太極拳對不同疾病與保健之助益

[[abstract]]無論預防保健或疾病復健，醫療人員常須推薦民眾運動，然運動種類繁多，而適於老人、慢性疾病患者的運動非太極拳莫屬，現今太極拳已廣為西方醫學 所接受，也越來越多的研究實證其對醫療的效益，如預防社區老人跌倒、改善平衡、增進肌力，能增加攜氧能力，改善慢性阻塞性肺疾病與助益於心臟病、 中風後的復健，但對有些疾病如糖尿病、慢性心衰竭、類風濕性關節炎截至目前證據顯示並無助益，本文綜整多篇回顧系統性文獻回顧的研究結果，供醫療 人員提供民眾訊息的參考

太極拳對不同疾病與保健之助益

[[abstract]]無論預防保健或疾病復健，醫療人員常須推薦民眾運動，然運動種類繁多，而適於老人、慢性疾病患者的運動非太極拳莫屬，現今太極拳已廣為西方醫學所接受，也越來越多的研究實證其對醫療的效益，如預防社區老人跌倒、改善平衡、增進肌力，能增加攜氧能力，改善慢性阻塞性肺疾病與助益於心臟病、中風後的復健，但對有些疾病如糖尿病、慢性心衰竭、類風濕性關節炎截至目前證據顯示並無助益，本文綜整多篇回顧系統性文獻回顧的研究結果，供醫療人員提供民眾訊息的參考

太極拳對改善類風濕性關節炎患者生活品質之成效

[[abstract]]無論預防保健或疾病復健，醫療人員常須推薦民眾運動，然運動種類繁多，而適於老人、慢性疾病患者的運動非太極拳莫屬，現今太極拳已廣為西方醫學所接受，也越來越多的研究實證其對醫療的效益，如預防社區老人跌倒、改善平衡、增進肌力，能增加攜氧能力，改善慢性阻塞性肺疾病與助益於心臟病、中風後的復健，但對有些疾病如糖尿病、慢性心衰竭、類風濕性關節炎截至目前證據顯示並無助益，本文綜整多篇回顧系統性文獻回顧的研究結果，供醫療人員提供民眾訊息的參考

The Relationship among ERP Problem Type, Customer Satisfaction and Customer Service Performance-The Case of D System Integration Company

在面臨全球化競爭激烈的市場，企業要提升競爭優勢就必須依靠e化來改善內部流程並提升競爭力，因此導入企業資源規劃系統(Enterprise Resource Planning﹔ ERP)就成為企業e化的基礎建設，企業要能順利使用ERP系統並達成工作目標，除了系統廠商所提供的顧問輔導及系統環境建置、教育訓練外，最重要就是長期仰賴系統廠商的客服中心人員的協助；因此客服人員的服務品質及效率，就成為顧客評估是否與系統廠商長期合作並續購產品的重要考量，也相對影響了顧客對產品的忠誠度；因此其客服中心服務品質就成為系統廠商評估顧客滿意度的首要指標，而如何有效掌握客服人員績效並提升顧客滿意度，即成為系統廠商必須重視並面對的議題。本研究主要個案為ERP系統廠商之客服中心現況探討，蒐集2006-2009年客服中心所訪談的600多筆客戶滿意度資料，運用統計方法，探討： (1)ERP問題類型對顧客滿意度之影響；(2)顧客滿意度對客服人員績效之影響，期望可以將研究結果提供給D系統廠商改善或提升服務品質之參考，使業者能在有限的資源之下，更適切的提供符合企業客戶需求的服務。也可做為其他ERP系統廠商客服人員績效及提升客戶滿意度之參考。 本研究的結論及建議歸納如下： （一） 當ERP問題類型屬於專業管理性問題，其顧客滿意度較低。 因此建議個案公司可針對顧客不滿意的問題類型進行人員分組服務、加強專業管理類問題教育訓練、顧客問題知識庫建立；也可思考問題類型是否重新調整更聚焦客戶問題執行改善並提高顧客滿意度。 （二） 顧客滿意度對客服人員績效並無顯著影響。 建議訂定顧客滿意度為客服人員重要並有效影響性之績效指標或訂立激勵方式，促使客服人員以提升顧客戶滿意度為工作首要目標。Responding to the challenges of the highly competitive global market environment, enterprises rely on information technology, such as Enterprise Resource Planning (ERP) system, to streamline their internal processes, to improve efficiency and to boost productivity. Implementing ERP system becomes vital and essential for companies to stay competitive and to gain their competitive edges. The critical success factors in ERP projects are not only the consulting service, the project management, the software and hardware installations and the user trainings, but also the long term customer services and supports after the implementation phase. The quality of the customer service, hence, has become a major measure for companies on selecting their software vendors. As a software vendor or application service provider, ensuring quality customer service improves the customer experience, satisfaction, retention as well as loyalty. Therefore, the performance of the customer service center, or the customer call center, becomes significantly important; customers who are satisfied with the call-support experience are more likely to become loyal repeat customers and in turn reinforce the reputation of the software vendors. The main objective of this research is to study the relation between the performance of the customer service center and the customer satisfaction of an ERP system vendor. By collecting and analysis over 600 customer satisfaction surveys between 2006 and 2009, this research studies the followings: (1) The affect of ERP problem types on customer satisfaction. (2) The affect of customer satisfaction on the customer service performance. The results of this research would be a reference for software vendor D to improve their customer service quality and to develop services that meet customers' expectation and needs. The conclusion & recommendation of this research are as the followings: (1) If the ERP problem type is related to professional management problem, the customer satisfaction is relatively low. Therefore, the recommendation for the software vendor is to identify and classify the main problem types of their customers and to establish different service sub teams specifically for each main problem type. For the professional management problem type, this is necessary to reinforce the user trainings and to establish a knowledge base for continuous improvement. Furthermore, this is recommended to have a continuous study of the classification of the customer problem types and to make any adjustments and redefinitions if necessary in order to improve the customer satisfaction and retention. (2) Customer satisfaction has no significant effects on the performance of the customer service center or customer call center. Therefore, the recommendation for the customer service center is to identify and re-define Key Performance Indicators that are significantly related to the customer satisfaction; these indicators help the customer service team to clarify the real customer needs and to refocus on their organization and workforce in order to meet the customer expectation. Furthermore, to establish employee motivation and incentives programs enables the software vendor to facilitate a high performance customer service team that is able to continuously satisfy the user experiences, to boost the productivity as well as to maintain customer retention and loyalty.目錄 摘要 i Abstract ii 表目錄 v 圖目錄 vi 第一章 緒論 1 第一節研究背景與動機 1 第二節研究目的 3 第三節研究範圍 4 第二章 文獻探討 5 第一節企業資源規劃(ERP) 5 第二節客服中心介紹 10 第三節顧客滿意度 16 第四節激勵理論 25 第五節績效管理 30 第三章 研究方法 39 第一節研究架構與假設 39 第二節研究對象 40 第三節變數操作型定義 49 第四節資料分析方法 52 第四章研究結果 53 第一節敘述統計 53 第二節問題類型對顧客滿意度、耗用時數之差異分析 56 第三節顧客滿意度、IT客服人員績效之相關分析 58 第四節人口變項對滿意度之分析 59 第五節結論 60 第五章 研究結論與建議 61 第一節研究結果與討論 61 第二節研究建議 62 第三節研究限制及後續研究之建議 64 參 考 文 獻 65 中文部分 65 英文部分 6

Spiritual Well-Being in Patients With Rheumatoid Arthritis

[[abstract]]BACKGROUND: Rheumatoid arthritis (RA) is a chronic, long-term, and non-life-threatening disease. Individuals with RA face various daily pressures that include physical symptoms as well as feelings of helplessness, dependency, threats to self-respect, interference with social activities, disruptions of family ties, and difficulties in continuing to work. Quality of life reflects a patient's spiritual well-being and can be used as an important indicator of adaptation to RA. PURPOSE: The aim of this study was to describe the status of spiritual well-being in RA patients. METHODS: This study used meta-synthesis with Sandelowski and Barroso's qualitative meta-summary technique. A comprehensive search of Academic Search Complete, CINAHL, MEDLINE, PsycARTICA LES, and SocINDEX using relevant keywords identified primary research studies that have previously explored spiritual well-being in patients with RA. Each study was systematically evaluated on the basis of the following inclusion criteria: (a) clear descriptions of research purposes and qualitative research, sampling strategies and techniques used; (b) statement of sample size and sample variables; (c) description of data analysis methods used; and (d) quality of research finding presentation. RESULTS: A total of 675 articles, published between 1995 and 2009, were found. Ten met the inclusion criteria. The results revealed four consistent themes related to RA patients' spiritual well-being, namely, living with the disease, reclaiming control, reframing the situation, and bolstering courage. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Multifaceted resources should be used to give patients spiritual support. These resources should include establishing cognition-based education programs that provide information about the disease and programs that offer strong support for patient groups. Curricula should address how to plan family education courses. Spiritual well-being as presented in this study should be integrated into quality-of-life evaluations of RA patients and provide an evaluation tool able to assess the effectiveness of various interventions

照顧一位糖尿病腎病變病患初次血液透析之護理經驗

[[abstract]]本篇報告主要是在探討糖尿病腎病變個案初次接受血液透析治療過程中所遭遇的身 、心、社會的問題，尤其是針對糖尿病飲食的規劃及自我照顧能力的提昇，筆者運用衛教 指導、營養諮詢、支持與提供資源等護理措施，協助個案適應疾病及住院所帶來的壓力與 危機，使個案成功調適初次接受血液透析治療所帶來的衝擊。筆者以 Gordon 十一項健康 功能型態進行護理評估，運用觀察、會談技巧收集資料，確立個案有潛在危險性感染、舒 適情況改變-皮膚搔癢症、知識缺失-糖尿病、腎衰竭與血液透析後日常生活照護、營養改變- 少於身體所需等護理問題，提供相關護理措施，並於個案出院後透過電訪及返診會談，評 值衛教指導的成效，以了解新接受血液透析個案在出院後所遭遇的困難，給予持續性的護 理服務，增加個案的安全感及信心，增強參與健康促進活動的意願及因應透析後生活型態 的改變

Development of a fall-risk using the Delphi technique

[[abstract]]AIMS AND OBJECTIVES: This study developed a checklist of both intrinsic and extrinsic risk factors for falls among older people based on consensus among a panel of experts and obtained expert content validity. The developed checklist is intended to help nurses better understand risk factors and take effective measures to prevent falls. BACKGROUND: Ageing involves changes in musculoskeletal and neuromuscular systems that make older people more prone to balance problems and falling. While it is believed that both environmental factors and personal habits play important roles in predisposing older people to falls, few broad-based approach checklists to identify both intrinsic and extrinsic risk factors have been published. Even fewer checklists addressing psychosocial problems currently exist. The authors developed a preliminary checklist through literature review. DESIGN: This study was designed using the Delphi technique, which is widely accepted as an effective method to secure consensus from experts of different backgrounds and perspectives. METHODS: The Delphi technique was used to consolidate and compare the opinions of qualified experts from six different fields over three review rounds. Experts' content validity index was used to confirm validity. RESULTS: Authors developed a preliminary checklist covering nine domains, which, after using the Delphi technique, was expanded to the 10 domains of demographics, illness, medicine, balance measurement, footwear, nutrition, cognitive function, social support, environment and fear of falling. Changes based on panel member suggestions made in the first review round included clarification of definitions for 'dim light', 'slippery', 'doormat' and 'clutter' and revisions to definitions of cigarette and alcohol consumption and types of exercise. Changes made following the second round review included clarification of the meaning and function of social support and the replacement of SPMSQ with MMSE. In the final round, the term 'physical mental disturbance' was changed to 'fear of falling'. The scores of CVI were very high. CONCLUSIONS: The Delphi technique was used successfully to refine the author-developed checklist based on experts' input. To ensure expert input reliability, concepts were defined by the authors and supported with photographs and videos, as needed. RELEVANCE TO CLINICAL PRACTICE: The checklist helps assess risk factors and identify older people at higher risk of falls and may help reduce fall risk

[[alternative]]To Explore Lived Experience And Spiritual Well-Being Of Patients With Rheumatoid Arthritis

[[abstract]]　　類風濕性關節炎是一罹病時間長、病理變化不可逆、可能進展成關節變形造成殘障的疾病，對有些患者而言，疾病將帶來生活上的巨變，影響擴及身、心、靈各層面，協助重建病患之身心靈以能提升病患的生活品質是一重要的議題。　　本研究的目的一為以質性研究初探台灣類風濕性關節炎患者之生活經驗。二為以質性統合分析探討類風濕性關節炎患者之靈性安適。三為以量性研究探討影響類風濕性關節炎患者靈性安適之因素。對應前述三個目的，研究設計分三部份，第一部份採現象學研究法，以立意取樣訪談病友會病患共21名，瞭解其罹病之生活經驗。第二部份以質性統合分析方式，整合現有與類風濕性關節炎「靈性安適」有關之質性研究文獻。第三部份採量性研究法，依據前二部份之研究結果，提出影響靈性安適之假說加以驗證，採橫斷性設計，方便取樣於病友會病患及北部一家醫學中心二處門診進行問卷的填寫或訪談，共回收223名有效問卷。研究工具包括史丹佛健康問卷評估、多層次健康重心量表、Jalowiec因應策略量表、社會支持量表、FACIT靈性安適量表等。　　研究結果，第一部份類風濕性關節炎病患之生活經驗，共呈現四個主題，「承受身心的磨難」、「對病因的疑惑」、「挫折的求醫經驗」呈現了病患因疾病所帶來的身、心、靈個層面的衝擊，「克服疾病的挑戰」呈現出病患適應疾病的助力、態度與策略。第二部份質性研究之統合分析類風濕性關節炎病患之靈性安適，呈現病患靈性安適的四個特質，需有「與疾病共存」之覺知，藉由「重構情境」、「增長勇氣」以能「重掌控制」。第三部份病患靈性安適相關因素探討，共測試七個概念，社會人口學變項、疾病影響狀況、宗教信仰、控制信念、社會支持、因應策略與靈性安適；結果顯示靈性安適未因宗教信仰及性別而有差異；沒有經濟壓力者、傾向採取問題因應策略、社會支持越佳、傾向內在控制、醫師控制者，靈性安適越佳，而其中問題因應策略更扮演重要的中介角色。此外，日常生活功能越差者及越疼痛者，越無法感到「內在控制」及較少使用問題導向策略，而疼痛也直接衝擊靈性安適，使病患更傾向使用情緒導向因應策略，而透過宗教信仰與社會支持能增進其靈性安適。　　根據本研究研究結果，能協助醫護人員了解類風濕性關節炎患者疾病所帶給病患的是整體的狀態改變，在病患調適的歷程中，應協助投注靈性力量，包括疾病照護的知識，解決日常生活問題的技巧，也應含括評估家庭互動的狀況，以營造協助病患的有利環境，而病患適應的評估應納入靈性的內涵特質。[[abstract]]　　Rheumatoid arthritis (RA) is a disease which is chronic, and whose pathological change has been irreversible, and which may cause joint deformation, leading to physical disabilities. Although this disease is without any immediate life threat, to some patients it may cause a drastic change in life, influencing their body, mind, and spirit. Therefore, it is an important subject to help reconstruct the patients’ body, mind, and spirit to elevate their life quality. 　　The purposes of this study were as follows. 1. The qualitative research was used to initially explore the lived experiences of Taiwanese RA patients. 2. The qualitative meta-synthesis analysis was employed to understand the spiritual well-being of RA patients. 3. The quantitative research was used to analyze the spiritual well-being of Taiwanese RA patients, researching the related factors that influence spiritual well-being. The research design was divided into three parts. First, adopting the phenomenological approach, we use a purposive sampling to interview 21 patients belonging to a national aid group association of RA patients in order to explore the lived experience. Second, the qualitative meta-synthesis method was used to integrate the published studies that were related to the RA spiritual well-being. The third part adopted the quantitative method, based on the findings of the first two parts to propose and confirm the factors that related to spiritual well-being. The cross-section design was adopted for the convenience of sampling the patients in the national aid group of RA patients and two clinics of a northern medical center. The participants were invited to answer the questionnaires or to be interviewed. Participants were 223 patients of RA who completed the HAQ, the Multidimentional Health Locus of Control Scales, the Jalowiec Coping Scale, the ISEL, and the FACIT-Sp.　　According to the result of this study, the first part of RA lived experiences manifested four themes: “suffering of body and mind”, “doubting about the cause of disease”, and “feeling frustration when seeking treatment” these three themes presented how the illness influenced the patient’s body, mind, and spirit. Additionally, the fourth theme “coping with the challenge of the illness”, presented the help, attitude, and strategy the patient has while adapting to the illness. In the second part, the meta-analysis of the qualitative research presented four characteristics of the spiritual well-being of RA patients. There were, they needed to have the awareness of “living with disease.” And by “reframing the situation,” and “bolstering courage,” they could “reclaim control.” In the third part, we tested seven concepts, the demographic characteristic, disease status, religious belief, health control faith, social support, coping strategy and the spiritual well-being. Result demonstrated that spiritual well-being was not significant difference with religious belief and gender. RA patients who had lower stress in economics, tendency to adopt problem-oriented strategies, with better social support, tendency internal control, doctor control, who with better spiritual well-being. The problem-oriented strategy acts the important intermediary role in all factors. In addition, patients who had worse function of daily activities and physical pain, had more difficult to feel “the internal control” and to use the problem-oriented strategies. Problem oriented strategies and social support could directly enhance the spiritual well-being. Via the problem-oriented strategies, the function of daily activities, pain, social support, doctors’ control, and internal control can improve and enhance the spiritual well-being. Pain directly influences the spiritual well-being, making patients more inclined to employ affective-oriented strategies, which could enhance spiritual well-being through religious faith and social support. 　　The result of this study can help medical and nursing staff to understand that the RA disease makes the whole condition of the patient changed. When the patient seeks to adapt to the illness, they should help with spiritual power including knowledge of caring for the illness, the skills of solving the problems confronted in everyday life, and evaluation of the interaction in a family. In this way, the advantageous surroundings can be created to help the patient. And evaluation of how the patient adapts to the illness should be included in the characteristics of the contents of the spiritual well-being

Non-pharmacologic care for chronic constipation in the elderly based on intergraded guidelines and literature review

[[abstract]]老年人因老化、生理功能改變、咀嚼能力減弱、罹患各種慢性疾病及用藥等多重因素影響下，使便秘成了老年人常見的健康問題，便秘的盛行率隨著年紀增長而增加。長期便秘引起腹部脹痛、食慾不振、噁心、嘔吐等不適；此外，若因便秘致使排便用力，也易誘發心肌梗塞、中風猝死等危險，影響老年人的生理及心理健康，降低生活品質，因此便秘的預防和處置是照護者均需面對的重要課題。本文整合現今國內外老年人慢性便秘非藥物照護指引與文獻，提出慢性便秘照護上的實證建議，內容包括護理人員及主要照顧者在評估老年人便秘時應留意的重點，於便秘的預防及處置上，如何適當的攝取膳食纖維、益生菌及水分等，並配合腹部按摩與活動來改善便秘問題，可適用於無特殊疾病(如慢性腎衰竭、神經性便秘)之居家、社區、機構及醫療院所有慢性便秘困擾的老年人，提供照護人員之參考，以提升老年人之生活品質。 Constipation is a common medical disorder in the elderly, and results from aging, physiologic changes, co-existing chronic diseases, and the administration of multiple drugs. The prevalence of constipation increases with advancing age. Chronic constipation may lead to significant gastrointestinal discomfort. In addition, defecating with force induces myocardial infarction and death from stroke, which affect physiologic and psychological health, thus impairing the quality of life. It is therefore of paramount importance for caregivers to prevent and manage constipation. Herein we provide evidence-based suggestions for chronic constipation care on the basis of guidelines and a literature review pertaining to the non-pharmacologic care of chronic constipation. The themes derived from the guidelines and a literature review are intended to aid nurses and primary health caregivers focus on the prevention and the treatment of constipation, and consists of an adequate intake of dietary fiber, probiotics, and fluids, together with interventions, such as abdominal massage and physical activity, to improve constipation while taking care of these elderly patients. Evidence-based suggestions provided herein are useful for the management of chronic constipation in the elderly free of other specific diseases (e.g. chronic renal failure and neurotic constipation) dwelling at home or institutions

腹膜透析病人旅遊的準備

[[abstract]]腹膜透析病人比血液透析病人在生活上有較高自由度，然有些病人會難以克服離開熟悉環境而畫地自限，有些病人會因工作所需、出差、旅遊等因素，必須離開自己生活常軌，自行面對處理攸關生命安全的種種難題，因此，護理人員如何協助病人克服障礙，做好與透析相關的知能準備，使之能夠在陌生的環境中妥善處理自己的狀況，而有更彈性自在的生活，此是護理人員至為重要的角色功能。為準備病人能安排國內外旅遊或從事各種活動的知能，教學的內容包括旅遊地事前的評估、換液環境的評估與選擇、透析液的安排、如何預防合併症，與旅遊間注意事項等旅遊須知，可以團體或個別方式進行指導，期望能讓腹膜透析病人有意願走出家門，在旅遊前做好準備，更能玩得盡興享受人生。 People who receive peritoneal dialysis (PD) have more freedom than those who are on hemodialysis. However, some PD patients have difficulty adapting to their new environment and thus remain largely homebound. When they work or travel abord, who cannot rely wholly on others, these patients must handle certain life problems alone. It is essential for nursing staff to help PD patients to prepare for overcoming typical inconveniences, improving quality of life, and handling unfamiliar environments. The present study assists patients to arrange domestic and foreign tourism and to participate in various activities. The intervention teaches the pre-assessment of tourism, the assessment and selection of the sterile environment for exchange, the arrangements for dialysate, planning for handling complications, the travel matters attention, and other tourist information using group or individual instruction. It is expected that patients with peritoneal dialysis will be more willing to leave their houses and be better prepared to travel, which should lead to their having more fun and to their greater enjoyment of life