowerment and education group: imparting of information, instillation of hope, university, catharsis, interpersonal learning, existential factors and self-understanding. The results indicated that through emerged therapeutic factors, the group effectively reduced the senses of anxiety, depression, and uncertainty, increased the confidence about illness recovery, improved the sense of hope toward the future life, established social support network, and discovered the meanings and the purposes of life.onclusion: By the psychiatric nurse’s cooperation with oncology nurse in the body-mind-spirit empowerment and education group, the psychiatric nurse’s knowledge about group therapy and empowerment skills help breast cancer women to obtain supports from group members and to strengthen their inner self positive power. The oncology nurse’s knowledge about cancer care helps to decrease body-mind-spirit distress. The future may enlarge the size of sample in order to demonstrate the effects of the body-mind-spirit empowerment and education group.口試委員會審定書…………………………………………………..I謝…………………………………………………………………..II文摘要…………………………………………………………..…III-IV文摘要…………………………………………………………..…IV-VI 一章 緒論 第一節 研究動機和背景…………………………………………1-2 第二節 研究目的…………………………………………………3 第三節 名詞界定…………………………………………………4二章 文獻查証 第一節 乳癌的診斷和治療方式…………………………………5-7 第二節 症狀困擾…………………………………………………8-11 第三節 團體治療…………………………………………………12-16 第四節 身心靈賦能團體…………………………………………17-18五節 研究概念架構……………………………………………19三章 研究方法一節 研究設計………………………………………………….20二節 實驗組介入措施………………………………………….21-24三節 研究對象………………………………………………….25四節 研究假設………………………………………………….26五節 研究工具…………………………………………………27-28六節 研究分析…………………………………………………29-30七節 研究步驟…………………………………………………31八節 倫理考量…………………………………………………32四章 分析與結果 第一節 研究樣本之相關資料……………………………………33-44 第二節 實驗組之前後測資料……………………………………45-46 第三節 控制組之前後測資料……………………………………47-48 第四節 實驗組和控制組於治療前後之差異................................49-50五節 個案對身心靈療效的主觀看法…………………………51-69五章 討論一節 樣本特性………………………………………………….70二節 研究樣本的身心靈困擾………………………………….70-72三節 身心靈賦能暨衛教團體成效之探討…………………….73-76六章結論與建議第一節研究結論一節 研究結論………………………………………………….77二節 研究與限制……………………………………………….78三節 研究貢獻與建議………………………………………….79-80考資料 中文文獻……………………………………………………………81-82 英文文獻……………………………………………………………82-88錄 附錄一 IRB審查通過函…………………………………………..89 附錄二 研究問卷…………………………………………………..90-92表目錄一、身心靈賦能暨衛教團體的概念架構…………………………19二、收案過程………………………………………………………34一、乳癌團體介入措施及結果……………………………………13-15二、研究設計………………………………………………………20三、身心靈賦能暨衛教團體活動內容……………………………22-24四、統計方法………………………………………………………29五、研究樣本之基本資料…………………………………………35六、研究樣本之疾病相關資料……………………………………37七、研究樣本前測之相關資料……………………………………39八、過度執著次量表………………………………………………41九、身心鬱結次量表………………………………………………42十、情感-姿勢抑制次量表………………………………………...43十一、焦慮狀態之排序……………………………………………44十二、實驗組鬱結和焦慮狀態組內比較…………………………46十三、控制組鬱結和焦慮狀態組內比較…………………………48十四、實驗組和控制組在治療前後之差異………………………50十五、身心靈賦能暨衛教團體治療療效因子總表………………52十六、身心靈賦能暨衛教團體「資訊傳導」層面療療效因子…………………………………………………………54-56十七、身心靈賦能暨衛教團體「灌輸希望」層面療療效因子………………………………………………58十八、身心靈賦能暨衛教團體「普同感」層面療療效因子………………………………………………60十九、身心靈賦能暨衛教團體「情緒的宣洩」層面療療效因子………………………………………………62二十、身心靈賦能暨衛教團體「社交技巧的發展」層面療療效因子………………………………………………64二十一、身心靈賦能暨衛教團體「存在因素」層面療療效因子………………………………………………66二十二、身心靈賦能暨衛教團體「自我了解」層面療療效因子………………………………………………68application/pdf11544124 bytesapplication/pdfen-US乳癌婦女身心靈賦能暨衛教團體鬱結焦慮women with breast cancerbody-mind-spirit empowerment and education groupstagnationanxiety[SDGs]SDG3http://ntur.lib.ntu.edu.tw/bitstream/246246/180386/1/ntu-97-R94426026-1.pdf