發(fā)布時(shí)間：2018-03-15 10:06

  本文選題：晚期癌癥患者　切入點(diǎn)：本土化尊嚴(yán)　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究旨在做三方面的研究:首先,通過半結(jié)構(gòu)式訪談,結(jié)合扎根理論的資料分析方法,探索本土晚期癌癥患者的尊嚴(yán)內(nèi)涵,構(gòu)建本土晚期癌癥患者尊嚴(yán)的理論模型,為有效開展臨終關(guān)懷和安寧療護(hù)提供理論支持;其次,以建構(gòu)的晚期癌癥患者尊嚴(yán)模型為理論基礎(chǔ),編制本土化的晚期癌癥患者尊嚴(yán)量表,為臨床實(shí)踐提供方便有效的評(píng)估工具;最后,將編制好的晚期癌癥患者尊嚴(yán)量表應(yīng)用到臨床,探索晚期癌癥患者的尊嚴(yán)狀況以及影響因素,為下一步的干預(yù)研究奠定前期基礎(chǔ)。方法:⑴質(zhì)性研究:采用目的性抽樣,對(duì)符合入組標(biāo)準(zhǔn)的晚期癌癥患者進(jìn)行半結(jié)構(gòu)式訪談;訪談的同時(shí),通過扎根理論的方法對(duì)訪談資料進(jìn)行編碼分析,訪談資料理論達(dá)到飽和時(shí)停止訪談。最終形成晚期癌癥患者尊嚴(yán)主題編碼表,并獲得建構(gòu)的晚期癌癥患者尊嚴(yán)模型。⑵量表編制:依據(jù)構(gòu)建的尊嚴(yán)模型,編制晚期癌癥患者尊嚴(yán)量表?xiàng)l目池;經(jīng)過專家評(píng)判和被試易讀性評(píng)判形成初始量表;對(duì)155名晚期癌癥患者初測(cè),繼而對(duì)回收的數(shù)據(jù)進(jìn)行項(xiàng)目分析和探索性因素分析,最終得到16個(gè)條目的晚期癌癥患者尊嚴(yán)量表;將尊嚴(yán)量表對(duì)148名晚期癌癥患者進(jìn)行正式施測(cè),對(duì)回收的數(shù)據(jù)進(jìn)行信效度檢驗(yàn)。⑶調(diào)查研究:采用自編一般資料調(diào)查表、自編晚期癌癥患者尊嚴(yán)量表、跨文化(中國(guó)人)個(gè)性測(cè)量表、生命意義感量表中文修訂版、心理痛苦溫度計(jì)對(duì)160名晚期癌癥患者進(jìn)行施測(cè),回收有效問卷151份。采用描述性統(tǒng)計(jì)、相關(guān)分析、多元逐步回歸分析等方法進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:⑴通過對(duì)29名晚期癌癥患者訪談資料的三級(jí)編碼,最終獲得了晚期癌癥患者尊嚴(yán)內(nèi)涵的四大因素,即軀體尊嚴(yán)、社會(huì)尊嚴(yán)、心理尊嚴(yán)和靈性尊嚴(yán),并形成了尊嚴(yán)內(nèi)涵模型。⑵以建構(gòu)的尊嚴(yán)模型為理論基礎(chǔ),初步建立90個(gè)條目的條目池;經(jīng)過專家評(píng)判和被試易讀性評(píng)判形成32個(gè)條目的初測(cè)版本;繼而對(duì)量表進(jìn)行初測(cè),經(jīng)過項(xiàng)目分析和探索性因素分析,最終保留16個(gè)條目。⑶信效度檢驗(yàn)結(jié)果顯示:驗(yàn)證性因素分析獲得的四維結(jié)構(gòu)模型擬合指數(shù)良好;維量分析中,因子之間基本處于中等程度的相關(guān),因子與總分之間處于中等偏上程度的相關(guān);自編的晚期癌癥患者尊嚴(yán)量表與西方患者尊嚴(yán)量表呈顯著負(fù)相關(guān),與幸福感指數(shù)呈顯著正相關(guān);并且自編的晚期癌癥患者尊嚴(yán)量表比西方患者尊嚴(yán)量表顯著多預(yù)測(cè)患者幸福感程度的6%。問卷的ɑ系數(shù)和分半信度均在0.7以上。該問卷信效度較好。⑷調(diào)查研究結(jié)果顯示:尊嚴(yán)總分在性別(t=2.09,p=0.038)、不同痛苦程度(t=6.15,p0.000)、不同文化程度(F=3.41,p=0.006)、不同年齡分組(F=3.97,p=0.021)和不同經(jīng)濟(jì)壓力狀況(F=8.37,p0.000)上有顯著差異;在居住地、有無宗教信仰、對(duì)病情的了解程度、疾病分期、是否化療、是否轉(zhuǎn)移和病情持續(xù)時(shí)間上無顯著差異。⑸尊嚴(yán)總分與需要關(guān)注、自卑自信和心理痛苦程度呈顯著負(fù)相關(guān),與生命意義感總分及分量表和內(nèi)外控制點(diǎn)呈顯著正相關(guān)。⑹晚期癌癥患者尊嚴(yán)的主要影響因素為經(jīng)濟(jì)壓力、性別、自卑自信、擁有意義感、心理痛苦程度,這些因素可以解釋晚期癌癥患者尊嚴(yán)感變異的42.1%。結(jié)論:⑴中國(guó)傳統(tǒng)文化背景下尊嚴(yán)的內(nèi)涵有其獨(dú)特性,在晚期癌癥患者尊嚴(yán)理論和模型的研究中應(yīng)注重中西文化差異的敏感性和本土文化的獨(dú)特性。⑵自編的晚期癌癥患者尊嚴(yán)量表信效度良好,符合心理測(cè)量學(xué)要求,可用于我國(guó)晚期癌癥患者尊嚴(yán)水平的評(píng)估。⑶不同背景的晚期癌癥患者尊嚴(yán)狀況差異明顯,經(jīng)濟(jì)壓力、性別、自卑自信、擁有意義感、心理痛苦程度可以預(yù)測(cè)患者的尊嚴(yán)狀況。
[Abstract]:Objective: This study aims to do research on three aspects: first, through semi-structured interviews, combined with the grounded theory method of data analysis and exploration of the connotation of the dignity of local advanced cancer patients, the theoretical model of advanced cancer patients with local dignity, for the effective implementation of hospice and palliative care to provide theoretical support; secondly, the dignity of late cancer patients model as the theoretical foundation, the native dignity of patients with advanced cancer scale, to provide convenient and effective assessment tool for clinical practice; finally, will prepare the dignity of patients with advanced cancer scale applied to clinical factors in patients with advanced cancer, explore the dignity of status and influence, will lay the foundation for the intervention of a step 1. Methods: qualitative research: by purposive sampling, semi-structured interviews of eligible patients with advanced cancer; interview at the same time, through the bar The theory of encoding method of root analysis of interview data, interview data stop reaches saturation. The final formation of the theory of advanced cancer patients dignity theme encoding tables, and obtain the dignity of patients with advanced cancer model construction. The scale of the model: on the basis of dignity, the dignity of patients with advanced cancer were compiled by experts scale items; evaluation and readability evaluation subjects formed the initial scale; on 155 patients with advanced cancer detection, analysis and recovery of the data item and exploratory factor, finally got 16 to advanced cancer patients with dignity scale; the dignity scale in 148 patients with advanced cancer of the formal test, test of the validity of the data. The recovery of investigation: using a self-designed questionnaire, the self dignity of patients with advanced cancer scale, cross culture (Chinese) personality questionnaire, the meaning of life Chinese scale revised edition, psychological distress thermometer on 160 patients with advanced cancer were tested, and 151 valid questionnaires were collected. Using descriptive statistics, correlation analysis, multiple stepwise regression analysis were used for statistical analysis. Results: the 29 patients with advanced cancer through the interview data of three level encoding, eventually won four dignity factors in patients with advanced cancer connotation, namely body dignity, social psychological and spiritual dignity dignity, dignity, dignity and the formation of the model. The connotation of dignity to construct model as the theoretical foundation, the initial establishment of a 90 item pool; after expert evaluation and test readability evaluation form 32 a preliminary survey and then on the scale version; the initial test, through the project analysis and exploratory factor analysis, finally kept 16 items. The reliability and validity of the test results show: confirmatory factor analysis to obtain the quasi four dimensional structure model Good index; dimension analysis, the basic factors in the middle level, in the medium and high degree of correlation between factor score and total score; the dignity of patients with advanced cancer patients with dignity and the western scale scale was negatively correlated, and well-being index showed significant positive correlation; and the dignity of advanced cancer the patients scale than Western patients with dignity scale significantly more predictive coefficient alpha level of 6%. were happiness and split half reliability were above 0.7. The questionnaire has good reliability and validity. The survey results showed that: the total score of dignity in gender (t= 2.09, p=0.038), different degrees of pain (t=6.15, p0.000), different (F=3.41, p=0.006) level of culture, different age groups (F=3.97, p=0.021) and different economic pressure conditions (F=8.37, p0.000) there are significant differences; in the residence, there are no religious beliefs, the degree of understanding of the disease stage of disease, whether Chemotherapy, metastasis and disease duration had no significant difference. The total score and the dignity of concern, is negatively related to self confidence and psychological pain degree was positively correlated with the sense of the meaning of life score and subscale and locus of control. In patients with advanced cancer, the dignity of the main influencing factors are gender, economic pressure. Self confident, have a sense of meaning, psychological pain degree, 42.1%. conclusion these factors can explain the variation of the sense of dignity in patients with advanced cancer: the connotation of China dignity under the background of traditional culture has its unique characteristics, in the study of patients with advanced cancer dignity theory and model should focus on the unique cultural differences and the sensitivity of the local culture. The self dignity of patients with advanced cancer had good reliability and validity, in line with the requirements of psychometrics, can be used for the evaluation of our patients with advanced cancer. The level of dignity of different backgrounds There is a significant difference in the dignity of patients with advanced cancer, economic pressure, gender, self inferiority, sense of sense, and the degree of psychological distress that can predict the dignity of the patient.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：B848

【參考文獻(xiàn)】

中國(guó)期刊全文數(shù)據(jù)庫(kù) 前10條

1 仇德媛;;年輕乳腺癌患者術(shù)后家庭支持的現(xiàn)況及護(hù)理[J];中國(guó)現(xiàn)代醫(yī)藥雜志;2016年01期

2 馬丹丹;;本土心理學(xué)研究從“獨(dú)白”走向“對(duì)話”之后的思考[J];社會(huì)心理科學(xué);2016年01期

3 明星;徐燕;;臨終患者尊嚴(yán)內(nèi)涵及影響因素的國(guó)內(nèi)外研究進(jìn)展[J];護(hù)理學(xué)雜志;2015年19期

4 吳梅利洋;劉小紅;曾鐵英;;晚期腫瘤患者尊嚴(yán)感及尊嚴(yán)模型適用性的研究[J];中華護(hù)理雜志;2015年10期

5 景懷斌;;德性認(rèn)知的心理機(jī)制與啟示[J];中國(guó)社會(huì)科學(xué);2015年09期

6 葛國(guó)靖;曹艷梅;劉捷;牛潤(rùn)桂;辛麗艷;于靜;薛云珍;;中文版患者尊嚴(yán)量表初步修訂及信、效度評(píng)價(jià)[J];中國(guó)公共衛(wèi)生;2016年08期

7 韓章勇;;先秦儒家德壽思想初探[J];亞太傳統(tǒng)醫(yī)藥;2015年09期

8 胡廣宇;毛阿燕;董佩;嚴(yán)曉玲;邱五七;;北京地區(qū)六種癌癥患者的診療情況和疾病經(jīng)濟(jì)負(fù)擔(dān)分析[J];腫瘤防治研究;2015年02期

9 劉方;徐琳;;中文版患者尊嚴(yán)量表的信效度研究[J];中國(guó)實(shí)用護(hù)理雜志;2015年01期

10 王福玲;;康德哲學(xué)中的尊嚴(yán)與價(jià)值[J];齊魯學(xué)刊;2014年06期

中國(guó)碩士學(xué)位論文全文數(shù)據(jù)庫(kù) 前1條

1 曹艷梅;患者尊嚴(yán)量表初步修訂及晚期癌癥患者尊嚴(yán)研究[D];山西醫(yī)科大學(xué);2015年

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