走出藍色風暴──探討宜蘭憂鬱病人求醫問題

本研究旨在探討宜蘭地區憂鬱病人求醫問題及精神醫療資源現況分析。研究目的為探討精神科醫師對民俗療法之看法、瞭解民俗療法執行者對「憂鬱症」之看法、研究憂鬱病人選擇民俗療法之原因、探究民俗療法和精神醫學互相妥協或合作之可能性、分析媒體報導憂鬱病人與民俗療法之現況及改善方法。 故以宜蘭的憂鬱病人、家屬、精神科醫師、臨床心理師、民俗療法執行者為訪談對象，研究方法係以質性研究中的參與觀察法、深度訪談法為主。 結果發現，宜蘭地區雖民風保守，但在憂鬱症衛教宣導相關訊息上並不見得較少，而因老年人口居多，故老年人憂鬱症佔最多，兒童、青少年憂鬱症相對上較少，女性憂鬱的可能原因以婆媳衝突較為常見。是故，以間接的研究文獻和訪談結果推論，宜蘭縣之憂鬱症盛行率為5至10％。 關於宜蘭地區目前精神醫療資源之研究結果，諸如精神科醫師、臨床心理師等與全縣人口數相比之下，均明顯不足，值得政府單位重視。而專業人士對於精神醫療與民俗療法之未來合作多半持正面看法，但宜蘭的憂鬱病人較少尋求民俗療法，大多透過教會與精神科醫師合作下前往醫院治療，與本研究原先假設不同。 對於媒體新聞之看法，精神醫療專業人員大多持負面評價，以不滿記者報導角度、用詞方式、內容選取為主，並認為對憂鬱病人造成嚴重負面影響，亦加深社會大眾的偏見與刻板印象。 然而因採深度訪談法，屬於敘述且非系統性方法，故研究結果可能因而產生偏誤，且因憂鬱病人的樣本取得困難，難以窮盡真實面貌，是本研究不足之處。 對於後續研究之建議，可針對新聞報導對憂鬱病人之用字遣詞、消息來源人數比例是否平衡，以及精神科醫師對於新聞內容之看法，進行量化或質化研究。致謝詞…………………………………………………………………03 中文摘要………………………………………………………………04 第一章　緒論…………………………………………………………05 第一節 研究動機……………………………………………………05 第二節 研究目的……………………………………………………15 第三節 研究問題……………………………………………………15 第四節 研究名詞……………………………………………………16 第五節 研究範圍與限制……………………………………………17 第二章 文獻分析……………………………………………………18 第一節 憂鬱症之相關理論探究……………………………………18 第二節 民俗療法之相關理論探究…………………………………27 第三節 綜合討論……………………………………………………36 第三章 研究方法……………………………………………………37 第一節 研究方法……………………………………………………37 第二節 研究對象……………………………………………………42 第三節 研究流程……………………………………………………45 第四節 深度報導型態與架構………………………………………46 第四章 深度報導……………………………………………………48 第一節 揭開憂鬱症神秘面紗………………………………………48 第二節 憂鬱人口比例知多少………………………………………59 第三節 宜蘭精神資源面面觀………………………………………66 第四節 尋求民俗療法的秘辛………………………………………80 第五節 媒體報導載舟或覆舟………………………………………87 第五章 結論與建議…………………………………………………92 第一節 研究結論……………………………………………………92 第二節 研究價值……………………………………………………93 第三節 研究限制……………………………………………………93 第四節 後續報導建議………………………………………………94 參考書目………………………………………………………………96 中文部分………………………………………………………………96 英文部分………………………………………………………………100 附錄 附錄A：訪談問題大綱………………………………………………103 附錄B：台灣人憂鬱症量表…………………………………………108 表次 表1.1、WHO公佈造成「失能調整過的生命年」之十大疾病………06 表1.2、WHO公佈造成「失能的生命年」之十大疾病………………08 表2.1、國內外身體化傾向之相關研究………………………………26 表3.1、訪談對象名單一覽表…………………………………………43 表4.1、憂鬱（鬱卒）、憂鬱症與躁鬱症癥狀比較…………………51 表4.2、宜蘭地區精神醫療資源一覽表………………………………7

[[alternative]]Behavior Intention and Factors Affecting Decision-Making in Palliative Care Among Nurses in Non-Palliative Units

[[abstract]]安寧緩和療護是全球趨勢，台灣也推行多年，對於非癌末期病人之安寧共同照護需求日益增加，處於臨床照護工作第一線的護理人員，需對安寧療護有正確的認知、支持的態度及行為意向，才能有助臨床實務之推展，提供完善的臨終照護，本研究旨在探討非安寧病房護理人員對安寧緩和療護決策行為意向之重要影響因素。採橫斷式研究設計，參酌「理性行為理論」模式，以自擬式結構問卷「安寧緩和醫療條例知識量表」、「安寧緩和療護之行為態度量表」、「安寧緩和療護之主觀規範量表」及「安寧緩和療護決策行為意向量表」進行資料收集。於台灣北部某醫學中心非安寧病房之臨床護理人員為研究對象，簡單隨機抽樣15個病房單位，施測時間為105年3月1日~3月31日，發出問卷367份，回收有效問卷350份，回收率95.4%，研究資料以SPSS20.0統計軟體進行分析。結果顯示，非安寧病房護理人員之「安寧緩和療護決策行為意向」總分百分比為59.46%，與安寧緩和醫療條例的知識、行為態度呈正相關。影響安寧緩和療護決策行為意向重要因子依其預測力依序為「主治醫生之態度」、「安寧緩和療護的行為態度」、「病人之態度」、「家屬之態度」、「近兩年有無參加安寧療護實體課程訓練」、「自覺對病情嚴重度判別的能力」、「醫院政策」及「安寧緩和醫療條例的認知」等8個變項，共可解釋63.6%變異量，其中可看出，「主觀規範」對於護理人員安寧療護決策行為意向佔有最重要的影響力，其次為護理人員本身對「安寧緩和療護的行為態度」。本研究「安寧緩和醫療條例知識」總平均分數為67.86%，「安寧緩和療護行為態度」總分百分比71.87%，「安寧緩和療護主觀規範」總分百分比70.16%。整體而言，護理人員個人因素上對於安寧緩和醫療條例有相當程度的認識、趨向支持的態度，然末期醫療決策行為意向仍受多重複雜的外在因素所影響，如主治醫師、病人與家屬等的態度對護理人員的影響最大。護理人員是醫療團隊成員中與病人接觸最密切的人，扮演照顧、諮詢、協調、教育等多元角色，更是醫病關係連結的關鍵人物，應該在病人做末期醫療決策之際，主動發揮專業自決及自主性，協助病人及家屬得以善終、善別、善生。本研究結果可供相關單位在推動安寧緩和療護政策與臨床護理實務教育訓練內容之參考。[[abstract]]Palliative care is a global trends and demand grows in Taiwan for non-cancer Patients. Nurses contact patients directly who sensitive to patients’ needs of palliative care. They must have accurate knowledge, attitudes to provide palliative care. The aim of this study is to investigate the behavioral intention and factors affecting decision-making in palliative care among nurses in non-palliative units. It was a cross-sectional study. The self designed questionnaires including knowledge, attitude, subjective norm and behavioral intention of palliative care based on reasoned action theory were used. From 1st March 2016 to 31th March 2016, a total of 367 questionnaires were distributed and 350 valid samples were obtained with random sampling of non-palliative units in a medical center of northern Taiwan. SPSS 20.0 suit software was used for statistical analysis. The results showed behavioral intention of palliative care was positive correlated to knowledge and attitude. The behavioral intention scale of palliative care ”percentage is 59.46%, significant predictors included “attitude of physician”, “attitude(toward the palliative care)”, “attitude of family members ” , “attitude of patient ”,“palliative care educational programs ”, “perception of ability to judge severity and progress of the disease” ,“ knowledge (of palliative care) ” , and “ hospital policy ” . In particular, “attitude of physician ” have the highest predictive power. “ Knowledge” scale was 67.86%, “attitude” level was 71.87%, “subjective norm score of hospice palliative care ” was 70.16%. As a whole, the nursing staffs have a well-informed and positive attitude towards the palliative care. However, the behavioral intention of palliative care affected by the complex external factors, such as attitude of physician, patient and family members. Nurses play key role in the medical team, should demostrate self-determination and autonomy, assisting patients to make medical decisions in the end of life. The result of this study provides informations for clinical nursing practice, nursing education and making policy. This may eventually lead to better nursing care quality for palliative care

[[alternative]]A Study of the Motivation of Overseas Voluntary Services of College Students in Taiwan--The Education Voluntary Services in Northern Thailand as Example

[[abstract]]　　本研究主要為探討台灣的大專院校學生參與海外教育志工服務的動機、服務歷程、服務後所產生的影響及相關建議。　　　本研究採用訪談法進行研究，以參與2008年泰北教育志願服務團中的八位大學生為研究對象。　　　根據研究發現，歸納結論如下：一、先前是否有志願服務經驗並非影響決定參與海外志願服務。二、大學生的服務動機以「利己」為主，原因多為：想出國去看看、 友人的邀約、較為便宜、想留下美好回憶等動機。三、大學生參與海外志願服務的過程與經驗分為三類說明：文化背景、服務教學、 日常生活，如尊師重道的禮節、透過教學更肯定自己的能力以及對於 日常生活中的不適應。四、影響方面，帶給自己的是增廣見聞、對志願服務更增興趣、懂得惜福…… 等；給當地形成的影響除了帶來樂趣和新知外，也同時影響了原本的課程進 度及當地人民價值觀。五、大學生參與海外志願服務的建議主要為「要有正確的服務心態」及其他相 關建議。　　　最後，根據文獻分析、研究發現與結論，針對欲參與海外志願服務之青年、派遣海外志願服務志工管理單位及後續研究三方面，提出建議，以供日後推展海外教育志願服務活動之參考。[[abstract]]　　The purpose of this study is to explore the motive and process of college students parthcipating in overseas voluntary serviecs, offer suggestions and explain the service which influence on these students’ individuals learning　　　The study is made from interviews with the target of eight students participating the Education Voluntary Services in northern Thailand in 2008.　　　Based on the findings, the conclusions are:1.Whether you have voluntary services experiences is not the main reason to decide join overseas voluntary serviecs2.The primary motive for college students was self-interest, most resons are going abroad, inviting by friends, much cheaper than other tourist groups, collect happy memory, etc.3. The process and experience of college students participating in overseas voluntary services have three aspects：difference in the cultural background, service teaching and daily life. For example, the courtesy of learning to respect teachers, affirm their ability by teaching and unfit in daily life.4.To themselves, they can broaden their horizens, interest in voluntary services, cherish what they have, etc.For the local, they can bring interests and knowledge.But at the same time, they influence original courses and value of local people.5. The main suggestion for college students in overseas service is “own right attitude” and other related suggestions.　　　At last, based on literature analysis, research findings and conclusions, three aspects of the suggestions for encourge overseas education voluntary service are：(1)college students in overseas service；(2) the organization to accredit overseas education volunteers；(3)futural research

[[alternative]]Relevant Factors Affecting Nurse Use of a Pain Management System

[[abstract]]疼痛已成為病人第五生命徵象，如何有效評估和處理疼痛已成為醫療品質重要的指標。隨著資通訊科技的發展，臨床照護已邁入資訊化時代，許多醫療機構發展護理資訊系統，提供以病人為中心的照護。但近年來探討護理資訊發展成效的報告中，有關疼痛照護資訊系統導入的成效研究較少，因此本研究目的是以資訊系統成功模式為架構，於疼痛照護系統導入後，探討影響護理人員使用疼痛照護系統的相關因素。本研究採用橫斷式研究，以方便取樣方式，選取中部某醫學中心的282位護理人員為研究對象，採用問卷調查法，於2017年3月1日疼痛照護系統正式導入後三個月進行資料收集究。研究資料以SPSS 19.0版軟體進行資料建檔，採用描述性統計和推論性統計方法進行資料分析。研究結果發現：（1）影響護理人員使用疼痛照護系統的各項因素中，以「資訊品質」平均數4.71分為得分最高，顯示此系統能提供完整性及正確性的疼痛照護資訊。（2）影響護理人員使用疼痛照護系統各項因素之間相關性皆為正相關，以「資訊品質」對「使用意圖」和「使用滿意度」相關性最高，而「使用意圖」、「使用滿意度」與「淨效益」亦有高度的相關性，以「使用滿意度」對「淨效益」的相關性最高。（3）在使用疼痛照護系統效益的預測因素中，以「資訊品質」對「使用意圖」和「使用滿意度」預測力最高，解釋力分別為72.6 %和69.1 %，同時「使用滿意度」對「淨效益」亦有極高影響力，解釋力為81.2 %。經由本研究驗證資訊系統成功模式，能探討影響護理人員使用疼痛照護系統的相關因素，且可進一步預測此系統推展的淨效益，本研究結果期望做為未來評值疼痛相關照護系統和臨床資訊系統導入成效的參考。[[abstract]]Over the past decade, pain has come to been known as the fifth vital sign. The effective assessment and management of pain has become an important indicator of quality in medical care. With the development of information and communication technology, clinical care also has entered the age of information technology. In recent years, many medical institutions have been developing nursing information systems to support patient-centered care. However, there are few studies about the effectiveness of pain management information systems in Taiwan. This study aimed to explore influencing factors and predictive capability for nursing staff use of a pain management system based on the information system success model（ISSM）.A cross-sectional studies method was employed in this study. A total of 282 nurses were recruited from a medical center in the center of Taiwan through convenience sampling. Research data was collected through a structured questionnaire three months after a pain management system was implemented on March 1, 2017. Analysis of descriptive statistics and inferential statistics were done with SPSS Statistical version 19.0.There were three key results: (1) In the relevant factors, the highest average score was 4.71 for “information quality”. This showed that the system provided complete and correct information regarding pain care. (2) The correlations between these factors were all positively correlated. “Information quality” had the highest relevance to “intention to use” and “user satisfaction”. “Intention to use”, “user satisfaction” and “net benefits” had high correlations, and “user satisfaction” was significantly correlated with “net benefits”. (3) In the predictor analysis, “information quality” had the highest positive power for “intention to use” and “user satisfaction” with an explanatory power of 72.6 % and 69.1 %, respectively. Meanwhile, “user satisfaction” highly affected “net benefits”, with an explanatory power of 81.2 %.These results elucidate the relevant factors affecting use of a pain management system by nurses, and can also predict system benefits. This study serves as a reference for the evaluation of a pain-related care system and the performance of future clinical information systems

One Third of Truth： A Research and Development for an Interactive Narrative App

新資訊科技演變速度之快，除了替市場帶來消費刺激之外，更對媒體的產製觀念與流程，形成不小衝擊，以說故事為軸心發展的相關產業因為其新媒體科技的轉變而產生不同的敘事方式，而近幾年崛起的App，也同樣對敘事產業造成影響。 目前台灣的敘事App大部份以繪本或動畫為主要內容素材，使用真人實拍影像作為素材的App數量非常少。針對此現況，筆者希望能藉由App作為開發平台並採用真人實拍的劇情短片作為內容素材，實驗傳統敘事與新媒體之間的可能路徑。 一方面以故事創作者的身分檢視傳統敘事與數位敘事上的差異，不管是線性敘事結構與非線性敘事結構之間的辯證，或是互動技術對於劇情的輔助程度，另一方面則是透過開發App的過程，檢視數位敘事產製流程的轉變。 最後，App開發完成，則會規劃試測活動邀請使用者試用、填寫問卷並進行焦點團體訪談，綜合檢視數位互動敘事的傳播效果，除了幫助App在上架前進行最後修正，更能給予後續創作者開發建議。Today, new media technology advances so fast that it brings out significant impact to the process of media production, as well as the stimulation to the market. It also influences the way of narrating a story. The Apps that are increasingly popular in recent years seem to have the same effects on storytelling. Most storytelling Apps in Taiwan today are mostly based on picture books or animation. Only a handful of them are developed by using filmic images with real actors. This project is designed to create an App, The One-Third of Truth, as a platform for a short film and to explore possible new paths to combine traditional ways of storytelling and new media. On one hand, differences between traditional storytelling and digital one are examined, in terms of their narrative structures (linear vs. nonlinear), their interactive techniques, etc. On the other hand, the idea of digital storytelling is examined through the creation of the App. Finally, after the App is designed and created, a testing process will be organized by inviting users to try this App, fill out questionnaires and conduct focus group interview. It is hoped that, before this App is open to the public, final modification will improve it and provide suggestions for future creation of the similar Apps

An examination of homeodomains and their binding sites

published_or_final_versionBiochemistryMasterMaster of Philosoph

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

數位典藏前端系統建置以音樂數位博物館為例

出處：真理大學工業管理學